Health - New H.I.V. Cases Steady Despite Better Treatment

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• New H.I.V. Cases Steady Despite Better Treatment
• Medtronic Giving Yale Grant to Review Bone Growth Data
• Home Tech: A Dashboard for Your Body
• Recipes for Health: Peach Vanilla Smoothie
• Pfizer Is Said to Pursue Nonprescription Lipitor
• Cargill Recalls Ground Turkey Linked to Outbreak
• Drugs Found Ineffective for Veterans’ Stress
• Skin Deep: When Dieting Becomes a Role to Play
• Well: Breaking Bread Everywhere, Plentifully or Pitifully
• Essay: Who Falls to Addiction, and Who Is Unscathed?
• Insurance Coverage for Contraception Is Required
• Abused and Used : Reaping Millions in Nonprofit Care for Disabled
• Somalis Waste Away as Insurgents Block Escape From Famine
• Cases: A Worker With No ID and Great Medical Need
• Well: Fruit Smoothies Without the Dairy
• Well: Friendly Workplace Linked to Longer Life
• Well: Centenarians Have Plenty of Bad Habits Too
• Well: A Better Way to Keep Patients Safe
• Well: Calculating the Real Age of Your Dog
• The Phantom Menace of Sleep Deprived Doctors
• Personal Health: Ancient Moves for Orthopedic Problems
• Well: The Claim: A Normal Heart Rate Is 60 to 100 Beats a Minute
• The New Old Age: When They Won't Spend the Money
• The New Old Age: A Blog Worth Reading
• Sales of Pain Drugs Help Pfizer’s Profit Beat Forecasts
• The Consumer: The Doctor Will See You ... Eventually
• Study Sheds Light on Auditory Role in Dyslexia
• Vital Signs: Screening: Mammograms Seen Ineffective in Europe
• Recipes for Health: Plum, Red Grape and Almond Smoothie
• Recipes for Health: Fresh Fig and Date Shake
• Recipes for Health: Watermelon Mint Smoothie
• Recipes for Health: Fruit Smoothies for Summer

New H.I.V. Cases Steady Despite Better Treatment Posted: 04 Aug 2011 08:06 AM PDT Despite years of great progress in treating AIDS, the number of new infections with the virus that causes it has remained stubbornly around 50,000 a year in the United States for a decade, according to new figures released on Wednesday by federal officials. Enlarge This Image Mary Altaffer/Associated Press Activists urged full financing for AIDS treatment during a demonstration in New York in June. Multimedia Interactive Feature Patient Voices: AIDS and H.I.V. Related Times Topic: AIDS / H.I.V. Enlarge This Image The American epidemic is still concentrated primarily in gay men, and is growing rapidly worse among young black gay men. That realization is causing a rift in the AIDS community. Activists say the persistent H.I.V. infection rate proves that the government prevention policy is a flop. Federal officials are on the defensive even as they concede that the epidemic will grow if prevention does not get better, which they know is unlikely while their budgets are being cut. And some researchers believe it is impossible to wipe out a fatal, incurable disease when it is transmitted through sex and carries so much stigma that people deny having it and avoid being tested for it. Looking back, epidemiologists at the Centers for Disease Control and Prevention believe that new cases peaked at 130,000 a year in the 1980s, sank slowly during the ’90s and reached a plateau at 50,000 around the year 2000. Larry Kramer, a longtime AIDS activist and the author of “The Normal Heart,” a play about the epidemic’s early days, said: “It means I don’t see an AIDS policy, and I don’t see anyone in charge. It’s so dispiriting that it’s hard to find something to say about it. How many times can you yell ‘Help!’ without ever getting anywhere?” Both Dr. Kevin Fenton, chief of AIDS prevention for the C.D.C., and Dr. Anthony S. Fauci, chief of AIDS research at the National Institutes of Health, took issue with Mr. Kramer’s interpretation. While both agreed that 50,000 new annual infections was, in Dr. Fauci’s words, “a great concern,” both pointed to some areas where substantial progress had been made. They said that new studies were seeking ways to get more people tested and treated early in the course of the illness, which would make them less infectious and drive transmission rates down. “The C.D.C. is absolutely not resting,” Dr. Fenton said. “It was a major accomplishment to drop infections from 130,000 to 50,000, and we’re dealing with an epidemic that is dynamic.” But, he conceded, 50,000 is an “unacceptably high level,” and without better prevention efforts “we’re likely to face an era of rising infection rates.” Philip Alcabes, a public health epidemiologist at Hunter College in Manhattan, noted that 50,000 is close to the number of Americans who die in road accidents each year — almost 40,000 — “and in some ways, we consider dying on the road an ordinary thing.” By contrast, he said, nearly one million Americans a year die of heart disease and strokes. “So it’s not clear that prevention is a failure,” he said. “The average adult’s chances of encountering H.I.V. infection — 0.02 percent a year — are rather low. It’s not reasonable to expect that a sexually transmitted virus will disappear in America, or anywhere else. But I agree with Larry Kramer that there has been a dearth of new policy ideas.” For most risk groups, infection rates are stable, with 61 percent of cases contracted through gay or bisexual sex, 27 percent through heterosexual sex and 9 percent through drug injections. But they are increasing rapidly in one subgroup: young gay black men. Black teenage boys who realize they are attracted to men are often too poor to move to gay-friendly cities like San Francisco or New York, researchers said, and often must keep their homosexuality hidden from relatives and friends, making it more likely they will have furtive, risky sex. They often lack health insurance, meaning they do not get checkups where a doctor might suggest testing. And while new surveys find that they use condoms at about the same rates as young gay white and Hispanic men, sex tends to stay within racial groups and more older black gay and bisexual men are infected. Also, untreated syphilis, whose sores open a path for H.I.V., is more common among blacks. The National Institutes of Health is supporting studies in the Bronx, Washington and other heavily black urban areas seeking new ways to reach these men, Dr. Fauci said. Results will be ready in two or three years. Prevention has worked for two groups, Dr. Fenton said. The number of women infecting their children at birth or through breast-feeding has dropped to only 100 a year from about 1,300 two decades ago. In that respect, the United States is like Africa: scarce public clinics focus on women and children, and many poor women see a doctor only when pregnant. Also, the number of infections through drug use has dropped 80 percent, although that may be a result of changing fashions among addicts: Fewer inject heroin and more smoke or inhale heroin, crack, crystal meth and cocaine or swallow prescription opiates like OxyContin. Only needle-sharing passes virus-tainted blood. Chris Collins, director of public policy for amfAR, the Foundation for AIDS Research, said the decade-long persistence of 50,000 infections “shows that we’ve failed to target prevention services adequately and have not gotten treatment coverage in many communities that would bring down community viral loads.” A recent study has shown that getting people on antiretroviral drugs early makes them 96 percent less likely to infect others, so there is a growing outcry for “test and treat” — shorthand for actively seeking out gay men and those injecting drugs and asking them to get tested, and then helping them find medical care if they have the disease. Dr. Fauci and Dr. Fenton said there was no discussion now of making such tests mandatory — as, for example, syphilis tests once were for marriage licenses. San Francisco and Vancouver, British Columbia, have lowered new infection rates, Mr. Collins noted. But how applicable those lessons are to the United States as a whole is debatable; both cities have very small black populations, and Vancouver’s success relies partly on a government-approved center where drug addicts can shoot up under the eyes of a nurse and without fear of arrest — an experiment unlikely to be repeated in the United States. The new C.D.C. figures are based partly on a new blood test that can tell recent infections from old ones, said Joseph Prejean, who led the team that made the new estimates. The test, invented in 2005 and nicknamed the “BED test,” for the B, D and E viral subtypes it uses, measures H.I.V. antibodies in the blood relative to total antibodies. That ratio rises rapidly from infection to about six months, then levels off, he said. Dr. Alcabes, who was once a harsh critic of C.D.C. estimates, said he believed the new numbers were as accurate as they could get. “They’ve done an enormous amount of number-crunching with stupefying amounts of detail,” he said.

Medtronic Giving Yale Grant to Review Bone Growth Data Posted: 03 Aug 2011 10:34 PM PDT Facing intensifying scrutiny over one of its bone growth products, Medtronic announced Wednesday that it was giving a $2.5 million grant to Yale to oversee a complete review of the study data that examined the product’s safety and effectiveness. In June, a medical journal charged that researchers sponsored by Medtronic had generated misleading studies about the product, called Infuse, that overstated its benefits and asserted that it did not pose risks. Infuse is a bioengineered material used primarily in spinal fusions, a procedure in which vertebrae are joined to reduce back pain. Industry analysts have speculated that sales of Infuse have dropped since the periodical, The Spine Journal, published its special issue on the product. Experts said that Medtronic’s action was the first time that a medical device maker would turn over the underlying and detailed patient data from company-sponsored studies to independent experts so that they could review it and draw their own conclusions. Typically, companies release only summaries of that information, a practice that can hamstring the ability of experts to examine it. Infuse has been used in about a quarter of the estimated 432,000 spinal fusions performed in the United States each year. When The Spine Journal special issue first appeared, the company announced that it would respond to the publication’s assertions by conducting a review of all Infuse-related study information. Under the plan announced Friday, Yale will use the $2.5 million provided by Medtronic to assemble of panel of outside experts, who will then commission two academically recognized research organizations to review the company’s study data. Dr. Harlan Krumholz, a cardiologist at Yale, who will oversee the effort, said that Medtronic’s decision was groundbreaking because it would allow independent researchers to assess the underlying data supporting a product’s safety and effectiveness. “Published data is often missing critical information,” Dr. Krumholz said. Dr. Eugene Carragee, editor of The Spine Journal, said he was pleased that Medtronic officials had decided to release the data. The plan will give access to the study data to other researchers along with the groups Yale retains. Dr. Carragee, a professor at Stanford, said that he remained concerned that little study data exists for one major use of Infuse, a type of spinal fusion, because a study of that application was halted early when patients suffered complications. Still, he added Medtronic’s decision was “a big step in the right direction”. Side effects associated with Infuse include infection, bone loss, unwanted bone growth and male sterility. A stronger version of Infuse called Amplify, was recently rejected for approval by the Food and Drug because of concerns about possible cancer risks. Along with the recent issue of The Spine Journal, the Justice Department is conducting a criminal investigation of Medtronic’s marketing of the product and a Senate committee is also conducting an inquiry. Medtronic has not been accused of any wrongdoing, and researchers who conducted research on Infuse have defended their findings.

Home Tech: A Dashboard for Your Body Posted: 04 Aug 2011 08:17 AM PDT ONE recent morning, I woke up at 6:45, spent about 20 minutes preparing for the day (mainly this involves my persnickety multistep coffee-making process), and then strolled down the hall to my home office. Related More Home Tech Columns Enlarge This Image MYTREK WORKOUT MONITOR Due out this fall,MyTrek ($129) tracks pulse, distance and calories,but links only to Apple devices. FITBIT TRACKER A $100pedometer-plus thatcalculates your steps andyour sleep movements, andgraphs them online. Enlarge This Image IHEALTH BP MONITOR IHealth’s blood-pressuredevice works like Withings’s and costs $30less, but is a hard fit in some phones. Enlarge This Image WITHINGS SCALE This device ($159)tracks weight, fat percentage andbody-mass index, and sends the badnews to computers and phones. Enlarge This Image EXERGEN THERMOMETER Fever?Slide this $33 device over achild’s (or adult’s) foreheadfor a highly accurate answer. In that time, I’d walked only about 400 steps and burned about 200 calories, and things went downhill from there. According to a log created by Fitbit, a tiny gadget that hooks onto my belt loop and tracks my activities, I had only tiny spurts of movement the rest of the workday. There was a big spike of activity around lunchtime, when I walked about 50 steps to the kitchen and 50 steps back, and a couple other small flurries when I walked to the bathroom or answered the door for the delivery guy. Most of the time, though, I remained parked in front of my computer, as sedentary as a hibernating bear. Although Fitbit doesn’t explicitly acknowledge this in its marketing materials, the gadget makes you feel bad about yourself. The device ($100) is a super-powered pedometer; it monitors movement while you sleep as well as counts your steps, and it sends all the data back to Fitbit’s Web-based tracking program, which displays your lethargy on the sort of precise charts and graphs that economists use to monitor recessions. The theory underlying Fitbit is that once you know where you’re failing, you can begin to make healthy changes in your life. And these changes don’t have to be very big — for instance, mulling the Fitbit data, I noticed that on the weekend I recorded more than twice as much daily activity as I had on the weekdays. But I don’t recall working especially hard on that weekend — I’d just walked around the garden a couple times to water the plants. And this was the point: I didn’t even have to do anything strenuous to get in slightly better shape. Fitbit is one of the best of several health-related gadgets I’ve been testing recently. They run the gamut — a few were modern versions of old technology, including a novel body scale, blood-pressure monitors and one amazing thermometer. Others, like the Fitbit, are meant to let you track and display your fitness in the hope that you’ll change your lazy ways. But all these devices fit nicely into what has been called the “self-tracking” or “quantified self” movement, in which folks use technology to measure their bodily functions either to improve their health or, increasingly, just to have fun. Take, for instance, the MyTrek, a wireless pulse monitor made by Scosche. The $129 workout device, which will go on sale this fall at Apple, Target and 24 Hour Fitness stores, slips around your arm, where it tracks your pulse and your movements. The MyTrek connects to an iPhone or iPod Touch, which displays and remembers all your workout statistics. For instance, it shows a graph of your pulse rate throughout the exercise session, the number of calories you burned, and the distance you traveled. Scosche says that measuring your pulse, rather than just your movement (like the Fitbit), leads to a more accurate estimate of calories burned. This may be so, but I was disappointed that the MyTrek data can be viewed only on an Apple device. The company plans an app for Android phones to be released next year, and a representative said it was considering offering ways to view your pulse data on the Web or other devices as well. I also tested the Withings WiFi Body Scale, which in some respects works like every other bathroom scale: You step on it, it displays your weight. But then it transmits the data over your home Internet connection to your computer or your phone (it works on Macs and Windows, as well as Android phones, the iPhone, iPad or iPod Touch). The scale’s software displays a graph of your weight over time and calculates your fat percentage and body-mass index. It also lets you create profiles for up to eight people, and track each person’s weight on a dedicated graph. At $159, it is pricey for a bathroom scale, but I suspect it will prove useful to dieters and others watching their weight. Withings also makes a blood-pressure monitor that works with the iPhone, iPad and iPod Touch. It sells for about $130, while another Apple-friendly blood-pressure monitor, made by iHealth, sells for about $100. I tested both and found the Withings model to be slightly better than iHealth’s. For some reason, the iHealth dock wouldn’t fit into my phone unless I removed my phone’s protective case; I didn’t have that problem with the Withings version. Still, they were both easy to use, and each worked the same way: After connecting it to my phone, I slipped the cuff around my arm and pressed Start. The cuff began to expand, and within a minute my blood-pressure reading appeared on my phone. Each app saves your readings, so you can see how your blood pressure changes over time. Adam Lin, the general manager of iHealth, told me that while home blood-pressure devices aren’t new, Apple-friendly versions are aimed at a younger set. “The calls we’re getting are from people who are 35 or 40, people who are saying they’ve just been diagnosed with hypertension and they want this kind of device,” he said. Of all the gadgets I tried, my favorite is the Exergen TemporalScanner, a thermometer that doesn’t connect to your phone or to the Web, and doesn’t save your data over time. But it allowed me to accurately measure my baby’s temperature without removing his clothes, even while he is sleeping. This was a revelation to me: Pediatricians have long argued that the only accurate way to measure a baby’s temperature is rectally. Other methods (under the arm, under the tongue or in the ear canal) give readings that are slightly lower or higher than the true one. The Exergen thermometer, $33 on Amazon, promises to give a more accurate reading of an infant’s temperature, and to do so without disturbing the baby. The thermometer, a small hand-held device, has an infrared scanner at its tip. Place the thermometer on your child’s forehead (or your spouse’s — it’s for adults, too), hit the scan button and slowly slide the thermometer across the skin. The temperature reading appears instantly. The thermometer was invented by Francesco Pompei, a research scientist and Exergen’s founder. He said that the device reads the temperature of the temporal artery, which is in the forehead and has long been considered one of the places near the outside of the body that best reflects “core” temperature. A study in the Archives of Pediatrics & Adolescent Medicine, reflecting this theory, concluded that Exergen’s thermometer came far closer than inner-ear thermometers at determining the infants’ true temperature, as measured rectally. The study did show that forehead thermometers could not replace rectal thermometers; in some cases, the TemporalScanner missed fevers that were found rectally. But the TemporalScanner is far more convenient than measuring a baby’s temperature rectally, which allows you to measure it more often, sometimes just for the peace of mind of knowing he’s O.K. Who can resist? This posting includes an audio/video/photo media file: Download Now

Recipes for Health: Peach Vanilla Smoothie Posted: 05 Aug 2011 12:30 AM PDT 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: Fruit Smoothies for Summer (August 1, 2011) Recipes for Health: Watermelon Mint Smoothie (August 2, 2011) Recipes for Health: Fresh Fig and Date Shake (August 3, 2011) Recipes for Health: Plum, Red Grape and Almond Smoothie (August 4, 2011) I was thinking of peaches and almonds when I began working on this granola-thickened smoothie, but it ended up tasting more like peach ice cream with a hint of vanilla. 1 large or 1 1/2 medium ripe peaches, white or yellow, pitted (about 6 ounces) 1/3 cup granola 2/3 cup almond milk 1/8 teaspoon almond extract 1/2 to 3/4 teaspoon vanilla extract (to taste) 2 teaspoons rose geranium syrup A few drops of fresh lemon juice (to taste) 3 ice cubes 1. Place all of the ingredients in a blender. Blend until frothy, about one minute. Yield: One serving. Nutritional information per serving: 251 calories; 0 grams saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 0 milligrams cholesterol; 51 grams carbohydrates; 5 grams dietary fiber; 174 milligrams sodium; 5 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

Pfizer Is Said to Pursue Nonprescription Lipitor Posted: 03 Aug 2011 10:00 PM PDT Pfizer hopes to introduce an over-the-counter version of Lipitor, the world’s best-selling drug, after it loses patent protection in November, a person close to the situation said Wednesday. Related Times Topic: Lipitor (Drug) Selling a version of the drug to consumers without a prescription would allow Pfizer to retain some of the $11 billion in annual revenue that Lipitor has been generating. However, a nonprescription version would not be available immediately after the patent on Lipitor expires because Pfizer would first have to convince the Food and Drug Administration that consumers could take the drug without a doctor’s supervision. That will probably be difficult. Merck failed three times to win the agency’s approval for over-the-counter versions of Mevacor, which, like Lipitor, is a statin. Bristol-Myers Squibb also failed to obtain approval for an over-the-counter version of Pravachol, another statin. Pfizer declined to either confirm or deny its intention. “We can confirm that we have strategic plans in place for Lipitor’s loss of exclusivity and will comment no further at this time,” Raymond F. Kerins Jr., a spokesman for the company, said. The person close to the situation, who would speak only anonymously because the discussions were private, said a nonprescription version of the drug was not the only option pursued by Pfizer. Another would be a so-called branded generic version. The company might pursue both options. Pfizer announced last month that it was looking to sell or spin off animal health and baby formula businesses to streamline the company and help prepare for the loss of Lipitor sales to generic competitors. But the company decided to keep two businesses that Wall Street had speculated might be sold: the generic drug business and the consumer business, which now sells products like Advil and Robitussin. That has led to speculation that the company was planning to sell generic and over-the-counter versions of Lipitor and other drugs that face a loss of patent protection. Pfizer’s plans for the nonprescription Lipitor were first reported by The Wall Street Journal. An over-the-counter version of Lipitor would no doubt be welcomed by insurers because it would cost less. In the past, the F.D.A. advisers have been concerned that over-the counter versions of statins could not be used safely, that some patients who did not need the drugs would take them. Others at significant risk of cardiovascular problems might take the over-the-counter drug and forgo seeing a doctor or getting other necessary care. Since high cholesterol is a symptomless condition, consumers would not know whether the drug was working without having their cholesterol checked periodically. But Steven Francesco of Francesco International, a consulting firm that specializes in converting brand name drugs to over-the-counter products, said technology such as prescription cards used at the drug store would better allow patients to be monitored without physician supervision. “There’s any number of ways to insure that the consumer can use the drug,” said Mr. Francesco. “Lipitor will be one of the first of many drugs that will attempt to switch between now and 2016.”

Cargill Recalls Ground Turkey Linked to Outbreak Posted: 03 Aug 2011 10:00 PM PDT Cargill, a major United States meat processor, said Wednesday that it was recalling about 36 million pounds of ground turkey produced at an Arkansas plant after it was linked to a nationwide outbreak of salmonella sickness. It appeared to be one of the largest meat recalls ever. Enlarge This Image Cargill Some of the ground turkey was sold in supermarkets under the Honeysuckle White brand. Related Turkey Plant May Be Salmonella Link (August 3, 2011) One person in California has died in the outbreak and at least 76 have fallen ill. The outbreak involved a strain of the bacteria known as Salmonella Heidelberg, which is resistant to many commonly prescribed antibiotics, according to the federal Centers for Disease Control and Prevention. Cargill said that it was suspending ground turkey production at the plant in Springdale, Ark., where the tainted meat originated, until it could identify the source of the contamination and fix it. “It is regrettable that people may have become ill from eating one of our ground turkey products and, for anyone who did, we are truly sorry,” Steve Willardsen, president of Cargill’s turkey processing business, said in a written statement. The recall was among the largest ever for meat products associated with an outbreak of illness, said William Marler, a Seattle lawyer who specializes in food poisoning cases. The recall was announced by Cargill Value Added Meats Retail, a unit of Cargill’s meat subsidiary. The company said some of the ground turkey was sold in supermarkets under the Honeysuckle White brand. The company said it was recalling ground turkey produced at the Arkansas plant since late February. Federal data shows that 10 to 15 percent of ground turkey typically is contaminated with salmonella. Federal data from tests in 2009 also showed that more than three-quarters of salmonella samples found on ground turkey was resistant to at least one type of antibiotic. Bacteria can develop resistance after exposure to antibiotics that are routinely used in raising food animals. Salmonella is killed by cooking, and public health officials say ground poultry should be heated to 165 degrees, as measured by a meat thermometer. But people can also be infected through cross-contamination in the kitchen, as when utensils or cutting boards used for raw turkey meat come in contact with other food. The first cases of sickness associated with the current outbreak occurred in early March. Additional cases have continued to crop up every week. Officials said the number of illnesses was likely to increase because there is often a time lag in reporting new cases. So far illnesses have been reported in 26 states. Salmonella infection can lead to fever and diarrhea. Severe cases can lead to blood poisoning. Mild cases are typically not treated with antibiotics but health officials said antibiotics are used to treat blood poisoning. They can also be used to safeguard against complications in patients with weakened immune systems, as well as in the elderly and very young. It was not clear why it took five months to identify the outbreak and its source and to notify the public of the investigation. The C.D.C. said in a report released Monday that routine sampling of meat bought at supermarkets detected four packages of turkey meat containing a strain of salmonella that matched the outbreak strain. Those packages were bought between March 7 and June 27, the agency said, and at least three were produced at the same plant. As recently as Tuesday, the Agriculture Department, which regulates the meat industry, said that it did not have evidence that conclusively linked any particular plant to the outbreak. Cargill Value Added Meats is the third-largest turkey processor in the country, according to an annual industry ranking compiled by WATT PoultryUSA, a trade journal. Total ground turkey production nationwide was 450 million pounds in 2009, according to the National Turkey Federation.

Drugs Found Ineffective for Veterans’ Stress Posted: 03 Aug 2011 03:56 PM PDT Drugs widely prescribed to treat severe post-traumatic stress symptoms for veterans are no more effective than placebos and come with serious side effects, including weight gain and fatigue, researchers reported on Tuesday. Related Times Topic: Veterans and Post Traumatic Stress Disorder The surprising finding, from the largest study of its kind in veterans, challenges current treatment standards so directly that it could alter practice soon, some experts said. Ten percent to 20 percent of those who see heavy combat develop lasting symptoms of post-traumatic stress disorder, and about a fifth of those who get treatment receive a prescription for a so-called antipsychotic medication, according to government numbers. The new study, published in The Journal of the American Medical Association, focused on one medication, Risperdal. But experts said that its results most likely extend to the entire class, including drugs like Seroquel, Geodon and Abilify. “I think it’s a very important study” given how frequently the drugs have been prescribed, said Dr. Charles Hoge, a senior scientist at the Walter Reed Army Institute of Research, who was not involved in the study but wrote an editorial accompanying it. He added, “It definitely calls into question the use of antipsychotics in general for PTSD.” The use of such drugs has grown sharply over the past decade, as thousands of returning soldiers and Marines have found that their post-traumatic stress symptoms do not respond to antidepressants, the only drugs backed by scientific evidence for the disorder. Doctors have turned to antipsychotics, which strongly affect mood, to augment treatment, based almost entirely on their experience with them and how they expect them to work. To test those assumptions, a team of researchers affiliated with the Veterans Affairs medical system had 123 veterans with the disorder begin a regimen that added Risperdal to their treatment. Some of the patients served in Vietnam, others in Iraq or Afghanistan; all had tried courses of antidepressant treatment and found little relief. After six months of treatment, these veterans were doing no better than a similar group of 124 veterans, who were given a placebo. About 5 percent in both groups recovered, and 10 percent to 20 percent reported at least some improvement, based on standardized measures. “We didn’t find any suggestion that the drug treatment was having an overall benefit on their lives,” said Dr. John H. Krystal, the director of the clinical neurosciences division of the Department of Veterans Affairs’ National Center for PTSD and the lead author of the study. Dr. Krystal said the benefits many doctors thought they were getting from the drugs “quite possibly came from simply engaging the patient in treatment, and not from the medication.” He said that antipsychotic drugs might help certain people with psychotic features as well as post-traumatic symptoms, but that the study was not designed to identify them. The findings come at a time when the Departments of Defense and Veterans Affairs are straining to provide treatment to returning service members who are not only concerned about the stigma of mental illness but are also often skeptical of the value of treatment. Surveys have found that only about half of those thought to need treatment actually seek it out. Yet studies suggest that talk therapy, alone or in combination with antidepressants, can accelerate the relief of common symptoms, like nightmares and reclusive behavior. These psychotherapies tend to include relaxation skills; incrementally increased exposure to stress triggers; and challenging some inaccurate assumptions that fuel anxiety. Time, too, should be taken into consideration, recent research has found. “We’re finding that about 24 months after a one-year deployment is about enough” for the body to reset itself physiologically, Dr. Hoge said.

Skin Deep: When Dieting Becomes a Role to Play Posted: 03 Aug 2011 09:20 PM PDT SHE calls it wishful shrinking. Last May, Carrie Fisher showed off her 30-pound weight loss, a result of 18 weeks on the Jenny Craig diet, to People magazine — the most recent of the company’s series of celebrity spokespeople to reach a major milestone in weight loss. Enlarge This Image Andrew H. Walker/Getty Images Jennifer Hudson revealed her weight loss in her Weight Watchers campaign last year. Enlarge This Image Dave Peterson/The Des Moines Register, via Associated Press Sarah Ferguson, the Duchess of York, a former Weight Watchers spokeswoman. It’s understandable that diet companies would want to incorporate celebrities in their marketing plans. Consumers believe they “know” famous people — especially forthcoming ones like Valerie Bertinelli (Jenny Craig), Jennifer Hudson (Weight Watchers) and Marie Osmond (Nutrisystem) — and can be inspired by them. But employing celebrities can be a double-edged sword. When a company advertises a successful but anonymous dieter — say, Melissa K. from Fairfield, Conn., who lost 50 pounds* (*results not typical) — its target audience never learns how Melissa ultimately fared. Did she keep the weight off? Did she gain the 50 pounds back, as well as 50 more? Only she and her acquaintances will ever know. Famous people, however, play out their weight struggles under glaring lights. It’s hard to forget commercials of the actress and former Jenny Craig spokeswoman Kirstie Alley lustily drooling over the program’s sanctioned fettuccine, or of her triumphant disrobing on “Oprah” to reveal her new bikini body in pantyhose. It’s equally hard to forget photos of Ms. Alley, after regaining the lost weight and then some, again on “Oprah”: this time more conservatively dressed and contrite. Or, more recently, falling with an audible thud during a lift on “Dancing With the Stars.” Last year, another diet program, the Fresh Diet, parted ways with its famous “spokesdieter,” the pop singer Carnie Wilson, after she gained weight while under contract. “It didn’t work out with Carnie,” said Zalmi Duchman, chief executive for the Fresh Diet, which delivers fresh meals daily across the nation. “She dropped like 20 pounds in the first three months. Then she, I mean, she had to go off of it. There’s no question. She might have eaten the meals, but she ate the meals with a lot of other stuff. She started a cheesecake company.” Mr. Duchman said he didn’t fire Ms. Wilson; he chose not to renew her contract. (Ms. Wilson and Ms. Alley declined to comment for this article.) The specter of Ms. Alley’s and Ms. Wilson’s failure on these diet programs has done nothing to deter Nutrisystem and Jenny Craig from gathering a slew of other celebrities to represent them. But Nutrisystem is being more cautious. The company’s current spokespeople, Ms. Osmond and Dan Marino, the former Miami Dolphin, were not used as guinea pigs, said Stacie Mullen, its executive of celebrity marketing, but were approached after news reports that they used the program. . “We have gained our celebrity spokespeople through them being real clients first,” Ms. Mullen said. “We learned about Marie as a client of ours through an entertainment magazine.” Jenny Craig is pursuing celebrity spokespeople more voraciously. “We are interested in helping any celebrity lose weight,” said Dana Fiser, the chief executive for Jenny Craig. Indeed, the company employs six current and active celebrity spokespeople: Ms. Bertinelli, Ms. Fisher, the actress Sara Rue, Jason Alexander, the actress Nicole Sullivan and the reality show personality Ross Mathews. Not everyone agrees with this strategy. Cheryl Callan, chief marketing officer for Weight Watchers, said she suspected that what she called her competitors’ “parade” of celebrities is a method of distraction. “It may be about spreading risk,” she said. In other words, if Ms. Bertinelli regains weight, members of the public won’t notice because they’re too captivated by Ms. Fisher’s success. Collecting celebrity spokespeople is not Weight Watchers’ way. In its history, there have been only four celebrity spokeswomen for the company: Lynn Redgrave, Jenny McCarthy, Sarah Ferguson and, now, Ms. Hudson, who said she has lost 80 pounds on the plan. 1 2 Next Page »

Well: Breaking Bread Everywhere, Plentifully or Pitifully Posted: 02 Aug 2011 08:20 AM PDT

Essay: Who Falls to Addiction, and Who Is Unscathed? Posted: 03 Aug 2011 08:28 AM PDT Shortly after the singer Amy Winehouse, 27, was found dead in her London home, the airwaves were ringing with her popular hit “Rehab,” a song about her refusal to be treated for drug addiction. Related Amy Winehouse, British Soul Singer With a Troubled Life, Dies at 27 (July 24, 2011) The man said “Why you think you here?” I said, “I got no idea.” I’m gonna, gonna lose my baby, So I always keep a bottle near. The official cause of Ms. Winehouse’s death won’t be announced until October pending toxicology reports, but her highly publicized battle with alcohol and drug addiction seems to have played a significant role. Indeed, her mother echoed a sentiment heard everywhere when she told The Sunday Mirror that her daughter’s death was “only a matter of time.” But was it? Why is it that some people survive drug and alcohol abuse, even manage their lives with it, while others succumb to addiction? It’s a question scientists have been wrestling with for decades, but only recently have they begun to find answers. Illicit drug use in the United States, as in Britain, is very common and usually begins in adolescence. According to the 2008 National Survey of Drug Use and Health, 46 percent of Americans have tried an illicit drug at some point in their lives. But only 8 percent have used an illicit drug in the past month. By comparison, 51 percent have used alcohol in the past month. Most people who experiment with drugs, then, do not become addicted. So who is at risk? Clinicians have long been aware that patients with certain types of psychiatric illnesses — including mood, anxiety and personality disorders — are more likely to become addicts. According to the National Institute of Mental Health’s Epidemiologic Catchment Area Study, patients with mental health problems are nearly three times as likely to have an addictive disorder as those without. Conversely, 60 percent of people with a substance abuse disorder also suffer from another form of mental illness. Still, it’s unclear whether addiction predisposes someone to mental illness, or vice versa. Scientists do know that having a mental illness doesn’t just increase the chance of intermittent drug abuse; it also significantly raises the risk of outright dependence and addiction. The conventional wisdom is the link represents a form of “self-medication” — that is, people are using drugs long-term to medicate their own misery. There is clinical and epidemiologic evidence to support this notion. Alcohol and drugs affect mood and behavior by activating the same brain circuits that are disrupted in major psychiatric illnesses. No surprise, then, that depressed and anxious patients in particular turn to alcohol and other sedatives. But these substances are terrible antidepressants and only worsen the underlying problem, leading to a downward spiral of depression and addiction. Certain personality disorders also raise the odds of drug abuse and alcohol abuse. Narcissistic patients, who constantly battle feelings of inadequacy, are frequently drawn to stimulants, like cocaine, that provide a fleeting sense of power and self-confidence. People with borderline personality disorder, who struggle to control their impulses and anger, often resort to drugs and alcohol to soften their intolerable moods. But precarious mental health is not the only risk for long-term addiction. Emerging evidence suggests that drug abuse can be a developmental brain disorder, and that people who become addicted are wired differently from those who do not. Dr. Nora Volkow, director of the National Institute on Drug Abuse, has shown in several brain-imaging studies that people addicted to such drugs as cocaine, heroin and alcohol have fewer dopamine receptors in the brain’s reward pathways than nonaddicts. Dopamine is a neurotransmitter critical to the experience of pleasure and desire, and sends a signal to the brain: Pay attention, this is important. When Dr. Volkow compared the responses of addicts and normal controls with an infusion of a stimulant, she discovered that controls with high numbers of D2 receptors, a subtype of dopamine receptors, found it aversive, while addicts with low receptor levels found it pleasurable. This finding and others like it suggest that drug addicts may have blunted reward systems in the brain, and that for them everyday pleasures don’t come close to the powerful reward of drugs. There is some intriguing evidence that there is an increase in D2 receptors in addicts who abstain from drugs, though we don’t yet know if they fully normalize with time. But people are not brains in a jar; we are heavily influenced by our environments, too. The world in which Ms. Winehouse traveled appears to have been awash in illicit drugs and alcohol whose use was not just accepted but encouraged. Even people who aren’t wired for addiction can become dependent on drugs and alcohol if they are constantly exposed to them, studies have found. Drug use changes the brain. Primates that aren’t predisposed to addiction will become compulsive users of cocaine as the number of D2 receptors declines in their brains, Dr. Volkow noted. And one way to produce such a decline, she has found, is to place the animals in stressful social situations. A stressful environment in which there is ready access to drugs can trump a low genetic risk of addiction in these animals. The same may be true for humans, too. And that’s a notion many find hard to believe: Just about anyone, regardless of baseline genetic risk, can become an addict under the right circumstances. It also has profound implications for intervention and treatment. Long-term drug use usually begins during adolescence, a time when the brain is the most plastic. In those who are most vulnerable, substance abuse must be confronted early in adolescence, before it has set the stage for a lifetime of addiction. Who can experiment uneventfully with drugs and who will be undone by them results from a complex interplay of genes, environment and psychology. And, unfortunately, just plain chance.

Insurance Coverage for Contraception Is Required Posted: 01 Aug 2011 10:02 PM PDT WASHINGTON — The Obama administration issued new standards on Monday that require health insurance plans to cover all government-approved contraceptives for women, without co-payments or other charges. Related Panel Recommends Coverage for Contraception (July 20, 2011) The standards, which also guarantee free coverage of other preventive services for women, follow recommendations from the National Academy of Sciences and grew out of the new health care law. “These historic guidelines are based on science and existing literature and will help ensure women get the preventive health benefits they need,” said Kathleen Sebelius, the secretary of health and human services. The requirements apply to insurance in years starting on or after Aug. 1, 2012. They take effect in January 2013 for insurance plans that operate on the basis of a calendar year. Supporters of the new requirement said it would go a long way toward removing cost as a barrier to birth control, a longtime goal of advocates for women’s rights and experts on women’s health. But the requirement does not immediately help women who have no health insurance. It is sure to reignite debate over the federal role in health care at a time when Republicans in Congress are trying to repeal the health care law signed last year by President Obama. A major goal of the law is to increase the use of preventive services like mammograms, colonoscopies, blood pressure checks and childhood immunizations. The law generally bans co-payments, deductibles and other charges for preventive services recommended by expert professional organizations. The law directed federal health officials to pay attention to the health needs of women in particular when listing preventive services that must be covered. The new standards require coverage of the full range of contraceptive methods approved by the Food and Drug Administration, as well as sterilization procedures. Among the drugs and devices that must be covered are emergency contraceptives including pills known as ella and Plan B. Senator Richard Blumenthal, Democrat of Connecticut, said, “These guidelines will save countless dollars and lives, and send a hugely powerful message about the importance of women’s preventive health care.” Representative Lois Capps, Democrat of California, also praised the requirements, saying they would “ensure that women have increased access to the services they need to be healthy.” The United States Conference of Catholic Bishops and some conservative groups, including the Family Research Council, have strenuously opposed any requirement for coverage of contraceptives. Health plans offered by certain religious employers would be exempt from the requirement to cover contraceptive services. This provision is similar to the exemption for churches found in many of the states that already require coverage of contraception, federal health officials said. Researchers have found that people who have coverage of preventive services, under Medicare or private insurance, use them much less than recommended. Federal officials said they would try to promote their use by publicizing the fact that wider, cost-free coverage is now available. The National Academy of Sciences said the Obama administration had told its experts not to consider “the cost-effectiveness of screenings or services” in deciding which ones to recommend. Insurers expressed concern that coverage for some of the newly required preventive services could be costly. Under the federal rules governing preventive services, insurers can use “reasonable medical management techniques” to control costs and promote the efficient delivery of care. The administration said Monday, for example, that an insurer could charge co-payments for brand-name drugs if a lower-cost generic version was available and was just as safe and effective. In addition to contraceptive services for women, the government will require health plans to cover screening to detect domestic violence; screening for H.I.V., the virus that causes AIDS; and counseling and equipment to promote breast-feeding, including breast pumps. Other preventive services that must be covered, without co-payments, include screening for gestational diabetes in pregnant women; DNA testing for the human papillomavirus as part of cervical cancer screening; and annual preventive-care visits. Such visits could include prenatal care and preconception care, to make sure women are healthy when they become pregnant. In a report commissioned by the Obama administration, the academy’s Institute of Medicine said free contraceptive coverage was justified because nearly half of all pregnancies in the United States were unintended, and about 40 percent of unintended pregnancies ended in abortion. Thus, it said, greater use of contraception will reduce the rates of unintended pregnancy, teenage pregnancy and abortion. Certain health plans that were in place on March 23, 2010, when Mr. Obama signed the health care law, may be able to avoid the requirement to cover preventive services for a while. But as time passes and insurers and employers modify their coverage, the number of plans entitled to such “grandfather status” is shrinking.

Abused and Used : Reaping Millions in Nonprofit Care for Disabled Posted: 05 Aug 2011 06:33 AM PDT Medicaid money created quite a nice life for the Levy brothers from Flatbush, Brooklyn. Abused and Used Spending Under Scrutiny Articles in this series examine the treatment of the developmentally disabled in New York State and how money is spent on their care. Read More » Multimedia Graphic Developmental Disabilities Inc. Interactive Feature Case Study: The Young Adult Institute Graphic: An Outsize Share The brothers, Philip and Joel, earned close to $1 million a year each as the two top executives running a Medicaid-financed nonprofit organization serving the developmentally disabled. They each had luxury cars paid for with public money. And when their children went to college, they could pass on the tuition bills to their nonprofit group. Philip H. Levy went as far as charging  the organization $50,400 for his daughter’s living expenses one year when she attended graduate school at New York University. That money paid not for a dorm room, but rather it helped her buy a co-op apartment in Greenwich Village. The rise of the Levy brothers, from scruffy bearded social workers in the 1970s to millionaires with homes in the Hamptons, Sutton Place and Palm Beach Gardens, reveals much about New York’s system for caring for the developmentally disabled — those with conditions like cerebral palsy, Down syndrome and autism. The state spends, by far, more than any other caring for this population: $10 billion this year, and roughly 20 cents of every dollar spent nationally. More than half of that money goes to private providers like the Levys, with little oversight of their spending. And the providers have become so big and powerful that they shape much about how the system operates, from what kinds of care are emphasized to how much they will be paid for it. “They’re bigger than government in some ways,” said Thomas A. Maul, former commissioner of the state’s Office of Mental Retardation and Developmental Disabilities. “That isn’t what our system was supposed to be.” The organization run by the Levys, the Young Adult Institute Network, has been among the most aggressive, and is now the largest operator of group homes for the state, collecting more than $1 billion from Medicaid over the past decade and running homes with a total of 700 beds, along with day programs, a school, dental care and transportation for the developmentally disabled. The organization and the Levys have earned many admirers in the field for the quality and range of their programs. They are known for recruiting and keeping good employees, many of whom spend decades with the organization. But their spending is seldom scrutinized, and, even when state officials turn up questionable expenses, there are few consequences. The state, of course, has a financial interest in maintaining and expanding the programs, which bring more federal money and more jobs, especially to areas upstate, where many of the nonprofit organizations are major employers. At the end of June, two days after The New York Times asked about the spending for his daughter’s apartment, Philip Levy, 60, abruptly retired as chief executive. Joel M. Levy, 67, also departed in June, after serving as a $250,000-a-year part-time consultant following his departure from the chief executive’s position in 2009. A spokesman said the changes were unrelated to the inquiry by The Times. Filling a Vacuum Philip and Joel Levy were running Saturday night bingo games to support a tiny program for 15 developmentally disabled people in the early 1970s when their whole world changed. In 1972, Geraldo Rivera, then a young reporter at WABC-TV, found his way inside the Willowbrook State School on Staten Island, a state-run institution that housed some 5,000 developmentally disabled residents in deplorable conditions. His footage showed naked children huddled on floors, feces smeared on walls, and an attendant oddly grinning through the darkness. Public outrage exploded. A lawsuit brought by a parents group, the New York State Association for Retarded Children, resulted in a court order that forced the state to quickly move thousands of people into smaller community homes. The state released a wave of public money and turned to nonprofit providers, which opened more than 100 group homes from 1976 through 1979. The Young Adult Institute, founded by a psychologist and his wife in 1957, emerged as a leader, opening and operating a dozen group homes. The Levy brothers were determined to be a part of the revolution in care, and ascended at the Young Adult Institute, eventually taking over the top jobs in 1979: Joel as executive director and Philip as associate executive director. Their ambition to expand sometimes conflicted with the views of the network’s board of directors, made up mostly of parents of children with developmental disabilities, who felt that the organization should remain small and focused on their children. Over the years, the parents were replaced by professionals from other fields who supported growth. 1 2 3 4 Next Page »

Somalis Waste Away as Insurgents Block Escape From Famine Posted: 04 Aug 2011 11:08 AM PDT MOGADISHU, Somalia — The Shabab Islamist insurgent group, which controls much of southern Somalia, is blocking starving people from fleeing the country and setting up a cantonment camp where it is imprisoning displaced people who were trying to escape Shabab territory. Enlarge This Image Tyler Hicks/The New York Times A malnourished child at Banadir Hospital in Mogadishu, Somalia. More than 500,000 Somali children are verging on starvation. More Photos » Multimedia Photographs Amid Famine, Dangers Hinder Aid to Somalia Photographs Amid Famine, Dangers Hinder Aid to Somalia Related Off Media Radar, Famine Garners Few Donations (August 2, 2011) How to Help Victims of the East Africa Famine (August 3, 2011) Food Crisis in Somalia Is a Famine, U.N. Says (July 21, 2011) Times Topic: Somalia Related in Opinion Dot Earth Blog: Somali Agony and the Outside World (August 2, 2011) The group is widely blamed for causing a famine in Somalia by forcing out many Western aid organizations, depriving drought victims of desperately needed food. The situation is growing bleaker by the day, with tens of thousands of Somalis already dead and more than 500,000 children on the brink of starvation. Every morning, emaciated parents with emaciated children stagger into Banadir Hospital, a shell of a building with floors that stink of diesel fuel because that is all the nurses have to fight off the flies. Babies are dying because of the lack of equipment and medicine. Some get hooked up to adult-size intravenous drips — pediatric versions are hard to find — and their compromised bodies cannot handle the volume of fluid. Most parents do not have money for medicine, so entire families sit on old-fashioned cholera beds, with basketball-size holes cut out of the middle, taking turns going to the bathroom as diarrhea streams out of them. “This is worse than 1992,” said Dr. Lul Mohamed, Banadir’s head of pediatrics, referring to Somalia’s last famine. “Back then, at least we had some help.” Aid groups are trying to scale up their operations, and the United Nations has begun airlifting emergency food. But many seasoned aid officials are speaking in grim tones because one of Africa’s worst humanitarian disasters in decades has struck one of the most inaccessible countries on earth. Somalia, especially the southern third where the famine is, has been considered a no-go zone for years, a lawless caldron that has claimed the lives of dozens of aid workers, peacekeepers and American soldiers, going back to the “Black Hawk Down” battle in 1993, spelling a legacy that has scared off many international organizations. “If this were Haiti, we would have dozens of people on the ground by now,” said Eric James, an official with the American Refugee Committee, a private aid organization. But Somalia is considered more dangerous and anarchic than Haiti, Iraq or even Afghanistan, and the American Refugee Committee, like other aid groups, is struggling to get trained personnel here. “It is safe to say that many people are going to die as a result of little or no access,” Mr. James said. This leaves millions of famished Somalis with two choices, aside from fleeing the country to neighboring Kenya or Ethiopia, where there is more assistance. They can beg for help from a weak and divided transitional government in Mogadishu, the capital. Just the other day there was a shootout between government forces at the gates of the presidential palace. “Things happen,” was the response of Abdiweli Mohamed Ali, Somalia’s new prime minister. Or they can remain in territory controlled by the Shabab, who have pledged allegiance to Al Qaeda and have tried to rid their areas of anything Western — Western music, Western dress, even Western aid groups during a time of famine. Much of the Horn of Africa, which includes Kenya, Somalia, Ethiopia, Eritrea and Djibouti, has been struck this summer by one of the worst droughts in 60 years. But two Shabab-controlled parts of southern Somalia are the only areas where the United Nations has declared a famine, using scientific criteria of death and malnutrition rates. People from those areas who were interviewed in Mogadishu say Shabab fighters are blocking rivers to steal water from impoverished villagers and divert it to commercial farmers who pay them taxes. The Shabab are intercepting displaced people who are trying to reach Mogadishu and forcing them to stay in a Shabab-run camp about 25 miles outside the city. The camp now holds several thousand people and receives only a trickle of food. “I was taken off a bus and put here,” said a woman at the camp who asked not to be identified. Several drought victims who have succeeded in making it to Mogadishu said that the Shabab were threatening to kill anyone who left their areas, either for refugee camps in Kenya and Ethiopia, or for government zones in Somalia, and that the only way out was to sneak away at night and avoid the main roads. A few years ago, the Shabab began banning immunizations, deeming them a Western plot to kill Somali children. Now countless unvaccinated children are dying from measles and cholera as tens of thousands of malnourished, immunity-suppressed people flee the drought areas and pack into filthy, crowded camps. The other day, Kufow Ali Abdi, a destitute herder who lost all his cattle, trudged out of Banadir Hospital, gently carrying a small package in his arms wrapped in blue cloth. It looked almost like a swaddled newborn but it was the opposite. It was the body of his 3-year-old daughter, Kadija, who had just succumbed to measles. “I just hope they can save the others,” he said, referring to his two remaining children, down to skin and bone. The magnitude of suffering could shift the political landscape, which has been dominated by chaos since 1991, when clan warlords overthrew the central government and then tore apart the country. The Transitional Federal Government — the 15th attempt at a government — is trying to assert itself and beat back the Shabab, and the famine and attendant relief effort could mean an enormous opportunity. “It could be a face-lift for them, an opportunity to deliver services and show they are committed,” said Sheik Abdulkadir, a militia leader. “But if a lot of people die here, people will say it’s the government’s fault.” The famine could affect the Shabab as well, deepening the fissures in their organization. Shabab leaders are now beginning to cut their own deals in the face of mass starvation. Unicef recently delivered a planeload of food and medicine to Baidoa, a Shabab stronghold. In Xarardheere, another Shabab-controlled town and a notorious pirate den, a Shabab commander said in an interview on Saturday that he would welcome Western aid organizations despite the anti-Western policies imposed by his leadership, which has been hit by the deaths of several prominent figures recently. Sheik Yoonis, a Shabab spokesman, said in an e-mail that the declaration of a famine was “an exaggeration.” He said that Shabab fighters were not imprisoning people in the camp, but that the people were attracted to it by “this sense of serenity and security.” He also denied that the Shabab were diverting river water or scaring away aid agencies. Still, many aid organizations are reluctant to venture into Shabab areas because of the obvious dangers — the Shabab have killed dozens of aid workers — and because of American government restrictions. In 2008, the State Department declared the Shabab a terrorist group, making it a crime to provide material assistance to them. Aid officials say the restrictions have had a chilling effect because it is nearly impossible to guarantee that the Shabab will not skim off some of the aid delivered in their areas. Even United Nations contractors have been accused of siphoning food aid, resulting in extensive investigations and cuts in life-saving assistance. Western aid agencies are now trying to work through Islamic and local organizations as much as possible, but the Somali partners do not usually have as much technical expertise. And heavy fighting has erupted in Mogadishu again, making it dangerous even for Somali aid workers. “Somalia is one of the most complicated places in the world to deliver aid, more complicated than Afghanistan,” said Stefano Porretti, who heads the World Food Progam’s efforts in Somalia and recently worked in Afghanistan. Mohammed Ibrahim contributed reporting.

Cases: A Worker With No ID and Great Medical Need Posted: 01 Aug 2011 09:20 PM PDT In San Francisco, where bicycle commuters often wear full-body spandex suits, my patient Carlos could easily be spotted: the Mexican man in mustard-colored work boots and painter’s overalls stained with gear grease, furiously pedaling an adolescent’s red Huffy. Enlarge This Image Tim Lane Related More Cases Columns He was the only patient I’ve ever had who rode a bike to his medical appointments, making his way from the docks under the Bay Bridge to our roving clinic about three miles across town. Our clinic for uninsured patients like Carlos was actually a converted cargo van that drove the back alleys of the city, stopping behind big-box stores and beneath bridges to repair cuts and scrapes among the city’s homeless population. We saw Carlos arrive in the van’s rear-view mirror. He would pant while locking his bike to the bumper, then wipe sweat off his upper lip and compose himself, extending a firm handshake to our nurse. I saw him so often with his helmet on that it was not until our third visit that I realized he was nearly bald. What I had noticed, though, was a growth the size of a golf ball emerging above his left clavicle that had begun to press on his airway, causing him to wheeze. “I come here as fast as I can,” he would say every time, apologizing for how long it took to ascend San Francisco’s hills. Carlos propped himself up on the exam table in the back of the van as our nurse rushed back and forth between the steering wheel and the filing cabinets of medical paperwork chained to the walls. In a normal doctor’s office, each of Carlos’s visits would have been carefully documented in a folder labeled with his last name in block letters, slipped into a wall of manila patient records. But here, we stapled the sheets together and slid them into an envelope at the back of a cabinet labeled “Undocumented.” Unlike most of our other patients, Carlos didn’t have any identification. He gladly paid out of pocket for ointments and creams for incidental cuts and bruises. But what he really needed was a biopsy, a $200 procedure that, given the location of the mass in his neck, could not be done safely in the back of a van. We could find no medical office willing to schedule an appointment for a man without identification. One private hospital sent us a typed note: “This unfortunate gentleman will not be eligible for services here.” We told Carlos to go to the emergency room of the public hospital, San Francisco General. He was not yet sick enough to be formally admitted, though, so he sat on a gurney for six hours and was charged $1,085 for a bag of intravenous salt water he didn’t really need. He was passed a note instructing him to “follow up with your primary care provider.” The hospital eventually gave him an appointment for a biopsy; it was scheduled in five months and three weeks. Carlos kept the yellow appointment slip in the front pocket of his overalls. He would bike with it; his sweat stained the paper until the edges wore thin. “I will not miss this,” he said whenever we reminded him of the date. As a temporizing show of support before his biopsy, we would see him every Tuesday at 5:30 p.m. He would roll in, wheezing, but would smile after a brief breathing treatment or 15 minutes with a heating pad on his shoulder. During those early weeks of September, the health care debates raged on television. We watched as President Obama told Congress that illegal immigrants would not get health care coverage. We heard someone yell, “You lie!” On any given day, the bodies of illegal immigrants lie in San Francisco’s coroner’s office, found by police or firefighters in alleys or on sidewalks, unclaimed and unnamed. Before they died, their medical costs may well have been passed on to taxpayers. But it’s also true that many were taxpayers themselves. From 2000 to 2005, illegal immigrant workers paid an estimated $6 billion to $7 billion in Social Security taxes and about $1.5 billion to Medicare, according to the Social Security Administration. And the president’s Council of Economic Advisers has estimated that illegal immigrants pay $80,000 more in taxes per person than they consume in government benefits over their lifetimes. The question of whether to insure Carlos and others like him is really a decision about whether to pay now or later — that is, to pay for preventive medical care now, or to pay in the future for hospital and emergency services, or for the internment of unclaimed bodies. Carlos stopped coming to his appointments. Our driver would wait an extra 30 minutes for him to reappear, brushing off demands from traffic cops to make way for the evening restaurant crowd. Weeks passed. Carlos’s friends from the docks approached the van, wondering if we had seen him. Early one morning, a clerk at the public hospital handed me a message. Carlos’s red bike had turned up at a police auction. Sold, for $32. I fear the growth in his throat may have been cancer, that it may have killed him. The coroner’s office cannot tell us, but it would not be that surprising, really. At the age of 50, Carlos already had surpassed by an entire year the average life expectancy of a migrant laborer in the United States. Dr. Sanjay Basu is a resident in internal medicine at the University of California, San Francisco. This essay was written as part of the university’s Partnership for Physician Advocacy Skills program. Dr. Sanjay Basu is a resident in internal medicine at the University of California, San Francisco. This essay was written as part of the university’s Partnership for Physician Advocacy Skills program.

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The Phantom Menace of Sleep Deprived Doctors Posted: 05 Aug 2011 08:14 AM PDT Last month something extraordinary happened at teaching hospitals around the country: Young interns worked for 16 hours straight — and then they went home to sleep. After decades of debate and over the opposition of nearly every major medical organization and 79 percent of residency-program directors, new rules went into effect that abolished 30-hour overnight shifts for first-year residents. Sanity, it seemed to people who had long been fighting for a change, had finally won out. Related A Life-Changing Case for Doctors in Training (March 3, 2009) Of course, the overworked, sleep-deprived doctor valiantly saving lives is an archetype that is deeply rooted in the culture of physician training, not to mention television hospital dramas. William Halsted, the first chief of surgery at Johns Hopkins in the 1890s and a founder of modern medical training, required his residents to be on call 362 days a year (only later was it revealed that Halsted fueled his manic work ethic with cocaine), and for the next 100 years the attitude of the medical establishment was more or less the same. Doctors, influenced by their own residency experiences, often see hospital hazing as the most effective way to learn the practice of medicine. But over the last three decades, a counterpoint archetype has emerged: the sleep-deprived, judgment-impaired young doctor in training who commits a serious medical error. “Doctors think they’re a special class and not subject to normal limitations of physiology,” says Dr. Christopher Landrigan, an associate professor at Harvard Medical School and one of the most influential voices calling for work-hour reform. A large body of research on the hazards of fatigue ultimately led to the new rule on overnight shifts by the Accreditation Council for Graduate Medical Education, the independent nonprofit group that regulates medical-residency programs. More than anything else, it was the death of 18-year-old Libby Zion 27 years ago that served as a catalyst for reform. Zion was jerking uncontrollably and had a fever of 103 degrees when she was admitted to New York Hospital on March 4, 1984. After she was admitted, Zion was given Tylenol and evaluated by a resident and an intern. They prescribed Demerol, a sedative. But her thrashing continued, and the intern on duty, who was just eight months out of medical school, injected another sedative, Haldol, and restrained her to the bed. Shortly after 6 a.m., the teenager’s fever shot up to 108 degrees and, despite efforts to cool her, she went into cardiac arrest. Seven hours after she was admitted, Libby Zion was declared dead. Libby’s father was Sidney Zion, a columnist for The Daily News. When Zion learned that his daughter’s doctor had by then been on duty for almost 24 hours and that young doctors were routinely awake for more than 36 hours, he sued the hospital and doctors and publicized the conditions he was convinced had led to her death. Stories about overtired interns appeared in major newspapers and on “60 Minutes.” Reforms followed, albeit slowly. In 1989, New York State cut the number of hours that doctors in training could work, setting a limit of 80 hours per week. And in 2003, the accreditation council imposed the 80-hour limit on all U.S. training programs, prohibited trainees from direct patient care after 24 hours of continuous duty and mandated at least one day off per week. To Landrigan, this was tremendous, if incomplete, progress. He ran a yearlong study during which a team of interns at Brigham and Women’s Hospital worked alternate rotations, one on the traditional schedule — a 30-hour shift every third night — and the other on a staggered schedule, during which the longest shift was only 16 hours. The results, published in 2004 in The New England Journal of Medicine, shocked the medical world. Interns working the traditional 30-hour shifts made 36 percent more serious medical errors, including ordering drug overdoses, missing a diagnosis of Lyme disease, trying to drain fluid from the wrong lung and administering drugs known to provoke an allergy. Thomas Nasca, the director of the accreditation council, cites this data as the single strongest argument for limiting doctors’ work hours. But this is where the neat story of the correlation between doctor fatigue and hospital error hits a wall. Landrigan’s research was compelling, but his study was small and controlled. In normal, day-to-day practice in hospitals across the country, medical errors didn’t fall when work hours were reduced. A massive national study of 14 million veterans and Medicare patients, published in 2009, showed no major improvement in safety after the 2003 reforms. The researchers parsed the data to see whether even a subset of hospitals improved, but the disappointing results appeared in hospitals of all sizes and all levels of academic rigor. “The fact that the policy appeared to have no impact on safety is disappointing,” says David Bates, a professor at the Harvard School of Public Health and a national authority on medical errors. 1 2 3 4 Next Page » Darshak Sanghavi (sanghavi@post.harvard.edu) is the chief of pediatric cardiology at UMass Medical School and Slate's health care columnist. Editor: Vera Titunik (v.titunik-MagGroup@nytimes.com)

Personal Health: Ancient Moves for Orthopedic Problems Posted: 03 Aug 2011 10:45 AM PDT With the costs of medical care spiraling out of control and an ever-growing shortage of doctors to treat an aging population, it pays to know about methods of prevention and treatment for orthopedic problems that are low-cost and rely almost entirely on self-care. As certain methods of alternative medicine are shown to have real value, some mainstream doctors who “think outside the box” have begun to incorporate them into their practices. Enlarge This Image Jason Lee FASTER THAN AN OPERATION The triangular forearm support may relieve shoulder pain in those with injured rotator cuffs. Related More Personal Health Columns One of them is Loren Fishman, a physiatrist — a specialist in physical and rehabilitative medicine affiliated with NewYork-Presbyterian/Columbia hospital. Some in the medical profession would consider Dr. Fishman a renegade, but to many of his patients he’s a miracle worker who treats their various orthopedic disorders without the drugs, surgery or endless months of physical therapy most doctors recommend. Many years ago, I wrote about Dr. Fishman’s nonsurgical treatment of piriformis syndrome, crippling pain in the lower back or leg caused by a muscle spasm in the buttocks that entraps the sciatic nerve. The condition is often misdiagnosed as a back problem, and patients frequently undergo surgery or lengthy physical therapy without relief. Dr. Fishman developed a simple diagnostic technique for piriformis syndrome and showed that an injection into the muscle to break up the spasm, sometimes followed by yoga exercises or brief physical therapy, relieves the pain in an overwhelming majority of cases. Nowadays yoga exercises form a centerpiece of his practice. Dr. Fishman, a lifelong devotee of yoga who studied it for three years in India before going to medical school, uses various yoga positions to help prevent, treat, and he says, halt and often reverse conditions like shoulder injuries, osteoporosis, osteoarthritis and scoliosis. I rarely devote this column to one doctor’s approach to treatment, and I’m not presenting his approach as a cure-all. But I do think it has value. And he has written several well-illustrated books that can be helpful if used in combination with proper medical diagnosis and guidance. For many years, yoga teachers and enthusiasts have touted the benefits to the body of this ancient practice, but it is the rare physician who both endorses it and documents its value in clinical tests. Dr. Fishman has done both. Rotator Cuff Relief This year, Dr. Fishman received a prize at the International Conference on Yoga for Health and Social Transformation for a paper he presented on a surprising yoga remedy for rotator cuff syndrome, a common shoulder injury that causes extreme pain when trying to raise one’s arm to shoulder height and higher. He described a modified form of a yoga headstand that does not require standing on the head and takes only 30 seconds to perform, and presented evidence that it could relieve shoulder pain in most patients, and that adding brief physical therapy could keep the problem from recurring. Rotator cuff injuries are extremely common, especially among athletes, gym and sports enthusiasts, older people, accident victims and people whose jobs involve repeated overhead motions. For patients facing surgery to repair a tear in the rotator cuff and many months of rehabilitation, the yoga maneuver can seem almost a miracle. It is especially useful for the elderly, who are often poor candidates for surgery. Dr. Fishman said he successfully treated a former basketball player, who responded immediately, and a 40-year-old magazine photographer who had torn his rotator cuff while on assignment. The photographer, he said, had been unable to lift his arm high enough to shake someone’s hand. Instead of an operation that can cost as much as $12,000, followed by four months of physical therapy, with no guarantee of success, Dr. Fishman’s treatment, is an adaptation of a yoga headstand called the triangular forearm support. His version can be done against a wall or using a chair as well as on one’s head. The maneuver, in effect, trains a muscle below the shoulder blade, the subscapularis, to take over the job of the injured muscle, the supraspinatus, that normally raises the arm from below chest height to above the shoulder. The doctor discovered the benefit of this technique quite accidentally. He had suffered a bad tear in his left shoulder when he swerved to avoid a taxi that had pulled in front of his car. Frustrated by an inability to practice yoga during the month he waited to see a surgeon, one day he attempted a yoga headstand. After righting himself, he discovered he could raise his left arm over his head without pain, even though an M.R.I. showed that the supraspinatus muscle was still torn. Dr. Fishman, who has since treated more than 700 patients with this technique, said it has helped about 90 percent of them. “It doesn’t work on everyone — not on string musicians, for example, whose shoulder muscles are overtrained,” he said in an interview. In a report published this spring in Topics in Geriatric Rehabilitation (an issue of the journal devoted to therapeutic yoga), he described results in 50 patients with partial or complete tears of the supraspinatus muscle. The initial yoga maneuver was repeated in physical therapy for an average of five sessions and the patients were followed for an average of two and a half years. The doctor and his co-authors reported that the benefits matched, and in some cases exceeded, those following physical therapy alone or surgery and rehabilitation. All the yoga-treated patients maintained their initial relief for as long as they were studied, up to eight years, and none experienced new tears. Yoga for Bone Disease Perhaps more important from a public health standpoint is the research Dr. Fishman is doing on yoga’s benefits to bones. Bone loss is epidemic in our society, and the methods to prevent and treat it are far from ideal. Weight-bearing exercise helps, but not everyone can jog, dance or walk briskly, and repeated pounding on knees and hips can eventually cause joint deterioration. Strength training, in which muscles pull on bones, is perhaps even more beneficial, and Dr. Fishman has observed that osteoporosis and resulting fractures are rare among regular yoga practitioners. In a pilot study that began with 187 people with osteoporosis and 30 with its precursor, osteopenia, he found that compliance with the yoga exercises was poor. But the 11 patients who did 10 minutes of yoga daily for two years increased bone density in their hips and spines while seven patients who served as controls continued to lose bone. He noted that yoga’s benefits also decrease the risk of falls, which can result in osteoporotic fractures. Medical guidance here is important, especially for older people who may have orthopedic issues that require adaptations of the yoga moves.

Well: The Claim: A Normal Heart Rate Is 60 to 100 Beats a Minute Posted: 01 Aug 2011 11:35 AM PDT

The New Old Age: When They Won't Spend the Money Posted: 04 Aug 2011 09:29 AM PDT

The New Old Age: A Blog Worth Reading Posted: 02 Aug 2011 01:20 PM PDT

Sales of Pain Drugs Help Pfizer’s Profit Beat Forecasts Posted: 02 Aug 2011 10:30 PM PDT Pfizer, the world’s biggest drug maker, reported second-quarter profit that topped analysts’ estimates as sales of pain medicines offset declining revenue from expired patents. Profit excluding some items was 60 cents a share, beating by a cent the average estimate of 16 analysts surveyed by Bloomberg. Revenue fell 0.9 percent to $16.98 billion, matching estimates. Sales of the company’s Lyrica pain pill and Enbrel arthritis medicine topped analysts’ predictions. Pfizer is selling its animal health and infant formula units and trimming its work force to prepare for the loss in November of exclusive rights to Lipitor, the world’s best-selling drug, with $10.7 billion in annual sales. Pfizer has three late-stage experimental medicines that analysts estimate may bring in more than $3.5 billion annually by 2015. “Investors are shifting their focus back to the pipeline, shifting back to the cost cutting and the share repurchases,” said Damien Conover, an analyst at Morningstar. “We probably have one more quarter where the divestitures will be of high interest, but people are going back to the core business.” Net income rose 5.2 percent to $2.61 billion, or 33 cents a share, from $2.48 billion, or 31 cents a share, a year earlier, the company said. Pfizer reiterated its 2011 profit forecast range of $2.16 to $2.26 a share. It also maintained its guidance for 2012, the first full year of generic competition to Lipitor. Shares of Pfizer, which is based in New York, fell 87 cents, or 4.5 percent, to $18.14. Revenue at Pfizer’s animal health division rose 18 percent to $1.056 billion for the quarter, the company said. Nutrition sales climbed 4 percent to $493 million. Sales of Pfizer’s Enbrel arthritis treatment rose 13 percent $914 million for the quarter. The pain pill Lyrica increased 19 percent to $908 million. Sales of legacy pain products, gained in March by the $3.3 billion acquisition of King Pharmaceuticals, added $357 million in sales, Pfizer reported. Lipitor had sales of $2.59 billion in the second quarter. Sales will decline by half next year after generics makers flood the United States market with cheaper copies, according to eight analysts surveyed. Pfizer’s most promising experimental drugs are its apixaban blood thinner, tofacitinib for rheumatoid arthritis and crizotinib for lung cancer. Crizotinib was accepted for priority review by the Food and Drug Administration, with a decision expected by the end of the year. Pfizer has said it will seek approval of tofacitinib and apixaban this year. The company is a partner with Bristol-Myers Squibb on apixaban.

The Consumer: The Doctor Will See You ... Eventually Posted: 01 Aug 2011 11:05 PM PDT “How much of human life is lost in waiting!” Ralph Waldo Emerson lamented in his 1841 essay “Prudence.” Enlarge This Image Tim Robinson Lately that observation has begun to seem particularly keen. I just did a quick tally: Over the past month, I have spent a total of six hours in three different medical offices, and nearly half of that time was spent just waiting to be seen. In one month alone, I lost three hours of this “human life” dawdling in waiting rooms. No one likes to be kept waiting. But it’s particularly annoying to spend an hour or more in a waiting room when you’re self-employed, like me; when you bill by the hour, as many lawyers, architects and designers do; or when you’re just plain busy. Lisa Qiu, 23, an inventor in Manhattan, recently waited for 50 minutes to see her gastroenterologist. During the wait, the receptionist quizzed Ms. Qiu about her bills and asked her to fork over that day’s co-payment. When the doctor finally called her in, “she didn’t bother to apologize,” said Ms. Qiu. Some consumers are clearly getting fed up. When MedPageToday.com, a medical information Web site, recently asked readers if they thought patients who were kept waiting for a scheduled appointment should get a discount on their bills, nearly half of the 3,200 respondents said yes. And 16 percent said that a discount wasn’t necessary but that waiting patients should get a small token, like a gift card, that compensated them for being inconvenienced. Thirty eight percent said no acknowledgment was necessary. Nationwide, the average wait time to see a doctor last year was 23 minutes, according to the health care consultants Press Ganey. Neurosurgeons have the longest wait times (30 minutes) and optometrists the shortest (17 minutes), according to the report. In urban areas and among certain specialties, however, the waits can be much longer. Doctors work very hard, of course, and they are treating humans, not car parts. Emergencies can throw a well-planned day into chaos, and doctors who accept insurance may feel forced to overbook their schedules to assure they can bill for every minute of the day. But still: Patients are paying customers who have financial and time pressures of their own. “You should be seen within a few minutes of a scheduled appointment,” said Dr. Mark Gray, medical director of West Care Medical Associates, a primary care group in Manhattan with six offices. “But it goes both ways. We expect our patients to be respectful of our time, too.” Rather than girding for combat, asking for discounts or storming out in a huff, consider a few ways to minimize (or at least cope with) protracted waits. FIND A NEW DOCTOR “I will not see a doctor who keeps me waiting for hours without a very good excuse and a very big apology,” said Rachel Schwartz, 47, a lawyer who lives in Brooklyn. “I have begun to surround myself with great doctors who don’t make me wait and who are as respectful of my time as I am of theirs.” If you set out to find a new doctor, be aware that an ultra-efficient practice may not be quite what you need, either. Many doctors schedule 10- to 15-minute appointments and speed through the day with robotic precision. A doctor who does not keep you waiting also may not spend much time with you. So be sure to ask about the length of appointments, too. A CONCIERGE PRACTICE If you can afford it, you may have better luck with a doctor that does not take insurance. Dr. Catherine Hart, an internist in Manhattan, allows 60 minutes when seeing a new patient and 30 minutes for an annual checkup. She does not accept insurance, but she rarely keeps patients waiting and is available 24/7 by phone or e-mail. By comparison, the average doctor’s visit today is around 19 minutes, according to the National Center for Health Statistics. “Everyone’s time is valuable,” Dr. Hart said. “We’re living in a medical mecca. Why put up with long waits?” SPEAK UP Julia Lloyd, 48, has a rare heart condition that few doctors in the country are qualified to treat. When she was repeatedly kept waiting by her specialist, she spoke to him directly. “By talking it over, I realized he wasn’t out playing golf or something. He was dealing with emergency situations and doing his best,” said Ms. Lloyd, who lives in the San Francisco Bay Area. After their conversation her doctor agreed to start informing the front desk when he was running late, so patients could know what to expect. “As patients, we need to learn how to speak up,” Ms. Lloyd said. “At the same time, doctors need to learn to listen.” BE ON TIME If you’re late, not only do you throw off the schedule for others, but you may be put at the end of a very long queue. Ask whether you have a firm appointment. Some offices with long waits book patients in groups — say, at 9 a.m., noon, and 4 p.m., Dr. Gray said. Patients are seen in the order in which they arrive. If that’s how your doctor’s office operates, ask if you can have a scheduled appointment instead; if not, show up 15 minutes before the specified hour. Book the first appointment of the day. You’ve probably heard this advice countless times. That’s because it works. Unless your doctor books blocks of patients at once or an emergency crops up, you’re likely to be seen pronto. CHECK IN Before you leave for an appointment, call to find out if the doctor is running late, or ask the minute you walk in the door. Ms. Lloyd now goes out to a nearby cafe if her doctor is delayed. NECESSARY APPOINTMENTS ONLY Sometimes small issues can be resolved without setting foot in the doctor’s office. If you’ve had a sinus headache for three days, for instance, you may not need an appointment. Your doctor’s office should be able to tell you over the phone that the best treatment is an over-the-counter antihistamine and an anti-inflammatory medication. Still, it’s impossible to completely avoid time in the waiting room. Heidi Boghosian, executive director of the National Lawyers Guild, has resigned herself to the fact that “some New York doctors double book or schedule appointments so closely that they need to juggle two or more patients in different examining rooms.” “When I’m left in the exam room, instead of sitting and worrying about when the doctor will show up, I now lie down on the examining table and focus on deep breathing,” said Ms. Boghosian, who lives in Lower Manhattan. Prudent. Emerson would approve.

Study Sheds Light on Auditory Role in Dyslexia Posted: 02 Aug 2011 09:28 AM PDT Many people consider dyslexia simply a reading problem in which children mix up letters and misconstrue written words. But increasingly scientists have come to believe that the reading difficulties of dyslexia are part of a larger puzzle: a problem with how the brain processes speech and puts together words from smaller units of sound. Well Share your thoughts on this column at the Well blog. Go to Well » Now, a study published last week in the journal Science suggests that how dyslexics hear language may be more important than previously realized. Researchers at the Massachusetts Institute of Technology have found that people with dyslexia have more trouble recognizing voices than those without dyslexia. John Gabrieli, a professor of cognitive neuroscience, and Tyler Perrachione, a graduate student, asked people with and without dyslexia to listen to recorded voices paired with cartoon avatars on computer screens. The subjects tried matching the voices to the correct avatars speaking English and then an unfamiliar language, Mandarin. Nondyslexics matched voices to avatars correctly almost 70 percent of the time when the language was English and half the time when the language was Mandarin. But people with dyslexia were able to do so only half the time, whether the language was English or Mandarin. Experts not involved in the study said that was a striking disparity. “Typically, you see big differences in reading, but there are just subtle general differences between individuals who are afflicted with dyslexia and individuals who aren’t on a wide variety of tests,” said Richard Wagner, a psychology professor at Florida State University. “This effect was really large.” Dr. Sally Shaywitz, a director of the Center for Dyslexia and Creativity at Yale University, said the study “demonstrates the centrality of spoken language in dyslexia — that it’s not a problem in meaning, but in getting to the sounds of speech.” That is why dyslexic children often misspeak, she said, citing two examples drawn from real life. “A child at Fenway Park watching the Red Sox said, ‘Oh, I’m thirsty. Can we go to the confession stand?,’ ” she said. “Another person crossing a busy intersection where many people were walking said, ‘Oh, those Presbyterians should be more careful.’ It’s not a question of not knowing, but being unable to attach what you know is the meaning to the sounds.” Dr. Gabrieli said the findings underscored a critical problem for dyslexic children learning to read: the ability of a child hearing, say, a parent or teacher speak to connect the auditory bits that make up words, called phonemes, with the sight of written words. If a child has trouble grasping the sounds that make up language, he said, acquiring reading skills will be harder. The research shows that spoken language deficiencies persist even when dyslexics learn to read well. The study subjects were mostly “high-functioning, high-I.Q. young adults who had overcome their reading difficulty,” Dr. Gabrieli said. “And yet when they had to distinguish voices, they were not one iota better with the English-language voices that they’ve heard all their life.” Experts said the new study also shows the interconnectedness of the brain processes involved in reading. Many scientists had considered voice recognition to be “like recognizing melodies or things that are primarily nonverbal,” Dr. Gabrieli said. Voice recognition was thought to be a separate task in the brain from understanding language. But this research shows that normal reading involves a “circuit, the ability to have all of those components integrated absolutely automatically,” said Maryanne Wolf, a dyslexia expert at Tufts University. “One of the great weaknesses in dyslexia is that the system is not able to integrate these phoneme-driven systems” with other aspects of language comprehension. As a follow-up, the M.I.T. researchers have been scanning the brains of subjects performing voice recognition and other activities, and have found “very big differences in dyslexics and nondyslexics in a surprisingly broad range of tasks,” Dr. Gabrieli said. “We think there might be a broader kind of learning that’s not operating very well in these individuals and that in some areas you can circumvent it pretty well. But in language and reading, it’s hard to circumvent.” One of the unusual aspects of the M.I.T. study is that it isolated the skill of processing vocal speech from reading and from skills involving the meaning of language, experts said. The sentences were basic, like “The boy was there when the sun rose,” and the Mandarin sounds meant nothing to the listeners. Dr. Wagner suggested that something like the voice-recognition task might be used to identify young children at risk for dyslexia. Often diagnostic tests require separating sounds from words. A child might be asked to say “cowboy” without the “boy” part. “For young children, it’s a real difficult task,” Dr. Wagner said. “Sometimes they’ll say, ‘cowboy without saying boy,’ because that’s exactly what you’ve asked them. The holy grail is to come up with tasks you can give to a 3-year-old.” Dr. Shaywitz said the study also has implications for teaching. If a teacher asked, “ ‘Oh, Johnny, what is the capital of New York State?,’ Johnny will go, ‘Uh, uh, uh,’ and the teacher will say, ‘Oh, gee, you don’t know it,’ ” Dr. Shaywitz said. “It’s more likely to be a problem of word retrieval than knowledge. If she reframes it as, ‘Is the capital Houston or Albany?,’ Johnny is more likely to answer correctly.”

Vital Signs: Screening: Mammograms Seen Ineffective in Europe Posted: 01 Aug 2011 11:05 PM PDT An analysis of data from six European countries suggests that mammography screening has had no effect on breast cancer mortality. Related Health Guide: Breast Cancer More Vital Signs Columns Deaths from breast cancer have declined substantially in most industrialized countries, but it is difficult to know how much of the decline is due to early detection, treatment, or the efficiency of health care systems. Researchers took advantage of a natural experiment in three pairs of countries. Some had instituted regular mammography screening significantly earlier than the others, but their health care systems and socioeconomic levels were nearly identical. The countries matched for comparison were Northern Ireland and the Republic of Ireland; the Netherlands and Belgium; and Sweden and Norway. The study, published online July 28 in the British medical journal BMJ, found that in all three cases, earlier implementation of screening had no effect on mortality. For example, in Northern Ireland, screening was introduced in the early 1990s, and by 1995, 75 percent of the women were getting mammograms. In the Republic of Ireland, screening was not introduced until 2000, and it was not until 2008 that 76 percent of the population was screened. Yet from 1989 to 2006, breast cancer mortality decreased by 29.6 percent in Northern Ireland and by 26.7 percent in Ireland. “We were surprised and quite sad to find that breast cancer screening doesn’t work,” said Dr. Philippe Autier, the lead author. “We were expecting to find the reverse.”

Recipes for Health: Plum, Red Grape and Almond Smoothie Posted: 04 Aug 2011 09:10 AM PDT 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: Fruit Smoothies for Summer (August 1, 2011) Recipes for Health: Watermelon Mint Smoothie (August 2, 2011) Recipes for Health: Fresh Fig and Date Shake (August 3, 2011) Recipes for Health: Peach Vanilla Smoothie (August 5, 2011) I decided to combine red grapes and plums here because of how well plums and wine go together in desserts. (I wasn’t about to attempt a red wine smoothie, but I hope this recipe inspires some daring mixologists.) 2 1/2 small or 2 large plums, pitted and sliced (about 3/4 cup sliced) 1/2 cup red grapes, rinsed 1 to 2 teaspoons rose geranium syrup 1 tablespoon almond meal 1/8 teaspoon vanilla extract 1/4 cup almond beverage 3 to 4 ice cubes 1. Place all of the ingredients in a blender and blend until frothy, about one minute. Yield: One serving. Nutritional information per serving: 177 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 1 gram monounsaturated fat; 0 milligrams cholesterol; 34 grams carbohydrates; 3 grams dietary fiber; 42 milligrams sodium; 3 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

Recipes for Health: Fresh Fig and Date Shake Posted: 04 Aug 2011 09:10 AM PDT 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: Fruit Smoothies for Summer (August 1, 2011) Recipes for Health: Watermelon Mint Smoothie (August 2, 2011) Recipes for Health: Plum, Red Grape and Almond Smoothie (August 4, 2011) Recipes for Health: Peach Vanilla Smoothie (August 5, 2011) Many of us who frequent farmers’ markets this time of year bring home far more figs than we need. This thick, date-sweetened smoothie is a great way to get rid of the extras. 4 fresh ripe figs (about 4 ounces) 2 moist, plump Medjool dates (about 1 1/2 ounces) 1/2 cup freshly squeezed orange juice 4 ice cubes A few fig slices for the glass 1. Place all of the ingredients except the sliced fig in the blender. Blend until frothy, about one minute. Pour into a glass, garnish with fig slices, and serve at once. Yield: One serving. Nutritional information per serving: 285 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 74 grams carbohydrates; 7 grams dietary fiber; 3 milligrams sodium; 3 grams protein Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

Recipes for Health: Watermelon Mint Smoothie Posted: 04 Aug 2011 08:56 AM PDT 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: Fruit Smoothies for Summer (August 1, 2011) Recipes for Health: Fresh Fig and Date Shake (August 3, 2011) Recipes for Health: Plum, Red Grape and Almond Smoothie (August 4, 2011) Recipes for Health: Peach Vanilla Smoothie (August 5, 2011) I’m always tossing watermelon with fresh mint, so I decided to see how the two would blend in a smoothie. The result is like a cross between a sweet mint tea and a watermelon agua fresca. 2 cups, tightly packed, diced seedless watermelon 1 tablespoon fresh mint leaves 1 teaspoon sugar, agave syrup or vanilla sugar 3 to 4 ice cubes (more to taste) Watermelon balls for garnish 1. Place all of the ingredients except the watermelon balls in the blender. Blend until frothy, about one minute. Pour into a glass, and garnish with watermelon balls. Serve right away. Yield: One serving. Nutritional information per serving: 110 calories; 0 grams saturated fat; 0 grams polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 28 grams carbohydrates; 1 gram dietary fiber; 6 milligrams sodium; 2 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Fruit Smoothies for Summer Posted: 04 Aug 2011 08:56 AM PDT When I go to a farmers’ market in summer, I can’t resist buying more fruit than I need. I blame those cut fruit samples — one taste, and I’m filling my bag. 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: Watermelon Mint Smoothie (August 2, 2011) Recipes for Health: Fresh Fig and Date Shake (August 3, 2011) Recipes for Health: Plum, Red Grape and Almond Smoothie (August 4, 2011) Recipes for Health: Peach Vanilla Smoothie (August 5, 2011) Fruit from the market is already ripe, and there are times when I need to use up what I have. Smoothies are a great solution; you can blend a lot of fruit into one drink, more than you’d cut up and stir into your morning yogurt. This week I tried something different. I didn’t use frozen bananas in these recipes, as I usually do for smoothies, and I decided not to use dairy. Some of this week’s offerings are pure fruit and ice, sweetened with a rose geranium-infused syrup or agave nectar. When I needed to bulk up a smoothie or make it creamier, I used almond milk. Except for one made with dates and figs, you’ll find these smoothies only moderately sweet. In all of them, you can really taste the fruit. Berry and Rose Geranium Smoothie Fragrant rose geranium is very easy to grow in pots, and a little goes a long way. I use it to make a syrup that I add to just about anything I make with berries. 1/2 cup blueberries 1/2 cup raspberries 3/4 cup hulled strawberries 2 to 3 tablespoons rose geranium syrup (see below) 4 ice cubes 1. Place all of the ingredients in the blender. Blend until frothy, about one minute. Serve at once. Yield: One serving. Rose Geranium Syrup 1/2 cup sugar 1/2 cup water 2 sprigs rose geranium Combine the sugar and water, and bring a to a boil. Reduce the heat, and simmer three to five minutes until slightly thick. Add the rose geranium sprigs to the pot, turn off the heat and cover tightly. Allow the rose geranium to steep for 15 minutes. Strain into a jar, and place in the refrigerator. The syrup will keep for about a week. Yield: A little less than 1 cup. Nutritional information per serving: 157 calories; 0 grams saturated fat; 1 gram polyunsaturated fat; 0 grams monounsaturated fat; 0 milligrams cholesterol; 39 grams carbohydrates; 8 grams dietary fiber; 3 milligrams sodium; 2 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

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