By ANNE D'INNOCENZIO, RACHEL BECK
The Associated Press
updated 11/7/2010 2:40:00 PM ET 2010-11-07T19:40:00
NEW YORK — Layaway, once the province of the poor, has gone mainstream. At the Mall of America in Minnesota, shoppers dart in for just one or two things. In New York, socialites do the unthinkable: They wear the same ball gown twice.
During the Great Recession, people made drastic changes in how they spent their money. They stopped treating credit cards as cash. They learned to save and learned to wait.
After a long stretch of subpar job growth, businesses may finally be getting back in a hiring mood.
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..Now the recession is over, at least technically, and the economy is growing again, at least a little. But many changes in spending habits that most Americans first saw as temporary have taken hold, perhaps for good, some economists say.
This is the reality of the new American consumer — focused, cautious and tactical.
In Jacksonville, Fla., Bernie Decelles and his wife both have jobs and own their home. They recognize that the economy is still fragile, though, and that they work in industries still struggling. They scrutinize every purchase they make.
"It used to be if we saw something, and liked it, we bought it," says Decelles, a salesman for a company that makes storage equipment. "Nowadays, no way."
In dozens of interviews nationwide with shoppers, retailers, manufacturers, economists and analysts, The Associated Press identified key changes in consumer behavior that have endured after the recession. They include:
•Americans are buying brands and shopping at stores that they shunned before. They are trying more store-brand products for things like detergent and beer. Goodwill and consignment shops are attracting customers across the income spectrum. And people are putting big-ticket items on layaway rather than whipping out charge cards.
•Consumers are taking a surgical approach to shopping, buying only what they need, when they need it. Pantries are no longer filled with weeks' worth of food, nor closets with clothes bought seasons in advance. Shoppers are visiting fewer stores, both traditional and online, and getting only what's on their shopping list.
•The wealthy are spending again, but their behavior is much like everyone else. They are buying more timeless and classic goods: watches and handbags that won't go out of style quickly. They are even — gasp! — recycling some of their most expensive clothes and wearing them twice.
These behavioral shifts aren't at the extremes of the Great Depression, which produced changes so drastic that many who lived through it adopted frugality as a lifelong habit.
Still, some experts say the changes from the recession of 2007, 2008 and 2009 could last.
"This was a massive cultural event for our society," says John Gerzema, a branding executive at marketing and advertising firm Young & Rubicam and co-author of a new book about the changing ways we spend money. "Eighty percent of Americans were born after World War II, so essentially this is our Depression."
The impact is hard to overstate. Consumer spending represents 70 percent of economic activity. Every business feels the pullback in some way, and it's more pronounced for those that sell things directly to people.
The new patterns of spending represent a radical turn from the boom years of the last decade. Americans up and down the income ladder piled on credit-card debt and used their homes as ATMs by taking out home-equity loans to pay for third cars, clothes and far-flung vacations.
During that time, the savings rate plunged to nearly zero. Americans accumulated debts that far exceeded their incomes. Household debt, including obligations for mortgages and credit cards, rose to about 140 percent of disposable income, double what it was before the boom years.
Credit was easy, and money seemed readily available. Until it wasn't.
"We saw a period of consumption that was unusual and unstable," says Jarrett Paschel, vice president of strategy and innovation at The Hartman Group, a consumer research firm in Bellevue, Wash.
A plunge in housing prices set off the economy's slump. Most Americans were left financially stressed in some way. Millions of people abandoned all but the necessities; for some, the necessities became luxuries.
The worst recession since the Depression ended in June 2009, according to the National Bureau of Economic Research, a group of academic economists that officially declares the starts and ends of recessions.
Americans' psyche hasn't recovered. An index of consumer confidence from The Conference Board has been in a tight range from the high 40s to high 50s. A reading of 90 indicates a healthy economy, and that level has not been seen since December 2007, the month the recession began.
U.S. households lost 17 percent of their wealth over in the past three years, more than $10 trillion, according to the Federal Reserve. The labor market remains in shambles, with nearly one in 10 Americans unemployed. One in six Americans now receives some form of government assistance, including food stamps and extended jobless benefits.
You may not see soup lines, but only because "the soup lines are in the mail," says David Rosenberg, chief economist and investment strategist at the Toronto-based money management firm Gluskin Sheff.
This stressful economic climate isn't just affecting Americans who are struggling to get by. Those who are more fortunate also have a new approach to spending.
Before the financial meltdown, philanthropist and socialite Allison Weiss Brady didn't think twice about dropping $20,000 each season on posh accessories. One prized possession she bought at the height of the boom? A $4,950 Fendi lizard handbag.
Brady still springs for luxury labels like Chanel, but she's snubbing the "it" handbags in favor of clothes and accessories that have staying power beyond a season.
She won't buy a new dress for every occasion, and will be wearing a Lanvin gown bought for a charity event last year to a few parties this year. And for the first time, she bought a peach-colored Chanel bag at a second-hand store, saving $2,000.
"I do think my mentality is more need-based now," says Brady, who lives in Florida and is a vice president of marketing for Florida Dental Benefits, a dental insurance company. "Am I going to show up with a new pair of diamond earrings every times I go to a ball? That's not happening." Brady is also buying more items at charity auctions — not only to save but to give to others.
Tempered spending by Americans of most income levels means the economic recovery is having a harder time gaining steam. Rosenberg says that at this point of the economic cycle — two years and 11 months since the recession began — things should be much better.
Retail sales are off by 2.6 percent since the recession began in December 2007. That's a stark contrast to the last 60 years. At this stage in an economic recovery, retail sales on average were up 25 percent, according to Gluskin Sheff. Retail sales include food, autos, clothing, furniture and electronics.
Decelles, of Jacksonville, acknowledges his spending was more careless a few years back. Saving was barely on the radar. Now he eats out far less, doesn't entertain much and spends little time shopping.
"Things certainly feel a lot different now," he says, "than they did back then
Sunday, November 7, 2010
Wednesday, October 27, 2010
Lung cancer pill shrinks some tumors
Drug may be effective for up to 10,000 cancer patients in the United States
By Gene Emery
Reuters
updated 10/27/2010 5:30:44 PM ET 2010-10-27T21:30:44
BOSTON — A promising cancer pill that could help as many as 5 percent of people with the most common type of lung cancer helps most patients treated but may be vulnerable to resistant tumors, researchers reported Wednesday.
The Pfizer Inc drug, crizotinib, shrank the tumors of 57 percent of patients and stabilized another 33 percent, Dr. Eunice Kwak of the Massachusetts General Hospital and colleagues reported in the New England Journal of Medicine.
Kwak's team projected that 72 percent of the patients would have enjoyed six months without their disease worsening. Their findings update earlier reports given to various cancer meetings.
"While this is a Phase 1 study, the high response rates observed in patients with ALK-positive (lung cancer) who received crizotinib suggest that we may be one step closer to the development of 'precision' or 'personalized' cancer treatments that target specific genetic factors that drive certain tumors," said Pfizer's Dr. Mace Rothenberg.
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..But a team of doctors led by Young Lim Choi of the University of Tokyo reported on a patient who developed two independent mutations that made the tumor resistant to crizotinib.
The appearance of resistance is not surprising, Dr. Hiroyuki Mano of the University of Tokyo said in a telephone interview. Other so-called ALK inhibitors have the same problem to some degree.
"The news is both good and bad," said Mano. "It's bad in that there may be some refractory population. But it's good that we know the resistant mutations, so the next generation of ALK inhibitors will use that information to make a less refractory drug in the very near future."
Pfizer said it planned to start submitting data for approval of the drug to the U.S. Food and Drug Administration later this year.
The experimental drug works against cells that have turned cancerous when two genes fuse to form a new gene called EML4-ALK. Although only about 3 percent to 5 percent of people with non-small-cell lung cancer fall into this category, that translates into nearly 10,000 cancer patients in the United States.
Nearly all the volunteers in that study had already undergone one round of treatment with cancer drugs.
..Second-round chemotherapy typically only works in about 10 percent of such cases, Bengt Hallberg and Ruth Palmer of Umea University in Sweden said in a Journal commentary.
Side-effects such as nausea and diarrhea were reported to be mild to moderate and seen in 40 percent of patients.
The medical journal also reported that the drug, sometimes designated PF-02341066, helped a 44-year-old man with a rare inflammatory myofibroblastic tumor that had the ALK mutation.
A younger patient without the mutation did not benefit from the treatment, according to a team led by Dr. James Butrynski of the Dana-Farber Cancer Institute in Boston.
Existing cancer pills like AstraZeneca's Iressa and Roche's Tarceva are already known to be effective against cancer in patients with a mutation activating the epidermal growth factor receptor (EGFR).
Lung cancer is the most common cancer killer, with 1.61 million cases worldwide, according to the International Agency for Research on Cancer and it kills 1.2 million of them.
By Gene Emery
Reuters
updated 10/27/2010 5:30:44 PM ET 2010-10-27T21:30:44
BOSTON — A promising cancer pill that could help as many as 5 percent of people with the most common type of lung cancer helps most patients treated but may be vulnerable to resistant tumors, researchers reported Wednesday.
The Pfizer Inc drug, crizotinib, shrank the tumors of 57 percent of patients and stabilized another 33 percent, Dr. Eunice Kwak of the Massachusetts General Hospital and colleagues reported in the New England Journal of Medicine.
Kwak's team projected that 72 percent of the patients would have enjoyed six months without their disease worsening. Their findings update earlier reports given to various cancer meetings.
"While this is a Phase 1 study, the high response rates observed in patients with ALK-positive (lung cancer) who received crizotinib suggest that we may be one step closer to the development of 'precision' or 'personalized' cancer treatments that target specific genetic factors that drive certain tumors," said Pfizer's Dr. Mace Rothenberg.
Health highlights AP Could overhaul undermine employer health coverage?
The new health care law wasn't supposed to undercut employer plans that have provided most people in the U.S. with coverage for generations. But some employers are weighing the options.
..But a team of doctors led by Young Lim Choi of the University of Tokyo reported on a patient who developed two independent mutations that made the tumor resistant to crizotinib.
The appearance of resistance is not surprising, Dr. Hiroyuki Mano of the University of Tokyo said in a telephone interview. Other so-called ALK inhibitors have the same problem to some degree.
"The news is both good and bad," said Mano. "It's bad in that there may be some refractory population. But it's good that we know the resistant mutations, so the next generation of ALK inhibitors will use that information to make a less refractory drug in the very near future."
Pfizer said it planned to start submitting data for approval of the drug to the U.S. Food and Drug Administration later this year.
The experimental drug works against cells that have turned cancerous when two genes fuse to form a new gene called EML4-ALK. Although only about 3 percent to 5 percent of people with non-small-cell lung cancer fall into this category, that translates into nearly 10,000 cancer patients in the United States.
Nearly all the volunteers in that study had already undergone one round of treatment with cancer drugs.
..Second-round chemotherapy typically only works in about 10 percent of such cases, Bengt Hallberg and Ruth Palmer of Umea University in Sweden said in a Journal commentary.
Side-effects such as nausea and diarrhea were reported to be mild to moderate and seen in 40 percent of patients.
The medical journal also reported that the drug, sometimes designated PF-02341066, helped a 44-year-old man with a rare inflammatory myofibroblastic tumor that had the ALK mutation.
A younger patient without the mutation did not benefit from the treatment, according to a team led by Dr. James Butrynski of the Dana-Farber Cancer Institute in Boston.
Existing cancer pills like AstraZeneca's Iressa and Roche's Tarceva are already known to be effective against cancer in patients with a mutation activating the epidermal growth factor receptor (EGFR).
Lung cancer is the most common cancer killer, with 1.61 million cases worldwide, according to the International Agency for Research on Cancer and it kills 1.2 million of them.
Wednesday, October 13, 2010
Could Losing Weight Ease Your Arthritis Pain?
Osteoarthritis Health Center
By Gina Shaw
WebMD Feature Reviewed by Brunilda Nazario, MD
For 12 years, Robin Lutchansky spent most of her time in a wheelchair. The pain from her severe osteoarthritis, first diagnosed in her early 30s, made it difficult to walk more than short distances.
Then, a little over three years ago, Lutchansky found her way to a pain management clinic that taught her how to exercise -- first, teaching her how to walk again. Over the next three years, Lutchansky, now 51, gradually lost nearly 100 pounds with calorie reduction and exercise.
“I did it slowly. I started out just lifting 2-pound weights, and I walked in the pool every day,” she says.
Today, Lutchansky is out of the wheelchair and back at work as a public relations representative for a high-tech firm, and says that her daily pain levels have gone from an 8 or a 9 to a 1. “It’s amazing. It’s a new life. I had no idea it was possible.”
What Weight Does to Your Joints
If you are at all overweight, one of the best ways to reduce osteoarthritis pain is by taking off excess pounds. Being overweight increases the load that you put on your joints -- your knees, your hips, your ankle -- with every step you take.
“When we walk, when we go up and down stairs, or get into or out of a chair or car, we can put three to five times our body weight, and sometimes more, on the joints,” says Geoffrey Westrich, attending orthopedic surgeon and Director of Joint Replacement Research at the Hospital for Special Surgery in New York. “So if you’re 50 pounds overweight, you’re putting around 250 pounds of increased stress across your knees and hips.”
Over time, that extra weight makes you much more prone to developing arthritis and can cause arthritis to progress much more rapidly, leading to much more pain once it has developed.
Fortunately, the same principle works in reverse. “For every pound people lose, they lose 3 pounds of stress across their knee and 6 pounds of stress on their hip, on average,” says Westrich.
Small Steps, Big Changes
You don’t have to lose 100 pounds, like Lutchansky, to see a difference in your pain levels. C. Thomas Vangsness, Jr., MD, professor of orthopaedic surgery and chief of sports medicine at the Keck School of Medicine at the University of Southern California, says most of his arthritis patients who lose weight notice that their pain is diminishing after losing about 20 pounds.
Jane Angelich, a 58-year-old California businesswoman, has lost 33 pounds on Weight Watchers.
“What a difference!” she says. “It starts when I get out of bed in the morning. No more limping around and groaning for the first few minutes. Instead of finding excuses to sit on my couch instead of walking around, I now walk the equivalent of a 5k without any issues and can even function the next day!”
Losing weight cannot repair the damage that’s already been done to your joints by arthritis, but in addition to decreasing your pain, it can also help to slow down the further progression of the disease. One study found that knee osteoarthritis in obese men would decrease by 21.5% if they lost enough weight to be categorized as merely overweight; for women, arthritis would decrease by 31%.
“The damage is already done, and arthritis is a progressive process,” says Westrich. “But weight loss can be tremendously helpful in alleviating pain, allowing greater function, and prolonging the period of time before someone needs joint replacement surgery.”
And if you haven’t developed arthritis but you’re worried about it, losing excess weight can significantly lower your risk. If you’re significantly overweight, every 11 pounds you lose cuts your risk of developing arthritis by more than 50%.
Making It Happen
The best way to lose weight, any doctor will tell you, is to eat less, eat healthy foods, and exercise more. But while someone with arthritis can start to change their eating habits in pretty much the same way that someone without the disease can, having arthritis makes exercise a little more complicated.
High-impact exercise, like running, jogging, and aerobics, can put too much stress on the joints, so doctors recommend against these activities. “They can hasten the arthritis process and cause injury,” says Westrich.
Instead, Vangsness recommends that his patients pursue one of three types of exercise that are particularly well suited for people with arthritis:
Swimming
Cycling (especially on a recumbent stationary bike, which is easier on knees and hips than a standard bike)
Elliptical trainers
“These all get your heart rate up without putting any stress on the knee,” he says. “The buoyancy of water helps to alleviate pain during water exercise. And working out using a stationary bike or an elliptical trainer can help strengthen key muscles like the quadriceps. If your quadriceps are strong, that can cushion the ‘heel strike’ moment when you step forward while walking, and decrease pain as well.”
He adds that some of his extremely obese patients have gotten their weight loss started through gastric bypass or gastric banding surgery. “They start peeling off the pounds, and this tremendous loss of weight really knocks down their pain,” he says. “It’s like a whole new knee. And after losing that weight, they can exercise where they couldn’t before, strengthen their muscles, and further reduce pain.”
By Gina Shaw
WebMD Feature Reviewed by Brunilda Nazario, MD
For 12 years, Robin Lutchansky spent most of her time in a wheelchair. The pain from her severe osteoarthritis, first diagnosed in her early 30s, made it difficult to walk more than short distances.
Then, a little over three years ago, Lutchansky found her way to a pain management clinic that taught her how to exercise -- first, teaching her how to walk again. Over the next three years, Lutchansky, now 51, gradually lost nearly 100 pounds with calorie reduction and exercise.
“I did it slowly. I started out just lifting 2-pound weights, and I walked in the pool every day,” she says.
Today, Lutchansky is out of the wheelchair and back at work as a public relations representative for a high-tech firm, and says that her daily pain levels have gone from an 8 or a 9 to a 1. “It’s amazing. It’s a new life. I had no idea it was possible.”
What Weight Does to Your Joints
If you are at all overweight, one of the best ways to reduce osteoarthritis pain is by taking off excess pounds. Being overweight increases the load that you put on your joints -- your knees, your hips, your ankle -- with every step you take.
“When we walk, when we go up and down stairs, or get into or out of a chair or car, we can put three to five times our body weight, and sometimes more, on the joints,” says Geoffrey Westrich, attending orthopedic surgeon and Director of Joint Replacement Research at the Hospital for Special Surgery in New York. “So if you’re 50 pounds overweight, you’re putting around 250 pounds of increased stress across your knees and hips.”
Over time, that extra weight makes you much more prone to developing arthritis and can cause arthritis to progress much more rapidly, leading to much more pain once it has developed.
Fortunately, the same principle works in reverse. “For every pound people lose, they lose 3 pounds of stress across their knee and 6 pounds of stress on their hip, on average,” says Westrich.
Small Steps, Big Changes
You don’t have to lose 100 pounds, like Lutchansky, to see a difference in your pain levels. C. Thomas Vangsness, Jr., MD, professor of orthopaedic surgery and chief of sports medicine at the Keck School of Medicine at the University of Southern California, says most of his arthritis patients who lose weight notice that their pain is diminishing after losing about 20 pounds.
Jane Angelich, a 58-year-old California businesswoman, has lost 33 pounds on Weight Watchers.
“What a difference!” she says. “It starts when I get out of bed in the morning. No more limping around and groaning for the first few minutes. Instead of finding excuses to sit on my couch instead of walking around, I now walk the equivalent of a 5k without any issues and can even function the next day!”
Losing weight cannot repair the damage that’s already been done to your joints by arthritis, but in addition to decreasing your pain, it can also help to slow down the further progression of the disease. One study found that knee osteoarthritis in obese men would decrease by 21.5% if they lost enough weight to be categorized as merely overweight; for women, arthritis would decrease by 31%.
“The damage is already done, and arthritis is a progressive process,” says Westrich. “But weight loss can be tremendously helpful in alleviating pain, allowing greater function, and prolonging the period of time before someone needs joint replacement surgery.”
And if you haven’t developed arthritis but you’re worried about it, losing excess weight can significantly lower your risk. If you’re significantly overweight, every 11 pounds you lose cuts your risk of developing arthritis by more than 50%.
Making It Happen
The best way to lose weight, any doctor will tell you, is to eat less, eat healthy foods, and exercise more. But while someone with arthritis can start to change their eating habits in pretty much the same way that someone without the disease can, having arthritis makes exercise a little more complicated.
High-impact exercise, like running, jogging, and aerobics, can put too much stress on the joints, so doctors recommend against these activities. “They can hasten the arthritis process and cause injury,” says Westrich.
Instead, Vangsness recommends that his patients pursue one of three types of exercise that are particularly well suited for people with arthritis:
Swimming
Cycling (especially on a recumbent stationary bike, which is easier on knees and hips than a standard bike)
Elliptical trainers
“These all get your heart rate up without putting any stress on the knee,” he says. “The buoyancy of water helps to alleviate pain during water exercise. And working out using a stationary bike or an elliptical trainer can help strengthen key muscles like the quadriceps. If your quadriceps are strong, that can cushion the ‘heel strike’ moment when you step forward while walking, and decrease pain as well.”
He adds that some of his extremely obese patients have gotten their weight loss started through gastric bypass or gastric banding surgery. “They start peeling off the pounds, and this tremendous loss of weight really knocks down their pain,” he says. “It’s like a whole new knee. And after losing that weight, they can exercise where they couldn’t before, strengthen their muscles, and further reduce pain.”
Gene Predicts Breast Cancer Treatment Success
Breast Cancer Health
Tamoxifen Works Poorly in Women With Active BCAR4 Gene, Study Shows
By Nicky Broyd
WebMD Health NewsReviewed by Keith Barnard, MDOct. 12, 2010 -- Scientists have identified a gene that could help predict whether a breast cancer patient will respond to the drug tamoxifen.
A study published today in the British Journal of Cancer showed a potential link between the activity of a gene called BCAR4 and the likelihood that a breast cancer tumor will not respond to tamoxifen hormone therapy.
The study also found that the level of BCAR4 in a tumour was linked to a poor prognosis regardless of whether the patient received tamoxifen.
A Visual Guide to Breast Cancer
Breast Cancer and Hormone Therapy
Tamoxifen is a hormone treatment given after surgery. It was developed more than 30 years ago and is widely used to treat women with breast cancer.
Tamoxifen comes in tablet form and is given for about five years after surgery to help prevent the disease from returning.
Tamoxifen prevents estrogen from stimulating the growth of breast cancer cells, but some tumors can eventually develop resistance to the treatment, making the drug ineffective.
BCAR4 in Breast Cancer
The research looked into why this might happen by examining whether the BCAR4 gene is involved in tamoxifen resistance. Using samples from 280 breast cancer patients, the researchers found that tamoxifen had a weak, or limited effect, on tumors with a highly active BCAR4 gene.
Study researcher Ton van Agthoven, says in a news release: “We know that breast cancer cells have different ways to escape tamoxifen therapy. Now BCAR4 may be a promising target for development of new treatments.
“Preliminary results show that BCAR4 is only active in the cancer cells and not in normal adult tissues. Therefore, treatments which fight against BCAR4 may have limited side effects for the patient.”
Research into the genes that control how breast cancer responds to treatment will help doctors provide patients with the most effective treatment for their tumor as early as possible, increasing their chance of survival.
It could also lead to the development of new breast cancer drugs to target tumors with a specific genetic makeup.
Further Research
Julie Sharp, senior science information manager at Cancer Research UK, says in a news release, “These early results tell us more about why tamoxifen can stop working for some women. We need further research into the BCAR4 gene to decide if it could lead to better ways to treat patients.
“Understanding the makeup of a tumor can enable drugs to be tailored to individual patients, and this could potentially improve cancer survival in the long term. In the future, doctors may be able to use this type of information to match the best treatment to the patients most likely to benefit and avoid giving treatment that is less likely to be effective.”
Tamoxifen Works Poorly in Women With Active BCAR4 Gene, Study Shows
By Nicky Broyd
WebMD Health NewsReviewed by Keith Barnard, MDOct. 12, 2010 -- Scientists have identified a gene that could help predict whether a breast cancer patient will respond to the drug tamoxifen.
A study published today in the British Journal of Cancer showed a potential link between the activity of a gene called BCAR4 and the likelihood that a breast cancer tumor will not respond to tamoxifen hormone therapy.
The study also found that the level of BCAR4 in a tumour was linked to a poor prognosis regardless of whether the patient received tamoxifen.
A Visual Guide to Breast Cancer
Breast Cancer and Hormone Therapy
Tamoxifen is a hormone treatment given after surgery. It was developed more than 30 years ago and is widely used to treat women with breast cancer.
Tamoxifen comes in tablet form and is given for about five years after surgery to help prevent the disease from returning.
Tamoxifen prevents estrogen from stimulating the growth of breast cancer cells, but some tumors can eventually develop resistance to the treatment, making the drug ineffective.
BCAR4 in Breast Cancer
The research looked into why this might happen by examining whether the BCAR4 gene is involved in tamoxifen resistance. Using samples from 280 breast cancer patients, the researchers found that tamoxifen had a weak, or limited effect, on tumors with a highly active BCAR4 gene.
Study researcher Ton van Agthoven, says in a news release: “We know that breast cancer cells have different ways to escape tamoxifen therapy. Now BCAR4 may be a promising target for development of new treatments.
“Preliminary results show that BCAR4 is only active in the cancer cells and not in normal adult tissues. Therefore, treatments which fight against BCAR4 may have limited side effects for the patient.”
Research into the genes that control how breast cancer responds to treatment will help doctors provide patients with the most effective treatment for their tumor as early as possible, increasing their chance of survival.
It could also lead to the development of new breast cancer drugs to target tumors with a specific genetic makeup.
Further Research
Julie Sharp, senior science information manager at Cancer Research UK, says in a news release, “These early results tell us more about why tamoxifen can stop working for some women. We need further research into the BCAR4 gene to decide if it could lead to better ways to treat patients.
“Understanding the makeup of a tumor can enable drugs to be tailored to individual patients, and this could potentially improve cancer survival in the long term. In the future, doctors may be able to use this type of information to match the best treatment to the patients most likely to benefit and avoid giving treatment that is less likely to be effective.”
Monday, October 11, 2010
Diabetic information
- Diabetes is a chronic condition for which there IS no cure.
- Every year more than one million Americans learn they have diabetes.
- Nearly one in five Americans over the age of 60 have diabetes.
- Diabetes is the fourth leading cause of death in the USA. Most of these deaths are due to heart disease and high blood pressure.
- The risk of stroke and heart disease is 2 to 4 times higher in people with diabetes.
- Up to 65% of people with diabetes have high blood pressure and 70% have some nerve damage.
- Over 20,000 people lose their eyesight every year due to complications from diabetes.
- Every year more people die of diabetes than all the deaths from AIDS, breast cancer, and car accidents.
- One in three American kids will develop diabetes in their lifetime. Many American kids do not exercise enough and overeat.
Elvis Presely, Earnest Hemingway, Arthur Ashe, Sugar Ray Robinson, Mary Tyler Moore, Halle Berry, Thomas Edison, and Elizabeth Taylor were ALL diabetics.
- $592 billion is spent every year taking care of diabetic patients.
- Over 6% of Americans have diabetes, more than 18 million. Unfortunately 1/3 of them have not been diagnosed.
- The average American eats about 150 pounds of sugar every year.
- Simple sugars- candy, cake, jam, white flour- are absorbed and digested quickly and causes a sudden surge of sugar into the blood stream.
- Complex sugars- whole wheat bread, pasta, brown rice, dried beans, and vegetables- are absorbed and digested much more slowly and results in a steady level of blood sugars.
- Every year more than one million Americans learn they have diabetes.
- Nearly one in five Americans over the age of 60 have diabetes.
- Diabetes is the fourth leading cause of death in the USA. Most of these deaths are due to heart disease and high blood pressure.
- The risk of stroke and heart disease is 2 to 4 times higher in people with diabetes.
- Up to 65% of people with diabetes have high blood pressure and 70% have some nerve damage.
- Over 20,000 people lose their eyesight every year due to complications from diabetes.
- Every year more people die of diabetes than all the deaths from AIDS, breast cancer, and car accidents.
- One in three American kids will develop diabetes in their lifetime. Many American kids do not exercise enough and overeat.
Elvis Presely, Earnest Hemingway, Arthur Ashe, Sugar Ray Robinson, Mary Tyler Moore, Halle Berry, Thomas Edison, and Elizabeth Taylor were ALL diabetics.
- $592 billion is spent every year taking care of diabetic patients.
- Over 6% of Americans have diabetes, more than 18 million. Unfortunately 1/3 of them have not been diagnosed.
- The average American eats about 150 pounds of sugar every year.
- Simple sugars- candy, cake, jam, white flour- are absorbed and digested quickly and causes a sudden surge of sugar into the blood stream.
- Complex sugars- whole wheat bread, pasta, brown rice, dried beans, and vegetables- are absorbed and digested much more slowly and results in a steady level of blood sugars.
Tuesday, October 5, 2010
Health Care’s Lost Weekend
Contributing Columnist
By PETER ORSZAG
Published: October 3, 2010
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.
Related
A Health Care Plan for Colleges (September 19, 2010)
One Nation, Two Deficits (September 7, 2010)
Peter Orszag's Columns for the Opinionator
That’s why an effort at New York University Langone Medical Center to institute both of these changes is so important. If it succeeds, it will help point the way to the health care system of the future.
First, weekends. It’s never good to be hospitalized, but you really don’t want to be hospitalized on a weekend. There are fewer doctors around, and people admitted on Saturdays and Sundays fare relatively poorly.
One study in 2007 found, for example, that for every 1,000 patients suffering heart attacks who were admitted to a hospital on a weekend, there were 9 to 10 more deaths than in a comparable group of patients admitted on a weekday. The weekend patients were less likely to quickly receive the invasive procedures they needed — like coronary artery bypass grafts or cardiac catheterization.
It’s not just a safety issue but, for less life-threatening medical problems, also a matter of convenience. Wouldn’t it be nice to be able to schedule your elective surgery on a Saturday if you wanted? Most hospitals don’t offer that option.
And then there are the economics of a $750 billion-a-year industry letting its capacity sit idle a quarter or more of the time. If hospitals were in constant use, costs would fall as expensive assets like operating rooms and imaging equipment were used more fully. And if the workflow at existing hospitals was spread more evenly over the entire week, patients could more often enjoy the privacy of single-bed rooms.
N.Y.U.’s first step toward seven-day service has been to keep certain functions going all weekend, like radiology study interpretation, magnetic resonance imaging and elective cardiac surgery. The cancer center also now provides some treatments on weekends. And some procedures, like elective Caesarean sections, are offered on Saturdays. So far, the doctors involved are on board.
A second innovation is quality assessment and management. As the saying goes, if you can’t measure it, you can’t manage it — or improve it. That’s why the federal government is now making key investments to encourage hospitals, clinics and doctors to adopt health information technology and report statistics on quality of care.
Robert Grossman, the dean and chief executive of N.Y.U. Langone, has gathered data from around the medical center into a “management dashboard.” This allows him to monitor not only financial information like operating margins and cash balances but also detailed quality data on individual doctors like 30-day hospital readmission rates and the number of infections associated with invasive procedures.
The patterns he has been able to discern this way have been eye-opening. The dashboard data revealed, for instance, that on any given day a disproportionately small number of eligible patients were discharged before noon, so that many people were kept in the hospital longer than necessary. Further analysis revealed a key reason: several routine procedures that some patients need before leaving, like the insertion of central catheters, were not performed in the morning. The medical center has since begun to offer the procedures earlier, and the percentage of discharges before noon has increased significantly.
So far, so good. But will these initiatives become a permanent part of the culture? And if the strategies do survive, how much difference can they make in the cost and quality of care?
N.Y.U. has historically not stacked up that well in cost comparisons with other hospitals. The Dartmouth Atlas of Health Care, which tracks data on regional variations in Medicare costs, suggested that from 2001 to 2005 a Medicare beneficiary’s care at N.Y.U. during the final two years of his life cost taxpayers more than $100,000 — roughly twice the cost at America’s most efficient hospitals.
The Dartmouth data also indicate that the N.Y.U. patients received no clear benefit for the higher cost. They saw, on average, more than 14 different doctors, compared with fewer than 10 for patients at the most efficient hospitals. But the extra visits did not seem to produce better outcomes. In fact, seeing more doctors may have caused harm, as patients ran the risk of side effects and complications from additional tests, treatments and medicines.
N.Y.U. will know that its innovations in weekend operations and doctor assessment are working if, in time, they help improve the cost-effectiveness of care. If they do, it’s important that any practices found effective be adopted widely. Better ways of spreading such innovations will be the focus of my next column. In health care, experimentation is the mother of improvement.
Peter Orszag, the director of the White House Office of Management and Budget from 2009 to 2010 and a distinguished visiting fellow at the Council on Foreign Relations, is a contributing columnist for The Times.
By PETER ORSZAG
Published: October 3, 2010
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or a television network that didn’t measure its ratings. Improving the quality of health care and reducing its cost will require that doctors make many changes — but working weekends and consenting to quality management are two clear ones.
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That’s why an effort at New York University Langone Medical Center to institute both of these changes is so important. If it succeeds, it will help point the way to the health care system of the future.
First, weekends. It’s never good to be hospitalized, but you really don’t want to be hospitalized on a weekend. There are fewer doctors around, and people admitted on Saturdays and Sundays fare relatively poorly.
One study in 2007 found, for example, that for every 1,000 patients suffering heart attacks who were admitted to a hospital on a weekend, there were 9 to 10 more deaths than in a comparable group of patients admitted on a weekday. The weekend patients were less likely to quickly receive the invasive procedures they needed — like coronary artery bypass grafts or cardiac catheterization.
It’s not just a safety issue but, for less life-threatening medical problems, also a matter of convenience. Wouldn’t it be nice to be able to schedule your elective surgery on a Saturday if you wanted? Most hospitals don’t offer that option.
And then there are the economics of a $750 billion-a-year industry letting its capacity sit idle a quarter or more of the time. If hospitals were in constant use, costs would fall as expensive assets like operating rooms and imaging equipment were used more fully. And if the workflow at existing hospitals was spread more evenly over the entire week, patients could more often enjoy the privacy of single-bed rooms.
N.Y.U.’s first step toward seven-day service has been to keep certain functions going all weekend, like radiology study interpretation, magnetic resonance imaging and elective cardiac surgery. The cancer center also now provides some treatments on weekends. And some procedures, like elective Caesarean sections, are offered on Saturdays. So far, the doctors involved are on board.
A second innovation is quality assessment and management. As the saying goes, if you can’t measure it, you can’t manage it — or improve it. That’s why the federal government is now making key investments to encourage hospitals, clinics and doctors to adopt health information technology and report statistics on quality of care.
Robert Grossman, the dean and chief executive of N.Y.U. Langone, has gathered data from around the medical center into a “management dashboard.” This allows him to monitor not only financial information like operating margins and cash balances but also detailed quality data on individual doctors like 30-day hospital readmission rates and the number of infections associated with invasive procedures.
The patterns he has been able to discern this way have been eye-opening. The dashboard data revealed, for instance, that on any given day a disproportionately small number of eligible patients were discharged before noon, so that many people were kept in the hospital longer than necessary. Further analysis revealed a key reason: several routine procedures that some patients need before leaving, like the insertion of central catheters, were not performed in the morning. The medical center has since begun to offer the procedures earlier, and the percentage of discharges before noon has increased significantly.
So far, so good. But will these initiatives become a permanent part of the culture? And if the strategies do survive, how much difference can they make in the cost and quality of care?
N.Y.U. has historically not stacked up that well in cost comparisons with other hospitals. The Dartmouth Atlas of Health Care, which tracks data on regional variations in Medicare costs, suggested that from 2001 to 2005 a Medicare beneficiary’s care at N.Y.U. during the final two years of his life cost taxpayers more than $100,000 — roughly twice the cost at America’s most efficient hospitals.
The Dartmouth data also indicate that the N.Y.U. patients received no clear benefit for the higher cost. They saw, on average, more than 14 different doctors, compared with fewer than 10 for patients at the most efficient hospitals. But the extra visits did not seem to produce better outcomes. In fact, seeing more doctors may have caused harm, as patients ran the risk of side effects and complications from additional tests, treatments and medicines.
N.Y.U. will know that its innovations in weekend operations and doctor assessment are working if, in time, they help improve the cost-effectiveness of care. If they do, it’s important that any practices found effective be adopted widely. Better ways of spreading such innovations will be the focus of my next column. In health care, experimentation is the mother of improvement.
Peter Orszag, the director of the White House Office of Management and Budget from 2009 to 2010 and a distinguished visiting fellow at the Council on Foreign Relations, is a contributing columnist for The Times.
Thursday, September 30, 2010
New Genetic Clues for ADHD
Rare DNA Errors in ADHD Kids Linked to Brain-Development Genes
By Daniel J. DeNoon
WebMD Health News Reviewed by Laura J. Martin, MD Sept. 29, 2010
-- Attention deficit hyperactivity disorder (ADHD) is a brain disorder and not purely a behavioral problem, say the first researchers to identify rare genetic errors in ADHD kids.
People with ADHD have an unusually large number of "copy number variants" or CNVs -- chunks of DNA that are either missing or duplicated, says study researcher Anita Thapar, MD, professor of child and adolescent psychiatry at Cardiff University in Wales.
"These missing or duplicated chunks of DNA are in the areas of the chromosome that overlap with those implicated in autism and schizophrenia, [which are] established brain disorders," Thapar said at a news conference. "And we found that the most significant excess of these copy number variants was in a specific region ... that includes genes for brain development."
Thapar and colleagues analyzed genetic data from 366 children with ADHD ranging in age from 5 to 17 and from 1,047 matched children in the general population. They found that the kids with ADHD carried twice as many large CNVs.
This difference was even more pronounced in ADHD kids with intellectual disability. These children, with IQs of less than 70, had nearly six times more large CNVs than normal children. But regardless of intellectual disability, ADHD kids had significantly more large chunks of DNA that were missing and duplicated.
Slideshow: ADHD in Children
Complexity of ADHD
Because the findings don't identify a specific "ADHD gene," the kind of genetic analysis used in the study cannot be used as a test for ADHD.
"ADHD is a very complex disorder, which will have a number of different genetic factors involved, and also non-genetic, environmental factors. It is this combination that is the likely cause of ADHD," study researcher Kate Langley, PhD, a psychologist at Cardiff University, said at the news conference.
However, Thapar said the findings should be a great relief to parents and to people with ADHD who have been stigmatized by the disorder.
"There is a lot of misunderstanding about ADHD. Some say it is not a real disorder or that it is just the result of bad parenting," she said. "Our results show it should be considered a neurodevelopmental disorder like autism."
Indeed, kids with ADHD and kids with autism have some symptoms in common. This leads the researchers to suggest that there might be a biological link between the two disorders.
Thapar said that the study findings will spur more intensive research likely to uncover more specific information on the genetic factors that predispose a person to ADHD.
The study is reported in the Sept. 30 online issue of The Lancet.
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Anxiety, Stress and ADHD
By Daniel J. DeNoon
WebMD Health News Reviewed by Laura J. Martin, MD Sept. 29, 2010
-- Attention deficit hyperactivity disorder (ADHD) is a brain disorder and not purely a behavioral problem, say the first researchers to identify rare genetic errors in ADHD kids.
People with ADHD have an unusually large number of "copy number variants" or CNVs -- chunks of DNA that are either missing or duplicated, says study researcher Anita Thapar, MD, professor of child and adolescent psychiatry at Cardiff University in Wales.
"These missing or duplicated chunks of DNA are in the areas of the chromosome that overlap with those implicated in autism and schizophrenia, [which are] established brain disorders," Thapar said at a news conference. "And we found that the most significant excess of these copy number variants was in a specific region ... that includes genes for brain development."
Thapar and colleagues analyzed genetic data from 366 children with ADHD ranging in age from 5 to 17 and from 1,047 matched children in the general population. They found that the kids with ADHD carried twice as many large CNVs.
This difference was even more pronounced in ADHD kids with intellectual disability. These children, with IQs of less than 70, had nearly six times more large CNVs than normal children. But regardless of intellectual disability, ADHD kids had significantly more large chunks of DNA that were missing and duplicated.
Slideshow: ADHD in Children
Complexity of ADHD
Because the findings don't identify a specific "ADHD gene," the kind of genetic analysis used in the study cannot be used as a test for ADHD.
"ADHD is a very complex disorder, which will have a number of different genetic factors involved, and also non-genetic, environmental factors. It is this combination that is the likely cause of ADHD," study researcher Kate Langley, PhD, a psychologist at Cardiff University, said at the news conference.
However, Thapar said the findings should be a great relief to parents and to people with ADHD who have been stigmatized by the disorder.
"There is a lot of misunderstanding about ADHD. Some say it is not a real disorder or that it is just the result of bad parenting," she said. "Our results show it should be considered a neurodevelopmental disorder like autism."
Indeed, kids with ADHD and kids with autism have some symptoms in common. This leads the researchers to suggest that there might be a biological link between the two disorders.
Thapar said that the study findings will spur more intensive research likely to uncover more specific information on the genetic factors that predispose a person to ADHD.
The study is reported in the Sept. 30 online issue of The Lancet.
Top Picks
Health Check: Is ADHD Affecting Your Life?
Adult ADHD Symptoms: Do You Know Them?
Slideshow: Top Concentration Killers
Anxiety, Stress and ADHD
Thursday, September 23, 2010
Clinton Says Give Democrats More Time
Breaking from Newsmax.com
NEW YORK — Bill Clinton asked the American people Wednesday to give the Democrats two more years to dig the country out of the economic hole he blamed on the Republicans — and then, if the Democrats fail, "throw us all out."
The former president said in an interview with The Associated Press that the Democrats can still pull the November midterm elections out of the fire if they go on the offensive.
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The Democrats won "a lot of exceedingly marginal seats" in the last two elections and have to assume they will lose some of them this year, but "whether these elections will be a big setback for the Democrats is yet to be determined," he said.
"If the Democrats can make this a choice, not a referendum, they can win," Clinton said. "If it's a referendum on anger, apathy, laced with amnesia, they're going to have a problem."
He urged Democrats to start countering GOP claims with facts and statistics demonstrating what President Barack Obama's administration has done to avert a more severe downturn and what Republican promises to roll back key legislation would mean for voters.
"I think the Democrats ought to stand up and say ... 'You gave them eight years to dig this hole, and to double the debt of the country, and not to produce any jobs, and then to have a financial collapse and all this calamity. At least give us four to dig out of it,'" Clinton said.
"If we're wrong, throw us all out. But don't bring back the people that dug the hole."
Clinton spoke in a lengthy telephone conversation from the Clinton Global Initiative, a conference that brings together leaders from government, business and philanthropy who make financial commitments to reduce poverty and disease around the world. Obama and his wife, Michelle, are expected to address the closing session on Thursday.
Democrats are facing a wave of voter anger over the struggling economy, and the Republicans appear poised to gain seats and possibly control of the House, and pick up seats in the Senate, too. That could position them to block virtually any Obama initiatives in the next two years.
In the next five weeks, Clinton said, the Democrats need to answer the two key GOP arguments — that they should be thrown out because they haven't reversed the fallout from the global financial crisis, and that the Obama administration is spending too much and trying to turn the U.S. into "some big European-style social democratic bureaucracy."
Clinton said it is important for Democrats to tell voters that "we didn't get out of the hole, but we have stopped digging." The U.S. has recovered 70 percent of the income growth it lost in the 2008 global financial meltdown, he said. In contrast, Germany has recovered 60 percent, Japan 50 percent and Britain 30 percent.
"We got into this mess because there was too much risk and too little oversight," Clinton said. The Republicans want to repeal the Obama administration's financial oversight legislation "and let the interest groups go back to basically gambling not only with their future but ours."
He said Democrats need to make the case that the $800 billion stimulus package provided a modest tax cut for many people and enabled state and local governments to avoid layoffs of teachers and health care workers.
"I think we ought to defend the stimulus," Clinton said. "The hole was $3 trillion. Two-thirds of the stimulus was not designed to get us out of the hole. It was designed to help us tread water so we didn't drown."
NEW YORK — Bill Clinton asked the American people Wednesday to give the Democrats two more years to dig the country out of the economic hole he blamed on the Republicans — and then, if the Democrats fail, "throw us all out."
The former president said in an interview with The Associated Press that the Democrats can still pull the November midterm elections out of the fire if they go on the offensive.
Editor's Notes:
Top Doctors Share Secrets to Surviving Cancer
10 Prescription Drugs That Don't Work
The Democrats won "a lot of exceedingly marginal seats" in the last two elections and have to assume they will lose some of them this year, but "whether these elections will be a big setback for the Democrats is yet to be determined," he said.
"If the Democrats can make this a choice, not a referendum, they can win," Clinton said. "If it's a referendum on anger, apathy, laced with amnesia, they're going to have a problem."
He urged Democrats to start countering GOP claims with facts and statistics demonstrating what President Barack Obama's administration has done to avert a more severe downturn and what Republican promises to roll back key legislation would mean for voters.
"I think the Democrats ought to stand up and say ... 'You gave them eight years to dig this hole, and to double the debt of the country, and not to produce any jobs, and then to have a financial collapse and all this calamity. At least give us four to dig out of it,'" Clinton said.
"If we're wrong, throw us all out. But don't bring back the people that dug the hole."
Clinton spoke in a lengthy telephone conversation from the Clinton Global Initiative, a conference that brings together leaders from government, business and philanthropy who make financial commitments to reduce poverty and disease around the world. Obama and his wife, Michelle, are expected to address the closing session on Thursday.
Democrats are facing a wave of voter anger over the struggling economy, and the Republicans appear poised to gain seats and possibly control of the House, and pick up seats in the Senate, too. That could position them to block virtually any Obama initiatives in the next two years.
In the next five weeks, Clinton said, the Democrats need to answer the two key GOP arguments — that they should be thrown out because they haven't reversed the fallout from the global financial crisis, and that the Obama administration is spending too much and trying to turn the U.S. into "some big European-style social democratic bureaucracy."
Clinton said it is important for Democrats to tell voters that "we didn't get out of the hole, but we have stopped digging." The U.S. has recovered 70 percent of the income growth it lost in the 2008 global financial meltdown, he said. In contrast, Germany has recovered 60 percent, Japan 50 percent and Britain 30 percent.
"We got into this mess because there was too much risk and too little oversight," Clinton said. The Republicans want to repeal the Obama administration's financial oversight legislation "and let the interest groups go back to basically gambling not only with their future but ours."
He said Democrats need to make the case that the $800 billion stimulus package provided a modest tax cut for many people and enabled state and local governments to avoid layoffs of teachers and health care workers.
"I think we ought to defend the stimulus," Clinton said. "The hole was $3 trillion. Two-thirds of the stimulus was not designed to get us out of the hole. It was designed to help us tread water so we didn't drown."
Wednesday, September 22, 2010
Stem Cell Research: Science, Not Politics
Read More: Barack Obama , Dickey-Wicker , Fdr , Nih , Stem Cell Research , Stem Cells , Politics News
Speech delivered in Washington, DC on September 21, 2010:
Good evening. It is an honor to be speaking to all of you this evening. I'd like to thank John Walker, our Chairman and Tom Okarma, who heads our Government Relations Committee to the Board. And of course I need to acknowledge the hard work of Michael Werner and Morrie Ruffin. I also want to thank Congressman Mike Castle for his steadfast support of stem cell research.
On October 31, 1940, Franklin Delano Roosevelt dedicated the Campus of the National Institutes of Health in Bethesda, Maryland, just a few miles from here. That day, knowing we were moving toward a world war, he said:
The total defense, which this Nation seeks, involves a great deal more than building airplanes, ships, guns and bombs. We cannot be a strong Nation unless we are a healthy Nation. And so we must recruit not only men and materials but also knowledge and science in the service of national strength.
FDR understood the role that science would play in the future of a strong and healthy United States and he was clear that medical breakthroughs were as important to our nation as guns and missiles.
Never has that been more apparent in our history than today. In some ways FDR's vision became a reality. Americans are living longer than at any time in our history......but there's a difference between living a long life that's productive and healthy--and one filled with illness, disease and disability. FDR was saying that the government had a responsibility to do what it could to use the tools of medical research to help its citizens to live healthy and productive lives.
August 9, 2001 was another important date in our country's history. It was the day President Bush limited federal funding for human embryonic stem cell research and, in effect, took the opposite position from Franklin Delano Roosevelt--closing, or at least partly closing, the door that Roosevelt had opened so wide to Federal support of medical research. By his action in 2001, President Bush ignited a debate that has continued to rage for the last nine years. Politicians, scientists, religious leaders, ethicists, the American public and of course millions of Americans living with disease and disability have passionately argued all sides of this issue.
The debate has not ended, and will not end, but what those of us committed to the promise of stem cell science know is that the ability of science to proceed unencumbered by politics was severely compromised. The Federal government was saying that values other than those of pure science could determine research and funding priorities. For many stem cell scientists, it felt like, as one of them said, a boxer 'going into the ring with only his left hook but not his right jab' . And for the millions suffering from a debilitating and sometimes fatal disease, the pace of discovery was slowed to a crawl.
What this country truly needed then--as it had since Jamie Thompson and John Gearhart discovered the potential of human embryonic stem cell research in l998--was leadership. Political leadership that understood the difference between politics and science, political leadership that knew, as FDR did, that the act of support for science meant allowing the values of science to take precedence over the issues of politics. I was honored to have been in the East Room of the White House on March 9, 2009 when President Obama signed the Order stating:
Today... we will bring the change that so many scientists and researchers; doctors and innovators; patients and loved ones have hoped for, and fought for, these past eight years: we will lift the ban on federal funding for promising embryonic stem cell research. We will vigorously support scientists who pursue this research. And we will aim for America to lead the world in the discoveries it one day may yield.
But medical miracles do not happen simply by accident. They result from painstaking and costly research -- and from a government willing to support that work... When government fails to make these investments, opportunities are missed. Promising avenues go unexplored.
Those were inspiring words, and despite the fact that there were still limitations to the NIH guidelines, it looked like it was now time to get to work.
And then on August 23rd of this year, all of you know what happened. Just as the door of Federal support had finally begun to open, Federal district Judge Lamberth blocked President Obama's 2009 executive order that expanded embryonic stem cell research, saying it violated a ban on federal money being used to destroy embryos. Research at the NIH was disrupted yet again, and a cold chill went through the scientific community in this country. Francis Collins, director of the NIH, likened the decision to "pouring sand into the engine of discovery." While a temporary stay of this ruling has occurred, we still don't know, long-term, where this will end up if it is left to the courts. And the last thing science needs is a nail-biter. Thrillers belong in the movies, not in the world in which scientists try to plan medical research.
What these recent events have made absolutely clear is that we need unambiguous legislation passed by Congress this year. Stem cell research is the "don't ask, don't tell" of science. The Dickey-Wicker Amendment remains in full force and Congress must find the political will to change it. As most of you know, Dickey-Wicker was created in 1996, two years before the field of human embryonic stem cell research even existed, and it was created to be a deterrent to abortion, not to slow down the most promising medical research of our time. But the opponents of stem cell research, in their determination to block the progress of science, are using the old law to new purposes. It will mean, among other things, that more than 400,000 frozen embryos left over from IVF treatments that could have been used for medical research will instead be discarded as medical waste. Is this what is meant by "pro life"?
Everyone wants cures for diseases and it is time to acknowledge that the tens of millions of living Americans suffering from chronic illness and disabling conditions are more important than cells in a petri dish. The Dickey Wicker Amendment has had the net effect of giving political cover to conservative members of Congress, both Democratic and Republican, and it is time for them to act courageously and stand up for those who cannot. Now is the moment to vote, not for what is politically expedient but for what it right.
We have primed the pump and now we need to establish programs that truly challenge our scientific community to take human embryonic stem cell research to the next level. Let the only limits be those that our scientists place on their own imagination, creativity and perseverance. Let us seize the opportunity for excellence.
The partner for support from federal and state governments is private philanthropy. The role of private philanthropy is to be nimble, to be entrepreneurial, to do the cutting edge and controversial work--to test the concepts that, if they prove successful, can later be scaled up by public support. Historically, private philanthropy has been at the root of almost all of our major medical breakthroughs. But private philanthropy has always operated on the assumption that public support would be waiting in the wings to scale up the most promising work. Now, in the stem cell field, we have no such certainty. We don't know if the NIH will be there for us.
We are working hard to keep up our side of the bargain at The New York Stem Cell Foundation, where our stem cell research laboratory in Upper Manhattan has now become one of the finest such laboratories in the United States, with 20 fulltime researchers deriving stem cell lines and making them available to researchers throughout the country. Because we are private and receive no Federal funds, we are able to continue our work through these frustrating and debilitating cycles of off-again, on-again, off-again NIH support. But most of our collaborators are not so lucky. And there is no satisfaction for us in continuing to work when so many of our colleagues and collaborators cannot, especially since one of NYSCF's core missions is to expand the field. But it is not easy to do that when the climate is so uncertain.
We are growing the stem cell field now through our post doctoral Fellowship program and our new Investigator Program, both of which train and support young scientists in the pursuit of the most innovative and advanced translational stem cell research. This elite group of researchers is revolutionizing the practice of medicine. We have had 23 post-doctoral fellows in our program since we began in 2006. And this year I am proud to announce that NYSCF is expanding its efforts to cultivate the next generation of stem cell scientist by providing $24.5 million in funding to 17 Investigators to launch their own independent research, train other scientists, and foster innovative high risk / high reward research. But for the NYSCF's Fellowship and Investigators programs to truly succeed we must have a climate in this country that encourages these young men and women to enter this exciting field of science, not one that makes them worry if it is going to be a dead end. We don't want our program to feel like a small safe house in a hostile world. We want it to be the center of a large and healthy scientific community.
Like Franklin Delano Roosevelt, the United States must continue to recruit not only men and materials but also knowledge and science in the service of national strength. By doing so we will continue to be the model for the world in judging stem cell research for its scientific merit, and in making science, not politics, the standard we go by--and we will know that we are doing all we can to enable the great discoveries that will be made by all of you in this room today. Tomorrow you are all going to Capitol Hill to educate our elected officials as to why stem cell research is so critical. It is critical to American leadership. It is critical to the economy. It is critical to our great institutions and the scientists who make them great. But it is critical most of all to the tens of millions of Americans who suffer from chronic diseases and disabling conditions, for whom stem cell research symbolizes promise, not politics. I am confident that what we do tomorrow will truly make a difference.
Speech delivered in Washington, DC on September 21, 2010:
Good evening. It is an honor to be speaking to all of you this evening. I'd like to thank John Walker, our Chairman and Tom Okarma, who heads our Government Relations Committee to the Board. And of course I need to acknowledge the hard work of Michael Werner and Morrie Ruffin. I also want to thank Congressman Mike Castle for his steadfast support of stem cell research.
On October 31, 1940, Franklin Delano Roosevelt dedicated the Campus of the National Institutes of Health in Bethesda, Maryland, just a few miles from here. That day, knowing we were moving toward a world war, he said:
The total defense, which this Nation seeks, involves a great deal more than building airplanes, ships, guns and bombs. We cannot be a strong Nation unless we are a healthy Nation. And so we must recruit not only men and materials but also knowledge and science in the service of national strength.
FDR understood the role that science would play in the future of a strong and healthy United States and he was clear that medical breakthroughs were as important to our nation as guns and missiles.
Never has that been more apparent in our history than today. In some ways FDR's vision became a reality. Americans are living longer than at any time in our history......but there's a difference between living a long life that's productive and healthy--and one filled with illness, disease and disability. FDR was saying that the government had a responsibility to do what it could to use the tools of medical research to help its citizens to live healthy and productive lives.
August 9, 2001 was another important date in our country's history. It was the day President Bush limited federal funding for human embryonic stem cell research and, in effect, took the opposite position from Franklin Delano Roosevelt--closing, or at least partly closing, the door that Roosevelt had opened so wide to Federal support of medical research. By his action in 2001, President Bush ignited a debate that has continued to rage for the last nine years. Politicians, scientists, religious leaders, ethicists, the American public and of course millions of Americans living with disease and disability have passionately argued all sides of this issue.
The debate has not ended, and will not end, but what those of us committed to the promise of stem cell science know is that the ability of science to proceed unencumbered by politics was severely compromised. The Federal government was saying that values other than those of pure science could determine research and funding priorities. For many stem cell scientists, it felt like, as one of them said, a boxer 'going into the ring with only his left hook but not his right jab' . And for the millions suffering from a debilitating and sometimes fatal disease, the pace of discovery was slowed to a crawl.
What this country truly needed then--as it had since Jamie Thompson and John Gearhart discovered the potential of human embryonic stem cell research in l998--was leadership. Political leadership that understood the difference between politics and science, political leadership that knew, as FDR did, that the act of support for science meant allowing the values of science to take precedence over the issues of politics. I was honored to have been in the East Room of the White House on March 9, 2009 when President Obama signed the Order stating:
Today... we will bring the change that so many scientists and researchers; doctors and innovators; patients and loved ones have hoped for, and fought for, these past eight years: we will lift the ban on federal funding for promising embryonic stem cell research. We will vigorously support scientists who pursue this research. And we will aim for America to lead the world in the discoveries it one day may yield.
But medical miracles do not happen simply by accident. They result from painstaking and costly research -- and from a government willing to support that work... When government fails to make these investments, opportunities are missed. Promising avenues go unexplored.
Those were inspiring words, and despite the fact that there were still limitations to the NIH guidelines, it looked like it was now time to get to work.
And then on August 23rd of this year, all of you know what happened. Just as the door of Federal support had finally begun to open, Federal district Judge Lamberth blocked President Obama's 2009 executive order that expanded embryonic stem cell research, saying it violated a ban on federal money being used to destroy embryos. Research at the NIH was disrupted yet again, and a cold chill went through the scientific community in this country. Francis Collins, director of the NIH, likened the decision to "pouring sand into the engine of discovery." While a temporary stay of this ruling has occurred, we still don't know, long-term, where this will end up if it is left to the courts. And the last thing science needs is a nail-biter. Thrillers belong in the movies, not in the world in which scientists try to plan medical research.
What these recent events have made absolutely clear is that we need unambiguous legislation passed by Congress this year. Stem cell research is the "don't ask, don't tell" of science. The Dickey-Wicker Amendment remains in full force and Congress must find the political will to change it. As most of you know, Dickey-Wicker was created in 1996, two years before the field of human embryonic stem cell research even existed, and it was created to be a deterrent to abortion, not to slow down the most promising medical research of our time. But the opponents of stem cell research, in their determination to block the progress of science, are using the old law to new purposes. It will mean, among other things, that more than 400,000 frozen embryos left over from IVF treatments that could have been used for medical research will instead be discarded as medical waste. Is this what is meant by "pro life"?
Everyone wants cures for diseases and it is time to acknowledge that the tens of millions of living Americans suffering from chronic illness and disabling conditions are more important than cells in a petri dish. The Dickey Wicker Amendment has had the net effect of giving political cover to conservative members of Congress, both Democratic and Republican, and it is time for them to act courageously and stand up for those who cannot. Now is the moment to vote, not for what is politically expedient but for what it right.
We have primed the pump and now we need to establish programs that truly challenge our scientific community to take human embryonic stem cell research to the next level. Let the only limits be those that our scientists place on their own imagination, creativity and perseverance. Let us seize the opportunity for excellence.
The partner for support from federal and state governments is private philanthropy. The role of private philanthropy is to be nimble, to be entrepreneurial, to do the cutting edge and controversial work--to test the concepts that, if they prove successful, can later be scaled up by public support. Historically, private philanthropy has been at the root of almost all of our major medical breakthroughs. But private philanthropy has always operated on the assumption that public support would be waiting in the wings to scale up the most promising work. Now, in the stem cell field, we have no such certainty. We don't know if the NIH will be there for us.
We are working hard to keep up our side of the bargain at The New York Stem Cell Foundation, where our stem cell research laboratory in Upper Manhattan has now become one of the finest such laboratories in the United States, with 20 fulltime researchers deriving stem cell lines and making them available to researchers throughout the country. Because we are private and receive no Federal funds, we are able to continue our work through these frustrating and debilitating cycles of off-again, on-again, off-again NIH support. But most of our collaborators are not so lucky. And there is no satisfaction for us in continuing to work when so many of our colleagues and collaborators cannot, especially since one of NYSCF's core missions is to expand the field. But it is not easy to do that when the climate is so uncertain.
We are growing the stem cell field now through our post doctoral Fellowship program and our new Investigator Program, both of which train and support young scientists in the pursuit of the most innovative and advanced translational stem cell research. This elite group of researchers is revolutionizing the practice of medicine. We have had 23 post-doctoral fellows in our program since we began in 2006. And this year I am proud to announce that NYSCF is expanding its efforts to cultivate the next generation of stem cell scientist by providing $24.5 million in funding to 17 Investigators to launch their own independent research, train other scientists, and foster innovative high risk / high reward research. But for the NYSCF's Fellowship and Investigators programs to truly succeed we must have a climate in this country that encourages these young men and women to enter this exciting field of science, not one that makes them worry if it is going to be a dead end. We don't want our program to feel like a small safe house in a hostile world. We want it to be the center of a large and healthy scientific community.
Like Franklin Delano Roosevelt, the United States must continue to recruit not only men and materials but also knowledge and science in the service of national strength. By doing so we will continue to be the model for the world in judging stem cell research for its scientific merit, and in making science, not politics, the standard we go by--and we will know that we are doing all we can to enable the great discoveries that will be made by all of you in this room today. Tomorrow you are all going to Capitol Hill to educate our elected officials as to why stem cell research is so critical. It is critical to American leadership. It is critical to the economy. It is critical to our great institutions and the scientists who make them great. But it is critical most of all to the tens of millions of Americans who suffer from chronic diseases and disabling conditions, for whom stem cell research symbolizes promise, not politics. I am confident that what we do tomorrow will truly make a difference.
Monday, September 20, 2010
What Diabetes Can Do to Your Body
This content is selected and controlled by WebMD's editorial staff and is funded by Pfizer.
Next Article:
What Diabetes Can Do to Your Body
Simple tricks to help you follow a healthy diet.
The Diabetes Diet: Eating Right
Cut your risk for kidney, eye, heart, and foot damage.
How to Avoid Silent Complications
Risk Checklist
Uncontrolled diabetes can do your body harm. Learn how to avoid complications.
Nerve Pain Relief
Options to relieve stinging, tingling, burning. And how to prevent more damage.
12 Heart Disease Warning Signs
What to watch for and how to protect yourself.
Save Your Feet
Foot care tips to prevent injury, avoid infection, and help healing.
False
Diabetes Complications: What's Your Risk?
Why are people with diabetes at high risk of nerve pain, heart disease, and blindness?
WebMD Feature
By Jeanie Lerche Davis
Reviewed By Brunilda Nazario, MD
Heart attack, stroke, blindness, amputation, kidney failure. When doctors describe these diabetes complications, it may sound melodramatic -- like an overblown worst-case scenario. The truth is, these things can happen when blood sugar, blood pressure, and cholesterol are out of control.
"A lot of people don't really think it will happen to them," says David C. Ziemer, MD, director of the Diabetes Clinic at Grady Hospital in Atlanta. "For a lot of folks, the wake-up comes when they actually have a complication ... a bad infection in the foot. That's a nasty wake-up call."
If you have uncontrolled diabetes, a serious and deep-seated foot infection can mean loss of a toe, foot, or leg -- amputation -- to save your life. Seriously.
How is this possible? Over time, high blood sugar slowly injures the blood vessels, nerves, and organs in your body. The higher your blood sugar is -- and the longer it stays high -- the worse the damage is. Smoking and alcohol ratchet up the damage several more notches.
"Damage is slow and occurs over a period of years -- but it probably begins when blood sugar is at mildly elevated levels," says Ronald Goldberg, MD, associate director of the Diabetes Research Institute at the University of Miami Medical Center. "You may not be diagnosed with diabetes, but the damage has already begun."
The damage from diabetes shows up a bit differently in everyone -- whether it attacks the nerves, eyes, or kidneys, Goldberg tells WebMD. "Genetics probably influence which complications you are more susceptible to."
The problem is, "many people have diabetes a lot longer than they realize," says Ziemer. "Most have diabetes an average of five to seven years before they're diagnosed."
Diabetes Complications: The Risks You Face
As blood vessels, nerves, and organs become damaged, your risk of diabetes complications increases. These are the most serious:
Heart disease, heart attack, heart failure, and stroke risks are doubled. Heart disease and stroke cause at least 65% of deaths from diabetes.
Major eye complications (diabetic retinopathy) are linked to blood vessel problems in the eyes. Diabetes is a leading cause of preventable blindness; cataracts and glaucoma are also common.
Reduced blood flow to nerves and high blood sugar results in nerve pain, burning, numbness (peripheral neuropathy).
Serious leg and foot infections, even gangrene and amputation, are due to poor blood circulation, lack of oxygen and nutrients to tissue, and nerve damage.
Kidney damage (diabetic nephropathy) is a common risk for people with diabetes.
The complications of diabetes are indeed serious -- but they are not inevitable, Ziemer tells WebMD. "Keeping blood sugar under control is the single the most important factor in preventing them. But people have a hard time grasping just how critical that is," he says. "It's hard to get them to tune into it."
Next Article:
What Diabetes Can Do to Your Body
Simple tricks to help you follow a healthy diet.
The Diabetes Diet: Eating Right
Cut your risk for kidney, eye, heart, and foot damage.
How to Avoid Silent Complications
Risk Checklist
Uncontrolled diabetes can do your body harm. Learn how to avoid complications.
Nerve Pain Relief
Options to relieve stinging, tingling, burning. And how to prevent more damage.
12 Heart Disease Warning Signs
What to watch for and how to protect yourself.
Save Your Feet
Foot care tips to prevent injury, avoid infection, and help healing.
False
Diabetes Complications: What's Your Risk?
Why are people with diabetes at high risk of nerve pain, heart disease, and blindness?
WebMD Feature
By Jeanie Lerche Davis
Reviewed By Brunilda Nazario, MD
Heart attack, stroke, blindness, amputation, kidney failure. When doctors describe these diabetes complications, it may sound melodramatic -- like an overblown worst-case scenario. The truth is, these things can happen when blood sugar, blood pressure, and cholesterol are out of control.
"A lot of people don't really think it will happen to them," says David C. Ziemer, MD, director of the Diabetes Clinic at Grady Hospital in Atlanta. "For a lot of folks, the wake-up comes when they actually have a complication ... a bad infection in the foot. That's a nasty wake-up call."
If you have uncontrolled diabetes, a serious and deep-seated foot infection can mean loss of a toe, foot, or leg -- amputation -- to save your life. Seriously.
How is this possible? Over time, high blood sugar slowly injures the blood vessels, nerves, and organs in your body. The higher your blood sugar is -- and the longer it stays high -- the worse the damage is. Smoking and alcohol ratchet up the damage several more notches.
"Damage is slow and occurs over a period of years -- but it probably begins when blood sugar is at mildly elevated levels," says Ronald Goldberg, MD, associate director of the Diabetes Research Institute at the University of Miami Medical Center. "You may not be diagnosed with diabetes, but the damage has already begun."
The damage from diabetes shows up a bit differently in everyone -- whether it attacks the nerves, eyes, or kidneys, Goldberg tells WebMD. "Genetics probably influence which complications you are more susceptible to."
The problem is, "many people have diabetes a lot longer than they realize," says Ziemer. "Most have diabetes an average of five to seven years before they're diagnosed."
Diabetes Complications: The Risks You Face
As blood vessels, nerves, and organs become damaged, your risk of diabetes complications increases. These are the most serious:
Heart disease, heart attack, heart failure, and stroke risks are doubled. Heart disease and stroke cause at least 65% of deaths from diabetes.
Major eye complications (diabetic retinopathy) are linked to blood vessel problems in the eyes. Diabetes is a leading cause of preventable blindness; cataracts and glaucoma are also common.
Reduced blood flow to nerves and high blood sugar results in nerve pain, burning, numbness (peripheral neuropathy).
Serious leg and foot infections, even gangrene and amputation, are due to poor blood circulation, lack of oxygen and nutrients to tissue, and nerve damage.
Kidney damage (diabetic nephropathy) is a common risk for people with diabetes.
The complications of diabetes are indeed serious -- but they are not inevitable, Ziemer tells WebMD. "Keeping blood sugar under control is the single the most important factor in preventing them. But people have a hard time grasping just how critical that is," he says. "It's hard to get them to tune into it."
Blueberries May Help Improve Insulin Sensitivity
Obese Patients With Prediabetes May Benefit From Drinking Blueberry Smoothies, Study Shows
By Katrina Woznicki
WebMD Health News Reviewed by Laura J. Martin, MD Sept. 17, 2010 -- Drinking blueberry smoothies helped obese adults who were pre-diabetic improve insulin sensitivity, researchers report.
Sixty-seven percent of people who drank a blueberry smoothie twice a day for six weeks experienced a 10% or greater improvement in their insulin sensitivity, compared with 41% of people in the placebo smoothie group. The study results are published in the October issue of The Journal of Nutrition.
The findings suggest that compounds found in blueberries, which have also been found to improve heart health, may help people with prediabetes by making the body more responsive to insulin. What the biochemical chain reaction or cellular pathways might be remain unclear. But given the challenges of getting people to eat more fruits and vegetables, researchers suggest a smoothie may be a tasty alternative to help people increase their fruit and vegetable intake and boost their health.
Two Blueberry Smoothies a Day
In the study, researchers led by April Stull, an instructor in diabetes and nutrition from the Pennington Biomedical Research Center at the Louisiana State University System in Baton Rouge, compared 32 obese adults who had high insulin levels but did not have type 2 diabetes. Fifteen participants were randomly assigned to drink a smoothie containing 22.5 grams of blueberry freeze-dried powder twice a day for six weeks, while the remaining participants drank a placebo smoothie that did not contain blueberries.
Participants were asked to fill out food questionnaires and were also asked to avoid eating or drinking other fruits or wines containing berries and grapes throughout the study.
The participants did not change their physical activity levels and the calorie intakes remained the same between the two groups. Diets were adjusted so that drinking the smoothies did not add to the participants’ daily caloric intake, because the researchers did not want anyone to gain weight as a result of drinking the smoothies.
The researchers also measured the participants’ blood pressure, weight, cholesterol, and C-reactive protein levels at the start and end of the study. C-reactive protein is a biomarker that serves as a red flag for inflammation, which could indicate a risk for developing heart disease. Diabetes is also a major risk factor for heart disease.
Blueberries’ Effect on Prediabetes
Blueberry smoothies did not have an effect on the participants’ overall biomarker profile, meaning that blood pressure and cholesterol levels did not change nor differ between the two groups at the end of the study. The participants did not lose or gain weight during the study, either. But the effect of drinking blueberry smoothies on insulin sensitivity was far more pronounced.
Compounds in blueberries, called anthocyanins, have antioxidant properties, which may contribute to health benefits such as improved insulin sensitivity. Researchers say more studies are needed to determine the biological effect of blueberries
By Katrina Woznicki
WebMD Health News Reviewed by Laura J. Martin, MD Sept. 17, 2010 -- Drinking blueberry smoothies helped obese adults who were pre-diabetic improve insulin sensitivity, researchers report.
Sixty-seven percent of people who drank a blueberry smoothie twice a day for six weeks experienced a 10% or greater improvement in their insulin sensitivity, compared with 41% of people in the placebo smoothie group. The study results are published in the October issue of The Journal of Nutrition.
The findings suggest that compounds found in blueberries, which have also been found to improve heart health, may help people with prediabetes by making the body more responsive to insulin. What the biochemical chain reaction or cellular pathways might be remain unclear. But given the challenges of getting people to eat more fruits and vegetables, researchers suggest a smoothie may be a tasty alternative to help people increase their fruit and vegetable intake and boost their health.
Two Blueberry Smoothies a Day
In the study, researchers led by April Stull, an instructor in diabetes and nutrition from the Pennington Biomedical Research Center at the Louisiana State University System in Baton Rouge, compared 32 obese adults who had high insulin levels but did not have type 2 diabetes. Fifteen participants were randomly assigned to drink a smoothie containing 22.5 grams of blueberry freeze-dried powder twice a day for six weeks, while the remaining participants drank a placebo smoothie that did not contain blueberries.
Participants were asked to fill out food questionnaires and were also asked to avoid eating or drinking other fruits or wines containing berries and grapes throughout the study.
The participants did not change their physical activity levels and the calorie intakes remained the same between the two groups. Diets were adjusted so that drinking the smoothies did not add to the participants’ daily caloric intake, because the researchers did not want anyone to gain weight as a result of drinking the smoothies.
The researchers also measured the participants’ blood pressure, weight, cholesterol, and C-reactive protein levels at the start and end of the study. C-reactive protein is a biomarker that serves as a red flag for inflammation, which could indicate a risk for developing heart disease. Diabetes is also a major risk factor for heart disease.
Blueberries’ Effect on Prediabetes
Blueberry smoothies did not have an effect on the participants’ overall biomarker profile, meaning that blood pressure and cholesterol levels did not change nor differ between the two groups at the end of the study. The participants did not lose or gain weight during the study, either. But the effect of drinking blueberry smoothies on insulin sensitivity was far more pronounced.
Compounds in blueberries, called anthocyanins, have antioxidant properties, which may contribute to health benefits such as improved insulin sensitivity. Researchers say more studies are needed to determine the biological effect of blueberries
Sunday, September 19, 2010
Six Tricky Relationships Talks You Must Have
Don't just aim to survive a conversation with your partner. Say the right thing and your relationship will be richer, fuller, and more electric than ever.
By Kelly Marages, Men's Health
More on Men's Health
"Survive" Serious Talks with Her
The Perfect Thing to Tell Her Every Time
5 Things You Should Never Say to Her
10 Sexy Statements to Turn Her On
6 Phrases to Get Her Into Bed
[Editor's note: This article contains sexual references.]
The way to a woman's bedroom is through her ears. That's because for me and most women I know, chatting about relationships is as much fun as having them. It starts during kindergarten ("Want to be my boyfriend?") and continues through adolescence ("Do you like him, or do you like him like him?") and adulthood ("Call me after your date, to recap").
To have a rich, full, potentially naked relationship with one of us, you have to participate in this sort of chatter. And that can be a problem. "She's doing something she's done throughout her life and feels good at," says Deborah Tannen, Ph.D., whose book You Just Don't Understand unlocks the mysteries of male-female communication. "He hasn't done much of it, doesn't particularly enjoy it, and feels it's not his game." So you try your best — asking good questions, giving solid answers, and making her laugh. But there are a few difficult conversations that men, try as they might, tend to screw up.
That's about to change. Here is your guide to the six trickiest relationship talks. "Each of these, if handled correctly, is a ticket to the next level of intimacy with a woman," promises Les Parrott, Ph.D., the author of Love Talk. In other words, say the right thing and your relationship will be richer, fuller, and more electric than ever. And that's worth talking about.
1. The STD Talk
She asks: "How many women have you slept with?"
You answer: "Thirty-six."
Why that's a mistake: Uh, hello, McFly, she wasn't really asking how many women you've slept with. She was asking if you've ever been tested for sexually transmitted diseases. But now that you've answered truthfully, she'll be sure to hold it against you.
What to say instead: "I'm not really into keeping score, but if you're worried about STDs, I was tested last month" — or whatever the reality is — "and if it'll make you feel better, I'll see my doctor next week." Then go. The more proactive you are, the more comfortable she'll be and the better the sex will be. "The only way you're going to enjoy sex is if you get this talk out of the way," says Logan Levkoff, a sexologist and the author of Third Base Ain't What It Used to Be.
2. The Birth-Control Talk
She asks: "Did you bring a condom?"
You answer: "Why don't you go on the Pill?"
Why that's a mistake: You think you're being honest and direct. She thinks you're being selfish, and isn't that just typical. Anger ensues. Sex doesn't.
What to say instead: "Do you like how sex feels when I'm wearing a condom?" You do have a shot, because most women prefer sex au naturel, too. Take her answer as a jumping-off point to share your preferences. She's not likely to say, "What a great idea. I'll see my gynecologist tomorrow." So be willing to shelve this discussion for a few months — and to try various types of condoms — while she determines whether you're Pillworthy.
3. The Where's-This-Going? Talk
She asks: "Where's this going?"
You answer: "Back off, man trap."
Why that's a mistake: You think she's asking why you haven't proposed. But she's just wondering if you see her in your short-or long-term future. You feel cornered and storm out. She shatters a vase on the wall.
What to say instead: "Can we talk about this on Saturday?" You need to think about where the relationship actually is going. On Saturday, put all your thoughts and concerns on the table, says Janet Surrey, Ph.D., coauthor of We Have to Talk. Don't worry about having all answers. She just wants you to think about the question. The one exception: If you don't want the relationship to go farther, say so. She's prepared for the worst, so she'll take the news pretty well.
4. The Sexual-Desire Talk
She says: "Let's just snuggle tonight."
You answer: "Why don't you ever want to have sex with me?"
Why that's a mistake: Guilt isn't hot. Neither is selfishness. "Don't make it seem like you're only interested in getting what you want, even if you are," says Surrey. If you become frustrated, she'll become frosty.
What to say instead: "How would you like a massage?" She'll know what your motive is, but since you're putting her pleasure first, she's more apt to overlook it. If she still wants only to sleep in your arms, let her. Then initiate sex in the a.m. Her testosterone spikes in the morning, and cuddling increases oxytocin, a hormone that makes her feel more amorous.
5. The Money Talk
She asks: "Do you like my new shoes?"
You answer: "You really need more shoes?"
Why that's a mistake: No, she didn't need another pair of shoes, just like you didn't need an iPhone. But she's modeling them for you now, so get over it.
What to say instead: "They look great on you." Then gently remind her about that trip you're both saving for. "What leads to fighting is not being clear about financial goals," says Sharon Epperson, author of The Big Payoff. If you haven't agreed on what you're saving for yet, take this as a sign you should start. Go over your budget at the start of every month, suggests Epperson. Along with long-term goals, it needs room for pleasure purchases like shoes and iStuff.
6. The Room-To-Breathe Talk
She says: "I need some space."
You answer: "Have a nice life."
Why that's a mistake: When a woman asks for space, she's not dumping you. She just wants a few days to herself. Or ... she's testing you to see how invested you are in the relationship. If you bolt, you fail.
What to say instead: "Take as much space as you need." Chances are she'll clear her head, miss you, and end up calling within a week. During that time, put your thoughts about the relationship — the good and bad, and where you see it going — in a letter. "Writing it will allow you to gather your thoughts and convey to her how you truly feel," says Surrey. Send the letter. She may not come running back to you, but at least you'll have started the conversation.
By Kelly Marages, Men's Health
More on Men's Health
"Survive" Serious Talks with Her
The Perfect Thing to Tell Her Every Time
5 Things You Should Never Say to Her
10 Sexy Statements to Turn Her On
6 Phrases to Get Her Into Bed
[Editor's note: This article contains sexual references.]
The way to a woman's bedroom is through her ears. That's because for me and most women I know, chatting about relationships is as much fun as having them. It starts during kindergarten ("Want to be my boyfriend?") and continues through adolescence ("Do you like him, or do you like him like him?") and adulthood ("Call me after your date, to recap").
To have a rich, full, potentially naked relationship with one of us, you have to participate in this sort of chatter. And that can be a problem. "She's doing something she's done throughout her life and feels good at," says Deborah Tannen, Ph.D., whose book You Just Don't Understand unlocks the mysteries of male-female communication. "He hasn't done much of it, doesn't particularly enjoy it, and feels it's not his game." So you try your best — asking good questions, giving solid answers, and making her laugh. But there are a few difficult conversations that men, try as they might, tend to screw up.
That's about to change. Here is your guide to the six trickiest relationship talks. "Each of these, if handled correctly, is a ticket to the next level of intimacy with a woman," promises Les Parrott, Ph.D., the author of Love Talk. In other words, say the right thing and your relationship will be richer, fuller, and more electric than ever. And that's worth talking about.
1. The STD Talk
She asks: "How many women have you slept with?"
You answer: "Thirty-six."
Why that's a mistake: Uh, hello, McFly, she wasn't really asking how many women you've slept with. She was asking if you've ever been tested for sexually transmitted diseases. But now that you've answered truthfully, she'll be sure to hold it against you.
What to say instead: "I'm not really into keeping score, but if you're worried about STDs, I was tested last month" — or whatever the reality is — "and if it'll make you feel better, I'll see my doctor next week." Then go. The more proactive you are, the more comfortable she'll be and the better the sex will be. "The only way you're going to enjoy sex is if you get this talk out of the way," says Logan Levkoff, a sexologist and the author of Third Base Ain't What It Used to Be.
2. The Birth-Control Talk
She asks: "Did you bring a condom?"
You answer: "Why don't you go on the Pill?"
Why that's a mistake: You think you're being honest and direct. She thinks you're being selfish, and isn't that just typical. Anger ensues. Sex doesn't.
What to say instead: "Do you like how sex feels when I'm wearing a condom?" You do have a shot, because most women prefer sex au naturel, too. Take her answer as a jumping-off point to share your preferences. She's not likely to say, "What a great idea. I'll see my gynecologist tomorrow." So be willing to shelve this discussion for a few months — and to try various types of condoms — while she determines whether you're Pillworthy.
3. The Where's-This-Going? Talk
She asks: "Where's this going?"
You answer: "Back off, man trap."
Why that's a mistake: You think she's asking why you haven't proposed. But she's just wondering if you see her in your short-or long-term future. You feel cornered and storm out. She shatters a vase on the wall.
What to say instead: "Can we talk about this on Saturday?" You need to think about where the relationship actually is going. On Saturday, put all your thoughts and concerns on the table, says Janet Surrey, Ph.D., coauthor of We Have to Talk. Don't worry about having all answers. She just wants you to think about the question. The one exception: If you don't want the relationship to go farther, say so. She's prepared for the worst, so she'll take the news pretty well.
4. The Sexual-Desire Talk
She says: "Let's just snuggle tonight."
You answer: "Why don't you ever want to have sex with me?"
Why that's a mistake: Guilt isn't hot. Neither is selfishness. "Don't make it seem like you're only interested in getting what you want, even if you are," says Surrey. If you become frustrated, she'll become frosty.
What to say instead: "How would you like a massage?" She'll know what your motive is, but since you're putting her pleasure first, she's more apt to overlook it. If she still wants only to sleep in your arms, let her. Then initiate sex in the a.m. Her testosterone spikes in the morning, and cuddling increases oxytocin, a hormone that makes her feel more amorous.
5. The Money Talk
She asks: "Do you like my new shoes?"
You answer: "You really need more shoes?"
Why that's a mistake: No, she didn't need another pair of shoes, just like you didn't need an iPhone. But she's modeling them for you now, so get over it.
What to say instead: "They look great on you." Then gently remind her about that trip you're both saving for. "What leads to fighting is not being clear about financial goals," says Sharon Epperson, author of The Big Payoff. If you haven't agreed on what you're saving for yet, take this as a sign you should start. Go over your budget at the start of every month, suggests Epperson. Along with long-term goals, it needs room for pleasure purchases like shoes and iStuff.
6. The Room-To-Breathe Talk
She says: "I need some space."
You answer: "Have a nice life."
Why that's a mistake: When a woman asks for space, she's not dumping you. She just wants a few days to herself. Or ... she's testing you to see how invested you are in the relationship. If you bolt, you fail.
What to say instead: "Take as much space as you need." Chances are she'll clear her head, miss you, and end up calling within a week. During that time, put your thoughts about the relationship — the good and bad, and where you see it going — in a letter. "Writing it will allow you to gather your thoughts and convey to her how you truly feel," says Surrey. Send the letter. She may not come running back to you, but at least you'll have started the conversation.
Sunday, September 12, 2010
GETJAR - Get Apps
Ilja Laurs
GETJAR | U.S.
Rebecca Marshall for TIME.
GetJar, based in San Mateo, Calif., offers more than 70,000 free downloadable mobile applications to cell-phone users of all stripes. It has quickly become the second largest mobile application storefront, behind only Apple's iTunes mobile-app store in terms of downloads. "You don't even have to know the name of your phone," says Ilja Laurs, the 34-year-old brain behind the site. GetJar detects the phone, model and platform of your phone and then offers the apps that are compatible. (Owners of iPhones and other closed platforms are out of luck, though.)
An economist by education and a mobile-games programmer by trade, Laurs conceived the idea for GetJar while developing games from his studio apartment in Vilnius, Lithuania. "Consumers spend much more time with mobile phones than their desktops, so it was easy to see that mobile as an industry would take off and be really big," he says. With less than $10,000 in his pocket and the help of his cousin and three friends, he launched a beta site in 2005. There, developers could try out their latest mobile apps on a variety of handsets. But Laurs soon discovered an avalanche of interest from developers wanting to distribute apps to consumers as well. He opened the doors to consumers, and the site exploded. "It was a crazy time. Traffic would double every two weeks until the end of the year without any marketing. It was purely viral promotion," he says. About 300,000 developers in 200 nations have signed up to submit apps; another 130,000 have registered as beta testers. The site now offers 73,000 apps, can handle 2,500 kinds of phones and has seen 1.05 billion apps downloaded to date. Laurs expects to hit 100 million downloads a month before the end of the year.
Read more: http://www.time.com/time/specials/packages/article/0,28804,2017050_2017049_2017039,00.html#ixzz0zKYriKAJ
GETJAR | U.S.
Rebecca Marshall for TIME.
GetJar, based in San Mateo, Calif., offers more than 70,000 free downloadable mobile applications to cell-phone users of all stripes. It has quickly become the second largest mobile application storefront, behind only Apple's iTunes mobile-app store in terms of downloads. "You don't even have to know the name of your phone," says Ilja Laurs, the 34-year-old brain behind the site. GetJar detects the phone, model and platform of your phone and then offers the apps that are compatible. (Owners of iPhones and other closed platforms are out of luck, though.)
An economist by education and a mobile-games programmer by trade, Laurs conceived the idea for GetJar while developing games from his studio apartment in Vilnius, Lithuania. "Consumers spend much more time with mobile phones than their desktops, so it was easy to see that mobile as an industry would take off and be really big," he says. With less than $10,000 in his pocket and the help of his cousin and three friends, he launched a beta site in 2005. There, developers could try out their latest mobile apps on a variety of handsets. But Laurs soon discovered an avalanche of interest from developers wanting to distribute apps to consumers as well. He opened the doors to consumers, and the site exploded. "It was a crazy time. Traffic would double every two weeks until the end of the year without any marketing. It was purely viral promotion," he says. About 300,000 developers in 200 nations have signed up to submit apps; another 130,000 have registered as beta testers. The site now offers 73,000 apps, can handle 2,500 kinds of phones and has seen 1.05 billion apps downloaded to date. Laurs expects to hit 100 million downloads a month before the end of the year.
Read more: http://www.time.com/time/specials/packages/article/0,28804,2017050_2017049_2017039,00.html#ixzz0zKYriKAJ
The Gramateller ATM - Time Magazine
Lakshminarayan Kannan and Vijay Babu
VORTEX | India
Jyothy Karat for TIME.
When Lakshminarayan Kannan set out to design a low-cost ATM to help deliver banking to the rural poor, he had never used one before. When he was growing up in India, ATMs were a convenience of the wealthy. "I had seen ATMs from a distance through glass doors but had not gotten near one," he says. Kannan teamed up with Vortex CEO Vijay Babu to turn his inexperience into his advantage in creating an ATM that is everything traditional ones are not: low power, low cost, low maintenance and highly robust. The Gramateller ATM was designed not to be fussy. "Our thinking was, if a person can count and issue notes by a flick of the fingers, then it shouldn't consume a lot of power," Kannan says. The machine uses about as much electricity as a 70-watt lightbulb. Backup batteries and solar panels can keep it online if the grid fails. Vortex installed a biometric touch pad to combat fraud and assure villagers new to banking that their money is safe. The Gramateller is built to dispense soiled notes without a hiccup in villages where crisp bills are often suspected of being counterfeit. The company estimates that the sales potential of the $7,000 ATMs (vs. $20,000 for conventional ones) could be as high as 40,000 a year worldwide. "Developing countries' ATM market is highly underserved," says Babu.
Read more: http://www.time.com/time/specials/packages/article/0,28804,2017050_2017049_2017042,00.html#ixzz0zKW17GuU
VORTEX | India
Jyothy Karat for TIME.
When Lakshminarayan Kannan set out to design a low-cost ATM to help deliver banking to the rural poor, he had never used one before. When he was growing up in India, ATMs were a convenience of the wealthy. "I had seen ATMs from a distance through glass doors but had not gotten near one," he says. Kannan teamed up with Vortex CEO Vijay Babu to turn his inexperience into his advantage in creating an ATM that is everything traditional ones are not: low power, low cost, low maintenance and highly robust. The Gramateller ATM was designed not to be fussy. "Our thinking was, if a person can count and issue notes by a flick of the fingers, then it shouldn't consume a lot of power," Kannan says. The machine uses about as much electricity as a 70-watt lightbulb. Backup batteries and solar panels can keep it online if the grid fails. Vortex installed a biometric touch pad to combat fraud and assure villagers new to banking that their money is safe. The Gramateller is built to dispense soiled notes without a hiccup in villages where crisp bills are often suspected of being counterfeit. The company estimates that the sales potential of the $7,000 ATMs (vs. $20,000 for conventional ones) could be as high as 40,000 a year worldwide. "Developing countries' ATM market is highly underserved," says Babu.
Read more: http://www.time.com/time/specials/packages/article/0,28804,2017050_2017049_2017042,00.html#ixzz0zKW17GuU
NEURONETICS
Bruce Shook
NEURONETICS | U.S. View All
Colin M. Lenton for TIME.
For a good portion of the 15 million Americans fighting depression, the available treatments of counseling and medication bring scant relief. The next step — electroshock, or, as it has been rebranded, "electroconvulsive" therapy — bears a gothic stigma and has frightening side effects. But research into the brain's complex wiring is yielding new therapeutic avenues. Neuronetics, a Philadelphia-based start-up, has tapped that deepening vein of knowledge to develop a therapy called transcranial magnetic stimulation (TMS). It uses a device that generates electrified magnetic impulses to stimulate the prefrontal cortex of the brain, the area that controls mood. That ultra-targeted tweak, channeled through a coil placed against the scalp, sparks a small arc of electrical activity in the brain, which in turn sets off chemical changes that elevate a patient's state of mind. Approved by the U.S. Food and Drug Administration in 2008, TMS won't cure depression, but it may be a big step toward tamping its terrible impact. "I've seen what depression and the side effects of drug treatment do to people," says CEO Bruce Shook. "That painted a very vivid picture for me of how serious and debilitating a disorder this can be." TMS doesn't require anesthesia or sedation. It's usually administered in a doctor's office in a surprisingly relaxed 40-minute procedure. The patient remains awake, free to read or watch TV. There's a tiny risk of scalp burns, headaches and seizures. Some 200 doctors and institutions have each spent $70,000 to buy treatment stations. Dr. Martha Koo, a psychiatrist in Hermosa Beach, Calif., is seeing positive responses in about 70% of her TMS patients. "I certainly think it's an excellent tool to have in the psychiatry toolbox," she says. A typical patient undergoes 20 to 30 treatments over a six-week period. Cost: $8,000. Insurance won't cover the sessions, but that could change as adoption rates and demand increase. Says Dr. Philip G. Janicak of Rush University Medical Center in Chicago: "We are in the nascent stages of TMS playing a quite crucial role in psychiatry as a whole."
Read more: http://www.time.com/time/specials/packages/article/0,28804,2017050_2017049_2017044,00.html#ixzz0zKUUPOsn
NEURONETICS | U.S. View All
Colin M. Lenton for TIME.
For a good portion of the 15 million Americans fighting depression, the available treatments of counseling and medication bring scant relief. The next step — electroshock, or, as it has been rebranded, "electroconvulsive" therapy — bears a gothic stigma and has frightening side effects. But research into the brain's complex wiring is yielding new therapeutic avenues. Neuronetics, a Philadelphia-based start-up, has tapped that deepening vein of knowledge to develop a therapy called transcranial magnetic stimulation (TMS). It uses a device that generates electrified magnetic impulses to stimulate the prefrontal cortex of the brain, the area that controls mood. That ultra-targeted tweak, channeled through a coil placed against the scalp, sparks a small arc of electrical activity in the brain, which in turn sets off chemical changes that elevate a patient's state of mind. Approved by the U.S. Food and Drug Administration in 2008, TMS won't cure depression, but it may be a big step toward tamping its terrible impact. "I've seen what depression and the side effects of drug treatment do to people," says CEO Bruce Shook. "That painted a very vivid picture for me of how serious and debilitating a disorder this can be." TMS doesn't require anesthesia or sedation. It's usually administered in a doctor's office in a surprisingly relaxed 40-minute procedure. The patient remains awake, free to read or watch TV. There's a tiny risk of scalp burns, headaches and seizures. Some 200 doctors and institutions have each spent $70,000 to buy treatment stations. Dr. Martha Koo, a psychiatrist in Hermosa Beach, Calif., is seeing positive responses in about 70% of her TMS patients. "I certainly think it's an excellent tool to have in the psychiatry toolbox," she says. A typical patient undergoes 20 to 30 treatments over a six-week period. Cost: $8,000. Insurance won't cover the sessions, but that could change as adoption rates and demand increase. Says Dr. Philip G. Janicak of Rush University Medical Center in Chicago: "We are in the nascent stages of TMS playing a quite crucial role in psychiatry as a whole."
Read more: http://www.time.com/time/specials/packages/article/0,28804,2017050_2017049_2017044,00.html#ixzz0zKUUPOsn
Friday, September 10, 2010
Health Plan Won’t Fuel Big Spending, Report Says
By ROBERT PEAR
Published: September 9, 2010
WASHINGTON — A new government study says President Obama’s health care law will have negligible effects on total national health spending in the next 10 years, neither slowing nor fueling the explosive growth of medical costs.
Related
Times Topic: Health Care Reform
About 32.5 million people will gain coverage, and health spending will grow slightly faster than projected under prior law — at an annual rate of 6.3 percent, rather than 6.1 percent, the report said.
The government report, by the office of the chief Medicare actuary, undermines the claims of the law’s fiercest critics and some of its biggest champions.
Cuts in Medicare spending, which start in the next few months, and a tax on high-cost employer-sponsored health plans, which takes effect in 2018, will largely offset the cost of expanding Medicaid and subsidizing private insurance for low-income people, said the report, being published online Thursday by the journal Health Affairs.
“In the aggregate,” said Andrea M. Sisko, the principal author of the report, “it appears that the new law will have a moderate effect on health spending growth rates and the health care share of the economy.”
In 2009, the report said, national health spending, public and private, totaled $2.5 trillion and accounted for 17.3 percent of the economy, as measured by the gross domestic product. The report predicts that health spending will rise to $4.6 trillion and account for 19.6 percent of the economy in 2019.
By contrast, in February, before passage of the comprehensive health care law, the same team of government experts, using the same economic and demographic assumptions, predicted that national health spending would reach $4.5 trillion, or 19.3 percent of the gross domestic product, in 2019.
The report foresees a big jump in health spending in 2014, when major provisions of the new law, including a requirement for most Americans to have insurance, take effect.
From 2013 to 2014, the report says, overall health spending is expected to increase by 9.2 percent, which is significantly more than the 6.6 percent increase predicted in February.
The report foresees an abrupt increase in private health insurance spending, expected to rise 12.8 percent in 2014, to $1.1 trillion. The government had been predicting a 6.7 percent increase before the signing of the new law.
“We expect that the level of health care spending for the formerly uninsured will nearly double as a result of their gaining coverage” through new insurance exchanges, the report said. “For those who previously held individually purchased coverage, many are projected to be eligible for federal premium subsidies.”
The report predicts that some workers will have to pay more out of pocket as many employers scale back coverage in 2018 to avoid the tax on high-cost plans.
Under the law, all states will have insurance exchanges where individuals, families and small businesses can buy coverage. The report predicts that 30.6 million people will be getting insurance through such exchanges by 2019, significantly more than the 24 million estimated by the Congressional Budget Office.
The report offers the first official estimates of new administrative costs. Federal and state agencies will spend more than $37 billion over 10 years creating and operating the exchanges, it said, and “Medicaid administration costs at the state and federal level are projected to increase by $31 billion over the same period.”
Published: September 9, 2010
WASHINGTON — A new government study says President Obama’s health care law will have negligible effects on total national health spending in the next 10 years, neither slowing nor fueling the explosive growth of medical costs.
Related
Times Topic: Health Care Reform
About 32.5 million people will gain coverage, and health spending will grow slightly faster than projected under prior law — at an annual rate of 6.3 percent, rather than 6.1 percent, the report said.
The government report, by the office of the chief Medicare actuary, undermines the claims of the law’s fiercest critics and some of its biggest champions.
Cuts in Medicare spending, which start in the next few months, and a tax on high-cost employer-sponsored health plans, which takes effect in 2018, will largely offset the cost of expanding Medicaid and subsidizing private insurance for low-income people, said the report, being published online Thursday by the journal Health Affairs.
“In the aggregate,” said Andrea M. Sisko, the principal author of the report, “it appears that the new law will have a moderate effect on health spending growth rates and the health care share of the economy.”
In 2009, the report said, national health spending, public and private, totaled $2.5 trillion and accounted for 17.3 percent of the economy, as measured by the gross domestic product. The report predicts that health spending will rise to $4.6 trillion and account for 19.6 percent of the economy in 2019.
By contrast, in February, before passage of the comprehensive health care law, the same team of government experts, using the same economic and demographic assumptions, predicted that national health spending would reach $4.5 trillion, or 19.3 percent of the gross domestic product, in 2019.
The report foresees a big jump in health spending in 2014, when major provisions of the new law, including a requirement for most Americans to have insurance, take effect.
From 2013 to 2014, the report says, overall health spending is expected to increase by 9.2 percent, which is significantly more than the 6.6 percent increase predicted in February.
The report foresees an abrupt increase in private health insurance spending, expected to rise 12.8 percent in 2014, to $1.1 trillion. The government had been predicting a 6.7 percent increase before the signing of the new law.
“We expect that the level of health care spending for the formerly uninsured will nearly double as a result of their gaining coverage” through new insurance exchanges, the report said. “For those who previously held individually purchased coverage, many are projected to be eligible for federal premium subsidies.”
The report predicts that some workers will have to pay more out of pocket as many employers scale back coverage in 2018 to avoid the tax on high-cost plans.
Under the law, all states will have insurance exchanges where individuals, families and small businesses can buy coverage. The report predicts that 30.6 million people will be getting insurance through such exchanges by 2019, significantly more than the 24 million estimated by the Congressional Budget Office.
The report offers the first official estimates of new administrative costs. Federal and state agencies will spend more than $37 billion over 10 years creating and operating the exchanges, it said, and “Medicaid administration costs at the state and federal level are projected to increase by $31 billion over the same period.”
Topical Gel Catches Up With Pills for Relief
By LAURIE TARKAN
Published: September 6, 2010
When I strained a back muscle playing tennis not long ago, my doubles partner, who happened to be a doctor, pulled a tube of cream from her gym bag and told me to rub it on.
Related
Health Guides: Pain Medications | Osteoarthritis
It wasn’t Bengay or one of those instant ice gels. It was a nonsteroidal anti-inflammatory drug, like Advil or Motrin, in a cream applied to the skin. She raved about the stuff, which she buys over the counter when she goes to Europe, and lamented that it is so hard to find in the United States.
In fact, Europeans have long been able to buy nonsteroidal anti-inflammatory drugs, or Nsaids (pronounced EN-seds), in gels, creams, sprays and patches to ease muscle and joint pain more directly than a pill. But in the United States, the first of these topical Nsaids was approved just three years ago, for prescription use only, with a “black box” insert warning of side effects.
“I slap it on as soon as I get an injury,” said R. Andrew Moore, a pain researcher at the University of Oxford in England who was an author of a recent analysis of studies on the use of topical Nsaids for acute injuries like sprains and strains. (Dr. Moore has received research financing from and has consulted for drug companies in the past.)
At first, he said, the researchers were skeptical of the drugs. Older studies had been poorly designed or too brief, and there has been little evidence of effectiveness for other types of medicated creams or those containing the chili pepper component capsaicin.
But a number of new controlled trials and meta-analyses like Dr. Moore’s suggest that topical Nsaids are as effective as their oral counterparts for treating osteoarthritis in the knee and hand as well as musculoskeletal injuries like soreness and tendinitis.
The main advantage of a skin cream is that it bypasses the stomach and much of the bloodstream, theoretically minimizing serious side effects. Oral Nsaids can be toxic to the kidneys, and they increase the risk of gastrointestinal bleeding. And some, including Vioxx and Bextra, were taken off the market after they were linked to heart attacks and strokes.
“The turning point for topical Nsaids was the fright over heart problems with Vioxx,” Dr. Moore said. “Suddenly there were tons of folks who thought topical Nsaids were a good idea.”
Dr. Roy D. Altman, a rheumatology professor at the David Geffen School of Medicine at the University of California, Los Angeles, said the drugs might be especially helpful for “the elderly or those taking multiple medications, who were not getting treated but who can now use topical Nsaids and get some benefit.”
(Dr. Altman has consulted with Novartis, which makes one of the painkillers, Voltaren gel.)
Another leading pain researcher, Dr. Roger Chou, an associate professor of medicine at Oregon Health and Science University, noted that the skin creams delivered “very high joint concentrations of the topical Nsaid, higher than with standard oral doses, with very low blood levels” — less than 5 percent of those found with oral Nsaids.
In clinical trials, the skin creams are linked to a higher rate of redness, irritation and rash. And the three topical Nsaids sold in this country — Voltaren gel, the Flector Patch and Pennsaid, a liquid — all contain the Nsaid diclofenac, whose oral version has been linked to liver damage.
The risks in the most vulnerable population — people with other illnesses, like liver disease, or those on blood thinners — are not known, because these patients are generally excluded from studies. One analysis of 19 studies of older adults found that about 15 percent of patients had gastrointestinal complaints, although not life-threatening ones.
“Future research needs to be done using patients with co-morbidities to know that these agents are safe in the highest-risk population,” said the author of the analysis, Dr. Una Makris, an associate research scientist at the Yale School of Medicine.
Still, in one of the only head-to-head trials between topical and oral Nsaids, subjects taking the pills had a much higher rate of indigestion, diarrhea, abdominal pain, abnormal liver tests and anemia than those using the creams.
No randomized, controlled study has assessed the risks for serious events like heart attacks, kidney failure and gastrointestinal bleeding, but other types of studies have found no association between topical Nsaids and these serious risk factors.
The American College of Rheumatology is rewriting its guidelines for osteoarthritis management and will include topical Nsaids in the recommendations, said Dr. Altman, who is on the guidelines committee.
Sports medicine and pain doctors are also recommending them for problems like tennis elbow, Achilles tendinitis and overuse injuries and strains. “We used them off label for a while before they were approved,” said Dr. Robin M. Gehrmann, the director of sports medicine at the University of Medicine and Dentistry of New Jersey. “Now that you can just write a prescription, I use them in my practice a lot more.”
Since the Food and Drug Administration approved the first topical Nsaid in 2007, sales in the United States have soared — to more than $264 million in 2009, according to IMS Health, a health care research company. The average copayment for a month’s supply of Voltaren gel or Pennsaid is around $30.
“I think many people are not aware of topical Nsaids, or there is a perception that they don’t work well, or people confuse topical Nsaids with other topical drugs, like the topical salicylates or capsaicin,” Dr. Chou said.
The topical painkillers are not for everyone. Aside from the possible risks to people with other illnesses, the drugs are not helpful for patients with pain throughout the body, like fibromyalgia, and should not be used along with oral Nsaids.
Nor are they recommended for stress fractures or tendon tears, because anti-inflammatory drugs in general have been shown to slow healing of tendons and bones.
And young, healthy patients may not want to bother with creams or gels, which have their maximum effect if applied four times a day. “It’s easier to pop a pill,” Dr. Altman said.
But for immediate relief of my tennis-related muscle pull, the cream was handy and helpful.
Published: September 6, 2010
When I strained a back muscle playing tennis not long ago, my doubles partner, who happened to be a doctor, pulled a tube of cream from her gym bag and told me to rub it on.
Related
Health Guides: Pain Medications | Osteoarthritis
It wasn’t Bengay or one of those instant ice gels. It was a nonsteroidal anti-inflammatory drug, like Advil or Motrin, in a cream applied to the skin. She raved about the stuff, which she buys over the counter when she goes to Europe, and lamented that it is so hard to find in the United States.
In fact, Europeans have long been able to buy nonsteroidal anti-inflammatory drugs, or Nsaids (pronounced EN-seds), in gels, creams, sprays and patches to ease muscle and joint pain more directly than a pill. But in the United States, the first of these topical Nsaids was approved just three years ago, for prescription use only, with a “black box” insert warning of side effects.
“I slap it on as soon as I get an injury,” said R. Andrew Moore, a pain researcher at the University of Oxford in England who was an author of a recent analysis of studies on the use of topical Nsaids for acute injuries like sprains and strains. (Dr. Moore has received research financing from and has consulted for drug companies in the past.)
At first, he said, the researchers were skeptical of the drugs. Older studies had been poorly designed or too brief, and there has been little evidence of effectiveness for other types of medicated creams or those containing the chili pepper component capsaicin.
But a number of new controlled trials and meta-analyses like Dr. Moore’s suggest that topical Nsaids are as effective as their oral counterparts for treating osteoarthritis in the knee and hand as well as musculoskeletal injuries like soreness and tendinitis.
The main advantage of a skin cream is that it bypasses the stomach and much of the bloodstream, theoretically minimizing serious side effects. Oral Nsaids can be toxic to the kidneys, and they increase the risk of gastrointestinal bleeding. And some, including Vioxx and Bextra, were taken off the market after they were linked to heart attacks and strokes.
“The turning point for topical Nsaids was the fright over heart problems with Vioxx,” Dr. Moore said. “Suddenly there were tons of folks who thought topical Nsaids were a good idea.”
Dr. Roy D. Altman, a rheumatology professor at the David Geffen School of Medicine at the University of California, Los Angeles, said the drugs might be especially helpful for “the elderly or those taking multiple medications, who were not getting treated but who can now use topical Nsaids and get some benefit.”
(Dr. Altman has consulted with Novartis, which makes one of the painkillers, Voltaren gel.)
Another leading pain researcher, Dr. Roger Chou, an associate professor of medicine at Oregon Health and Science University, noted that the skin creams delivered “very high joint concentrations of the topical Nsaid, higher than with standard oral doses, with very low blood levels” — less than 5 percent of those found with oral Nsaids.
In clinical trials, the skin creams are linked to a higher rate of redness, irritation and rash. And the three topical Nsaids sold in this country — Voltaren gel, the Flector Patch and Pennsaid, a liquid — all contain the Nsaid diclofenac, whose oral version has been linked to liver damage.
The risks in the most vulnerable population — people with other illnesses, like liver disease, or those on blood thinners — are not known, because these patients are generally excluded from studies. One analysis of 19 studies of older adults found that about 15 percent of patients had gastrointestinal complaints, although not life-threatening ones.
“Future research needs to be done using patients with co-morbidities to know that these agents are safe in the highest-risk population,” said the author of the analysis, Dr. Una Makris, an associate research scientist at the Yale School of Medicine.
Still, in one of the only head-to-head trials between topical and oral Nsaids, subjects taking the pills had a much higher rate of indigestion, diarrhea, abdominal pain, abnormal liver tests and anemia than those using the creams.
No randomized, controlled study has assessed the risks for serious events like heart attacks, kidney failure and gastrointestinal bleeding, but other types of studies have found no association between topical Nsaids and these serious risk factors.
The American College of Rheumatology is rewriting its guidelines for osteoarthritis management and will include topical Nsaids in the recommendations, said Dr. Altman, who is on the guidelines committee.
Sports medicine and pain doctors are also recommending them for problems like tennis elbow, Achilles tendinitis and overuse injuries and strains. “We used them off label for a while before they were approved,” said Dr. Robin M. Gehrmann, the director of sports medicine at the University of Medicine and Dentistry of New Jersey. “Now that you can just write a prescription, I use them in my practice a lot more.”
Since the Food and Drug Administration approved the first topical Nsaid in 2007, sales in the United States have soared — to more than $264 million in 2009, according to IMS Health, a health care research company. The average copayment for a month’s supply of Voltaren gel or Pennsaid is around $30.
“I think many people are not aware of topical Nsaids, or there is a perception that they don’t work well, or people confuse topical Nsaids with other topical drugs, like the topical salicylates or capsaicin,” Dr. Chou said.
The topical painkillers are not for everyone. Aside from the possible risks to people with other illnesses, the drugs are not helpful for patients with pain throughout the body, like fibromyalgia, and should not be used along with oral Nsaids.
Nor are they recommended for stress fractures or tendon tears, because anti-inflammatory drugs in general have been shown to slow healing of tendons and bones.
And young, healthy patients may not want to bother with creams or gels, which have their maximum effect if applied four times a day. “It’s easier to pop a pill,” Dr. Altman said.
But for immediate relief of my tennis-related muscle pull, the cream was handy and helpful.
Stress Hormone Predicts Heart Death
High Cortisol Levels Raise Risk of Heart Disease, Stroke 5-Fold
By Salynn Boyles
WebMD Health News
Reviewed by Laura J. Martin, MD Sept. 9, 2010 -- Doctors have long warned patients that stress is bad for the heart. Now new research provides direct evidence to back up the warning.
In the newly published study, high levels of the stress hormone cortisol in the urine were associated with a dramatic increase in death from cardiovascular disease years later.
Compared to study participants with the lowest cortisol levels, those with the highest levels were five times as likely to die of heart attack, stroke or other cardiovascular causes over six years of follow up.
The association was seen both in people with and without heart disease when they entered the study.
While earlier research suggested a link between high cortisol levels and cardiovascular risk, the study is the first to directly test the hypothesis that elevated stress hormones predict heart disease death, says lead researcher Nicole Vogelzangs, PhD, of VU University Medical Center in the Netherlands.
“We were actually surprised to find that the association was so strong,” Vogelzangs tells WebMD. “Cortisol levels in older adults were clearly predictive of death from cardiovascular causes, but were not predictive of other causes of death.”
The study was published less than a week after a separate team of researchers reported that high levels of the hormone in hair samples predict heart attack risk.
Cortisol Predicts Heart Health
Secreted by the adrenal glands, cortisol is known as the "stress hormone" because it is produced in high levels as the body’s "fight or flight" response to stressful events.
Prolonged cortisol production resulting from chronic stress is thought to play a role in a wide range of diseases, including diabetes, osteoporosis, and heart disease.
Cortisol can be measured in the blood, but blood measurements show only a snapshot of stress at the moment, which may be elevated in response to having blood drawn, Vogelzangs says.
In the new study, published in the Journal of Clinical Endocrinology & Metabolism, researchers measured cortisol levels over a 24-hour period in urine samples.
The study included 861 people aged 65 and older followed for an average of about six years after 24-hour cortisol levels were measured.
During this time, 183 study participants died. Death certificates were examined to determine the cause of death.
While urinary cortisol did not predict death from non-cardiovascular causes, it strongly predicted death from heart attack and stroke.
When divided into three groups based on levels of the stress hormone, the third of study participants with the highest cortisol levels had a fivefold increased risk of dying from cardiovascular causes as the third with the lowest levels.
Clinical Value of Stress Hormone Test Not Clear
In the study reported earlier this month, researchers from the University of Western Ontario measured cortisol levels in hair samples as a marker of chronic stress.
Study co-researcher Stan VanUum, MD, PhD, explains that hair grows at a rate of about 1 centimeter a month. So a 3 centimeter hair sample would measure stress levels over 3 months.
The researchers found that hair cortisol levels were a more important predictor of heart attack risk than established risk factors like high blood pressure and cholesterol.
VanUum and Vogelzangs agree that more research is needed to determine if stress hormone measurement can provide meaningful information about heart risk in clinical practice.
There is no consensus about what "high" and "normal" cortisol levels should be in terms of cardiovascular risk. And measuring levels of the hormone in hair remains expensive and labor intensive.
While there is some suggestion that cortisol levels might be reduced with exercise, weight loss or even the use of antidepressants, it is far from clear if directly targeting cortisol lowers cardiovascular risk.
“These studies reinforce the message that stress is bad for the heart, but we don’t really know if we can reduce stress hormone levels or what impact this would have,” VanUum tells WebMD
By Salynn Boyles
WebMD Health News
Reviewed by Laura J. Martin, MD Sept. 9, 2010 -- Doctors have long warned patients that stress is bad for the heart. Now new research provides direct evidence to back up the warning.
In the newly published study, high levels of the stress hormone cortisol in the urine were associated with a dramatic increase in death from cardiovascular disease years later.
Compared to study participants with the lowest cortisol levels, those with the highest levels were five times as likely to die of heart attack, stroke or other cardiovascular causes over six years of follow up.
The association was seen both in people with and without heart disease when they entered the study.
While earlier research suggested a link between high cortisol levels and cardiovascular risk, the study is the first to directly test the hypothesis that elevated stress hormones predict heart disease death, says lead researcher Nicole Vogelzangs, PhD, of VU University Medical Center in the Netherlands.
“We were actually surprised to find that the association was so strong,” Vogelzangs tells WebMD. “Cortisol levels in older adults were clearly predictive of death from cardiovascular causes, but were not predictive of other causes of death.”
The study was published less than a week after a separate team of researchers reported that high levels of the hormone in hair samples predict heart attack risk.
Cortisol Predicts Heart Health
Secreted by the adrenal glands, cortisol is known as the "stress hormone" because it is produced in high levels as the body’s "fight or flight" response to stressful events.
Prolonged cortisol production resulting from chronic stress is thought to play a role in a wide range of diseases, including diabetes, osteoporosis, and heart disease.
Cortisol can be measured in the blood, but blood measurements show only a snapshot of stress at the moment, which may be elevated in response to having blood drawn, Vogelzangs says.
In the new study, published in the Journal of Clinical Endocrinology & Metabolism, researchers measured cortisol levels over a 24-hour period in urine samples.
The study included 861 people aged 65 and older followed for an average of about six years after 24-hour cortisol levels were measured.
During this time, 183 study participants died. Death certificates were examined to determine the cause of death.
While urinary cortisol did not predict death from non-cardiovascular causes, it strongly predicted death from heart attack and stroke.
When divided into three groups based on levels of the stress hormone, the third of study participants with the highest cortisol levels had a fivefold increased risk of dying from cardiovascular causes as the third with the lowest levels.
Clinical Value of Stress Hormone Test Not Clear
In the study reported earlier this month, researchers from the University of Western Ontario measured cortisol levels in hair samples as a marker of chronic stress.
Study co-researcher Stan VanUum, MD, PhD, explains that hair grows at a rate of about 1 centimeter a month. So a 3 centimeter hair sample would measure stress levels over 3 months.
The researchers found that hair cortisol levels were a more important predictor of heart attack risk than established risk factors like high blood pressure and cholesterol.
VanUum and Vogelzangs agree that more research is needed to determine if stress hormone measurement can provide meaningful information about heart risk in clinical practice.
There is no consensus about what "high" and "normal" cortisol levels should be in terms of cardiovascular risk. And measuring levels of the hormone in hair remains expensive and labor intensive.
While there is some suggestion that cortisol levels might be reduced with exercise, weight loss or even the use of antidepressants, it is far from clear if directly targeting cortisol lowers cardiovascular risk.
“These studies reinforce the message that stress is bad for the heart, but we don’t really know if we can reduce stress hormone levels or what impact this would have,” VanUum tells WebMD
Friday, September 3, 2010
The Peanut Solution
Maggie Steber for The New York Times
THE WAIT A World Food Program screening center in Port-au-Prince.
By ANDREW RICE
Published: September 2, 2010
Like most tales of great invention, the story of Plumpy’nut begins with a eureka moment, in this case involving a French doctor and a jar of Nutella, and proceeds through the stages of rejection, acceptance, evangelization and mass production. The product may not look like much — a little foil packet filled with a soft, sticky substance — but its advocates are prone to use the language of magic and wonders.
What is Plumpy’nut? Sound it out, and you get the idea: it’s an edible paste made of peanuts, packed with calories and vitamins, that is specially formulated to renourish starving children. Since its widespread introduction five years ago, it has been credited with significantly lowering mortality rates during famines in Africa. Children on a Plumpy’nut regimen add pounds rapidly, often going from a near-death state to relative health in a month. In the world of humanitarian aid, where progress is usually measured in subtle increments of misery, the new product offers a rare satisfaction: swift, visible, fantastic efficacy.
Maggie Steber for The New York Times
Children, eating a peanut paste, at a seaside tent camp in Haiti.
THE FACTORY Partners in Health makes its own peanut-based supplement in Haiti.
Maggie Steber for The New York Times
THE SCALE Loramie Joseph is weighed at a Save the Children center.
Plumpy’nut is also a brand name, however, the registered trademark of Nutriset, a private French company that first manufactured and marketed the paste. It was not the intention of Plumpy’nut’s inventor, a crusading pediatrician named André Briend, to create an industry around Plumpy’nut. Briend, his friends say, was always personally indifferent to money. (Also, apparently, to publicity — he declined repeated requests to be interviewed for this article.) One element of genius in Briend’s recipe was precisely its easy replicability: it could be made by poor people, for poor people, to the benefit of patients and farmers alike. Most of the world’s peanuts are grown in developing countries, where allergies to them are relatively uncommon, and the rest of the concoction is simple to prepare. On a visit to Malawi, Briend whipped up a batch in a blender to prove that Plumpy’nut could be made just about anywhere.
Others, however, quickly realized that the miracle product had more than just moral value. Nutriset has aggressively protected its intellectual property, and the bulk of Plumpy’nut production continues to take place at Nutriset facilities in France. (Unicef, the world’s primary buyer, purchases 90 percent of its supply from that factory, according to a 2009 report prepared for the agency.) Internationally, there has been a vituperative debate over who should control the means of production, with India going so far as to impose sharp restrictions on Plumpy’nut, calling it an unproven colonialist import. Elsewhere, local producers are simply ignoring the patent. In Haiti, two manufacturers are making products similar to Plumpy’nut independently of Nutriset: one is Partners in Health, the charity co-founded by the prominent global-health activist Paul Farmer. Partners in Health harvests peanuts from a 30-acre farm or buys them from a cooperative of 200 smallholders. It’s planning to build a larger factory, but for now the nuts are taken to the main hospital in Cange, where women sort them in straw baskets, roast them over an outside gas burner, run them through a hand grinder and mix all the ingredients into a paste that is poured into reusable plastic canisters. Peanuts in Haiti and throughout the developing world have a high incidence of aflatoxin, a fungus that can sicken children, especially fragile ones. But Partners in Health says the product, which it calls Nourimanba, is safe.
When I visited one of the charity’s outpatient clinics in July, 1-year-old Elorky Decena was silent and listless as a nurse hooked a scale over the clinic’s doorway and put him in an attached harness. A month before, he was found to have severe acute malnutrition, a condition characterized by extreme stunting and wasting that afflicts an estimated 20 million children worldwide. The nurse announced that he had gained more than four pounds on a diet of Nourimanba.
Patents are meant to offer incentives to innovators by giving them a time-limited right to exclusively exploit their ideas for profit. But many say that lifesaving products should be treated by a different set of rules. There has been a long and bitter argument, for instance, over the affordability of patented AIDS drugs in Africa. Critics have made a similar case against Plumpy’nut, which is fairly expensive, costing about $60 per child for a full two-month treatment. “We were concerned because of the way Nutriset was managing their intellectual property,” said Stéphane Doyon, a nutrition specialist with Doctors Without Borders, a medical charity. “We felt that there was the possibility for the creation of a monopoly.”
“Poverty is a business,” Patricia Wolff, a St. Louis pediatrician, said. She founded Meds and Food for Kids, the other local producer of fortified nut paste in Haiti. When I first spoke with her in May, Meds and Food for Kids was struggling to raise money to expand its operations, and Wolff complained mightily about the difficulties she faced because of Nutriset’s market dominance. “There’s money to be made,” she said, “and there are people who have that kind of way of thinking.” Two months later, Wolff made a tentative deal for Meds and Food for Kids to become a Nutriset franchisee. In the end, she said, she couldn’t afford to battle hunger on her own.
In the United States, Plumpy’nut’s sole manufacturer and chief promoter is a 38-year-old mother of four from Barrington, R.I. Navyn Salem doesn’t have a background in medicine or aid work. She first glimpsed the potential of Plumpy’nut three years ago on “60 Minutes.” Since then, Salem has devoted herself to making the product for export to needy nations like Haiti. Though her Providence factory, a joint venture with Nutriset, has all the trappings of a business, selling its wares to relief agencies under the name Edesia Global Nutrition Solutions, the operation is registered as a nonprofit foundation and was established with seed money from Salem and her husband, Paul, a private-equity financier. Dancing along the nebulous line between capitalism and charity, Salem casts herself as a marketer, offering a neatly packaged solution to a tragic and no longer intractable malady. On a Tuesday in May, she brought her message of good news to a Mother’s Day benefit in Midtown Manhattan.
“This is not my ZIP code,” Salem said as she stood in the East Side Social Club, a wood-paneled restaurant, amid a jostling crowd of bejeweled women pinching noontime flutes of Champagne. She met one of the party’s hosts, Lauren Bush, the former model and niece of the most recent ex-president, a couple of years ago at a conference of the Clinton Global Initiative. Now Bush and her mother, Sharon, were selling a specially designed line of teddy bears — a big one called Plumpy and a small one called Nut — to raise money to purchase the product for children in Africa.
When it came time to eat their own meal, a three-course luncheon, the party guests found seats at tables set with elaborate centerpieces, made up of stuffed bears and Plumpy’nut packets. As volunteers sold raffle tickets for a Dior handbag, Salem delivered a practiced speech. Earnest and attractive, with wide brown eyes, she told the audience that her father, a member of an Indian merchant family, grew up in Tanzania. “There are over a billion people in our world that are malnourished,” Salem said. “It’s a shocking statistic. The good news is there’s a very simple solution.” And that, she said, was Plumpy’nut. “It’s really revolutionary, because it doesn’t need to be mixed with water or refrigerated,” Salem continued. “And the most miraculous part is, it will transform a child from literally skin and bones to certain survival in just four to six weeks.”
This transformation, seen in before-and-after photos — on one side a sick and wasted child, on the other, a chubby, smiling one — was the promise that captured imaginations far beyond the technocratic community of specialists that originally developed Plumpy’nut. “People love a silver bullet,” says the prominent nutritionist Steve Collins. Salem’s decision to devote a portion of her family’s fortune to the cause was impressive, but she is hardly the only person who was touched by the substance’s potential. At the benefit, many of the attendees said they had seen the same inspiring “60 Minutes” segment, in which Anderson Cooper compared the paste to penicillin, concluding that it “may just be the most important advance ever” in the realm of childhood malnutrition. After Salem spoke, she began squeezing dabs of Plumpy’nut onto plates and passing them around, assuring the partygoers that the brownish goo was surprisingly tasty, with the consistency and sweetness of a cookie filling. Everyone ate it right up.
Plumpy’nut proved so palatable and so valuable that it was only natural that other interests were now trying to take a bite. “You want to hear about the bad stuff?” Salem whispered. There was a lot to talk about. Outside the restaurant, beyond the protective cordon of appreciation, rival factions were fighting over a less innocent — though perhaps no less important — issue: who should profit? Plaintiffs were suing, accusing her partners at Nutriset of anticompetitive practices to protect their position atop a $200 million marketplace. Doctors, foreign-aid organizations and agribusinesses were staking competing claims, each invoking the interests of the world’s most fragile children. “Forget all the politics,” Salem pleads. “I’d like to erase them all.” But try as she might, she can’t wish away the questions of property and law.
Everyone, it seemed, wanted to own a bit of Plumpy’nut.
At the beginning, the problem was devilishly simple: malnutrition was killing millions in poor countries — it’s thought to be responsible for a third of all deaths of children under 5. And yet the global medical community was expending little effort to develop improved treatments. In the early 1990s, the accepted regimen for severe acute malnutrition — a watery mixture fed through a tube — was 30 years old and was unable to prevent the deaths of 20 to 60 percent of patients in hospitals. Frustrated, a small group of doctors began searching for a better way to get nutrients into starving children. One of them was André Briend.
According to legend, Briend hit upon the inspiration for Plumpy’nut one morning at the breakfast table, when, after years of vainly mixing nutrients into cookies, pancakes and yogurt, he opened a jar of Nutella, and the idea came to him: a paste! Like most such stories, this one is not completely true — or rather, it elides many years of false starts, research, scientific collaboration and infighting. The first advance came in the form of F100, a dried high-energy milk that was fortified with a mix of vitamins and minerals that were designed to counter the specific biochemical effects of malnutrition in children. F100 had to be mixed with water, though, which in poor countries was apt to be rife with bacteria. It also tasted unpleasant. As a childhood-nutrition expert attached to a French government institute, Briend came up with the idea of mixing F100 together with peanuts, milk, sugar and oil. The concoction was full of protein and fat, which insulated its nutrients from oxygen and humidity and masked their unappetizing flavor.
The true advance lay not in the formulation, however, but in the way the paste could be put to work. Earlier treatments had to be administered in a hospital setting, which meant a long, expensive stay away from home for both mother and patient, so children were rarely brought in for treatment until they were already extremely weak and susceptible to all the pathogens that lurk in third-world health facilities. What Briend and a few other specialists envisioned was a treatment that could be administered at home, by families instead of doctors. For medical professionals, this required a radical shift in mind-set. Briend searched the world for someone willing to conduct field tests, cautioning that collaborators in his experiments, as he put it in a 2000 message to a malnutrition Listserv, “should be ready to accept a road with trial and errors.”
One doctor who decided to take a risk was Mark Manary, a pediatrician and professor, who was working at a hospital in Malawi. His malnutrition ward was crammed full of dozens of children lying on mats. “It was really an incredible burden,” Manary recalled. “These kids are deathly ill, you’re doing whatever you can for them, and you think you’re on the right track, and then you come in the next morning and four of them have died.” Manary emptied out the ward, sending his patients home with Plumpy’nut. Many malnutrition experts were horrified. “It seemed dangerous to them, and it made them afraid,” said Manary, who recalled that one eminent figure stood up at a conference and said, “You’re killing children.” In fact, when the results were analyzed, it was found that 95 percent of the subjects who received Plumpy’nut at home made a full recovery, a rate far better than that achieved with inpatient treatment.
The Malawi test emboldened Doctors Without Borders, which recognized that treating children outside clinical settings would allow a vastly scaled-up response to humanitarian emergencies. In 2005, it distributed Plumpy’nut to 60,000 children with severe acute malnutrition during a famine in Niger. Ninety percent completely recovered, and only 3 percent died. Within two years, the United Nations endorsed home care with Plumpy’nut as the preferred treatment for severe acute malnutrition. “This is an enormous breakthrough,” said Werner Schultink, chief of nutrition for Unicef. “It has created the opportunity to reach many more children with relatively limited resources.” Nonetheless, Schultink estimates that the product reaches only 10 to 15 percent of those who need it, because of logistical and budgetary constraints.
Briend’s invention may satisfy a need, the hunger of children, but that doesn’t directly correspond to economic demand, which is set by buyers — the donor nations and international agencies that spend billions of dollars on food aid and famine relief. This is the gap Navyn Salem is hoping to fill. Her mission is threefold. First, her plant manufactures Plumpy’nut for sale. Second, she is trying to use publicity and humanitarian appeals to persuade the customer base — the foreign-aid donors — to allocate more money to purchase and distribute the product. Finally, and most ambitiously, she is advocating the use of Plumpy’nut and a number of spinoff products to address a wider array of challenges, including malnutrition prevention. The broadened market, in theory, could be enormous: The World Bank, in a recent report, recommended that aid agencies scale up their spending on such programs, which currently stands at $300 million annually, to $6 billion a year. The U.S. Agency for International Development, which administers the $2.2 billion Food for Peace program, has been examining the usefulness of Plumpy’nut and products similar to it. American food aid must comply with stringent regulations meant to encourage domestic procurement, a requirement Navyn Salem is perfectly placed to meet.
Salem’s interest in philanthropy was intensified after reading a biography of Farmer, the crusading physician, with whom she subsequently traveled to Rwanda, but it took Plumpy’nut to galvanize her thoughts. “We talk about AIDS, tuberculosis and malaria and how detrimental they are, these terrible epidemics, but then I realized that malnutrition was killing more than all of them combined,” Salem said. “And we know how to fix it.” She didn’t know much about famine relief or the insular community of nutritionists who deal with it, but she had a professional background in advertising and marketing, and she wanted to do something that drew on what she saw as her natural entrepreneurial strengths. “I thought, Let’s figure out if we can run a business that saves thousands and thousands of lives,” she said. Salem’s factory, located in an industrial area of Providence just off Interstate 95, cost $2 million to start. In March, right around the time she opened for business, she gave me a tour. The front lobby was decorated with large photos of grinning African children that Salem took on her trips to Rwanda and Tanzania. We donned blue smocks, hairnets and booties and entered the sanitized factory floor, where two workers, a Burundian and a Liberian, were using scoops to weigh out portions of sugar. “Most of our production staff are refugees who were recently resettled in Rhode Island,” Salem said. After the Plumpy’nut was mixed, it was run through overhead pipes into a contraption that squirted it into foil packets, which were sealed and ejected onto a conveyor belt, where workers packed them for shipping. In an adjacent warehouse, there were pallets of boxes labeled for delivery to Haiti, Yemen and Nicaragua.
Salem led me to a gleaming stainless-steel tank, which was about as tall as she was and hot to the touch. She opened a door on top, and a fragrant peanut smell wafted out as we craned to look in. “Here it is,” Salem said. “The magic stuff.”
That magic is the property of Nutriset. To trace how a family-run company based in a small town in the Normandy countryside ended up owning the patent to one of the world’s most promising humanitarian interventions, you have to go back to André Briend. He never knew anything about manufacturing food, so at the time he was trying to demonstrate the worth of Plumpy’nut, he signed a consulting agreement with Nutriset, which specialized in making therapeutic milk products. He and the company’s founder, a food scientist named Michel Lescanne, were listed as inventors on the 1997 French patent. The patent has since been registered in 38 countries, including much of Africa.
“Michel is a guy who probably holds hundreds of patents, he thinks up things all the time, but he didn’t have a viable business” before Plumpy’nut, said Mark Manary, who now runs a nonprofit group that manufactures the product under license in Malawi. “So André and I were all about this as a therapeutic opportunity, and Michel was like, ‘This is an entrepreneurial opportunity.’ ” Lescanne’s expertise was invaluable when it came to engineering the taste, texture and shelf life of Plumpy’nut.
For its contribution, Nutriset has been richly rewarded. Last year, the company produced around 14,000 metric tons of Plumpy’nut and related products, more than a tenfold increase over the amount it made in 2004, registering $66 million in sales. The family-owned company has paid out millions in dividends, according to an internal document, although the company claims the money has largely been reinvested in expanding the business. The state institute where Briend did his research receives 1 percent of sale proceeds, Nutriset says, while the inventor himself has renounced any ownership interest.
A few years ago, after some pressure from buyers, Nutriset announced that it would take a more liberal stance on licensing the product — but only in the developing world. Its affiliate network has since expanded to 11 countries, most of them in Africa. But when it comes to Europe and North America, the company has been aggressive about protecting its interests. When Salem first approached Nutriset about obtaining a license to make Plumpy’nut, she says she received a frosty reception, even though her original idea was to build a factory in Tanzania, her father’s birthplace. After meeting with Salem and her husband, the company relented, although the plan changed a bit in the process. The locus of their new joint venture, Edesia, was shifted to Rhode Island, so that it could satisfy domestic-sourcing requirements for U.S. government aid.
“Our idea with Edesia is for it to really be an incubator,” said Adeline Lescanne, Michel’s daughter and the deputy general manager of the company. She said the company was investing its profits in research into a new generation of ready-to-use therapeutic foods, or R.U.T.F., as they are called in the jargon of the foreign-aid community. The new lines would be designed to prevent malnutrition, not just cure it. “It’s a kind of pity that there is not a lot of research on new R.U.T.F.,” Lescanne said. “There are only people fighting to produce this product.”
Nutriset’s critics say that line of argument is disingenuous, because the Plumpy’nut patent is so broad as to encompass just about any kind of nut-based nutritional paste. “There are other people that would like to enter into the business,” Ben Tabatchnick, who runs a New Jersey-based kosher soup company, said. “But everybody is afraid of being sued.” Last year, Tabatchnick went to France to talk to Nutriset about his plans to develop ready-to-use therapeutic foods on a for-profit basis. “I had a meeting with them that lasted about 10 minutes, and they threw me out of the room,” he told me. Afterward, Nutriset sent him a pair of ominous letters, indicating that it had found “some similarities” between Plumpy’nut and his product, Nutty Butta.
Nutriset has sent similar saber-rattling correspondence to a number of other potential competitors. Lescanne told me that Nutriset’s vigilance over its intellectual property has a benevolent purpose. Between now and the time the patent is scheduled to expire, in 2017, the company wants to focus on building its network of affiliates in countries like Congo, Mozambique and Niger. (Salem’s plant in Tanzania is supposed to open later this year.) “We have to protect this network,” Lescanne said. “We are a bit afraid that big industrial companies will come.” In recent months, to take one example, PepsiCo Inc. has talked publicly about playing “a more decisive role” in bringing ready-to-use foods to needy populations. This has raised hackles: in a recent journal article titled “The Snack Attack,” three nutritionists warned that Pepsi-branded therapies would potentially be “potent ambassadors for equivalently branded baby foods, cola drinks and snack foods.”
“What we don’t want,” Salem told me, “is for General Mills to take over and put our Ethiopian producer out of business.” Opponents of the patent, however, say that Nutriset is just trying to avoid competition that would cut into its bottom line. Recently, a handful of companies have set up shop in countries where, because of the vagaries of various treaties, the Plumpy’nut patent is not in force. In the United States, two would-be competitors have taken a more confrontational route. They filed a lawsuit with the federal district court in Washington, D.C., seeking to have the patent invalidated.
The plaintiffs are a Texas-based manufacturer called Breedlove Foods and the Mama Cares Foundation, the charitable arm of a snack-food manufacturer based in Carlsbad, Calif. Both are small nonprofit organizations with strong ties to Christian aid organizations. But Nutriset’s defenders suspect that larger corporate interests are lurking in the background. In the French press, the patent dispute has been portrayed as a case of a plucky Gallic company besieged, as Le Monde put it, by “ ‘légions’ Américaines.”
In fact, there is a not-so-hidden instigator behind the case: the American peanut lobby. A few years ago, a Unicef official gave a presentation to an industry trade group, forecasting dramatically increasing demand for peanut pastes. That got the growers excited. They looked at Nutriset’s patent and came to the conclusion that, as a technical matter, Plumpy’nut was really nothing more than fortified peanut butter. “People have been making this stuff for centuries,” Jeff Johnson, a board member of the Peanut Institute, said. “It’s nothing new.” Johnson is the president of Birdsong Peanuts, one of the country’s largest shelling operations. Through a friend, he heard about Breedlove Foods, which was based in Lubbock, close to one of his processing plants. Johnson met with the company and proposed a challenge to Nutriset.
“It's a cotton-pickin’ shame that they decided to take the stance that they have with the intellectual-property issue,” said David Fish, Breedlove’s chief executive, whose lawsuit contends that the patent is hurting starving children. But even some Nutriset critics have questioned the motives behind the lawsuit, pointing out that America has a long and controversial history of dumping its agricultural surpluses on poor countries through food aid. “If you want to develop countries out of third-world status,” Fish replies, “they’ve got to come out and compete on the open market.”
Plumpy! Plumpy!”
With the shouted order from Rosemond Avril, an agent of a charity group, workers began unloading cardboard boxes full of foil packets from the back of a rusty blue truck. It was a sweltering Haitian morning, and next to a hive of canvas tents, the women of Bineau-Lestere were lined up beneath the branches of a gnarled quenepa tree. They were a handful of the millions displaced by last January’s earthquake, which had turned the nearby city of Léogâne into a jagged pile of concrete. Their camp, thrown up amid fields of sugar cane, was surviving on aid. On this morning, the U.N.’s World Food Program was distributing Supplementary’Plumpy, a slightly weaker formulation of the original product, to mothers with children between 6 months and 35 months.
Haiti wasn’t starving, but experts were still concerned about the perilous condition of its children. Even before the earthquake, an estimated quarter of them were chronically malnourished, and now many breadwinners were dead, livelihoods disrupted and much of the country’s commercial infrastructure destroyed. By administering Supplementary’Plumpy to children in the age group most vulnerable to severe malnutrition, the World Food Program was trying to keep a bad situation from turning into a crisis. Across Haiti, the agency was distributing such aid to 500,000 people, and the results of a survey suggested that malnutrition levels had remained stable. “This is all new,” said Myrta Kaulard, country director for the World Food Program in Haiti. “It’s preventative action.”
Darting around the scrum of women and toddlers, as a relief worker announced instructions in Creole through a bullhorn, Navyn Salem snapped pictures with her Nikon. She looked on with satisfaction as one jug-eared little boy ripped open a packet and squeezed the light brown paste into his mouth. She clicked the photo, and before long it was on its way to the Facebook page of Edesia Global Nutrition Solutions.
Salem had flown to Haiti a few days earlier aboard a private jet, lent by her husband, on a characteristically blurry mission: part sales call, part fact-finding tour. Edesia was sending its products to agencies in Haiti, the World Food Program among them, but what interested Salem most was the prospect of using ready-to-use foods to address conditions beyond severe malnutrition. She and Maria Kasparian, her second-in-command at Edesia, were shuttling from one charity to another in a loaned van, carrying boxes of free samples and brochures promoting three products designed to be taken as daily supplements. “Everyone knows Plumpy’nut,” Salem said before the trip, “but what we’re really trying to do is push these others, to address malnutrition sooner.”
Scientists have shown that there is, in the words of The Lancet, “a golden interval” for childhood nutrition that occurs before the age of 2. “This is the period when brain growth is very extensive and babies are developing their immune systems,” said Kathryn Dewey, a professor in the department of nutrition at the University of California, Davis. Stunting that persists after age 2 is generally irreversible, while improved nutrition in early childhood correlates to greater educational success. One study, in Guatemala, showed that boys given a nutritional supplement as babies made 46 percent higher wages as men. Dewey has been testing whether Nutributter, one of Nutriset’s new (and patent-protected) products, might achieve similar results. “There has to be a way to break the cycle of poverty and malnutrition that has plagued these populations for hundreds and hundreds of years,” she said. “That’s the more grandiose vision of where this is headed.”
In Haiti’s Artibonite Valley, Ian Rawson, the managing director of the Hôpital Albert Schweitzer, took Salem to see malnutrition inpatients — “our failures,” he called them — in a dimly lighted ward where they lay beneath a mural of parrots. Many of the children were unnaturally small and had patchy, orange-tinted hair, a classic sign of protein deficiency. “This,” Rawson said, waving a packet of Plumpy’nut, “is our immunization.” He was applying for a U.S. government grant to distribute Nutributter in the surrounding mountains, where poverty is dire, 9 out of 10 adults can’t read and acute malnutrition rates can top 35 percent. “It seems simple to me,” he said. “What’s the downside to me giving every child who’s over 4 months old a tube of Nutributter per day?”
Advocates of the preventive approach foresee a future in which children around the world consume a daily packet of nutrient-filled paste. “It’s not just for poverty-stricken people,” Salem said. “It’s just like I give my children a multivitamin.” Of course, this changes the nature of the intervention from an emergency treatment to a habitual routine and also dramatically escalates its prospective cost to donors. As a practical matter, Salem says, supplements will probably have to reach children through consumer markets, perhaps with subsidies. Edesia is conducting testing in Tanzania to see whether Nutributter could be sold in stores.
Some experts, however, warn that enthusiasm may be running ahead of the science. “In their rush to be innovators, I think a lot of agencies are using ready-to-use supplementary foods without evidence,” said Steve Collins, who was a pioneering advocate of home-based care for severe malnutrition. “I wouldn’t want to see a new world order where poor people are dependent on packaged supplementary foods that are manufactured in Europe or the United States.”
His wariness reflects a larger ideological divide over the proper distribution of profit. Nutriset says it is committed to opening more developing-world franchises, a strategy that brings down shipping costs and hence prices, but the majority of its network’s inventory still comes from France, and now, with the entry of Edesia, Nutriset is going to be expanding exports from the United States. Collins asks, “How are they addressing the need for poor people in Haiti not to be dependent on outside intervention in the first place?”
This question hung, unanswerable, over Salem’s journey through Haiti. Salem went there with a promise to donate a shipping container filled with $60,000 worth of Nutriset-patented products to Partners in Health, the charity run by her friend Paul Farmer. While grateful, the organization still preferred to manufacture its own product, Nourimanba, with the profits accruing to local farmers. But even this program was more a principled exercise than a development strategy. Haiti’s endemic problem of malnutrition wasn’t something you could solve with peanuts. Partners in Health also took Salem on a couple of home visits. At a one-room shack in Cange, a mother presented her 3-year-old daughter, saying she had gained 11 pounds on a regimen of Nourimanba. But the mother complained that there was no help for other serious problems she faced, like the fact that she had no job and the tin roof of her shack leaked.
Out in the hills, down a muddy path shaded by coconut palms, the health workers checked in on a small wooden farmhouse. Two children living there were on a regimen of ready-to-use food — and six were receiving nothing. The older ones watched as their little sister wolfed down an entire cup of peanut paste for the benefit of the visitors. The children’s grandmother, who was looking after them, was asked why malnutrition had been diagnosed in these two and the others not. She said she couldn’t really say, except that there simply wasn’t enough food to go around. There was no foil-wrapped answer to the maddening persistence of poverty. All that existed was a determination to meet the challenge with all the fallible tools of human ingenuity.
“We’re trying to put ourselves out of business,” said Salem, still brimming with optimism, after the trip. “That would be the best-case scenario.”
Andrew Rice is a contributing writer and author of “The Teeth May Smile but the Heart Does Not Forget,” about a Ugandan murder trial.
THE WAIT A World Food Program screening center in Port-au-Prince.
By ANDREW RICE
Published: September 2, 2010
Like most tales of great invention, the story of Plumpy’nut begins with a eureka moment, in this case involving a French doctor and a jar of Nutella, and proceeds through the stages of rejection, acceptance, evangelization and mass production. The product may not look like much — a little foil packet filled with a soft, sticky substance — but its advocates are prone to use the language of magic and wonders.
What is Plumpy’nut? Sound it out, and you get the idea: it’s an edible paste made of peanuts, packed with calories and vitamins, that is specially formulated to renourish starving children. Since its widespread introduction five years ago, it has been credited with significantly lowering mortality rates during famines in Africa. Children on a Plumpy’nut regimen add pounds rapidly, often going from a near-death state to relative health in a month. In the world of humanitarian aid, where progress is usually measured in subtle increments of misery, the new product offers a rare satisfaction: swift, visible, fantastic efficacy.
Maggie Steber for The New York Times
Children, eating a peanut paste, at a seaside tent camp in Haiti.
THE FACTORY Partners in Health makes its own peanut-based supplement in Haiti.
Maggie Steber for The New York Times
THE SCALE Loramie Joseph is weighed at a Save the Children center.
Plumpy’nut is also a brand name, however, the registered trademark of Nutriset, a private French company that first manufactured and marketed the paste. It was not the intention of Plumpy’nut’s inventor, a crusading pediatrician named André Briend, to create an industry around Plumpy’nut. Briend, his friends say, was always personally indifferent to money. (Also, apparently, to publicity — he declined repeated requests to be interviewed for this article.) One element of genius in Briend’s recipe was precisely its easy replicability: it could be made by poor people, for poor people, to the benefit of patients and farmers alike. Most of the world’s peanuts are grown in developing countries, where allergies to them are relatively uncommon, and the rest of the concoction is simple to prepare. On a visit to Malawi, Briend whipped up a batch in a blender to prove that Plumpy’nut could be made just about anywhere.
Others, however, quickly realized that the miracle product had more than just moral value. Nutriset has aggressively protected its intellectual property, and the bulk of Plumpy’nut production continues to take place at Nutriset facilities in France. (Unicef, the world’s primary buyer, purchases 90 percent of its supply from that factory, according to a 2009 report prepared for the agency.) Internationally, there has been a vituperative debate over who should control the means of production, with India going so far as to impose sharp restrictions on Plumpy’nut, calling it an unproven colonialist import. Elsewhere, local producers are simply ignoring the patent. In Haiti, two manufacturers are making products similar to Plumpy’nut independently of Nutriset: one is Partners in Health, the charity co-founded by the prominent global-health activist Paul Farmer. Partners in Health harvests peanuts from a 30-acre farm or buys them from a cooperative of 200 smallholders. It’s planning to build a larger factory, but for now the nuts are taken to the main hospital in Cange, where women sort them in straw baskets, roast them over an outside gas burner, run them through a hand grinder and mix all the ingredients into a paste that is poured into reusable plastic canisters. Peanuts in Haiti and throughout the developing world have a high incidence of aflatoxin, a fungus that can sicken children, especially fragile ones. But Partners in Health says the product, which it calls Nourimanba, is safe.
When I visited one of the charity’s outpatient clinics in July, 1-year-old Elorky Decena was silent and listless as a nurse hooked a scale over the clinic’s doorway and put him in an attached harness. A month before, he was found to have severe acute malnutrition, a condition characterized by extreme stunting and wasting that afflicts an estimated 20 million children worldwide. The nurse announced that he had gained more than four pounds on a diet of Nourimanba.
Patents are meant to offer incentives to innovators by giving them a time-limited right to exclusively exploit their ideas for profit. But many say that lifesaving products should be treated by a different set of rules. There has been a long and bitter argument, for instance, over the affordability of patented AIDS drugs in Africa. Critics have made a similar case against Plumpy’nut, which is fairly expensive, costing about $60 per child for a full two-month treatment. “We were concerned because of the way Nutriset was managing their intellectual property,” said Stéphane Doyon, a nutrition specialist with Doctors Without Borders, a medical charity. “We felt that there was the possibility for the creation of a monopoly.”
“Poverty is a business,” Patricia Wolff, a St. Louis pediatrician, said. She founded Meds and Food for Kids, the other local producer of fortified nut paste in Haiti. When I first spoke with her in May, Meds and Food for Kids was struggling to raise money to expand its operations, and Wolff complained mightily about the difficulties she faced because of Nutriset’s market dominance. “There’s money to be made,” she said, “and there are people who have that kind of way of thinking.” Two months later, Wolff made a tentative deal for Meds and Food for Kids to become a Nutriset franchisee. In the end, she said, she couldn’t afford to battle hunger on her own.
In the United States, Plumpy’nut’s sole manufacturer and chief promoter is a 38-year-old mother of four from Barrington, R.I. Navyn Salem doesn’t have a background in medicine or aid work. She first glimpsed the potential of Plumpy’nut three years ago on “60 Minutes.” Since then, Salem has devoted herself to making the product for export to needy nations like Haiti. Though her Providence factory, a joint venture with Nutriset, has all the trappings of a business, selling its wares to relief agencies under the name Edesia Global Nutrition Solutions, the operation is registered as a nonprofit foundation and was established with seed money from Salem and her husband, Paul, a private-equity financier. Dancing along the nebulous line between capitalism and charity, Salem casts herself as a marketer, offering a neatly packaged solution to a tragic and no longer intractable malady. On a Tuesday in May, she brought her message of good news to a Mother’s Day benefit in Midtown Manhattan.
“This is not my ZIP code,” Salem said as she stood in the East Side Social Club, a wood-paneled restaurant, amid a jostling crowd of bejeweled women pinching noontime flutes of Champagne. She met one of the party’s hosts, Lauren Bush, the former model and niece of the most recent ex-president, a couple of years ago at a conference of the Clinton Global Initiative. Now Bush and her mother, Sharon, were selling a specially designed line of teddy bears — a big one called Plumpy and a small one called Nut — to raise money to purchase the product for children in Africa.
When it came time to eat their own meal, a three-course luncheon, the party guests found seats at tables set with elaborate centerpieces, made up of stuffed bears and Plumpy’nut packets. As volunteers sold raffle tickets for a Dior handbag, Salem delivered a practiced speech. Earnest and attractive, with wide brown eyes, she told the audience that her father, a member of an Indian merchant family, grew up in Tanzania. “There are over a billion people in our world that are malnourished,” Salem said. “It’s a shocking statistic. The good news is there’s a very simple solution.” And that, she said, was Plumpy’nut. “It’s really revolutionary, because it doesn’t need to be mixed with water or refrigerated,” Salem continued. “And the most miraculous part is, it will transform a child from literally skin and bones to certain survival in just four to six weeks.”
This transformation, seen in before-and-after photos — on one side a sick and wasted child, on the other, a chubby, smiling one — was the promise that captured imaginations far beyond the technocratic community of specialists that originally developed Plumpy’nut. “People love a silver bullet,” says the prominent nutritionist Steve Collins. Salem’s decision to devote a portion of her family’s fortune to the cause was impressive, but she is hardly the only person who was touched by the substance’s potential. At the benefit, many of the attendees said they had seen the same inspiring “60 Minutes” segment, in which Anderson Cooper compared the paste to penicillin, concluding that it “may just be the most important advance ever” in the realm of childhood malnutrition. After Salem spoke, she began squeezing dabs of Plumpy’nut onto plates and passing them around, assuring the partygoers that the brownish goo was surprisingly tasty, with the consistency and sweetness of a cookie filling. Everyone ate it right up.
Plumpy’nut proved so palatable and so valuable that it was only natural that other interests were now trying to take a bite. “You want to hear about the bad stuff?” Salem whispered. There was a lot to talk about. Outside the restaurant, beyond the protective cordon of appreciation, rival factions were fighting over a less innocent — though perhaps no less important — issue: who should profit? Plaintiffs were suing, accusing her partners at Nutriset of anticompetitive practices to protect their position atop a $200 million marketplace. Doctors, foreign-aid organizations and agribusinesses were staking competing claims, each invoking the interests of the world’s most fragile children. “Forget all the politics,” Salem pleads. “I’d like to erase them all.” But try as she might, she can’t wish away the questions of property and law.
Everyone, it seemed, wanted to own a bit of Plumpy’nut.
At the beginning, the problem was devilishly simple: malnutrition was killing millions in poor countries — it’s thought to be responsible for a third of all deaths of children under 5. And yet the global medical community was expending little effort to develop improved treatments. In the early 1990s, the accepted regimen for severe acute malnutrition — a watery mixture fed through a tube — was 30 years old and was unable to prevent the deaths of 20 to 60 percent of patients in hospitals. Frustrated, a small group of doctors began searching for a better way to get nutrients into starving children. One of them was André Briend.
According to legend, Briend hit upon the inspiration for Plumpy’nut one morning at the breakfast table, when, after years of vainly mixing nutrients into cookies, pancakes and yogurt, he opened a jar of Nutella, and the idea came to him: a paste! Like most such stories, this one is not completely true — or rather, it elides many years of false starts, research, scientific collaboration and infighting. The first advance came in the form of F100, a dried high-energy milk that was fortified with a mix of vitamins and minerals that were designed to counter the specific biochemical effects of malnutrition in children. F100 had to be mixed with water, though, which in poor countries was apt to be rife with bacteria. It also tasted unpleasant. As a childhood-nutrition expert attached to a French government institute, Briend came up with the idea of mixing F100 together with peanuts, milk, sugar and oil. The concoction was full of protein and fat, which insulated its nutrients from oxygen and humidity and masked their unappetizing flavor.
The true advance lay not in the formulation, however, but in the way the paste could be put to work. Earlier treatments had to be administered in a hospital setting, which meant a long, expensive stay away from home for both mother and patient, so children were rarely brought in for treatment until they were already extremely weak and susceptible to all the pathogens that lurk in third-world health facilities. What Briend and a few other specialists envisioned was a treatment that could be administered at home, by families instead of doctors. For medical professionals, this required a radical shift in mind-set. Briend searched the world for someone willing to conduct field tests, cautioning that collaborators in his experiments, as he put it in a 2000 message to a malnutrition Listserv, “should be ready to accept a road with trial and errors.”
One doctor who decided to take a risk was Mark Manary, a pediatrician and professor, who was working at a hospital in Malawi. His malnutrition ward was crammed full of dozens of children lying on mats. “It was really an incredible burden,” Manary recalled. “These kids are deathly ill, you’re doing whatever you can for them, and you think you’re on the right track, and then you come in the next morning and four of them have died.” Manary emptied out the ward, sending his patients home with Plumpy’nut. Many malnutrition experts were horrified. “It seemed dangerous to them, and it made them afraid,” said Manary, who recalled that one eminent figure stood up at a conference and said, “You’re killing children.” In fact, when the results were analyzed, it was found that 95 percent of the subjects who received Plumpy’nut at home made a full recovery, a rate far better than that achieved with inpatient treatment.
The Malawi test emboldened Doctors Without Borders, which recognized that treating children outside clinical settings would allow a vastly scaled-up response to humanitarian emergencies. In 2005, it distributed Plumpy’nut to 60,000 children with severe acute malnutrition during a famine in Niger. Ninety percent completely recovered, and only 3 percent died. Within two years, the United Nations endorsed home care with Plumpy’nut as the preferred treatment for severe acute malnutrition. “This is an enormous breakthrough,” said Werner Schultink, chief of nutrition for Unicef. “It has created the opportunity to reach many more children with relatively limited resources.” Nonetheless, Schultink estimates that the product reaches only 10 to 15 percent of those who need it, because of logistical and budgetary constraints.
Briend’s invention may satisfy a need, the hunger of children, but that doesn’t directly correspond to economic demand, which is set by buyers — the donor nations and international agencies that spend billions of dollars on food aid and famine relief. This is the gap Navyn Salem is hoping to fill. Her mission is threefold. First, her plant manufactures Plumpy’nut for sale. Second, she is trying to use publicity and humanitarian appeals to persuade the customer base — the foreign-aid donors — to allocate more money to purchase and distribute the product. Finally, and most ambitiously, she is advocating the use of Plumpy’nut and a number of spinoff products to address a wider array of challenges, including malnutrition prevention. The broadened market, in theory, could be enormous: The World Bank, in a recent report, recommended that aid agencies scale up their spending on such programs, which currently stands at $300 million annually, to $6 billion a year. The U.S. Agency for International Development, which administers the $2.2 billion Food for Peace program, has been examining the usefulness of Plumpy’nut and products similar to it. American food aid must comply with stringent regulations meant to encourage domestic procurement, a requirement Navyn Salem is perfectly placed to meet.
Salem’s interest in philanthropy was intensified after reading a biography of Farmer, the crusading physician, with whom she subsequently traveled to Rwanda, but it took Plumpy’nut to galvanize her thoughts. “We talk about AIDS, tuberculosis and malaria and how detrimental they are, these terrible epidemics, but then I realized that malnutrition was killing more than all of them combined,” Salem said. “And we know how to fix it.” She didn’t know much about famine relief or the insular community of nutritionists who deal with it, but she had a professional background in advertising and marketing, and she wanted to do something that drew on what she saw as her natural entrepreneurial strengths. “I thought, Let’s figure out if we can run a business that saves thousands and thousands of lives,” she said. Salem’s factory, located in an industrial area of Providence just off Interstate 95, cost $2 million to start. In March, right around the time she opened for business, she gave me a tour. The front lobby was decorated with large photos of grinning African children that Salem took on her trips to Rwanda and Tanzania. We donned blue smocks, hairnets and booties and entered the sanitized factory floor, where two workers, a Burundian and a Liberian, were using scoops to weigh out portions of sugar. “Most of our production staff are refugees who were recently resettled in Rhode Island,” Salem said. After the Plumpy’nut was mixed, it was run through overhead pipes into a contraption that squirted it into foil packets, which were sealed and ejected onto a conveyor belt, where workers packed them for shipping. In an adjacent warehouse, there were pallets of boxes labeled for delivery to Haiti, Yemen and Nicaragua.
Salem led me to a gleaming stainless-steel tank, which was about as tall as she was and hot to the touch. She opened a door on top, and a fragrant peanut smell wafted out as we craned to look in. “Here it is,” Salem said. “The magic stuff.”
That magic is the property of Nutriset. To trace how a family-run company based in a small town in the Normandy countryside ended up owning the patent to one of the world’s most promising humanitarian interventions, you have to go back to André Briend. He never knew anything about manufacturing food, so at the time he was trying to demonstrate the worth of Plumpy’nut, he signed a consulting agreement with Nutriset, which specialized in making therapeutic milk products. He and the company’s founder, a food scientist named Michel Lescanne, were listed as inventors on the 1997 French patent. The patent has since been registered in 38 countries, including much of Africa.
“Michel is a guy who probably holds hundreds of patents, he thinks up things all the time, but he didn’t have a viable business” before Plumpy’nut, said Mark Manary, who now runs a nonprofit group that manufactures the product under license in Malawi. “So André and I were all about this as a therapeutic opportunity, and Michel was like, ‘This is an entrepreneurial opportunity.’ ” Lescanne’s expertise was invaluable when it came to engineering the taste, texture and shelf life of Plumpy’nut.
For its contribution, Nutriset has been richly rewarded. Last year, the company produced around 14,000 metric tons of Plumpy’nut and related products, more than a tenfold increase over the amount it made in 2004, registering $66 million in sales. The family-owned company has paid out millions in dividends, according to an internal document, although the company claims the money has largely been reinvested in expanding the business. The state institute where Briend did his research receives 1 percent of sale proceeds, Nutriset says, while the inventor himself has renounced any ownership interest.
A few years ago, after some pressure from buyers, Nutriset announced that it would take a more liberal stance on licensing the product — but only in the developing world. Its affiliate network has since expanded to 11 countries, most of them in Africa. But when it comes to Europe and North America, the company has been aggressive about protecting its interests. When Salem first approached Nutriset about obtaining a license to make Plumpy’nut, she says she received a frosty reception, even though her original idea was to build a factory in Tanzania, her father’s birthplace. After meeting with Salem and her husband, the company relented, although the plan changed a bit in the process. The locus of their new joint venture, Edesia, was shifted to Rhode Island, so that it could satisfy domestic-sourcing requirements for U.S. government aid.
“Our idea with Edesia is for it to really be an incubator,” said Adeline Lescanne, Michel’s daughter and the deputy general manager of the company. She said the company was investing its profits in research into a new generation of ready-to-use therapeutic foods, or R.U.T.F., as they are called in the jargon of the foreign-aid community. The new lines would be designed to prevent malnutrition, not just cure it. “It’s a kind of pity that there is not a lot of research on new R.U.T.F.,” Lescanne said. “There are only people fighting to produce this product.”
Nutriset’s critics say that line of argument is disingenuous, because the Plumpy’nut patent is so broad as to encompass just about any kind of nut-based nutritional paste. “There are other people that would like to enter into the business,” Ben Tabatchnick, who runs a New Jersey-based kosher soup company, said. “But everybody is afraid of being sued.” Last year, Tabatchnick went to France to talk to Nutriset about his plans to develop ready-to-use therapeutic foods on a for-profit basis. “I had a meeting with them that lasted about 10 minutes, and they threw me out of the room,” he told me. Afterward, Nutriset sent him a pair of ominous letters, indicating that it had found “some similarities” between Plumpy’nut and his product, Nutty Butta.
Nutriset has sent similar saber-rattling correspondence to a number of other potential competitors. Lescanne told me that Nutriset’s vigilance over its intellectual property has a benevolent purpose. Between now and the time the patent is scheduled to expire, in 2017, the company wants to focus on building its network of affiliates in countries like Congo, Mozambique and Niger. (Salem’s plant in Tanzania is supposed to open later this year.) “We have to protect this network,” Lescanne said. “We are a bit afraid that big industrial companies will come.” In recent months, to take one example, PepsiCo Inc. has talked publicly about playing “a more decisive role” in bringing ready-to-use foods to needy populations. This has raised hackles: in a recent journal article titled “The Snack Attack,” three nutritionists warned that Pepsi-branded therapies would potentially be “potent ambassadors for equivalently branded baby foods, cola drinks and snack foods.”
“What we don’t want,” Salem told me, “is for General Mills to take over and put our Ethiopian producer out of business.” Opponents of the patent, however, say that Nutriset is just trying to avoid competition that would cut into its bottom line. Recently, a handful of companies have set up shop in countries where, because of the vagaries of various treaties, the Plumpy’nut patent is not in force. In the United States, two would-be competitors have taken a more confrontational route. They filed a lawsuit with the federal district court in Washington, D.C., seeking to have the patent invalidated.
The plaintiffs are a Texas-based manufacturer called Breedlove Foods and the Mama Cares Foundation, the charitable arm of a snack-food manufacturer based in Carlsbad, Calif. Both are small nonprofit organizations with strong ties to Christian aid organizations. But Nutriset’s defenders suspect that larger corporate interests are lurking in the background. In the French press, the patent dispute has been portrayed as a case of a plucky Gallic company besieged, as Le Monde put it, by “ ‘légions’ Américaines.”
In fact, there is a not-so-hidden instigator behind the case: the American peanut lobby. A few years ago, a Unicef official gave a presentation to an industry trade group, forecasting dramatically increasing demand for peanut pastes. That got the growers excited. They looked at Nutriset’s patent and came to the conclusion that, as a technical matter, Plumpy’nut was really nothing more than fortified peanut butter. “People have been making this stuff for centuries,” Jeff Johnson, a board member of the Peanut Institute, said. “It’s nothing new.” Johnson is the president of Birdsong Peanuts, one of the country’s largest shelling operations. Through a friend, he heard about Breedlove Foods, which was based in Lubbock, close to one of his processing plants. Johnson met with the company and proposed a challenge to Nutriset.
“It's a cotton-pickin’ shame that they decided to take the stance that they have with the intellectual-property issue,” said David Fish, Breedlove’s chief executive, whose lawsuit contends that the patent is hurting starving children. But even some Nutriset critics have questioned the motives behind the lawsuit, pointing out that America has a long and controversial history of dumping its agricultural surpluses on poor countries through food aid. “If you want to develop countries out of third-world status,” Fish replies, “they’ve got to come out and compete on the open market.”
Plumpy! Plumpy!”
With the shouted order from Rosemond Avril, an agent of a charity group, workers began unloading cardboard boxes full of foil packets from the back of a rusty blue truck. It was a sweltering Haitian morning, and next to a hive of canvas tents, the women of Bineau-Lestere were lined up beneath the branches of a gnarled quenepa tree. They were a handful of the millions displaced by last January’s earthquake, which had turned the nearby city of Léogâne into a jagged pile of concrete. Their camp, thrown up amid fields of sugar cane, was surviving on aid. On this morning, the U.N.’s World Food Program was distributing Supplementary’Plumpy, a slightly weaker formulation of the original product, to mothers with children between 6 months and 35 months.
Haiti wasn’t starving, but experts were still concerned about the perilous condition of its children. Even before the earthquake, an estimated quarter of them were chronically malnourished, and now many breadwinners were dead, livelihoods disrupted and much of the country’s commercial infrastructure destroyed. By administering Supplementary’Plumpy to children in the age group most vulnerable to severe malnutrition, the World Food Program was trying to keep a bad situation from turning into a crisis. Across Haiti, the agency was distributing such aid to 500,000 people, and the results of a survey suggested that malnutrition levels had remained stable. “This is all new,” said Myrta Kaulard, country director for the World Food Program in Haiti. “It’s preventative action.”
Darting around the scrum of women and toddlers, as a relief worker announced instructions in Creole through a bullhorn, Navyn Salem snapped pictures with her Nikon. She looked on with satisfaction as one jug-eared little boy ripped open a packet and squeezed the light brown paste into his mouth. She clicked the photo, and before long it was on its way to the Facebook page of Edesia Global Nutrition Solutions.
Salem had flown to Haiti a few days earlier aboard a private jet, lent by her husband, on a characteristically blurry mission: part sales call, part fact-finding tour. Edesia was sending its products to agencies in Haiti, the World Food Program among them, but what interested Salem most was the prospect of using ready-to-use foods to address conditions beyond severe malnutrition. She and Maria Kasparian, her second-in-command at Edesia, were shuttling from one charity to another in a loaned van, carrying boxes of free samples and brochures promoting three products designed to be taken as daily supplements. “Everyone knows Plumpy’nut,” Salem said before the trip, “but what we’re really trying to do is push these others, to address malnutrition sooner.”
Scientists have shown that there is, in the words of The Lancet, “a golden interval” for childhood nutrition that occurs before the age of 2. “This is the period when brain growth is very extensive and babies are developing their immune systems,” said Kathryn Dewey, a professor in the department of nutrition at the University of California, Davis. Stunting that persists after age 2 is generally irreversible, while improved nutrition in early childhood correlates to greater educational success. One study, in Guatemala, showed that boys given a nutritional supplement as babies made 46 percent higher wages as men. Dewey has been testing whether Nutributter, one of Nutriset’s new (and patent-protected) products, might achieve similar results. “There has to be a way to break the cycle of poverty and malnutrition that has plagued these populations for hundreds and hundreds of years,” she said. “That’s the more grandiose vision of where this is headed.”
In Haiti’s Artibonite Valley, Ian Rawson, the managing director of the Hôpital Albert Schweitzer, took Salem to see malnutrition inpatients — “our failures,” he called them — in a dimly lighted ward where they lay beneath a mural of parrots. Many of the children were unnaturally small and had patchy, orange-tinted hair, a classic sign of protein deficiency. “This,” Rawson said, waving a packet of Plumpy’nut, “is our immunization.” He was applying for a U.S. government grant to distribute Nutributter in the surrounding mountains, where poverty is dire, 9 out of 10 adults can’t read and acute malnutrition rates can top 35 percent. “It seems simple to me,” he said. “What’s the downside to me giving every child who’s over 4 months old a tube of Nutributter per day?”
Advocates of the preventive approach foresee a future in which children around the world consume a daily packet of nutrient-filled paste. “It’s not just for poverty-stricken people,” Salem said. “It’s just like I give my children a multivitamin.” Of course, this changes the nature of the intervention from an emergency treatment to a habitual routine and also dramatically escalates its prospective cost to donors. As a practical matter, Salem says, supplements will probably have to reach children through consumer markets, perhaps with subsidies. Edesia is conducting testing in Tanzania to see whether Nutributter could be sold in stores.
Some experts, however, warn that enthusiasm may be running ahead of the science. “In their rush to be innovators, I think a lot of agencies are using ready-to-use supplementary foods without evidence,” said Steve Collins, who was a pioneering advocate of home-based care for severe malnutrition. “I wouldn’t want to see a new world order where poor people are dependent on packaged supplementary foods that are manufactured in Europe or the United States.”
His wariness reflects a larger ideological divide over the proper distribution of profit. Nutriset says it is committed to opening more developing-world franchises, a strategy that brings down shipping costs and hence prices, but the majority of its network’s inventory still comes from France, and now, with the entry of Edesia, Nutriset is going to be expanding exports from the United States. Collins asks, “How are they addressing the need for poor people in Haiti not to be dependent on outside intervention in the first place?”
This question hung, unanswerable, over Salem’s journey through Haiti. Salem went there with a promise to donate a shipping container filled with $60,000 worth of Nutriset-patented products to Partners in Health, the charity run by her friend Paul Farmer. While grateful, the organization still preferred to manufacture its own product, Nourimanba, with the profits accruing to local farmers. But even this program was more a principled exercise than a development strategy. Haiti’s endemic problem of malnutrition wasn’t something you could solve with peanuts. Partners in Health also took Salem on a couple of home visits. At a one-room shack in Cange, a mother presented her 3-year-old daughter, saying she had gained 11 pounds on a regimen of Nourimanba. But the mother complained that there was no help for other serious problems she faced, like the fact that she had no job and the tin roof of her shack leaked.
Out in the hills, down a muddy path shaded by coconut palms, the health workers checked in on a small wooden farmhouse. Two children living there were on a regimen of ready-to-use food — and six were receiving nothing. The older ones watched as their little sister wolfed down an entire cup of peanut paste for the benefit of the visitors. The children’s grandmother, who was looking after them, was asked why malnutrition had been diagnosed in these two and the others not. She said she couldn’t really say, except that there simply wasn’t enough food to go around. There was no foil-wrapped answer to the maddening persistence of poverty. All that existed was a determination to meet the challenge with all the fallible tools of human ingenuity.
“We’re trying to put ourselves out of business,” said Salem, still brimming with optimism, after the trip. “That would be the best-case scenario.”
Andrew Rice is a contributing writer and author of “The Teeth May Smile but the Heart Does Not Forget,” about a Ugandan murder trial.
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