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Recession Affects All

2010-11-07T20:47:00.000-08:00

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.

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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

Lung cancer pill shrinks some tumors

2010-10-27T19:44:00.000-07:00

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.

Could Losing Weight Ease Your Arthritis Pain?

2010-10-13T10:31:00.000-07:00

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.”

Gene Predicts Breast Cancer Treatment Success

2010-10-13T07:39:00.000-07:00

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.

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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.”

Diabetic information

2010-10-11T11:06:00.000-07:00

- 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.

Health Care’s Lost Weekend

2010-10-05T08:49:00.000-07:00

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.

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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.

New Genetic Clues for ADHD

2010-09-30T07:33:00.000-07:00

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.

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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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Clinton Says Give Democrats More Time

2010-09-23T12:08:00.000-07:00

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."

Stem Cell Research: Science, Not Politics

2010-09-22T08:53:00.000-07:00

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.

What Diabetes Can Do to Your Body

2010-09-20T07:52:00.000-07:00

This content is selected and controlled by WebMD's editorial staff and is funded by Pfizer.
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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

2010-09-20T07:46:00.000-07:00

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

Six Tricky Relationships Talks You Must Have

2010-09-19T20:45:00.000-07:00

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.

GETJAR - Get Apps

2010-09-12T08:45:00.000-07:00

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

The Gramateller ATM - Time Magazine

2010-09-12T08:34:00.000-07:00

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

NEURONETICS

2010-09-12T08:28:00.000-07:00

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

Health Plan Won’t Fuel Big Spending, Report Says

2010-09-10T07:04:00.000-07:00

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.”

Topical Gel Catches Up With Pills for Relief

2010-09-10T06:59:00.000-07:00

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.

Stress Hormone Predicts Heart Death

2010-09-10T05:39:00.000-07:00

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

The Peanut Solution

2010-09-03T11:20:00.000-07:00

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.

NYT :Years Later, No Magic Bullet Against Alzheimer’s Disease

2010-08-30T11:09:00.000-07:00

Years Later, No Magic Bullet Against Alzheimer’s Disease
By GINA KOLATA
Published: August 28, 2010

BETHESDA, Md. — The scene was a kind of science court. On trial was the question “Can anything — running on a treadmill, eating more spinach, learning Arabic — prevent Alzheimer’s disease or delay its progression?”

Elise Schoux has been more careful to exercise regularly and eat right as preventive measures since her husband, Bill, learned last year that he has Alzheimer’s. She figures it can’t hurt. “I don’t know what the answers are,” Mrs. Schoux said.

The Vanishing Mind
Analyzing the Research

Articles in this series are examining the worldwide struggle to find answers about Alzheimer’s disease.

Previous Articles in the Series »
Multimedia
Graphic
Mixed Evidence
Related
Health Guide: Alzheimer's DiseaseTo try to answer that question, the National Institutes of Health sponsored the court, appointing a jury of 15 medical scientists with no vested interests in Alzheimer’s research. They would hear the evidence and reach a judgment on what the data showed.

For a day and a half last spring, researchers presented their cases, describing studies and explaining what they had hoped to show. The jury also heard from scientists from Duke University who had been commissioned to look at the body of evidence — hundreds of research papers — and weigh it. And the jury members had read the papers themselves, preparing for this day.

The studies included research on nearly everything proposed to prevent the disease: exercise, mental stimulation, healthy diet, social engagement, nutritional supplements, anti-inflammatory drugs or those that lower cholesterol or blood pressure, even the idea that people who marry or stay trim might be saved from dementia. And they included research on traits that might hasten Alzheimer’s onset, like not having much of an education or being a loner.

It is an issue that has taken on intense importance because scientists recently reported compelling evidence that two types of tests, PET scans of Alzheimer’s plaque in the brain and tests of spinal fluid, can find signs of the disease years before people have symptoms. That gives rise to the question: What, if anything, can people do to prevent it?

But the jury’s verdict was depressing and distressing. So far, nothing has been found to prevent or delay this devastating disease, which ceaselessly kills brain cells, eventually leaving people mute, incontinent, unable to feed themselves, unaware of who they are or who their family and friends are.

“Currently,” the panel wrote, “no evidence of even moderate scientific quality exists to support the association of any modifiable factor (such as nutritional supplements, herbal preparations, dietary factors, prescription or nonprescription drugs, social or economic factors, medical conditions, toxins or environmental exposures) with reduced risk of Alzheimer’s disease.”

“I was surprised and, at the same time, very sad” about the lack of evidence, said Dr. Martha L. Daviglus, the panel chairwoman and a professor of preventive medicine and medicine at the Feinberg School of Medicine at Northwestern University. “This is something that could happen to any of us, and yet we are at such a primitive state of research.”

She said, “In the end, we concluded that the evidence is the evidence and we have to say what it is.”

The state of the evidence reflects in part the long time it took before researchers even realized that Alzheimer’s was a disease, said Dr. Richard J. Hodes, director of the National Institute on Aging. Until the mid-1980s, many thought dementia was a normal part of aging, and so serious studies of its causes and prevention did not really begin until then. Scientists have spent the years since searching for factors that might affect risk, checking data from other studies to see if, for example, diet or blood pressure or years of education might be associated with the disease.

In the meantime, doctors are in a bind. Should they tell people to do things like walk briskly or eat vegetables — activities that might someday be shown to protect against Alzheimer’s and that certainly cannot hurt? Or should they wait for absolute proof, confirmation that a diet or a drug or an exercise regimen prevents Alzheimer’s?

The Alzheimer’s Association tells people to exercise, challenge themselves mentally, remain socially engaged and keep their hearts healthy. Such measures can only help, says Dr. Maria C. Carrillo, a senior director of the organization.

But, she said, “The Alzheimer’s Association certainly agrees that there is not enough evidence to say anything definitive about the prevention of Alzheimer’s disease and any kind of intervention.”

Of course, Dr. Hodes said, there are many reasons to follow practices to improve general health. But, he said, researchers have to be careful about implying that any measures will protect against this degenerative brain disease.

“We don’t know that yet,” Dr. Hodes said.

Rating the Quality

Dr. John W. Williams Jr., head of the Duke group that evaluated the studies, thought the task would not be too arduous. He expected relatively few studies and clear results.

To its great surprise, the Duke group discovered a vast amount of literature on Alzheimer’s prevention. Instead of coming up empty on many topics, Dr. Williams said, “We came up empty on very few.”

The problem, the group wrote, was that “the quality of the evidence was typically low.”

Most studies observed people who happened to use or not use a possible preventive measure and then determined whether they got Alzheimer’s or not.

Such studies, known as observational ones, are not the gold standard, like those in which people are randomly assigned to take a pill or do something like exercise, or not. Observational studies are useful in generating hypotheses but are not proof. Still, if several well-done studies of this type come to the same conclusion, they can be valuable evidence.

In the case of Alzheimer’s prevention, though, the studies tended to have problems, Dr. Williams said.

Often it was not clear precisely what subjects were doing. They might have been using a drug or a supplement at the start of the study but the dose was not specified, nor was it clear whether subjects were taking the same doses, or for how long.

Some studies of drugs to lower blood pressure used self-reports as opposed to, for example, pharmacy data. A 12-year study asked participants about their use of cholesterol-lowering statins at the start of the study but never did again. A nine-year statin study used pharmacy records but included as users those who took the drugs at any time during the study period.

Definitions of conditions, like high blood pressure, tended to vary from study to study.

Descriptions of factors like “strong social support” were vague or idiosyncratic. For example, some studies classified married people as having strong social support for that reason alone, with no evaluation of whether the marriage was good or bad.

Often, there were vague assessments of Alzheimer’s disease. And often studies did not take into account other differences among subjects, like age or family history of Alzheimer’s, that might have independently led some to get the disease and others not.

Looking over the piles of studies, the group rated evidence as high, moderate or low, depending on how confident they were in the findings.

Low confidence did not necessarily mean the measures did not work — it meant the evidence was so faulty that there was no way of deciding.

In the end, it said it was highly confident in the findings for just one thing, the herb ginkgo biloba. But in that case the evidence pointed in only one direction: it did not prevent Alzheimer’s.

Moderate evidence, not totally convincing but not worthless, applied to only four factors studied.

Two were factors that increased risk. They were a particular gene, ApoE4, which, moderate evidence showed, increased risk about threefold, and menopause therapy with a combination of estrogens and progestins, which doubled risk.

The other moderate evidence indicated that certain things that had been hoped to be protective were not. For instance, there was moderate evidence that vitamin E, found in nuts, vegetable oils, green leafy vegetables and fortified cereals, had no effect on risk. There was also moderate evidence that cholinesterase inhibitors, drugs often used to treat Alzheimer’s symptoms, had no effect.

Other than that, evidence was poor.

There is only poor evidence, for example, that keeping your brain active, having a high level of education or exercising has a protective effect. There is also only poor evidence that eating a Mediterranean diet — high in fruits and vegetables, fish and olive oil — will help stave off Alzheimer’s.

There is only poor evidence that having poor social support or smoking increases risk.

In a way, it is not surprising that many thought the evidence was stronger than it was, says Dr. James R. Burke, a member of the Duke group and director of the Memory Disorders Clinic at Duke.

“You remember the positive studies,” Dr. Burke said. “The ones that are more marginal, you tend to put them out of your mind.”

And many things thought to protect against Alzheimer’s — a healthy diet, vigorous exercise and an active brain — just seem to be common sense. The science jury said it was still possible that those measures might be found to help and urged that better quality studies be done.

But that may not be so easy if studies have to follow people until they get the disease. Alzheimer’s seems to progress silently in the brain for a decade before the earliest symptoms of memory problems surface. It can take another decade until the distinctive signs of Alzheimer’s appear: profound memory loss and an inability to handle the normal activities of daily life like bathing and dressing.

“Once there is even minimal cognitive impairment, the brain is damaged, inflamed, burning like a bonfire,” said Dr. Caleb Finch, director of the Gerontology Research Institute at the University of Southern California.

As a result, high-quality studies of possible factors like diet and exercise or mental stimulation before the disease’s onset might have to last for decades.

In the meantime, patients, like those at Dr. Burke’s Memory Disorders Clinic, and their frightened family members want advice about things they can do now.

He tells them to do all they can to stay healthy: keep their heart disease risk factors under control, eat a good diet, exercise. He tells them that even if good health cannot prevent Alzheimer’s, it might delay its onset.

“We don’t have compelling evidence or proof that this will prevent Alzheimer’s disease,” he says. But those measures, he adds, “would improve quality of life.”

But Dr. Williams, head of the Duke group, said it was also important to keep an open mind; the measures may or may not affect a person’s chances of getting Alzheimer’s.

“Unfortunately, in medicine,” he said, “things that are logical and make good sense don’t necessarily work out.”

The Problem, Personified

Elise Schoux of Washington is facing the prevention problem. She is 53, an age when prevention might make sense — when Alzheimer’s strikes, people usually are in their 70s and 80s — and she is watching her 70-year-old husband’s slow decline into the dread disease.

Bill Schoux’s memory had been deteriorating for years, but in July 2009, when he got the diagnosis, Mrs. Schoux was devastated.

“For two weeks, we were at a loss, we would burst into tears,” she said. “How could this be?”

Mr. Schoux had been an athlete all his life, he ate a healthy diet, he was friendly and outgoing. He had been an expert on foreign aid, traveling around the world, and had certainly had a mentally stimulating career. Mrs. Schoux is not sure how much more her husband could have done to ward off Alzheimer’s. But she wants to do everything she can to protect herself from getting it and to slow the disease in him.

So Mrs. Schoux now unfailingly goes to the gym with her husband several days a week, lifting weights and spending 30 minutes on a treadmill or an elliptical cross trainer.

Her husband always worked crossword puzzles. Now she does them, too. She and her husband have a subscription to a local theater. And they read the newspaper every day.

“It can’t hurt to keep the brain cells moving,” Mrs. Schoux said.

Mrs. Schoux also tries to eat blueberries, salmon, intensely colored fruits and dark leafy vegetables, in case that helps.

She knows that much of what she is trying is unproved but feels that it can, at worst, be harmless.

“I don’t know what the answers are,” Mrs. Schoux said. “I hope they find something. It is a seriously debilitating disease.”

Bargains are out there

2010-08-09T18:34:00.000-07:00

BY KIMBERLY MILLER
Palm Beach Post

Thousands of South Florida homes can be picked up for about the same cost as a new Ford Mustang GT500 as the real estate crash continues to put the brakes on pricing.

A report released Friday by the Miami-based real estate and consultant firm Condo Vultures found 5,400 townhouses and condominiums, and 600 single-family homes in Broward, Miami-Dade and Palm Beach counties have list prices of $50,000 or less.

Peter Zalewski, a principal with Condo Vultures, said he compiled the data from the Multiple Listing Service because he had several clients who didn't want to spend more than $50,000 on investment properties.

Although a close observer of the South Florida market, Zalewski said he was surprised at the number of bargain-basement listings.

At the peak of the real estate boom, Zalewski said he paid $25,000 for a parking space at his condominium, which ``wasn't even a very good space,'' he said.

``Today, with that same money, I could theoretically go out and buy a property,'' he said. ``It's really reflective of how this market has changed so dramatically.''

Broward County had the most properties available under $50,000 with 2,400 listings. Palm Beach County was the runner-up, listing 2,100 cut-rate properties.

Zalewski acknowledged that some of the homes are in senior communities and that the majority are distressed properties -- either bank-owned or short sales.

Many are condos that have been abandoned by investors who paid sky-high prices during the boom.

At the Palm Beach Grande in suburban West Palm Beach west of the Turnpike, units were bought for up to $180,000 when the former apartment complex went condo conversion in 2006.

A one-bedroom unit purchased in April went for $24,900.

According to Condo Vultures, Palm Beach County has 21 single-family homes, and 437 condos currently listed with sales prices between $20,000 and $29,999.

``Before, you thought under $100,000 was a great value, now you have all these opportunities for under $50,000,'' Zalewski said.

Nancy Jennings, broker at Keller Williams Wellington, said her agents are busy with customers looking for those kinds of deals.

``I had a call this morning from a buyer in Ohio who wants to find something in the $30,000 to $35,000 range,'' Jennings said. ``We'll find him something for sure.''

Zalewski cautioned that some of the cheap listings are banks offering teaser prices on short sales.

Still, he found that about 7,000 South Florida residences have been bought since the beginning of the year for $50,000 or less.

Read more: http://www.miamiherald.com/2010/08/07/1765386/bargains-are-out-there.html#ixzz0wA9C3ksw

Wikipedia - Mango

2010-08-03T17:26:00.000-07:00

Mango
From Wikipedia, the free encyclopediaJump to: navigation, search
This article is about the fruit. For other meanings of the word, see Mango (disambiguation).
Mango

Australian Mango with its cross section
Scientific classification
Kingdom: Plantae

Division: Angiospermae

Class: Magnoliopsida

Order: Sapindales

Family: Anacardiaceae

Genus: Mangifera

Species: M.indica

Binomial name
Mangifera indica
L.

Ripe Banganpalli mangoes from Guntur, India.Mango is a fruit indigenous to the Indian subcontinent,[1] that belongs to the genus Mangifera, consisting of numerous species of tropical fruiting trees in the flowering plant family Anacardiaceae, of which Mangifera indica, or the common mango, is commonly cultivated and used for food. The mango is cultivated in many tropical and subtropical regions and distributed widely in the world, mango is one of the most extensively exploited fruits for food, juice, flavor, fragrance and color.

In several cultures, its fruit and leaves are ritually used as floral decorations at weddings, public celebrations and religious ceremonies.

Contents [hide]
1 Etymology
2 Description
3 Cultivation and uses
3.1 Potential for contact dermatitis
3.2 Food
3.2.1 Cuisine
3.3 Nutrients and phytochemicals
4 Cultural significance
5 Production and consumption
6 Cultivars
7 See also
8 Gallery
9 References
10 Further reading
11 External links

[edit] Etymology
The English word mango originated from the Tamil word "maangai" [2] and/or Malayalam word "māṅṅa" (Malayalam: മാങ്ങ), then via Portuguese as manga.[3] The word's first recorded attestation in a European language was a text by Ludovico di Varthema in Italian in 1510, as Manga; the first recorded occurrences in languages such as French and post-classical Latin appear to be translations from this Italian text.[4]

[edit] Description

Mango inflorescence and immature fruit
The seed of mango can be hairy or fibrousMango trees (Mangifera indica L.) grow 35–40 m (115–130 ft) tall, with a crown radius of 10 m (33 ft). The mango tree is long-lived; some specimens still fruit after 300 years. In deep soil the taproot descends to a depth of 6 m (20 ft) and the profuse, wide-spreading feeder roots also send down many anchor roots, which penetrate several feet of soil. The leaves are evergreen, alternate, simple, 15–35 cm (5.9–14 in) long and 6–16 cm (2.4–6.3 in) broad; when the leaves are young they are orange-pink, rapidly changing to a dark glossy red, then dark green as they mature. The flowers are produced in terminal panicles 10–40 cm (3.9–16 in) long; each flower is small and white with five petals 5–10 mm (0.20–0.39 in) long, with a mild sweet odor suggestive of lily of the valley. The fruit takes three to six months to ripen.

The ripe fruit is variable in size and color. Cultivars are variously yellow, orange, red or green and carry a single flat, oblong pit that can be fibrous or hairy on the surface. Ripe, unpeeled fruit gives off a distinctive resinous, sweet smell. Inside the pit 1–2 mm (0.039–0.079 in) thick is a thin lining covering a single seed, 4–7 mm (0.16–0.28 in) long, 3–4 cm (1.2–1.6 in) and 1 cm (0.4 in). The seed contains the plant embryo.

The "hedgehog" style is a common way of eating mangoes (left). A cross section of a mango can be seen on the right[edit] Cultivation and uses

Mango orchard in Multan, Pakistan
Unripe mangoes on a mango treeMangoes have been cultivated in the Indian subcontinent for thousands of years[5] and reached East Asia between the 5th-4th century BC. By the 10th century AD, cultivation had begun in East Africa[5], coming later to Brazil, West Indies and Mexico, where an appropriate climate allows its growth.[5] The 14th century Moroccan traveler, Ibn Battuta, reported it at Mogadishu.[6]

Mango is now cultivated in most frost-free tropical and warmer subtropical climates; nearly half of the world's mangoes are cultivated in India alone.[7][8][9] Mango is also being grown in Andalusia, Spain (mainly in Malaga province), which is one of the few places in mainland Europe that allow growth of tropical plants and fruit trees.[10] Many of the 1,000+ mango cultivars are easily cultivated using grafted saplings, ranging from the "turpentine mango" (named for its strong taste of turpentine, which according to the Oxford Companion to Food some varieties actually contain) to the huevos de toro ("eggs of the bull", a euphemism for "bull's testicles", referring to the shape and size).

Other cultivators include North, South and Central America, the Caribbean, south, west and central Africa, Australia, China, Pakistan, Bangladesh, and Southeast Asia. Though India is the largest producer of mangoes, it accounts for less than one percent of the international mango trade, consuming most of its own output.[11]

Dwarf or semi-dwarf varieties serve as ornamental plants and can be grown in containers.

A wide variety of diseases can afflict mangoes; see List of mango diseases.

[edit] Potential for contact dermatitis
Mango peel contains urushiol, the chemical in poison ivy and poison sumac that can cause urushiol-induced contact dermatitis in susceptible people.[12] Cross-reactions between mango contact allergens and urushiol have been observed.[13] Those with a history of poison ivy or poison oak may be most at risk for such an allergic reaction.[14] Urushiol is also present in mango leaves and vines. During mango's primary season, it is the most common source of plant dermatitis in Hawaii.[15]

[edit] Food
Mango is generally sweet, although the taste and texture of the flesh varies across cultivars, some having a soft, pulpy texture similar to an over-ripe plum, while the flesh of others is firmer, like a cantaloupe or avocado, or may have a fibrous texture. For consumption of unripe, pickled or cooked fruit, the mango skin may be consumed comfortably, but has potential to cause contact dermatitis (above) of the lips, gingiva or tongue in susceptible people. In ripe fruits which are commonly eaten fresh, the skin may be thicker and bitter tasting, so is typically not eaten.

[edit] Cuisine

Photo of commercially packaged mango powder sold in clear plastic wrappingMangoes are widely used in cuisine. Sour, unripe mangoes are used in chutneys, pickles, side dishes, or may be eaten raw with salt, chili, or soy sauce. A cooling summer drink called panna or panha comes from mangoes.

Ripe mangoes are typically eaten fresh, however, they can have many other culinary uses. Mango Lassi, a popular drink made throughout South Asia, is created by mixing ripe mangoes or mango pulp with yogurt and sugar. Ripe mangoes are also used to make curries. Aamras is a popular pulp/thick juice made of mangoes with sugar or milk and is consumed along with bread.

Mangoes are used in preserves like moramba, amchur (dried and powdered unripe mango) and pickles, including a spicy mustard-oil pickle. Ripe mangoes are often cut into thin layers, desiccated, folded, and then cut. These bars are similar to dried guava fruit bars available in some countries. The fruit is also added to cereal products like muesli and oat granola.

Native green mangoes from the Philippines
A basket of ripe mangoes from BangladeshUnripe mango may be eaten with bagoong (especially in the Philippines), fish sauce or with dash of salt. Dried strips of sweet, ripe mango (sometimes combined with seedless tamarind to form Mangorind) are also popular. Mangoes may be used to make juices, mango nectar, and as a flavoring and major ingredient in ice cream and sorbetes.

Mango is used to make juices, smoothies, ice cream, fruit bars, raspados, aguas frescas, pies and sweet chili sauce, or mixed with chamoy, a sweet and spicy chili paste. It is popular on a stick dipped in hot chili powder and salt or also as a main ingredient in fresh fruit combinations. In Central America, mango is either eaten green mixed with salt, vinegar, black pepper and hot sauce, or ripe in various forms. Toasted and ground pumpkin seed (called pepita) with lime and salt are the norm when eating green mangoes. Some people also add soy sauce or chili sauce.

Pieces of mango can be mashed and used as a topping on ice cream or blended with milk and ice as milkshakes. Sweet glutinous rice is flavored with coconut then served with sliced mango as a dessert. In other parts of South-east Asia, mangoes are pickled with fish sauce and rice vinegar. Green mangoes can be used in mango salad with fish sauce and dried shrimp. Mango may be used as a topping to shaved ice along with condensed milk.

[edit] Nutrients and phytochemicals
Mango, raw Nutritional value per 100 g (3.5 oz)
Energy 272 kJ (65 kcal)
Carbohydrates 17.00 g
Sugars 14.8 g
Dietary fiber 1.8 g
Fat 0.27 g
Protein .51 g
Vitamin A equiv. 38 μg (4%)
- beta-carotene 445 μg (4%)
Thiamine (Vit. B1) 0.058 mg (4%)
Riboflavin (Vit. B2) 0.057 mg (4%)
Niacin (Vit. B3) 0.584 mg (4%)
Pantothenic acid (B5) 0.160 mg (3%)
Vitamin B6 0.134 mg (10%)
Folate (Vit. B9) 14 μg (4%)
Vitamin C 27.7 mg (46%)
Calcium 10 mg (1%)
Iron 0.13 mg (1%)
Magnesium 9 mg (2%)
Phosphorus 11 mg (2%)
Potassium 156 mg (3%)
Zinc 0.04 mg (0%)
Percentages are relative to US recommendations for adults.
Source: USDA Nutrient database

Mango is rich in a variety of phytochemicals[16] and nutrients. The fruit pulp is high in prebiotic dietary fiber, vitamin C, polyphenols and provitamin A carotenoids.[17]

Mango contains essential vitamins and dietary minerals. The antioxidant vitamins A, C and E compose 25%, 76% and 9% of the Dietary Reference Intake (DRI) in a 165 grams (5.8 oz) serving. Vitamin B6 (pyridoxine, 11% DRI), vitamin K (9% DRI), other B vitamins and essential nutrients such as potassium, copper and 17 amino acids are at good levels. Mango peel and pulp contain other phytonutrients, such as the pigment antioxidants - carotenoids and polyphenols - and omega-3 and -6 polyunsaturated fatty acids.

Mango peel contains pigments that may have antioxidant properties,[16][18] including carotenoids, such as the provitamin A compound, beta-carotene, lutein and alpha-carotene,[19] polyphenols[20][21] such as quercetin, kaempferol, gallic acid, caffeic acid, catechins, tannins, and the unique mango xanthone, mangiferin,[22] any of which may counteract free radicals in various disease processes as revealed in preliminary research.[23][24] Phytochemical and nutrient content appears to vary across mango species.[25] Up to 25 different carotenoids have been isolated from mango pulp, the densest of which was beta-carotene, which accounts for the yellow-orange pigmentation of most mango species.[26] Peel and leaves also have significant polyphenol content, including xanthones, mangiferin and gallic acid.[27]

The mango triterpene, lupeol[28] is an effective inhibitor in laboratory models of prostate and skin cancers.[29][30][31] An extract of mango branch bark called Vimang, isolated by Cuban scientists, contains numerous polyphenols with antioxidant properties in vitro[32] and on blood parameters of elderly humans.[33]

The pigment euxanthin, known as Indian yellow, is often thought to be produced from the urine of cows fed mango leaves; the practice is described as having been outlawed in 1908 due to malnutrition of the cows and possible urushiol poisoning.[34] This supposed origin of euxanthin appears to rely on a single, anecdotal source and Indian legal records do not outlaw such a practice.[35]

[edit] Cultural significance

Mango roundabout, Rajshahi, BangladeshThe mango is the national fruit of India, Pakistan, and the Philippines.[citation needed]

In Hinduism, the perfectly ripe mango is often held by Lord Ganesha as a symbol of attainment, regarding the devotees potential perfection. Mango blossoms are also used in the worship of the goddess Saraswati.

Mango leaves are used to decorate archways and doors in Indian houses and during weddings and celebrations like Ganesh Chaturthi. Mango motifs and paisleys are widely used in different Indian embroidery styles and are found in Kashmiri shawls, Kanchipuram silk sarees, etc. Paisleys are also common to Iranian art, because of its pre-Islamic Zoroastrian past.

[edit] Production and consumption

Street vendor selling mangoes in VenezuelaMangoes account for approximately half of all tropical fruits produced worldwide. The Food and Agriculture Organization of the United Nations estimates worldwide production at more than 33,000,000 tonnes (32,000,000 LT; 36,000,000 ST) in 2007 (table below). The aggregate production of the top 10 countries is responsible for roughly 80% of production.

Alphonso, Beresha or Berisha (Banganapalli in Telugu and Tamil) and Kesar mango varieties are considered among the best mangoes in India's Southern states while Dussehri and Langda varieties are most popular in the Northern states.

Generally, ripe mangoes have an orange-yellow or reddish peel and are juicy for eating, while exported fruit are often picked while under-ripe with green peels. Although producing ethylene while ripening, unripened exported mangoes do not have the same juiciness or flavor as fresh fruit.

Like other drupaceous fruits, mangoes come in both freestone and clingstone varieties.

Top producers of mangoes, mangosteens, guavas, 2007 Country Production in Tons
India 13,501,000
People's Republic of China 3,752,000
Mexico 2,050,000
Thailand 1,800,000
Pakistan 1,719,180
Indonesia 1,620,000
Brazil 1,546,000
World total 33,445,279
Source

Food And Agricultural Organization of United Nations: Economic And Social Department: The Statistical Division

[edit] Cultivars
Main article: List of mango cultivars

Alphonso mangoes (local name: Hapoos) are grown mainly in Devgad, Sindhudurg and Ratnagiri districts of Maharashtra, India and favored there, are now popular in the United States.[36][37]Many hundreds of named mango cultivars exist. In mango orchards, several cultivars are often crossed to improve pollination. Many desired cultivars are mono-embryonic and must be propagated by grafting or they do not breed true. A common (mono-embryonic) cultivar is Alphonso, an important export product.

Cultivars that excel in one climate may fail elsewhere. For example, Indian cultivars such as Julie, a prolific cultivar in Jamaica, require annual fungicide treatment to escape a lethal fungal disease known as Anthracnose in Florida. Asian mangoes are resistant to Anthracnose.

The current world market is dominated by the cultivar Tommy Atkins, a seedling of Haden that first fruited in 1940 in southern Florida, USA. It was initially rejected commercially by Florida researchers[38]. For example, 80% of mangoes in UK supermarkets are Tommy Atkins. Despite its fibrous flesh and fair taste, growers worldwide have embraced the cultivar for its exceptional productivity and disease resistance, shelf-life, transportability and size and appealing color. Tommy Atkins is predominant in the USA as well, although other cultivars, such Kent, Keitt, the Haitian-grown Madame Francis and the Mexican grown Champagne are widely available.

In urban areas of southern Florida, small gardens, or lack thereof, have fueled the desire for dwarf mango trees. The Fairchild Tropical Botanic Garden has promoted "condo mangoes," Fairchild, which produce at a height below 2–2.5 m (6.6–8.2 ft)[citation needed]

Condo Mango is a term that became popular some years ago in Florida USA and the word "Condo" is derived from the word condominium because a Condo Mango Tree, being dwarfed and small in size was suitable for container growing in condominiums. Essentially, "Condo" means a smaller variety of tree that is dwarf or semi-dwarf in nature e.g. Ice Cream or grafted to achieve a dwarfing characteristic, that can be maintained to a certain size with careful foliage pruning and root pruning if necessary. While condo has been generally associated with mango trees it can be applied to any fruit tree that is a natural dwarf or has been dwarfed similar to the Bonsai technique. As such the words "Condo" and "Dwarf" are interchangeable.

There is an Australian variety of mango known as R2E2, a name based on the original plant's orchard row location. This variety produces large (up to 1 kilograms (2 lb))yellow-red fruit that attracts a premium price in the Australian market.

Comments

I love mangos. A couple weeks ago I had a hundred growing on my two large trees. Out of all of them I get maybe 10%, due to squirrels, mice, a raccoon, and some birds usually beating me to them. I have seen a squirrel climb down a branch with a mango at the end, and begin eating it facing straight down toward the ground.

Woman condemned to be stoned to death for adultery

2010-08-03T08:19:00.000-07:00

UPDATE: A glimmer of hope for Ashtiani comes from Brazilian president Luiz Inácio Lula da Silva with an offer of asylum in his country for the condemned woman.

Ashtiani son's Sajad is hopeful with the country's unexpected offer. "No countries in the world can have such impacts that Brazil and Turkey can have on Iran now. These two countries can save my mother's life," said Sajad.

When making his announcement at a rally in southern Brazil Lulu added, "I find myself imagining what would happen if one day there was a country in the world that would stone a man because he was cheating. Nothing justifies the state taking someone's life. Only God gives life and only He should take it away."

It is unclear at this time what Iran will do with this offer, but Ahadi of the Iran Committee against Stoning says the move "will change the way Iran sees Sakineh's (Ashtiani's) case," and has urged the country to use its influence to lobby for the release of at least 12 other women awaiting execution by stoning.

* * * * *

Like the international community, over at Care2 we have been following the tragic story of Sakineh Mohammadi Ashtiani, a mother of two sentenced to death by stoning in Iran for allegedly committing adultery – very closely.

It wasn't long ago that our very own Judy Molland delivered some bright news in the case – Ashtiani had been rescued from her stoning sentence – but since then Iran's judiciary has changed her sentence to execution by hanging because they now say she committed murder.

Documents detailing the stoning sentence, however, make it clear that Ashitani was convicted of adultery – a crime she only admitted to after receiving 99 lashes, a crime she later retracted completely.

New details, however, reveal that after the lashings her case was reopened when a court in Tabriz suspected her of murdering her husband. She was acquitted of murder by the court soon after and the adultery charges were reinstated. After review the death penalty sentence was handed down for adultery – not murder.

So why are the murder charges coming up again?

Mina Ahadi, of the Iran Committee against Stoning (ICAS), has the following insight: "In adultery cases, women are sentenced because of the complaints from their husbands or families generally, but surprisingly, Sakineh (Ashtiani) is sentenced to death by stoning not because the family of her husband have made a complaint against her, but because the Tabriz prosecutor has made a complaint. In other words, it's the authorities in Iran who want Sakineh (Ashtiani) to be stoned to death.”

Or as the case is now execution by hanging.

How the judiciary is able to change Ashtiani's conviction after all this time with no evidence is beyond me. It seems clear that as Ahadi says the authorities are the ones who want to punish Ashtiani – and will do so in with whatever means they can. In addition to the lashings she already received, recent reports from Ashtiani's cellmate reveal that she has been tortured and severely beaten by several guards while in prison too.

As if this case couldn't get any worse, Human rights attorney Mohammed Mostafaei, who up until recently represented Ashtiani, is believed to be in hiding now from officials as a warrant has been issued for his arrest.

His crime? Making Ashtiani's incredibly unjust case too public. In fact, given the great international attention that the case has received local media have been banned from reporting on the case.

Mostafaei's wife and brother-in-law have been arrested in his absence and have been told that they will not be released until Mostafaei presents himself.

"Other attorneys have been arrested similarly when they have tried to advocate for certain people," said Ahadi. "This is something the government of Iran has tried over and over again -- to hush, using fear and intimidation tactics and also imprisoning anyone that they feel is threatening."

Only time will tell what will happen to both Ashtiani and Mostafaei and his family but it is certain that the international community at large will be watching and waiting for justice

Edujobs bill lives again

2010-08-03T08:11:00.000-07:00

The emergency funding bill known as "Edujobs" has more lives than a cat. Put to rest again last week, Edujobs has found new life in a bill that would also provide $16 billion in desperately needed Medicaid funding for states.

The Obstacles to Edujobs
The key sticking points in Edujobs has always been the price tag and the offsets. Republicans balked at the $10 billion the bill asks for, citing the need for belt-tightening during an endless recession that now seems poised for a double dip. The White House turned up its nose at the idea that funding to restore teaching positions should come out of its pet reform projects, like Race to the Top.

Cutting the Budget to Find Funding
In this most recent incarnation, edujobs is tied to the idea of Medicaid funding the states' need in order to avoid another round of budget cuts. It also borrows funding from education programs that are not so near and dear to the Department of Education: the Striving Readers program, which promotes adolescent literacy and the Ready to Teach program, which provides funding for telecommunications programs for teachers and also cuts $82 for student financial aid administration.

Uncertainty
Even though the bill is likely to be supported by Democrats, it's not a sure thing. Passage would simply send it back to the House, which is in recess until mid-September.

In most states, school will have been in session for at least a month before the bill could pass the House, and the states could only then begin to apply for funding to restore lost teaching positions. While teachers might be glad of a job whenever they are hired back, the damage to students will have already occurred and won't be easily rectified.

Both parties talk long and loud about the importance of education, and their commitment to the youngest of our citizens, but their actions are still falling short.

Let Us Know What You Think
But that's just my opinion, what's yours? Is Congress doing everything it can for American students? What's the situation in your community?

Read more: education, teacher layoffs, edujobs bill, congress doesnt pass edujobs, race to top, medicaid bill to include edujobs, edujobs finds new life in senate bill

comments15 comments add your comment
Dianne D. says
Aug 3, 2010 8:00 AM
In my community, only about 34% of the money allocated for education actually makes it to the classrooms. The rest gets tied up in the administrative offices. There is something desperately wrong there.

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Carol B. says
Aug 3, 2010 7:56 AM
Jobs, but educating people whether children or adults is more than a job. It takes 24/7 attention to the work, it means no real holidays (always thinking how to do something that will work better, be more fun, enhance the program) and we need all our teachers and then some, to educate our people well. The "classroom teachers" are the ones in front, but everyone is an educator just by being there- teaching someone something by the way we live.

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Ann G. says
Aug 3, 2010 7:41 AM
Without health and education an individual will be struggling all his/her life unless incredibly lucky. Multiply this exponentially and the same goes for a country. United States has the worst health care "system" in the developed world and one of the worst, if not the worst, public education systems. That along with the greed of Wall Street is driving the USA down. When are these right wingers going to wake up and realize what they are doing to your country. What a shame!!!!!!!

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Edward M. says
Aug 3, 2010 6:43 AM
Has anyone with a modicum of intelligence considered that the funding for most of your projects could be found by cutting the "defence" budget, say by half.
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Alexandra R. says
Aug 3, 2010 6:33 AM
Education and health care are most important. The human and economic loss to a country is incalculable if these are deficient.

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Therese J. says
Aug 3, 2010 6:04 AM
To quote your article, "Republicans balked at the $10 billion the bill asks for, citing the need for belt-tightening during an endless recession..." Education should be a TOP priority, receiving the funding needed to educate our future wage-earners. Instead, Republicans have focused on having tax cuts for the wealthy continued, when, by their own planning 10 years ago, the cuts are set to expire this January. Now they blame the Democrats-- --for everything that has gone wrong, including the recession!

Congress needs to get its priorities right and focus on educating our students NOW so we'll have responsible, effective, thoughtful, adults in years to come.

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Jo B. says
Aug 3, 2010 5:39 AM
One word: Education. Without good education a country is nothing.
Interesting article.thank you for sharing x

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nobo dy says
Aug 3, 2010 1:16 AM
thanks

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Kaye Skinner says
Aug 2, 2010 11:25 PM
Prayers going up.

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Chien Chao says
Aug 2, 2010 7:20 PM
education is the root of a country

12 Foods With Super-Healing Powers

2010-08-01T10:27:00.000-07:00

posted by Mel, selected from Caring.com Apr 16, 2010 5:01 pm

filed under: Diet & Nutrition, Eating for Health, Elder Care, Food & Recipes, Health & Wellness
<1 of 12>

By Nikki Jong, Caring.com

As part of a healthy diet, whole foods play a significant role in helping our bodies function optimally. There are hundreds of extremely nutritious whole foods, but the dozen on this list do more than contribute healthy nutrients — they help you heal. In fact, every food on this list boasts multiple healing effects, from fighting cancer to reducing cholesterol, guarding against heart disease, and more. Eat these super-healing picks and start feeling pretty super yourself.

1. Cherries
Cherries boast a laundry list of healing powers. For starters, they pack a powerful nutritional punch for a relatively low calorie count. They’re also packed with substances that help fight inflammation and cancer. As if that weren’t enough, in lab studies, quercetin and ellagic acid, two compounds contained in cherries, have been shown to inhibit the growth of tumors and even cause cancer cells to commit suicide — without damaging healthy cells. Cherries also have antiviral and antibacterial properties.

Anthocyanin, another compound in cherries, is credited with lowering the uric acid levels in the blood, thereby reducing a common cause of gout. Researchers believe anthocyanins may also reduce your risk of colon cancer. Further, these compounds work like a natural form of ibuprofen, reducing inflammation and curbing pain. Regular consumption may help lower risk of heart attack and stroke.

In Chinese medicine, cherries are routinely used as a remedy for gout, arthritis, and rheumatism (as well as anemia, due to their high iron content). Plus they’re delicious.

How much:
Aim for a daily serving while they’re in season locally. And keep a bag of frozen cherries in your freezer the rest of the year; frozen cherries retain 100 percent of their nutritional value and make a great addition to smoothies, yogurt, and oatmeal.

Tip:
Buy organic, since conventionally grown cherries can be high in pesticides.

<2 of 12>2. Guavas
Guavas are a small tropical fruit that can be round, oval, or pear-shaped. They’re not all that common, so they might be hard to find, depending on where you live. But if you can track them down, it’s more than worth it. Guavas contain more of the cancer-fighting antioxidant lycopene than any other fruit or vegetable, and nearly 20 percent more than tomatoes. Our bodies can’t process much of the lycopene in tomatoes until they’re cooked; the processing helps break down tough cell walls. However, guavas’ cell structure allows the antioxidant to be absorbed whether the fruit is raw or cooked, and the whole fruit offers the nutrition without the added sodium of processed tomato products.

Lycopene protects our healthy cells from free radicals that can cause all kinds of damage, including blocked arteries, joint degeneration, nervous system problems, and even cancer. Lycopene consumption is associated with significantly lower rates of prostate cancer; in addition, men with prostate tumors who consumed lycopene supplements showed significant improvements, such as smaller tumors and decreased malignancy. Lycopene has also been found to inhibit the growth of breast cancer cells, and research suggests that this antioxidant may also help protect against coronary heart disease.

This strange-looking little fruit is also packed with vitamin C and other antioxidants. Serving for serving, guava offers more than 60 percent more potassium than a banana, which can help protect against heart disease and stroke. In fact, the nutrients found in guavas have been shown to lower LDL and boost HDL cholesterol, reduce triglycerides, and lower blood pressure.

How much:
Aim to eat fresh guavas as often as you can when you can find them in stores. They’re not commonly available in the freezer section; and most guava juices are processed and sweetened, so they don’t provide the same superior nutrition that the whole, fresh fruit does. One to two guavas a day is a good goal.

Tip:
Opt for the red-fleshed variety if you can; both are loaded with antioxidants, but the red type has more than the white-fleshed apple guava.

3. Beans
Beans are a miracle food. They lower cholesterol, regulate blood sugar and insulin production, promote digestive health, and protect against cancer. If you think of fiber, protein, and antioxidants and immediately think whole grains, meat, and fruit, think again — beans offer all three in a single package.

An assortment of phytochemicals found in beans has been shown to protect cells from cancerous activity by inhibiting cancer cells from reproducing, slowing tumor growth. Researchers at the Harvard School of Public Health reported that women who consumed beans at least twice a week were 24 percent less likely to develop breast cancer, and multiple studies have tied beans to a reduced risk of heart disease, type 2 diabetes, high blood pressure, and breast and colon cancers.

Beans deliver a whopping amount of antioxidants, which help prevent and fight oxidative damage. In fact, the USDA’s ranking of foods by antioxidant capacity places three varieties of beans (red beans, red kidney beans, and pinto beans) in the top four — and that’s among all food groups. Beans are a great source of dietary fiber, protein, and iron. They also contain the amino acid tryptophan; foods with high amounts of tryptophan can help regulate your appetite, aid in sleep, and improve your mood. Many are also rich in folate, which plays a significant role in heart health. And depending on the type of bean you choose, you’ll also get decent amounts of potassium, magnesium, vitamin B1 and B2, and vitamin K. Soybeans are a great source of omega-3 fatty acids.

In Chinese medicine, various types of beans have been used to treat alcoholism, food poisoning, edema (particularly in the legs), high blood pressure, diarrhea, laryngitis, kidney stones, rheumatism, and dozens of other conditions.

How much:
Aim for a minimum of two servings of beans per week.

Tip:
Adzuki and mung beans are among the most easily digested; pinto, kidney, navy, garbanzo, lima, and black beans are more difficult to digest.

4. Kiwifruit
This tiny, nutrient-dense fruit packs an amazing amount of vitamin C (double the amount found in oranges), has more fiber than apples, and beats bananas as a high-potassium food. The unique blend of phytonutrients, vitamins, and minerals found in kiwifruit helps protect against heart disease, stroke, cancer, and respiratory disease. Kiwifruit’s natural blood-thinning properties work without the side effects of aspirin and support vascular health by reducing the formation of spontaneous blood clots, lowering LDL cholesterol, and reducing blood pressure. Multiple studies have shown that kiwifruit not only reduces oxidative stress and damage to DNA but also prompts damaged cells to repair themselves.

Kiwifruit is often prescribed as part of a dietary regimen to battle cancer and heart disease, and in Chinese medicine it’s used to accelerate the healing of wounds and sores.

How much:
Aim to eat one to two kiwifruit a day while they’re in season, for the best taste and nutrition. California-grown kiwifruit are in season from October through May, and New Zealand kiwifruit are available between April and November.

Tips:
Kiwifruit contains enzymes that activate once you cut the fruit, causing the flesh to tenderize. So if you’re making a fruit salad, cut the kiwifruit last.
The riper the kiwifruit, the greater the antioxidant power, so let them ripen before you dig in.

5. Watercress
Not only is watercress extremely nutritious, it’s about as close as you can get to a calorie-free food. Calorie for calorie, it provides four times the calcium of 2 percent milk. Ounce for ounce, it offers as much vitamin C as an orange and more iron than spinach. It’s packed with vitamin A and has lots of vitamin K, along with multiple antioxidant carotenoids and protective phytochemicals.

The nutrients in watercress protect against cancer and macular degeneration, help build the immune system, and support bone health. The iron helps red blood cells carry oxygen to your body’s tissues for energy. The phytochemicals in watercress battle cancer in three ways: killing cancer cells, blocking carcinogens, and protecting healthy cells from carcinogens. They’ve also been shown to help prevent lung and esophageal cancer and can help lower your risk for other cancers.

In Chinese medicine, watercress is thought to help reduce tumors, improve night vision, and stimulate bile production (improving digestion and settling intestinal gas). It’s used as a remedy for jaundice, urinary difficulty, sore throat, mumps, and bad breath.

How much:
Eat watercress daily if you can. In some regions, it’s more widely available during the spring and summer, when it’s cultivated outdoors. But since it can also be grown hydroponically in greenhouses, you can find it year-round in many grocery stores and at your local farmer’s market.

Tip:
You can cook it, but watercress is better for you when you eat it raw. Tuck it into a sandwich in place of lettuce.
Toss it with your favorite vegetables and eat it in a salad.
Watercress is great in pesto — just replace the basil with watercress — and soups.
Use watercress as a wonderfully detoxifying ingredient in a juice or smoothie.

6. Spinach
You already knew spinach was good for you, but did you know just how good? Spinach protects against eye disease and vision loss; it’s good for brain function; it guards against colon, prostate, and breast cancers; it protects against heart disease, stroke, and dementia; it lowers blood pressure; it’s anti-inflammatory; and it’s great for bone health. Spinach has an amazing array of nutrients, including high amounts of vitamin K, calcium, vitamin A, vitamin C, folate, magnesium, and iron.

A carotenoid found in spinach not only kills prostate cancer cells, it also prevents them from multiplying. Folate promotes vascular health by lowering homocysteine, an amino acid that, at high levels, raises the risk of dementia and cardiovascular disease, including heart disease and stroke. Folate has also been shown to reduce the risk of developing colorectal, ovarian, and breast cancers and to help stop uncontrolled cell growth, one of the primary characteristics of all cancers. The vitamin C and beta-carotene in spinach protect against colon cancer in addition to fighting inflammation, making them key components of brain health, particularly in older adults.

Spinach is loaded with vitamin K (one cup of cooked spinach provides 1,111 percent of the recommended daily amount!), which builds strong bones by helping calcium adhere to the bone. Spinach is also rich in lutein, which protects against age-related macular degeneration, and it may help prevent heart attacks by keeping artery walls clear of cholesterol buildup.

How much:
Fresh spinach should be a daily staple in your diet. It’s available in practically every grocery store, no matter where you live, it’s easy to find year-round, and you’d be hard pressed to find a more nutritionally sound, versatile green. So do yourself a healthy favor and aim for a few ounces, raw or lightly steamed, every day.

Tips:
Add a handful of fresh spinach to your next fruit smoothie. It’ll change the color but not the taste.
Conventionally grown spinach is susceptible to pesticide residue; stick to organic.

7. Onions
Onions get a bad rap for their effect on the breath, but that’s not the only part of the body where they pack a wallop. Onions contain potent cancer-fighting enzymes; onion consumption has been shown to help lower the risk of prostate and esophageal cancers and has also been linked to reduced mortality from coronary heart disease. Research suggests that they may help protect against stomach cancer. Onions contain sulfides that help lower blood pressure and cholesterol, as well as a peptide that may help prevent bone loss by inhibiting the loss of calcium and other bone minerals.

Onions have super antioxidant power. They contain quercetin, a natural antihistamine that reduces airway inflammation and helps relieve symptoms of allergies and hay fever. Onions also boast high levels of vitamin C, which, along with the quercetin, battles cold and flu symptoms. Onions’ anti-inflammatory properties help fight the pain and swelling associated with osteo- and rheumatoid arthritis. Onions are also extremely rich in sulfur and they have antibiotic and antiviral properties, making them excellent for people who consume a diet high in protein, fat, or sugar, as they help cleanse the arteries and impede the growth of viruses, yeasts, and other disease-causing agents, which can build up in an imbalanced diet.

How much:
For all the health benefits onions provide, it would be ideal to eat one a day. However, if that’s not doable for you, add a few onions to your weekly grocery list and try to eat a little bit every day. All varieties are extremely good for you, but shallots and yellow onions lead the pack in antioxidant activity. Raw onions provide the best nutrition, but they’re still great for you when they’re lightly cooked. And cooking meat at high temperatures (such as on a grill) with onions can help reduce or counteract carcinogens produced by the meat.

Tip:
Onions should be stored at room temperature, but if they bother your eyes when you cut them, try refrigerating them for an hour beforehand.

8. Carrots
Carrots are a great source of the potent antioxidants known as carotenoids. Diets high in carotenoids have been tied to a decreased risk in postmenopausal breast cancer as well as cancers of the bladder, cervix, prostate, colon, larynx, and esophagus. Conversely, diets low in carotenoids have been associated with chronic disease, including heart disease and various cancers. Research suggests that just one carrot per day could reduce your risk of lung cancer by half. Carrots may also reduce your risk of kidney and ovarian cancers. In addition to fighting cancer, the nutrients in carrots inhibit cardiovascular disease, stimulate the immune system, promote colon health, and support ear and eye health.

Carrots contain calcium, potassium, magnesium, phosphorus, fiber, vitamin C, and an incredible amount of vitamin A. The alpha-carotene in carrots has shown promise in inhibiting tumor growth. Carrots also contain the carotenoids lutein and zeaxanthin, which work together to promote eye health and prevent macular degeneration and cataracts. In Chinese medicine, carrots are used to treat rheumatism, kidney stones, tumors, indigestion, diarrhea, night blindness, ear infections, earaches, deafness, skin lesions, urinary tract infections, coughs, and constipation.

How much:
Eat a serving of carrots each day if you can, and enjoy them year-round. Carrots are good for you whether they’re raw or lightly cooked; cooking helps break down the tough fiber, making some of the nutrients more easily absorbed. For the best nutrition, go for whole carrots that are firm and fresh-looking. Precut baby carrots are made from whole carrots and, although they’re convenient, they tend to lose important nutrients during processing.

Tips:
Remove carrot tops before storing them in the fridge, as the tops drain moisture from the roots and will cause the carrots to wilt.
Buy organic; conventionally grown carrots frequently show high pesticide residues.

9. Cabbage
Cabbage is a powerhouse source of vitamins K and C. Just one cup supplies 91 percent of the recommended daily amount for vitamin K, 50 percent of vitamin C, good amounts of fiber, and decent scores of manganese, vitamin B6, folate, and more — and it’ll only cost you about 33 calories. Calorie for calorie, cabbage offers 11 percent more vitamin C than oranges.

Cabbage contains high levels of antioxidant sulforaphanes that not only fight free radicals before they damage DNA but also stimulate enzymes that detoxify carcinogens in the body. Researchers believe this one-two approach may contribute to the apparent ability of cruciferous vegetables to reduce the risk of cancer more effectively than any other plant food group. Numerous studies point to a strong association between diets high in cruciferous vegetables and a low incidence of lung, colon, breast, ovarian, and bladder cancers.

Cabbage builds strong bones, dampens allergic reactions, reduces inflammation, and promotes gastrointestinal health. Cabbage is routinely juiced as a natural remedy for healing peptic ulcers due to its high glutamine content. It also provides significant cardiovascular benefit by preventing plaque formation in the blood vessels. In Chinese medicine, cabbage is used to treat constipation, the common cold, whooping cough, depression and irritability, and stomach ulcers. When eaten and used as a poultice, as a dual treatment, cabbage is helpful for healing bedsores, varicose veins, and arthritis.

How much:
The more cabbage you can include in your diet, the better. A study of Polish women found that those who ate at least four servings of cabbage per week as adolescents were 72 percent less likely to develop breast cancer later in life than their peers who consumed only one weekly serving or less.

Tips:

Try raw sauerkraut. It has all the health properties of cabbage, plus some potent probiotics, which are excellent for digestive health.
Use the whole cabbage; the outer leaves contain a third more calcium than the inner leaves.

Both are nutritional stars, but red cabbages are far superior to the white variety, with about seven times more vitamin C and more than four times the polyphenols, which protect cells from oxidative stress and cancer.

10. Broccoli
You’ll find it difficult to locate another single food source with as much naturally occurring health-promoting properties as broccoli. A single cup of steamed broccoli provides more than 200 percent of the RDA for vitamin C (again, more than oranges), nearly as much of vitamin K, and about half of the daily allowance for vitamin A, along with plentiful folate, fiber, sulfur, iron, B vitamins, and a whole host of other important nutrients. Calorie for calorie, broccoli contains about twice the amount of protein as steak — and a lot more protective phytonutrients.

Broccoli’s phytochemicals fight cancer by neutralizing carcinogens and accelerating their elimination from the body, in addition to inhibiting tumors caused by chemical carcinogens. Studies show evidence that these substances help prevent lung and esophageal cancers and may play a role in lowering the risk of other cancers, including gastrointestinal cancer.

Phytonutrients called indoles found in broccoli help protect against prostate, gastric, skin, breast, and cervical cancers. Some research suggests that indoles also protect the structure of DNA and may reduce the risk of prostate cancer. Extensive studies have linked broccoli to a 20 percent reduction in heart disease risk. In Chinese medicine, broccoli is used to treat eye inflammation.

How much:
If you can eat a little broccoli every day, your body will thank you for it. If you can’t swing it, aim for eating it as regularly as possible. Like many other vegetables, broccoli provides fantastic nutrition both in its raw form and when it’s properly cooked. Cooking reduces some of broccoli’s anticancer components, but lightly steaming it will preserve most of the nutrients. Broccoli is available fresh year-round in most areas, but if you can’t find it where you live, frozen broccoli is a good substitute.

Tip:
Steaming or cooking broccoli lightly releases the maximum amount of the antioxidant sulforaphane.

11. Kale
Kale is highly nutritious, has powerful antioxidant properties, and is anti-inflammatory. One cup of cooked kale contains an astounding 1,328 percent of the RDA for vitamin K, 192 percent of the RDA for vitamin A, and 89 percent of the RDA for vitamin C. It’s also a good source of calcium and iron.

Kale is in the same plant family as broccoli and cabbage, and, like its cruciferous cousins, it contains high levels of the cancer-fighting compound sulforaphane, which guards against prostate, gastric, skin, and breast cancers by boosting the body’s detoxification enzymes and fighting free radicals in the body. The indoles in kale have been shown to protect against breast, cervical, and colon cancers. The vitamin K in kale promotes blood clotting, protects the heart, and helps build strong bones by anchoring calcium to the bone. It also has more antioxidant power than spinach, protecting against free-radical damage. Kale is extra rich in beta-carotene (containing seven times as much as does broccoli), lutein, and zeaxanthin (ten times the amount in broccoli). In Chinese medicine, kale is used to help ease lung congestion.

How much:
Like cabbage, the more kale you can eat, the better. A daily serving is ideal. Eat it as much as you can, as long as you can find it fresh at your local grocery or farmer’s market. In some areas, it’s available all year; in others, it only makes an appearance during summer and fall.

Tips:

Kale’s growing season extends nearly year-round; the only time it’s out of season is summer, when plenty of other leafy greens are abundant.
Steam or saute kale on its own, or add it to soups and stews. Cooking helps tenderize the leaves.
Kale is also a great addition when it’s blended in fruit smoothies or juiced with other vegetables.

12. Dandelion
The same pesky weed known for ruining lawns has a long history of being used as a healing herb in cultures around the globe. One cup of raw dandelion greens provides 535 percent of the RDA of vitamin K and 112 percent of the RDA for vitamin A. Dandelion greens are also a good source of vitamin C, calcium, iron, fiber, and potassium. Among all foods, it’s one of the richest sources of vitamin A; among all green vegetables, it’s one of the best sources of beta-carotene.

Dandelion has been used for centuries to treat hepatitis, kidney, and liver disorders such as kidney stones, jaundice, and cirrhosis. It’s routinely prescribed as a natural treatment for hepatitis C, anemia, and liver detoxification (poor liver function has been linked to numerous conditions, from indigestion and hepatitis to irritability and depression). As a natural diuretic, dandelion supports the entire digestive system and increases urine output, helping flush toxins and excess salt from the kidneys. The naturally occurring potassium in dandelions helps prevent the loss of potassium that can occur with pharmaceutical diuretics.

Dandelion promotes digestive health by stimulating bile production, resulting in a gentle laxative effect. Inulin, a naturally occurring soluble fiber in dandelion, further aids digestion by feeding the healthy probiotic bacteria in the intestines; it also increases calcium absorption and has a beneficial effect on blood sugar levels, therefore being useful in treating diabetes. Both the dandelion leaves and root are used to treat heartburn and indigestion. The pectin in dandelion relieves constipation and, in combination with vitamin C, reduces cholesterol. Dandelion is excellent for reducing edema, bloating, and water retention; it can also help reduce high blood pressure. On top of all that, dandelion contains multiple antidiarrheal and antibacterial properties.

In Chinese medicine, dandelion is used in combination with other herbs to treat hepatitis and upper respiratory tract infections such as bronchitis and pneumonia. The sap from the stem and root is a topical remedy for warts. Imagine — all this from a lowly weed!

How much:

How much dandelion to incorporate into your diet boils down to two factors: availability and personal preference. Dandelion greens are considered a specialty item in some areas and therefore can be difficult to find. They also have a pungent taste, and people tend to love or hate the flavor. If you can find fresh dandelion greens and you enjoy the taste, make them a regular part of your diet.

Tip:
Use the root in soups or saute it on its own.
If the raw leaves are too bitter for you, try them lightly steamed or sauteed

Emotions as Guides

2010-08-01T10:23:00.000-07:00

posted by Karla McLaren Jul 31, 2010 3:09 pm

filed under: Emotional Genius, Health & Wellness, Healthy Mind, emotions, empathy
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Though regular readers of this blog may have caught onto this already, the premise of The Language of Emotions: What Your Feelings are Trying to Tell You is that all of your emotions exist for specific and protective reasons. Emotions are an irreplaceable aspect of your intelligence and your capacity to understand the world, and you feel emotions because they have something to tell you. If you learn what messages your emotions are trying to give you, you’ll be able to work with them in excellent new ways.

So far, we’ve looked at the gifts of anger, sadness, fear, and contentment. Every emotion has a purpose and is necessary to your well-being, but some of them are difficult to manage. However, if you can learn to listen closely to your emotions, you can access some of the most important aspects of your innate intelligence. Unfortunately, most of us have learned only two ways to deal with emotions: Expression and Repression (which don’t really work in all cases).

Take expression: Some emotions are good to express. Happiness and contentment are two that come to mind. Sadness is also nice to express (if it’s safe to cry). Depression can be good to express instead of bottle up. But think about rage, jealousy, hatred, or shame. You want to be able to feel these emotions (because they have a valid purpose in your psyche), but if you express them, you can hurt yourself or other people.

Expressing difficult emotions can be very problematic, as we all know. Current neurological and psychological research is showing us that constantly expressing strong emotions tends to essentially wear a pathway into your brain. If you let loose with rage or anxiety, your brain will learn how to rage and be anxious; therefore, the next time you meet a possibly enraging or anxiety-producing situation, your brain may move to rage or anxiety simply because you taught it to. The plasticity of your brain doesn’t just apply to learning new skills or new languages; it also applies to learning how to manage your emotions.

People tend to repress difficult emotions, which is a good idea if they don’t have any other skills. However, since all emotions carry truly important messages, repressing them means you won’t get those messages or learn those lessons; instead, you’ll just become less able to work with the emotions you repress. If you can envision your emotions moving forward to bring you messages and give you help, you can see that repression just shoves that help under the rug. In the case of strong emotions like rage or hatred, yes, repression is better than expression. But since rage and hatred have something very important to say to you, repressing them will actually impede your ability to understand yourself

Economy: double dip?

2010-07-31T22:42:00.000-07:00

WASHINGTON — They're a minority, but a vocal one, and they're hovering like storm clouds over a brittle recovery. They're the Double Dippers — the politicians, economists and analysts who foresee back-to-back recessions. Their warnings could become self-fulfilling prophecies if they frighten enough people into holding tightly onto their wallets. With consumer spending accounting for two-thirds of economic activity, anything that further rattles consumers can undercut recovery hopes. Recent data has shown that, after growing moderately for most of the past year, the U.S. economy appears to be slowing. This was underscored by Friday's government report that U.S. economic growth slowed to 2.4 percent from April to May, down from a revised 3.7 percent in the previous quarter. Such statistics are providing more ammunition to the double dippers. Recent data has shown that, after growing moderately for most of the past year, the economy appears to be slowing in some parts of the country and in key sectors such as consumer spending. That's providing more ammunition to the double dippers. Long road ahead Most mainstream economists agree the recovery road will be long and bumpy, but probably without leading into double-dip territory. But there are plenty of other voices warning of grimmer times ahead. Nobel Prize-winning economist Paul Krugman of Princeton University argues in his New York Times columns that the U.S. already may have fallen into the early stages of a long, deep depression such as Japan's "lost decade." He claims that President Barack Obama and Congress have failed to provide enough stimulus spending.

How Much Further Do Home Prices Need to Fall?

2010-07-31T11:46:00.000-07:00

By Morgan Housel | More Articles
July 30, 2010 | Comments (6)

I'll start by sparing you the details. Nationwide home prices need to fall another 10%-15%. If you want to know how I came to that conclusion, keep reading.

KISS

As much as possible, I try to follow Marty Whitman's philosophy that "rarely do more than three or four variables really count. Everything else is noise."

With housing, three variables tell you most of what you need to know: price-to-income, price-to-rent, and months of supply. So let's see what they tell us.

1. Price-to-income (chart)

Sources: Case Shiller Housing Index, Census Bureau.

Home prices have tanked measured against incomes. That's obvious. But two points here should stick out: One, price-to-income levels are still about 5%-8% above average. Two, the ratio is headed back up already. Don't get too comfortable with that. Since the ratio stabilized at an above-average level, the rebound is likely just a temporary blip caused by housing stimulus. "Temporary" is the key word there. You can't permanently exit the largest housing bubble in history at above-average prices. More on that in a second.

2. Price-to-rent

Sources: Case Shiller Housing Index, Census Bureau.

Prices against rents are actually back inline with average levels. That's encouraging. Four years ago, renting was far cheaper than owning. It's a much more equitable trade-off today. Embrace that -- it's what a normal market should look like.

Just don't get too excited. Supply is what's really important here. And it doesn't look good.

3. Months of Supply

Source: Census Bureau.

This chart is the most important. First, notice the recent spike on the far right. Both the spike and the drop to its immediate left are the result of the expiration of the first-time homebuyers credit. There was a massive buying rush before the deadline, which temporarily juiced sales. After the deadline passed, sales plummeted. Same goes for the drop and spike in late 2009, which shows a period when everyone thought the credit was about to expire, only to learn it would be extended. Congress has become the undisputed champion of creating obnoxious volatility.

The red line in this chart denotes six months, which is usually seen as a neutral level of supply. As a rough rule, prices tend to fall when there's more than six months supply, and vice versa. The temporary trip below six months supply earlier this year might explain why prices began rising.

But with the expiration of the housing credit, we're now solidly back above six months. If you want a good reason to expect housing prices to fall in the coming quarters, there it is. It's also a bad omen for homebuilders like KB Homes (NYSE: KBH) and Pulte Group (NYSE: PHM) -- there's simply too much supply out there to justify building more homes.

And the problem is actually deeper than it looks. This chart only shows actual on-market supply. What it doesn't show is so-called "shadow inventory," which are foreclosed homes that banks own but haven't put up for sale, or homes that are still occupied by homeowners who are about to get foreclosed on.

The size of the shadow inventory can only be estimated -- it's called "shadow" for a reason -- but credible estimates range between 2 million and 8 million units. Yes, that's a huge gap, which is testament to how uncertain things are. What's important is that inventory is still way too high. How high? No one knows. But it's high. And as long as that's the case, the housing bears have the ball.

To get inventory numbers back to healthy levels, homes need to be bought, of course. That happens when prices become so cheap that renters start buying, and to a larger extent when new households are formed.

Unfortunately, household formation is abysmal right now. Over the last decade, an average of 1.3 million households were created every year. In 2008, that dropped to 772,000. In 2009, it was a mere 398,000. What caused the drop? For one, the young and unemployed, especially new college grads, are living with their parents. Others are doubling-up with roommates. At a conference in Vancouver last week, analyst and blogger Barry Ritholtz noted that if you focus on household formation and new home construction at current rates, it could take as much as 12 years to absorb current inventory. Warren Buffett has quipped several times that best way to solve this is by encouraging teenagers to cohabitate, a program "not likely to suffer from a lack of volunteers."

Tying it all together

When I look at these three metrics, I see price-to-income levels that need to fall 5%-8%, price-to-rent levels that look pretty good, and a supply situation that's somewhere between bad and horrific.

Excess supply will cause prices to fall. How far? My best guess is 10%-15%. That would bring prices meaningfully below average against both incomes and rents, which would create a level where homeownership becomes affordable for new households and a better deal than renting. That's when you'll see real demand stabilizing the big picture.

And falling below average is, I think, a realistic expectation. Prices have to fall below average before buyers' animal spirits come back to life. That can last a while. Investor Vitaliy Katsenelson recently gave a great presentation where he notes that valuations "usually stay below average for eight years in a sideways cycle." He was referring to the stock market, but the theory should at least roughly extend to housing. Bubble wounds take time to heal.

Could I be wrong? Of course. Billionaire investor John Paulson, who called the housing crash, thinks home prices will rise 8%-12% in 2011, which explains why he's invested billions in Bank of America (NYSE: BAC), Citigroup (NYSE: C), and Wells Fargo (NYSE: WFC). But I try to keep it simple. And my simple metrics make me think housing isn't out of the woods just yet.

Comments

On July 30, 2010, at 4:16 PM, Melaschasm wrote: Excellent article with many great points. It is likely that your 10% fall in prices prediction will come true. However, there is a major factor which you did not address.

Commodity prices are already rebounding from their price collapse in 2008. Housing is in some ways like a commodity, and the same forces driving commodity prices higher could also keep housing at above average prices.

There is a previous time in US history where the economy was stagnant, yet commodity prices were rising. I am concerned that we are about to see a few years of such unpleasant economic circumstances.

Report this Comment On July 30, 2010, at 4:29 PM, outoffocus wrote: "Commodity prices are already rebounding from their price collapse in 2008. Housing is in some ways like a commodity, and the same forces driving commodity prices higher could also keep housing at above average prices."

I disagree. Housing demand used to "behave like a commodity" in that the price increases were driven by real organic inflation. In other words, wages went up, which increased affordability, which increased demand, which increased housing prices. The housing bubble threw that entire equation out of wack. Now we are dealing with an economy that has little to no growth, stagnant to falling wages, too much leverage, rising commodity prices, and high unemployment. All of this is stagflationary and will hurt housing in the short run.

Also, as with any bubble, once the bubble pops, the asset in question often over corrects to the DOWNSIDE before returning to equilibrium and rising again (see oil as a recent example) . Thanks to all of the bailouts and stimulus, we never saw that over correction. The problem with that is we will never see a true sustained rise in housing prices until that correction happens. All the government did was delay the inevitable and potentially make it worse.

10-15% drop is a fair prediction for a further drop in housing prices in the near term. But I see a more sustained drop over the next couple years before housing fully recovers. You can thank good ol Uncle Sam for that.

Report this Comment On July 30, 2010, at 6:39 PM, rd80 wrote: I agree that housing prices are still overvalued, but I think one of the three variables for housing should be mortgage rates since that determines the affordability for most buyers.

Report this Comment On July 30, 2010, at 7:43 PM, hcshew wrote: I think price to income ratio is a little simplistic because it ignores the effect of interest rates. The real measure of affordability is PAYMENT to income ratio, which inherently takes into account the predominant interest rate. House prices in the 80s and 90s had to be lower because the predominant interest rates ran 8-10% for fixed rate loans. The same home in an era of 4-5% interest rates can be twice as expensive and still be as affordable.

I would be interested in seeing a chart that compares the trend of payment to income ratio. I suspect that that would show homes today to be cheap!

Report this Comment On July 30, 2010, at 10:59 PM, thedavidfactor wrote: I think the interest rate is more then compensated by the increase in consumer debt over the same time period. Consumer Debt is at the highest levels in recorded history and that negatively impacts the affordability of payments more than interest rates positively impacts affordability.

Report this Comment On July 31, 2010, at 12:56 AM, xetn wrote: The simple answer as to how much further house prices should fall is: until people start buying them without government subsidies and no sub-prime loans.

Just as an aside, the same formula could apply to job creation; letting the wage rate (which is nothing more that a price) adjust until there was job for essentially every job seeker. We should end the minimum wage which destroys jobs for people without adequate education and/or job experience.

02Superfast Bullet Trains Are Finally Coming to the U.S

2010-07-29T23:05:00.000-07:00

FEATURE
U.S. Military Learns to Fight Deadliest Weapons

By James Glave and Rachel Swaby January 25, 2010 | 12:00 pm | Wired Feb 2010
Illustration: Paul Rogers

Believe it: Bullet trains are coming. After decades of false starts, planners are finally beginning to make headway on what could become the largest, most complicated infrastructure project ever attempted in the US. The Obama administration got on board with an $8 billion infusion, and more cash is likely en route from Congress. It’s enough for Florida and Texas to dust off some previously abandoned plans and for urban clusters in the Northeast and Midwest to pursue some long-overdue upgrades. The nation’s test bed will almost certainly be California, which already has voter-approved funding and planning under way. But getting up to speed requires more than just seed money. For trains to beat planes and automobiles, the hardware needs to really fly. Officials are pushing to deploy state-of-the-art rail rockets. Next stop: the future.

Fast Trains: A Brief History

When the first modern rail line connected Liverpool with Manchester in 1830, locals worried that flying sparks would set fire to buildings and that cows near the tracks would stop giving milk. That train couldn’t hit even 40 mph. Those British villagers would be downright terrified now. Here’s a quick trip through high-speed history.

1830 36 mph
Liverpool & Manchester Railway, England

A former member of Parliament was injured at the first modern rail line’s christening, and the Northumbrian train reached its top speed rushing him to a doctor. (He died soon after.)
1839 57 mph

Grand Junction Railway, England
Nine years after the Northumbrian’s emergency run, the high-speed record was broken in Staffordshire by an engine so powerful it was dubbed Lucifer.
1889 89.5 mph

Paris-Dijon line, France
France grabbed the speed title from England after a record run on the Paris-Dijon line. The engine that took the prize was designed by Thomas Crampton … of England.

1897 90 mph

Midland Railway, England
It took almost a decade for England to regain its dominance with a record-breaking run aboard an 8-foot-long, eight-wheeled locomotive from Melton Mowbray to Nottingham.

1903 126 mph
Military railway, Germany
Germany pulled ahead with this 12-wheel all-electric train between Marienfeld and Berlin, which would remain the country’s fastest for more than 70 years.

1932 92 mph Great Western Railway, England
The Cheltenham Spa Express became the Cheltenham Flyer after going 77 miles in just under 57 minutes — the first regular passenger service to achieve such speed.

1964 130 mph
Shinkansen, Japan
This new line between Tokyo and Osaka provided the first regular service operating at speeds above 100 mph. The Shinkansen’s aerodynamic design earned it the nickname “bullet train.”

1981 161.6 mph
TGV, France
When this high-speed rail opened, it became the fastest regularly running line in the world, shuttling passengers 264 miles between Paris and Lyon in just 2 hours, 40 minutes.
2004 267 mph

Shanghai Maglev, China
The fastest passenger train in the world, this line zips from Pudong International Airport to Shanghai via an electromagnetic reaction created between the cars and the tracks.
2007 357 mph

TGV, France
A souped-up, 25,000-hp TGV with oversize wheels holds the current record for non-maglev trains. Journalists on the title run reported dizziness at 300 mph and difficulty standing at around 335 mph.

Florida (roll over for detail) Texas (roll over for detail) Midwest (roll over for detail) California (roll over for detail) Northeast (roll over for detail) The Fast
Tracks
5 areas of the country have the population and geography to support high-speed rail now. But each route poses unique challenges.

California

First Phase

San Francisco
to Los Angeless
Ultimate Goal

Sacramento
to San Dieago
Estimated Completion Date

2025
Top Speed

220 mph
Final Tab

$45B
Conditions here are almost perfect. Not only does California possess a surplus of big-think, tech-whiz envirogeeks, it also boasts two major cities — San Francisco and Los Angeles — an ideal distance apart for bullet trains. In 2008, voters approved almost $10 billion to get started, and some of the environmental studies are already complete. But the biggest point in California’s favor? Ego. Governor Arnold Schwarzenegger wants the system to be his legacy.
Midwest

First Phase

Chicago to Madison, Detroit, and St. Louis.
Ultimate Goal

Hub-and-spoke network: 20 major cities using 3,000 miles of existing railway.
Estimated Completion Date

2025
Top Speed

110 mph
Final Tab

N/A
Nine Midwest states have teamed up to develop a regionwide network with Chicago as the hub. They will need to build atop a legacy freight system without a dedicated right-of-way — which means top speeds will be limited to 110 mph. Still, that should be fast enough to win over business travelers who currently brave three-hour-plus car trips between the region’s cities.
Texas

Ultimate Goal

“T-Bone” connecting Dallas/ Ft. Worth, San Antonio, and Houston
Estimated Completion Date

2020
Top Speed

220 mph
Final Tab

$12-22B
They think big down in Texas — as in a dedicated twin-track, 440-mile elevated corridor that will allow longhorns to wander underneath. The topography is forgiving, but the land-use patterns — miles of suburbs with scant public transit — are less than ideal. Lawyers for Southwest Airlines helped shoot down a proposal back in the 1990s, but with broad popular support this time, a Lone Star Shinkansen might happen.

Northeast

Ultimate Goal

Speed-boosting upgrades to existing lines to get Washington-to-Boston travel time down to five hours, 45 minutes.
Estimated Completion Date

2023
Top Speed

150 mph
Final Tab

$12B
On paper, the steel ribbon between Boston and DC is high-speed heaven: four large cities in close proximity, excellent transit connections, and overwhelmed airports. (The region already has the popular Amtrak Acela Express.) But on the ground, it’s stakeholder hell: eight commuter railroads with five owners, seven freight lines, and nine states — each with its own priorities and vision. And nobody seems to be coordinating the effort.
Florida

First Phase

Tampa
to Orlando
Ultimate Goal

Orlando
to Miami
Estimated Completion Date

2017
Top Speed

180 mph
Final Tab

$11.5+B
Florida has a checkered history with high-speed rail; its own voters nixed a bullet train in 2004. But now that there’s federal money on offer, the state has dusted off its plans and stands a good chance of becoming one of the first to start construction. The advantage: a 90-mile-long median along Interstate 4 that is government-owned and ready for trains. Plus, millions of Mouseketeers to ride the rails each year.

Fast or Superfast?
How rules and money limit speed.

Not all of the projects currently proposed are what many people think of as bullet trains. Turns out that while those 150-plus-mph rockets are insanely fast on the tracks, they’re slow to get off the ground. The first obstacle is regulatory: Federal rules demand environmental assessments, which require years of study and fieldwork by consultants, biologists, engineers, and planners. The second snag is cost: Superfast (or “express high-speed rail”) systems need new, exclusive lines, which are extremely expensive. That explains “emerging high-speed rail” projects, incremental improvements — new stations, bridges, and rolling stock — to existing infrastructure. These, like the Amtrak Acela Express in the Northeast, won’t have a dedicated right-of-way but will share tracks with freight and passenger trains and top out at around 110 mph.

The Bullet Decade
Can we have fast trains in 10 years? Yes we can.

The US hopes to have high-speed lines operational within the next decade. Sound impossible? It’s not. Other nations have shown the way. In 1990, Spain’s rail network was in even worse shape than America’s: Trains were slow and equipment dilapidated. Then the government made a commitment to modernize. Spain now has one of the most extensive high-speed systems in the world. Likewise, Taiwan built its entire infrastructure in just the past 10 years — despite a population density greater than that of the northeastern US. All it takes is planning: According to the island nation’s head of infrastructure construction, by threading the 60-foot-wide corridor carefully through the landscape, the builders had to knock down only about 1,000 homes over 214 miles. Finally, China plans to pour a staggering $300 billion into dedicated high-speed-rail corridors by 2020. Almost all of the first 60 trains will be manufactured in China under a technology-transfer agreement with bullet builder Siemens. In essence, Beijing intends to slash its costs by cloning the Siemens Velaro train, which could provide a model for a cheaper high-speed rollout in the US.

* Proposed by infrastructure-planning think tank America 2050

Illustration: Paul Rogers
The California
Challenge
The Golden State’s bullet train project will likely be a test bed for the nation. Here are some key hurdles.

Ridership

To be cost-efficient, any high-speed rail system needs an ample supply of riders. San Francisco hopes to deliver them through a new million-square-foot terminal. Dubbed the Transbay Transit Center, it will connect the new rail line with nine regional transportation systems, including the Caltrain commuter rail, Bay Area Rapid Transit, and Greyhound — once the thing finally is completed in a decade or so.
Nimbyism

The route across Pacheco Pass and up the San Francisco Peninsula — the California High-Speed Rail Authority’s preferred passage to San Francisco — is in peril. Menlo Park and Atherton have sued to stop construction from bisecting their posh towns. In August, a judge found in their favor. As an alternative, the train could run through the East Bay, but planners say the hurdles — 46 acres of wetlands, a San Francisco Bay crossing, and a little thing called the San Andreas Fault — are too great.
Instant Exurbs

High-speed rail will transform isolated and depressed Central Valley cities like Merced into commuter towns overnight, instantly cutting the hours-long odyssey to Sacramento to just 43 minutes. The resulting population boom (planners are already expecting an increase of more than 80 percent over the next 20 years) will mean higher employment rates and tax revenue but also a massive jump in urban infrastructure needs for local governments.
Farmland

Laying down track in Fresno County is like playing Operation. The goal is to carve out a 100-foot-wide corridor with minimal injury to the state’s most valuable agricultural land. Depending on the route from Fresno to Tulare, up to 300 acres of California’s best farmland will be disrupted. And parcels enrolled in the Williamson Act’s conservation program should be avoided altogether. Planners are scratching their heads over the issue now.

Mountains

Taking a bullet train over 4,000-foot-high mountains would feel more like a thrill ride than an office commute. So to navigate the Tehachapi range, rail planners initially sought to burrow through it. They soon realized that would require 23 miles of tunnels and negotiations with at least five major state parks, national forests, and recreation areas. The alternative: Lay an extra 35 miles of track to cross farther east, in Antelope Valley. The detour adds 10 minutes to the trip but would link Palmdale (population 139,000) to the greater LA metro area.
Car Culture

No city epitomizes the insane appeal of driving like Los Angeles, whose citizens cling to their steering wheels even as they face the worst congestion in the nation. Will high-speed rail persuade them to give up their autos? Maybe. Ridership on the local rail system has increased to 306,000 on weekdays, up from 265,000 in 2007. A faster, cheaper trip — the high-speed ride between Ontario and LA will save the average commuter at least 85 hours and as much as $6,400 a year in gas, parking, and lost productivity — might pry even the most dedicated motorist out of the driver’s seat.
Earthquakes

Since 1984, seismic activity has doubled in the area around San Diego (which suffered a magnitude 5.3 quake in 1986). But active faults are not necessarily deal breakers. Just look at Japan’s Shinkansen, which withstands some thousand tremors a year without any casualties. The trick is in the construction: Motion detectors are linked to a central control system that automatically shuts down trains during a significant rumble. Deep-reaching foundations resist an earthquake’s unsettling effects. And crossing fault lines at 90 degrees limits exposure to calamity.
Rail or Fail
The alternatives would cost more.

Getting California’s train up and running will be expensive. But doing nothing would cost two to three times more. Why? Currently, gridlocked lanes waste $20 billion in fuel and productivity annually. And it’s only going to get worse. The Golden State is growing — quickly. By 2030, another 12 million people could be calling it home. Without an infrastructure overhaul, drivers can expect a 10 percent congestion increase every year. To accommodate the billion trips between cities that residents and visitors will make annually, the state would need to build 3,000 more miles of freeway lanes, five more commercial airport runways, and 90 more airline departure gates. The price: at least $100 billion. Oh, and all that construction wouldn’t alleviate traffic; it would simply keep pace with it.

Speed Trials
San Francisco to L.A. in 2 hours, 40 minutes. Or else.

California’s bullet train system will need a steady flow of riders — lots of riders — to pay off. But studies show that when transportation times between major hubs exceed three hours, many travelers opt for planes. To address this dilemma, California’s high-speed-rail planners specify that trains must travel between San Francisco and Los Angeles in no more than two hours, 40 minutes, a feat that requires sustained intervals at 220 mph. The problem: Standard bullet trains don’t go that fast — yet. The state is gambling that technology will improve before it completes the planning process and starts laying track. Luckily, the tech doesn’t need to improve much: France’s new TGV already hits 200 mph, and Spain’s Alta Velocidad Española carries passengers at around 217 mph. Of course, the deadline also puts planners in a bind: Every route change that adds miles means the train needs to go that much faster. So be it. The target is necessary to ensure a fast ride and plentiful ridership.

Built for Speed

Forget diesel locomotives and human error. Modern bullet trains are high-voltage rockets with regenerative brakes, powered wheel sets, and centralized control systems.

Traffic Monitor

It’s easy to blow past a trackside signal, which is why dedicated high-speed corridors don’t use them. Instead, operators rely on a system known as automatic train control, in which traffic and speed information is monitored centrally and displayed on a screen in the driver’s cab. Trains are assigned a maximum speed, beyond which the brakes kick in automatically.

Aerodynamics

Designers must carefully taper the first car, not only for aerodynamic performance but also to eliminate the sonic boom that can occur when a train enters a tunnel at very high speed.

Auto-Shutdown

Sensors can be placed along the route to monitor for high winds, mud slides, flooding, earthquakes, or misaligned tracks — and can trigger alarms or tell the system to stop the train immediately.
Power Connection

A hinged arm called a pantograph connects the train to the power line. The trick is to keep the pantograph in contact at more than 200 mph. In addition to a pneumatic system that pushes upward, a small wing creates lift at high speed; the faster the train moves, the more force is applied. The arm can also be lowered to let the train coast between different electrical systems.

A.C. Inverter Car

A high-speed line’s inverter car looks like any other passenger car, but under the floor lurks the humming high-voltage heart of the train. In the case of Siemens’ Velaro, for example, the traction inverter turns 3,000-volt alternating current from the pantograph into direct current. The driver controls speed by changing the frequency of this current, throttling it up or down between 0 and 60 hertz.

Drivetrain

High-speed trains don’t have locomotives — they have powered axles paired into wheel sets called bogies. Rather than placing all the drive wheels at the front, state-of-the-art systems have bogies up and down the length of the train. This reduces axle load, maintenance costs, and possibly the risk of a catastrophic “accordion” effect in the event of an accident.

Regenerative Brakes

Regenerative brakes inside the bogies feed power back to the grid. They employ the same principle as a hybrid car, but instead of storing the energy in an onboard battery, the system shares the juice with other trains on the network.

Fail-Safe Systems

What happens if a train operator passes out at 150 mph? Hopefully nothing, thanks to a time-tested safety device: a dead man’s switch. On some lines, drivers must press a button with their foot every 30 seconds. Should they neglect this duty, an audible alarm sounds, and if it’s ignored, the train will initiate an emergency stop.

Close Posted by: Rybo | 01/30/10 | 7:31 pm |
Whatever happened to the idea of using really fast and safe Mag-Lev technology? As I understand it these trains cannot de-rail, and are extremely efficeint.

Posted by: greengestalt | 01/30/10 | 8:07 pm |
Wow!!!

I love that!

Frankly, I’d love to see such a full system, even though I’m in the more remote areas and would need to take a bus first. I’d LOVE to casually go to Seattle, for instance…

Posted by: methuselah | 01/30/10 | 8:22 pm |
I have wondered about all the problems with track movement, sabotage, weather, etc. But as to having to be really fast to beat out planes, all they have to do is not have to check in 2-3 hours before travel time to be faster. And if you don’t have to take off your shoes before riding, and can carry on a water bottle or soda, they’ve got air transport in the US beat. Of course, Amtrak is already losing oodles of money annually, so I suspect this will be also be subsidized for the rest of our lives.

Posted by: meelk | 01/30/10 | 8:29 pm |
acmartin9: you should look at facts and not propaganda regarding such claims. Conservatives oppose such measures because unlike liberals, we think often look at the facts, and do the math and research. For instance this article alone will explain some of the problems with alternate energy sources:
http://www.energytribune.com/articles.cfm?aid=2469

Posted by: dgroenier | 01/30/10 | 9:15 pm |
Anyone who thinks there will be no security lines or that they can show up five minutes before departure are fooling themselves. Not only would the trains be terror targets, but you would also need to scan for carry-on weapons and such things just to prevent regular ol’ American crime and ultra-violence. And if I’m a terrorist, I’m pinching myself–no need to committ suicide since I don’t need to be on-board the train. All I need to do is trespass onto any of the hundreds of farm fields the tracks will have to run through and detonate a trackside IED. But I guess you could create a special police patrol just to handle that security nightmare. That wouldn’t cost a lot…would it?

Posted by: citibob | 01/30/10 | 9:17 pm |
methuselah… Amtrak is profitable in the Northeast, where it is a popular, viable mid-speed train system. The Acela service is very profitable, for exactly the reasons you point out. It is expected that CA high-speed rail will be similarly profitable.

Amtrak loses money on pretty much all its operations OUTSIDE the Northeast. I mean, who wants to spend 24+ hours on a train that might come in 12 hours late, for no cheaper than an airplane that can do the same trip in 2 hours?

Posted by: Itzamna | 01/31/10 | 4:43 pm |
@ Rybo
The cost of MagLevs continue to be the main deterrent in adopting the plans. On top of that there are some worries about MagLevs in all conditions, such as deserts with dust and such.
.
Considering that it costs more to build one small MagLev rail than the administration is putting into a national high speed rail plan I wouldn’t plan on seeing them here anytime soon, unless it’s privately funded. Obviously the $8 billion won’t completely fund a national system and there will be outside funds. But we’re not trying to build one train here.

Posted by: JackDuran | 01/31/10 | 4:44 pm |
Wow! That was an interesting read. I think we’ll have to get the trains running at 300+ mph. Absolute necessity, not just thrill for speed.

Posted by: wiredcommentguy | 01/31/10 | 6:27 pm |
Hydrogen Maglev Engineered in Michigan, Contract to be built in Java…
http://www.youtube.com/watch?v=yONyv–AIdQ

Posted by: JWMeritt | 01/31/10 | 7:23 pm |
And where will these superfast bullet trains travel? The current curvey tracks do not allow that speed.

Posted by: acmartin9 | 01/31/10 | 8:58 pm |
Meelk: Alternative energies may have their problems, but the reality is that oil will not last forever and still buy oil from all these unstable countries. This money in turn is used by terrorist to push their extremist agendas. Not investing in alternative energies will be more costly because at the end of the day, we have to invade countries in the Middle East is a useless effort to stabilize them (To date, $1.05 trillion dollars have been allocated to the wars in Iraq and Afghanistan). In addition, many technologies such as coal have been claimed to be clean, but this is not true and they end up being more expensive on the long run because of its toll on people’s health and the environment ($120 billion in the U.S. in 2005, this is not counting impact on the environment). Furthermore, even if you don’t believe in global warming I still think that we should not be pumping so much CO2 into the atmosphere, which alternative energies could ameliorate. I think that a conservative being fiscally responsible is an illusion. Let me remind that W was the first to start the stimulus package and Republicans have poured millions of dollars in to programs that they know don’t work, but make people feel good, a clear example of this is sex abstinence programs. The reality is that there are many special interests that politicians have to cater to, and simple solutions such as making a stronger public transportation system (which conservative oppose) can go a long way. This has a greater social impact and at the end will save way more money in ways your equations from the energy tribune do not account for… Peace and sell your Hummer…

Posted by: billstewart | 01/31/10 | 11:52 pm |
The California train proponents promised us that when enough free money fell out of the sky to build the system, we’d be able to get 1-way fares of $55 from SF to LA, i.e. about the price of flying most airlines with a week’s advance purchase. Yes, trains are nicer – I used to commute between New Jersey and DC by Metroliner, which was slightly slower and cheaper than flying – but when I did fly, pre-9/11, I could get to the airport 15 minutes before my flight because there’d be another one in an hour if I missed it. Now, of course, they’re admitting that the train fares will probably be higher than Southwest’s, and don’t expect the TSA not to mess up the previously friendly railroad experience.

Posted by: moktarama | 02/1/10 | 11:56 am |
A few corrections and explanations from a french point of view :

If the new-gen TVGs are actually cruising at 200 mph, they are theorically able to run at 220 mph during long times, and will in France in 2 to 3 years. Problems here are essentially the economic sustainbility of the repairing costs of infrastructure at that speed. So the engines are not a problem at all.

Putting freight trains on the same railways kills the whole point of high speed trains. That’s why these trains are so expensive to build : it needs a dedicated railway to be efficient.

In 15 years of time, the TGV took 95 % of a domestic market dominated by planes. Same for the line between Paris and London, or for the Thalys between Paris and Brussels/Cologne, and many more. But a major hint for that success is the crucial need for stations located downtown, and the big problem in the US is the very low urban concentration (ie very extended cities) .

Posted by: SpeedRacer | 02/1/10 | 12:23 pm |
acmartin9: This may shock your kool-aid drunk mind but a Hummer has less environmental impact that a Prius. Further, nobody is going to ride your expensive public transportation making “High-Speed” rail that clear cuts through hundreds of miles of undeveloped space a unnecessary rape of the land. People like myself who pay taxes to subsidize these boondoggles in the name of conservation must shine the light on your ignorance. It is not the ignorance of a retrofuturism dream, but the ignorance of cost benefit analysis. An ignorance of why people do not ride trains anymore. You can’t change that by doubling their speed or making them shiny. You want to help the environment? Start by putting your trash in a waste basket. I can’t tell you how many “environmentalist” wanabes I see tossing garbage right into the street.

Posted by: Phillip123 | 02/1/10 | 4:07 pm |
Trains are one of the most energy efficient means of moving people around. They can be much more enjoyable than either cars or planes when done right. High speed trains can replace a lot of car and air travel for trips up to 300 miles making both driving and flying less crowded more efficient and more enjoyable and finally once the infrastructure is in place they can run off diesel or electricity which provides some redundancy for essential freight, ie in an oil shock you rely on the trains in a electricity shock you rely on trucking. There has been an over emphasis in this country on interstate highways, its good they are done but the over reliance has decreased quality of life and made the nation overly dependent on cars and trucks. More rail, I’m all for it.

Posted by: AnaC | 02/1/10 | 6:11 pm |
Well, one way they’ve got planes beat is the terrorism thing can still be achieved, but terrorists can’t jack a train and crash it into a building…it’s got rails…so nothing drastic like 9/11’s gonna happen with those train things. (Not that I mean nothing drastic can possibly happen using those, just not anything as bad as that…or if something as bad as that or worse lol then it’s something that would require alot more time, effort, and money…this is just imo. So I think there might actually not be much terrorist activity with these things.) And personally I think it would be nice to be able to look out the window and see something familiar..not people looking like ants and such things like that that can make you barf :S

Posted by: kemolledog | 02/4/10 | 12:45 pm |
It seems to me that the biggest problem is not techical, put political. Security for a known line would be almost impossible. Aircraft are quickly out of reach of terrorists after takeoff, but land based rail lines are vulnerable for the whole route, all the time. High speed makes the attacks more catastrophic and worthy as a terrorist target.

What are the solutions to these potential problems?

Posted by: Ardent | 02/5/10 | 2:38 pm |
@AntonioMalcolm: you’ve never been to Texas, have you?
.
Dallas to Austin is a haul. Out to Houston is even worse. Which is why everyone flies commuter hops everywhere. Which are substantially subsidized. To the point of the government losing money on them, since the airlines running the hops are paid regardless of the fact there’s only one or two people on the flight.
.
The Acela is great, if expensive. If the pricetag is about what you can expect for the other systems, they’ll be competitive, particularly once people get on board with riding trains. Up in the northeast corridor, the system is ancient and still way better than, say, driving into NYC. You usually only add a half hour to your travel time, and you get to sit and work while you’re doing it.
.
High-speed rail is probably the best bet for domestic mass transportation moving forward, particularly as airline domestic hops will become unsustainable and most carriers will probably shift to specifically international flights.
.
This, of course, in no way answers the question of when we’re going to get a line extension from Boston to Montreal, which would be insanely awesome.

Posted by: izaacsetec | 02/9/10 | 6:20 pm |
I love rail, I really do. I’d sooner take Amtrak than fly. It’s a more pleasurable experience all around.

However.

High speed rail will not come to the United States anytime soon, for two big reasons:

First, the practical aspects. Rail is very much a doable thing — when your entire nation is about the size of Georgia. The urban densities in Europe have no comparison in the United States, excepting perhaps the Boston-New York-Philadelphia-Baltimore-Washington axis. As has been previously stated, this corridor is the only profitable line for Amtrak. And their attempt at high speed rail service through it has amounted to little more than express train between those identified cities. And this says nothing for the physics, cost, and ancillary infrastructure investments (trains don’t just drop people off at the outskirts of cities, you know) necessary to make it all work in the first place.

Second, if for some reason the above is solved, it will be dead politically. In 1971, the National Passenger Railroad Corporation was formed. You may know it affectionately as Amtrak. After decades of strangulating regulation and taxation in the early 20th century, passenger railroads were out of money and facing early competition from highways and a subsidized and price-fixed airline industry (remember the Civil Aeronautics Board in the 1970s?). The remaining railroads were basically abandoned by their investors and nationalized. The story is very interesting in its nuance, but the bottom line is that all we have is Amtrak. And Federal Railroad Administration regulations pretty much ensure that all we’ll have is Amtrak.

Second, Amtrak is a government controlled entity. As such, it is subject to the whims of Washington. And Washington is subject to the whims of lobbyists. And one of the most active lobbies is for the airlines. How many times over the past few decades has the airline industry been bailed out, propped up, or subsidized by concerned Congressmen? Do yo honestly believe that a functional competitor to the airline industry will be allowed to appear, let alone be swaddled by Congress? There is no chance whatever.

This leaves private construction and investment. And frankly, there’s no money in passenger rail. No, not even between Los Angeles and Las Vegas — Amtrak killed the Desert Wind in 1997.

The simple fact is that the United States is a grand and beautiful place, and travel among Her cities is best achieved by air.

Posted by: tvoimat | 02/20/10 | 8:25 pm |
I rode the TGV from Paris to Cannes years ago,it really moved. Looking out the window it seemed that the landscape was a blur.

Comment

My dad worked for the Seabord Coastline RR for over 40 years and said he never knew a train conductor during that time that didnt just put a hammer or a wrench on the "dead mand pedal" to avoid the aggravation of having to keep it pressed down manually.

Economists see tepid recovery deep into 2011

2010-07-28T22:30:00.000-07:00

Economists see tepid recovery deep into 2011
Survey: Consumers will be tightfisted, unemployment will stay high

by JEANNINE AVERSA

updated 48 minutes ago

WASHINGTON — The U.S. economic recovery will remain slow deep into next year, held back by shoppers reluctant to spend and employers hesitant to hire, according to an Associated Press survey of leading economists.

The latest quarterly AP Economy Survey shows economists have turned gloomier in the past three months. They foresee weaker growth and higher unemployment than they did before. As a result, the economists think the Federal Reserve will keep interest rates near zero until at least next spring.

Yet despite their expectation of slower growth, a majority of the 42 economists surveyed believe the recovery remains on track, raising hopes that the economy can avoid falling back into a "double-dip" recession.

The AP survey compiles forecasts of leading private, corporate and academic economists on a range of indicators, including employment, consumer spending and inflation. Among their forecasts:

•Economic growth the rest of this year and early next year will weaken, to less than 3 percent. From January through May, the economy grew at roughly a 3.5 percent pace.

•The unemployment rate will be no lower at the end of the year than it is now — 9.5 percent. A majority think it will be 2015 or later before the rate falls to a historically normal 5 percent.

•State budget shortfalls pose a "significant" or "severe" risk to the national economy. The loss of tax revenue has forced state and local governments to cut services and lay off workers.

The weak economy leaves Democrats and Republicans on Capitol Hill vulnerable as they head into the November midterm elections. Democrats, who now control both chambers, have the most to lose. The gloomier outlook is also a liability for President Barack Obama.

The economists have turned more pessimistic since the recovery hit turbulence in May. Europe's debt crisis sent tremors through Wall Street, causing stocks to tumble and raising doubts about the durability of the rebound.

Since then, businesses have been slow to step up hiring. Americans' confidence in the economy has declined, leading shoppers to reduce spending. And the housing market has weakened further with the end of a homebuyer tax credit that had buoyed sales earlier this year.

Consumers aren't leading this rebound, as they usually do, despite ultra-low borrowing costs. Their spending growth will weaken in the second half of this year and strengthen only slightly next year, a majority of economists said. They think shoppers' reluctance to spend more money poses a "significant" or "severe" risk to the recovery.

"It seems like we hit an air pocket in consumer spending," said survey participant Richard DeKaser, president of Woodley Park Research.

Kasey Doshier, a graphic designer in Chicago, said the recession taught her to rein in her spending. The key moment came early last year, when her employer cut her pay 15 percent to avoid layoffs.

"I just lived paycheck to paycheck and had a good time," said Doshier, 32. "It's kind of scary to think that I am a paycheck away from being homeless."

Doshier's pay has been reinstated, but she's still watching her money. Dinner and drinks with friends are gone. Now she goes to free street festivals and the city pool. She explores Chicago neighborhoods by taking her dog on long "adventure walks."

The tight job market, scant pay raises and drooping home values are forcing others, too, to spend less and save more. Americans saved 4.2 percent of their disposable income last year. That was the highest level since 1998. Economists expect roughly the same level of saving this year and next.

That's why growth of less than 3 percent is forecast into 2011. And weak growth helps explain why unemployment is likely to stay high. It takes about 3 percent growth just to create enough jobs to keep pace with the population increase.

Growth would have to equal 5 percent for a full year to drive the unemployment rate down by 1 percentage point. Neither the economists in the AP survey nor the Obama administration expects that to happen.

The Fed's outlook has turned bleaker, too. It's why Chairman Ben Bernanke and his colleagues are weighing new steps to invigorate the economy if the recovery shows signs of backsliding. They are also expected to hold interest rates at record lows longer than economists thought three months ago.

A survey the Fed released Wednesday showed the economy facing a bumpy path back to health. The pace of economic activity remained modest in most of the country.

Most economists surveyed said the Fed would being raising short-term rates no sooner than next spring. In the last survey, most had thought it could happen as soon as late this year.

At the same time, state budget shortfalls have emerged as a major threat in the economists' view. State and local governments cut their spending in the first three months of this year at a 3.8 percent pace. That was the biggest cutback since the second quarter of 1981, just before the economy entered a severe recession.

When states and localities tighten spending by trimming services and jobs, the cutbacks ripple through the broader economy, causing individuals to spend less, too. The drop in state and local government spending shaved about half a percentage point off the U.S. gross domestic product in the first three months of this year.

Nearly two-thirds of the economists view the states' budget crises as a significant or severe threat to the rebound.

Despite such risks, 55 percent of the economists described the recovery as "on track" as of the middle of the year. The rest said it was "faltering."

"There's a risk that the loss of momentum will snowball and feed on itself, but I think in the end the recovery will stay on track," predicted another survey participant, James O'Sullivan, global chief economist at MF Global

Uncle Sam's unseen health care plan

2010-07-26T07:43:00.000-07:00

If you're in the market for long-term-care insurance, take a look at what the government will offer soon. But should you wait for it or buy other coverage now?

[Related content: insurance, health insurance, long term care, insurance rates, Liz Pulliam Weston]

By Liz Pulliam Weston
MSN Money

Tucked inside the health care reform law is a new, little-noticed federal program that could revolutionize long-term-care insurance in the U.S., providing coverage for millions of people who don't have it and easing the strain on unpaid family caregivers.

What does long-term care cost?

It could do that. Or it could be a complete disaster.

First, some background on long-term care, which is the aid provided to people who can't perform some or all of the daily functions of life, such as eating, bathing, dressing or using a toilet:

Most of the 10 million people (.pdf file) who need long-term care in the U.S. are older than 65.

The median income for households headed by people 65 to 74 is $39,000, according to the Federal Reserve. For households headed by people 75 or older, median income drops to $22,800.Health care reform and your retirement

A year in a nursing home costs $72,270 for a semiprivate room, according to the MetLife Mature Market Institute. Help at home costs an average of $21 an hour, so a full-time caregiver would cost $43,680. If a person needed around-the-clock care, you could triple that figure.

These costs typically aren't covered by Medicare, the government health plan for people 65 and older. (Long-term-care costs can be covered by Medicaid, the government health plan for the poor, but usually only after the person's savings have been exhausted.)

You see the problem: The costs of long-term care can be catastrophic, quickly depleting a family's savings. If a disabled person is lucky enough to have a family member to help, there's still a hefty price to be paid. Many family caregivers see substantial drops in income because they work fewer hours or even quit their jobs to look after someone.

A disastrous start

Insurance would seem to be the answer, but the history of the private long-term-care insurance market has been troubling, to say the least. It's a relatively new product, launched in the 1980s, and many insurers initially priced their policies too low. That led to insolvencies and dramatic premium increases. Some people who paid into their policies for years saw their premiums double or even triple, making the coverage unaffordable just as they were most likely to need it.

Furthermore, most private policies won't pay if the care is provided by a family member. Plus there's no such thing as a standardized policy, and varying exclusions, definitions of disability, waiting periods and payout limits make it a confusing product to buy.

So it's not surprising that only about 8 million long-term-care policies are currently in force in the U.S. or that the federal government winds up paying about 60% of long-term-care costs, largely through Medicaid.

Enter the Community Living Assistance Services and Supports (CLASS) Act. CLASS, which was part of the health care reform bill signed into law in March, would provide at least $50 a day for people who needed help with custodial care. The program is required to pay for itself over 75 years; no taxpayer subsidies are allowed.

Have some CLASS

Here's how it will work when it launches in 2013:

Workers will have as-yet-undetermined premiums deducted from their paychecks if their employers choose to enroll in the plan. These employees could opt out of the program if they chose.

If an employer decided not to participate, workers could sign up and contribute on their own. The self-employed and military personnel will also be allowed to participate.

Premiums can be based on age but not health.

Workers will have to pay premiums for five years before becoming eligible for benefits. They will have to be employed for at least three of those years, although they can continue to contribute after leaving their jobs.

By law, caregivers who are family members can't be excluded from payments. That means a spouse, child or other relative who provides care at home can be compensated for it.

There's no provision for coverage for people who are not employed; that was intended to keep people who are already disabled from overwhelming the system. But the disabled who can run their own small businesses could contribute, which could increase the program's costs. Low participation among workers also could doom the program.

"That's a concern everyone has," said Bonnie Burns, a long-term-care insurance expert for California Health Advocates who has written about CLASS. "There can't be any taxpayer funds, and it has to be financially stable."

If healthy people opted out and only at-risk people participated, the program could descend into a "death spiral" in which premiums had to be jacked up to ultimately unaffordable levels.

Buy your own -- or trust the government?

At this point, too much of the program is unknown to determine whether it will be a boon or a bust. If premiums are low enough, the program could offer cheap insurance against catastrophic risk for millions of workers. If the program fails to pay for itself, though, participants risk paying into a system for years with no guarantee the benefit will be there if they need it.

If you're under 40, you're probably not in the market yet for long-term-care insurance and may want to see how CLASS plays out. If you're much older, though, you shouldn't wait to get insurance if you need it -- and you can afford it.

Premiums for coverage are lower the earlier you buy, Burns noted, and you can reduce your non-CLASS coverage later if CLASS proves to be a success. (The average premium for someone who's 50 is about $1,700 annually, compared with $5,700 for someone who starts coverage at 70.)

What you need to know:

Check it out before you decide. The rule of thumb is that unless you're poor or rich, you should at least consider buying long-term-care insurance. (People who don't have much will likely be covered by Medicaid, while people with assets of $2 million and up can probably pay for care on their own, although they may opt to buy long-term-care insurance anyway, to preserve assets for a spouse or other heirs.)

Don't go for the cheapest option. A policy that's significantly cheaper than others either skimps on coverage or is at risk for big premium hikes later, Burns said.

Be prepared to carry some of the costs. A policy that covers all of your long-term-care costs without limits is likely to be prohibitively expensive. You can make the premiums more manageable by agreeing to longer waiting periods, lower daily payments or a limited payout period. Most nursing home stays are two years or less, for example, so you're unlikely to exhaust the benefits if you opt for a three-year plan.

But get the inflation protection. Don't agree to a policy that doesn't increase your benefit over time to match rising costs, Burns said. Remember, you may not use the benefits for decades, and a payout that seems adequate today could fall woefully short in 2030.

Make sure you can afford the premiums now and in the future. The idea with buying long-term-care insurance early is that you "lock in" a low premium -- insurers can't raise your rate as you get older or if your health deteriorates. But insurers can and likely will raise rates for whole classes of customers if it turns out they haven't adequately estimated future costs, Burns said. If your premium is barely affordable now, a single rate increase could force you to drop it, so you would have paid in a lot of money only to ultimately lose coverage.

Get second and third opinions before you buy. Ask competing agents to offer you policies, then carefully read each one and ask questions to clarify anything you don't understand. Take the policies to a neutral third party, such as a financial planner or an elder-law attorney with experience in long-term-care insurance, to get yet another opinion. "This is not a product that you can change, like homeowners or auto insurance," Burns said. "It's a contract for both you and the company, and it could be decades before you find out whether you made a good decision."

Comment

This sounds like a good program, but is hard to envision at this point in time. If it comes down to looking ten years down the road or eating ten days down the road, the choice is obvious.

Medical Claims for Marijuana—Just Blowing Smoke?

2010-07-21T19:25:00.000-07:00

Diseases & Conditions: Medications

Maybe, maybe not. We won't know until the federal government gives researchers more leeway.

By Megan Johnson, U.S. News & World Report

Legalize Marijuana? Obama Was Right to Say No
Marijuana Linked to Heart Disease and Depression
Photos: 10 Smokiest U.S. Cities

Multiple sclerosis patients can get prescription pot to ease their painful muscle spasms—if they live in Great Britain, where regulators recently approved a mouth spray made from cannabis, or marijuana. GW Pharmaceuticals, which developed Sativex and is preparing for advanced clinical trials to test its ability to relieve pain for cancer patients, wants to bring it to the United States.

Don't expect the company will have it easy. As far as the federal government is concerned, marijuana has no place in medicine. The Drug Enforcement Administration considers marijuana—like heroin and LSD—a schedule I controlled substance. Schedule I drugs are likely candidates for abuse, with no recognized therapeutic benefits. (Cocaine is a schedule II. Cough syrup is a V.)

Yet the medical use of marijuana by Americans is spreading. Fourteen states and the District of Columbia allow patients to use marijuana—and in some states to grow it—for medical purposes. Shops legally sell medical pot in California, Colorado, and New Mexico. But federal prosecutors continue to target growers, distributors, and users even in states where medical marijuana is legal.

The legal quagmire has hampered research into marijuana's potential medical benefits. Small studies by the Center for Medicinal Cannabis Research at the University of California, San Diego, demonstrate the pain-relieving ability of smoked marijuana in HIV and multiple sclerosis patients. Thousands of laboratory studies hint at a far greater range of medicinal properties, such as treating Alzheimer's disease, where it may inhibit an enzyme that leads to memory-robbing plaque formation in the brain, and fighting off MRSA infections, since certain compounds in cannabis have been shown to work against the superbug.

State Announces First Marijuana Dispensaries
Date:7/9/2010Duration: 04:01Video By: WMTW Portland ME
State officials Friday announced the organizations that will operate Maine's first medical marijuana dispensaries. News 8's Steve Minich reports.

But moving beyond lab rats has been tough. Only a handful of doubleblind, placebo-controlled clinical studies—the gold standard of medical research—have been done. Those favoring human research say it demands uncommon patience and persistence. Researchers must be cleared by the Drug Enforcement Administration, the proposed study has to pass muster with the Food and Drug Administration, and then the U.S. Public Health Service conducts its own review of the study's scientific merit and design. The entire process can take years, according to Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws, an advocacy group.

Americans can take synthesized THC, the main psychoactive compound in marijuana, as Marinol, a capsule made by Unimed Pharmaceuticals. Margaret Haney, a professor of clinical neurobiology at Columbia University in New York, has studied HIV patients whose appetites were enhanced when they smoked marijuana. Her findings suggest that either smoking pot or taking Marinol stimulates appetite. But there are downsides to both. A dose of Marinol may take three hours to kick in while smoked marijuana's effects are almost immediate, she says. Smoking the plant, however, may harm the respiratory system and, especially in young heavy users, the brain. Haney, whose research focuses on marijuana dependence, thinks cannabis could have a place in medicine. "There are clear medical potentials with this plant," she says. "I am not anti-marijuana, I'm not pro-marijuana. I want to understand it." Haney expresses frustration at what she considers wrongheaded efforts by states to legalize medical marijuana. There is too much, she says, that scientists do not know.

The American Medical Association asked the government last November to review marijuana's schedule I status. Downgrading cannabis would acknowledge its medical potential and encourage research. But that's not likely to happen. Keeping marijuana under schedule I, says DEA spokeswoman Dawn Dearden, is based on a lack of scientific evidence showing marijuana can be used safely and effectively as a treatment.

Meanwhile, patients like Dan Pope, 45, a Colorado resident with muscular dystrophy, continue their use of medical marijuana. He says it helps control his muscle spasms and makes his pain tolerable. But when he recently went to the Muscular Dystrophy Association, where he is a volunteer, to ask for support in reclassifying marijuana, he was turned down. There isn't enough research, he was told, to show that it works.

More on Medical Marijuana:

The Merits of Medical Marijuana
8 Facts You Might Not Know About Medical Marijuana
Marijuana's Memory Paradox
Bing: Medical Marijuana Dispensaries
Video: Willie Nelson on Pot's Stigma
Courtesy of U.S. News & World

Medicare corruption gusher worsens

2010-07-18T08:49:00.000-07:00

By Carl Hiaasen
chiaasen@MiamiHerald.com

Among South Florida's fearless Medicare rip-offs -- and there are thousands -- is the story of Guillermo Denis Gonzalez.

After serving 14 years in prison for murdering a man with a silencer-equipped handgun, Gonzalez decided in 2006 to try the medical supply business.

For $18,000, the Hialeah resident bought a Medicare-licensed company called DG Medical Equipment and within a year he'd submitted $586,953 in false claims for supplies that were never provided to patients.

Medicare, using federal tax dollars, reimbursed Gonzalez $31,442 before he was tracked down and arrested.

Last summer, after pleading guilty to defrauding the government, Gonzalez was marched over to state court to face another murder charge -- this one for allegedly stabbing and dismembering an acquaintance during a monetary dispute. He is scheduled to go on trial next month.

No one familiar with Florida was surprised to learn that a murderer had been welcomed into the health-care trades. Indeed, the most shocking thing about the Gonzalez case was that Medicare hadn't forked over the full half-a-million bucks in bogus claims that he'd sought.

South Florida remains the Deepwater Horizon of Medicare corruption in the United States, and the gusher is getting worse. No other place even comes close to matching the number of crooked health-care businesses, or the immense dollar amounts that wind up in the pockets of criminals.

While overworked prosecutors crack down on operators like Gonzalez, the latest wave of Medicare cheats is specializing in fictional billing for mental health services, rehab sessions and physical therapy.

As Jay Weaver reported in The Miami Herald last week, mental health clinics in Florida billed Medicare for $421 million in 2009. That's four times more than was billed during the same period by mental health clinics in Texas, and 635 times more than was billed by clinics in Michigan.

As crazy and depressed as Floridians can be, there's no way that we're four times crazier than Texans, or 635 times more depressed than Michiganders.

The only plausible explanation for such a staggering discrepancy in mental-health claims is stealing -- thieves in Florida are simply more adept at fleecing Medicare.

Our dubious distinction as the sleazebag capital of America brought Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius to Miami last week for the first-ever national summit on healthcare fraud.

It wasn't quite as flashy or upbeat as the LeBron James-Chris Bosh-Dwyane Wade summit at the American Airlines Arena, but the mission is nonetheless worthy of attention.

Medicare is the biggest drain on the federal budget, and epidemic fraud is the biggest drain on Medicare. Most older Americans depend on the program to cover many health-care expenses, but the system is sagging and bloated.

Experts say Medicare fraud in South Florida costs U.S. taxpayers between $3 billion and $4 billion annually. It's predictable that Miami-Dade, Broward and Palm Beach counties would be the hotbed, and also the venue for one of every three federal healthcare fraud prosecutions.

Part of the problem is that Medicare pays claims first, then asks questions later. That leaves criminals with a time gap that often allows them to bank the money, shut down their storefronts and scurry on before they get caught.

In 2008, Medicare paid $520 million to home healthcare agencies in Miami-Dade, just for treating diabetic patients. That was more money than the agency spent on that particular illness throughout the rest of the country combined.

The feds then changed the rules and put a cap on claims for homebound patients receiving insulin injections. The scammers simply turned their energies toward other exploitable areas -- in particular, mental health and physical therapy treatments.

Records show that Florida rehabilitation facilities billed $171 million to Medicare last year for physical and occupational services, which was 23 times more than California and 26 times more than New York -- two other states with no shortage of fraud artists.

For years, the Justice Department has been locking up Medicare fraudsters in Florida, yet business is booming. More FBI agents and prosecutors would help, but you'd need an army of them to dismantle all the bogus Medicare operations in South Florida.

Despite all the individuals indicted, including 94 nationwide on Friday, the risk of getting nabbed for Medicare fraud remains relatively small, and the potential profits from the crime remain large.

That's why health-care is such an appealing career move for local felons, even the occasional murderer. Why use a gun when you can make lots more money with a pencil?

Read more: http://www.miamiherald.com/2010/07/17/1735272/medicare-corruption-gusher-worsens.html#ixzz0u38EiK5F

Comment

You want to start hiring people? THIS is the place to start - prosecutors, judges, investigators, prison guards, prison construction people, etc. Billions can be saved by hiring some knowledgable IT guys to discover these scams earlier.

Bang for the Bite - AARP

2010-07-07T19:00:00.000-07:00

Seven Foods to Keep You Young
The fountain of youth in your grocery cart

by: Peter Jaret | from: AARP The Magazine | October 2009
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1. Olive oil

Four decades ago, researchers from the Seven Countries Study concluded that the monounsaturated fats in olive oil were largely responsible for the low rates of heart disease and cancer on the Greek island of Crete. Now we know that olive oil also contains polyphenols, powerful antioxidants that may help prevent age-related diseases.

2. Yogurt

In the 1970s, Soviet Georgia was rumored to have more centenarians per capita than any other country. Reports at the time claimed that the secret of their long lives was yogurt, a food ubiquitous in their diets. While the age-defying powers of yogurt never have been proved directly, yogurt is rich in calcium, which helps stave off osteoporosis and contains "good bacteria" that help maintain gut health and diminish the incidence of age-related intestinal illness.

3. Fish

Thirty years ago, researchers began to study why the native Inuits of Alaska were remarkably free of heart disease. The reason, scientists now think, is the extraordinary amount of fish they consume. Fish is an abundant source of omega-3 fats, which help prevent cholesterol buildup in arteries and protect against abnormal heart rhythms.

4. Chocolate

The Kuna people of the San Blas islands, off the coast of Panama, have a rate of heart disease that is nine times less than that of mainland Panamanians. The reason? The Kuna drink plenty of a beverage made with generous proportions of cocoa, which is unusually rich in flavanols that help preserve the healthy function of blood vessels. Maintaining youthful blood vessels lowers risk of high blood pressure, type 2 diabetes, kidney disease and dementia.

5. Nuts

Studies of Seventh-Day Adventists (a religious denomination that emphasizes healthy living and a vegetarian diet) show that those who eat nuts gain, on average, an extra two and a half years. Nuts are rich sources of unsaturated fats, so they offer benefits similar to those associated with olive oil. They’re also concentrated sources of vitamins, minerals and other phytochemicals, including antioxidants.

6. Wine

Drinking alcohol in moderation protects against heart disease, diabetes and age-related memory loss. Any kind of alcoholic beverage seems to provide such benefits, but red wine has been the focus of much of the research. Red wine contains resveratrol, a compound that likely contributes to its benefits—and, according to animal studies, may activate genes that slow cellular aging.

7. Blueberries

In a landmark study published in 1999, researchers at Tufts University’s Jean Mayer Human Nutrition Research Center on Aging fed rats blueberry extract for a period of time that in "rat lives" is equivalent to 10 human years. These rats outperformed rats fed regular chow on tests of balance and coordination when they reached old age. Compounds in blueberries (and other berries) mitigate inflammation and oxidative damage, which are associated with age-related deficits in memory and motor function.

Medical records go online, but at what cost to privacy?

2010-07-06T18:15:00.000-07:00

Allison Grisham learns how to navigate her medical records with help from Dr. David Seo, a cardiologist at University of Miami Miller School of Medicine.

MARICE COHN BAND / MIAMI HERALD STAFF

In online medical records, worries about privacy breaches

BY FRED TASKER

ftasker@MiamiHerald.com

You're a South Florida resident on vacation in Boise or Bogotá. You suffer stomach pains and visit a local doctor. You whip out your BlackBerry, punch in your access code and show the doctor a list of your medications, allergies, past illnesses, tests, surgeries and advice from your physician back home.

Electronic medical records, or EMRs, are quickly becoming a reality for doctors and hospitals in South Florida and beyond.

If EMRs work, they'll be high-tech marvels -- letting patients access their own medical records on their home computers, helping doctors coordinate tests with each other to avoid duplication, giving medical researchers access to millions of medical records.

Nearly every major South Florida hospital and many doctors are joining a push by the Obama administration to spend $19.2 billion in federal stimulus money to help create a national EMR system by 2014.

Allison Grisham of Miami Beach just got her own EMR from her doctor at University of Miami Hospital, which is spending $100 million on a new Epic brand system. She hopes it can help end medical errors like one she barely avoided a few years ago.

``I was in a hospital once and the nurse tried to give me the wrong medication. We only stopped it because my mother and I refused to let her put it in the IV,'' she said. ``It could have been serious.''

There are drawbacks. Patient advocates worry that EMRs could pose a threat to privacy. Doctors and hospitals say they're not being given enough time to set up the complex electronic systems or enough financial help to pay for them. The systems can cost $50 million to $100 million for hospitals and $15,000 to $50,000 for private doctors.

But the potential pluses outweigh those complaints, many doctors and hospitals believe. The new systems are voluntary, but federal financial incentives for using them and penalties for failing to do so have most medical officials at least resigned to making the change.

Here's what else EMRs will do:

You're a university medical researcher and you suspect a popular diabetes drug is causing heart problems. On your PC, you study the records -- with patient permission, and without their names -- of all the millions of people taking the suspect drug and compare them to those who aren't.

``A researcher could access the records of nearly every patient in the country and solve problems quickly,'' said Dr. Pascal Goldschmidt, dean of the UM Medical School.

Or you're a hospital CEO, and EMRs help you communicate better and faster with other hospitals and doctors around the country -- something most hospitals can't do today even if they have older, simpler electronic medical records.

DUPLICATION

``That would eliminate a lot of duplication,'' said Linda Quick, president of the South Florida Hospital & Healthcare Association. She cited an example: an acquaintance had an EKG from his private doctor, was sent to the hospital next door for follow-up and was given another EKG 90 minutes later.

``Patients will take control of their own records. Exchange of information will be very fluid,'' said Tom Gomez, head of a Florida International University initiative promoting hospital information sharing.

``When we have the whole system, it will be as easy as using an ATM card,'' said Quick.

Still, experts predict years of hard work getting all the new EMR systems -- Epic, Cerner, Seimens and other brands -- to communicate with each other.

``This is going to be complicated,'' says Gomez. ``And we're in the very early stages. It's probably 10 years away.'' There are problems. Private doctors, especially in small practices, say they lack the money and technical staff to implement EMRs -- buying computers, hiring techs to run and repair them, taking time for the training to operate them.

``It's the wave of the future, fortunately or unfortunately,'' says Dr. Tony Prieto, a sole-practitioner family medicine physician in Plantation. ``I agree it's needed. I'm not saying I can afford it.''

Even some big hospitals say the program is moving too fast.

``The goal is noble, but the timeline is unrealistic,'' said Mimi Taylor, Baptist Health South Florida's vice president for IT. ``You have to give hospitals time to do it right.''

Baptist Health's six-hospital, 2,000-doctor system will spend $96 million by 2013 to install a Siemens Soarian system to meet the new federal requirements. An informal Miami Herald survey of 26 South Florida hospitals found every one is putting in a new system or upgrading an old one. In addition to UM Hospital and Baptist Health, hospitals installing new or upgraded systems include Broward's six-hospital Memorial Healthcare System, Tenet's 10-hospital chain, Miami Children's Hospital and Mount Sinai Medical Center.

At UM Hospital, six clinics already have begun offering patients a personal electronic medical record called MyUHealthChart. By July, all clinics on the Miller School campus are to have them. By December, patients will be able to schedule appointments and pay their bills electronically. Even Jackson Health System, with its financial woes, is upgrading its current Cerner EMR system as part of the federal push.

``We have to do it to remain competitive,'' said Fernando Martinez, Jackson's chief information officer.

The Obama administration is using both carrots and sticks to persuade hospitals and doctors to put in EMRs. The president set aside $19.2 billion from the American Recovery and Reinvestment Act of 2009 to subsidize the systems. Doctors who start implementing EMRs by 2011 can get up to $44,000 in extra reimbursements from Medicare or $63,000 from Medicaid.

REIMBURSEMENTS

Hospitals will get bigger reimbursements, although their financial officers can't say how much yet. Local administrators estimate federal subsidies will repay 20 percent to 50 percent of the cost of an EMR system.

The problem, said Prieto, the Plantation physician, is that the expense is up front for the EMR system, but the reimbursement is after the fact.

``I have 26,000 patient charts. I can't imagine what that will cost me.''

The reimbursement ``won't even be close'' to the expense, he said.

``If you're a solo practitioner, you have to go out and buy a new system and educate your staff to use it,'' said Cynthia Peterson, head of the Broward Medical Association. The stick: Doctors and hospitals that don't comply by 2015 will see their Medicare and Medicaid payments reduced by 1 percent in 2015, 2 percent in 2016 and 3 percent in subsequent years.

A Congressional Budget Office report predicts 90 percent of hospitals and doctors will have EMRs by 2019.

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doc77 wrote on 07/06/2010 07:34:25 PM:
who cares? now is too late. EMR's are like HMO's, are here to stay. Did you know that a close friend of our president owns an EMR company in Chicago?

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lenny1 wrote on 07/06/2010 06:40:52 PM:
A friend, who is now retired from medical practise, was also my physician. When he closed down his practice, he had to keep medical files for years. (I think he kept them 10 years, but it was much longer than he required to). When he gave me my medical files, I was advised that most patients are not aware of the actual ownership of those records. They are your records, and if a doctor wants, he can make another copy of them for himself. Still, it is a leap of faith that things will turn out as intended. Wherever there is new technology, there are also opportunities for poorly intended people.

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Vinmoe6878 wrote on 07/06/2010 05:37:11 PM:
I was just informed by my old insurance company that they had two computers stolen and my whole families personal information was on them........

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MedSecurityGuru wrote on 07/06/2010 02:28:34 PM:
Replying to BHarrison (07/06/2010 01:31:53 PM):

"And once yourmedical records go on-line, the insurance companies will wind up (legally or illegally) having the information to decline coverage based upon "prior existing conditions".

As most people are now coming to realize, the NHC - national Health Care program is NOT going to reduce...":@BHarrison....Don't confuse the Electronic Health Care (EHR) issue with NHC...the two are not related.

The correct use of EHR could actually help lower the cost of any healthcare plan.

Putting EHR's on the Internet does not mean that they are open for all to see. That is why I said in my original statement that security of medical records is paramount. You will see a lot of "Mom and Pop" data centers popping up, so doctors need someone to help they work through that quagmire.

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BHarrison wrote on 07/06/2010 01:31:53 PM:

And once yourmedical records go on-line, the insurance companies will wind up (legally or illegally) having the information to decline coverage based upon "prior existing conditions".

As most people are now coming to realize, the NHC - national Health Care program is NOT going to reduce costs; but it IS going to reduce the quality of care. The reality of the NHC is it is a political farce, in an election year, to penalize the vast majority of Americans to subsidize the health care for the poor and indiginat, who wre receing care under government or tax subsidized services (for the services that they received but did not pay for).

The vast, VAST MAJORITY of Americans re NOT going to benefit from the NHC programs ... we're all just going to pay more for health care. Meanwhile the Federal government ahve failed to regulate and to rein in the exorbitant profits of the pharmaceutical and medical insurance industries, who have realized respective profit margins of 25% (Phar. Ind.) and 5% to 6% (insurance ind.). They are allowing these industries to continue to exploit the American people. Where is the common sense in any of this?

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MedSecurityGuru wrote on 07/06/2010 01:14:09 PM:

EHR's have been around for several years. Some are good and some not so good. Doctors now have to face the task of deciding which one is right for me AND has it met the requirements set forth by the Department of Health and Human Services? Right now there over 9,000 different makes of EHR software.
Also how does this EHR software handle medical imaging and files from support groups like labs, etc?
Now lets add something else to consider. Does the data center in which I store my medical records have the right level of security to house and share medical records. All Data Centers are not created equal!
Does the data center have redundant engress and egress so that should the need arise the record might be shared with two or more physicians?
If you don't know what to ask and can't decipher what someone tells you, you need to ask someone who knows the answers.

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CooperCity wrote on 07/06/2010 11:53:06 AM:
Information sharing is the way to go. Accessing any sensitive information by mobile devices is a very bad idea. It should only be done with wired computers with great firewalls. You think doctors will spend the money to safeguard your personal info? Think again.

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brainsprain wrote on 07/06/2010 11:07:39 AM:

The positives outweigh the negatives. Yes, it is expensive, but how expensive is it for a nurse, clerk whatever to sit and ask the same questions over and over again because one happens to be in a different doctors office or hospital. Faxing is also quite expensive as is shipping. The conflicts in systems could be easily overcome, look at all the info that is available online because the info is web based in some way or the other.

The medical folk at the top want not only to protect my privacy, they want to hold the information as if were theirs. That is the only reason these various companies cannot set up the systems to interact fluidly. It's the money.

As for privacy, most of our information that should be private is not. Do I really care that the world knows I had a physical or was treated for cancer. Oh, that's right the insurance company may raise my rate or exclude me for a condition. Solution was Obama Care that makes it illegal for them to do so. All one needs to do is check their credit rating and they discover that what we need kept private most (financial info) is available to any Joe or Jill who will pay for it. They don't even need our permission.

We can protect our medical privacy far more easily than we can protect our financial, our tax returns or retirement fund accounts if the system is set up right.

But no system is flawless. At this point anyone who wants can view your medical records just by going into a doctor's office. There is always a way.

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shotman wrote on 07/06/2010 10:15:01 AM:
This won't reduce costs. Take the EKG example, even though it was done 90 minutes earlier in a doctor's office, an EKG is a point in time look at the heart's electrical system and if there is a change in condition, it should be repeated. Plus hospitals won't take the risk of a lawsuit to save the cost of an EKG. They don't know if the doctor's office EKG is calibrated or working correctly. Also do you think that EKG was inputted into the EMR immediately? No doctor's offices take days or even weeks for them to be entered. Same goes for lab work.

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andrejk wrote on 07/06/2010 09:38:55 AM:
Damocles sword. Wow-- few controversies with so many obvious and profound pros and cons at the same time. The potential abuse of privacy is huge. On the other hand, the convenience, efficiencies and research potential and long run savings are fantastic. Obviously, we'll have to take the plunge at some point. Since we are doing this, what dismays me is the shocking fact that there are multiple systems?! I think the AMA and the CDC and the insurance companies should take this transitional opportunnity to MANDATE highly detaile dand STANDARDIZED medical record forms for EVERYTHING. An invoice, report, or record from hospital in Fairbankis should look EXACTLY the same as one from Key West down to the dianosis and billing codes and font type
.

Read more: http://www.miamiherald.com/2010/07/06/v-fullstory/1716657/medical-records-go-online-but.html#ixzz0sxGDhRMo