Health - Audit Finds Long Waits for Breast Exams

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• Audit Finds Long Waits for Breast Exams
• Calisthenics Come Back as the Anywhere Workout
• Skin Deep: New Stratagems in the Quest for Hair
• Cholera Surge in Haiti Is Feared
• Low-Salt Diet Ineffective, Study Finds. Disagreement Abounds.
• Recipes for Health: Gluten-Free Rice and Millet Flour Crackers
• Well: Adding Food and Subtracting Calories
• Asthma Rate Rises Sharply in U.S., Government Says
• Tugging at Threads to Unspool Stories of Torture
• Hormone Is Said to Cut Risk of Premature Birth
• Vital Signs: Screening: An Autism Questionnaire at Checkup Time
• Vital Signs: Patterns: An Omega-3 Fatty Acid Shows a Risky Side
• Vital Signs: Regimens: Noise Canceling, Without Headphones
• David J. Sencer, 86, Dies; Led Disease-Control Agency
• Global Update: Pesticides: Ban on a Cousin of DDT Has Loopholes in India, Where Children Were Harmed
• Drumbeat of Nuclear Fallout Fear Doesn’t Resound With Experts
• Well: A Better Medical School Admissions Test
• Well: Share Six Words About Your Mother
• Well: One Nurse, One Patient
• Well: Chemo Brain May Last 5 Years or More
• Well: How Sugar Affects the Body in Motion
• The New Old Age: A Better Way to Find Home Care Aides
• The New Old Age: A Marriage Reshaped by Stroke
• The New Old Age: Few Mental Health Professionals in Aging Communities
• Personal Health: A Thief That Robs the Brain of Language
• Really?: The Claim: Having Tonsil Surgery Causes Weight Gain
• Prescriptions: Board Disciplines 3 Doctors
• Letters: The Big Picture (2 Letters)
• Letters: Recovery Redefined (3 Letters)
• Rule Would Discourage States’ Cutting Medicaid Payments to Providers
• When Meeting a Congressman, Leave Nothing to Chance
• Proposal for Medicare Is Unlike Federal Employee Plan
• Editorial: The Ryan Plan for Medicaid
• Court Lets U.S. Resume Paying for Embryo Study
• Recipes for Health: Cheddar Cheese Crackers
• Recipes for Health: Olive Oil Crackers
• Recipes for Health: Buckwheat Crackers With Sesame
• Recipes for Health: Homemade Whole Grain Crackers

Audit Finds Long Waits for Breast Exams Posted: 04 May 2011 11:00 PM PDT Women have had to wait dangerously long times for mammograms at several of New York’s public hospitals, a city audit released on Wednesday found. Related Health Guide: Breast Cancer The audit examined waiting times at nine health care facilities in the 2009 fiscal year and found that the worst were at Elmhurst Hospital Center in Queens, where women had to wait 148 calendar days for routine screening mammograms and 50 working days for diagnostic mammograms, when cancer is suspected. John C. Liu, the city comptroller, said in a statement accompanying the audit that the long waiting times “placed women in jeopardy” and violated the city’s policies, which recommend waits of no more than two weeks for routine screening. He said women who had to wait long times for appointments were more likely to miss them. Ana Marengo, a spokeswoman for the city’s Health and Hospitals Corporation, which runs the public health system, said that the comptroller’s data was outdated and that high-risk patients at its hospitals received mammograms within 24 to 72 hours. “If there is a lump, if there is a family history, if there is a high-risk individual that had cancer before, all those are considered urgent,” and the patient would be seen within 72 hours, Ms. Marengo said. She conceded that “two years ago, the wait time was longer,” and that even now, in cases in which the risk of cancer was considered lower, the wait could still be longer. At Elmhurst, she said, the wait as of December 2010 was 20 days for screening and 23 days for a general diagnostic test, as opposed to an urgent one. At Queens Hospital Center, the wait for a screening test was 56 days in December, Ms. Marengo said. “It’s due to volume and higher demand,” she said. “We only have a certain amount of resources.” The audit found that the longest waits for diagnostic tests were at Bellevue Hospital Center, with 17 working days; Gouverneur Healthcare Services, with 20; Kings County Hospital Center, with 21; Woodhull Medical Center, with 28; and Elmhurst, with 50. For screening tests, the longest waits were 41 calendar days at Woodhull in Brooklyn, 49 days at Queens, and 148 days at Elmhurst. Elmhurst Hospital conducted the most mammograms, 11,425, and Queens was second, with 10,544, the comptroller said. Last year, public hospitals performed 100,000 mammograms systemwide, up from about 92,000 in 2009, Ms. Marengo said. This posting includes an audio/video/photo media file: Download Now

Calisthenics Come Back as the Anywhere Workout Posted: 04 May 2011 10:30 PM PDT Pierre Rougier, a publicist in Manhattan, is known as one of the fashion’s industry’s most powerful behind-the-scenes players. Multimedia Slide Show A Workout to Go Business Travel A Return to Spending and the Front Rows The years of trimming costs have given way to a rebound in travel as the economy picks up. This and other stories on business travel in a special section. Go to Special Section » But during his monthly trips to Paris or Milan, the source of Mr. Rougier’s power derives not only from his media contacts and his shrewd handling of designers and their latest apparel lines, but also from the way he starts his morning: with an intense, 15-minute exercise regimen done in his hotel room, his apartment in Paris or even, on warm days, outdoors at the nearby Jardin des Tuileries. “These workouts are quick, explosive and intense,” said Mr. Rougier, who is president of an agency called PR Consulting. “I feel totally energized when they’re done.” There are no weights, machines, kettle bells, treadmills or any of the other popular gym accessories in this exercise repertoire. Using his 195 pounds of body weight as resistance, the fit, 6-foot 3-inch Mr. Rougier moves rapidly through a series of exercises that would be recognizable to any World War II-era G.I. as the kind of calisthenics performed in basic training. And yet, the fast-paced, minimal-rest, pant-provoking circuit of push-ups and jumping jacks and squat thrusts has a very up-to-date feel to it, something the trend-conscious 48-year-old has noticed. “I’ve watched some of those P90X infomercials,” Mr. Rougier said, referring to the popular home exercise workout program. “They look very efficient, these guys seem to get ripped, but I think I’d have been more comfortable doing that when I was 25 or 30.” “I’ve worked up to this,” said Mr. Rougier, who has practiced the workout with his personal trainer, Rob Morea. “Rob watched my form to make sure I’m doing it right. I’m not a kid, I have to be careful.” In his Great Jones Street studio in Manhattan, Mr. Morea trains many people who travel frequently for business and prescribes similar workouts when they are about to go out of town. Lately, he says, the reaction is similar. “When I run through this with my clients, they say, ‘Oh wow, this is like Insanity,’ ” he said, referring to another popular exercise program. “They think they’re going on the road and doing the hottest workout in fitness.” “Things just run in cycles in this industry, and this seems like the latest and hot thing,” says Jeffrey Potteiger, an exercise scientist at Grand Valley State University in Grand Rapids, Mich. Still, unlike many past fitness trends, a circuit of body-weight exercises, performed properly, is an effective way to stay in shape — especially, he notes, for time-pressed business travelers. “If I was away on business and I had limited time, I think that would be an excellent workout to do,” Dr. Potteiger said. “You’re going to challenge the major muscle groups, maintain fitness, and because you’re doing the exercises in rapid succession, you’re going to raise your heart rate and get some of the cardiovascular benefits. Plus, you don’t need a lot of space and time.” These workouts do have their limits, of course: A regimen of body-weight exercises is likely to maintain but not increase strength. Moreover, he said, these short-duration workouts “shouldn’t be considered a replacement for one’s regular cardiovascular routine.” So business travelers who prefer to go for a five-mile run or a brisk, two- or three-mile walk should do so. For Mari Smith, a social media consultant from San Diego, who travels about one week a month, an hour of outdoor aerobic exercise in the morning is usually out of the question. Her workday while traveling often begins at 6:30 a.m. with a breakfast meeting or an early presentation to her corporate clients. To keep herself fit, Ms. Smith is up before dawn for the 20-minute “hotel workout” created by Ashley Mahaffey, a personal trainer who specializes in working with business travelers. “It’s a body-weight workout that is based upon time, not repetitions, and with little rest in between,” Ms. Mahaffey said.   Acknowledging that she is not an exercise enthusiast (“I wish I had been born with that gene!”), Ms. Smith, 44, said she liked the efficiency of the workout, in terms of both time and effort. “I work out hard but it doesn’t take long,” she said. “I don’t need any special equipment, so the workouts are completely portable.” Mr. Rougier’s regimen of calisthenics meets his on-the-road needs perfectly. “My job is to be there for the people I work for, not complaining that I’m jet-lagged, I’m tired,” he said. “When you get to Paris or Milan, especially for Fashion Week, they want people around who are alert and energized. These workouts do that for me.”

Skin Deep: New Stratagems in the Quest for Hair Posted: 05 May 2011 07:59 AM PDT RICHARD PADUDA, an athletic man with a dark, spiky coiffure, does not look like your typical user of Latisse, the prescription eyelash-enhancing solution that has been endorsed by Brooke Shields and Claire Danes. That’s because he has used it not on his eyelashes, which are fairly lush, but on his hairline, which he noticed last year was beginning to recede. Enlarge This Image Michael McElroy for The New York Times Richard Paduda liked how Latisse, an eyelash enhancer, thickened his hair, but he found the product too expensive. Related Beauty Spots (May 5, 2011) Tony Cenicola/The New York Times Enlarge This Image Fred R. Conrad/The New York Times Dr. Robert M. Bernstein believes hair will be cloned. “I just put three or four drops on each side of my temple once a day,” said Mr. Paduda, 32, an insurance worker from Boca Raton, Fla. “The hair in that area, which was real thin and wispy — all those hairs got thick again, dark.” Mr. Paduda is one of a growing number of men experimenting with Latisse as an antidote to encroaching baldness. Made by Allergan, the drug has already won a following among women for helping them grow long, fluttery eyelashes. It was only a matter of time before it made the leap to denuded pates. Indeed, dermatologists’ offices and Web forums for bald men (yes, they exist: baldtruthtalk.com) began buzzing with excitement over Latisse nearly the moment the Food and Drug Administration gave it the thumbs-up in December 2008. “First question everyone was asking was, ‘Gosh, if it grows eyelashes, what is it going to do on the scalp?’ ” said Dr. Alan Bauman, the dermatologist and hair-restoration specialist who prescribed the drug to Mr. Paduda as part of an informal study. While the F.D.A. has not approved Latisse as a hair-loss treatment — only two drugs have that designation: minoxidil (Rogaine, also a topical medication) and finasteride (Propecia, which is administered in pill form) — there are no laws preventing doctors from prescribing it for that purpose. Dr. Bauman said he has been prescribing a generic form of bimatoprost, the active ingredient in Latisse, to combat hair loss since 2007, and that it has worked for about 70 percent of his patients. “What we found is that where patients were applying Latisse, especially in areas where the hair was thinner and wispier and less pigmented, the hair grew thicker, stronger and healthier,” he said. Though some users of Latisse have experienced skin discoloration, Dr. Bauman said he had never seen any such reaction on the scalp of his patients. Certainly, Mr. Paduda, who used Latisse daily from November through February, is a happy customer. By the third week, he said, both he and friends he asked for reactions were seeing results. “I even busted out the old ‘before’ and ‘after’ pictures,” he said. “It was a noticeable difference.” But Latisse does not appear to be a silver bullet for hair loss. Instead, it appears to work in much the same way as Rogaine or Propecia: All three can strengthen and darken hair that grows from a dying follicle, but none can bring a dead one back to life. The result is an enhanced, refortified hairline rather than a brand new head of hair. Aside from hair transplants, which can cost about $10,000 each and do not always look natural, the only current hope for complete replacement is hair cloning, the act of producing entirely new hair from the DNA of an existing one, which researchers have been attempting, unsuccessfully, for years. A pair of researchers last year claimed to grow new hair by combining plucked hair with a wound-healing powder made by ACell, a regenerative-medicine company in Columbia, Md. Though the claim was met with some skepticism by other clinicians, the idea that ACell’s powder, which has been approved by the government, could facilitate new hair growth has breathed new life into the race to clone hair. Dr. Robert M. Bernstein, clinical professor of dermatology at Columbia University, is now one of several researchers experimenting with the product. “It’s just a question of time now” before hair cloning becomes a reality, Dr. Bernstein said. “We keep on moving back that time, but I think there’s absolutely no doubt that it’s going to be done.” He believes hair cloning will be commercially available within 10 years. This may sound like a long time to wait, but “it’s important to remember that baldness is unlike other conditions where you can progress past the point of being helped,” Dr. Bernstein said. “Once we have a cure for hair loss, everyone will be able to benefit.” It has been been 14 years since the F.D.A. approved a new hair-loss remedy (Propecia, in 1997), so it is understandable that anticipation for a new one might be running high. One advantage of Latisse is that it needs to be applied only once a day (Rogaine needs to be applied twice; Propecia is taken once daily), and does not seem to cause reactions in people who are allergic to minoxidil. It is, however, expensive: a month’s supply of Latisse can cost up to $150, and that is in amounts appropriate for use merely on the eyelashes. Rogaine, which is also available over the counter now, costs about $25 a month, and a month’s supply of Propecia runs about $75. (Even Mr. Paduda has now switched to Propecia, citing cost.) The potential for Latisse is not lost on Allergan. The company initiated a Phase 1 clinical study in August to determine whether bimatoprost can be used as a treatment in men and women suffering from hair loss (alopecia). “There is a great deal of interest in developing other uses of bimatoprost,” Heather Katt, a spokeswoman for Allergan, wrote in an e-mail message, “and Allergan is exploring ways to pursue that pathway through the F.D.A. approval process.” For those too impatient to wait, there is also the bold and fashionable solution of shaving one’s head. But the fact is that many men — and women — simply do not accept baldness easily. “Hair has been an evolutionary sign of health and sexuality and youth, and that doesn’t change,” Dr. Bernstein said. “Shaved heads look cool, but not everyone wants one, and not everyone looks good with one.” Mr. Paduda concurs. “I have really dark eyebrows,” he said. “I would look like a psycho if I shaved my head.”

Cholera Surge in Haiti Is Feared Posted: 04 May 2011 10:05 PM PDT PORT-AU-PRINCE, Haiti (AP) — An increase in new cholera patients in rural Haiti has raised concern that the outbreak may be starting to surge again with the spring rainy season, a medical aid group based in the United States said Wednesday. Related Labadie Journal: In Haiti, Class Comes With a Peek at Lush Life (May 4, 2011) Health experts in Haiti warned in January when the cholera outbreak began to slow that there could be a surge of new cases in the spring, when rain would help spread contaminated water. Workers for the aid group Partners in Health have noted an increase in new patients at treatment centers in the countryside, as well as in Port-au-Prince, the capital, said a spokeswoman for the group, Kathryn Mahoney. At centers in Mirebalais, a central town near where the outbreak was first detected in October, the number of new cholera patients has roughly tripled in recent weeks, Ms. Mahoney said. Sylvain Groulx, chief of mission in Haiti for Doctors Without Borders, which has had a leading role in responding to the outbreak, said that group’s workers had seen only a slight increase in new cases in the countryside.

Low-Salt Diet Ineffective, Study Finds. Disagreement Abounds. Posted: 04 May 2011 08:32 AM PDT A new study found that low-salt diets increase the risk of death from heart attacks and strokes and do not prevent high blood pressure, but the research’s limitations mean the debate over the effects of salt in the diet is far from over. Elena Elisseeva The debate over the effects of salt in the diet is far from over. Related Health Guide: High Blood Pressure In fact, officials at the Centers for Disease Control and Prevention felt so strongly that the study was flawed that they criticized it in an interview, something they normally do not do. Dr. Peter Briss, a medical director at the centers, said that the study was small; that its subjects were relatively young, with an average age of 40 at the start; and that with few cardiovascular events, it was hard to draw conclusions. And the study, Dr. Briss and others say, flies in the face of a body of evidence indicating that higher sodium consumption can increase the risk of cardiovascular disease. “At the moment, this study might need to be taken with a grain of salt,” he said. The study is published in the May 4 issue of The Journal of the American Medical Association. It involved only those without high blood pressure at the start, was observational, considered at best suggestive and not conclusive. It included 3,681 middle-aged Europeans who did not have high blood pressure or cardiovascular disease and followed them for an average of 7.9 years. The researchers assessed the participants’ sodium consumption at the study’s start and at its conclusion by measuring the amount of sodium excreted in urine over a 24-hour period.  All the sodium that is consumed is excreted in urine within a day, so this method is the most precise way to determine sodium consumption. The investigators found that the less salt people ate, the more likely they were to die of heart disease — 50 people in the lowest third of salt consumption (2.5 grams of sodium per day) died during the study as compared with 24 in the medium group (3.9 grams of sodium per day) and 10 in the highest salt consumption group (6.0 grams of sodium per day).  And while those eating the most salt had, on average, a slight increase in systolic blood pressure — a 1.71-millimeter increase in pressure for each 2.5-gram increase in sodium per day — they were no more likely to develop hypertension. “If the goal is to prevent hypertension” with lower sodium consumption, said the lead author, Dr. Jan A. Staessen, a professor of medicine at the University of Leuven, in Belgium, “this study shows it does not work.” But among the study’s other problems, Dr. Briss said, its subjects who seemed to consume the smallest amount of sodium also provided less urine than those consuming more, an indication that they might not have collected all of their urine in an 24-hour period. Dr. Frank Sacks of the Harvard School of Public Health agreed and also said the study was flawed. “It’s a problematic study,” Dr. Sacks said. “We shouldn’t be guiding any kind of public health decisions on it.” Dr. Michael Alderman, a blood pressure researcher at Albert Einstein College of Medicine and editor of the American Journal of Hypertension, said medical literature on salt and health effects was inconsistent. But, Dr. Alderman said, the new study is not the only one to find adverse effects of low-sodium diets. His own study, with people who had high blood pressure, found that those who ate the least salt were most likely to die. Dr. Alderman said that he once was an unpaid consultant for the Salt Institute but that he now did no consulting for it or for the food industry and did not receive any support or take any money from industry groups. Lowering salt consumption, Dr. Alderman said, has consequences beyond blood pressure. It also, for example, increases insulin resistance, which can increase the risk of heart disease. “Diet is a complicated business,” he said. “There are going to be unintended consequences.” One problem with the salt debates, Dr. Alderman said, is that all the studies are inadequate. Either they are short-term intervention studies in which people are given huge amounts of salt and then deprived of salt to see effects on blood pressure or they are studies, like this one, that observe populations and ask if those who happen to consume less salt are healthier. “Observational studies tell you what people will experience if they select a diet,” Dr. Alderman said. “They do not tell you what will happen if you change peoples’ sodium intake.” What is needed, Dr. Alderman said, is a large study in which people are randomly assigned to follow a low-sodium diet or not and followed for years to see if eating less salt improves health and reduces the death rate from cardiovascular disease. But that study, others say, will never happen. “This is one of those really interesting situations,” said Dr. Lawrence Appel, a professor of medicine, epidemiology and international health at Johns Hopkins Medical Institutions. “You can say, ‘O.K., let’s dismiss the observational studies because they have all these problems.’ ” But, he said, despite the virtues of a randomized controlled clinical trial, such a study “will never ever be done.” It would be impossible to keep people on a low-sodium diet for years with so much sodium added to prepared foods. Dr. Briss adds that it would not be prudent to defer public health actions while researchers wait for results of a clinical trial that might not even be feasible.  Dr. Alderman disagrees. “The low-salt advocates suggest that all 300 million Americans be subjected to a low-salt diet. But if they can’t get people on a low-salt diet for a clinical trial, what are they talking about?” He added: “It will cost money, but that’s why we do science. It will also cost money to change the composition of food.”

Recipes for Health: Gluten-Free Rice and Millet Flour Crackers Posted: 04 May 2011 11:40 PM PDT I’ve been wanting to offer some gluten-free baked goods for some time, and crackers are a good place to start. I used a bit of butter to get a better texture, because when I used only olive oil, the resulting crackers were too dry. 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: Homemade Whole Grain Crackers (May 2, 2011) Recipes for Health: Buckwheat Crackers With Sesame (May 3, 2011) Recipes for Health: Olive Oil Crackers (May 4, 2011) Recipes for Health: Cheddar Cheese Crackers (May 6, 2011) 1 3/4 cups rice flour (preferably brown rice flour) 3/4 cup plus 2 tablespoons millet flour (I make mine by grinding millet in a spice mill) 3/4 teaspoon salt 1 teaspoon sugar 1/4 cup water 2 large eggs 2 tablespoons unsalted butter, cut into 1/4-inch pieces 2 tablespoons extra virgin olive oil (or omit the butter and use 1/4 cup olive oil) 2 tablespoons seeds, like as sesame, charnushka (nigella) or poppy seeds 1. Preheat the oven to 375 degrees. Line two baking sheets with parchment. Combine the flours, salt and sugar in the bowl of a food processor fitted with a steel blade. Pulse a few times to combine. Add the butter, and pulse until the flour mixture is crumbly. Combine the water, eggs and olive oil in a measuring cup. Turn on the processor. Add the liquids with the machine running, and process until the dough comes together. The dough will be soft. If it seems wet, add another tablespoon or two of rice flour. 2. Remove from the food processor. Divide into two portions, and roll out each portion into thin sheets. Sprinkle on the seeds. Using the rolling pin, gently press the topping into the surface of the dough. Cut the dough into squares or rectangles, and transfer to the baking sheets. 3. Bake 15 minutes or until lightly browned and crisp. Yield: Eighty to 90 crackers. Advance preparation: These crackers will keep for about a week in an airtight container. Nutritional information per cracker: 26 calories; 0 grams saturated fat; 1 gram polyunsaturated fat; 1 gram monounsaturated fat; 0 milligrams cholesterol; 2 grams carbohydrates; 1 gram dietary fiber; 25 milligrams sodium; 1 gram protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Well: Adding Food and Subtracting Calories Posted: 03 May 2011 07:43 AM PDT

Asthma Rate Rises Sharply in U.S., Government Says Posted: 03 May 2011 10:18 PM PDT Americans are suffering from asthma in record numbers, according to a study released Tuesday by the Centers for Disease Control and Prevention. Nearly one in 10 children and almost one in 12 Americans of all ages now has asthma, government researchers said. Related Low-Salt Diet Ineffective, Study Finds. Disagreement Abounds. (May 4, 2011) According to the report, from 2001 to 2009 the prevalence of asthma increased among all demographic groups studied, including men, women, whites, blacks and Hispanics. Black children are most acutely affected: the study found that 17 percent of black children — nearly one in five — had a diagnosis of asthma in 2009, up from 11.4 percent, or about one in nine, in 2001. While officials at the Centers for Disease Control emphasized that asthma could be controlled if managed effectively, they were at a loss to explain why it had become more widespread even as important triggers like cigarette smoking had become less common. “We don’t know exactly why the number is going up, but, importantly, we know there are measures individuals with asthma can take to control symptoms,” said Ileana Arias, principal deputy director of the centers. Agency officials declined to comment on budgetary proposals that would reduce money for the National Asthma Control Program. Prevention depends on educating patients about appropriate use of medications and ensuring that each patient has a written medical plan to control asthma, but the report found that only one-third of patients had been given a plan and only about half had been advised to make changes to eliminate asthma triggers at home, school and work. Paul Garbe, chief of the Air Pollution and Respiratory Health Branch at the centers, noted the success of several state public health initiatives, including one in Connecticut in which asthma educators and environmental assessors were sent into homes to advise patients on what changes needed to be made and how to manage the disease. The report found that the overall prevalence of asthma increased to 8.2 percent in 2009, when 24.6 million cases were diagnosed, from 7.3 percent in 2001, when 20.1 million cases were diagnosed — a 12.3 percent increase. Among the most affected were children, 9.6 percent of whom had asthma, and especially poor children, of whom 13.5 percent had it. While 7.7 percent of adults were found to have asthma, the rate was higher among women (9.7 percent) and among poor adults of both sexes (10.6 percent). Asthma costs grew to about $56 billion in 2007, up from about $53 billion in 2002, the report said, though annual deaths attributed to asthma declined to about 3,500 in 2007, from a peak of about 5,500 deaths in 1996. Researchers are investigating several potential causes for the increase in asthma, including exposure to various allergens, traffic exhaust fumes, pesticides and certain plastics, as well as factors like obesity and diet that may play a role, said Dr. Rachel L. Miller, director of the asthma project at the Mailman School of Public Health at Columbia University. “There’s no easy singular explanation,” Dr. Miller said. “The more we study this, the more it raises a lot of questions. It’s not a straightforward puzzle at all.”

Tugging at Threads to Unspool Stories of Torture Posted: 03 May 2011 02:54 PM PDT AMMAN, Jordan — The first time the Iraqi Army arrested him, he said, soldiers burst into his shop in Baghdad, dragged him out in handcuffs and a blindfold, and took him to a filthy, overcrowded prison. Beatings, rape, hunger and disease were rampant, and he expected at any moment to be killed. He was held for four months, until December 2008. Enlarge This Image James Hill for The New York Times HOME AWAY FROM HOME The view from the North Hashmi neighborhood, and area of Amman where many Iraqis live, toward the city center. During an interview here, the shopkeeper, 35, a balding, stocky man wearing a T-shirt and slacks, was calm and soft-spoken at first, but grew increasingly loud and agitated as he told his story. He described enduring episodes of torture, threats by captors to go to his house and rape his wife, and daily horrors like the suicide of a young prisoner who electrocuted himself with wires from a hot plate after being raped by soldiers. He spoke through an interpreter, and asked to be identified by only his first initial, M., because his relatives were still in Iraq and he feared for their safety. After speaking for an hour, he shook his head and said softly: “What happened is not like what I just said. What happened was much worse.” The interview took place at a treatment center that opened in northeast Amman in December 2008 to help Iraqis who were tortured in their own country or who suffer from other war trauma. It is a branch of the Center for Victims of Torture, a St. Paul-based group that also operates in Africa and since 1985 has treated 20,000 torture victims from around the world. About half of the group’s financing comes from contracts with the American government. Its approach involves intensive talk therapy specifically devised for survivors of torture, using group counseling or individual psychotherapy or both. The group trains local therapists in host countries to take over all treatment within a few years. Researchers say its services are desperately needed: There are many torture victims in the Middle East, but little expert help. Most Iraqi victims in Jordan cannot travel elsewhere for treatment, because they lack money or cannot obtain visas or asylum. The St. Paul organization is among the oldest and largest in the field, treating about 2,750 people a year. Its experts act as mentors and trainers to other programs, and have played a crucial role in developing treatments, according to Dr. Allen Keller, who directs a center for torture survivors at Bellevue Hospital Center in Manhattan. (It is not affiliated with the St. Paul group.) The work requires a deft touch. Research shows that trained therapists can help survivors of torture, but that inept efforts to treat them can backfire. “If all you’re doing is bringing up disturbing memories,” Dr. Keller said, “you can do more harm than good.” Interviews last fall — the first time a journalist was given access to clients and therapists at the center in Amman — provided a grim look at widespread abuses occurring in Iraq as recently as 2010, and their crushing effects on individuals and families. High rates of torture and other forms of trauma have left many Iraqi refugees struggling with emotional wounds, some so severe that people are afraid to leave their homes. About 21 percent of Iraqis in Jordan were “severely traumatized” by attacks on them or their families, according to the International Organization for Migration, a group with 132 member countries. The number of Iraqis who have fled their country is not known; estimates have varied from 500,000 to more than two million, with the highest numbers thought to be in Syria and Jordan. So far, the political turmoil that has gripped the region in the last few months has not brought new clients. Joséphine Anthoine-Milhomme, a French psychologist at the center in Amman, has treated victims of war and natural disaster in Asia, Africa and Central America, but her 15 years of experience did not prepare her for the brutality described by Iraqis. What has shocked her, she said, is “the extreme violence and the intensity and frequency of perpetrations, the layers they might have of traumatic experience, because of the history of their country.” The events described in interviews have not been independently verified, but the clients were closely screened by the center and accepted only if their accounts were plausible and they had clear symptoms of trauma. Their stories are consistent with reports by medical groups that have interviewed other Iraqi torture victims, and with accounts in documents revealed by WikiLeaks and reported in The New York Times and other publications. The clients interviewed were selected by the therapists because their cases were representative of many others at the center, and because the therapists thought these clients would not be harmed by talking with a journalist and might even be helped by the chance to make their stories public. Iraqis at the center have described being kidnapped, beaten, given electric shocks, raped and burned. Some said they saw relatives killed or kidnapped, or were threatened repeatedly with the murder or rape of loved ones. One reported being sent a video of captors killing a family member by drilling into his skull. An 11-year-old girl and her family revealed that she was raped by a group of men who then shaved her head and threw her on a trash heap. A toddler witnessed her father’s murder; a schoolboy saw his teacher and classmates killed. The torturers, clients say, have included the Iraqi Army, American forces, Saddam Hussein’s henchmen, Al Qaeda in Iraq, and the sectarian groups, gangs and militias that continue to terrorize parts of Iraq. Some clients report having been tortured by more than one of these groups. Many clients still fear for their safety, so the treatment center omits victims’ names from its records and uses a code instead. 1 2 3 4 5 6 Next Page »

Hormone Is Said to Cut Risk of Premature Birth Posted: 03 May 2011 10:26 AM PDT A daily dose of a hormone gel reduced premature births by nearly half among women at particularly high risk, according to a recent study. Enlarge This Image Jim Wilson/The New York Times A hormone treatment could cut the number of premature babies born in the United States by 10,000 a year, a study found. “This is a big advance,” said Dr. Mary D’Alton, the chairwoman of the department of obstetrics and gynecology at Columbia University. Premature birth is the leading cause of death and illness among newborns. An estimated 12.9 million babies worldwide, 500,000 of them in the United States, are born prematurely every year. In the United States, about a third of early births result from decisions by doctors that the health of either the mother or child is threatened enough to end the pregnancy early, usually with a Caesarean section. But two-thirds of those early births are spontaneous, and any intervention that could reduce them could have significant public health consequences. The hormone treatment, a progesterone gel inserted vaginally every day during the second half of a pregnancy, reduced the risk of premature birth in women with a short cervix, which can soften too early. Dr. Roberto Romero, chief of the perinatology research branch at the National Institutes of Health, estimated that as many as 2 percent of the nation’s 500,000 annual preterm births could be prevented, leading 10,000 more babies a year to be born at full term. Screening all pregnant women and treating those found to have short cervixes would save the nation’s health system $12 million a year, Dr. Romero said. In the study, researchers financed by the federal government gave sonograms to more than 32,000 women who were about halfway through their pregnancies. Doctors found about 465 women in that group whose cervix was unusually short. Half were treated with vaginal progesterone and the other half got a placebo. Using the progesterone gel, which is relatively easy for women to administer to themselves, led to a 45 percent reduction in the rate of preterm birth before 33 weeks of gestation, and it led to improved outcomes for babies. Fourteen women with unusually short cervixes would need to be treated to prevent one preterm birth, the study found. Dr. Sonia Hassan, director of the Center for Advanced Obstetrical Care and Research at the National Health Institutes, a co-author of the study, said the study’s findings should lead all women to have sonograms around the 20th week of their pregnancies to see if they have short cervixes that put their pregnancies at increased risk. “The important thing is to screen all pregnant women,” Dr. Hassan said. Dr. Gary Hankins, chairman of the department of obstetrics and gynecology at the University of Texas Medical Branch, said the study offered great hope for many women. “If we can delay birth by just a few weeks, that can make a massive difference,” Dr. Hankins said.

Vital Signs: Screening: An Autism Questionnaire at Checkup Time Posted: 03 May 2011 02:53 PM PDT A questionnaire that parents can fill out in five minutes while waiting for the pediatrician can detect autism and other delays in 1-year-olds, a new study has found. But the test has a high false-positive rate that may cause unnecessary alarm. Multimedia Interactive Feature Patient Voices: Autism Related Health Guide: Autism More Vital Signs Columns Researchers asked pediatricians in San Diego to use the 24-item checklist to screen 10,479 babies at their 12-month checkups. The test identified some 1,318 babies as potentially having autism or other developmental problems. Of those, 184 infants were evaluated and tracked, including 32 who subsequently were found to have autism spectrum disorder, 56 with language delays, 9 with developmental delays and 36 with other problems. Another 46 were subsequently found to be developing normally, meaning the checklist’s false-positive rate was 25 percent. Although many pediatricians don’t screen 1-year-olds for autism, there is a growing body of evidence suggesting early intervention can be effective, said Dr. Karen Pierce, the lead author of the study — published Thursday in The Journal of Pediatrics — and assistant director of the Autism Center of Excellence at University of California, San Diego. The checklist poses simple questions, like whether a baby responds to his or her name, whether parents can tell when an infant is happy or upset, and whether a child engages in pretend play with dolls or stuffed animals.

Vital Signs: Patterns: An Omega-3 Fatty Acid Shows a Risky Side Posted: 03 May 2011 10:31 AM PDT Omega-3 fatty acids have anti-inflammatory effects that may help protect against heart disease, studies have shown. But men with high blood levels of the omega-3 fat docosahexaenoic acid, or D.H.A., were at significantly greater risk for aggressive prostate cancer, a large study has found. Multimedia Interactive Feature Patient Voices: Prostate Cancer Related Health Guide: Prostate Cancer More Vital Signs Columns The finding was published online April 24 in The American Journal of Epidemiology. Researchers at the Fred Hutchinson Cancer Research Center in Seattle examined the association between fatty acids in the blood and prostate cancer prevalence among participants in the Prostate Cancer Prevention Trial. Their analysis matched 1,658 participants ages 55 to 84 with 1,803 controls for comparison. Men with the highest blood D.H.A. levels were 2.5 times more likely to develop high-grade, aggressive prostate cancer than those with the lowest D.H.A. levels, the researchers found. Another surprising finding was that men with the highest blood levels of trans fatty acids, which are harmful to the heart, had half the risk of aggressive prostate cancer compared with those who had the lowest levels. Both results confounded the scientists. “I can’t really explain it,” said Theodore M. Brasky, lead author of the paper, adding: “If anyone is wondering whether to change their diet, the answer is no. You have to weigh the risks, and a man’s risk of dying of heart disease is much greater than his risk for high-grade prostate cancer, which is very rare.”

Vital Signs: Regimens: Noise Canceling, Without Headphones Posted: 04 May 2011 08:20 PM PDT Studies have found that meditation helps prevent the recurrence of depression, perhaps by producing changes in parts of the brain associated with learning and anxiety. A new study suggests that meditation may modulate brain waves called alpha rhythms, which help regulate the transmission of sensory input from the surrounding environment. Related More Vital Signs Columns Harvard researchers randomly assigned 12 healthy adults to an eight-week course of training in meditation-based stress reduction or to a control group whose participants did not meditate. At regular intervals, researchers used an imaging technique called magnetoencephalography to measure electrical currents in an area of the brain that processes signals from the left hand. During the tests, each participant was asked to direct his attention to his or her left hand or left foot. After eight weeks, the brain scans showed that alpha rhythms changed more quickly and in a more pronounced way in participants who had been meditating. “If you’re reading something in a noisy environment and you want to be in a bubble, you might use your alpha rhythms like a volume knob, to turn down the volume on neurons that represent sound from the outside world,” said Catherine E. Kerr, a neuroscientist at Harvard Medical School and a co-author of the report, published April 21 in the journal Brain Research Bulletin. “We all do this to some extent, but it turns out that meditators become much more skilled at it.”

David J. Sencer, 86, Dies; Led Disease-Control Agency Posted: 05 May 2011 06:37 AM PDT David J. Sencer, who as a federal and New York City public health official confronted some of the most threatening infectious diseases of the past half century, finding controversy in both roles, died on Monday in Atlanta. He was 86. Enlarge This Image William E. Sauro/The New York Times David J. Sencer, left, in 1985 with Mayor Edward I. Koch. His death, at Emory University Hospital, was caused by complications of heart disease, his daughter Susan said. Dr. Sencer was the longest-serving director of the Centers for Disease Control and Prevention, the federal agency based in Atlanta, holding the post from 1966 to 1977. Known as a personable, hands-on executive, he oversaw a substantial expansion of the agency as it dealt for the first time with malaria, nutrition, anti-smoking efforts, health education and occupational safety. Its greatest success under him was a program that eradicated smallpox, beginning in central Africa and eventually extending worldwide. “I never asked him for anything that he didn’t deliver,” said William H. Foege, who led the smallpox eradication project at the C.D.C., as the agency is known, and who succeeded Dr. Sencer as director. “He said you couldn’t protect U.S. citizens from smallpox without getting rid of it in the world, and that was a new approach. People in the field got all the praise, but he was the unsung hero. He just kept providing what we needed.” Dr. Sencer’s C.D.C. tenure was tainted in 1976 when a swine flu virus attacked more than 200 soldiers at Fort Dix, N.J., causing severe respiratory disease in 13 of them and one death. Fearing a reprise of the flu pandemic of 1918-19, and urged on by President Gerald R. Ford, Dr. Sencer made the decision — critics deemed it rash and wasteful — that all Americans ought to be immunized. The United States Public Health Service subsequently ordered the production of up to 200 million doses of vaccine, but the epidemic never materialized. Instead, a rare, potentially fatal nervous system disorder that causes paralysis, known as Guillain-Barré syndrome, appeared in rising percentages of the 45 million people who had been vaccinated, causing more than two dozen deaths. Dr. Sencer was vilified by some but defended by at least as many. “Dave Sencer made a hard choice, and he did it for the right reason — to protect the American public,” said James W. Curran, dean of the Rollins School of Public Health at Emory, who worked at the C.D.C. with Dr. Sencer. “We didn’t always agree. I’m not saying we’d have been better off with a swine flu epidemic. He was trying to protect Americans had there been one, and absent one, there was bound to be criticism.” The same year, 29 people who attended an American Legion convention in Philadelphia were killed by a mysterious ailment that quickly became known as Legionnaires’ disease. In an atmosphere of mounting public panic, Dr. Sencer, fearing an outbreak of swine flu or another infectious virus, dispatched 20 epidemiologists to the scene, but it took months for the agency scientists to determine the cause, which turned out to be a strain of bacteria found in the hotel air-conditioning system. In the aftermath of both scares, and after Jimmy Carter succeeded Ford as president, Dr. Sencer was removed from the directorship by Joseph A. Califano Jr., President Carter’s secretary of health, education and welfare, as the Department of Health and Human Services was then known. Dr. Sencer worked briefly in the private sector, but returned to public service in 1982 as health commissioner of New York City as the AIDS epidemic was taking root in the city. Admired by some for bringing doctors and public health officials together for weekly information exchanges, he was, as the leading health policy representative of Mayor Edward I. Koch’s administration, criticized by others, especially in the gay community, for dragging his feet. “He and his reign accounted for one of the most disastrous experiences of public health anywhere in the world,” Larry Kramer, the AIDS activist and playwright, said in an interview. (Mr. Kramer’s play about AIDS in New York in the 1980s, “The Normal Heart,” has just opened in a Broadway revival.) “What did he do? He didn’t do anything. He had a mayor who said, ‘I don’t want to know,’ and Sencer fell into line.” But James Colgrove, a professor at Columbia University’s School of Public Health and the author of the recently published book “Epidemic City: The Politics of Public Health in New York,” gave Dr. Sencer credit for amending the city’s codes so that AIDS cases were treated confidentially, defending the right of children with AIDS to attend public schools, and being an early advocate for a city-sponsored needle-exchange program. Dr. Sencer was rightfully criticized, Mr. Colgrove said, for not being a better public educator. He failed, for example, to produce and distribute guidelines for sexual risk reduction for gay and bisexual men and did not reassure the public early on that AIDS was not spread by casual contact, Mr. Colgrove said. “On the other hand, there was a lot of uncertainty at the time about how the virus was transmitted,” Mr. Colgrove added. “And you have to keep in mind he was working in extraordinarily difficult conditions. The health department had been gutted by the city’s fiscal crisis of the 1970s and had lost about a quarter of the staff. He helped strengthen the department, especially in areas like epidemiology and bio-statistics. But once AIDS emerged, it overshadowed everything else.” David Judson Sencer was born on Nov. 10, 1924, in Grand Rapids, Mich., where his father, who died when David was a boy, was in the furniture business. He was raised by his mother, Helen Furness, and earned scholarships to the Cranbrook School, near Detroit, and Wesleyan University. He left Wesleyan before graduating to join the Navy, which sent him to medical school at the University of Mississippi. He completed his medical degree at the University of Michigan, and later earned a master’s in public health at Harvard. While at Michigan he spent a year and a half in the hospital with tuberculosis, and his first job with the Public Health Service was screening migrant workers in Idaho for the disease. He joined the C.D.C. as assistant director in 1960. Dr. Sencer lived in Atlanta. In addition to his daughter Susan, a pediatric oncologist in Minneapolis, he is survived by his wife, Jane Blood Sencer, whom he married in 1951; another daughter, Ann, an oncology nurse practitioner, of Atlanta; a son, Stephen, general counsel for Emory University, and six grandchildren. While at the C.D.C., Dr. Sencer was instrumental in starting Emory’s program in public health in 1974; by the 1990s it had evolved into the Rollins School. “Dave Sencer was a public health giant,” said Dr. Thomas Frieden, the current director of the C.D.C. “And until the end he continued to be a thoughtful and vibrant member of the public health community. At the height of the H1N1 pandemic of 2009, he was here full time, and I said, ‘Can I pay you?’ He said, ‘No, this is a labor of love.’ ”

Global Update: Pesticides: Ban on a Cousin of DDT Has Loopholes in India, Where Children Were Harmed Posted: 03 May 2011 10:40 AM PDT Endosulfan, a powerful 50-year-old insecticide sometimes called DDT’s “cousin,” was officially banned last week at an international pesticides meeting in Geneva. Partial exemptions were created for India, however; the chemical may be used on some crops there for up to 10 years. Many countries outlawed endosulfan long ago because it is dangerous to farmworkers, accumulates in the body, kills beneficial insects and persists in the environment. The United States is an exception: Until last year, small amounts were still sold, as Thionex. But last June, after the Environmental Protection Agency declared it a threat to people and wildlife, the only remaining importer agreed to stop distribution. In India, endosulfan is ubiquitous and controversial. It is blamed for deforming hundreds of children in the southern state of Kerala whose parents worked on cashew plantations. Pictures of them are common there, reminiscent of “thalidomide babies” in the 1950s and victims of mercury poisoning in Minamata, Japan. But India’s agriculture ministry has resisted global pressure to drop endosulfan, arguing that crop prices will rise because there are no cheap alternatives. Blaming past illegal overuse for Kerala’s problems, some industry executives claim environmentalist pressure is a plot by Western chemical companies to hobble the Indian market. Meanwhile, in Kerala, demonstrators calling last week for an immediate ban closed trains and businesses.

Drumbeat of Nuclear Fallout Fear Doesn’t Resound With Experts Posted: 05 May 2011 11:24 AM PDT The nuclear disaster in Japan has sent waves of radiation and dread around the globe, prompting so many people to buy radiation detectors and potassium iodide to fend off thyroid cancer that supplies quickly sold out. Multimedia Graphic Sources of Radiation Interactive Feature Japan Earthquake and Tsunami Multimedia Related Life in Limbo for Japanese Near Nuclear Plant (May 2, 2011) Better Flood Plans Are Needed, Nuclear Regulator Says (May 3, 2011) RSS Feed Get Science News From The New York Times » The fear is unwarranted, experts say. People in Japan near the Fukushima Daiichi nuclear power plant may have reason to worry about the consequences of radiation leaks, scientists say, and some reactor workers, in particular, may suffer illness. But outside of Japan, the increase is tiny, compared with numerous other sources of radiation, past and present. Experts say that humans are bombarded by so much radiation from so many other sources, including many natural ones, that the uptick from Japan disappears as a cause of concern the big picture is considered. That perspective suggests a human population and a global environment in which exposure to radiation is constant and significant. For example, people around the globe were exposed to radioactive fallout from hundreds of nuclear bomb test explosions in the atmosphere during the cold war. Today, medical patients choose to be exposed to regular doses of radiation from millions of X-rays and CT scans. In the world’s oceans, thousands of decomposing drums of radioactive waste pose bigger dangers than the relatively small amounts of radioactive water released from the Fukushima Daiichi plant. And natural radiation from rocks, cosmic rays and other aspects of the environment, experts say, represents the biggest factor of all — far bigger than all the man-made emissions, including the current increase from the crippled Japanese reactors. “It disappears as a contributor to population radiation doses,” said Frank N. von Hippel, a nuclear physicist who advised the Clinton administration and now teaches at Princeton University. But the fear of radiation is different. “Somehow,” Dr. von Hippel added, “nuclear things get stigmatized relative to their statistical risks.” After the Japanese disaster began on March 11, blogs warned of government conspiracies to cover up radiation dangers, and public-interest groups sounded alarms. Dr. Dale Dewar, executive director of Physicians for Global Survival, a group that advocates the abolition of nuclear arms, said the accident meant future generations would live in a world with higher levels of background radiation. “Your hair won’t fall out,” she told an interviewer at the Vancouver Sun. “But ‘No immediate danger’ is an easy way for the nuclear industry to duck the long-term effects.” Even Washington got the jitters. On March 15, four days after the disaster’s start, the surgeon general, Regina M. Benjamin, said it was no overreaction for Americans to stock up on iodine pills. “It’s a precaution,” Dr. Benjamin told a television interviewer. Her office backpedaled two days later, after President Obama said Americans needed to take no protective measures. “Most people don’t have a good handle on the risks,” Dr. Fred A. Mettler Jr., professor of radiology at the University of New Mexico and the American representative to a United Nations panel on radiation assessment, said in an interview. “They don’t know the magnitude of the sources, so they don’t know how to put the risks in perspective.” The jargon doesn’t help. Radiation is measured in obscure units that change significantly depending on the strength of the radiation and whether the units characterize radioactivity itself, or the interaction of the radiation with the human body. Radioactive sources are said to emit curies or becquerels of radiation, but the effect on living things is measured in sieverts or rem (for “roentgen equivalent man” — it’s true). Given what may appear to be chaotic or incomplete information, people may base their perceptions of atomic risk on a volatile mix of sensational reports and instincts. “Risk resides mostly as a feeling,” said Paul Slovic, a pioneer of nuclear psychology at the University of Oregon. “It’s a quick gut reaction often triggered by an image,” especially ones in the movies and on television. Dr. Mettler said, “Children in the United States are inundated with all kinds of nonsense on television from the time they are 6 months old.” Cartoon characters like the Incredible Hulk, Spider-Man and Homer Simpson, he said, all of whom experience scientifically impossible but highly entertaining effects of radiation, tend to provide most of the nation’s “radiation biology lessons.” Dr. Slovic cited medical radiation as an example of variability in risk perception. Many experts see the public as getting a potentially risky overdose. But the public tends to think otherwise, he said. “We’re very tolerant of exposure,” Dr. Slovic said in an interview. “We want it or need it, so we feel it’s a strongly beneficial technology. And so the sense of risk is depressed.” 1 2 Next Page » This posting includes an audio/video/photo media file: Download Now

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Personal Health: A Thief That Robs the Brain of Language Posted: 05 May 2011 12:10 AM PDT Steve Riedner of Schaumburg, Ill., was a 55-year-old tool-and-die maker, a job that involves difficult mental calculations, and a frequent speaker at community meetings when he found himself increasingly at a loss for words and unable to remember numbers. He even began to have difficulty reading his own written comments. Enlarge This Image Yvetta Fedorova Related More Personal Health Columns The neurologist he consulted thought Mr. Riedner had suffered a stroke and for three years treated him with cholesterol-lowering medication. But instead of his language ability stabilizing or improving, as should happen following a stroke, it got worse. A second neurologist concluded after further testing that Mr. Riedner might have a condition called primary progressive aphasia, or P.P.A., a form of dementia affecting the brain’s language center. Having seen only one other case in his career, the neurologist referred Mr. Riedner and his wife, Mary Beth, to the Cognitive Neurology and Alzheimer’s Disease Center at Northwestern University, whose director, Dr. M. Marsel Mesulam, is perhaps the world’s leading expert on this relatively rare disorder. P.P.A. is a clinical syndrome, one of several forms of brain disease lost in the medical shadow of their much better known relative Alzheimer’s disease. While hardly as common as Alzheimer’s, P.P.A. is often misdiagnosed, and many patients like Mr. Riedner lose valuable time trying inappropriate and ineffective treatments. Though there is no cure, patients and families can learn ways to minimize the disabilities it causes. Unlike Alzheimer’s, P.P.A. does not affect memory, at least not initially. It also tends to occur at younger ages, often in the late 50s, and affects twice as many men as women. While symptoms of Alzheimer’s are readily recognized by friends and relatives but not those affected, people with P.P.A. are painfully aware of their struggle to communicate, often long before it is apparent to others. “Early symptoms are usually very subtle, and patients may be the only ones aware of the problem because they have to work harder to communicate, even though they may not make obvious errors,” said Joseph R. Duffy, head of speech pathology at the Mayo Clinic in Rochester, Minn. “Initially, their communicative errors are like those we all make and may be written off as due to chronic fatigue. But gradually the errors of speech occur with increasing frequency.” ‘Like Being a Parent Again’ The disorder is also commonly misdiagnosed, usually as Alzheimer’s disease or a result of depression or anxiety, Dr. Duffy said in an interview. But while a definitive diagnosis can be made only at autopsy, the results of neuropsychological testing and the patient’s progressive difficulty with communication despite a normal memory can pinpoint P.P.A. as the problem. As the condition worsens, cognitive difficulties may become apparent. Now seven years into the disorder, Mr. Riedner is having increasing problems performing the tasks of daily living. “He can no longer punch in the numbers to operate the garage door or the microwave or the remote for the TV,” Mrs. Riedner, his wife of 38 years, said in an interview. “He might open the car window, then not know how to close it. We bought him an iPad, but he can’t learn how to use it.” New ways of communicating have to be learned, like using gestures or making lists of things to say or do or eat, so that the person can point to them when needed. Unfortunately, sign language doesn’t work because it, too, depends on the region of the brain that is diseased. “In some ways it’s like being a parent again. He acts in childlike ways sometimes, but he still wants to be himself, an independent adult,” Mrs. Riedner said. “Coping with the problem takes an immense amount of patience on both our parts.” Mrs. Riedner said the center at Northwestern has been “a lifesaver for us,” a source of support, speech therapy and rehabilitation, help with practical matters like applying for Social Security disability insurance, and tips on how to minimize the inevitable frustrations that can accompany lost language skills. Dr. Mesulam was the first in modern times to recognize the distinction between P.P.A. and other forms of dementia. In 1975, as a newly minted neurologist at Beth Israel Hospital in Boston, he became puzzled by a group of patients who seemed to know what they wanted to say but couldn’t string words together in an intelligible sequence. Their communicative problems got progressively worse, although there were no lesions apparent in their brains. His report in 1982 on six such cases stimulated modern interest in P.P.A. As Dr. Mesulam explained in a retrospective article in the journal Alzheimer Disease and Associated Disorders in the fall of 2007, “The aphasia can interfere with word-finding, object naming, syntax, phonology, morphology, spelling or word comprehension. The progression occurs in the course of years rather than months, and the primary nature of the aphasia is demonstrated by showing that memory for recent events, recognition of familiar faces and objects, reasoning, and basic aspects of comportment are relatively preserved at the initial stages.” Focus on What Remains With no therapy available to treat the underlying disease, treatment involves determining which aspects of language are strongest, then providing speech therapy that emphasizes those areas and avoids areas in which patients are weakest, Dr. Mesulam said. Dr. Duffy said that early intervention is important and should focus on alternative approaches to communication like using a computer, picture icons, or iPhones or iPads that have apps that can talk for a person. Family members are taught how to aid comprehension by communicating simply and clearly: telling patients only one thing at a time, reducing noise and other distractions, and avoiding multitasking. Family members are also taught coping skills and helped to prepare for the future as the disease progresses, said Darby Morhardt, a social worker at the Northwestern center. “There’s inevitably a grieving process as patients change right before their eyes, but at the same time families want to grasp as much as possible of what remains.” Patients often are encouraged to develop new hobbies and skills that don’t rely on communication, like woodworking, gardening, fishing, sculpting or painting. Among Northwestern’s patients is one who began breeding pigeons and another who started judging dog races. Unfortunately, if patients live long enough, other deficits — including those involving memory and cognitive abilities, and motor problems resembling symptoms of Parkinson’s disease — often become apparent, as is now happening to Mr. Riedner. Like Alzheimer’s disease, P.P.A. shortens life expectancy: The average age of death is 67. Ms. Morhardt said it’s important for patients and their families not to delay getting financial matters in order. Many would be wise to consult a lawyer who specializes in elder law, she said.

Really?: The Claim: Having Tonsil Surgery Causes Weight Gain Posted: 03 May 2011 02:53 PM PDT THE FACTS Enlarge This Image Christoph Niemann Well Share your thoughts on this column at the Well blog. Go to Well » Related Health Guides: Tonsillectomy | Tonsillitis More Really? Columns Despite concerns about its effectiveness, the childhood tonsillectomy is common. Each year more than half a million children in the United States have their tonsils removed. But scientists have noticed what appears to be an unexpected side effect: Children who have the surgery are at greater risk of becoming overweight. At first glance it makes little sense. Tonsils are typically removed after they become enlarged from repeated infections. Why would that have any effect on weight? One theory is that enlarged tonsils cause difficulty swallowing, prompting a child to eat less. Once the tonsils are removed, appetite returns. No one knows how to explain it, but studies show a link between the surgery and weight gain. In the most recent and exhaustive report, published this year in the journal Otolaryngology — Head and Neck Surgery, researchers analyzed data from 11 studies, following 1,549 children for up to seven years. Obviously, the children put on weight as they aged, but the analysis showed that the gains were much greater than expected after the surgery and greater than the weight gain in children who had not had their tonsils removed. But so far only an association has been confirmed, not a direct causal effect. For now, experts say parents should simply keep an eye on a child’s weight after the surgery. THE BOTTOM LINE Studies show tonsillectomies are associated with weight gain, but it’s not clear there’s a causal relationship. ANAHAD O’CONNOR scitimes@nytimes.com

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Letters: The Big Picture (2 Letters) Posted: 03 May 2011 02:53 PM PDT To the Editor: Re “Thyroid Fears Aside, That X-Ray’s Worth It” (Personal Health, April 26): In seeking explanations for the rising incidence of thyroid cancer, Jane Brody exonerates the occasional X-ray or mammogram but overlooks the increasing use of computed tomography. CT scans can expose patients to doses up to 80 times greater than those linked to a single chest X-ray. Their use has grown by about 10 percent every year since the early 1990s. According to the 2008-9 annual report of the President’s Cancer Panel, “Americans now are estimated to receive nearly half (48 percent) of their total radiation exposure from medical imaging and other medical sources, compared with only 15 percent in the early 1980s.” The report also said: “The increase in medical radiation has nearly doubled the total average effective radiation dose per individual in the United States.” Ellen Leopold Cambridge, Mass. ♦ To the Editor: I am correctly cited in Ms. Brody’s article stating that I would not get routine dental X-rays, as there is little evidence to support them in asymptomatic patients. The situation for mammography is completely different. Randomized clinical studies have shown mammography saves lives. It is unlikely to impact thyroid cancer, and the benefits of mammography clearly outweigh any risks. So, the message is clear: Get your mammogram and skip the “routine” dental X-ray if you do not have symptoms. Carolyn D. Runowicz, M.D. Miami 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: Recovery Redefined (3 Letters) Posted: 03 May 2011 02:53 PM PDT To the Editor: Re “In Fighting Anorexia, Recovery is Elusive” (April 26): The experiences of clients, their families and therapists tell us that full recovery from an eating disorder is possible when psychological/cognitive recovery is included in the definition of recovery — that is, when you also assess ways of thinking about weight, shape and food, rather than stopping at physical (e.g., weight restored) and behavioral (e.g., no binge eating) dimensions to define recovery. The inclusion of a cognitive piece may seem obvious but has not yet become the norm in defining recovery. Anna Bardone-Cone, Ph.D. Chapel Hill, N.C. ♦ To the Editor: Abby Ellin discusses some of the challenges and fears faced by many suffering from anorexia nervosa. While everyone’s journey to recovery varies, it is important to note that recovery is possible. The form it takes may vary for each individual, not unlike other illnesses. It is important that we as a society stop expecting absolute measurements of wellness, and we continue to support healthy environments that enable those who struggle with eating disorders to live full lives to their own satisfaction. Evelyn Attia, M.D. New York ♦ To the Editor: I am beyond disappointed with the overall tone of the article on anorexia. I battled eating disorders for 10 years and have been recovered for 10 years. I am not the exception, and through my work with the Alliance for Eating Disorders, I have met many people living completely beyond their eating disorders. After reading the article, members of my support group said, “Why should I struggle so much with the recovery process if there is no hope for recovery?” If it affected members of my group so significantly, what will the impact be on individuals (and their loved ones) nationwide? What about people who haven’t yet reached out for help? Whether you say “recovered” or “in recovery” from eating disorders, the point is people need to know that they can do this. They deserve to have hope and know that recovery is possible. Johanna S. Kandel West Palm Beach, Fla. 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.

Rule Would Discourage States’ Cutting Medicaid Payments to Providers Posted: 03 May 2011 08:46 AM PDT WASHINGTON — In a new effort to increase access to health care for poor people, the Obama administration is proposing a rule that would make it much more difficult for states to cut Medicaid payments to doctors and hospitals. Blogs The Caucus The latest on President Obama, the new Congress and other news from Washington and around the nation. Join the discussion. FiveThirtyEight: Nate Silver's Political Calculus More Politics News The rule could also put pressure on some states to increase Medicaid payment rates, which are typically lower than what Medicare and commercial insurance pay. Federal officials said Monday that the rule was needed to fulfill the promise of federal law, which says Medicaid recipients should have access to health care at least to the same extent as the general population. “We have a responsibility to ensure sufficient beneficiary access to covered services,” the administration said in issuing the proposal, to be published Friday in the Federal Register. In many parts of the country, Medicaid recipients have difficulty finding doctors who will take them because Medicaid payment rates are so low. Faced with huge financial problems, many states have frozen or reduced Medicaid payments to health care providers, and governors of both parties have proposed additional cuts this year. Medicaid recipients and health care providers have sued state officials to block such cuts, and one case, from California, is pending in the United States Supreme Court. “Tight state budgets, coupled with increased demand for services during the recession, have led many states to propose reductions in Medicaid provider payments, without clear federal guidance on how to assure access,” said Cindy Mann, the federal official in charge of Medicaid. The new rule provides that guidance, but several state officials expressed concerns. Dennis G. Smith, secretary of the Wisconsin Department of Health Services, described the proposal as “a federal power grab.” “The administration talks about flexibility and working with states, but continues to take actions such as this that are contrary to the partnership,” Mr. Smith said. “Putting states in jeopardy, by inventing a new meaning for a longstanding statutory provision, is another example of how distant and disconnected the administration is from what is happening across the country.” Medicaid is financed jointly by the federal government and the states. Even before the recent recession, it was one of the fastest-growing items in most state budgets. Douglas Porter, the Medicaid director in Washington State, said: “The intent of the proposed regulation is reasonable. But the administration has gone overboard, creating a system of access review that is far too complex, elaborate and burdensome.” Bruce D. Greenstein, secretary of the Louisiana Department of Health and Hospitals, said: “The proposal leaves too much discretion with the federal government. It does not clearly enunciate the criteria to be used in measuring access to care.” The new initiative comes as federal and state officials prepare for a huge expansion of Medicaid eligibility, scheduled to occur in 2014 under the new health care law. About half of the 34 million uninsured people who are expected to gain coverage under the law will get it through Medicaid. The proposed rule generally prevents states from cutting Medicaid payments to providers unless they can show that Medicaid recipients will have “sufficient access” to care after the cuts. Regardless of whether they want to cut payment rates, states must continually monitor Medicaid recipients’ access to care and develop plans to fix any problems they discover, the rule says. Under the rule, states must measure and document access to “each covered benefit” at least once every five years. Data from such reviews could provide doctors, hospitals and nursing homes with powerful new tools to lobby for higher reimbursement. States set Medicaid payment rates within broad federal guidelines. Federal law has long said that states must “enlist enough providers” to make sure Medicaid recipients have access to care equivalent to that of other people in the area. Under presidents of both parties, federal officials have often disregarded this requirement, approving cuts in Medicaid payment rates that discouraged doctors from accepting Medicaid patients. In an effort to rein in costs, states have increasingly turned to health maintenance organizations and other types of managed care. The new rule does not apply to managed care. But the Obama administration said it was “considering future proposals” to guarantee access to care for Medicaid recipients in such private health plans. Under the proposal being issued this week, “beneficiary access must be considered in setting and adjusting” Medicaid payments to doctors, dentists, psychologists, hospitals, clinics, pharmacies, nursing homes and suppliers of medical equipment. States must consult Medicaid recipients because, the rule says, their experience is “the most important indicator of whether access is sufficient.” Federal officials suggested that states survey Medicaid recipients to see how much difficulty they had in scheduling doctor’s appointments. In addition, the rule says, states should compare Medicaid payment rates with the amounts paid by Medicare or commercial insurers, with providers’ costs or with their customary charges. Another important factor, it said, is the number and percentage of doctors who accept new Medicaid patients.

When Meeting a Congressman, Leave Nothing to Chance Posted: 03 May 2011 08:46 AM PDT SUN LAKES, Ariz. — It was no accident that Gina Gennaro found herself outnumbered at a town-hall-style meeting the other night and shushed when she tried to press her objections to Republican plans to remake Medicare. Multimedia Graphic Freedom to Argue: Town Hall Quotables Blogs The Caucus The latest on President Obama, the new Congress and other news from Washington and around the nation. Join the discussion. FiveThirtyEight: Nate Silver's Political Calculus More Politics News Enlarge This Image Joshua Lott for The New York Times “Those health care town halls, those were heated and the anger was real; no one was organizing them. Now, there's the hiring of people to come in, no doubt about it.” REPRESENTATIVE JEFF FLAKE Throughout the two-week Congressional recess that ended Monday, at public meetings across the country, a running skirmish was fought among grass-roots activists from both parties. They wanted to duplicate — or prevent — the kind of angry confrontations, many of them organized by Tea Party supporters, that occurred at such meetings during the heat of the 2009 debate over the health care overhaul. This time, the focus was on budget cutting. Who won the skirmishes depended on which side filled the most chairs. And supporters of both parties were taking part in the maneuvering. “We need you to show up in force to make sure the far left doesn’t drown out the debate!” Tea Party activists said in an e-mail alert intended to fill as many seats as possible at a gathering that Representative David Schweikert, a freshman Republican from the Phoenix area, held Wednesday night in a police substation in Tempe. The e-mail said the liberal group MoveOn.org was at work lining up liberals to stack the audience. Indeed, MoveOn.org is one of numerous groups across the political spectrum that have been busy organizing partisans to attend public meetings, but Mr. Schweikert still faced a generally supportive audience. Generally. “It felt like it was me and a couple of others against everyone else,” said Ms. Gennaro, an artist and an independent, and one of a handful of critics in the audience who grilled Mr. Schweikert. “Next time, I’m going to bring more people with me.” Every public meeting has similar nuts and bolts: the chairs, the sound system and, increasingly, with the debate over budgeting at a fever pitch, the big screen used to blow up multicolored pie charts and graphs showing government spending gone wild. The big variable determining whether a meeting will resemble a graduate policy seminar or degenerate into a shouting match is the makeup of the audience. Who will fill the chairs, and spring out of them to take the microphone and comment vociferously on the overhead projections, is no accident, as a glimpse behind the scenes at several meetings in Arizona last week made clear. Long before the member of Congress in question strides out in front of a crowd, activists are at work trying to shape the crowd. Ms. Gennaro was attending her first public meeting, and she said she showed up on her own, without any activist group contacting her. She acted like a veteran, though, throwing her hand into the air often to be called upon, offering hard-edged questions and comments and, at the end, ignoring altogether Mr. Schweikert’s protestations that the event was over as she continued her critique of Republican proposals to reduce future spending on Medicare. At another public meeting just down the Interstate on Friday morning, Representative Jeff Flake, another Arizona Republican, found a friendly crowd at the community center of a well-off retirement community known as Sun Lakes. But there was plenty of behind-the-scenes dialing to fill the seats and shape the audience beforehand. The meeting was officially a campaign event for Mr. Flake’s fledgling effort to replace Senator Jon Kyl, a Republican who is retiring. After hiring a firm to contact voters with electronic robocalls, the campaign informed the Sun Lakes Republican Club of the event just a couple days beforehand, leaving far less time than the political activists there were accustomed to turn out a crowd. “I just found out about it,” Michael Tennant, the club chairman and a retired construction equipment salesman, said on the eve of the meeting. “I’m doing all I can to fill the room, but it’s on a Friday. That’s the day people are playing golf, getting ready to go out to dinner or resting by the pool. They might be at a class or singing at the church choir, and many people still have their grandchildren around from Easter.” Still, through a barrage of e-mails to club members and phone calls to the 30 or 40 members who do not use computers, he was beaming that the room was packed with Republicans. One of them was Richard D. Fife, 79, a retired electrical engineer, who considers the country off the rails and who raised his hand high when Mr. Flake asked, as many Republican lawmakers have been asking, whether anyone in the audience feared that their children and grandchildren would have less opportunity than they had. “It’s our turn to get out of our seats and into the streets,” said Inez McGee, a retired teacher seated nearby, speaking of older Americans who have the free time to become politically engaged. 1 2 Next Page » Marisa Gerber contributed reporting from Sun Lakes, Ariz.

Proposal for Medicare Is Unlike Federal Employee Plan Posted: 02 May 2011 12:30 AM PDT WASHINGTON — House Republicans say their budget proposal would make Medicare work just like the health insurance that covers federal employees, including members of Congress. But a close examination shows the two plans are very different, and the differences help explain why the Republican plan has set off a political uproar. Enlarge This Image Jeffrey Phelps/Associated Press Protesters in Kenosha, Wis., on Tuesday sought the attention of Representative Paul D. Ryan over the House budget proposal. Under the federal employees’ health plan, which covers eight million people, the government pays a fixed share of premiums. So the federal contribution generally keeps pace with rising premiums, which in turn reflect rising health costs. No such guarantee exists under the Republicans’ plan to transform Medicare, approved by the House on April 15 as part of a budget blueprint to cut federal spending and deficits. Medicare and the budget will be high on the agenda when Congress reconvenes Monday after a two-week recess in which Republicans were barraged with complaints from constituents alarmed about the possible erosion of Medicare benefits. Under the House Republican proposal, starting in 2022 new Medicare beneficiaries would receive coverage through private insurance plans, and Medicare would subsidize the cost. The federal payment for a typical 65-year-old would be set at $8,000 a year in 2022, about the same as what Medicare is expected to spend under current law. In later years, the federal payment would be increased to reflect the age of a beneficiary and general inflation, measured by the Consumer Price Index. But health costs and insurance premiums have, for years, been rising faster than consumer prices in general. So, the Congressional Budget Office says, under the Republican plan, Medicare would pay a shrinking share of beneficiaries’ total health costs, and seniors would pay a growing share. For a typical 65-year-old, that share would be 68 percent in 2030, more than twice what it would be under current law, the budget office said. Today, Medicare is an open-ended entitlement. It does not have a fixed budget, though Congress has defined the benefits and prescribed payment rates for doctors and hospitals. House Republicans have repeatedly likened their proposal to the Federal Employees Health Benefits Program, in which most lawmakers are enrolled. “We want to prevent Medicare from going bankrupt,” said Representative Paul D. Ryan of Wisconsin, chairman of the House Budget Committee and the lead advocate for the budget proposal. “We want a system that’s sustainable. We want a system that’s solvent and that people can rely upon: guaranteed coverage options just like we have in Congress. That’s what we are proposing.” Beginning in 2022, Mr. Ryan said, “new Medicare beneficiaries would be enrolled in the same kind of health care program that members of Congress enjoy.” Under their proposal, House Republicans say, Medicare would subsidize private health plans offered to beneficiaries, just as the federal government helps pay premiums for private health plans offered to its employees. But Representative Chris Van Hollen of Maryland, the senior Democrat on the House Budget Committee, said the similarities ended there. “We keep hearing that Republicans are offering seniors exactly what members of Congress get,” Mr. Van Hollen said. “It simply is not true.” Under the federal employee program, the government’s share of premiums is set at 72 percent of the average premium for all plans, but it cannot exceed 75 percent of the premium for any particular plan. The health care handbook for federal employees explains, “This formula is known as the ‘fair share’ formula because it will maintain a consistent level of government contributions, as a percentage of total program costs, regardless of which health plan enrollees elect.” In practice, the government pays three-fourths of the premium for relatively inexpensive health plans and about two-thirds of the premium for those that cost more than the average. The maximum annual government contribution this year is $10,503 for family coverage. An example shows how the formula works. For family coverage under the most popular plan — the standard option offered by Blue Cross and Blue Shield — the total annual premium is $15,682 this year. The government pays $10,503 (67 percent) and the federal worker pays the rest, $5,179. For family coverage under the cheaper Blue Cross basic option, the total premium is $12,744; the government pays $9,558 (75 percent) and the employee pays $3,186. Even so, Conor Sweeney, a spokesman for Mr. Ryan, insisted that the comparison to the federal employees’ plan was valid. “The model, the structure, the approach is inarguably similar: the government pays a share of the individual’s premiums” in both the employee program and the House Republicans’ Medicare proposal. If Democrats showed any interest in this approach, lawmakers could still negotiate the amount of the federal payment to private health plans, and how to adjust it from year to year, Mr. Sweeney said. Earlier versions of Mr. Ryan’s Medicare proposal, he added, would have allowed the federal contribution to grow at a somewhat higher rate than assumed in the House budget blueprint.

Editorial: The Ryan Plan for Medicaid Posted: 30 Apr 2011 09:10 PM PDT With Washington looking for ways to rein in costly entitlement programs and state governments struggling to balance budgets, conservatives have revived an old nostrum: turning Medicaid into a block grant program. The desire for fiscal relief is understandable. Medicaid insures low-income people and in these tough economic times, enrollment and costs — for the federal government and state governments — have swelled. Representative Paul Ryan, and the House Republicans, are now proposing to ease Washington’s strain by capping federal contributions. Like his proposal for Medicare, that would only shift the burden — this time onto both state governments and beneficiaries. Still, some governors may be tempted. His plan promises them greater flexibility to manage their programs — and achieve greater efficiency and save money. That may sound good, but the truth is, no foreseeable efficiencies will compensate for the big loss of federal contribution. Mr. Ryan also wants to repeal the health care reform law and its requirement that states expand their Medicaid rolls starting in 2014. Once again Washington would pay the vast bulk of the added cost, so states would be turning down a very good deal to save a lesser amount of money. • Here’s how Medicaid currently works: Washington sets minimum requirements for who can enroll and what services must be covered, and pays half of the bill in the richest states and three-quarters of the bill in the poorest state. If people are poor enough to qualify and a medical service recommended by their doctors is covered, the state and federal governments will pick up the tab, with minimal co-payments by the beneficiaries. That is a big plus for enrollees’ health, and a healthy population is good for everyone. But the costs are undeniably high. Enter the House Republicans’ budget proposal. Instead of a commitment to insure as many people as meet the criteria, it would substitute a set amount per state. Starting in 2013, the grant would probably equal what the state would have received anyway through federal matching funds, although that is not spelled out. After that, the block grant would rise each year only at the national rate of inflation, with adjustments for population growth. There are several problems with that, starting with that inflation-pegged rate of growth, which could not possibly keep pace with the rising cost of medical care. The Congressional Budget Office estimates that federal payments would be 35 percent lower in 2022 than currently projected and 49 percent lower in 2030. To make up the difference, states would probably have to cut payments to doctors, hospitals or nursing homes; curtail eligibility; reduce benefits; or increase their own payments for Medicaid. The problems do not end there. If a bad economy led to a sharp jump in unemployment, a state’s grant would remain the same. Nor would the block grant grow fast enough to accommodate expensive advances in medicine, rising demand for long-term care, or unexpected health care needs in the wake of epidemics or natural disasters. This would put an ever-tightening squeeze on states, forcing them to drop enrollees, cut services or pump up their own contributions. This is not the way to go. The real problem is not Medicaid. Contrary to most perceptions, it is a relatively efficient program — with low administrative costs, a high reliance on managed care and much lower payments to providers than other public and private insurance. The real problem is soaring medical costs. The Ryan plan does little to address that. The health care law, which Republicans have vowed to repeal, seeks to reform the entire system to deliver quality care at lower cost. To encourage that process, President Obama recently proposed a simplified matching rate for Medicaid, which would reward states for efficiencies and automatically increase federal payments if a recession drives up enrollments and state costs. The president’s approach is better for low-income Americans and for state budgets as well.

Court Lets U.S. Resume Paying for Embryo Study Posted: 29 Apr 2011 10:35 PM PDT WASHINGTON — Government financing of human embryonic stem cell research can continue, a federal appeals court ruled Friday. The decision was an important victory for the Obama administration in a legal battle that is far from over. Related Times Topic: Stem Cells The 2-to-1 ruling, by a panel of judges from the United States Court of Appeals for the District of Columbia Circuit, blocks a lower-court decision last August holding that such research is illegal under a law that bans public spending on research in which human embryos are damaged or destroyed. The stem cells are derived from donated human embryos left over from fertility treatments; the embryos are destroyed in the process, leading some opponents of abortion to liken the research to murder. But the appellate court said Friday that because the law is written in the present tense, “it does not extend to past actions.” Samuel B. Casey, a lawyer for two scientists who sued the government to stop paying for research into human embryonic stem cells, said that he was “a little disappointed” but also pleased that the appeals court kept his suit alive, and that he was considering an appeal. Representative Diana DeGette, Democrat of Colorado, said she was “extremely pleased with this decision.” But she promised to push for unambiguous legislation that would allow such research to continue. The ruling sends the case back to Chief Judge Royce C. Lamberth of Federal District Court in Washington, who concluded in August that the Obama administration was so unlikely to win the case that he issued an immediate ban on any federal spending on human embryonic research. That decision shocked government scientists, who said it would force the cancellation of dozens of experiments on an array of diseases, from diabetes to Parkinson’s. The government appealed, and the appeals court stopped the ban from going into effect while it heard arguments in the case. Friday’s ruling is the end of the first phase of the litigation. “This is a momentous day not only for science but for the hopes of thousands of patients and their families who are relying on N.I.H.-funded scientists to pursue life-saving discoveries and therapies that could come from stem cell research,” said Dr. Francis S. Collins, director of the National Institutes of Health. David A. Prentice of the Family Research Council, an anti-abortion group, said he was disappointed. “Federal taxpayer funds should go towards helping patients first, not unethical experiments,” he said. The research potential for embryonic stem cells, which were discovered in 1998, arises from their ability to morph into any cell in the body and possibly form new organs. President George W. Bush was the first to allow federal financing of human embryonic stem cell research, but he limited the research to 21 cell lines already in existence to discourage further destruction of embryos. President Obama promised in his campaign to expand the research and ordered the health institutes soon after his inauguration to do just that. Judge Lamberth’s ruling was so sweeping that the Obama administration interpreted it as a ban on all stem cell research, including projects that passed muster under his predecessor. Dr. George Q. Daley, director of the stem cell transplant program at Children’s Hospital Boston, said he was happy with the ruling. “But it’s tempered by the fact that there’s a court case that is still pending,” he added. Dr. Daley’s laboratory is using embryonic stem cells to research cures into bone marrow failure, a rare genetic condition sometimes called “bubble boy disease” because it forces children to live in sterile environments. His lab is also comparing the relative properties of embryonic stem cells and so-called pluripotent stem cells derived from adult tissue; some anti-abortion activists say the pluripotent cells, which have the potential to turn into the many kinds of specialized cells in the body, are an ethical alternative to the embryonic kind. The plaintiffs in the case are two scientists, Theresa Deisher and Dr. James L. Sherley, who use only adult stem cells in their research. They argue that the administration’s policy puts their own research at a disadvantage in the competition for government financing. Judge Karen LeCraft Henderson, the dissenter in Friday’s appeals court ruling, wrote that her colleagues “perform linguistic jujitsu” to arrive at their conclusion. The plain language of the law bars financing for all research that follows the destruction of embryos, she wrote, and it is meaningless to try to separate the process of destruction from the use of the stem cells that result from that destruction. Mr. Casey, the lawyer for the plaintiffs, said Judge Henderson’s dissent might lead him to ask the full Court of Appeals to reconsider the case. “But my mother told me to always sleep on these things, so that’s what we’re going to do,” he said.

Recipes for Health: Cheddar Cheese Crackers Posted: 03 May 2011 01:00 PM PDT My son may not be convinced these can substitute for the ubiquitous orange crackers sold commercially, but I’ll take the homemade version any time. 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: Homemade Whole Grain Crackers (May 2, 2011) Recipes for Health: Buckwheat Crackers With Sesame (May 3, 2011) Recipes for Health: Olive Oil Crackers (May 4, 2011) Recipes for Health: Gluten-Free Rice and Millet Flour Crackers (May 5, 2011) 1 cup whole-wheat or whole-wheat pastry flour 1/3 cup unbleached all-purpose flour (more as needed) 1/2 teaspoon salt 1 teaspoon sugar 2 tablespoons unsalted butter, cut into 1/4-inch pieces 1 cup tightly packed grated sharp Cheddar cheese (4 ounces) 1/4 cup tightly packed grated Parmesan (4 ounces) 2 tablespoons extra virgin olive oil 2 eggs 1. Preheat the oven to 375 degrees. Line two baking sheets with parchment. Sift together the flours, salt and sugar, and place in the bowl of a food processor fitted with the steel blade. Add the butter, and pulse until the mixture is crumbly. Add the cheese, and pulse several times to distribute it evenly throughout the flour mixture. Turn on the food processor, and add the olive oil and eggs. Stop the machine when the dough comes together. It will be soft and somewhat sticky. If it seems very moist, add another tablespoon of flour and pulse until incorporated. 2. Lightly flour your hands and your work surface. Scrape out the dough and form two equal pieces. Shape into rounds, wrap in plastic and let rest for 15 minutes. 3. Roll out each piece of dough between pieces of lightly floured parchment. Cut into squares or rectangles, and place on the parchment-lined baking sheets. Bake 15 to 20 minutes, switching the pans after the first 10 minutes from front to back and top to bottom. They will foam in the oven because of the cheese, but that will subside and they will bake crisply. The crackers are done when they are lightly browned. Remove from the oven, and cool on racks. Store in an airtight container. Yield: About five dozen crackers. Advance preparation: These crackers will keep for about a week in an airtight container. Nutritional information per cracker: 28 calories; 1 gram saturated fat; 0 grams polyunsaturated fat; 1 gram monounsaturated fat; 9 milligrams cholesterol; 2 grams carbohydrates; 0 grams dietary fiber; 39 milligrams sodium; 1 gram protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Olive Oil Crackers Posted: 04 May 2011 12:10 AM PDT I like to top these with a little Parmesan cheese and a generous sprinkling of za’atar, a spice mix made with thyme, sesame seeds and sumac. You can find it in Middle Eastern groceries or make your own. 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: Homemade Whole Grain Crackers (May 2, 2011) Recipes for Health: Buckwheat Crackers With Sesame (May 3, 2011) Recipes for Health: Gluten-Free Rice and Millet Flour Crackers (May 5, 2011) Recipes for Health: Cheddar Cheese Crackers (May 6, 2011) 1 1/2 cups whole-wheat or whole-wheat pastry flour 3/4 cup unbleached flour (or use all whole-wheat flour) 3/4 teaspoon salt 1/4 cup water 2 large eggs 1/4 cup plus up to 1 tablespoon extra virgin olive oil 1/4 cup grated Parmesan 2 tablespoons za’atar (see below) 1. Preheat the oven to 375 degrees. Line baking sheets with parchment. Sift together the flours and the salt. Combine the water, eggs and 1/4 cup of the olive oil in a measuring cup. Place the flour mixture in the bowl of a food processor fitted with a steel blade, and turn on the processor. Add the liquids with the machine running, and process until the dough comes together. The dough will be soft. If it seems wet, add another tablespoon of flour. 2. Remove from the food processor, and wrap in plastic. Let rest 15 minutes. Divide into two portions, and roll out each portion into thin sheets. Brush the top of the sheets with the remaining olive oil, and sprinkle with Parmesan and za’atar. Using the rolling pin, gently press the topping into the surface. Cut the dough into squares or rectangles, and transfer to the baking sheets. 3. Bake 15 minutes until lightly browned and crisp. Note: To make za’atar, mix together 1/4 cup finely crumbled dried thyme, 1 tablespoon sesame seeds, 1 teaspoon sumac (available in Middle Eastern markets) and a pinch of salt. Place in a jar, and keep in a cool, dark place. A number of seeds can stand in for the za’atar. I like charnushka, also known as nigella, as well as sesame seeds, cumin seeds, poppy seeds and flax seeds. Try different combinations. Yield: Eighty to 90 crackers. Advance preparation: These crackers will keep for a week in an airtight container. Nutritional information per cracker: 23 calories; 0 grams saturated fat; 0g polyunsaturated fat; 1 gram monounsaturated fat; 5 milligrams cholesterol; 3 grams carbohydrates; 0 grams dietary fiber; 28 milligrams sodium; 1 gram protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Buckwheat Crackers With Sesame Posted: 03 May 2011 01:00 PM PDT Buckwheat contributes an earthy, nutty flavor to these crackers. Try them with smoked salmon. 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: Homemade Whole Grain Crackers (May 2, 2011) Recipes for Health: Olive Oil Crackers (May 4, 2011) Recipes for Health: Gluten-Free Rice and Millet Flour Crackers (May 5, 2011) Recipes for Health: Cheddar Cheese Crackers (May 6, 2011) 3/4 cup whole-wheat flour 1/2 cup unbleached all-purpose flour 1/2 cup buckwheat flour 2 tablespoons sesame seeds 1/2 teaspoon salt 5 tablespoons extra virgin olive oil or canola oil 4 to 5 tablespoons water, as needed 1. Preheat the oven to 350 degrees with the racks positioned inside in the middle and upper third. Line two baking sheets with parchment paper. Sift together the flours. 2. Mix together the flours, sesame seeds and salt in a mixing bowl, in the bowl of a stand mixer, or in a food processor fitted with a steel blade. If using a mixing bowl, add the oil and cut in with a fork until the mixture is crumbly. In a stand mixer, mix at medium speed; in a food processor, pulse until crumbly. Add the water, and mix with your hands (or at medium speed in a mixer or food processor) until you can gather the dough into a ball. 3. Lightly dust your work surface, and roll out the dough, or roll out between pieces of parchment, plastic or wax paper. Cut into desired shapes -- squares, diamonds or cookie-cutter shapes -- and place on the baking sheet, close together but not touching. 4. Bake 15 to 20 minutes until lightly browned, switching the sheet trays halfway through from front to back and top to middle. Remove from the heat, and allow to cool on racks. Yield: About four dozen crackers. Advance preparation: These will keep for about a week in an airtight container. Nutritional information per cracker: 30 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 1 gram monounsaturated fat; 0 milligrams cholesterol; 3 grams carbohydrates; 0 grams dietary fiber; 25 milligrams sodium; 1 gram protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Homemade Whole Grain Crackers Posted: 03 May 2011 01:00 PM PDT There are plenty of whole-grain crackers on store shelves, but none taste as good to me as those made at home. You can use a mix of grains and flours to make them, including gluten-free varieties like millet, buckwheat and rice flours, and top them with any number of seeds, herbs or spices. They’re quick to mix together and very easy to roll out. 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: Buckwheat Crackers With Sesame (May 3, 2011) Recipes for Health: Olive Oil Crackers (May 4, 2011) Recipes for Health: Gluten-Free Rice and Millet Flour Crackers (May 5, 2011) Recipes for Health: Cheddar Cheese Crackers (May 6, 2011) Crackers are a great destination for sesame seeds, an excellent source of copper and manganese, and high in lignans, a type of fiber that may help lower cholesterol. I sprinkle my crackers with everything from sesame seeds to za’atar, Parmesan and chili powder. I also like to use delicious black seeds known as both nigella and charnushka, which are used in Indian and Middle Eastern cuisines to flavor breads and other pastries. “Healthy” crackers can be hard and dry, but this week’s offerings are not. I use olive oil in all of them, and some work best with a small amount of butter. Sesame Crackers I’ve been making sesame crackers for decades, tweaking my recipe over the years. They have a wholesome, rich, nutty flavor. 1 1/4 cups whole-wheat flour 1/2 cup toasted sesame seeds 1/2 teaspoon salt 5 tablespoons extra virgin olive oil or sesame oil 4 to 5 tablespoons water, as needed 1. Preheat the oven to 350 degrees with the racks positioned in the middle and upper third. Line two baking sheets with parchment paper. 2. Mix together the flour, sesame seeds and salt in a mixing bowl, in the bowl of a stand mixer, or in a food processor fitted with a steel blade. If using a mixing bowl, add the oil and cut in with a fork. If using a stand mixer, mix at medium speed. In a food processor, pulse until the mixture is crumbly. Add the water, and mix with your hands, or at medium speed in a mixer or in the food processor, until you can gather the dough into a ball. 3. Lightly dust your work surface and roll out the dough, or roll out between pieces of parchment, plastic or wax paper. Cut into desired shapes -- squares, diamonds or cookie-cutter shapes -- and place on the baking sheet, close together but not touching. 4. Bake 15 to 20 minutes until lightly browned, switching the sheet trays front to back and top to middle halfway through. Remove from the heat, and allow to cool on racks. Yield: About four dozen crackers. Advance preparation: These will keep for about a week in an airtight container. Nutritional information per cracker: 33 calories; 0 grams saturated fat; 1 gram polyunsaturated fat; 1 gram monounsaturated fat; 0 milligrams cholesterol; 2 grams carbohydrates; 1 gram dietary fiber; 25 milligrams sodium; 1 gram protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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