Health - Ready to Swim 103 Miles With the Sharks

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• Ready to Swim 103 Miles With the Sharks
• Consults: Expert Answers on Macular Degeneration
• Radiation-Tainted Beef Spreads Through Japan’s Markets
• Findings: Can a Playground Be Too Safe?
• Heart Warning Added to Label on Popular Antipsychotic Drug
• News Analysis: Add Patience to a Leap of Faith to Discover Cancer Signatures
• Personal Best: For Runners, Soft Ground Can Be Hard on the Body
• The Consumer: A Vaccine May Shield Boys Too
• Patient Voices: Adapting as Vision and Independence Ebb
• Global Update: Epidemiology: In Losing Its Southern States to Secession, Sudan Also Sheds Its Guinea Worm Cases
• Recipes for Health: Tomato-Cucumber Soup With Basil
• Vital Signs: Patterns: Faster Treatment for the Married Man
• Vital Signs: Exercise: Limits in Heart Screenings for Youths
• Vital Signs: Hazards: Secondhand Smoke May Affect Hearing
• Well: Gardasil for Daughters and Sons?
• Well: The Nagging Effect: Better Health for Married Men
• Well: Giving Chronic Pain a Medical Platform of Its Own
• Well: Swimming With Sharks, at 61
• Well: A Running Debate: Dirt Trails or Pavement?
• Personal Health: Still Counting Calories? Your Weight-Loss Plan May Be Outdated
• Well: The Claim: Allergies Reduce the Risk of Cancer
• The New Old Age: A Guided Tour of the Past
• Letters: To Vaccinate or Not (1 Letter)
• Letters: A Cheaper Solution (1 Letter)
• Where Families Are Prized, Help Is Free
• Marijuana for Patients Remains Off-Limits
• Coming Together to Fight for a Troubled Veteran
• Unboxed: Seeing Promise and Peril in Digital Records
• Marijuana May Be Studied for Combat Disorder
• New Diabetes Drug Faces a Critical Review Before an F.D.A. Advisory Panel
• Opinion: Patrolling Cancer’s Borderlands
• Recipes for Health: Chilled Yogurt Soup With Spinach and Chickpeas
• Recipes for Health: Chilled Summer Soups

Ready to Swim 103 Miles With the Sharks Posted: 19 Jul 2011 08:28 AM PDT KEY WEST, Fla. — Any day now, Diana Nyad will set out to do something no athlete has ever done: swim all day and all night, then all day and all night, then all day again. Multimedia Slide Show Swimming With the Sharks She will swim about 60 hours in the churning sea, 103 miles across the Straits of Florida from Cuba to Key West. Every hour and a half, she will stop to tread water for a few minutes as she swallows a liquid mixture of predigested protein and eats an occasional bit of banana or dollop of peanut butter. She will most likely hallucinate and endure the stings of countless jellyfish. Along the way, sea salt will swell her tongue to cartoonish proportions and rub her skin raw. “She is up against the most outlandish, outrageous, unbelievable physical endurance activity of, certainly, my lifetime,” said Steven Munatones, a champion open-water swimmer who runs the organization Open Water Source and will serve as an independent observer during Ms. Nyad’s swim. “I can’t imagine being in the ocean for 60 hours. I can’t imagine doing anything for 60 hours. It is inconceivable. It simply is.” “Especially,” he added, “at her age.” Her age is 61. Ms. Nyad attempted this swim once before, unsuccessfully, in 1978 at the age of 28. She swam inside a shark cage for 41 hours 49 minutes until the raucous weather and powerful current pushed her far off course and she was forced to give up. She had traveled only 50 miles. (One year later, she swam 102 miles from Bimini, in the Bahamas, to Jupiter, Fla., without a shark cage. She still holds the record for the world’s longest ocean swim.) This time, armed with better technology and a battered but tough body, she is certain she will make it. “Physically, I am much stronger than I was before, although I was faster in my 20s,” said Ms. Nyad, who looks sturdy enough to defy a linebacker. “I feel strong, powerful, and endurance-wise, I’m fit.” Dr. Michael J. Joyner, a professor of anesthesiology and exercise research at the Mayo Clinic, agrees that older athletes, particularly superb ones, do well in endurance sports, because experience and training can offset the need for speed. At 52, Jeannie Longo still ranks as a top competitive cyclist. Gordie Howe played hockey into his 50s, and Jack LaLanne was 60 when he swam from Alcatraz Island to Fisherman’s Wharf, in San Francisco, for a second time, handcuffed, shackled and towing a 1,000-pound boat. Swimming is particularly technique-driven, which will help Ms. Nyad tremendously. “There are a ton of examples of people in their late 50s and early 60s doing all sorts of wild things,” Dr. Joyner said. “If the logistics work out, barring bad storms or currents, it is doable. It’s not a sure thing. But it wouldn’t be a sure thing if it were Michael Phelps.” If Ms. Nyad makes it from Cuba to Key West, she will be the first person to have done so without a shark cage. In 1997, an Australian woman completed the swim inside a shark cage. But with a boat pulling the cage, the swim is easier and faster; the woman completed it in less than 24 hours. “I’m in uncharted territory,” Ms. Nyad said. This time around, Ms. Nyad, an accomplished marathon swimmer and sportscaster, is taking no chances. She has trained harder — for a year and a half — and changed her regimen. Rather than swim every day, she swims every other day. Last year, she completed a 24-hour swim in Mexico. To help her succeed, she has organized an armada of people — 22 in all — to serve as her support team. All of them will travel to Cuba, visas in hand, and will try to arrive within three days of her swim. (An effort last year was called off because of visa difficulties.) “That’s the part that really interests me about Diana,” Mr. Munatones said. “It’s not just the swimming part. There are people who can swim this. But they don’t have the organizational, political and passionate oratorical skills she has.” She also has technology on her side: satellites, global positioning systems, advanced navigation software, even shark shields, none of which were available in 1978. The cost for all this is $500,000. She has raised money and depleted her own bank account, but she is still $150,000 short. Ms. Nyad, a commentator for the Los Angeles-based public radio station KCRW, shrugs it off. “If I wind up $150,000 in debt, I won’t lose sleep over it,” she said. At the moment, four experts are looking seven days ahead to pinpoint the ideal weather for her to travel to Cuba and wade into the ocean: a satellite oceanographer and meteorologist trained in the vagaries of the Gulf Stream; another meteorologist who works for CNN; and two officials at NOAA, the National Oceanic and Atmospheric Administration. They are all hoping for the beginning of a low-pressure system that could create the doldrums, a waveless sea, for a few days. 1 2 Next Page »

Consults: Expert Answers on Macular Degeneration Posted: 19 Jul 2011 10:22 AM PDT

Radiation-Tainted Beef Spreads Through Japan’s Markets Posted: 18 Jul 2011 10:02 PM PDT MINAMISOMA, Japan — Even after explosions rocked the Fukushima Daiichi nuclear power plant, Kuniaki Sato, who raises cattle here about 20 miles from the crippled complex, said he had received no clear warning from the government about the possible dangers of radiation to his herd. Related Japan Operator Shutting Down Nuclear Reactor After Malfunction (July 16, 2011) Times Topic: Japan â€" Earthquake, Tsunami and Nuclear Crisis (2011) Enlarge This Image The New York Times Beef from the tainted area has been sent across Japan. So six weeks after the accident, on April 23, he shipped 12 of his prized cattle from his farm to market. Now Japanese agricultural officials say meat from more than 500 cattle that were likely to have been contaminated with radioactive cesium has made its way to supermarkets and restaurants across Japan in recent weeks. Officials say the cattle ate hay that had been stored outside and exposed to radiation. “I was a little worried, but we had to sell when we could,” said Mr. Sato, whose cattle were not fed hay and so were unlikely to have been contaminated. When a precautionary order to halt all farm shipments was lifted soon after the accident, area farmers took it as a go-ahead sign, he said. “We all resumed shipments,” he said. “Of course we did.” The revelations by the government this month that contaminated meat reached Japanese markets have intensified food safety concerns in Japan, underscoring the government’s inability to control the spread of radioactive material into the nation’s food. Radioactive material has been detected in a range of produce, including spinach, tea leaves, milk and fish. Contaminated hay has been found at farms more than 85 miles from the crippled Fukushima Daiichi plant, suggesting that the radioactive fallout has reached a wider area than first suspected. Still, because of a severe shortage of testing equipment, and local governments that are still swamped with disaster relief, only a small percentage of farm products grown in the region get checked for radiation. The government has suspended agricultural shipments from within a radius of about 12 miles around the Fukushima plant, as well as a number of other identified radiation “hot spots.” But farms outside those areas, even those relatively close to the plant, have faced few restrictions in shipping their produce. For months the government balked at placing a wider ban on produce from the Fukushima region despite sporadic discoveries of contaminated produce, for fear of bringing fresh confusion in the disaster-stricken area, putting thousands more people out of work and adding to growing compensation claims for Tokyo Electric Power, which operates the Fukushima plant. Now, with the number of contamination cases rising, the government is finally moving to ban beef shipments from Fukushima Prefecture, an area of 5,300 square miles, slightly smaller than Connecticut. Yukio Edano, the chief cabinet secretary, said Tuesday that the government was in the “final stages” of coordinating such a ban and an announcement could come later that day. Fukushima Prefecture has also said it issued instructions in late March warning farmers to make sure hay was stored indoors, to prevent possible contamination from rain. But many farmers said they were not aware of such a directive. Cattle from some areas with high radiation readings, including here in Minamisoma, a city in Fukushima Prefecture, had been checked for radiation on the surface of their skins before being shipped to market. But those checks do not sufficiently measure whether cattle have been exposed to radiation internally by eating contaminated feed, officials say. Fukushima government officials said they were starting inspections of all 4,000 or so cattle farms in the prefecture to make sure that none of them was using radioactive hay. Meanwhile, ranchers have been asked to comply with a new voluntary shipment ban. This month, officials testing hay fed to cattle at a ranch in Minamisoma detected radioactive cesium 250 times above Japan’s official limit. Beef from that farm contained almost five times the official limit. Officials suspect that the hay was stored outside and became tainted with rainwater, which can carry radioactive elements in the atmosphere as it falls. Though hay is not usually fed to cattle here, a feed-supply shortage after the March 11 quake and tsunami forced some farms to substitute it for other food. Some farmers in the region say that they welcome tougher checks, and that cattle can still be shipped from Fukushima if precautions are taken against radiation exposure. 1 2 Next Page » Max Hodges contributed research.

Findings: Can a Playground Be Too Safe? Posted: 18 Jul 2011 09:20 PM PDT When seesaws and tall slides and other perils were disappearing from New York’s playgrounds, Henry Stern drew a line in the sandbox. As the city’s parks commissioner in the 1990s, he issued an edict concerning the 10-foot-high jungle gym near his childhood home in northern Manhattan. Related More Findings Columns RSS Feed Get Science News From The New York Times » Enlarge This Image Barton Silverman/The New York Times LIVE AND LEARN A bad fall may mean a child is less likely to have a fear of heights later in life. “I grew up on the monkey bars in Fort Tryon Park, and I never forgot how good it felt to get to the top of them,” Mr. Stern said. “I didn’t want to see that playground bowdlerized. I said that as long as I was parks commissioner, those monkey bars were going to stay.” His philosophy seemed reactionary at the time, but today it’s shared by some researchers who question the value of safety-first playgrounds. Even if children do suffer fewer physical injuries — and the evidence for that is debatable — the critics say that these playgrounds may stunt emotional development, leaving children with anxieties and fears that are ultimately worse than a broken bone. “Children need to encounter risks and overcome fears on the playground,” said Ellen Sandseter, a professor of psychology at Queen Maud University in Norway. “I think monkey bars and tall slides are great. As playgrounds become more and more boring, these are some of the few features that still can give children thrilling experiences with heights and high speed.” After observing children on playgrounds in Norway, England and Australia, Dr. Sandseter identified six categories of risky play: exploring heights, experiencing high speed, handling dangerous tools, being near dangerous elements (like water or fire), rough-and-tumble play (like wrestling), and wandering alone away from adult supervision. The most common is climbing heights. “Climbing equipment needs to be high enough, or else it will be too boring in the long run,” Dr. Sandseter said. “Children approach thrills and risks in a progressive manner, and very few children would try to climb to the highest point for the first time they climb. The best thing is to let children encounter these challenges from an early age, and they will then progressively learn to master them through their play over the years.” Sometimes, of course, their mastery fails, and falls are the common form of playground injury. But these rarely cause permanent damage, either physically or emotionally. While some psychologists — and many parents — have worried that a child who suffered a bad fall would develop a fear of heights, studies have shown the opposite pattern: A child who’s hurt in a fall before the age of 9 is less likely as a teenager to have a fear of heights. By gradually exposing themselves to more and more dangers on the playground, children are using the same habituation techniques developed by therapists to help adults conquer phobias, according to Dr. Sandseter and a fellow psychologist, Leif Kennair, of the Norwegian University for Science and Technology. “Risky play mirrors effective cognitive behavioral therapy of anxiety,” they write in the journal Evolutionary Psychology, concluding that this “anti-phobic effect” helps explain the evolution of children’s fondness for thrill-seeking. While a youthful zest for exploring heights might not seem adaptive — why would natural selection favor children who risk death before they have a chance to reproduce? — the dangers seemed to be outweighed by the benefits of conquering fear and developing a sense of mastery. “Paradoxically,” the psychologists write, “we posit that our fear of children being harmed by mostly harmless injuries may result in more fearful children and increased levels of psychopathology.” The old tall jungle gyms and slides disappeared from most American playgrounds across the country in recent decades because of parental concerns, federal guidelines, new safety standards set by manufacturers and — the most frequently cited factor — fear of lawsuits. Shorter equipment with enclosed platforms was introduced, and the old pavement was replaced with rubber, wood chips or other materials designed for softer landings. These innovations undoubtedly prevented some injuries, but some experts question their overall value. “There is no clear evidence that playground safety measures have lowered the average risk on playgrounds,” said David Ball, a professor of risk management at Middlesex University in London. He noted that the risk of some injuries, like long fractures of the arm, actually increased after the introduction of softer surfaces on playgrounds in Britain and Australia. “This sounds counterintuitive, but it shouldn’t, because it is a common phenomenon,” Dr. Ball said. “If children and parents believe they are in an environment which is safer than it actually is, they will take more risks. An argument against softer surfacing is that children think it is safe, but because they don’t understand its properties, they overrate its performance.” Reducing the height of playground equipment may help toddlers, but it can produce unintended consequences among bigger children. “Older children are discouraged from taking healthy exercise on playgrounds because they have been designed with the safety of the very young in mind,” Dr. Ball said. “Therefore, they may play in more dangerous places, or not at all.” Fear of litigation led New York City officials to remove seesaws, merry-go-rounds and the ropes that young Tarzans used to swing from one platform to another. Letting children swing on tires became taboo because of fears that the heavy swings could bang into a child. “What happens in America is defined by tort lawyers, and unfortunately that limits some of the adventure playgrounds,” said Adrian Benepe, the current parks commissioner. But while he misses the Tarzan ropes, he’s glad that the litigation rate has declined, and he’s not nostalgic for asphalt pavement. “I think safety surfaces are a godsend,” he said. “I suspect that parents who have to deal with concussions and broken arms wouldn’t agree that playgrounds have become too safe.” The ultra-safe enclosed platforms of the 1980s and 1990s may have been an overreaction, Mr. Benepe said, but lately there have been more creative alternatives. “The good news is that manufacturers have brought out new versions of the old toys,” he said. “Because of height limitations, no one’s building the old monkey bars anymore, but kids can go up smaller climbing walls and rope nets and artificial rocks.” Still, sometimes there’s nothing quite like being 10 feet off the ground, as a new generation was discovering the other afternoon at Fort Tryon Park. A soft rubber surface carpeted the pavement, but the jungle gym of Mr. Stern’s youth was still there. It was the prime destination for many children, including those who’d never seen one before, like Nayelis Serrano, a 10-year-old from the South Bronx who was visiting her cousin. When she got halfway up, at the third level of bars, she paused, as if that was high enough. Then, after a consultation with her mother, she continued to the top, the fifth level, and descended to recount her triumph. “I was scared at first,” she explained. “But my mother said if you don’t try, you’ll never know if you could do it. So I took a chance and kept going. At the top I felt very proud.” As she headed back for another climb, her mother, Orkidia Rojas, looked on from a bench and considered the pros and cons of this unfamiliar equipment. “It’s fun,” she said. “I’d like to see it in our playground. Why not? It’s kind of dangerous, I know, but if you just think about danger you’re never going to get ahead in life.” This posting includes an audio/video/photo media file: Download Now

Heart Warning Added to Label on Popular Antipsychotic Drug Posted: 19 Jul 2011 08:44 AM PDT AstraZeneca is adding a new heart warning to the labels of Seroquel, its blockbuster antipsychotic drug, at the request of the Food and Drug Administration, company and agency officials said on Monday. Enlarge This Image J.B. Reed/Bloomberg News Warnings for Seroquel will soon recommend that the drug be avoided in combination with 12 drugs linked to arrhythmia. The revised label, posted without fanfare last week on the F.D.A. Web site, says Seroquel and extended-release Seroquel XR “should be avoided” in combination with at least 12 other medicines linked to a heart arrhythmia that can cause sudden cardiac arrest. Sandy Walsh, a spokeswoman for the F.D.A., said the statement was only a precaution for doctors, and should not be considered a complete ban against prescribing Seroquel with the other drugs. Ms. Walsh said the label was changed after the F.D.A. received new information about reports of arrhythmia in 17 people who took more than the recommended doses of Seroquel. Though it should not be a problem at a normal dosage, she said, it may still be good advice to avoid using the drugs together. The arrhythmia, known as prolongation of the QT interval, referring to two waves of the heart’s electrical rhythm, is estimated to cause several thousand deaths a year in the United States. As AstraZeneca prepares to report its second-quarter earnings at the end of this month, it faces additional scrutiny this week. The F.D.A. is considering the London-based company’s dapagliflozin, a proposed diabetes drug with Bristol-Myers Squibb, and is expected to decide soon on Brilinta, an anticoagulant. The company is facing the loss of patents for Seroquel next year and for the heartburn drug Nexium in 2014. Seroquel is one of the top-selling drugs in the world, at $5.3 billion last year, including $3.7 billion in the United States. Introduced in 1997, it has been approved for schizophrenia, bipolar disorder and severe depression. Seroquel has caused legal problems for AstraZeneca, including a $520 million payment in 2009 to settle government charges of illegal marketing. Thousands of lawsuits are pending over side effects like diabetes. The previous Seroquel labels had mentioned the risk of a prolonged QT interval, but had not identified other drugs to avoid, Stephanie Andrzejewski, a spokeswoman for AstraZeneca, said Monday. The new warning also is separated from other warnings and precautions on the label, she said, “to provide some additional guidance to physicians” treating patients ”who are already at risk of QT prolongation.” The new warning will be added to printed labels as soon as possible, Ms. Andrzejewski said. The new label lists the other drugs to avoid as antiarrhythmic drugs like quinidine, procainamide, amiodarone and sotalel; antipsychotic drugs like ziprasidone, chlorpromazine and thioridazine; antibiotics like gatifloxacin and moxifloxacin; the anti-infective drug pentamidine; and synthetic opioids like levomethadyl acetate and methadone. The label also raises caution about use by the aged and people with heart disease. James J. Pepper, a lawyer in Pennsylvania who is involved in drug litigation, has been arguing for months in letters to government officials that Seroquel has a potentially deadly interaction with methadone in regard to the QT interval. “This is a huge, huge step,” Mr. Pepper said of the label change, though he said he thought it should be stronger. Ms. Walsh said the F.D.A. action was unrelated to Mr. Pepper’s arguments. Three months ago, Dr. Janet Woodcock, director of the F.D.A. Center for Drug Evaluation and Research, rejected those arguments in a letter to the Project on Government Oversight, a nonprofit group in Washington, which had also raised the issues. Dr. Woodcock wrote that a thorough agency review had found it “exceedingly unlikely” that patients faced an unreasonable risk from the interaction between Seroquel and methadone. The review found only one death that was probably caused by the interaction, she wrote. Dr. Woodcock concluded that the F.D.A. would take no action to change the label. Ms. Walsh said that conclusion was still correct, because the F.D.A. had found no biological basis for a problem or unusual numbers of deaths at normal dosages. Methadone use and deaths have increased drastically in recent years as more doctors prescribe it for chronic pain. The number of methadone prescriptions for pain in the United States rose to 4.3 million in 2010 from 2.2 million in 2006, IMS Health, an industry data firm, said Monday. The use for pain has surpassed that for heroin withdrawal and maintenance. This posting includes an audio/video/photo media file: Download Now

News Analysis: Add Patience to a Leap of Faith to Discover Cancer Signatures Posted: 18 Jul 2011 10:33 PM PDT Are we outsmarting cancer? Or just ourselves? Related Health Guide: Cancer Over the past several years, scientists have begun looking not just for individual genes linked to cancer, but for collections of genes and molecules, like proteins, that form telltale patterns, or signatures, that can be used to identify a cancer cell and reveal what drugs might kill it. Signatures can be used to diagnose the disease, scientists hope, and to give a prognosis to patients who have cancer. But there have been few successes in this brave new world of cancer research, and some notable failures. Genetic tests devised at Duke University by researchers using the new methodology have turned out to be worthless, though they were once hailed as breakthroughs. Two new blood tests for ovarian cancer have also been abandoned. Despite the setbacks, researchers say they cannot give up on their quest for cancer signatures. Dr. Lajos Pusztai, a breast cancer researcher at the University of Texas MD Anderson Cancer Center, is one of them. How many new drugs, he asks, were approved for breast cancer treatment in the past decade? His answer: seven. None was much different from drugs already on the market. Yet in the same decade, he said, there were 8,000 publications in medical and scientific journals on breast cancer and more than 3,000 clinical trials at a cost of over $1 billion. “What came out of this is seven ‘me too’ drugs,” Dr. Pusztai said. Yes, there have been studies showing single genes can go awry and fuel certain cancers, he and other scientists say. And yes, those studies have led to new drugs, so-called targeted therapies, that block the genes, extending the lives of some patients with some types of cancer. But for a major advance in the way cancer is diagnosed and treated, Dr. Pusztai and other researchers believe that work must continue on genomic signatures. It’s a very different sort of science, an elaborate enterprise that involves complicated analyses of patterns of genes or other components of cells. The hunt for cancer signatures also is a type of work that requires a leap of faith. It is impossible for scientists to use their intuition to know whether a signature has any biological meaning — it is just a pattern, and the meaning comes from its statistical association with a result. By looking for these signatures, scientists are looking for a sort of next generation of biomarkers, and biomarkers have a troubled history in cancer research. About 15 years ago, when the world was simpler, the American Society for Clinical Oncology called together a group of experts and asked them to develop some guidelines. Which cancer biomarkers are useful for making clinical decisions? Dr. Daniel Hayes, a breast cancer researcher at the University of Michigan, was part of the group. “We all kind of sat around and looked at each other and said, ‘We have no idea how to do this,’ ” Dr. Hayes recalled. The field of tumor biomarkers, he said, “had been so chaotic.” All too often, researchers claimed to have discovered reliable ways to identify a particular cancer, but studies confirming they were valid had never been done. The group ended up writing a paper with what they called a “level of evidence scale” outlining the results they needed before they would believe a claim. Only a handful of tumor biomarkers met their criteria. Yet, Dr. Hayes said, “during that time there had been hundreds of putative markers reported for breast cancer alone, let alone other diseases.” With genomic signatures, the situation is more involved than it was 15 years ago, but the many of the same problems remain, Dr. Hayes and others say. Signatures can be used to identify cancer cells in the way a tartan can identify a Scottish clan, Dr. Hayes said. “Each tartan is composed of threads of several different colors, but when woven into a single cloth, presents a distinctive pattern or signature that distinguishes one clan from another,” he said. Yet the tools used to find signatures are so complex they can be misleading if the results are not tested properly. Investigators look for patterns in huge arrays of genes or proteins or RNA molecules, and they constantly find spurious associations with cancer that look for all the world like true ones. “The question is, what is noise and what is real?” said Dr. Steven Goodman, a biostatistician at Johns Hopkins University. In these studies, he added, “you are guaranteed to find things,” and almost always what is found is nonsense. 1 2 Next Page »

Personal Best: For Runners, Soft Ground Can Be Hard on the Body Posted: 18 Jul 2011 07:20 PM PDT Hirofumi Tanaka, an exercise physiologist at the University of Texas at Austin, bristles when he sees dirt paths carved out of the grass along paved bicycling or running routes. The paths are created by runners who think softer ground protects them from injuries. Well Share your thoughts on this column at the Well blog. Go to Well » Related More Personal Best Columns Dr. Tanaka, a runner, once tried it himself. He was recovering from a knee injury, and an orthopedist told him to stay away from hard surfaces, like asphalt roads, and run instead on softer surfaces, like grass or dirt. So he ran on a dirt path runners had beaten into the grass along an asphalt bike path. The result? “I twisted my ankle and aggravated my injury while running on the softer and irregular surface,” he said. In the aftermath of his accident, Dr. Tanaka said he could not find any scientific evidence that a softer surface is beneficial to runners, nor could other experts he asked. In fact, it makes just as much sense to reason that runners are more likely to get injured on soft surfaces, which often are irregular, than on smooth, hard ones, he said. His experience makes me wonder. Is there a good reason why many runners think a soft surface is gentler on their feet and limbs? Or is this another example of a frequent error we all make, trusting what seems like common sense and never asking if the conventional wisdom is correct? Perhaps a runner who, like me, strikes the ground with her forefoot instead of her heel, might risk more injuries on softer ground. After all, every time I push off on a soft surface, I twist my foot. Exercise researchers say there are no rigorous gold-standard studies in which large numbers of people were assigned to run on soft or hard surfaces, then followed to compare injury rates. There’s a good reason for that, said Stuart J. Warden, director of the Indiana Center for Translational Musculoskeletal Research at Indiana University. It’s too hard to recruit large numbers of people willing to be randomly assigned to one surface or another for their runs. “I think the reason people haven’t answered that question is that it is not an easy question to answer,” Dr. Warden said. When Dr. Willem van Mechelen, head of public and occupational health at VU University Medical Center in Amsterdam, searched for published studies on running injuries and how to prevent them, he, too, concluded that there were no good studies that directly support running on softer ground. “Significantly not associated with running injuries seem age, gender, body mass index, running hills, running on hard surfaces, participation in other sports, time of the year and time of the day,” Dr. van Mechelen concluded. So what is going on? It seems obvious that the forces on your legs and feet are different depending on whether you run on soft packed dirt or on hard concrete. Why aren’t injury rates affected? An answer that many accept comes from studies that addressed the question indirectly. In several of them, study subjects ran on plates that measured the force with which they struck the ground. Instead of varying the hardness of the ground, the researchers varied the cushioning of the shoes. More cushioning approximated running on softer ground. Over and over again, studies like these found that the body automatically adjusts to different surfaces — at least, as mimicked by cushioning in shoes — to keep forces constant when foot strikes plate. That finding makes sense, Dr. Warden said. If you jump from a table to the floor, you automatically bend your knees when you land. If you jump on a trampoline, you can keep your knees stiff when you land. Something similar happens when you run on different surfaces. “If you run on a hard surface, your body decreases its stiffness,” Dr. Warden said. “Your knees and hips flex more. On a soft surface, your legs stiffen.” Running on a soft surface “is basically a different activity,” he said. But those studies did not actually measure forces inside the body, Dr. van Mechelen noted. Instead, they used biomechanical modeling to estimate those forces. “It is models, so God knows whether it is true,” Dr. van Mechelen said. “But to me it doesn’t seem far-fetched.” Dr. Warden said some people adapt quicker than others to running surfaces, and he advised that anyone wanting to change from a soft to a hard surface, or vice versa, play it safe and make the change gradually. Changing your running surface, Dr. Warden said, “is much like increasing your mileage, changing your shoes or some other aspect of your training program.” Abrupt changes can be risky. But with no evidence that softer surfaces prevent injuries, there is no reason to run on softer ground unless you like to, Dr. Warden and other experts said. Dr. van Mechelen tells runners to get a pair of comfortable shoes and run on whatever surface they prefer. Dr. van Mechelen, a runner himself, says his favorite surface is asphalt. Mine is too. My coach, Tom Fleming, never suggested soft surfaces and never thought they prevented injuries. And, he said, there’s a good reason to run on asphalt, at least if you want to compete. “Most road races are on hard roadways,” he told me. “So let’s get used to them.”

The Consumer: A Vaccine May Shield Boys Too Posted: 19 Jul 2011 08:49 AM PDT Snapshots of two clean-cut teenagers, a boy and a girl, stare out from a newspaper advertisement for the vaccine Gardasil. “Boys can be affected by HPV disease too,” says the bold headline. The ad urges parents to protect “both your son and daughter.” Well Share your thoughts on this column at the Well blog. Go to Well » Until recently, Gardasil was a girls-only proposition. Approved for young women ages 9 to 26, the vaccine promised a great benefit: protection against four strains of sexually transmitted human papillomavirus (HPV), including two that can lead to cancer of the cervix, vagina and vulva. Yet the vaccine has been a tough sell. It requires three shots, often painful, over the course of seven months. So far, only one in four teenage girls younger than 18 have completed all three shots. Now, in the wake of new research suggesting that the vaccine protects against other cancers, Gardasil is increasingly marketed as an important vaccine for boys, too. The Food and Drug Administration has approved it for young men ages 9 to 26, expanding the list of indications just last December. All of which is sure to leave many parents asking: What’s in it for our sons? The answer, it turns out, is changing fast. When first approved in late 2009, Gardasil appeared to offer little to boys aside from a selfless opportunity to curb the sexual transmission of HPV to future partners. There was one direct health benefit: a reduced risk of — though not complete protection from — genital warts. (A similar vaccine, Cervarix, also has been approved for use in young women, but its manufacturer, GlaxoSmithKline, has no plans to study its effectiveness in boys.) Dr. Joel Palefsky, an infectious disease specialist at the University of California, San Francisco, who has studied Gardasil’s effects in boys, said, “If all we did was prevent genital warts, that would be cause for celebration.” But genital warts aren’t cancer. Only two in 1,000 men get a new diagnosis of genital warts each year. While they can be painful, embarrassing and persistent, much like warts on the hands or feet, they are not life-threatening, as cervical cancer may be. With this modest benefit, many parents of boys have been reluctant to subject their sons to a relatively new vaccine simply to help curb the spread of HPV. “You do a public service by getting your child vaccinated,” said Jane Kim, an assistant professor at Harvard School of Public Health. But as a mother of two young boys herself, she said, she is not inclined to weigh the benefits to their future sex partners: “Whether or not this vaccine can benefit my boys directly is probably my biggest concern.” The perception that the vaccine does little for young men has been underscored by tepid endorsements from medical organizations. Pediatricians, too, haven’t promoted the vaccine aggressively. The Vaccines for Children program covers shots for boys, but not all health plans do (and the cost, almost $400, may be prohibitive if paid out of pocket). “It seems like a lot of effort for little return,” said Dr. Glen Stream, president-elect of the American Association of Family Physicians, who practices in Spokane, Wash. Yet a growing body of evidence implicates the human papillomavirus in a wide range of equal-opportunity cancers that don’t discriminate based on gender. HPV strains 16 and 18, which the vaccine protects against, have been linked to anal cancer, penile cancer and common cancers of the back of the throat and tonsils, where the virus can spread through oral sex. Merck, which makes Gardasil, is trying to muster enthusiasm for the vaccine with new data suggesting that the vaccine may protect against anal cancer and, possibly, other cancers as well. The research may soon tip the scales in favor of a national recommendation to make male vaccination routine. New data from a Merck clinical trial that included several hundred men who have sex with men indicate that three years after vaccination, those who received Gardasil were significantly less likely to have developed high-grade precancerous anal lesions than a comparison group. Only three of the 194 men who were vaccinated developed the abnormalities, compared with 13 of 208 men who received placebo shots. Debbie Saslow, director for breast and gynecological cancers at the American Cancer Society, said that even though the numbers are small, “the data are believable.” Gay men will benefit most from the vaccine’s protection from anal cancer, because their risk is higher than that of heterosexual men. (Yet women are even more likely to develop anal cancer: There are 5,820 new cases of anal cancer diagnosed each year, 3,680 of them in women.) But so far public health experts have dismissed the idea of a vaccination campaign singling out young gay men specifically. “It’s very stigmatizing,” Dr. Saslow said. It’s also impractical, since the vaccine is supposed to be given to young people before they become sexually active, she said. “Most young men don’t realize they’re in that category or tell their health care provider they’re in that category until after they’ve been sexually active, usually with multiple partners,” Dr. Saslow said, “and then it’s much less beneficial to vaccinate them.” The data have been presented to an advisory panel of the Centers for Disease Control and Prevention, which reconvenes on Oct. 25. Yet parents may want to keep some numbers in mind. Some 12,710 new cases of cervical cancer are diagnosed every year in the United States, and 4,290 women die of the disease. Both anal cancer and penile cancer in men are rare by comparison. HPV has been strongly linked to some throat cancers, but there are no clinical trials under way assessing the vaccine’s affect on this type of cancer, which is also strongly affected by smoking and alcohol use. Most experts are convinced that Gardasil is as safe as any other vaccine. But all vaccines carry some risk, and it’s not entirely clear why so many girls don’t complete the full set of three shots they need to get the full benefit. Several girls have died after receiving the vaccinations, although it’s not known whether the shots were related. The vaccine has been tested for safety in just 1,000 boys younger than 16. In a trial of 4,055 young men ages 16 to 26, the most common side effects were headache, fever and pain, itching, redness, swelling and bruising.

Patient Voices: Adapting as Vision and Independence Ebb Posted: 19 Jul 2011 10:20 AM PDT A man wakes up one morning to find that he cannot make out the details of a picture on the wall. His wife’s face, too, has become a blur. A trip to the ophthalmologist reveals he has macular degeneration. Multimedia Interactive Feature Patient Voices: Macular Degeneration Related Health Guide: Macular Degeneration Enlarge This Image Josh Ritchie for The New York Times Charlotte Isen suffers from macular degeneration. His story isn’t unique. More than eight million people in the United States have macular degeneration, a disease that generally affects people over the age of 60. (A related condition, Stargardt’s disease, affects children as young as 6.) Both conditions rob people of their central vision, and with it their independence and ability to function without devices to help them read and navigate. There are two forms of macular degeneration: dry and wet. The symptoms of both are the same, and neither type can be cured — although some treatments are now available to slow the progression of the wet form. The course of the disease varies from patient to patient. Some patients become legally blind, while others just need a few tools to get by. Below, two people living with macular degeneration or Stargardt’s disease talk about the world as they see it. The excerpts have been condensed and edited for space. Hear more from these patients and others in an interactive feature.   Charlotte Isen Boca Raton, Fla. My husband and I were playing golf. On the 14th hole, I was chipping up toward the flag, and suddenly, instead of seeing one ball rolling up there, I saw two balls wobbling up toward two strange-looking flags. I became terribly upset and almost hysterical, and I said to my husband, “I have macular degeneration.” I went from doctor to doctor seeking the magic bullet that was going to cure me. At that time, they were doing laser treatments. Unfortunately, that was bad because those laser treatments left scars in the eyes. What we thought was helping us was really making things worse for us. Everyone I know that suffers from macular degeneration has a sense of loss, because so many things that one was once capable of doing, one is no more. That loss of independence is a very, very difficult thing for people to bear.   Jim Bernardin, 25 Chicago I have an extreme visual impairment, but I get by pretty well and people don’t realize it. Oftentimes, I’ll meet people face to face, we’ll have a great conversation, and then the next day I’ll walk right by that person, having not seen them. Then they’ll be, like, “Why didn’t he say anything?” Having Stargardt’s disease, I think it’s really important to tell people right off the bat. I realized in college that one of my symptoms was that I wasn’t looking people in the eyes. Looking someone in the eyes is a really important social agreement we have to let other people know you’re a normal person. Well, I’ve basically taught myself how to fake eye contact. It’s something I do to convey to other people that I’m not a weirdo. We live in a sighted world of 12-point font and smaller, and it’s tough. It’s kind of a crappy deal of the cards, but there are worse hands to be dealt.

Global Update: Epidemiology: In Losing Its Southern States to Secession, Sudan Also Sheds Its Guinea Worm Cases Posted: 19 Jul 2011 10:14 AM PDT As of July 15, one more country was declared free of the guinea worm: Sudan. But it was a hollow victory. That was the date Sudan split in two and South Sudan became the world’s newest country — and all the known Sudanese cases are in the south. As of early July, 98 percent of the world’s 806 guinea worm cases were in South Sudan. The rest were in Ethiopia (six cases), Mali (three) and Chad (two). Guinea worm infection, or dracunculiasis (meaning “affliction with little dragons”), is transmitted by drinking water containing microscopic flealike creatures with worm larvae in their intestines. The larvae break out, migrate just under the skin and grow until they resemble yardlong strands of angel-hair pasta. Then they exude acid to make a painful blister, and a new crop of larvae bursts out when the victim dips the burning limb in water. A global eradication campaign is fighting the worms by pouring a mild pesticide into ponds and giving people fine mesh filters. According to the latest report from the campaign, a joint project of the Carter Center in Atlanta, the Centers for Disease Control and Prevention and the World Health Organization, the number of cases in South Sudan rose slightly from last year. Almost 6,000 villages are supposed to be under surveillance, the campaign reported, but a W.H.O. representative recently found that local monitors were badly trained and unsupervised.

Recipes for Health: Tomato-Cucumber Soup With Basil Posted: 19 Jul 2011 10:15 AM PDT Not quite a gazpacho, because it contains no bread, this is a summer soup that I can keep in the refrigerator and enjoy every day for lunch or dinner. Related Recipes for Health: Chilled Summer Soups (July 18, 2011) Recipes for Health: Chilled Yogurt Soup With Spinach and Chickpeas (July 20, 2011) Recipes for Health: Watermelon Gazpacho (July 21, 2011) Recipes for Health: Yogurt Soup With Spelt, Cucumbers and Watercress (July 22, 2011) 1 long European or 4 Persian cucumbers, peeled and coarsely chopped 1 1/2 pounds ripe tomatoes, quartered 2 slices onion, rinsed 2 large garlic cloves, halved, green germs removed 2 tablespoons sherry vinegar 2 tablespoons extra virgin olive oil Salt to taste Slivered fresh basil leaves or very small whole basil leaves for garnish 1. Working in two batches, blend all of the ingredients except the basil leaves in a blender for two minutes or longer until smooth and frothy. Transfer to a bowl or container (a metal bowl is the most efficient for chilling), and chill for at least two hours before eating. Garnish each bowl or glass with slivered or very small whole basil leaves. Yield: Four regular servings, or 8 to 12 aperitifs in shot glasses. Advance preparation: You can serve this the day after you make it. Leftovers are good for two or three days. Nutritional information per serving (four servings): 102 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 9 grams carbohydrates; 3 grams dietary fiber; 10 milligrams sodium (does not include salt to taste); 2 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Vital Signs: Patterns: Faster Treatment for the Married Man Posted: 19 Jul 2011 07:17 AM PDT After a heart attack, even a brief delay in getting medical attention may mean the difference between life and death. A new study suggests that being married is a significant factor in getting treatment faster — but only for men. Well Share your thoughts on this column at the Well blog. Go to Well » Related Health Guide: Heart Attack More Vital Signs Columns Researchers in Canada checked how long it took for 4,401 heart attack victims, 1,486 of them women, to arrive at treatment after the onset of chest pain. In a study published online on Monday in The Canadian Medical Association Journal, the scientists defined late arrival as a delay of six hours or more from the onset of pain to the beginning of treatment. On average, married heart attack victims arrived at the hospital half an hour sooner than those who were not married. But when the researchers analyzed the data separately for men and women, they found that while married men were more than 60 percent less likely to arrive late than their single peers, there was no statistically significant difference between married and single women. “Wives are more likely to take the caregiver role and advise their husbands to go to the E.R.,” said Dr. Clare L. Atzema, the lead author and an assistant professor of emergency medicine at the University of Toronto. “But as my husband put it, even if I wasn’t there telling him to go to the hospital, he’d hear my voice telling him to do so. Even when they’re not there, women have a pronounced effect.”

Vital Signs: Exercise: Limits in Heart Screenings for Youths Posted: 19 Jul 2011 10:20 AM PDT Screening young athletes with electrocardiograms to prevent sudden cardiac death may be ineffective, a new study has found. As it turns out, even pediatric cardiologists often fail to interpret the tests correctly. Related More Vital Signs Columns Researchers at Stanford University selected 18 EKGs, 8 from patients with normal hearts and 10 from patients with any of six different abnormalities that commonly underlie sudden cardiac death. The scientists showed the EKGs to 53 experienced pediatric cardiologists to see if they could make the correct diagnosis, properly restrict or allow athletic activity, and order appropriate follow-up tests. The correct diagnosis and recommendations were based on the report of two electrophysiologists, cardiologists who specialize in interpreting EKGs. The cardiologists correctly identified only 68 percent of truly abnormal cases — 32 percent of teenagers with abnormal EKGs were never detected. And of the cases the doctors did identify as abnormal, 30 percent were actually normal. “One of the most striking findings was the inability of the cardiologists to give correct sports guidance,” said Dr. Anne M. Dubin, an associate professor of pediatrics at Stanford and lead author of the new study. Twenty-six percent of patients who should have been allowed to exercise were not, and 19 percent of patients who should have been restricted were not, she noted. The report appeared online on Thursday in The Journal of Pediatrics. Dr. Dubin has received fellowship support from Medtronic Inc., a manufacturer of medical equipment. This posting includes an audio/video/photo media file: Download Now

Vital Signs: Hazards: Secondhand Smoke May Affect Hearing Posted: 18 Jul 2011 10:34 PM PDT Add yet another item to the long list of damaging effects of secondhand smoke: hearing loss in teenagers. Related Health Guide: Hearing Loss More Vital Signs Columns Researchers, writing in the July issue of The Archives of Otolaryngology — Head and Neck Surgery, tested more than 2,000 teenagers for cotinine, an indicator of exposure to tobacco smoke. After eliminating smokers from the study, they were left with 799 nonsmokers whose cotinine levels indicated exposure to secondhand smoke, along with 754 who were not exposed to cigarette smoke. After controlling for many variables they found that the higher the cotinine level in a participant’s blood, the greater the likelihood there was some type of hearing loss. More than 17 percent in the highest quartile for cotinine levels had hearing loss at low frequencies. It is unclear exactly how exposure to secondhand smoke could cause the damage, but tobacco is known to affect blood flow through the smallest blood vessels, the kind the inner ear depends on “Most kids, about 85 percent, were unaware of their hearing loss,” said Dr. Anil K. Lalwani, the lead author of the study. “You can’t rely on self-reports.”

Well: Gardasil for Daughters and Sons? Posted: 19 Jul 2011 06:34 AM PDT

Well: The Nagging Effect: Better Health for Married Men Posted: 19 Jul 2011 08:56 AM PDT

Well: Giving Chronic Pain a Medical Platform of Its Own Posted: 19 Jul 2011 11:59 AM PDT

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Personal Health: Still Counting Calories? Your Weight-Loss Plan May Be Outdated Posted: 19 Jul 2011 08:36 AM PDT It’s no secret that Americans are fatter today than ever before, and not just those unlucky people who are genetically inclined to gain weight or have been overweight all their lives. Many who were lean as young adults have put on lots of unhealthy pounds as they pass into middle age and beyond. Enlarge This Image Yvetta Fedorova Related Choose Foods to Shed the Pounds (July 19, 2011) More Personal Health Columns It’s also no secret that the long-recommended advice to eat less and exercise more has done little to curb the inexorable rise in weight. No one likes to feel deprived or leave the table hungry, and the notion that one generally must eat less to control body weight really doesn’t cut it for the typical American. So the newest findings on what specific foods people should eat less often — and more importantly, more often — to keep from gaining pounds as they age should be of great interest to tens of millions of Americans. The new research, by five nutrition and public health experts at Harvard University, is by far the most detailed long-term analysis of the factors that influence weight gain, involving 120,877 well-educated men and women who were healthy and not obese at the start of the study. In addition to diet, it has important things to say about exercise, sleep, television watching, smoking and alcohol intake. The study participants — nurses, doctors, dentists and veterinarians in the Nurses’ Health Study, Nurses’ Health Study II and the Health Professionals Follow-up Study — were followed for 12 to 20 years. Every two years, they completed very detailed questionnaires about their eating and other habits and current weight. The fascinating results were published in June in The New England Journal of Medicine. The analysis examined how an array of factors influenced weight gain or loss during each four-year period of the study. The average participant gained 3.35 pounds every four years, for a total weight gain of 16.8 pounds in 20 years. “This study shows that conventional wisdom — to eat everything in moderation, eat fewer calories and avoid fatty foods — isn’t the best approach,” Dr. Dariush Mozaffarian, a cardiologist and epidemiologist at the Harvard School of Public Health and lead author of the study, said in an interview. “What you eat makes quite a difference. Just counting calories won’t matter much unless you look at the kinds of calories you’re eating.” Dr. Frank B. Hu, a nutrition expert at the Harvard School of Public Health and a co-author of the new analysis, said: “In the past, too much emphasis has been put on single factors in the diet. But looking for a magic bullet hasn’t solved the problem of obesity.” Also untrue, Dr. Mozaffarian said, is the food industry’s claim that there’s no such thing as a bad food. “There are good foods and bad foods, and the advice should be to eat the good foods more and the bad foods less,” he said. “The notion that it’s O.K. to eat everything in moderation is just an excuse to eat whatever you want.” The study showed that physical activity had the expected benefits for weight control. Those who exercised less over the course of the study tended to gain weight, while those who increased their activity didn’t. Those with the greatest increase in physical activity gained 1.76 fewer pounds than the rest of the participants within each four-year period. But the researchers found that the kinds of foods people ate had a larger effect over all than changes in physical activity. “Both physical activity and diet are important to weight control, but if you are fairly active and ignore diet, you can still gain weight,” said Dr. Walter Willett, chairman of the nutrition department at the Harvard School of Public Health and a co-author of the study. As Dr. Mozaffarian observed, “Physical activity in the United States is poor, but diet is even worse.” Little Things Mean a Lot People don’t become overweight overnight. Rather, the pounds creep up slowly, often unnoticed, until one day nothing in the closet fits the way it used to. Even more important than its effect on looks and wardrobe, this gradual weight gain harms health. At least six prior studies have found that rising weight increases the risk in women of heart disease, diabetes, stroke and breast cancer, and the risk in men of heart disease, diabetes and colon cancer. The beauty of the new study is its ability to show, based on real-life experience, how small changes in eating, exercise and other habits can result in large changes in body weight over the years. On average, study participants gained a pound a year, which added up to 20 pounds in 20 years. Some gained much more, about four pounds a year, while a few managed to stay the same or even lose weight. Participants who were overweight at the study’s start tended to gain the most weight, which seriously raised their risk of obesity-related diseases, Dr. Hu said. “People who are already overweight have to be particularly careful about what they eat,” he said. The foods that contributed to the greatest weight gain were not surprising. French fries led the list: Increased consumption of this food alone was linked to an average weight gain of 3.4 pounds in each four-year period. Other important contributors were potato chips (1.7 pounds), sugar-sweetened drinks (1 pound), red meats and processed meats (0.95 and 0.93 pound, respectively), other forms of potatoes (0.57 pound), sweets and desserts (0.41 pound), refined grains (0.39 pound), other fried foods (0.32 pound), 100-percent fruit juice (0.31 pound) and butter (0.3 pound). 1 2 Next Page »

Well: The Claim: Allergies Reduce the Risk of Cancer Posted: 18 Jul 2011 11:31 AM PDT

The New Old Age: A Guided Tour of the Past Posted: 19 Jul 2011 08:51 AM PDT

Letters: To Vaccinate or Not (1 Letter) Posted: 18 Jul 2011 07:20 PM PDT To the Editor: Re “Drive to Stem Shingles Meets Few Expectations” (July 12): No doubt the lack of Medicare coverage for shingles vaccinations has a lot to do with the low demand for protection from this truly horrible disease. However, I was surprised that your article made no mention of factors that dissuaded me from my previous decision to be vaccinated. The fact that a live vaccine is used entails a post-vaccination period of up to six weeks, during which I would need to keep away from small children, a serious consideration for a grandmother. Travel plans would be restricted, and I would most likely need a second shot. I simply could not free up my calendar enough. I remain vulnerable. Joan Fleming Princeton, N.J. 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: A Cheaper Solution (1 Letter) Posted: 18 Jul 2011 07:20 PM PDT To the Editor: Re “The Claim: A tennis ball on the back of pajamas can cut snoring” (Really?, July 12): The tennis ball does work, but it takes more than one. Several years ago, after a night in a sleep lab, I was given a diagnosis of obstructive sleep apnea. A specialist then put me back into the lab using a CPAP machine. Problem solved. Then he suggested that I buy a snug-fitting sleeveless undershirt and have my spouse sew a narrow pocket on the back capable of holding three tennis balls right up to my spine. Problem solved, and as effectively as with the CPAP machine. Dave Nelson Old Greenwich, Conn. 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.

Where Families Are Prized, Help Is Free Posted: 18 Jul 2011 08:30 AM PDT TEL AVIV, Israel — Jewish and Arab, straight and gay, secular and religious, the patients who come to Assuta Hospital in Tel Aviv every day are united by a single hope: that medical science will bring them a baby. Enlarge This Image Rina Castelnuovo for The New York Times Vered Letai-Sever, an Israeli from the small town of Tsoran, with her son Eitan, whom she had through in vitro fertilization. Israel is the world capital of in vitro fertilization and the hospital, which performs about 7,000 of the procedures each year, is one of the busiest fertilization clinics in the world. Unlike countries where couples can go broke trying to conceive with the assistance of costly medical technology, Israel provides free, unlimited IVF procedures for up to two “take-home babies” until a woman is 45. The policy has made Israelis the highest per capita users of the procedure in the world. “It’s amazing when you think about it,” marveled Keren, 35, who asked to be identified only by her first name. She was seated in a waiting room at Assuta’s in vitro fertilization clinic, a beige canister of her husband’s frozen sperm at her feet. The sperm had been delivered from another hospital where she had her first IVF attempt three years ago, resulting in the birth of her daughter. “I want at least three kids, and if we had to pay so much money I’m not sure we would be able to do this,” she said. Although the procedures account for one of the country’s largest public health expenditures, the policy has drawn little debate or criticism, one of the few issues nearly all sectors of the typically fractious Israeli society seem to agree upon. There is even a growing pool of single religious women using in vitro fertilization, their efforts sanctioned by rabbis. “The unique thing about Israel is that it’s a high-tech culture on the one hand and a very traditional one on the other,” said Sigal Gooldin, a Hebrew University medical sociologist who has studied IVF regulation in Israel. “It’s not just because of the fear of losing children in high-risk military activity, it’s because family is an extremely important social institution in Israel and what makes a family is the children. “Anyone who lives here is expected to have children,” she added. “In casual conversation you will be asked how many children you have and if you say one, people will ask why only one, and if you say two, why only two?” Israelis already have a high fertility rate: an average of 2.9 children per family. Beyond the biblical imperative to be fruitful, some Israeli Jews remain concerned with replenishing their numbers in the wake of the Holocaust. Demographics here are also political. Israel has historically focused on promoting Jewish birthrates to retain a Jewish majority and more recently as a counterweight to higher fertility rates of Palestinians in the occupied territories. Arab citizens of Israel, however, have the same rights to state-paid fertility treatments as their Jewish counterparts. A survey published by the journal Human Reproduction Update in 2002 showed that 1,657 in vitro fertilization procedures per million people per year were performed in Israel, compared with 899 in Iceland, the country with the second highest rate, and 126 in the United States, which trailed far behind European countries. Experts say Israel’s rate still far outstrips the rest of the world. Four percent of Israeli children today are the products of in vitro fertilization, compared with about 1 percent estimated in the United States. A major center of the baby-making industry is Assuta, which performs about a quarter of Israel’s approximately 28,000 IVF procedures a year. At the fertility center there, a lab housing 25 incubators and 60,000 frozen embryos stored in liquid nitrogen sits between an operating room where women have their eggs aspirated and a so-called transfer room where the embryos are implanted in the patient. Citing the countless prayers that have been sent up from within its sterile white walls, Shai Elizur, the in vitro fertilization director at Assuta, calls the transfer room “a holy room.” 1 2 Next Page »

Marijuana for Patients Remains Off-Limits Posted: 18 Jul 2011 11:40 PM PDT Irvina Booker makes a most unlikely criminal. She lives in constant pain, disabled by multiple sclerosis and arthritis, a grandmother whose limited mobility depends on her walker, her daughter and marijuana. Enlarge This Image Nicole Bengiveno/The New York Times Irvina Booker at her home in Englewood, N.J. She expressed frustration about the lack of access to medical marijuana. “I never smoked it before I got sick, and I don’t smoke it for fun,” said Ms. Booker, 59, who lives in Englewood, N.J. She would not divulge how she obtains her marijuana, but said, “I don’t want to be sneaking around, afraid someone is going to get arrested getting it for me.” Like many people who contend that marijuana eases pain and appetite loss from serious diseases, Ms. Booker cheered in January 2010, when New Jersey legalized its use in cases like hers. But a year and a half later, there is still no state-sanctioned marijuana available for patients, and none being grown, and there is no sign of when there might be. In the last few months, officials in New Jersey, as well as several other states, have said that mixed signals from the Obama administration have left them unsure whether their medical marijuana programs could draw federal prosecution of the people involved, including state employees. A Justice Department memorandum issued late last month left unanswered questions, and Gov. Chris Christie has not said how he will proceed. But medical marijuana advocates say that in New Jersey, at least, the state law is stringent enough not to run afoul of federal policy, and that the governor’s true goal has been to block the program. “You don’t have to be Sherlock Holmes to figure that out,” said State Senator Nicholas P. Scutari, a Democrat. “He’s used every tactic he can to delay and deny.” The governor, a Republican, and his aides have insisted that every delay has been a genuine attempt to make the program work properly. “In light of the Obama administration’s memorandum, the governor’s office is performing its due diligence to ensure implementation of the program is not in conflict with federal law and does not put state employees charged with directing the program at risk,” Kevin Roberts, a spokesman for Mr. Christie, said. On July 7, Mr. Scutari — who is a local prosecutor — and Assemblyman Reed Gusciora, the law’s primary sponsors, met with the governor’s legal advisers. “They told us they don’t have their minds made up; that they want our input,” Mr. Scutari said. But for the first time, he said, “the possibility of just scrapping the program” came up, though only in passing. Aides to the governor denied that there was any discussion of abandoning the program. The state has named six nonprofit organizations to grow and dispense marijuana. The would-be growers say that if they were given the go-ahead, it would take at least four months to get up and running. “A lot of people ask when, how, if we’re really going to open, and we can’t tell them anything,” said Ida Umanskaya, a director of Foundation Harmony of Cliffside Park, which plans to open a treatment center in Secaucus. Another operator, Compassionate Care Centers of America Foundation, which would be based in New Brunswick, “remains cautiously hopeful,” said Raj Mukherji, a spokesman for the group. Though marijuana remains illegal under federal law, in 2009 David W. Ogden, the deputy attorney general at the time, sent a memo to federal prosecutors across the country saying that they should not focus “on individuals who are in clear and unambiguous compliance with existing state laws providing for the medical use of marijuana.” But the memo came with caveats, stressing the Justice Department’s commitment to prosecute commercial marijuana growers and traffickers who feed the illegal market but hide behind “claims of compliance with state or local law.” In March of this year, federal agents raided marijuana dispensaries in Montana, and some states wondered about the extent of Justice Department tolerance. Including New Jersey, 16 states and the District of Columbia have laws allowing medical use of marijuana. Gov. Christine Gregoire of Washington, a Democrat, vetoed proposed changes to the state’s marijuana program, which she said could expose state workers to prosecution. Gov. Lincoln Chafee of Rhode Island, an independent, suspended plans to license marijuana dispensaries. Arizona sued the federal government. 1 2 Next Page »

Coming Together to Fight for a Troubled Veteran Posted: 18 Jul 2011 06:17 AM PDT OKEMOS, Mich. — When the standoff began on a humid August night, it seemed destined to become one more case of a returned soldier pulled down by a war he could not leave behind. Enlarge This Image Fabrizio Costantini for The New York Times Mr. Eifert with his stepdaughter. Staff Sgt. Brad Eifert circled through the woods behind his house here, holding a .45-caliber pistol. The police were out there somewhere and, one way or the other, he was ready to die. He raised the gun to his head and then lowered it. Then he fired nine rounds. “They’re going to take me down, they’re going to finish me off, so,” he remembers thinking, “finish me off.” Leaving his weapon, he ran into the driveway, shouting, “Shoot me! Shoot me! Shoot me!” The police officers subdued him with a Taser and arrested him. A few hours later, he sat in a cell at the Ingham County Jail, charged with five counts of assault with intent to murder the officers, each carrying a potential life sentence. In daring the police to kill him, Mr. Eifert, who had served in Iraq and was working as an Army recruiter, joined an increasing number of deployed veterans who, after returning home, plunge into a downward spiral, propelled by post-traumatic stress disorder or other emotional problems. Their descent is chronicled in suicide attempts or destructive actions that bring them into conflict with the law — drunken driving, bar fights, domestic violence and, in extreme instances, armed confrontations with the police of the kind that are known as “suicide by cop.” Such stories often end in death or prison, the veteran in either case lost to the abyss. But something different happened in Mr. Eifert’s case. Headed for disaster, he was spared through a novel court program and an unusual coming together of a group of individuals — including a compassionate judge, a flexible prosecutor, a tenacious lawyer and an amenable police officer — who made exceptions and negotiated compromises to help him. If he takes advantage of the chance to recover his life, he is likely to avoid incarceration and receive the care he needs to move forward. How this came about — it evolved over more than seven months, during which Mr. Eifert remained in jail — says much about what is required to pull a psychically wounded soldier back to safety and raises questions about the limitations of the systems in place to deal with troubled veterans, whose trespasses can in many cases be traced to a lack of adequate help earlier on. Some officials believe that war trauma should not qualify veterans for special treatment in the criminal justice system, especially in cases where public safety is endangered. “P.T.S.D. is not a get out of jail free card,” said a prosecutor in a Missouri case involving a veteran who had a faceoff with the police. Yet a growing number of legal and law enforcement experts argue that when a veteran’s criminal actions appear to stem from the stresses of war, a better solution than traditional prosecution and punishment is called for. The society that trained them and sent them into harm’s way, they say, bears some responsibility for their rehabilitation. And they point to other exceptions in the legal system like diversion programs for drug offenders and the mentally ill. “I don’t interpret it as excusing behavior, but as addressing what the behavior is,” said Judge Robert T. Russell Jr. of Buffalo City Court, who founded the first special court for veterans there in 2008. It can provide an alternative to punishment, mandating treatment and close supervision and holding them to strict requirements. “The benefit is, you increase public safety, you don’t have a person reoffending and, hopefully, that person can become functioning and not suffer the invisible wounds of war,” Judge Russell said. Mr. Eifert, 36, was fortunate that, just months before, his county had become one of 80 jurisdictions around the country that have adopted the veterans court model. But the resolution of his case took more than that. The judge had to take an interest in his case and accept him in the court, which did not normally hear serious cases involving the use of a firearm. The prosecutor had to ultimately decide that Mr. Eifert’s emotional difficulties warranted leniency. 1 2 3 4 Next Page »

Unboxed: Seeing Promise and Peril in Digital Records Posted: 17 Jul 2011 02:57 AM PDT TECHNICAL standards may seem arcane, but they are often powerful tools of economic development and social welfare. They can be essential building blocks for innovation and new industries. The basic software standards for the Web are striking proof. Enlarge This Image Photo illustration by The New York Times Safety is also a potent argument for standards. History abounds with telling examples, like the Baltimore fire of 1904. That inferno blazed for 30 hours, destroying more than 1,500 buildings across 70 city blocks. Fire engines from other cities came to help, but could not. Their hose couplings — each a different size — did not fit the Baltimore fire hydrants. Until then, cities saw little reason to adopt a standard size coupling, and local equipment manufacturers did not want competition. So competing interests undermined the usefulness of, and investment in, the technology of the day. Today, the matter of standards for electronic health records is raising similar concerns, prompting heated debate in recent meetings of representatives from medicine, industry, academia and government. The stakes, they say, could scarcely be higher. They agree that, when well designed and wisely used, digital records can deliver the power of better information to medicine, improving care and curbing costs. But computer forms, they add, can also be difficult to use, cluttered and distracting, causing more harm than good in health care. “This is an issue that potentially affects the health and safety of every American,” says Ben Shneiderman, a computer scientist at the University of Maryland. The controversy points to the delicate balancing of interests involved when creating technical standards that inherently limit some design choices yet try to keep the door open to innovation. It also raises the question of the appropriate role for government in devising such technology requirements. At issue is the Obama administration’s plan to develop standards to measure how effective and easy digital patient records are to use — applying a research discipline known as human-computer interaction or human factors. (The International Organization for Standardization, which is based in Geneva, defines the usability of a product by three attributes: “effectiveness, efficiency and satisfaction.”) The need to improve the usability of computerized records is clearly evident — and has been for some time. A 2009 study by the National Research Council, an arm of the National Academy of Sciences, found that electronic health record systems were often poorly designed, and so could “increase the chance of error, add to rather than reduce work flow, and compound the frustrations doing the required tasks.” At a government-sponsored gathering last month, Dr. David Brick, a pediatric cardiologist in New York, demonstrated how it took eight mouse clicks on a digital record to find the patient information presented comfortably on the single sheet of a paper chart. Hearing such complaints, countless times, from doctors and nurses is what prompted the administration to put usability on its policy agenda. The main users of electronic health records are doctors and nurses. And the uses are tasks like recording a patient’s basic information, ordering lab tests, electronically prescribing medications and checking for possibly dangerous drug interactions. For example, taking the blood thinner warfarin (Coumadin) with aspirin, which also inhibits clotting, increases the risk of internal bleeding. The most important early measurement, officials say, will be to ensure that the electronic records are designed to avoid errors, embracing the physician’s dictum, “First, do no harm.” The administration’s initiative takes on particular significance because this year is when the government begins spending billions of dollars to accelerate the adoption of computerized patient records. The incentive payments, typically as much as $44,000 a physician, begin this year. But those payments require doctors to make “meaningful use” of “certified” electronic health records. The payments are staggered over five years, and to get the money physicians must use the technology for increasingly extensive record-keeping and reporting. The administration has not said whether a usability standard will be in the next stage of requirements, due by early next year. The government says it is committed to working with technology companies, medical professionals and academics, to adopt the best approach. Yet common ground has been elusive so far. 1 2 Next Page » This posting includes an audio/video/photo media file: Download Now

Marijuana May Be Studied for Combat Disorder Posted: 18 Jul 2011 10:10 PM PDT DENVER — For years now, some veterans groups and marijuana advocates have argued that the therapeutic benefits of the drug can help soothe the psychological wounds of battle. But with only anecdotal evidence as support, their claims have yet to gain widespread acceptance in medical circles. Enlarge This Image Matthew Staver for The New York Times “There is a widely accepted need for a new treatment of PTSD,” said Rick Doblin, who wants to do research on marijuana. Related Coming Together to Fight for a Troubled Veteran (July 18, 2011) Times Topic: Marijuana and Medical Marijuana Now, however, researchers are seeking federal approval for what is believed to be the first study to examine the effects of marijuana on veterans with chronic post-traumatic stress disorder. The proposal, from the Multidisciplinary Association for Psychedelic Studies in Santa Cruz, Calif., and a researcher at the University of Arizona College of Medicine, would look at the potential benefits of cannabis by examining 50 combat veterans who suffer from the condition and have not responded to other treatment. “With so many veterans from the wars in Iraq and Afghanistan, there is a widely accepted need for a new treatment of PTSD,” said Rick Doblin, founder and executive director of the psychedelic studies group. “These are people whom we put in harm’s way, and we have a moral obligation to help them.” In April, the Food and Drug Administration said it was satisfied that safety concerns over the study had been addressed by Mr. Doblin and Dr. Sue Sisley, an assistant professor of psychiatry and internal medicine at Arizona, according to a letter from the drug administration provided by Mr. Doblin. But the letter also noted that the project could not go forward until the researchers identified where they would get their marijuana. And that cannot happen, Mr. Doblin said, until the project is approved by a scientific review panel from the Department of Health and Human Services, which includes representatives from an assortment of federal health agencies. If the proposal is approved, Mr. Doblin said, the researchers will use marijuana grown by the University of Mississippi under a contract with the National Institute on Drug Abuse. It is the only marijuana permitted to be used in federally approved studies. A Health and Human Services spokeswoman said the proposal was still under review. “The production and distribution of marijuana for clinical research is carefully restricted under a number of federal laws and international commitments,” the spokeswoman, Tara Broido, said in an e-mail. “Study proposals are reviewed for scientific quality and the likelihood that they will yield data on meaningful benefits.” An institutional review board must also approve the study, as well as the Drug Enforcement Administration, Mr. Doblin said. Getting final approval from the federal government could prove difficult, Mr. Doblin and Dr. Sisley conceded. They said it was far more challenging to get authorization for a study that examines the benefits of an illegal drug than its risks. “We really believe science should supersede politics,” Dr. Sisley said. “This illness needs to be treated in a multidisciplinary way. Drugs like Zoloft and Paxil have proven entirely inadequate. And there’s anecdotal evidence from vets that cannabis can provide systematic relief.” Medical marijuana is legal in 16 states and the District of Columbia. But only New Mexico and Delaware specifically list post-traumatic stress disorder as a qualifying condition for treatment, according to the Marijuana Policy Project, a Washington-based group that supports legal regulation of the drug. Currently, nearly a third of the 4,982 patients approved for medical marijuana in New Mexico suffer from post-traumatic stress disorder, more than any other condition, according to the state’s health department. It is unclear how many are veterans. One recent Army veteran from Texas who fought in Iraq for 18 months beginning in 2006, said he used marijuana three times a day in lieu of the painkillers and antidepressants he was prescribed after returning home. He asked that his name not be used because Texas does not allow medical marijuana. The veteran, who said he had been shot in the leg and suffered numerous head injuries from explosions while deployed as a Humvee gunner, said marijuana helped quiet his physical and psychological pain, while not causing the weight loss and sleep deprivation brought on by his prescription medications. “I have seen it with my own eyes,” he said. “It works for a lot of the guys coming home.” If the study is approved, veterans who participate would be observed on an outpatient basis over three months, Mr. Doblin said. During two four-week increments, they would be given up to 1.8 grams of marijuana a day to treat anxiety, depression, nightmares and other symptoms brought on by PTSD. Researchers would also observe the veterans for periods when they are not permitted to use marijuana. In addition to a placebo, researchers plan to use four marijuana strains in the study, each containing different levels of tetrahydrocannabinol (THC), a primary component of the drug. One of the strains will also contain cannabidiol (CBD), another ingredient thought to have an anti-anxiety effect. Mr. Doblin said the veterans would be allowed to use the marijuana at their own discretion. Half will be instructed to smoke the drug, while the other half will inhale it through a vaporizer.

New Diabetes Drug Faces a Critical Review Before an F.D.A. Advisory Panel Posted: 17 Jul 2011 10:58 PM PDT New diabetes drugs are being developed that reduce blood sugar in a straightforward way — by causing it to be excreted in the urine. On Tuesday, a committee that advises the Food and Drug Administration is to consider whether the first of those drugs can overcome safety concerns and reach the market. The outcome of the F.D.A. review is far from certain. The drug, dapagliflozin, might raise the risk of breast and bladder cancer, liver damage and infections of the genitals and urinary tract, according to an F.D.A. examination of the data posted on the agency’s Web site on Friday. Bristol-Myers Squibb and AstraZeneca, the co-developers of dapagliflozin, are in the lead to bring these drugs, so-called SGLT2 inhibitors, to market. Others developing such drugs include Johnson & Johnson; the team of Eli Lilly and Boehringer Ingelheim; Lexicon Pharmaceuticals; Isis Pharmaceuticals; and several Japanese companies including Astellas Pharma, the Chugai Pharmaceutical Company and the Taisho Pharmaceutical Company. Currently, only a tiny amount of glucose that is filtered by the kidneys is excreted in the urine; the rest is returned to the bloodstream. This mechanism apparently evolved to help the body preserve a vital source of energy. The job of returning glucose to the bloodstream is performed mainly by a protein called the sodium glucose co-transporter 2. By inhibiting SGLT2, the drugs cause a substantial increase in the amount of glucose that flows out in the urine. At least in principle, this does not appear to be dangerous. There is a rare genetic disease in which people do not have functioning SGLT2. They have very high sugar levels in their urine but appear otherwise to be generally healthy. In clinical trials, dapagliflozin, a once-a-day pill, was about as effective as other types of diabetes drugs in lowering blood sugar. According to the F.D.A., however, the drug does not work in patients with moderate to severe kidney impairment. Experts say that SGLT2 inhibitors would be a useful addition because many diabetics go through various drugs, often more than one at a time, to try to control their blood sugar. “It’s not a must-have, but it’s a nice thing,” said Dr. Jay S. Skyler, deputy director of the Diabetes Research Institute at the University of Miami. “I’d like to have it in my toolbox.” A potential advantage of these drugs is that their mechanism of action is independent of insulin, making it potentially easy to combine SGLT2 inhibitors with other drugs. Many other diabetes drugs work either by providing the body with insulin, inducing the pancreas to secrete more insulin or making the body more sensitive to insulin. Moreover, because so many calories are now flowing out in the urine, the SGLT2 inhibitors help people lose a little weight. That could be of some benefit because many people with diabetes are overweight and because some other diabetes drugs can cause weight gain. In clinical trials, patients receiving dapagliflozin lost an average of about five pounds more than those getting a placebo after six months. They also experienced a slight reduction in blood pressure. One drawback, however, is that the extra sugar in the urine makes the urinary tract and genitals more hospitable to micro-organisms, leading to an increase in infections. What seemed to concern the F.D.A. reviewers more than these infections was a possible increased risk of breast and bladder cancers. Nine women, or 0.4 percent of those who took the drug, got breast cancer compared with one woman, or 0.09 percent, of those in the control group, according to AstraZeneca and Bristol-Myers. For bladder cancer, the rate was nine cases, or 0.3 percent, for those taking the drug compared with one case, or 0.05 percent, for those in the control group. The companies argue that when all types of cancer, not just breast and bladder cancer, are considered, there is no increased risk for those taking dapagliflozin. They also say that some of the cancers were diagnosed so soon after the start of the trial that they were unlikely to be linked to the drug. “Based on a thorough nonclinical and clinical assessment, the data do not suggest that dapagliflozin is associated with a risk for either of these cancers,” the companies wrote in their own briefing document, adding, however, that data was limited.

Opinion: Patrolling Cancer’s Borderlands Posted: 18 Jul 2011 08:16 AM PDT THREE recent events highlight the extraordinary task that lies ahead for cancer prevention. Related Health Guide: Cancer First: in late May, a World Health Organization panel added cellphones to a list of things that are “possibly carcinogenic” — a category that also includes pickles and coffee. Second: in mid-June, the National Toxicology Program, countering years of lobbying by certain industries, finally classified formaldehyde (used in plywood manufacturing and embalming) as a carcinogen. And third: in late June, the Food and Drug Administration issued newer and more graphic warning labels for cigarette packages. These include deliberately disturbing images of a patient with mouth cancer and of a man with tobacco smoke coming out of a tracheotomy stoma. What connects these events? Together, they serve to remind us of three of the most potent challenges that cancer-control agencies face today. Indeed, it is essential to recognize these events as representing a progression: each corresponds to a crucial stage in the process of patrolling the borderlands of cancer. Effective cancer control depends on successful action at each of these complex stages. The first challenge is scientific. It concerns the complexity of identifying new carcinogens, and the need for consistent standards for doing so. Take the purported link between cellphone radiation and brain cancer. This link is based largely on the so-called Interphone study. In Interphone, men and women with a variant of brain cancer (called glioma) were asked to recall their level of exposure to cellphone radiation. The results, at first glance, were provocative. Men and women who recalled moderate phone use seemed to have decreased rates of brain cancer compared to those who rarely used cellphones. In contrast, men and women with the highest usage seemed to have an increased rate of brain cancer. But pivotal uncertainties remain. Trials like Interphone depend on the ability of subjects to recall their prior exposures. Such recollections can be surprisingly inconsistent. Indeed, when some subjects’ actual phone use was logged, there were broad discrepancies between actual and reported usage. There are other difficulties. Despite a drastic increase in cellphone usage over the past decades, there has been no significant change in glioma cancer rates across the nation. Perhaps it is too early to judge, but the enormous increase in phone usage should have caused at least a minor blip in glioma rates over 20 years — but no such increase is apparent. And finally, the kind of radiation emitted by cellphones — unlike the radiation emitted by X-rays or nuclear bombs — cannot directly damage DNA. X-rays and nuclear radiation possess the energy required to alter genes and thereby cause cancer. But the frequency of cellphone radiation is more than a million-fold lower. If cellphone radiation is causing cancer, it is doing so through a mechanism that defies our current understanding of carcinogenesis. Brain cancer is a devastating illness, and it’s worth being cautious, but the current data supporting the link between phone radiation and glioma are weak. The cellphone case is a reminder of how difficult it is to identify a new carcinogen — and how important it therefore is to have standards to make such classifications possible. Discrepancies in standards for classifying carcinogens have led to confusion and turmoil in the public realm. In contrast to the World Health Organization, many agencies, including the National Cancer Institute, remain skeptical about the link between phone radiation and cancer, and are awaiting more definitive studies to clarify the issue. In part, the problem is semantic: the W.H.O.’s definition of “possibly carcinogenic” is much looser; coffee and pickles are included, even though the evidence for their carcinogenicity remains weak. But the split between the W.H.O. and other agencies on cellphones — emblematic of the split within the scientific community — has had the unfortunate effect of confounding the public, which now does not know which faction to believe. The second challenge facing cancer control agencies is political. The formaldehyde case illustrates this. Unlike phone radiation, formaldehyde has a well-established mechanism to cause cancer: it is a strikingly reactive chemical that can directly attack DNA. Experiments performed in the 1970s demonstrated that the chemical causes cancer in mice and rats. Following this data, sophisticated trials showed that men and women exposed to formaldehyde — morticians, for instance — had higher rates of leukemia than unexposed people. But some of these studies were performed three decades ago. Why have 30 years elapsed between them and the National Toxicology Program announcement? In part, because of active lobbying by various industries, in particular, plywood manufacturers, who have tried to thwart this classification. Identifying a carcinogen, in short, isn’t sufficient. Beyond the science — which, as the cellphone example shows, can be hard enough — cancer-control agencies need to bolster political support, and neutralize lobbying interests, before a culprit carcinogen can be revealed to the public. The third challenge for the cancer community is social. The F.D.A.’s new labels on cigarette packages are a case in point. The human trials that established that tobacco smoke is a carcinogen were initially performed in the mid-1950s (some even earlier). The tobacco industry mounted an aggressive campaign to discredit the data, and continued marketing tobacco to the public. The landmark Surgeon General’s Report on smoking and cancer was released in 1964. And it took yet another decade of innovative strategies, including powerful antitobacco advertisements and tort cases against tobacco companies, to alter the trajectory of smoking behavior in America. But young men and women in some parts of the nation are smoking again: consumption in certain regions has been rising, and cancer rates will rise concomitantly. Evidently, identifying a carcinogen or advertising the risk to the public is not enough: cancer-control agencies need to invent and reinvent strategies continuously. Old warning labels generate habitual responses, so new, more disturbing labels are needed to invigorate attention. Patrolling the world for real carcinogens, in short, is a complex task. Scientific challenges morph into political challenges that lead to social challenges. If reducing the incidence of cancer is a national goal — as it surely must be — then it is essential to recognize the many-dimensional nature of countering carcinogens. Siddhartha Mukherjee is an assistant professor of medicine at Columbia University and the author of “The Emperor of All Maladies: A Biography of Cancer.”

Recipes for Health: Chilled Yogurt Soup With Spinach and Chickpeas Posted: 19 Jul 2011 08:47 AM PDT I don’t know if you can call a cold soup comforting, but that’s the word that this soup brings to my mind. 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: Chilled Summer Soups (July 18, 2011) Recipes for Health: Tomato-Cucumber Soup With Basil (July 19, 2011) 1 bunch spinach, stemmed and washed, or 12 ounces baby spinach 1 to 2 large garlic cloves (to taste) Salt to taste 3 cups plain yogurt 1 cup cold water 1 teaspoon cumin seeds, lightly toasted and coarsely ground 1 can chickpeas, drained and rinsed Freshly ground pepper Finely chopped dill or parsley for garnish Optional: 1 to 2 tablespoons extra virgin olive oil Juice of 1/2 lemon 1. Steam the spinach until just wilted, about two minutes. Rinse with cold water, squeeze out excess water and chop. Set aside. 2. In a mortar and pestle, combine the garlic and a generous pinch of salt; mash to a paste. Stir into the yogurt. Add the water, and stir together. Add the cumin seeds, and stir in the spinach and chickpeas. Season to taste with salt and pepper. Chill several hours. If desired, add the lemon juice. Garnish each serving with chopped fresh dill or parsley and an optional drizzle of olive oil. Yield: Serves four. Advance preparation: You can make this soup up to a day ahead of serving, but the bright color of the spinach will fade. It’ll still taste great. Nutritional information per serving (four servings): 222 calories; 2 grams saturated fat; 1 gram polyunsaturated fat; 1 gram monounsaturated fat; 11 milligrams cholesterol; 30 grams carbohydrates; 5 grams dietary fiber; 455 milligrams sodium (does not include salt to taste); 17 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Chilled Summer Soups Posted: 19 Jul 2011 09:10 AM PDT Last week was a perfect week to be working with cold soups — what with the sweltering heat, I was happy to be drinking my lunch or dinner every day. 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: Tomato-Cucumber Soup With Basil (July 19, 2011) Recipes for Health: Chilled Yogurt Soup With Spinach and Chickpeas (July 20, 2011) Recipes for Health: Watermelon Gazpacho (July 21, 2011) Recipes for Health: Yogurt Soup With Spelt, Cucumbers and Watercress (July 22, 2011) As it turned out, some of these blended soups were elegant enough to serve not only as meals but also as dinner party aperitifs. I poured them into shot glasses and espresso cups and passed them on a tray. I also made more robust yogurt-based soups, combining greens, legumes, grains, herbs and spices. These made hearty meals with lots of texture, packed with nutritious ingredients like spinach, watercress and tomatoes. And though a few of this week’s soups require some cooking, I’ve kept it to a minimum. Chilled Pea, Lettuce and Herb Soup This elegant soup is sweet and heavenly. The texture is silky and the consistency thick -- but only because there are lots of peas in it. I used water rather than stock when I tested this recipe, and it worked just fine. 3 tablespoons extra virgin olive oil 2 leeks, white and light green part only, cleaned and sliced Salt to taste 5 cups frozen or fresh peas (1 1/2 pounds, or 2 12-ounce bags frozen) 3 cups, tightly packed, coarsely chopped Boston or bibb lettuce 5 cups chicken stock, vegetable stock or water 1/3 cup coarsely chopped fresh tarragon leaves 1/4 cup coarsely chopped flat-leaf parsley leaves 1/4 cup coarsely chopped fresh mint leaves 1/4 cup chopped chives, plus additional for garnish Chopped fresh tarragon, chives and/or mint for garnish 1. Heat 1 tablespoon of the oil over medium heat in a large, heavy soup pot or Dutch oven. Add the leeks and a pinch of salt. Cook, stirring, until tender, about five minutes. Add the peas, lettuce and stock or water, and bring to a boil. Add salt to taste, reduce the heat, cover and simmer five minutes. Remove from the heat. Drain through a strainer set over a bowl, and allow the vegetables and the broth to cool for 15 minutes. Taste the broth, and season as desired. 2. Working in batches, purée the vegetables and herbs in a blender with the broth and additional olive oil for two minutes until frothy and smooth. Pour into a bowl, and stir to combine. Taste and adjust seasonings. Chill for several hours. 3. Serve, garnishing with additional chives, tarragon and/or mint. Yield: Six regular servings or 12 aperitifs. Advance preparation: You can make this dish a day ahead. Nutritional information per serving (six servings): 183 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 22 grams carbohydrates; 6 grams dietary fiber; 155 milligrams sodium (does not include salt to taste); 9 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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