HEALTH

HEALTH http://www.therochesterdemocrat.com/ee/index.php en editor@TheRochesterDemocrat.com Copyright 2008 2008-07-01T11:54:01-06:00 Dr. Alan Goldbloom: Get ready for higher medical costs http://www.therochesterdemocrat.com/index.php/weblog/dr_alan_goldbloom_get_ready_for_higher_medical_costs/ {summary} Health Insurance Health-care consumers will feel the sting of the Legislature's decision to cut payment rates.

By DR. ALAN GOLDBLOOM
Star Tribune
June 30, 2008

While the close of the 2008 session was largely dominated by the topic of health-care reform, another significant topic missed the public's attention -- how legislators balanced the state's $935 million budget shortfall. As part of the budget-balancing work, the Legislature voted, once again, to cut payment rates to hospitals serving individuals insured by our public programs, Medical Assistance (MA) and General Assistance Medical Care (GAMC).

If you've already tuned out, tune back in. Every person with private health insurance will help pay for this cut. Let me explain.

Hospitals get paid by two main sources: private insurance and the government's public programs.

The problem is the government pays hospitals less than it costs to provide care to people with MA and GAMC. As of July 1, it got worse. Currently, hospitals are paid at 11.5 percent below the cost of providing care in 2002. The Legislature needed more money to balance its books, so it increased the discount to 14.96 percent below 2002 costs.

In other words, the reimbursement formula used to determine hospital payment rates is based on what it cost to deliver care in 2002, minus 14.96 percent.

Hospitals lose money on every patient they served with MA coverage. For example, Children's Hospitals and Clinics of Minnesota, where I serve as CEO, derives 40 percent of its revenue from the Medicaid program. This means that, because we serve a very large number of low-income children, the new rate cut hurts us deeply. For hospitals, the more Medical Assistance patients you serve, the more money you lose.

Hospitals must make up for those losses by having private insurance pay more. Private insurance passes on to their enrollees the higher costs through higher premiums. It is no coincidence that health-insurance premiums continue to rise at the same time government payments to hospitals continue to fall.

Some lawmakers will tell you they were forced to cut hospital rates as a way of managing the state's budget deficit. Faced with less money coming into the state's coffers than proposed expenses, how did lawmakers balance the budget? They took two major actions: They cut hospital payment rates and spent 70 percent of the state's savings account.

By cutting hospitals, the state saved $109 million over three years. But, because the Medical Assistance program has a federal match, hospitals lose two dollars for every dollar the state saves. This loss of federal-matching dollars doubles the impact of the state's decision.

The state's budget problems are not going away. Looking ahead, another budget shortfall is projected, this one worse than the one in 2008.

As an individual, you would manage this problem either by cutting expenses or by trying to make more money. The state has the same options.

If individuals and the business community are tired of paying more in health-insurance premiums, everyone must voice their concerns about future cuts to hospitals. Because when the state makes a shortsighted decision to cut hospital payments, everyone pays.

Dr. Alan Goldbloom, St. Paul, is the chairman of the Minnesota Hospital Association Board of Directors and CEO of Children's Hospitals and Clinics of Minnesota.

]]> 2008-07-01T11:54:01-06:00 The 11 Best Foods You Aren’t Eating http://www.therochesterdemocrat.com/index.php/weblog/the_11_best_foods_you_arent_eating/ {summary} Food beets cabbageMaybe you should be eating more beets, left, or chopped cabbage. (Credit: Evan Sung for The New York Times, left

Nutritionist and author Jonny Bowden has created several lists of healthful foods people should be eating but aren’t. But some of his favorites, like purslane, guava and goji berries, aren’t always available at regular grocery stores. I asked Dr. Bowden, author of “The 150 Healthiest Foods on Earth,” to update his list with some favorite foods that are easy to find but don’t always find their way into our shopping carts. Here’s his advice.

You can find more details and recipes on the Men’s Health Web site, which published the original version of the list last year.

In my own house, I only have two of these items — pumpkin seeds, which I often roast and put on salads, and frozen blueberries, which I mix with milk, yogurt and other fruits for morning smoothies. How about you? Have any of these foods found their way into your shopping cart?

]]> 2008-07-01T11:13:00-06:00 Fit, Not Frail: Exercise as a Tonic for Aging http://www.therochesterdemocrat.com/index.php/weblog/fit_not_frail_exercise_as_a_tonic_for_aging/ {summary} Lifestyle

By JANE E. BRODY
NY Times
Published: June 24, 2008

Fact: Every hour of every day, 330 Americans turn 60.

Fact: By 2030, one in five Americans will be older than 65.

Fact: The number of people over 100 doubles every decade.

Fact: As they age, people lose muscle mass and strength, flexibility and bone.

Fact: The resulting frailty leads to a loss of mobility and independence.

The last two facts may sound discouraging. But they can be countered by another. Regular participation in aerobics, strength training and balance and flexibility exercises can delay and may even prevent a life-limiting loss of physical abilities into one’s 90s and beyond.

This last fact has given rise to a new group of professionals who specialize in what they call “active aging” and an updated series of physical activity recommendations for older adults from the American Heart Association and the American College of Sports Medicine. These recommendations are expected to match new federal activity guidelines due in October from the United States Health and Human Services Department.

But you need not — indeed should not — wait for the government. Even if you have a chronic health problem or physical limitation, there are safe ways to improve fitness and well-being. Any delay can increase the risk of injury and make it harder to recoup your losses.

Miriam E. Nelson, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University in Boston and lead author of the new recommendations, observed last fall in The Journal on Active Aging that “with every increasing decade of age, people become less and less active.”

“But,” Dr. Nelson said, “the evidence shows that with every increasing decade, exercise becomes more important in terms of quality of life, independence and having a full life. So as of now, Americans are not on the right path.”

Jim Concotelli of the Horizon Bay Senior Communities in Tampa, who oversees fitness and wellness program development for communities for the elderly in several states, noted this year in The Journal on Active Aging that many older Americans were unfamiliar with exercise activities and feared that they would cause injury and pain, especially if they have arthritis or other chronic problems. Yet by strengthening muscles, he said, they can improve joints and bones and function with less pain and less risk of injury.

The key is start slowly and build gradually as ability and strength improve. Most important is simply to start — now— perhaps under the guidance of a fitness professional or by creating a program based on the guidelines outlined here.

Although medical clearance may not be necessary for everyone for the moderate level of activity suggested, those with a known or possible problem would be wise to consult a doctor. And a few sessions with a trainer can help assure that the exercises are being done correctly and not likely to cause injury.

Until recently, physical activity recommendations for all ages have emphasized aerobics, or cardiovascular conditioning, through moderate to vigorous activities like brisk walking, cycling, lap swimming or jogging for half an hour a day five or more days a week. For those unable to do 30 minutes at a time, the activities can be broken up into three 10-minute intervals a day. If you have long been sedentary, start with even shorter intervals.

For people who prefer indoor workouts, a treadmill, cross-trainer, step machine or exercise bike can provide excellent aerobic training for the heart, lungs and circulation. Those unable to do weight-bearing exercise might try swimming or water aerobics. Keep in mind that 30 minutes a day of aerobic activity five days a week is the minimum recommendation. More is better and can reduce the risk of chronic disease related to inactivity.

Contrary to what many active adults seem to believe, physical fitness does not end with aerobics. Strength training has long been advocated by the National Institute on Aging, and the heart association has finally recognized the added value of muscle strength to reduce stress on joints, bones and soft tissues; enhance stability and reduce the risk of falls; and increase the ability to meet the demands of daily life, like rising from a chair, climbing stairs and opening jars.

Strength training can be done in a gym on a series of machines, each working a different set of major muscle groups: hips, legs, chest, back, shoulders, arms and abdomen. Or it can be done at home with resistance bands or tubes, hand-held barbells or dumbbells or even body weight. One program, the Key 3 program diagrammed here, was devised by Michael J. Hewitt, research director for exercise science at the Canyon Ranch Health Resort in Tucson. It can be completed in 10 minutes with practice.

As Dr. Hewitt explained in the International Longevity Center-USA newsletter, skeletal muscles can only contract and thus are always arranged in pairs. “One muscle of the pair pulls to bend the joint (flexion), and its antagonist pulls to straighten the joint (extension).” Thus, a strengthening program must be balanced, he said, “pairing every pulling lift with an opposite pushing action.”

Dr. Hewitt emphasized that to reduce the risk of injury and premature muscle fatigue, the large muscles should be exercised first, followed by the smaller muscles, with the postural muscles exercised last. For example, one would start with chest and upper back muscles, then the arms and shoulders and finally the lower back and abdomen.

Muscles have to be overworked to grow stronger. The goal for each exercise is three sets of 8 to 12 repetitions to muscle fatigue. Muscles also need time to recover. So strength training should be done two or three times a week on nonconsecutive days.

The new recommendations add flexibility and balance to the mix. Improving balance and reducing the risk of falls is critical as you age — if you fall, break your hip and die of pneumonia, aerobic capacity will not save you. Ten minutes a day stretching legs, arms, shoulders, hips and trunk can help assure continued mobility, and daily exercises like standing on one foot and then the other, walking heel to toe or practicing tai chi can improve balance.

The recommendations, issued last August, are geared to healthy adults 18 to 64, with a companion set for those 65 and older or those 50 to 64 who have chronic health problems or physical limitations. Details can be found at www.acsm.org. Under “Influence,” click on Physical Activity Guidelines From ACSM and AHA.

The experts who made these recommendations urge all adults to adopt them now. As C. Jessie Jones, co-director of the Center for Successful Aging at California State University, Fullerton, said, “People can’t wait until they’re in residential or long-term care to get started.”

]]> 2008-06-28T13:20:00-06:00 Your Brain Lies to You http://www.therochesterdemocrat.com/index.php/weblog/your_brain_lies_to_you/ {summary} Mental Health

By SAM WANG and SANDRA AAMODT
NY Times
Published: June 27, 2008

FALSE beliefs are everywhere. Eighteen percent of Americans think the sun revolves around the earth, one poll has found. Thus it seems slightly less egregious that, according to another poll, 10 percent of us think that Senator Barack Obama, a Christian, is instead a Muslim. The Obama campaign has created a Web site to dispel misinformation. But this effort may be more difficult than it seems, thanks to the quirky way in which our brains store memories — and mislead us along the way.

The brain does not simply gather and stockpile information as a computer’s hard drive does. Facts are stored first in the hippocampus, a structure deep in the brain about the size and shape of a fat man’s curled pinkie finger. But the information does not rest there. Every time we recall it, our brain writes it down again, and during this re-storage, it is also reprocessed. In time, the fact is gradually transferred to the cerebral cortex and is separated from the context in which it was originally learned. For example, you know that the capital of California is Sacramento, but you probably don’t remember how you learned it.

This phenomenon, known as source amnesia, can also lead people to forget whether a statement is true. Even when a lie is presented with a disclaimer, people often later remember it as true.

With time, this misremembering only gets worse. A false statement from a noncredible source that is at first not believed can gain credibility during the months it takes to reprocess memories from short-term hippocampal storage to longer-term cortical storage. As the source is forgotten, the message and its implications gain strength. This could explain why, during the 2004 presidential campaign, it took some weeks for the Swift Boat Veterans for Truth campaign against Senator John Kerry to have an effect on his standing in the polls.

Even if they do not understand the neuroscience behind source amnesia, campaign strategists can exploit it to spread misinformation. They know that if their message is initially memorable, its impression will persist long after it is debunked. In repeating a falsehood, someone may back it up with an opening line like “I think I read somewhere” or even with a reference to a specific source.

In one study, a group of Stanford students was exposed repeatedly to an unsubstantiated claim taken from a Web site that Coca-Cola is an effective paint thinner. Students who read the statement five times were nearly one-third more likely than those who read it only twice to attribute it to Consumer Reports (rather than The National Enquirer, their other choice), giving it a gloss of credibility.

Adding to this innate tendency to mold information we recall is the way our brains fit facts into established mental frameworks. We tend to remember news that accords with our worldview, and discount statements that contradict it.

In another Stanford study, 48 students, half of whom said they favored capital punishment and half of whom said they opposed it, were presented with two pieces of evidence, one supporting and one contradicting the claim that capital punishment deters crime. Both groups were more convinced by the evidence that supported their initial position.

Psychologists have suggested that legends propagate by striking an emotional chord. In the same way, ideas can spread by emotional selection, rather than by their factual merits, encouraging the persistence of falsehoods about Coke — or about a presidential candidate.

Journalists and campaign workers may think they are acting to counter misinformation by pointing out that it is not true. But by repeating a false rumor, they may inadvertently make it stronger. In its concerted effort to “stop the smears,” the Obama campaign may want to keep this in mind. Rather than emphasize that Mr. Obama is not a Muslim, for instance, it may be more effective to stress that he embraced Christianity as a young man.

Consumers of news, for their part, are prone to selectively accept and remember statements that reinforce beliefs they already hold. In a replication of the study of students’ impressions of evidence about the death penalty, researchers found that even when subjects were given a specific instruction to be objective, they were still inclined to reject evidence that disagreed with their beliefs.

In the same study, however, when subjects were asked to imagine their reaction if the evidence had pointed to the opposite conclusion, they were more open-minded to information that contradicted their beliefs. Apparently, it pays for consumers of controversial news to take a moment and consider that the opposite interpretation may be true.

In 1919, Justice Oliver Wendell Holmes of the Supreme Court wrote that “the best test of truth is the power of the thought to get itself accepted in the competition of the market.” Holmes erroneously assumed that ideas are more likely to spread if they are honest. Our brains do not naturally obey this admirable dictum, but by better understanding the mechanisms of memory perhaps we can move closer to Holmes’s ideal.

Sam Wang, an associate professor of molecular biology and neuroscience at Princeton, and Sandra Aamodt, a former editor in chief of Nature Neuroscience, are the authors of “Welcome to Your Brain: Why You Lose Your Car Keys but Never Forget How to Drive and Other Puzzles of Everyday Life.”

]]> 2008-06-28T13:09:00-06:00 Studies Find Link Between Alzheimer’s, Calcium http://www.therochesterdemocrat.com/index.php/weblog/studies_find_link_between_alzheimers_calcium/ {summary} Research

by Jonathan Hamilton
MPR Radio
All Things Considered
June 25, 2008 ·

Sticky clumps of protein called amyloid usually get the blame for causing Alzheimer's disease. But the real culprit may be calcium, according to a pair of studies published in the research journals Cell and Neuron.

"These two papers together will force everyone in the Alzheimer's field to put the calcium hypothesis much more on the map than it has been," says Kevin Foskett of the University of Pennsylvania, who is an author on both studies.

"This begins to suggest that calcium may be something we can't afford to ignore," says Sam Gandy, chairman of the national Medical and Scientific Advisory Council of the Alzheimer's Association and an Alzheimer's researcher at Mount Sinai School of Medicine in New York.

The new studies look at the connection between Alzheimer's and the way brain cells regulate the amount of calcium they contain.

In order to stay healthy, brain cells need to maintain just the right amount of calcium at any given moment. That depends on the cells responding to signals from elsewhere in the brain.

Foskett and others say an abnormal response to these signals leads to abnormal calcium levels in brain cells, which ultimately leads to Alzheimer's.

One of the new studies appears to confirm the link between calcium and Alzheimer's. It identifies a gene linked to both Alzheimer's and the calcium balance in brain cells.

Researchers found that people who carry one copy of the gene are at least 44 percent more likely to develop the disease.

The study's lead author, Philippe Marambaud of Albert Einstein Medical College in New York, says scientists have been able to discover which chemicals in the brain are produced by the gene.

"So we have potentially not only identified a new risk factor, but also a gene product that could be targeted for drug discovery and therapy," Marambaud says.

He says future drugs might be designed to correct abnormal calcium levels in brain cells. So far, efforts to treat Alzheimer's have focused on preventing or eliminating the buildup of amyloid.

The second study suggests how an imbalance in calcium might actually cause Alzheimer's.

Researchers looked at brain cells from people who have a rare, inherited form of the disease that can strike before the age of 40. They found that these people carry genes that not only cause amyloid buildup, but also problems with calcium regulation.

And the researchers found that when calcium regulation went awry, brain cells produced more amyloid.

Gandy of the Alzheimer's Association says this suggests a new way of looking at an old disease.

"It seems that calcium and amyloid have a sort of hand-and-glove relationship," Gandy says. "So one can cause the other and they can begin a vicious cycle that we think can lead to the disease."

]]> 2008-06-26T11:11:00-06:00 New clue to Alzheimer’s found http://www.therochesterdemocrat.com/index.php/weblog/new_clue_to_alzheimers_found/ {summary} Research

WASHINGTON (AP) - Researchers have uncovered a new clue to the cause of Alzheimer's disease.

The brains of people with the memory-robbing form of dementia are cluttered with a plaque made up of beta-amyloid, a sticky protein. But there long has been a question whether this is a cause of the disease or a side effect. Also involved are tangles of a protein called tau; some scientists suspect this is the cause.

Now, researchers have caused Alzheimer's symptoms in rats by injecting them with one particular form of beta-amyloid. Injections with other forms of beta-amyloid did not cause illness, which may explain why some people have beta-amyloid plaque in their brains but do not show disease symptoms.

The findings by a team led by Dr. Ganesh M. Shankar and Dr. Dennis J. Selkoe of Harvard Medical School were reported in Sunday's online edition of the journal Nature Medicine.

The researchers used extracts from the brains of people who donated their bodies to medicine.

Forms of soluble beta-amyloid containing different numbers of molecules, as well as insoluble cores of the brain plaque, were injected into the brains of rats. There was no detectable effect from the insoluble plaque or the soluble one-molecule or three-molecule forms, the researchers found.

But the two-molecule form of soluble beta-amyloid produced characteristics of Alzheimer's in the rats, they reported.

Those rats had impaired memory function, especially for newly learned behaviors. Studies were also done on mice and when their brains were inspected, the density brain cells were reduced by 47 percent. The beta-amyloid seemed to affect synapses, the connections between cells that are essential for communication between them.

The research, for the first time, showed the effect of a particular type of beta-amyloid in the brain, said Dr. Marcelle Morrison-Bogorad, director of the division of neuroscience at the National Institute on Aging, which helped fund the research.

It was surprising that only one of the three types had an effect, she said in a telephone interview.

Morrison-Bogorad said the findings may help explain the discovery of plaque in the brains of people who do not develop dementia. For some time, doctors have wondered why they find some brains in autopsy that are heavily coated with beta-amyloid, but the person did not have Alzheimer's.

The answer may lie in the two types of beta-amyloid that did not cause symptoms.

Now, the question is why one has the damaging effect and not others.

"A lot of work needs to be done," Morrison-Bogorad said. "Nature keeps sending us down paths that look straight at the beginning, but there are a lot of curves before we get to the end."

Dr. Richard J. Hodes, director of the National Institute on Aging, said that "while more research is needed to replicate and extend these findings, this study has put yet one more piece into place in the puzzle that is Alzheimer's."

In addition to the Institute on Aging, the research was funded by Science Foundation Ireland, Wellcome Trust, the McKnight and Ellison foundations and the Lefler Small Grant Fund.

---

On the Net:

Nature Medicine: http://www.nature.com/naturemedicine

National Institute on Aging: http://www.nia.nih.gov

]]> 2008-06-23T11:29:00-06:00 Calif. cracks down on 13 genetic testing startups http://www.therochesterdemocrat.com/index.php/weblog/calif_cracks_down_on_13_genetic_testing_startups/ {summary} Genetic Engineering

SAN FRANCISCO (AP) - California health regulators have demanded that 13 direct-to-consumer genetic testing startups halt sales in the state until they prove they meet state standards.

The state Department of Public Health sent the cease-and-desist letters last week following an investigation spurred by consumer complaints about the tests' accuracy and cost, a department spokeswoman said Monday.

Two of the most visible companies to offer consumer genetic tests - Redwood Shores-based Navigenics Inc. and Mountain View-based 23andMe Inc. - confirmed receiving the letters.

Health officials would not identify the companies involved until confirming they had received the letters but said all the targeted companies advertise on the Internet.

All the companies have two weeks to demonstrate to regulators that their laboratories are certified by the state and federal governments, said department spokeswoman Lea Brooks. The startups also must show the tests they are selling California residents have been ordered by a doctor as required by state law.

"There's either concern they don't have a license, there isn't a physician's order, or both," Brooks said. "That's what's under investigation."

Companies face fines of up to $3,000 a day.

The New York State Department of Health issued similar notices to nearly two dozen testing companies in April.

The crackdowns follow the launch of a batch of new DNA analysis services spawned by recent genetic discoveries. The mostly Web-based services will scan customers' genes to spot potential health risks, from cancer to lower back pain.

State and federal public health officials have urged consumers to be skeptical, pointing out that related research is in its earliest stages and doctors have little training in interpreting the results.

The federal Food and Drug Administration does not evaluate the tests for accuracy, though a federal panel recently recommended stepped-up oversight to ensure their validity.

A spokeswoman for 23andMe, which has financial backing from Google Inc. (GOOG) and Genentech Inc. (DNA), described the company as an "informational service."

"What we do is offer people information about their genetic makeup, including ancestry and applicable scientific research," spokeswoman Rachel Cohen said. The company scans customers' DNA for about $1,000. Cohen declined to say Monday whether 23andMe had halted sales in California.

Navigenics charges $2,500 to screen nearly 2 million genetic markers in a DNA sample - typically a swab of saliva - for potential health risks.

In a statement released Monday, Navigenics said it believed it was in full compliance with California law. The company said it would submit details to regulators showing its labs were certified and its tests are ordered and reviewed by California-licensed physicians.

]]> 2008-06-17T01:54:00-06:00 Tomatoes pulled off shelves amid salmonella scare http://www.therochesterdemocrat.com/index.php/weblog/tomatoes_pulled_off_shelves_amid_salmonella_scare/ {summary} Food

CHICAGO (AP) - Federal officials hunted for the source of a 17-state salmonella outbreak linked to three types of raw tomatoes, while the list of supermarkets and restaurants yanking those varieties from shelves and menus grew.

McDonald's, Wal-Mart, Burger King, Kroger, Outback Steakhouse, Winn-Dixie and Taco Bell were among the companies that voluntarily withdrew red plum, red Roma or round red tomatoes unless they were grown in certain states and countries.

In addition, officials at the Los Angeles Unified School District - the nation's second largest - said Monday they have "indefinitely suspended" serving uncooked tomatoes.

The FDA is investigating the source of the outbreak, agency spokeswoman Kimberly Rawlings said. "We are working hard and fast on this one and hope to have something as quickly as possible," Rawlings said Monday.

Cherry tomatoes, grape tomatoes, tomatoes sold with the vine still attached and homegrown tomatoes are likely not the source of the outbreak, federal officials said.

Also not associated with the outbreak are raw red Roma, red plum and round red tomatoes from Arkansas, California, Georgia, Hawaii, North Carolina, South Carolina, Tennessee, Texas, Belgium, Canada, Dominican Republic, Guatemala, Israel, Netherlands and Puerto Rico.

The Centers for Disease Control and Prevention has said that since mid-April, 167 people infected with salmonella with the same "genetic fingerprint" have been identified. At least 23 people have been hospitalized.

A 67-year-old cancer patient in Texas who health officials said was sickened by salmonella at a Mexican restaurant is believed to be the first death associated with the outbreak.

The death of Raul Rivera last week has been officially attributed to his cancer, but Houston health department spokeswoman Kathy Barton told the Houston Chronicle in Tuesday's editions that the salmonella strain was a contributing factor.

Rivera's wife said he was hospitalized after eating pico de gallo, a tomato-based condiment, in late May while celebrating good news about his cancer treatment.

Salmonella is a bacteria that lives in the intestinal tracts of humans and other animals. The bacteria are usually transmitted to humans by eating foods contaminated with animal feces.

Most infected people suffer fever, diarrhea and abdominal cramps starting 12 to 72 hours after infection. The illness tends to last four to seven days.

The Food and Drug Administration warned consumers in New Mexico and Texas as early as June 3 about the outbreak. The agency expanded its warning during the weekend and chains began voluntarily removing many red plum, red Roma or round red tomatoes from their shelves in response.

The salmonella causing the outbreak is a very unusual type called salmonella saintpaul, said FDA Commissioner Andrew C. von Eschenbach, who added it was not more virulent than other types of salmonella.

McDonald's, the world's largest hamburger chain, stopped serving sliced tomatoes on its sandwiches as a precaution, but will continue serving grape tomatoes in its salads because no problems have been linked to that variety.

The decision didn't upset Connie Semaitis, a 49-year-old travel agent in downtown Chicago, who bought a cheeseburger and a drink at a McDonald's during lunch hour Monday.

"I'd rather be safe than sorry," Semaitis said.

Tampa-based OSI Restaurant Partners LLC, which owns and operates eight brands including Outback Steakhouse, Carrabba's and Bonefish Grill, said it stopped serving all raw tomatoes other than grape tomatoes on Saturday evening. The company also instructed restaurants to discard salsa and other prepared foods containing raw tomatoes.

Burger King Corp. said it had withdrawn raw round red tomatoes from most of its U.S. restaurants, as well as locations in Canada and Puerto Rico and some other Caribbean islands. Some California restaurants continued using the tomatoes because they buy from growers in states the FDA has said are not involved in the outbreak, Burger King said.

Other restaurant operators that stopped serving most tomatoes: Yum Brands Inc. (YUM), which owns Taco Bell, KFC, Long John Silver's and A&W All-American Food Restaurants; Darden Restaurants, which owns and operates six brands including Red Lobster and Olive Garden; Chipotle Mexican Grill Inc. (CMG); and Garden Fresh Restaurant Corp., which operates Souplantation and Sweet Tomatoes restaurants in 15 states.

Among retailers, Wal-Mart Stores Inc. (WMT) - the largest grocery seller in the U.S. - is working with federal officials to ensure affected tomatoes are pulled from Wal-Marts, Neighborhood Markets and Sam's Club warehouse stores nationwide, spokeswoman Deisha Galberth said.

Galberth said the company is modifying orders to its stores and putting an electronic block at its registers as an added safety measure to keep the recalled tomatoes from being purchased.

Cincinnati-based Kroger Co. (KR), the nation's largest traditional grocery chain, said it pulled the three types of tomatoes from all its stores in 31 states on Sunday per the FDA advisory. The company had early last week pulled the tomatoes from stores in Texas and New Mexico.

Winn-Dixie Stores Inc. (WINN), which operates 521 stores in five southern states, also stopped selling tomatoes involved in the FDA warning, as did Publix Super Markets Inc. Publix offered refunds to customers who bought the tomatoes before they were removed from shelves.

Trader Joe's, with more than 280 grocery stores in 23 states, also stopped selling the tomatoes in question and offered refunds, according to a statement from spokeswoman Alison Mochizuki.

Giant Eagle, which has 223 supermarkets in western Pennsylvania, West Virginia, Ohio and Maryland, said it also removed the tomatoes from store shelves; as did SuperValu Inc., which operates Jewel, Shaw's, Cub Foods, Acme and some Albertson's stores.

---

On the Net:

FDA warning: http://www.fda.gov/bbs/topics/NEWS/2008/NEW01848.html

CDC: http://www.cdc.gov/salmonella/saintpaul/

]]> 2008-06-10T11:40:00-06:00 CDC: Salmonella illnesses spread to 16 states http://www.therochesterdemocrat.com/index.php/weblog/cdc_salmonella_illnesses_spread_to_16_states/ {summary} Food First linked to uncooked tomatoes; officials now try to determine cause

ALBUQUERQUE, N.M. (AP) -- Salmonella food poisoning first linked to uncooked tomatoes has spread to 16 states, federal health officials said Saturday.

Investigations by the Texas and New Mexico Departments of Health and the U.S. Indian Health Service have tied 56 cases in Texas and 55 in New Mexico to raw, uncooked, tomatoes.

"We're seeing a steady increase," Deborah Busemeyer, New Mexico Department of Health communications director, said Saturday.

An additional 50 people have been sickened by the same Salmonella "Saintpaul" infection in Arizona, California, Colorado, Connecticut, Idaho, Illinois, Indiana, Kansas, Oklahoma, Oregon, Utah, Virginia, Washington and Wisconsin, the federal Centers for Disease Control and Prevention reported.

Investigators are trying to determine if raw tomatoes also are responsible for the illnesses in those states, said Arleen Porcell, a CDC spokeswoman.

The source of the tomatoes responsible for the illnesses has not been pinpointed, but health officials in Texas and New Mexico said none of them was grown in those two states.

At least 23 people have been hospitalized, and no deaths have been reported, she said. Patients ranged in age from 1 to 82.

The rarity of the Saintpaul strain and the number of illnesses "suggest that implicated tomatoes are distributed throughout the country," she said.

Interviews conducted with 73 people found the illnesses began between April 16 and May 27, Porcell said.

Source of outbreak

Cherry tomatoes, grape tomatoes, tomatoes sold with the vine still attached and homegrown tomatoes are likely not the source of the outbreak, Busemeyer said.

Also not associated with the outbreak are raw Roma, red plum and round red tomatoes from Arkansas, California, Georgia, North Carolina, South Carolina, Tennessee, Texas, Belgium, Canada, the Dominican Republic, Guatemala, Israel, Netherlands and Puerto Rico, according to the U.S. Food and Drug Association.

Salmonella is a bacteria that lives in the intestinal tracts of humans and other animals. It usually is transmitted to humans by eating food contaminated with animal feces.

Most infected people suffer fever, diarrhea and abdominal cramps starting 12 to 72 hours after infection. The illness tends to last four to seven days. Many people recover without treatment, but severe infection and death is possible.

]]> 2008-06-08T13:52:00-06:00 CDC: Tomatoes eyed in salmonella cases in 9 states http://www.therochesterdemocrat.com/index.php/weblog/cdc_tomatoes_eyed_in_salmonella_cases_in_9_states/ {summary} Food

ATLANTA (AP) - An outbreak of salmonella food poisoning first linked to uncooked tomatoes has now been reported in nine states, U.S. health officials said Tuesday.

Lab tests have confirmed 40 illnesses in Texas and New Mexico as the same type of salmonella, right down to the genetic fingerprint. An investigation by Texas and New Mexico health authorities and the Indian Health Service tied those cases to uncooked, raw, large tomatoes.

At least 17 people in Texas and New Mexico have been hospitalized. None have died, according to the U.S. Centers for Disease Control and Prevention.

Another 30 people have become sick with the same Salmonella Saintpaul infection in Arizona, Utah, Colorado, Kansas, Idaho, Illinois and Indiana. CDC investigators are looking into whether tomatoes were culprits there, too.

In Texas and New Mexico, raw large tomatoes - including Roma and red round tomatoes - were found to be a common factor in the 40 illnesses. But no farm, distributor or grocery chain has been identified as the main source, said Casey Barton Behravesh, a CDC epidemiologist working on the investigation.

"The specific type and source of tomatoes is under investigation," she said.

Salmonella is a bacterial infection that lives in the intestinal tracts of humans and other animals. The bacteria are usually transmitted to humans by eating foods contaminated with animal feces.

Most infected people suffer fever, diarrhea and abdominal cramps starting 12 to 72 hours after infection. The illness tends to last four to seven days.

Many people recover without treatment. However, severe infection and even death is possible. Infants, the elderly and people with weakened immune systems are at greatest risk for severe infections.

In Texas and New Mexico, the patients ranged in age from ages 3 to 82. Of the 40, 38 were interviewed. Most said they ate raw tomatoes from either stores or restaurants before becoming ill between April 23 and May 27.

Another 17 cases are under investigation in New Mexico, CDC officials said.

---

On the Net:

The CDC: http://www.cdc.gov

]]> 2008-06-03T22:58:00-06:00 Efficacy of a green tea extract rich in catechin polyphenols and caffeine in increasing 24-h energy http://www.therochesterdemocrat.com/index.php/weblog/efficacy_of_a_green_tea_extract_rich_in_catechin_polyphenols_and_caffeine_i/ {summary} Research

American Journal of Clinical Nutrition
June 3, 2008

Efficacy of a green tea extract rich in catechin polyphenols and caffeine in increasing 24-h energy expenditure and fat oxidation in humans1,2,3
Abdul G Dulloo, Claudette Duret, Dorothée Rohrer, Lucien Girardier, Nouri Mensi, Marc Fathi, Philippe Chantre and Jacques Vandermander

1 From the Department of Physiology, Faculty of Medicine, University of Geneva; Geneva University Hospital; and Laboratoires Arkopharma, Nice, France.

Background: Current interest in the role of functional foods in weight control has focused on plant ingredients capable of interfering with the sympathoadrenal system.

Objective: We investigated whether a green tea extract, by virtue of its high content of caffeine and catechin polyphenols, could increase 24-h energy expenditure (EE) and fat oxidation in humans.

Design: Twenty-four–hour EE, the respiratory quotient (RQ), and the urinary excretion of nitrogen and catecholamines were measured in a respiratory chamber in 10 healthy men. On 3 separate occasions, subjects were randomly assigned among 3 treatments: green tea extract (50 mg caffeine and 90 mg epigallocatechin gallate), caffeine (50 mg), and placebo, which they ingested at breakfast, lunch, and dinner.

Results: Relative to placebo, treatment with the green tea extract resulted in a significant increase in 24-h EE (4%; P < 0.01) and a significant decrease in 24-h RQ (from 0.88 to 0.85; P < 0.001) without any change in urinary nitrogen. Twenty-four–hour urinary norepinephrine excretion was higher during treatment with the green tea extract than with the placebo (40%, P < 0.05). Treatment with caffeine in amounts equivalent to those found in the green tea extract had no effect on EE and RQ nor on urinary nitrogen or catecholamines.

Conclusions: Green tea has thermogenic properties and promotes fat oxidation beyond that explained by its caffeine content per se. The green tea extract may play a role in the control of body composition via sympathetic activation of thermogenesis, fat oxidation, or both.

]]> 2008-06-03T21:17:00-06:00 The Miracle of Green Tea http://www.therochesterdemocrat.com/index.php/weblog/the_miracle_of_green_tea/ {summary} Food "Better to be deprived of food for three days, than tea for one." (Ancient Chinese Proverb)

Source: About.com
June 3, 2008

Is any other food or drink reported to have as many health benefits as green tea? The Chinese have known about the medicinal benefits of green tea since ancient times, using it to treat everything from headaches to depression. In her book Green Tea: The Natural Secret for a Healthier Life, Nadine Taylor states that green tea has been used as a medicine in China for at least 4,000 years.

Today, scientific research in both Asia and the west is providing hard evidence for the health benefits long associated with drinking green tea. For example, in 1994 the Journal of the National Cancer Institute published the results of an epidemiological study indicating that drinking green tea reduced the risk of esophageal cancer in Chinese men and women by nearly sixty percent. University of Purdue researchers recently concluded that a compound in green tea inhibits the growth of cancer cells. There is also research indicating that drinking green tea lowers total cholesterol levels, as well as improving the ratio of good (HDL) cholesterol to bad (LDL) cholesterol.

To sum up, here are just a few medical conditions in which drinking green tea is reputed to be helpful:

* cancer
* rheumatoid arthritis
* high cholesterol levels
* cariovascular disease
* infection
* impaired immune function

What makes green tea so special?

The secret of green tea lies in the fact it is rich in catechin polyphenols, particularly epigallocatechin gallate (EGCG). EGCG is a powerful anti-oxidant: besides inhibiting the growth of cancer cells, it kills cancer cells without harming healthy tissue. It has also been effective in lowering LDL cholesterol levels, and inhibiting the abnormal formation of blood clots. The latter takes on added importance when you consider that thrombosis (the formation of abnormal blood clots) is the leading cause of heart attacks and stroke.

Links are being made between the effects of drinking green tea and the "French Paradox." For years, researchers were puzzled by the fact that, despite consuming a diet rich in fat, the French have a lower incidence of heart disease than Americans. The answer was found to lie in red wine, which contains resveratrol, a polyphenol that limits the negative effects of smoking and a fatty diet. In a 1997 study, researchers from the University of Kansas determined that EGCG is twice as powerful as resveratrol, which may explain why the rate of heart disease among Japanese men is quite low, even though approximately seventy-five percent are smokers.

Why don't other Chinese teas have similar health-giving properties? Green, oolong, and black teas all come from the leaves of the Camellia sinensis plant. What sets green tea apart is the way it is processed. Green tea leaves are steamed, which prevents the EGCG compound from being oxidized. By contrast, black and oolong tea leaves are made from fermented leaves, which results in the EGCG being converted into other compounds that are not nearly as effective in preventing and fighting various diseases.

Other Benefits

New evidence is emerging that green tea can even help dieters. In November, 1999, the American Journal of Clinical Nutrition published the results of a study at the University of Geneva in Switzerland. Researchers found that men who were given a combination of caffeine and green tea extract burned more calories than those given only caffeine or a placebo.

Green tea can even help prevent tooth decay! Just as its bacteria-destroying abilities can help prevent food poisoning, it can also kill the bacteria that causes dental plaque. Meanwhile, skin preparations containing green tea - from deodorants to creams - are starting to appear on the market.

Harmful Effects?

To date, the only negative side effect reported from drinking green tea is insomnia due to the fact that it contains caffeine. However, green tea contains less caffeine than coffee: there are approximately thirty to sixty mg. of caffeine in six - eight ounces of tea, compared to over one-hundred mg. in eight ounces of coffee.

How much Green Tea should you drink?

There are as many answers to this question as there are researchers investigating the natural properties of green tea. For example, Herbs for Health magazine cites a Japanese report stating that men who drank ten cups of green tea per day stayed cancer-free for three years longer than men who drank less than three cups a day (there are approximately 240 - 320 mg of polyphenols in three cups of green tea). Meanwhile, a study by Cleveland's Western Reserve University concluded that drinking four or more cups of green tea per day could help prevent rheumatoid arthritis, or reduce symptoms in individuals already suffering from the disease. And Japanese scientists at the Saitama Cancer Research Institute discovered that there were fewer recurrances of breast cancer, and the disease spread less quickly, in women with a history of drinking five cups or more of green tea daily.

It gets more confusing. A University of California study on the cancer-preventative qualities of green tea concluded that you could probably attain the desired level of polyphenols by drinking merely two cups per day. On the other hand, a company selling a green tea capsule formula insists that ten cups per day are necessary to reap the maximum benefits.

How can you make sense of these conflicting claims? Given all the evidence, it is probably safe to plan on drinking four to five cups of green tea per daily. If you're a real devotee, by all means drink more; but whether or not you'll derive added health benefits remains to be determined by further research.

How to Brew a Cup of Green Tea

Producing the perfect cup of green tea is a tricky process. If not handled properly, those same polyphenols that provide health benefits can ruin the flavor, making the tea taste "gassy." It's particularly important not to overbrew. While it's best to follow the manufacturer's instructions for each variety of green tea, here are some general instructions:

* Use one tea bag, or 2 - 4 grams of tea,* per cup.
* Fill a kettle with cold water and bring to a boil.
* After unplugging the kettle, allow it to stand for up to 3 minutes.
* Pour the heated water over the tea bag or tea, and allow it to steep for up to 3 minutes. If using a tea bag, remove the bag.
* Allow the tea to cool for three more minutes.

*One to two teaspoons, depending on the variety of green tea you are brewing.]]> 2008-06-03T21:11:00-06:00 World Bank acts to mitigate food crisis http://www.therochesterdemocrat.com/index.php/weblog/world_bank_acts_to_mitigate_food_crisis/ {summary} Food
By Chris Bryant in Washington

Published: May 29 2008 19:10 | Last updated: May 29 2008 20:20

The World Bank on Thursday unveiled a $1.2bn fast-track funding facility to help combat the impact of rising food prices on the poor.

The facility includes a $200m trust fund which will pay for grants targeted at the world’s poorest countries.

The facility will be used to speed up the financing of safety net programmes, including conditional cash transfers and school feeding programmes.

It will also support food production by supplying seeds and fertiliser, as well as providing budget assistance to countries that have cut food tariffs.

In addition the bank is establishing a multi-donor trust fund to leverage financial support for small farmers ahead of the upcoming critical planting season.

Overall World Bank support for global agriculture and food is set to increase from $4bn to $6bn next year, which includes more than $350m in new lending for agriculture in Africa and an extra $150m for Latin America.

Regional organisations in Latin America, Africa and Asia have announced emergency funding in the past month to mitigate the impact of the food crisis. Rising food prices have triggered riots in 30 countries.

The World Bank initiative comes ahead of a United Nations summit in Rome next week when the bank and other multinational institutions hope to galvanise support and find more donor money to tackle the food crisis.

A World Food Programme call for $755m in donor funds to help meet a budget shortfall this year was met last week when Saudi Arabia pledged $500m in assistance.

“Along with our partners, these initiatives will help address the immediate danger of hunger and malnutrition for the 2bn people struggling to survive in the face of rising food prices, and contribute to a longer-term solution that must involve many countries and institutions,” Mr Zoellick said.

The $200m emergency grant funding will be capped at $10m for each poor country which applies for the money. Grants totalling $25m were approved for Djibouti, Haiti and Liberia on Thursday.

“The World Bank has shown impressive leadership on the food crisis in the last few weeks. We need to see similar political momentum and serious response from next week’s meeting in Rome,” Elizabeth Stuart, senior policy advisor at Oxfam, said.

The World Bank’s plan comes as the Organisation for Economic Co-operation and Development and the UN Food and Agriculture Organisation confirmed an earlier report by the Financial Times that food prices would remain high for the next 10 years, although they would fall from current near-record levels.

The organisations said in their Agricultural Outlook that the world needed to reconsider the use of geneticically-modified organisms to boost agricultural production, as well as embark on a “serious review” of biofuel policies.

]]> 2008-05-29T23:44:00-06:00 Scientists warn of rising Pacific Coast acidity http://www.therochesterdemocrat.com/index.php/weblog/scientists_warn_of_rising_pacific_coast_acidity/ {summary} Food

SEATTLE (AP) - A panel of marine scientists are warning that the Pacific Coast's increasing acidity could disrupt food chains and threaten the Pacific Northwest's shellfish industry.

The increasingly corrosive water threatens the survival of many organisms, from microscopic plants and animals at the base of the food chain to shellfish, corals and the young of some marine species, the researchers told a congressional field hearing Tuesday at the Seattle Aquarium.

The data indicates acidic water is appearing along the Pacific Coast decades earlier than expected. The acidified water does not pose a threat to humans, but it could dissolve the shells of clams, oysters and other shellfish.

The acidic seawater is moving closer to shallow waters containing the bulk of marine life, according to a recent article in the journal Science.

One of the article's authors, Christopher Sabine, said Tuesday he watched small marine snails placed in water of similar acidity to that recorded last summer off the northern California coast.

"We actually saw the shells dissolving off these living organisms. They were dissolving off the terapods as they were swimming around," Sabine said. Such creatures comprise as much as 40 percent of the Pacific king salmon's diet.

Global ocean currents make the Pacific Northwest's coastal ecosystems particularly vulnerable to acidification's effects, Sabine said.

A worldwide "conveyor belt" very slowly carries colder water from the North Atlantic to the North Pacific. Along the way, the water accumulates carbon dioxide from dead organisms, so it naturally has a higher carbon dioxide concentration before man-made carbon dioxide is added. A process known as 'up-welling' drags this water into shallower, coastal areas.

"As long as CO2 continues to increase in the atmosphere, the oceans will continue to absorb that," Sabine said. "What we're seeing is only going to get worse."

Corrosive water could be disastrous for Washington state's shellfish industry, noted one panel member, Brian Bishop, owner of Little Skookum Shellfish Growers in Shelton, Wash. Washington state produces 85 percent of all shellfish on the West Coast, Bishop said.

"This acidity dissolves calcium carbonate, which is the thing that shells are made out of. If diatoms, corals, clams and oysters succumb to this it not only wipes out the shellfish industry but potentially the entire marine food chain," said Bishop, a fifth-generation shellfish harvester.

The panel members said they did not know exactly how acidification will affect Puget Sound and other Northwest coastal waters.

"We know very little about the biological effects of acidification on the West Coast," said Terrie Klinger, of the University of Washington's School of Marine Affairs. However, research has demonstrated that there will be early and strong effects in Northwest coastal ecosystems, she added.

"We won't see a total collapse in food chains, but we will see substitutions," Klinger said. "We may end up with food chains or food webs that are highly undesirable and not productive for the means that we use them today."

]]> 2008-05-28T12:19:00-06:00 World Hunger http://www.therochesterdemocrat.com/index.php/weblog/world_hunger/ {summary} Food

Source: http://www.World Hunger.org

Children are the most visible victims of undernutrition. Children who are poorly nourished suffer up to 160 days of illness each year. Poor nutrition plays a role in at least half of the 10.9 million child deaths each year--five million deaths. Undernutrition magnifies the effect of every disease, including measles and malaria. The estimated proportions of deaths in which undernutrition is an underlying cause are roughly similar for diarrhea (61%), malaria (57%), pneumonia (52%), and measles (45%) (Black 2003, Bryce 2005). Malnutrition can also be caused by diseases, such as the diseases that cause diarrhea, by reducing the body's ability to convert food into usable nutrients.

According to the most recent estimate that Hunger Notes could find, malnutrition, as measured by stunting, affects 32.5 percent of children in developing countries--one of three (de Onis 2000). Geographically, more than 70 percent of malnourished children live in Asia, 26 percent in Africa and 4 percent in Latin America and the Caribbean. In many cases, their plight began even before birth with a malnourished mother. Under-nutrition among pregnant women in developing countries leads to 1 out of 6 infants born with low birth weight. This is not only a risk factor for neonatal deaths, but also causes learning disabilities, mental, retardation, poor health, blindness and premature death.

The world produces enough food to feed everyone. World agriculture produces 17 percent more calories per person today than it did 30 years ago, despite a 70 percent population increase. This is enough to provide everyone in the world with at least 2,720 kilocalories (kcal) per person per day (FAO 2002, p.9). The principal problem is that many people in the world do not have sufficient land to grow, or income to purchase, enough food.

Poverty is the principal cause of hunger. The causes of poverty include poor people's lack of resources, an extremely unequal income distribution in the world and within specific countries, conflict, and hunger itself. As of 2008 (2004 statistics), the World Bank has estimated that there were an estimated 982 million poor people in developing countries who live on $1 a day or less (World Bank, Understanding Poverty, Chen 2004). This compares to the FAO estimate of 850 million undernourished people. Extreme poverty remains an alarming problem in the world’s developing regions, despite the advances made in the 1990s till now, which reduced "dollar a day" poverty from (an estimated) 1.23 billion people to 982 million in 2004, a reduction of 20 percent over the period. Progress in poverty reduction has been concentrated in Asia, and especially, East Asia, with the major improvement occurring in China. In Sub-Saharan Africa, the number of people in extreme poverty has increased.

Conflict as a cause of hunger and poverty. The United Nations High Commissioner for Refugees (UNHCR) reports that as of December 2006, there were at least 22.7 million displaced, including 9.9 million refugees and 12.8 million internally displaced persons (UNHCR 2007). (Refugees flee to another country while internally displaced people move to another area of their own country.) Most people become refugees or are internally displaced as a result of conflict, though there are also natural causes such as drought, earthquakes, and flooding. In the early stages of refugee emergencies, malnutrition runs rampant, exponentially increasing the risk of disease and death (World Health Organization 2003). But, important and (relatively) visible though it is, conflict is less important as poverty as a cause of hunger. (Using the statistics above 798 million people suffer from chronic hunger while 22.7 million people are displaced.)

Hunger is also a cause of poverty. By causing poor health, low levels of energy, and even mental impairment, hunger can lead to even greater poverty by reducing people's ability to work and learn. [Expand with citations]

Progress in reducing the number of hungry people. The target set at the 1996 World Food Summit was to halve the number of undernourished people by 2015 from their number in 1990-92. (FAO uses three year averages in its calculation of undernourished people.) The (estimated) number of undernourished people in developing countries was 824 million in 1990-92. In 2000-02, the number had declined only slightly to 820 million (854 million worldwide including countries in transition--formerly part of the Soviet bloc--and developed countries [FAO 2006])

So, overall, the world is not making progress toward the world food summit goal, although there has been progress in Asia, and Latin America and the Caribbean. [Mention Millennium development goals.]

Micronutrients Quite a few trace elements or micronutrients--vitamins and minerals--are important for health. 1 out of 3 people in developing countries are affected by vitamin and mineral deficiencies, according to the World Health Organization. Three--perhaps the most important in terms of current health consequences for poor people in developing countries--are:

Vitamin A Vitamin A deficiency can cause night blindness and reduces the body's resistance to disease. In children Vitamin A deficiency can also cause growth retardation. Between 100 and 140 million children are vitamin A deficient. An estimated 250,000 to 500 000 vitamin A-deficient children become blind every year, half of them dying within 12 months of losing their sight. (World Health Organization)

Iron Iron deficiency is a principal cause of anemia. Two billion people—over 30 percent of the world’s population—are anemic, mainly due to iron deficiency, and, in developing countries, frequently exacerbated by malaria and worm infections. For children, health consequences include premature birth, low birth weight, infections, and elevated risk of death. Later, physical and cognitive development are impaired, resulting in lowered school performance. For pregnant women, anemia contributes to 20 percent of all maternal deaths (World Health Organization).

Iodine Iodine deficiency disorders (IDD) jeopardize children’s mental health– often their very lives. Serious iodine deficiency during pregnancy may result in stillbirths, abortions and congenital abnormalities such as cretinism, a grave, irreversible form of mental retardation that affects people living in iodine-deficient areas of Africa and Asia. IDD also causes mental impairment that lowers intellectual prowess at home, at school, and at work. IDD affects over 740 million people, 13 percent of the world’s population. Fifty million people have some degree of mental impairment caused by IDD (World Health Organization).

]]> 2008-05-26T20:09:00-06:00 Finding the Best Way to Cook All Those Vegetables http://www.therochesterdemocrat.com/index.php/weblog/finding_the_best_way_to_cook_all_those_vegetables/ {summary} Food

By TARA PARKER-POPE
NY Times
Published: May 20, 2008

By now, most people know they should be eating more vegetables. But are there ways to get more from the vegetables you already eat?

A growing body of research shows that when it comes to vegetables, it’s not only how much we eat, but how we prepare them, that influences the amount of phytochemicals, vitamins and other nutrients that enter our body.

The benefits are significant. Numerous studies show that people who consume lots of vegetables have lower rates of heart disease, hypertension, diabetes, eye problems and even cancer. The latest dietary guidelines call for 5 to 13 servings — that is two and a half to six and a half cups a day. For a person who maintains her weight on a 2,000-calorie-a-day diet, this translates into nine servings, or four and a half cups a day, according to the Harvard School of Public Health. But how should they be served?

Surprisingly, raw and plain vegetables are not always best. In The British Journal of Nutrition next month, researchers will report a study involving 198 Germans who strictly adhered to a raw food diet, meaning that 95 percent of their total food intake came from raw food. They had normal levels of vitamin A and relatively high levels of beta carotene.

But they fell short when it came to lycopene, a carotenoid found in tomatoes and other red-pigmented vegetables that is one of the most potent antioxidants. Nearly 80 percent of them had plasma lycopene levels below average.

“There is a misperception that raw foods are always going to be better,” says Steven K. Clinton, a nutrition researcher and professor of internal medicine in the medical oncology division at Ohio State University. “For fruits and vegetables, a lot of times a little bit of cooking and a little bit of processing actually can be helpful.”

The amount and type of nutrients that eventually end up in the vegetables are affected by a number of factors before they reach the plate, including where and how they were grown, processed and stored before being bought. Then, it’s up to you. No single cooking or preparation method is best. Water-soluble nutrients like vitamins C and B and a group of nutrients called polyphenolics are often lost in processing. For instance, studies show that after six months, frozen cherries have lost as much as 50 percent of anthocyanins, the healthful compounds found in the pigment of red and blue fruits and vegetables. Fresh spinach loses 64 percent of its vitamin C after cooking. Canned peas and carrots lose 85 percent to 95 percent of their vitamin C, according to data compiled by the University of California, Davis.

Fat-soluble compounds like vitamins A, D, E and K and the antioxidant compounds called carotenoids are less likely to leach out in water. Cooking also breaks down the thick cell walls of plants, releasing the contents for the body to use. That is why processed tomato products have higher lycopene content than fresh tomatoes.

In January, a report in The Journal of Agriculture and Food Chemistry concluded that over all, boiling was better for carrots, zucchini and broccoli than steaming, frying or serving them raw. Frying was by far the worst..

Still, there were tradeoffs. Boiling carrots, for instance, significantly increased measurable carotenoid levels, but resulted in the complete loss of polyphenols compared with raw carrots.

That report did not look at the effects of microwaving, but a March 2007 study in The Journal of Food Science looked at the effects of boiling, steaming, microwaving and pressure cooking on the nutrients in broccoli. Steaming and boiling caused a 22 percent to 34 percent loss of vitamin C. Microwaved and pressure-cooked vegetables retained 90 percent of their vitamin C.

What accompanies the vegetables can also be important. Studies at Ohio State measured blood levels of subjects who ate servings of salsa and salads. When the salsa or salad was served with fat-rich avocados or full-fat salad dressing, the diners absorbed as much as 4 times more lycopene, 7 times more lutein and 18 times the beta carotene than those who had their vegetables plain or with low-fat dressing.

Fat can also improve the taste of vegetables, meaning that people will eat more of them. This month, The American Journal of Preventive Medicine reported on 1,500 teenagers interviewed in high school and about four years later on their eating habits. In the teenage years, many factors influenced the intake of fruits and vegetables. By the time the study subjects were 20, the sole factor that influenced fruit and vegetable consumption was taste. Young adults were not eating vegetables simply because they didn’t like the taste.

“Putting on things that make it taste better — spices, a little salt — can enhance your eating experience and make the food taste better, so you’re more likely to eat vegetables more often,” Dr. Clinton said.

Because nutrient content and taste can vary so widely depending on the cooking method and how a vegetable is prepared, the main lesson is to eat a variety of vegetables prepared in a variety of ways.

As Susan B. Roberts, director of the energy metabolism laboratory at the Tufts University Friedman School of Nutrition, put it, “Eating a variety of veggies is especially important so you like them enough to eat more.”

]]> 2008-05-23T12:37:01-06:00 Older Brain Really May Be a Wiser Brain http://www.therochesterdemocrat.com/index.php/weblog/older_brain_really_may_be_a_wiser_brain/ {summary} Research

By SARA REISTAD-LONG
NY Times
Published: May 20, 2008

When older people can no longer remember names at a cocktail party, they tend to think that their brainpower is declining. But a growing number of studies suggest that this assumption is often wrong.

Instead, the research finds, the aging brain is simply taking in more data and trying to sift through a clutter of information, often to its long-term benefit.

The studies are analyzed in a new edition of a neurology book, “Progress in Brain Research.”

Some brains do deteriorate with age. Alzheimer’s disease, for example, strikes 13 percent of Americans 65 and older. But for most aging adults, the authors say, much of what occurs is a gradually widening focus of attention that makes it more difficult to latch onto just one fact, like a name or a telephone number. Although that can be frustrating, it is often useful.

“It may be that distractibility is not, in fact, a bad thing,” said Shelley H. Carson, a psychology researcher at Harvard whose work was cited in the book. “It may increase the amount of information available to the conscious mind.”

For example, in studies where subjects are asked to read passages that are interrupted with unexpected words or phrases, adults 60 and older work much more slowly than college students. Although the students plow through the texts at a consistent speed regardless of what the out-of-place words mean, older people slow down even more when the words are related to the topic at hand. That indicates that they are not just stumbling over the extra information, but are taking it in and processing it.

When both groups were later asked questions for which the out-of-place words might be answers, the older adults responded much better than the students.

“For the young people, it’s as if the distraction never happened,” said an author of the review, Lynn Hasher, a professor of psychology at the University of Toronto and a senior scientist at the Rotman Research Institute. “But for older adults, because they’ve retained all this extra data, they’re now suddenly the better problem solvers. They can transfer the information they’ve soaked up from one situation to another.”

Such tendencies can yield big advantages in the real world, where it is not always clear what information is important, or will become important. A seemingly irrelevant point or suggestion in a memo can take on new meaning if the original plan changes. Or extra details that stole your attention, like others’ yawning and fidgeting, may help you assess the speaker’s real impact.

“A broad attention span may enable older adults to ultimately know more about a situation and the indirect message of what’s going on than their younger peers,” Dr. Hasher said. “We believe that this characteristic may play a significant role in why we think of older people as wiser.”

In a 2003 study at Harvard, Dr. Carson and other researchers tested students’ ability to tune out irrelevant information when exposed to a barrage of stimuli. The more creative the students were thought to be, determined by a questionnaire on past achievements, the more trouble they had ignoring the unwanted data. A reduced ability to filter and set priorities, the scientists concluded, could contribute to original thinking.

This phenomenon, Dr. Carson said, is often linked to a decreased activity in the prefrontal cortex. Studies have found that people who suffered an injury or disease that lowered activity in that region became more interested in creative pursuits.

Jacqui Smith, a professor of psychology and research professor at the Institute for Social Research at the University of Michigan, who was not involved in the current research, said there was a word for what results when the mind is able to assimilate data and put it in its proper place — wisdom.

“These findings are all very consistent with the context we’re building for what wisdom is,” she said. “If older people are taking in more information from a situation, and they’re then able to combine it with their comparatively greater store of general knowledge, they’re going to have a nice advantage.”

]]> 2008-05-22T13:09:00-06:00 Receptor which causes sun-induced skin cancer found http://www.therochesterdemocrat.com/index.php/weblog/receptor_which_causes_sun_induced_skin_cancer_found/ {summary} Research

by Sea Stachura,
Minnesota Public Radio
May 16, 2008

St. Paul, Minn. — Researchers now know what causes sun-induced skin cancer. Dr. Zigang Dong is the director of the Homel Institute at the University of Minnesota.

He said their research found that a receptor on the skin called the cannabinoid receptor absorbs UV light. That leads to inflammation, sun burn and skin cancer. Dong says researchers tested their theory on mice.

"So we use genetic engineering method to take the receptor away and then the mice without the receptor are no longer sensitive to UV to induce sun burns or skin cancer," Dong said.

The next step in the research is to find a way to block the receptor from absorbing the UV light or develop a drug that would prevent skin cancer, said Dong.

]]> 2008-05-21T13:45:01-06:00 Medicare’s Much-Too-Hard Sell http://www.therochesterdemocrat.com/index.php/weblog/medicares_much_too_hard_sell/ {summary} Health Insurance

NY Times Editorial
Published: May 21, 2008

The Bush administration has proposed welcome new regulations to curb the deceptive, hard-sell tactics often used to foist private Medicare policies on unwary consumers. Unfortunately, it has been unwilling to eliminate the root cause of the problem: the high subsidies that prop up these plans and make them so attractive to high-pressure marketers.

The worst abuses have been committed by predatory marketers selling the comprehensive policies known as Medicare Advantage plans. The government pays these plans 13 percent more, on average, than the same services would cost in the traditional Medicare program. The subsidies are even more egregious — averaging 17 percent above cost — for the so-called private fee-for-service plans within Medicare Advantage. All told, the unjustified subsidies will cost the government more than $50 billion from 2009 to 2012.

Small wonder that plans use high-pressure tactics to market these lucrative policies. In the worst cases, sales agents have masqueraded as Medicare officials, forged the signatures of elderly clients, switched people from traditional Medicare into private plans that don’t include their doctors and barged into homes to pressure semiliterate people into signing.

The administration is to be commended for taking aggressive steps over the past year to combat abuses. The new regulations could still fall short of what is needed, unless the states are also given greater powers to enforce them.

The rules, which would apply to private plans that offer comprehensive coverage or a stand-alone prescription-drug benefit, would prohibit door-to-door marketing, cold calling and accosting beneficiaries in doctors’ waiting rooms or outside apartment buildings or senior centers. Commissions would be regulated to discourage agents from churning people from one plan to another. Insurers could not offer free meals to potential customers, and promotional gifts would be limited.

The problem is that the states — which have many more investigators on the ground to police the industry — have very little authority to regulate the marketing of private Medicare plans. Under a law passed when the Republicans controlled Congress, states cannot hold health plans responsible for the acts of their agents. That deprives consumers of an important layer of protection.

Congress will need to assess whether the new rules will be sufficient to curb abuses and should grant the states the power to enforce rules and respond to consumer complaints. Congress also must eliminate the subsidies granted to private Medicare Advantage plans.

Those subsidies help private plans woo beneficiaries away from the traditional program. And they create a big incentive for insurers to maximize sales through aggressive, sometimes unscrupulous, marketing.

]]> 2008-05-21T11:03:01-06:00 Carbon nanotubes mimic asbestos in early study http://www.therochesterdemocrat.com/index.php/weblog/carbon_nanotubes_mimic_asbestos_in_early_study/ {summary} Research

BOSTON (AP) - Strong, versatile little "nanotubes" made out of carbon are considered future stars in nanotechnology research in medicine and industry. Now a study finds that longer threads of the stuff mimic the toxic qualities of asbestos, renewing questions about how carbon nanotubes can be used safely.

Researchers with British institutes and the U.S.-based Project on Emerging Nanotechnologies injected mice with asbestos and with commercial samples of carbon nanotubes of varying sizes. When they examined the lining of the rodents' abdominal cavities, the researchers observed that longer nanotubes behaved like asbestos, provoking inflammation and lesions.

The study was reported Tuesday in Nature Nanotechnology, a scientific journal.

Carbon nanotubes are widely available for sale, but the study's authors and outside experts said they are not certain how extensively the materials have begun to be used in electronic gear, composite metal structures or consumer products. Such uses are expected eventually.

Because of that uncertainty, the researchers hope to pressure companies developing carbon nanotube-based materials to reveal whether they are using longer strands such as the ones that appear to act like asbestos - which was once a wonder material, too, before its cancerous consequences were discovered.

"I think it ups the stakes," said one of the authors, Andrew Maynard of the Project on Emerging Nanotechnologies, a partnership of the Woodrow Wilson International Center for Scholars and the Pew Charitable Trusts. "Up to this point we could talk hypothetically about the risks, but there wasn't enough there to demand action."

Vicki Colvin, a Rice University chemist who directs the National Science Foundation-funded Center for Biological and Environmental Nanotechnology, said carbon nanotubes' potential applications - such as cars that could be 80 percent lighter than today's models, but just as sturdy - are too powerful to ignore. She said the new study drove home the importance of making sure "we know how to handle it." Colvin was not involved in the new research.

The researchers acknowledged their work had limitations and called for more study.

For one thing, they put nanotubes directly into the abdomens of mice and stopped their experiments after a week - before seeing whether the nanotubes went on to induce mesothelioma, the cancer of the organ lining caused by asbestos exposure.

Mesothelioma is slow to develop; it can take 30 to 40 years in humans. But Vincent Castranova, chief of a pathology research unit at the National Institute for Occupational Safety and Health, said signs of the cancer would have been apparent in the mice after a month or two.

Whether that would have happened in a meaningful way is a vital question.

Castranova noted that earlier research in Japan, similar to Tuesday's paper, found that mice injected with carbon nanotubes did develop mesothelioma. But the doses of carbon nanotubes were so high that Castranova questioned the results.

And in research in his labs, in which mice are not injected with nanotubes but breathe it into their lungs - the way people would presumably be exposed - the animals developed inflammation that peaked within seven days of exposure, and returned to normal within one or two months.

"Whether the material is asbestos-like is still a question to be debated," Castranova said. "Having a panic that you have the next asbestos is a little bit premature in my view."

It's also worth noting that the new study did not find an asbestos-like effect with shorter or more tangled strands of carbon nanotubes. That does not mean smaller carbon nanotubes are necessarily safe. It just means that the asbestos-like effects in this experiment did not come from inherent properties of all carbon nanotubes. Rather, those effects came from stacking nanotubes together into a long, thin, asbestos-like fiber, which the body struggles to process.

Carbon nanotubes basically are minuscule, rolled pipes of graphite. They can be as narrow as one nanometer, or one billionth of a meter. (For comparison, a human hair is more than 80,000 nanometers across.)

Because their structure endows them with powerful physical properties, such as strength greater than that of steel, carbon nanotubes are being explored for a wide range of uses in electronics and medicine. Some potential applications involve coating the nanotubes in other substances, which could blunt any toxic effects.

For example, researchers have explored using nanotubes as the mechanism for delivering tiny, cancer-killing smart bombs to tumors. Stanford University scientists involved in such work found that coated, short carbon nanotubes - unlike the ones at issue in the asbestos study - were safely digested by mice after being injected into their bloodstreams.

Maynard said the combination of that research with his group's new study "shows there are no simple answers here. What type of materials you're using and what you're using them for makes a big difference."

]]> 2008-05-21T10:57:01-06:00 Genetically modified human embryo stirs criticism http://www.therochesterdemocrat.com/index.php/weblog/genetically_modified_human_embryo_stirs_criticism/ {summary} Genetic Engineering

NEW YORK (AP) - News that scientists have for the first time genetically altered a human embryo is drawing fire from some watchdog groups that say it's a step toward creating "designer babies."

But an author of the study says the work was focused on stem cells. He notes that the researchers used an abnormal embryo that could never have developed into a baby anyway.

"None of us wants to make designer babies," said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at NewYork-Presbyterian/Weill Cornell Medical Center.

The idea of designer babies is that someday, scientists may insert particular genes into embryos to produce babies with desired traits like intelligence or athletic ability. Some people find that notion repugnant, saying it turns children into designed objects, and would create an unequal society where some people are genetically enriched while others would be considered inferior.

The study appears to be the first report of genetically modifying a human embryo. It was presented last fall at a meeting of the American Society for Reproductive Medicine, but didn't draw widespread public attention then. The result was reported over the weekend by The Sunday Times of London, which said British authorities highlighted the work in a recent report.

Rosenwaks and colleagues did the work with an embryo that had extra chromosomes, making it nonviable. Following a standard procedure used in animals, they inserted a gene that acts as a marker that can be easily followed over time. The embryo cells took up the gene, he said.

The goal was to see if a gene introduced into an abnormal embryo could be traced in stem cells that are harvested from the embryo, he said. Such work could help shed light on why abnormal embryos fail to develop, he said.

No stem cells were recovered from the human embryo, said Rosenwaks, noting that abnormal embryos frequently don't develop well enough to produce them.

Marcy Darnovsky, associate executive director of the Center for Genetics and Society, said the Cornell scientists were developing techniques that others might use to make genetically modified people, "and they're doing it without any kind of public debate."

A London-based group called Human Genetics Alert similarly criticized the work.

But Kathy Hudson, director of the Genetics and Public Policy Center in Washington, D.C., said she's not troubled by the work. She said the idea of successfully modifying babies by inserting genes remains a technically daunting challenge.

"We're not even close to having that technology in hand to be able to do it right," she said, and it would be ethically unacceptable to try it when it's unsafe.

---

On the Net:

Center for Genetics and Society: http://www.geneticsandsociety.org

Human Genetics Alert: http://www.hgalert.org

Genetics and Public Policy Center: http://www.dnapolicy.org

]]> 2008-05-13T12:23:01-06:00 Democrats Warn About Hospital Capacity http://www.therochesterdemocrat.com/index.php/weblog/democrats_warn_about_hospital_capacity/ {summary} Other

By Spencer S. Hsu and Mary Beth Sheridan
Washington Post
Tuesday, May 6, 2008

Hospitals in seven major U.S. cities would be overwhelmed if any of the cities were struck by a terrorist attack on the scale of the 2004 train bombings in Madrid, and shortages of emergency room capacity and intensive care beds will grow worse if Bush administration Medicaid changes are implemented, House Democrats charged yesterday.

In a survey by the House Committee on Oversight and Government Reform, more than half of 34 hospitals in five U.S. cities deemed at greatest risk of attack and two cities that will host this summer's national political conventions said they had no emergency room treatment space available to accept severely injured patients.

The March 11, 2004, bombings in Spain killed 191 people, injured more than 2,000 and sent as many as 270 patients to a single hospital within three hours. In New York City, only 56 Level 1 emergency room treatment beds were available on the afternoon the House survey was conducted, Tuesday, March 25. The six other cities had fewer beds available.

"America's emergency departments are already operating over capacity," said the committee chairman, Rep. Henry A. Waxman (D-Calif.). Despite warnings, he added, the Department of Health and Human Services "has issued three Medicaid regulations that will reduce federal funds to public and teaching hospitals by tens of billions of dollars over the next five years."

Rep. Christopher Shays (Conn.), the senior Republican on the panel, said he agreed that changes are needed to the administration's Medicaid plan but cautioned that making them would not create adequate hospital "surge capacity" by itself. "Stabilizing Medicaid payment policies alone won't guarantee readiness against bombs or epidemics any more than the annual cost-of-living raises assure people they're safe against inflation or a recession," he said. "It's a factor, to be sure, but not the sole . . . element to worry about."

Rep. Darrell Issa (R-Calif.) said Democrats were exploiting long-known hospital capacity problems to score political points in a debate over Medicaid's future. "I am particularly concerned that a partisan, amateur survey was done to justify and politicize today's hearing," he said.

President Bush has threatened to veto legislation passed by the House last month that would impose a one-year moratorium on Medicaid reimbursement changes sought by HHS. States argue the changes would shift costs of the program to them, but the White House argues that states are padding their overall budgets with the reimbursements.

Planned changes to the program, which provides medical insurance for the poor, would eliminate reimbursement for residents and interns at teaching hospitals and payments to public hospitals. The Congressional Budget Office says the moves would reduce federal spending by about $17.8 billion over five years.

Jay Wayne Meredith, chairman of the general surgery department at Wake Forest University Baptist Medical Center, testified yesterday that the changes would cost his hospital $36 million, on top of $4.5 million it spends on its trauma center and $13 million to care for the uninsured. "We will go under," he said, warning that the hospital would have to kill its trauma center. "I just beg you, stop the Medicaid cuts."

In the committee's survey, Washington and Los Angeles hospitals were especially strained. Three of five Los Angeles hospitals were diverting ambulances to other hospitals on March 25. Two Washington hospitals that responded to the survey reported no available beds.

Washington Hospital Center was operating at 286 percent of capacity, making it the single most overcrowded hospital surveyed. Hospital officials and Republican aides said the statistics are misleading because emergency room space and inpatient beds would be cleared in an actual emergency. Other cities surveyed were Chicago, Houston, Denver and Minneapolis.

"Given the increased financial stress on our nation's health system in general -- and urban hospitals in particular -- any degradation of our existing capabilities will pose major challenges to our nation's readiness for an attack," testified Bruce Hoffman, a terrorism analyst at Georgetown University. He said the opposite approach is needed: strengthening preparedness for conventional suicide bombings.

]]> 2008-05-06T12:36:00-06:00 Health Economics 101 http://www.therochesterdemocrat.com/index.php/weblog/health_economics_101/ {summary} Health Insurance

By Paul Krugman
The New York Times
Monday 14 November 2005

Several readers have asked me a good question: we rely on free markets to deliver most goods and services, so why shouldn't we do the same thing for health care? Some correspondents were belligerent, others honestly curious. Either way, they deserve an answer.

It comes down to three things: risk, selection and social justice.

First, about risk: in any given year, a small fraction of the population accounts for the bulk of medical expenses. In 2002 a mere 5 percent of Americans incurred almost half of U.S. medical costs. If you find yourself one of the unlucky 5 percent, your medical expenses will be crushing, unless you're very wealthy - or you have good insurance.

But good insurance is hard to come by, because private markets for health insurance suffer from a severe case of the economic problem known as "adverse selection," in which bad risks drive out good.

To understand adverse selection, imagine what would happen if there were only one health insurance company, and everyone was required to buy the same insurance policy. In that case, the insurance company could charge a price reflecting the medical costs of the average American, plus a small extra charge for administrative expenses.

But in the real insurance market, a company that offered such a policy to anyone who wanted it would lose money hand over fist. Healthy people, who don't expect to face high medical bills, would go elsewhere, or go without insurance. Meanwhile, those who bought the policy would be a self-selected group of people likely to have high medical costs. And if the company responded to this selection bias by charging a higher price for insurance, it would drive away even more healthy people.

That's why insurance companies don't offer a standard health insurance policy, available to anyone willing to buy it. Instead, they devote a lot of effort and money to screening applicants, selling insurance only to those considered unlikely to have high costs, while rejecting those with pre-existing conditions or other indicators of high future expenses.

This screening process is the main reason private health insurers spend a much higher share of their revenue on administrative costs than do government insurance programs like Medicare, which doesn't try to screen anyone out. That is, private insurance companies spend large sums not on providing medical care, but on denying insurance to those who need it most.

What happens to those denied coverage? Citizens of advanced countries - the United States included - don't believe that their fellow citizens should be denied essential health care because they can't afford it. And this belief in social justice gets translated into action, however imperfectly. Some of those unable to get private health insurance are covered by Medicaid. Others receive "uncompensated" treatment, which ends up being paid for either by the government or by higher medical bills for the insured. So we have a huge private health care bureaucracy whose main purpose is, in effect, to pass the buck to taxpayers.

At this point some readers may object that I'm painting too dark a picture. After all, most Americans too young to receive Medicare do have private health insurance. So does the free market work better than I've suggested? No: to the extent that we do have a working system of private health insurance, it's the result of huge though hidden subsidies.

Private health insurance in America comes almost entirely in the form of employment-based coverage: insurance provided by corporations as part of their pay packages. The key to this coverage is the fact that compensation in the form of health benefits, as opposed to wages, isn't taxed. One recent study suggests that this tax subsidy may be as large as $190 billion per year. And even with this subsidy, employment-based coverage is in rapid decline.

I'm not an opponent of markets. On the contrary, I've spent a lot of my career defending their virtues. But the fact is that the free market doesn't work for health insurance, and never did. All we ever had was a patchwork, semiprivate system supported by large government subsidies.

That system is now failing. And a rigid belief that markets are always superior to government programs - a belief that ignores basic economics as well as experience - stands in the way of rational thinking about what should replace it.

]]> 2008-05-06T11:55:01-06:00 Minn. working to prevent a measles outbreak http://www.therochesterdemocrat.com/index.php/weblog/minn_working_to_prevent_a_measles_outbreak/ {summary} Immunization

MPR News
May 5, 2008

St. Paul, Minn. — Wisconsin health officials are dealing with an outbreak of measles. Seven Wisconsin patients have come down with measles since January first. Nationwide, 70 cases have been diagnosed in the first four months of 2008. The worst outbreaks are in Arizona, California and New York.

Minnesota health department epidemiologist Kris Ehresmann said so far, Minnesota hasn't had any measles cases this year. She says eight years ago, measles had been almost eliminated in the US, but that is not the case now.

"And what we're seeing now is a number of cases that are linked to importations coming from outside the United States. Certainly that can happen because measles is occurring in other countries. But what concerns us is when we have unvaccinated populations measles gets introduced and then we see ongoing transmission. So that's why it's of such concern," Ehresmann said.

Ehresmann says while measles is very contagious, officials have seen more people who are choosing to not be vaccinated against measles.

]]> 2008-05-06T00:25:00-06:00 Pentagon moves to reduce stigma of mental counseling http://www.therochesterdemocrat.com/index.php/weblog/pentagon_moves_to_reduce_stigma_of_mental_counseling/ {summary} Mental Health

WASHINGTON (AP) - Advocates of better mental health care for troops say a new Pentagon policy aimed at reducing the stigma of getting psychiatric counseling could be a small but important step.

Under the new policy, troops won't have to reveal past job-related therapy when they apply for security clearances. The change was prompted partly by the finding that many don't get treatment because they fear acknowledging a mental problem could cost them their security clearance, harm their careers and embarrass them before commanders and comrades.

Defense Secretary Robert Gates planned to announce the policy Thursday at Fort Bliss, Texas, where he was visiting a center for troops recovering from post-traumatic stress disorder, several officials said. They spoke on condition of anonymity ahead of the announcement.

"I think it will help," said Paul Riechoff, executive director of Iraq and Afghanistan Veterans of America. "This needs to be followed by a mental health campaign - not just for service members but for their families as well. But I really do think it's a significant evolution.

A survey released Wednesday by the American Psychiatric Association found that about three in five service members think seeking help for mental health concerns would have at least some impact on their careers.

"The military has made strides in raising awareness of mental health, but it's going to take a tremendous commitment to overcome attitudes that are ingrained in the military culture," association president Dr. Carolyn B. Robinowitz said.

The new policy relates to a question on the application required by the Office of Personnel Management, the agency that does the majority of investigations for security clearances for military and civilian federal workers.

Currently, Question 21 asks applicants whether they have consulted a mental health professional in the past seven years. If so, they are asked to list the names, addresses and dates they saw the doctor or therapist, unless it was for marriage or grief counseling and not related to violent behavior.

The amended question Gates has approved is less stringent. It essentially means troops would not have to worry about therapy they got for difficulties caused by their wartime tours of duty or other missions, said four officials familiar with the revision.

"No service member should fail to seek professional care because he doesn't want to answer a security clearance question," said Rep. Ike Skelton, D-Mo., chairman of the House Armed Services Committee. "This small step may pay big dividends by encouraging our forces to get the help they need."

The Pentagon says the perception of stigma for security applicants is far worse than the reality.

The most recently released data show less than 1 percent of some 800,000 people investigated for clearances in 2006 were rejected on the sole issue of their mental health profiles.

Up to 20 percent of the more than 1.6 million troops who have served in Iraq and Afghanistan are estimated to have mental health problems, the Defense Department says.

Successive government and private studies have found roughly half of those who need help are seeking it.

Revising the security clearance procedure is the latest in a string of efforts aimed at changing military attitudes on mental health:

- The Army last year held special sessions to teach 800,000 troops how to recognize concussions and mental problems in themselves and their buddies.

- The Army and Navy have put mental health professionals into primary care centers - rather than setting them off in separate locations - so troops can go for appointments discreetly.

---

On the Net:

National Security Questionnaire: http://www.opm.gov/forms/pdf_fill/sf86.pdf

Army battlefront survey: http://tinyurl.com/38zfmq

]]> 2008-05-01T11:52:00-06:00 Cash Before Chemo: Hospitals Get Tough http://www.therochesterdemocrat.com/index.php/weblog/cash_before_chemo_hospitals_get_tough/ {summary} Health Insurance

By Barbara Martinez
The Wall Street Journal
Monday 28 April 2008

Lake Jackson, Texas - When Lisa Kelly learned she had leukemia in late 2006, her doctor advised her to seek urgent care at M.D. Anderson Cancer Center in Houston. But the nonprofit hospital refused to accept Mrs. Kelly's limited insurance. It asked for $105,000 in cash before it would admit her.

Sitting in the hospital's business office, Mrs. Kelly says she told M.D. Anderson's representatives that she had some money to pay for treatment, but couldn't get all the cash they asked for that day. "Are they going to send me home?" she recalls thinking. "Am I going to die?"

A growing trend in the hospital industry means cancer patients like Lisa Kelly are being asked to pay cash upfront before receiving treatment. Even ill patients without enough funds are being turned away.

Hospitals are adopting a policy to improve their finances: making medical care contingent on upfront payments. Typically, hospitals have billed people after they receive care. But now, pointing to their burgeoning bad-debt and charity-care costs, hospitals are asking patients for money before they get treated.

Hospitals say they have turned to the practice because of a spike in patients who don't pay their bills. Uncompensated care cost the hospital industry $31.2 billion in 2006, up 44% from $21.6 billion in 2000, according to the American Hospital Association.

The bad debt is driven by a larger number of Americans who are uninsured or who don't have enough insurance to cover medical costs if catastrophe strikes. Even among those with adequate insurance, deductibles and co-payments are growing so big that insured patients also have trouble paying hospitals.

Letting bad debt balloon unchecked would threaten hospitals' finances and their ability to provide care, says Richard Umbdenstock, president of the American Hospital Association. Hospitals would rather discuss costs with patients upfront, he says. "After, when it's an ugly surprise or becomes contentious, it doesn't work for anybody."

M.D. Anderson says it went to a new upfront-collection system for initial visits in 2005 after its unpaid patient bills jumped by $18 million to $52 million that year. The hospital said its increasing bad-debt load threatened its mission to cure cancer, a goal on which it spends hundreds of millions of dollars a year.

The change had the desired effect: The hospital's bad debt fell to $33 million the following year.

Asking patients to pay after they've received treatment is "like asking someone to pay for the car after they've driven off the lot," says John Tietjen, vice president for patient financial services at M.D. Anderson. "The time that the patient is most receptive is before the care is delivered."

M.D. Anderson says it provides assistance or free care to poor patients who can't afford treatment. It says it acted appropriately in Mrs. Kelly's case because she wasn't indigent, but underinsured. The hospital says it wouldn't accept her insurance because the payout, a maximum of $37,000 a year, would be less than 30% of the estimated costs of her care.

Tenet Healthcare and HCA, two big, for-profit hospital chains, say they have also been asking patients for upfront payments before admitting them. While the practice has received little notice, some patient advocates and health-care experts find it harder to justify at nonprofit hospitals, given their benevolent mission and improving financial fortunes.

In the Black

An Ohio State University study found net income per bed nearly tripled at nonprofit hospitals to $146,273 in 2005 from $50,669 in 2000. According to the American Hospital Directory, 77% of nonprofit hospitals are in the black, compared with 61% of for-profit hospitals. Nonprofit hospitals are exempt from taxes and are supposed to channel the income they generate back into their operations. Many have used their growing surpluses to reward their executives with rich pay packages, build new wings and accumulate large cash reserves.

M.D. Anderson, which is part of the University of Texas, is a nonprofit institution exempt from taxes. In 2007, it recorded net income of $310 million, bringing its cash, investments and endowment to nearly $1.9 billion.

"When you have that much money in the till and that much profit, it's kind of hard to say no" to sick patients by asking for money upfront, says Uwe Reinhardt, a health-care economist at Princeton University, who thinks all hospitals should pay taxes. Nonprofit organizations "shouldn't behave this way," he says.

It isn't clear how many of the nation's 2,033 nonprofit hospitals require upfront payments. A voluntary 2006 survey by the Internal Revenue Service found 14% of 481 nonprofit hospitals required patients to pay or make an arrangement to pay before being admitted. It was the first time the agency asked that question.

Nataline Sarkisyan, a 17-year-old cancer patient who died in December waiting for a liver transplant, drew national attention when former presidential candidate John Edwards lambasted her health insurer for refusing to pay for the operation. But what went largely unnoticed is that Ms. Sarkisyan's hospital, UCLA Medical Center, a nonprofit hospital that is part of the University of California system, refused to do the procedure after the insurance denial unless the family paid it $75,000 upfront, according to the family's lawyer, Tamar Arminak.

The family got that money together, but then the hospital demanded $300,000 to cover costs of caring for Nataline after surgery, Ms. Arminak says.

UCLA says it can't comment on the case because the family hasn't given its consent. A spokeswoman says UCLA doesn't have a specific policy regarding upfront payments, but works with patients on a case-by-case basis.

Federal law requires hospitals to treat emergencies, such as heart attacks or injuries from accidents. But the law doesn't cover conditions that aren't immediately life-threatening.

At the American Cancer Society, which runs call centers to help patients navigate financial problems, more people are saying they're being asked for large upfront payments by hospitals that they can't afford. "My greatest concern is that there are substantial numbers of people who need cancer care" who don't get it, "usually for financial reasons," says Otis Brawley, chief medical officer.

Mrs. Kelly's ordeal began in 2006, when she started bruising easily and was often tired. Her husband, Sam, nagged her to see a doctor.

A specialist in Lake Jackson, a town 50 miles from Houston, diagnosed Mrs. Kelly with acute leukemia, a cancer of the blood that can quickly turn fatal. The small cancer center in Lake Jackson refers acute leukemia patients to M.D. Anderson.

When Mrs. Kelly called M.D. Anderson to make an appointment, the hospital told her it wouldn't accept her insurance, a type called limited-benefit.

"When an insurer is going to pay the small amounts, we don't feel financially able to assume the risk," says M.D. Anderson's Mr. Tietjen.

An estimated one million Americans have limited-benefit plans. Usually less expensive than traditional plans, such insurance is popular among people like Mrs. Kelly who don't have health insurance through an employer.

Mrs. Kelly, 52, signed up for AARP's Medical Advantage plan, underwritten by UnitedHealth Group Inc., three years ago after she quit her job as a school-bus driver to help care for her mother. Her husband was retired after a career as a heavy-equipment operator. She says that at the time, she hardly ever went to the doctor. "I just thought I needed some kind of insurance policy because you never know what's going to happen," says Mrs. Kelly. She paid premiums of $185 a month.

A spokeswoman for UnitedHealth, one of the country's largest marketers of limited-benefit plans, says the plan is "meant to be a bridge or a gap filler." She says UnitedHealth has reimbursed Mrs. Kelly $38,478.36 for her medical costs. Because the hospital wouldn't accept her insurance, Mrs. Kelly paid bills herself, and submitted them to her insurer to get reimbursed.

M.D. Anderson viewed Mrs. Kelly as uninsured and told her she could get an appointment only if she brought a certified check for $45,000. The Kellys live comfortably, but didn't have that kind of cash on hand. They own an apartment building and a rental house that generate about $11,000 a month before taxes and maintenance costs. They also earn interest income of about $35,000 a year from two retirement accounts funded by inheritances left by Mrs. Kelly's mother and Mr. Kelly's father.

Mr. Kelly arranged to borrow the money from his father's trust, which was in probate proceedings. Mrs. Kelly says she told the hospital she had money for treatment, but didn't realize how high her medical costs would get.

The Kellys arrived at M.D. Anderson with a check for $45,000 on Dec. 6, 2006. After having blood drawn and a bone-marrow biopsy, the hospital oncologist wanted to admit Mrs. Kelly right away.

But the hospital demanded an additional $60,000 on the spot. It told her the $45,000 had paid for the lab tests, and it needed the additional cash as a down payment for her actual treatment.

In the hospital business office, Mrs. Kelly says she was crying, exhausted and confused.

The hospital eventually lowered its demand to $30,000. Mr. Kelly lost his cool. "What part don't you understand?" he recalls saying. "We don't have any more money today. Are you going to admit her or not?" The hospital says it was trying to work with Mrs. Kelly, to find an amount she could pay.

Mrs. Kelly was granted an "override" and admitted at 7 p.m.

Appointment "Blocked"

After eight days, she emerged from the hospital. Chemotherapy would continue for more than a year, as would requests for upfront payments. At times, she arrived at the hospital and learned her appointment was "blocked." That meant she needed to go to the business office first and make a payment.

One day, Mrs. Kelly says, nurses wouldn't change the chemotherapy bag in her pump until her husband made a new payment. She says she sat for an hour hooked up to a pump that beeped that it was out of medicine, until he returned with proof of payment.

A hospital spokesperson says "it is very difficult to imagine that a nursing staff would allow a patient to sit with a beeping pump until a receipt is presented." The hospital regrets if patients are inconvenienced by blocked appointments, she says, but it "is a necessary process to keep patients informed of their mounting bills and to continue dialog about financial obligations." She says appointments aren't blocked for patients who require urgent care.

Once, Mrs. Kelly says she was on an exam table awaiting her doctor, when he walked in with a representative from the business office. After arguing about money, she says the representative suggested moving her to another facility.

But the cancer center in Lake Jackson wouldn't take her back because it didn't have a blood bank or an infectious-disease specialist. "It risks a person's life by doing that [type of chemotherapy] at a small institution," says Emerardo Falcon Jr., of the Brazosport Cancer Center in Lake Jackson.

Ron Walters, an M.D. Anderson physician who gets involved in financial decisions about patients, says Mrs. Kelly's subsequent chemotherapy could have been handled locally. He says he is sorry if she was offended that the payment representative accompanied the doctor into the exam room, but it was an example of "a coordinated teamwork approach."

On TV one night, Mrs. Kelly saw a news segment about people who try to get patients' bills reduced. She contacted Holly Wallack, who is part of a group that works on contingency to reduce patients' bills; she keeps one-third of what she saves clients.

Ms. Wallack began firing off complaints to M.D. Anderson. She said Mrs. Kelly had been billed more than $360 for blood tests that most insurers pay $20 or less for, and up to $120 for saline pouches that cost less than $2 at retail.

On one bill, Mrs. Kelly was charged $20 for a pair of latex gloves. On another itemized bill, Ms. Wallack found this: CTH SIL 2M 7FX 25CM CLAMP A4356, for $314. It turned out to be a penis clamp, used to control incontinence.

M.D. Anderson's prices are reasonable compared with other hospitals, Mr. Tietjen says. The $20 price for the latex gloves, for example, takes into account the costs of acquiring and storing gloves, ones that are ripped and not used and ones used for patients who don't pay at all, he says. The charge for the penis clamp was a "clerical error" he says; a different type of catheter was used, but the hospital waived the charge. The hospital didn't reduce or waive other charges on Mrs. Kelly's bills.

Continuing Treatment

Mrs. Kelly is continuing her treatment at M.D. Anderson. In February, a new, more comprehensive insurance plan from Blue Cross Blue Shield that she has switched to started paying most of her new M.D. Anderson bills. But she is still personally responsible for $145,155.65 in bills incurred before February. She is paying $2,000 a month toward those. Last week, she learned that after being in remission for more than a year, her leukemia has returned.

M.D. Anderson is giving Blue Cross Blue Shield a 25% discount on the new bills. This month, the hospital offered Mrs. Kelly a 10% discount on her balance, but only if she pays $130,640.08 by this Wednesday, April 30. She is still hoping to get a bigger discount, though numerous requests have been denied. The hospital says it gives commercial insurers a bigger discount because they bring volume and they are less risky than people who pay on their own.

The hospital has urged Mrs. Kelly to sell assets. But she worries about losing her family's income and retirement savings. Mrs. Kelly says she wants to pay, but, suspicious of the charges she's seen, she says, "I want to pay what's fair."

]]> 2008-04-29T00:39:00-06:00 The Frightening Heparin Case http://www.therochesterdemocrat.com/index.php/weblog/the_frightening_heparin_case/ {summary} FDA

NY Times Editorial
Published: April 28, 2008

The story of a deadly, contaminated blood thinner has laid bare serious deficiencies in the regulatory oversight of drugs imported from China and other developing countries. Congress is rightly determined to plug holes in Food and Drug Administration procedures that leave the American public vulnerable to toxic imports. But that is only half of the problem. It also must ensure that American companies, eager to cut costs by outsourcing, are especially diligent about monitoring their suppliers.

The F.D.A. has now linked contaminated batches of Chinese-made heparin to 81 deaths in the United States. The agency says the contaminant has been found in the drug supplies of 10 other countries as well, although only Germany has reported illnesses associated with it.

Chinese officials, while acknowledging the contamination, deny that it has caused any deaths. Research published in leading scientific journals suggests otherwise. Scientists at the Massachusetts Institute of Technology found that the contaminant activates two inflammatory pathways in the body that can lead to a dangerous decrease in blood pressure or to a severe allergic reaction. Normal heparin does not.

Whether the contaminant was introduced through sloppy manufacturing processes or was deliberately added is unclear.

Two Congressional hearings last week reinforced contentions that the F.D.A. is short of the money, manpower and legal authority it needs to cope with the flood of drug imports. The current regulatory structure was established to oversee domestic companies. It has not evolved to handle today’s global marketplace, in which more than 80 percent of all active ingredients in drugs sold here are made in other countries, with an increasing portion coming from China and India.

Congress needs to ensure, through adequate financing, that the F.D.A. deploys more inspectors abroad. The administration needs to press for agreements that will allow inspectors to examine foreign factories. Inspectors may not be able to spot every problem, but the prospect of regular inspections would surely goad legitimate manufacturers to clean up their processes.

That said, the primary responsibility for ensuring the safety of this country’s drug supply clearly rests with the American companies that import active ingredients from low-cost foreign manufacturers. They