Health - The Doctor’s World: 30 Years In,We Are Still Learning From AIDS

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• The Doctor’s World: 30 Years In,We Are Still Learning From AIDS
• Doctors Inc.: As Physicians’ Jobs Change, So Do Their Politics
• A Conversation With Ellen Bialystok: The Bilingual Advantage
• Recipes for Health: Seeds of Promise
• Vital Signs: Risks: Hypertension Lurking in Young Adults
• Vital Signs: Childbirth: Every Week in Utero Counts, Study Says
• Vital Signs: Patterns: Seniors Fare Better Where Doctors Are
• Changes in Oregon Law Put Faith-Healing Parents on Trial
• Outbreak of Infections Kills 10 in Germany
• Well: The Changing Politics of Doctors
• Personal Health: A Good Night’s Sleep Isn’t a Luxury; It’s a Necessity
• Really?: The Claim: A Diet High in Protein Is Bad for Your Kidneys
• Administration Opposes Challenges to Medicaid Cuts
• Recipes for Health: Cornmeal and Flax-Crusted Rockfish

The Doctor’s World: 30 Years In,We Are Still Learning From AIDS Posted: 30 May 2011 01:18 PM PDT At first it seemed an oddity: a scattering of reports in the spring and early summer of 1981 that young gay men in New York and California were ill with forms of pneumonia and cancer usually seen only in people with severely weakened immune systems. Multimedia In order to view this feature, you must download the latest version of flash player here. HIV@30: Revisiting ‘AIDS Doctors’ (thehivstoryproject.org) Enlarge This Image Neal Boenzi/The New York Times ADVOCACY A protest at New York's City Hall in 1985. In Council hearings on AIDS-related bills, gay residents said they had become victims of discrimination and hysteria. In hindsight, of course, these announcements were the first official harbingers of AIDS — the catastrophic pandemic that would infect more than 60 million people (and counting) worldwide, killing at least half that number. But at the time, we had little idea what we were dealing with — didn’t know that AIDS was a distinct disease, what caused it, how it could be contracted, or even what to call it. As AIDS has become entrenched in the United States and elsewhere, a new generation has grown up with little if any knowledge of those dark early days. But they are worth recalling, as a cautionary tale about the effects of the bafflement and fear that can surround an unknown disease and as a reminder of the sweeping changes in medical practice that the epidemic has brought about. Reports of the initial cases were confusing. The first federal announcement, 30 years ago this week, concerned “five young men, all active homosexuals,” with pneumocystis carinii pneumonia, or P.C.P., a disease “almost exclusively limited to severely immunosuppressed patients.” Initial suspicion fell on a known infectious agent, cytomegalovirus. A month later, on July 3, 1981, I wrote The New York Times’s first article about AIDS, this one headlined “Rare Cancer Seen in 41 Homosexuals.” (“Gay” had yet to be accepted by The Times’s style manual.) The cancer was Kaposi’s sarcoma, and until then it had seldom been seen in otherwise healthy young men. As it gradually became clear that the underlying illness was neither pneumonia nor cancer but a sexually transmitted disease that was profoundly damaging the immune system, experts argued their many theories about the cause. A popular one held that the impact of combinations of microbes overwhelmed the immune system. Other theoretical causes included sperm deposited in the bowel, or some chemical that would damage the immune system. It took three years to conclusively identify H.I.V., the virus that causes AIDS, and longer to settle disputed claims for the discovery. When doctors learned that it took about a decade to get sick from AIDS after H.I.V. first entered the body, they realized that people had been unwittingly transmitting the virus for years, spreading it to thousands of people in many countries, who in turn spread it to thousands and ultimately millions more. Epidemiologists quickly showed that H.I.V. could be transmitted through heterosexual sex; from infected women to their newborns; in transfusions of blood and blood products; and via contaminated needles. Patients and doctors feared the disease, often for different reasons. Many doctors, uncertain whether AIDS was an infectious disease, refused to do essential procedures on their patients; sometimes superiors had to order them to. And while most doctors did treat their patients professionally and compassionately, they did fear they might catch the disease because no one knew how it was communicated. A few health care workers were infected when they accidentally stuck themselves with contaminated needles. Compassionate care for the dying has always been a difficult issue for doctors of any age. But in the AIDS epidemic, many medical students and doctors in their 20s and 30s suddenly had to cope with dying patients their own age. Many senior medical school professors were ill prepared to advise them. For doctors, nurses, patients and anyone who might be deemed at risk, the anxiety was pervasive. Might the first coughs or sneezes from a common cold or some other respiratory infection actually be a sign of P.C.P.? Might a small skin blemish represent Kaposi’s sarcoma? Federal health officials and experts came up with a succession of names for the disease before they settled on acquired immune deficiency syndrome in 1982. (Some of the early efforts smacked of discrimination, like GRID, for gay-related immune deficiency.) But whatever it was called, it carried a bitter stigma. Some patients were shunned by friends and relatives. Customers avoided restaurants for fear that gay waiters would spread the virus. Some parents, fearing their children might catch AIDS from infected classmates, kept them out of school. Ryan White, a teenager with AIDS in Indiana, spoke up for all infected children and became a national hero before his death in 1990. His case also helped the medical profession address its obligation to care for all patients. Communications to the public often lacked clarity. Because health officials and journalists used the phrase “bodily fluids” instead of specifying semen, blood and vaginal secretions, many people feared they could contract AIDS from toilet seats or drinking fountains. AIDS appeared shortly after the eradication of smallpox, which had renewed declarations of the demise of infectious diseases. As a result, public health leaders were not well prepared to deal with a newly recognized deadly disease. A common attitude was that all diseases were known, and all that remained for scientists was to fill in the blanks. For example, a newly recognized condition like Legionnaires’ disease was really a form of pneumonia. Yet it did not seem to occur to many scientists that novel agents might also be at work — even though viruses like Ebola, Lassa and Marburg, which cause hemorrhagic fever, had been discovered in just the past decade or so. In covering the emerging AIDS epidemic along with developments like these, I tapped my training in infectious diseases and epidemiology. I joined my doctor friends in late-night telephone bull sessions to discuss the mysteries of AIDS. Some experts thought the agent must be a drug or chemical because no infectious agent fit. (The closest was hepatitis B, which became a model for research and precautions to protect people.) And some toxicologists used similar exclusionary reasoning to say no known drug or chemical could be responsible, so the cause must be an infectious agent. 1 2 Next Page »

Doctors Inc.: As Physicians’ Jobs Change, So Do Their Politics Posted: 30 May 2011 12:02 PM PDT AUGUSTA, Me. — With Republicans in complete control of Maine’s state government for the first time since 1962, State Senator Lois A. Snowe-Mello offered a bill in February to limit doctors’ liability that she was sure the powerful doctors’ lobby would cheer. Instead, it asked her to shelve the measure. Enlarge This Image Craig Dilger for The New York Times Gordon Smith of the Maine Medical Association, testifying, says he's “less comfortable” with Republican positions on health care. Shifting Priorities Articles in this series are examining recent shifts in medical care. Are You a Doctor? Share your insights on the changing medical profession with The New York Times and the Public Insight Network from American Public Media. Tell us your story. Well Share your thoughts on this column at the Well blog. Go to Well » “It was like a slap in the face,” said Ms. Snowe-Mello, who describes herself as a conservative Republican. “The doctors in this state are increasingly going left.” Doctors were once overwhelmingly male and usually owned their own practices. They generally favored lower taxes and regularly fought lawyers to restrict patient lawsuits. Ronald Reagan came to national political prominence in part by railing against “socialized medicine” on doctors’ behalf. But doctors are changing. They are abandoning their own practices and taking salaried jobs in hospitals, particularly in the North, but increasingly in the South as well. Half of all younger doctors are women, and that share is likely to grow. There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states. That change could have a profound effect on the nation’s health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama’s legislation last year because the new law would provide health insurance to the vast majority of the nation’s uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said. Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors’ groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products. Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs. “It was a comfortable fit 30 years ago representing physicians and being an active Republican,” said Gordon H. Smith, executive vice president of the Maine Medical Association. “The fit is considerably less comfortable today.” Mr. Smith, 59, should know. The child of a prominent Republican family, he canvassed for Barry Goldwater in 1964, led the state’s Youth for Nixon and College Republicans chapters, served on the Republican National Committee and proudly called himself a Reagan Republican — one reason he got the job in 1979 representing the state’s doctors’ group. But doctors in Maine have abandoned the ownership of practices en masse, and their politics and points of view have shifted dramatically. The Maine doctors’ group once opposed health insurance mandates because they increase costs to employers, but it now supports them, despite Republican opposition, because they help patients. Three years ago, Mr. Smith found himself leading an effort to preserve a beverage tax — a position anathema to his old allies at the Maine State Chamber of Commerce and the Republican Party but supported by doctors because it paid for a health program. The doctors lost by a wide margin, and the tax was overturned. Mr. Smith still goes to the State Capitol wearing gray suits, black wingtips and a gold name badge, but he increasingly finds himself among allies far more casually dressed, including the liberal Maine People’s Alliance and labor groups. And while he still greets old Republican friends — he is a lobbyist, after all — he spends much of his time strategizing with Democrats. Representative Sharon Anglin Treat, a powerful Democrat who was first elected in 1990, said that she and Mr. Smith were once bitter foes. “But Gordon’s become like a consumer activist,” she said with a big smile. “I’ve seen him more times in the last few years than I can count.” Dr. Nancy Cummings, a 51-year-old orthopedic surgeon in Farmington, is the kind of doctor who has changed Mr. Smith’s life. She trained at Harvard, but after her first son was born she began rethinking 18-hour workdays. “My husband used to drive my son to the hospital so that I could nurse him,” she said. “I decided that I really wanted to be a good surgeon, but also wanted to raise healthy, well-adjusted kids I would actually see.” 1 2 Next Page »

A Conversation With Ellen Bialystok: The Bilingual Advantage Posted: 30 May 2011 01:17 PM PDT A cognitive neuroscientist, Ellen Bialystok has spent almost 40 years learning about how bilingualism sharpens the mind. Her good news: Among other benefits, the regular use of two languages appears to delay the onset of Alzheimer’s disease symptoms. Dr. Bialystok, 62, a distinguished research professor of psychology at York University in Toronto, was awarded a $100,000 Killam Prize last year for her contributions to social science. We spoke for two hours in a Washington hotel room in February and again, more recently, by telephone. An edited version of the two conversations follows. Enlarge This Image Chris Young for The New York Times MENTAL WORKOUT Ellen Bialystok with a neuroimaging electrode cap. RSS Feed Get Science News From The New York Times » Q. How did you begin studying bilingualism? A. You know, I didn’t start trying to find out whether bilingualism was bad or good. I did my doctorate in psychology: on how children acquire language. When I finished graduate school, in 1976, there was a job shortage in Canada for Ph.D.’s. The only position I found was with a research project studying second language acquisition in school children. It wasn’t my area. But it was close enough. As a psychologist, I brought neuroscience questions to the study, like “How does the acquisition of a second language change thought?” It was these types of questions that naturally led to the bilingualism research. The way research works is, it takes you down a road. You then follow that road. Q. So what exactly did you find on this unexpected road? A. As we did our research, you could see there was a big difference in the way monolingual and bilingual children processed language. We found that if you gave 5- and 6-year-olds language problems to solve, monolingual and bilingual children knew, pretty much, the same amount of language. But on one question, there was a difference. We asked all the children if a certain illogical sentence was grammatically correct: “Apples grow on noses.” The monolingual children couldn’t answer. They’d say, “That’s silly” and they’d stall. But the bilingual children would say, in their own words, “It’s silly, but it’s grammatically correct.” The bilinguals, we found, manifested a cognitive system with the ability to attend to important information and ignore the less important. Q. How does this work — do you understand it? A. Yes. There’s a system in your brain, the executive control system. It’s a general manager. Its job is to keep you focused on what is relevant, while ignoring distractions. It’s what makes it possible for you to hold two different things in your mind at one time and switch between them. If you have two languages and you use them regularly, the way the brain’s networks work is that every time you speak, both languages pop up and the executive control system has to sort through everything and attend to what’s relevant in the moment. Therefore the bilinguals use that system more, and it’s that regular use that makes that system more efficient. Q. One of your most startling recent findings is that bilingualism helps forestall the symptoms of Alzheimer’s disease. How did you come to learn this? A. We did two kinds of studies. In the first, published in 2004, we found that normally aging bilinguals had better cognitive functioning than normally aging monolinguals. Bilingual older adults performed better than monolingual older adults on executive control tasks. That was very impressive because it didn’t have to be that way. It could have turned out that everybody just lost function equally as they got older. That evidence made us look at people who didn’t have normal cognitive function. In our next studies , we looked at the medical records of 400 Alzheimer’s patients. On average, the bilinguals showed Alzheimer’s symptoms five or six years later than those who spoke only one language. This didn’t mean that the bilinguals didn’t have Alzheimer’s. It meant that as the disease took root in their brains, they were able to continue functioning at a higher level. They could cope with the disease for longer. Q. So high school French is useful for something other than ordering a special meal in a restaurant? A. Sorry, no. You have to use both languages all the time. You won’t get the bilingual benefit from occasional use. Q. One would think bilingualism might help with multitasking — does it? A. Yes, multitasking is one of the things the executive control system handles. We wondered, “Are bilinguals better at multitasking?” So we put monolinguals and bilinguals into a driving simulator. Through headphones, we gave them extra tasks to do — as if they were driving and talking on cellphones. We then measured how much worse their driving got. Now, everybody’s driving got worse. But the bilinguals, their driving didn’t drop as much. Because adding on another task while trying to concentrate on a driving problem, that’s what bilingualism gives you — though I wouldn’t advise doing this. Q. Has the development of new neuroimaging technologies changed your work? A. Tremendously. It used to be that we could only see what parts of the brain lit up when our subjects performed different tasks. Now, with the new technologies, we can see how all the brain structures work in accord with each other. In terms of monolinguals and bilinguals, the big thing that we have found is that the connections are different. So we have monolinguals solving a problem, and they use X systems, but when bilinguals solve the same problem, they use others. One of the things we’ve seen is that on certain kinds of even nonverbal tests, bilingual people are faster. Why? Well, when we look in their brains through neuroimaging, it appears like they’re using a different kind of a network that might include language centers to solve a completely nonverbal problem. Their whole brain appears to rewire because of bilingualism. Q. Bilingualism used to be considered a negative thing — at least in the United States. Is it still? A. Until about the 1960s, the conventional wisdom was that bilingualism was a disadvantage. Some of this was xenophobia. Thanks to science, we now know that the opposite is true. Q. Many immigrants choose not to teach their children their native language. Is this a good thing? A. I’m asked about this all the time. People e-mail me and say, “I’m getting married to someone from another culture, what should we do with the children?” I always say, “You’re sitting on a potential gift.” There are two major reasons people should pass their heritage language onto children. First, it connects children to their ancestors. The second is my research: Bilingualism is good for you. It makes brains stronger. It is brain exercise. Q. Are you bilingual? A. Well, I have fully bilingual grandchildren because my daughter married a Frenchman. When my daughter announced her engagement to her French boyfriend, we were a little surprised. It’s always astonishing when your child announces she’s getting married. She said, “But Mom, it’ll be fine, our children will be bilingual!” This posting includes an audio/video/photo media file: Download Now

Recipes for Health: Seeds of Promise Posted: 30 May 2011 11:44 AM PDT A few years ago, we began to hear a lot about flax seeds. Rich in omega-3 fatty acids, these seeds also are loaded with vitamin E, B vitamins and certain important minerals (manganese, potassium, calcium, iron, magnesium, zinc and selenium). Impressed, I’d buy flax seeds from time to time and add them to breads, muffins or granola. But to be honest, I never much liked the taste. Recipes for Health Each week this series will present recipes around a particular type of produce or a pantry item. This is food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and a pleasure to eat. See previous recipes » Related Recipes for Health: Cornmeal and Flax-Crusted Rockfish (May 31, 2011) Recipes for Health: Flax and Mixed Grains Granola (June 1, 2011) Recipes for Health: Granola Bars With Chocolate (June 2, 2011) Recipes for Health: Raspberry Crumble (June 3, 2011) Then one day I sampled some toasted flax seeds sprinkled atop yogurt -- and that changed everything. Once toasted, they have a delicious nutty flavor similar to that of sesame seeds. I bought a bag of toasted flax seeds right away and spent a week experimenting with them in the kitchen. Flax seeds harder than sesame seeds, so it’s a good idea to grind them -- coarse or fine, depending on the recipe. That way, too, all the nutrition in flax seeds is more readily available to the body. Keep what you don’t use in the refrigerator or freezer, as the oils in flax seeds, like those in most nuts and seeds, will oxidize if not kept cold. Besides using them in this week’s recipes, you can add ground toasted flax seeds to yogurt, smoothies, granola and baked goods. You can sprinkle them on salads or mix them into salad dressings, or even stir them into mustard, mayonnaise or other sandwich spreads. Banana Almond Flax Smoothie This substantial smoothie is perfect following a high-energy workout. 1 medium or large banana, preferably frozen, sliced 2/3 cup buttermilk, yogurt or almond milk 1 tablespoon roasted unsalted almond butter 1 tablespoon flax seeds 1 teaspoon honey or agave nectar A couple of drops of almond extract or vanilla 1. Place all of the ingredients in a blender, along with a few ice cubes if the bananas have not been previously frozen. Blend until smooth. Yield: One serving. Advance preparation: This smoothie is best if served right away. Nutritional information per serving: 337 calories; 14 grams fat; 2 grams saturated fat; 2 grams polyunsaturated fat; 6 grams monounsaturated fat; 7 milligrams cholesterol; 47 grams carbohydrates; 7 grams dietary fiber; 175 milligrams sodium; 12 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Vital Signs: Risks: Hypertension Lurking in Young Adults Posted: 30 May 2011 12:15 PM PDT A new study finds that nearly one in five young adults has high blood pressure, a startling estimate much higher than any previously reported. Related More Vital Signs Columns Researchers at the University of North Carolina at Chapel Hill analyzed data on more than 14,000 adults, ages 24 to 32, who have been followed since 1995 in the National Longitudinal Study of Adolescent Health, known as Add Health. The researchers found that 19 percent of the young adults had blood pressure readings of 140/90 millimeters of mercury or higher, which is defined as high blood pressure. Only about one-quarter of them had been informed of their condition. Earlier estimates from the much smaller National Health and Nutrition Examination Survey had suggested a far lower number of young adults — just 4 percent — had hypertension. “We find it rather surprising, and we think the obesity epidemic is behind it,” said Kathleen Mullan Harris, principal investigator of Add Health and interim director of the U.N.C. Carolina Population Center, who is a co-author of the paper, published online on Wednesday in the journal Epidemiology. While the number could prove to be less than 19 percent in further testing, Dr. Harris said, “we really need to get the message out to young adults to get their blood pressure screened.”

Vital Signs: Childbirth: Every Week in Utero Counts, Study Says Posted: 30 May 2011 12:10 PM PDT Pregnancies lasting at least 37 weeks are regarded as safely full-term, but new research finds that babies born in the 37th or 38th week of pregnancy have a higher risk of dying before their first birthdays than those born after 39 weeks of gestation. Related More Vital Signs Columns The study, carried out by researchers at the National Institutes of Health, the Food and Drug Administration and the March of Dimes, analyzed data about more than 46 million infants born in the United States from 1995 to 2006. In that period, the proportion of infants born before 39 weeks of gestation increased to nearly one in three births from more than one in five. The new analysis, published online on May 23 in the journal Obstetrics & Gynecology, is among the first to examine differences between so-called early term births and later births. In 2006, infants born at 37 weeks were twice as likely to die in the first year of life, with 3.9 deaths per 1,000 births, as those born at 40 weeks, with 1.9 deaths per 1,000 births. “Women need to know that all ‘term’ pregnancies are not alike,” said Dr. Uma M. Reddy, the study’s lead author and a medical officer with the pregnancy and perinatology branch at the National Institute of Child Health and Human Development. “If the pregnancy is uncomplicated, babies should not be delivered before 39 weeks.”

Vital Signs: Patterns: Seniors Fare Better Where Doctors Are Posted: 30 May 2011 12:12 PM PDT Older adults who live in areas with high concentrations of primary care doctors are less likely than those in areas with fewer such doctors to be hospitalized for illnesses that can be managed outside a hospital, like asthma and diabetes, a new study has found. Related More Vital Signs Columns Seniors with greater access to primary care doctors also have lower death rates, the study authors reported. But the availability of these physicians did not correspond to lower medical costs, which were just as high in areas rich in primary care doctors, the study found. Researchers at the Dartmouth Institute for Health Policy and Clinical Practice analyzed the medical records and hospital claims of 5.1 million beneficiaries in traditional Medicare programs in 2007. In the areas with the highest concentrations of primary care doctors working full time in outpatient clinical settings, people 65 and older had death rates 5 percent lower than in areas with fewer primary care doctors. They were almost 10 percent less likely to be hospitalized in these areas for conditions that can be treated outside a hospital. Yet the researchers also found Medicare spending was slightly higher in these areas: $8,857 per beneficiary per year, compared with $8,769 in areas with fewer primary care doctors. The paper was published on Wednesday in The Journal of the American Medical Association.

Changes in Oregon Law Put Faith-Healing Parents on Trial Posted: 29 May 2011 11:23 PM PDT OREGON CITY, Ore. — At the Clackamas County courthouse here, Timothy and Rebecca Wyland sat next to each other — ramrod straight, their shoulders barely touching — as they watched images of their daughter flash on the screen. Enlarge This Image Randy L. Rasmussen/The Oregonian, via Associated Press Timothy Wyland, left, and his wife, Rebecca, center, face charges of criminal mistreatment of their ill baby daughter. At birth, the girl, Alayna, was a pink-cheeked bundle, but by 6 months, a growth the size of a baseball had consumed the left side of her face, pushing her eyeball out of its socket. The Wylands, members of the Followers of Christ Church, a faith-healing sect whose members shun medicine, would not take her to a doctor. “Timothy and Rebecca Wyland — they recognized that medical attention was mandated for this condition,” said Christine Landers, the state prosecutor who is trying the Wylands for first-degree criminal mistreatment, a felony that can carry a five-year prison term. “Instead, they anointed her with oils and laid down hands.”   Alayna was found to have a hemangioma, a benign tumor that may cause blindness if it grows around the eye. In June, half a dozen police officers and a caseworker took the infant from her parents and placed her in foster care for two months while she received treatment. She is now 17 months old. Mr. Wyland, 45, and Ms. Wyland, 24, are the most recent members of the Followers of Christ Church to face trial for not obtaining medical care for their children. The church first came under criticism in 1998 after the local news media reported that of the 78 children buried in the church’s graveyard, at least 21 could have survived if they had received medical attention. At the time, Clackamas County prosecutors said they were prevented from intervening by Oregon laws that gave legal protection to parents who refused because of their faith to seek medical care for their children. The next year, the state Legislature repealed this exemption. In 2008, the church was in the spotlight again when two of its young members died. One of them, Ava Worthington, 2, died of pneumonia. Her parents were the first Followers of Christ couple to be criminally charged under the changed state laws. Ava’s father, Carl Worthington, was sentenced to 60 days in prison. Three months later, Ava’s teenage uncle, Neil Beagley, died of complications resulting from a blocked urinary tract. His parents were tried and sentenced to 16 months in prison. Another Followers of Christ Church couple is scheduled to stand trial in September for the death of their son, who was born six weeks premature, weighing 3 pounds, 5 ounces. He was born at home and was never taken to the hospital. He lived just nine hours. Rita Swan, the co-founder of Children’s Healthcare is a Legal Duty, has been involved since the late 1990s in pushing for legislative change in Oregon. Ms. Swan’s son, Matthew, died of meningitis at 16 months because she and her husband, who were Christian Scientists, trusted religious practitioners to heal him. They left the church after their son’s death. “The parents are absolutely convinced that God is on their side,” Ms. Swan said. “Nevertheless, society should set forth the standard that children should be protected up until the age of 18. We just can’t let people do whatever they want in the name of religion.” But Dr. Douglas S. Diekema, a medical ethicist at Children’s Hospital in Seattle, says that more harm than good may have been done to Alayna Wyland when state caseworkers pulled her from her parents’ care. Dr. Diekema testified for the defense in the case against Neil Beagley’s parents. “For me, the real question is, could you not have done that without taking the child from the parents?” he said. “I think you could accomplish getting some of these kids treated by getting a home health nurse — and if you need a police officer there, that’s fine. But taking a child away from their parents for two months causes harm. People don’t understand that.” Nor would sending parents to jail change their preference for faith healing, Dr. Diekema said. The Followers of Christ Church was founded in Kansas in the early 1900s. In the 1940s, the church’s leader, the Rev. Walter White, moved his congregation to Oregon City, which at the time was a rural farming area. Since then, the city has grown up around the church, most of whose members live here, about a half an hour southeast of Portland, although there are also some in Idaho. The women in the congregation dress modestly, in long skirts, and they wear their hair long. On Friday morning, as lawyers for the state and the defense presented their opening statements, members of the church packed the small courtroom here. Among them was Mr. Worthington, whose daughter died three years ago. As the courthouse buzzed with activity, the cemetery outside of town where the church members are buried was deserted. The cemetery sits off a gravel road in a rural part of the county, about a mile from the highway, and is surrounded by a chain-link fence and marked with “No Trespassing” signs.  Along the fence are grave markers with the names of the dead, including children. Several are those of babies, some with grave markers adorned with flowers and engraved with toy trains and the words “My Little Angel.”

Outbreak of Infections Kills 10 in Germany Posted: 29 May 2011 10:10 PM PDT BERLIN — With 10 people dead of infection and 400 cases reported, the European Center for Disease Prevention and Control said Sunday that a bacterial outbreak in northern Germany was one of the largest of its kind ever reported worldwide. The infection, from a strain of Escherichia coli, can lead to kidney failure and death and is difficult to treat with antibiotics, according to the Robert Koch Institute, which is Germany’s disease control authority. Fifteen other cases have been identified in Britain, Denmark, the Netherlands and Sweden. The patients are German or had visited northern Germany. Agriculture ministers from the European Union are scheduled to discuss the issue Monday when they meet in Debrecen, Hungary. Food safety officials in Austria and the Czech Republic said Sunday that small numbers of vegetables that had come from Germany were being pulled off the shelves there, The Associated Press reported. The Czechs said cucumbers from a contaminated shipment had also gone to Hungary and Luxembourg. The infections came from eating raw tomatoes, cucumbers and lettuce that were bought in northern Germany. The symptoms include bloody diarrhea and stomach cramps. In most cases, patients recover after about eight days. Scientists at the Institute for Hygiene and Environment in Hamburg, northern Germany’s major port city and one of Europe’s largest cargo terminals, suggested that the bacteria could have come from Spain. The Hamburg health minister, Cornelia Prüfer, said three out of four cucumbers carrying the strain of the bacteria were from a shipment from Spain that had been sold in supermarkets in Hamburg. The Robert Koch Institute issued a warning against eating such vegetables. “As long as the experts in Germany and Spain have not found the definitive source of the bacteria, we have to stick with our warnings against raw vegetables,” the federal consumer protection minister, Ilse Aigner, said Sunday in an interview with Bild am Sonntag. The European disease center, however, said an alternative food item could be the carrier of the infection. “The definite source of the infection remains to be confirmed,” it said. There have been no reported cases of infection in Spain. The bacterium in question, Shiga toxin-producing Escherichia coli, or STEC, can cause severe enteric and systemic disease in humans, including hemolytic uremic syndrome, or HUS, which can lead to kidney failure or death. “To date, this outbreak is one of the largest described outbreaks of STEC/HUS worldwide and the largest ever reported in Germany,” said the European disease center, which is based in Stockholm. The infection usually occurs through contaminated food or water, unwashed vegetables and contact with animals. Person-to-person transmission is also possible through the close contact that can occur within families, child care centers and nursing homes, according to the Koch Institute. The European disease center said milder E. coli outbreaks had been linked to unpasteurized milk and cheese and undercooked beef as well as a variety of fresh produce, including sprouts, spinach and lettuce. The first cases in the latest outbreak were reported three weeks ago in Hamburg. On Friday, the European Commission said that two Spanish farms in Málaga and Almería had been shut down after German experts identified Spanish cucumbers as the source of the E. coli bacteria. The Spanish authorities denied over the weekend that the two farms had been closed temporarily. The regional health ministry in Andalusia said that water, soil and cucumber samples from the farms were being analyzed. The produce continues to be exported. This posting includes an audio/video/photo media file: Download Now

Well: The Changing Politics of Doctors Posted: 30 May 2011 07:49 AM PDT

Personal Health: A Good Night’s Sleep Isn’t a Luxury; It’s a Necessity Posted: 30 May 2011 12:38 PM PDT In my younger years, I regarded sleep as a necessary evil, nature’s way of thwarting my desire to cram as many activities into a 24-hour day as possible. I frequently flew the red-eye from California, for instance, sailing (or so I thought) through the next day on less than four hours of uncomfortable sleep. Enlarge This Image Yvetta Fedorova Related More Personal Health Columns But my neglect was costing me in ways that I did not fully appreciate. My husband called our nights at the ballet and theater “Jane’s most expensive naps.” Eventually we relinquished our subscriptions. Driving, too, was dicey: twice I fell asleep at the wheel, narrowly avoiding disaster. I realize now that I was living in a state of chronic sleep deprivation. I don’t want to nod off during cultural events, and I no longer have my husband to spell me at the wheel. I also don’t want to compromise my ability to think and react. As research cited recently in this newspaper’s magazine found, “The sleep-deprived among us are lousy judges of our own sleep needs. We are not nearly as sharp as we think we are.” Studies have shown that people function best after seven to eight hours of sleep, so I now aim for a solid seven hours, the amount associated with the lowest mortality rate. Yet on most nights something seems to interfere, keeping me up later than my intended lights-out at 10 p.m. — an essential household task, an e-mail requiring an urgent and thoughtful response, a condolence letter I never found time to write during the day, a long article that I must read. It’s always something. What’s Keeping Us Up? I know I’m hardly alone. Between 1960 and 2010, the average night’s sleep for adults in the United States dropped to six and a half hours from more than eight. Some experts predict a continuing decline, thanks to distractions like e-mail, instant and text messaging, and online shopping. Age can have a detrimental effect on sleep. In a 2005 national telephone survey of 1,003 adults ages 50 and older, the Gallup Organization found that a mere third of older adults got a good night’s sleep every day, fewer than half slept more than seven hours, and one-fifth slept less than six hours a night. With advancing age, natural changes in sleep quality occur. People may take longer to fall asleep, and they tend to get sleepy earlier in the evening and to awaken earlier in the morning. More time is spent in the lighter stages of sleep and less in restorative deep sleep. R.E.M. sleep, during which the mind processes emotions and memories and relieves stress, also declines with age. Habits that ruin sleep often accompany aging: less physical activity, less time spent outdoors (sunlight is the body’s main regulator of sleepiness and wakefulness), poorer attention to diet, taking medications that can disrupt sleep, caring for a chronically ill spouse, having a partner who snores. Some use alcohol in hopes of inducing sleep; in fact, it disrupts sleep. Add to this list a host of sleep-robbing health issues, like painful arthritis, diabetes, depression, anxiety, sleep apnea, hot flashes in women and prostate enlargement in men. In the last years of his life, my husband was plagued with restless leg syndrome, forcing him to get up and walk around in the middle of the night until the symptoms subsided. During a recent night, I was awake for hours with leg cramps that simply wouldn’t quit. Beauty Rest and Beyond A good night’s sleep is much more than a luxury. Its benefits include improvements in concentration, short-term memory, productivity, mood, sensitivity to pain and immune function. If you care about how you look, more sleep can even make you appear more attractive. In a study published online in December in the journal BMJ, researchers in Sweden and the Netherlands reported that 23 sleep-deprived adults seemed to untrained observers to be less healthy, more tired and less attractive than they appeared to be after a full night’s sleep. Perhaps more important, losing sleep may make you fat — or at least, fatter than you would otherwise be. In a study by Harvard researchers involving 68,000 middle-aged women followed for 16 years, those who slept five hours or less each night were found to weigh 5.4 pounds more — and were 15 percent more likely to become obese — than the women who slept seven hours nightly. Michael Breus, a clinical psychologist and sleep specialist in Scottsdale, Ariz., and author of “The Sleep Doctor’s Diet Plan,” points out that as the average length of sleep has declined in the United States, the average weight of Americans has increased. There are plausible reasons to think this is a cause-and-effect relationship. At least two factors may be involved: more waking hours in homes brimming with food and snacks; and possible changes in the hormones leptin and ghrelin, which regulate appetite. In a study published in 2009 in The American Journal of Clinical Nutrition, Dr. Plamen D. Penev, an endocrinologist at the University of Chicago, and co-authors explored calorie consumption and expenditure by 11 healthy volunteers who spent two 14-day stays in a sleep laboratory. Both sessions offered unlimited access to tasty foods. During one stay, the volunteers — five women and six men — were limited to 5.5 hours of sleep a night, and during the other they got 8.5 hours of sleep. Although the subjects ate the same amount of food at meals, during the shortened nights they consumed an average of 221 more calories from snacks than they did when they were getting more sleep. The snacks they ate tended to be high in carbohydrates, and the subjects expended no more energy than they did on the longer nights. In just two weeks, the extra nighttime snacking could add nearly a pound to body weight, the scientists concluded. These researchers found no significant changes in the participants’ blood levels of the hormones leptin and ghrelin, but others have found that short sleepers have lower levels of appetite-suppressing leptin and higher levels of ghrelin, which prompts an increase in calorie intake. Sleep loss may also affect the function of a group of neurons in the hypothalamus of the brain, where another hormone, orexin, is involved in the regulation of feeding behavior. The bottom line: Resist the temptation to squeeze one more thing into the end of your day. If health problems disrupt your sleep, seek treatment that can lessen their effect. If you have trouble falling asleep or often awaken during the night and can’t get back to sleep, you could try taking supplements of melatonin, the body’s natural sleep inducer. I keep it at my bedside. If you have trouble sleeping, the tips accompanying this article may help. And if all else fails, try to take a nap during the day. Naps can enhance brain function, energy, mood and productivity. This is the second of two columns on sleep needs.

Really?: The Claim: A Diet High in Protein Is Bad for Your Kidneys Posted: 30 May 2011 12:44 PM PDT THE FACTS Christoph Niemann Related More Really? Columns Anyone who has tried a high-protein diet has probably heard this warning: You may lose weight, but you risk kidney damage. The idea is that processing large amounts of protein strains your kidneys, which filter blood and remove waste. But there is little research backing that assertion. In one study, in The International Journal of Sport Nutrition and Exercise Metabolism, researchers recruited bodybuilders and other athletes, then examined their kidney function over seven days as they followed high- and medium-protein diets. The researchers found that every marker of kidney function was within the normal range in all of the athletes who consumed large amounts of protein. In a much larger study, published in The Annals of Internal Medicine, researchers looked at protein intake in 1,624 women over an 11-year period. They found that high-protein diets did not cause any problems in women with normal kidney function. But in women who had “mild renal insufficiency,” they wrote, consuming large amounts of protein accelerated renal decline. University of Connecticut researchers reached a similar conclusion when they reviewed years of research on the subject in a 2005 report in the journal Nutrition & Metabolism. For those considering such a diet, a physical and a kidney function test can reveal any underlying problems. THE BOTTOM LINE Studies show that in healthy adults, increased protein intake does not put excess strain on the kidneys. ANAHAD O’CONNOR scitimes@nytimes.com

Administration Opposes Challenges to Medicaid Cuts Posted: 28 May 2011 11:40 PM PDT WASHINGTON — Medicaid recipients and health care providers cannot sue state officials to challenge cuts in Medicaid payments, even if such cuts compromise access to health care for poor people, the Obama administration has told the Supreme Court. Dennis Cook/Associated Press Neal K. Katyal, the acting solicitor general, filed a brief with the Supreme Court. States around the country, faced with severe budget problems, have been reducing Medicaid rates for doctors, dentists, hospitals, pharmacies, nursing homes and other providers. Federal law says Medicaid rates must be “sufficient to enlist enough providers” so that Medicaid recipients have access to care to the same extent as the general population in an area. In a friend-of-the court brief filed Thursday in the Supreme Court, the Justice Department said that no federal law allowed private individuals to sue states to enforce this standard. Such lawsuits “would not be compatible” with the means of enforcement envisioned by Congress, which relies on the secretary of health and human services to make sure states comply, the administration said in the brief, by the acting solicitor general, Neal K. Katyal. In many parts of the country, payment rates are so low that Medicaid recipients have difficulty finding doctors to take them. But, the Justice Department said, the Medicaid law’s promise of equal access to care is “broad and nonspecific,” and federal health officials are better equipped than judges to balance that goal with other policy objectives, like holding down costs. The administration expressed its views in a set of cases consolidated under the name Douglas v. Independent Living Center of Southern California, No. 09-958. In 2008 and 2009, the California Legislature passed several laws reducing Medicaid payment rates. Recipients and providers challenged the cuts in court, arguing that the California plan violated — and was pre-empted by — the federal Medicaid statute. The law does not explicitly allow such lawsuits. But the United States Court of Appeals for the Ninth Circuit, in San Francisco, said beneficiaries and providers could sue under the supremacy clause of the Constitution, which makes federal law “the supreme law of the land.” In reducing payment rates, the appeals court said, California violated the requirements of federal Medicaid law and threatened access to “much-needed medical care.” California appealed to the Supreme Court, which is likely to hear oral arguments in the fall, with a decision by next spring. Consumer advocates were dismayed by the administration’s position, which they said undermined Medicaid recipients’ rights and access to the courts. “I find it appalling that the solicitor general in a Democratic administration would assert in a Supreme Court brief that businesses can challenge state regulation under the supremacy clause, but that poor recipients of Medicaid cannot challenge state violations of federal law,” said Prof. Timothy S. Jost, an expert on health law at Washington and Lee University, who is usually sympathetic to the administration. Representative Henry A. Waxman of California, the senior Democrat on the Energy and Commerce Committee and an architect of Medicaid, said the administration’s brief was “wrong on the law and bad policy.” “I am bitterly disappointed that President Obama would accept the position of the acting solicitor general to file a brief that is contrary to the decades-long practice of giving Medicaid beneficiaries and providers the ability to turn to the courts to enforce their rights under federal law,” Mr. Waxman said. He said that he and other Democratic lawmakers planned to file a brief opposing the administration’s view. By contrast, many state officials agree with California and the Obama administration. The National Governors Association and the National Conference of State Legislatures filed a friend-of-the-court brief endorsing California’s position that Medicaid recipients and providers could not sue. In a separate friend-of-the-court brief, Michigan and 30 other states went further. “Allowing ‘supremacy clause lawsuits’ to enforce federal Medicaid laws will be a financial catastrophe for states,” they said. Medicaid is financed jointly by the federal government and the states. The number of recipients and the costs increased sharply in the recent recession and will increase further with the expected addition of 16 million people to the rolls under the new federal health care law.

Recipes for Health: Cornmeal and Flax-Crusted Rockfish Posted: 30 May 2011 11:13 AM PDT Fish will not absorb much of the oil in which it is fried if the oil is properly heated. These crisp fillets are a great way to work flax seeds, toasted or not, into a main dish. Recipes for Health Each week this series will present recipes around a particular type of produce or a pantry item. This is food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and a pleasure to eat. See previous recipes » Related Recipes for Health: Seeds of Promise (May 30, 2011) 1 1/2 pounds rockfish (such as snapper or cod) fillets Salt and freshly ground pepper 1/4 cup fine cornmeal (if you only have polenta or coarse cornmeal, you can grind it to a fine powder in a spice mill) 1/4 cup flax seeds, untoasted or toasted, coarsely ground 1/4 cup all-purpose flour or rice flour 2 eggs, beaten 1/2 teaspoon freshly ground pepper 2 to 4 tablespoons canola oil Lemon wedges for serving 1. Heat a large, heavy cast iron skillet over medium high heat (unless you’re planning to cook the fish later). 2. Pat the fish fillets dry, and season with salt and pepper. In a wide bowl, mix together the cornmeal, flax seeds, and salt and pepper to taste. 3. Place the flour on a plate or in a baking dish. Beat the eggs in a wide bowl. Dredge the fillets first in the flour -- tap them to remove excess flour -- then in the egg, then in the cornmeal-flax mixture. If not cooking right away, place the fish on a baking sheet, uncovered, in the refrigerator. 4. Add 2 tablespoons canola oil to the hot pan. When it is rippling, carefully add as many fillets as will fit your pan. Cook four to five minutes on each side (depending on the thickness of the fillets) or until nicely browned. Remove from the pan, and keep warm in a low oven while you repeat with the remaining fish and oil, as necessary. Serve hot, with lemon wedges. Yield: Serves four. Advance preparation: You can prepare this through Step 3 several hours before cooking the fish. Nutritional information per serving (based on 2 tablespoons oil): 364 calories; 2 grams saturated fat; 4 grams polyunsaturated fat; 7 grams monounsaturated fat; 153 milligrams cholesterol; 16 grams carbohydrates; 3 grams dietary fiber; 138 milligrams sodium (does not include salt to taste); 39 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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