Do No Harm??????

In January, University of Utah hospital surgeons removed half the skull of Briana Lane, age 22 and unemployed, in order to save her life after an auto accident, but because putting the skull back in place was not quite an emergency, it was delayed by negotiations over cost. The skull remained in a freezer for three months, with Lane battling serious pain (and wearing a plastic helmet for protection, feeling her brain "shifting" on her) while the hospital negotiated with the state Medicaid office, which pays only for long-term "disabilities." Her skull was finally reattached on April 30. [Salt Lake Tribune-AP, 5-11-04

Portraits by an artist in a fight for his young life 4-year-old's paintings help pay for his treatment

About two dozen new works of art on exhibit at the Fresno Art Museum may strike some patrons as somewhat juvenile.

They are abstract. One is a collection of circles and dots. Another is a depiction of rudimentary bicycles of varying sizes and clarity.

Earlier works by the painter have sold for as much as $7,500, purchased by collectors drawn by the talent and financial need of the artist -- a 4-year-old boy with leukemia.

Parker Fritsch, who lives in Fresno, was diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia two years ago. The disease is an aggressive malignancy that the American Cancer Society says strikes 3% of children with acute lymphoblastic leukemia, the most common form of childhood cancer.

Parker has been treated with chemotherapy and is in remission. But he might need a bone marrow transplant, and the search for a match is expected to cost his family $250,000 because of the number of potential donors who must be tested.

Parker is helping pay for the search, putting to use a talent that his mother, an art teacher, discovered when he was just 18 months old.

''Most little kids will take all the paint and blend it on the paper and make it brown, but he didn't do that,'' Melissa Fritsch says.

At a friend's suggestion, the toddler's parents donated one of his paintings to a charity function at Children's Hospital Central California in Madera, Calif. The painting sold for $1,600, and the family realized that Parker could contribute a lot to his own cause.

''It just kind of snowballed, and he has sold somewhere in the neighborhood of $30,000 of artwork so far, all for charity,'' his mother says.

Parker's paintings will be displayed at the museum through July 10, when they will be auctioned off. Nicole Gonzales, the museum's marketing director, says she understands why there has been such an outpouring of interest in Parker's artwork.

''It's inspiring and it feels good to the person who is bidding that the money is going to a good cause,'' she says. ''It puts a face on the disease, and the artwork is something nice to have in a home.''

Friends of the Fritsch family have long been active in charity functions. ''I believe that the more support you have, the better chances of survival you have,'' says Marilyn Kelarjian, who has become a coordinator and activist on the boy's behalf.

''When he was diagnosed, it was a knee-jerk reaction for me to do something to help.''

Two charity golf tournaments have contributed to Parker's medical expenses, and a team inspired by his story participated in a 100-mile bike ride to benefit the Leukemia and Lymphoma Society.

Parker's family has been overwhelmed by the outpouring of concern and generosity from friends and strangers.

''It's amazing to me how much love a little boy can bring into your life,'' Melissa Fritsch says. ''You do whatever you can, and the littlest things have meant so much to us.''

Experts stress post-exercise nutrition

Two decades of research have shown that consuming carbs after a hard workout rebuilds worn muscles and primes the body for the next training. Failure to eat the right food after exercise — or worse — skipping the post-exercise meal altogether can harm your body.

"You never think that you can just continue to ride your car without ever going to the gas station. We can't expect to be able to continue to exercise our bodies without refueling them," said Cedric Bryant, chief exercise physiologist of the American Council on Exercise.

Carbs — the main source of energy during physical activity — are stored as glycogen in muscle cells. During exercise, the glycogen reserves deplete and an intake of carbs is needed to replenish the body. Neglecting or avoiding the post-workout meal could result in muscle breakdown and leave your body feeling fatigued during the next workout.

In 2000, the American College of Sports Medicine, along with the American Dietetic Association and the Dietitians of Canada, reviewed numerous studies on the subject and took a stand on the issue. In a published joint position statement, they acknowledged the importance of post-game nutrition on athletic performance.

How much carbs should be eaten after exercise depends on the duration and intensity of the workout, as well as when the next training will occur. For example, a post-workout meal is generally more essential for a triathlete who runs in the morning and cycles in the afternoon than a marathoner who just runs one race. That's because the triathlete needs to refuel in between workouts while the marathoner has more time between runs to recover.

Experts recommend that carbs be eaten 30 minutes to an hour after vigorous exercise since that's when the body will act like a sponge and absorb the nutrients. Some post-workout snacks may include cooked pasta, rice, English muffin, oatmeal or low-fat yogurt.

The casual health club visitor may not need to follow the post-workout rule as strictly because the body will naturally take in carbs from other meals during the day. But experts say it doesn't hurt to consume a carb-rich snack after workout to get a boost of energy.

Recent research shows that a combination of carbs and protein can also help the body recoup. Protein helps repair muscle damage, but carbs are king when it comes to replenishing carbohydrate stores. Eating too much protein after exercise is not good either because it can slow rehydration.

The general guideline is a carb intake of a half-gram per pound of body weight. So a 150-pound person should eat about 75 grams of carbs, or the equivalent of a cup of cooked pasta.

"That is really going to be the only way that you're going to be able to continue to power your working muscles," said Cindy Moore, a Cleveland-based registered dietitian and spokeswoman for the American Dietetic Association.

For those who are weight-conscious and wary about consuming too many carbs, experts say they still should make sure to eat the right food after intense exercise. But they can take steps like limiting carb-rich snacks that are high in simple sugars like cookies and cakes and eat more nutritious carb sources like legumes and whole-grain cereals.

"This isn't going to sabotage weight-loss efforts," Bryant said. "If anything, it will allow you to be more productive in your exercise, which in the long term is going to help you with your weight-loss efforts."

Nancy Clark, nutrition guidebook author and sports nutritionist at a fitness center in Chestnut Hill, Mass., advises that athletes plan their post-workout meal in advance to prevent unhealthy snacking afterward.

Lisa Avellino, a certified personal trainer and aerobics instructor from Scarsdale, N.Y., said most of her clients understand the importance of eating after exercising, many do not know the correct food ratios and combinations to maximize their energy.

"When they learn how they can combine certain foods and make subtle changes in their dietary post-workout meal, they get better results," she said.

Some doctors want cash payment — and their patients aren't complaining

 When Chuck O'Brien visits his doctor, they talk about his aches and pains, his heart problems and his diet, but never about his health insurance.

That's because his doctor only accepts cash.

Dr. Vern Cherewatenko is one of a small but growing number of physicians across the country who are dumping complicated insurance contracts in favor of simple cash payments.

When O'Brien leaves the exam room, he writes a check for $50 and he's done — no forms, no ID numbers, no copayments.

"This is traditional medicine. This is what America was like 30 years ago," said O'Brien, 55 and self-employed, who believes he has saved thousands of dollars by dropping his expensive insurance policy and paying cash. "It's a whole world of difference."

Is this the health care wave of the future? Probably not, experts say. Most people are content with monthly premiums and $10 copays; nine out of 10 doctors contract with managed-care companies.

But cash-only medicine is becoming an increasingly attractive option for doctors frustrated by red tape and for the 43 million Americans who lack health insurance.

"It's a terrible indictment of the collapsing health care system," said Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania Medical School. "Insurance and managed care were supposed to streamline — instead what they've done is add so much paperwork and bureaucracy they're driving some doctors out."

Health insurers downplay the trend, while emphasizing recent efforts to mend tattered relationships between doctors and managed care companies.

"I don't look at it as a threat," said Mohit Ghose, spokesman for the industry group America's Health Insurance Plans. "It's just a different way of practicing."

Medical establishment leaders don't object to doctors working for simple cash.

"This is America. One size does not fit all," said Dr. John C. Nelson, president-elect of the American Medical Association. "We certainly support the physicians' right to do that."

An obstetrician-gynecologist in Salt Lake City, Nelson easily recalled times when he believed managed care rules prevented his patients from getting the best treatment. He said cash-only doctors are driven by the desire to practice medicine without interference.

"There is a great intrusion by third parties into the patient-physician relationship," Nelson said. "We can understand their frustration."

Cherewatenko, a broad-shouldered 45-year-old who wears black jackets and red stethoscopes at work, switched to cash out of desperation six years ago. His suburban Seattle practice was hemorrhaging money, and he and his partners realized they were spending hundreds of thousands of dollars just to process insurance paperwork.

"We said, 'Let's cut out this administrative waste,'" Cherewatenko said. Before, he charged $79 for an office visit and got $43 from an insurance company months later, minus the $20 in staff time it took to collect the payment. Now he charges $50 — and he never worries about collection costs, because patients pay in full after every visit.

Cherewatenko sees fewer patients now. His whole office would probably fit inside his old waiting room. But he says the freedom is worth it.

"Accounts receivable is zero. It's a great feeling," Cherewatenko said. "I feel like I'm a real doctor again."

He started a group called SimpleCare to spread the gospel of cash-only medicine. The organization steers patients to doctors who offer cash discounts, and gives technical and moral support to doctors who want to start cutting their ties to insurance. Membership has grown to 22,000 patient members and 1,500 doctors. Some reject all insurance and take only cash, while others continue to accept insurance while offering discounts of 15% to 50% for cash-paying patients.

Independent of SimpleCare, doctors in California, Colorado, Minnesota, Texas, Mississippi and other states have also quit the insurance game. Some tired of the paperwork and administrative expenses. Some wanted to spend more time with patients without managed care bean-counters peering over their shoulders. The patients who pay cash range from poor to wealthy, with most in the blue-collar middle.

"When I first started, I thought it would be the elite. That's not the case," said Dr. Shelley Giebel, an obstetrician-gynecologist in Temple, Texas, who washed her hands of insurance eight years ago.

Her standard, hour-long annual checkup costs $140. Everyone pays cash.

If a patient needs extra tests or treatment, Giebel tells them upfront what it will cost.

"If it is an urgent test, we'll go ahead and do it. We're not going to delay medical care because they don't have the money in hand," she said. Often, patients return later with the money.

"It has usually not been a problem that people forgo medical care," she said.

The cash-only movement isn't just changing the way people pay, it's changing the way these doctors work. Because of managed care's low reimbursement rates, doctors on insurance contracts must limit their time with each patient.

Giebel, a typical example, said she would have to double her patient load to make ends meet if she relied on insurance — something she can't imagine. "How can you possibly talk about prevention of cancer and heart disease when you're seeing patients every 12 minutes?" she asked.

Cash-only patients rave about the quality of care.

"They take time here with you," said Jesse Rainwater, a 59-year-old church pastor from Bellevue, Wash., who credits Cherewatenko with teaching him to manage his diabetes. "They don't just bring you in and run you out like a bunch of cattle. You feel like you're loved."

The cash-only approach evokes Norman Rockwell-tinged visions of country doctors being paid with chickens. The simplicity is tempting, but the truth is many people went without preventive health care in those "good old days." A $50 charge can be powerful incentive to delay seeing a doctor until you're in pain — which can lead to more expensive health problems later.

"Medicine used to be a cash-only business, and there were certainly many people who didn't have the cash," said Caplan, the medical ethicist. Doctors who insist on cash also have an ethical obligation to help people who can't afford the fee, he said — even if it means accepting chickens.

Cash crusaders acknowledge the need for some type of insurance. Without it, expensive surgery or hospitalization would force most people into bankruptcy. But they think health insurance should work more like car insurance: you pay for the routine maintenance and little dings yourself, and insurance pays for more expensive repairs.

O'Brien, a freelance marketing specialist, switched from a comprehensive health plan with $300 monthly premiums to a catastrophic plan that costs $75 a month, with a $2,000 deductible. He pays out-of-pocket for routine checkups, and his insurance will kick in if he ever needs expensive care.

The promise of a simple cash payment lured him to Cherewatenko's office, but the doctor's personal attention keeps him coming back. The $50 exams are just part of the bargain for O'Brien. Cherewatenko recently met him for coffee to talk about improving his diet — including an admonition to cut back on caffeine.

"How often does your doctor go out and have a cup of coffee with you?" O'Brien asked.

Green Tea Component Kills Leukemia Cells


 A component of green tea helps kill cells of B-cell chronic lymphocytic leukemia (CLL), the second most common leukemia in American adults, according to new research.
Mayo Clinic researchers found that the component, called epigallocatechin-3-gallate (EGCG), destroys leukemia cells by interrupting the communication signals they need to survive. The research appears online in the journal Blood.

CLL is most often diagnosed in people in their mid-to-late 60s. Chemotherapy is used to treat the most severe cases, but there is no cure for CLL.

In this study, the Mayo scientists found that EGCG prompted leukemia cells to die in eight of 10 patient samples tested in a laboratory.

"We're continuing to look for therapeutic agents that are nontoxic to the patient but kill cancer cells, and this finding with EGCG is an excellent start," study leader Dr. Neil E. Kay said in a prepared statement. "Understanding this mechanism and getting these positive early results gives us a lot to work with in terms of offering patients with this disease more effective, easily tolerated therapies earlier."

A Surprising Reason Why Soft Drinks Make You Fat
The rate of obesity in the U.S. started to increase in the 1970s, about the same time that manufacturers switched from sugar to cheaper corn syrup for their colas and other soft drinks. Now researchers say this may be because high fructose corn syrup—a food, like margarine, that is created in the lab and not found in nature—does not trigger the same appetite response in the body as sugar, so it's more likely to make us fat.

Connoisseurs who remember the great taste of old-time sodas try to find Kosher Coke and Coca-Cola bottled in Mexico, where it's still made with sugar. But these sodas may not just taste better; the cost-cutting measures of major manufacturers may be the leading cause of obesity in America. Obesity researcher Dr. George A. Bray says the rise in corn sweeteners is "coincidental with the epidemic of obesity. Body weights rose slowly for most of the 20th century until the late 1980s. At that time, many countries showed a sudden increase in the rate at which obesity has been galloping forward."

Unlike glucose (sugar), fructose doesn't trigger responses in the hormones that regulate your appetite and energy output, meaning it's much more likely to be converted into fat.

"Fake foods" have been a major cause of disease in the past few years. Margarine, which replaced butter when it was scarce during World War II, was once touted by the American Heart Association as a miracle food that lowered cholesterol levels. It's now been shown to do just the opposite and we're warned not to eat it.

Despite being vegetarians, cows were fed protein in the form of the ground-up bones of other cows, leading to Mad Cow Disease.

High-fructose corn syrup made soft drinks cheap, especially after we could no longer import sugar from Cuba. Like all the other "fake foods" of recent years, it was created so manufacturers could cut costs and make more profit. And like the other fakes, it has ended up costing the public large amounts of money for treating heart disease, obesity and for Mad Cow monitoring.

What will they try to sell us next?

From USA Today

06/04.2004

Child obesity worse than thought, study suggests

Childhood obesity in the USA looks significantly worse than previously believed, suggests the largest assessment ever of public school students.

The report, released Thursday, indicates 40% of students in Arkansas are overweight or at risk of becoming so. Currently, the U.S. government estimates that 30% of the nation's kids are overweight or on their way to being too heavy.

Arkansas is one of the nation's poorest states, and low-income adults are known to have high obesity levels. But researchers say the study's numbers show problems across income levels.

''As more data comes in, I think it's going to be this bad everywhere. I don't think it's isolated to Arkansas,'' says Carden Johnston, president of the American Academy of Pediatrics.

''The epidemic of obesity in children is advancing much more quickly than the (Centers for Disease Control and Prevention) and others predicted,'' says pediatrician Joe Thompson, director of the Arkansas Center for Health Improvement, a non-profit organization that analyzed the data.

William Dietz of the CDC says, ''Either this reflects an ongoing increase in the prevalence of overweight children or that Arkansas has a more severe problem than other parts of the country. Either way it's bad news.''

Children who weigh too much are at a greater risk of becoming heavy adults, are more likely to have low self-esteem and have a greater chance of developing health complications such as diabetes, high blood pressure and bone and joint problems.

Arkansas is the only state to require that its 450,000 students from kindergarten to 12th grade have their height and weight measured to determine their body mass index (BMI), a formula that also considers age and gender.

Among findings reported at the Time/ABC News summit on obesity in Williamsburg, Va.:

* 22% of the students are overweight; 18% show signs of developing weight problems.

* 58% are in the normal weight range; 2% are underweight.

* African-American and Hispanic students are more likely to be overweight or at risk of becoming so than white children.

The state will send letters home to parents this summer. If the child is reported to be overweight, parents will be advised to ask their doctor whether it is a problem, Thompson says.

In some cases, really muscular kids may not actually be overweight, he says. ''One in four of our high school boys are overweight and some of them may have the muscles of Arnold Schwarzenegger, but most clearly have a problem with obesity,'' he says.

Parents of overweight kids are advised to reduce the children's TV time, increase their physical activity and suggest low-calorie beverages.

05/18/2004

Study: Low-carb not a slimmer diet But research finds other advantages

In the largest study of its kind, researchers have found that dieters on low-carbohydrate plans don't lose more weight over the long term than traditional dieters.

But there's good news for carb-counters: They get greater improvement in their levels of triglycerides, blood fats linked to coronary disease. That is important because nutritionists have raised concern for years over low-carb diets' high intake of saturated animal fat and its potential impact on the heart.

Millions are on Atkins and similar diets that push beef, fish, chicken, pork, cheese and high-fat salad dressings but slash carbohydrates, including sweets, potatoes, bread and pasta, starchy vegetables and many fruits.

Researchers at the Veterans Affairs Medical Center in Philadelphia followed 132 obese adults for a year. Half were told to try to eat less than 30 grams of carbs a day. The others were told to follow a more conventional plan: cutting 500 calories a day and limiting fat to 30% of calories.

Findings in today's Annals of Internal Medicine:

* At six months, the low-carb group had lost an average of 13 pounds; the conventional dieters lost about 4 pounds.

* After a year, the low-carb group was down an average of 11 pounds. The other group continued to lose and was down an average of 8 pounds. The difference was not statistically significant.

* The low-carb group had a decrease in triglycerides, and diabetics in the group had better control of their blood sugar.

* Both diet groups had fairly high dropout rates. Almost a third of the dieters quit.

''Cutting back on carbohydrates for most Americans means getting rid of junk food like French fries, sodas, doughnuts,'' says Linda Stern, the study's lead author.

A second study, conducted at Duke University, also found that low-carb dieters had better improvements in triglycerides and ''good'' cholesterol. Duke tracked 120 overweight people for six months. Low-carb dieters lost an average of 26 pounds, compared with 14 for traditional dieters.

The Duke study, also published in the medical journal, was funded by the Atkins Foundation.

03/29/2004

Is high-fructose corn syrup the culprit? Sweetener feeds obesity problem, researchers say

High-fructose corn sweeteners in soft drinks and other products may be contributing significantly to obesity in the USA, researchers said last week. But that conclusion is drawing fire from industry and consumer groups.

Almost 65% of Americans are either overweight or obese today, compared with 47% in the 1970s. Experts believe that is a result of many factors, including a decrease in physical activity, larger portion sizes, high-calorie fare and the availability of food everywhere.

High-fructose corn sweeteners, which are cheaper to produce than sugars from cane and beets, began being more widely used in the late 1980s and 1990s, when Americans' weight started creeping up, says Barry Popkin, a nutrition professor at the University of North Carolina-Chapel Hill.

Popkin and other researchers examined government food-consumption data from 1967 to 2000 as well as other studies and found that Americans age 2 and above get an average 132 calories a day from high-fructose corn sweeteners, mostly in soft drinks, compared with 80 calories in 1977. The study is in April's American Journal of Clinical Nutrition.

''We know from animal studies that fructose doesn't affect appetite,'' Popkin says. ''So if you drink a soft drink, you don't get filled up like you would if you drank milk.'' That means that if you were hungry when you consumed the drink, you would need to consume additional calories from some other food or beverage, he says.

Others disagree. The researchers ''give the impression that high-fructose corn syrup is the secret reason Americans are all obese, and that is patently false,'' says Stephanie Childs of the Grocery Manufacturers of America, a trade group representing Coca-Cola Co., PepsiCo and others.

''High-fructose corn syrup is very similar to sugar in its chemical makeup. We are overweight and have an obesity epidemic because we have an imbalance in how many calories we consume and how many we burn,'' she says.

Michael Jacobson, executive director of the Center for Science in the Public Interest, a Washington-based consumer group, says there's no nutritional difference in the soft drinks that decades ago were sweetened with table sugar, or sucrose, and those sold today with high-fructose corn sweeteners.

He says either blend would contribute to a weight problem because of the increase in container sizes and the mass distribution of soft drinks.

From USA Today

FDA issues new rules vs. mad cow disease Materials banned from human use

Six months after the discovery of the first U.S. case of mad cow disease, the Food and Drug Administration issued long-delayed rules Friday banning nervous system tissue and other cattle parts from use in human food, dietary supplements and cosmetics.

The ban prohibits the use of the brain, skull, eyes and spinal cord tissue -- where infectious agents of the brain-wasting disease first appear -- from animals 30 months and older. Banned from all cattle are tonsils and small intestines and material from cattle that cannot stand up on their own.

Manufacturers and processors must immediately cease using any of those materials.

The agency also is seeking public and industry comment on a proposed ban on the use of the materials in animal feed.

The rules bring the FDA in line with those issued by the U.S. Department of Agriculture just weeks after the discovery in December of a diseased cow in Washington state. The FDA ensures that food for humans as well as animals is pure, wholesome and does not contain unsafe additives.

But the agency might not finalize all its animal feed rules until 2006, says Stephen Sundlof, director of the FDA's Center for Veterinary Medicine, and that has food safety advocates up in arms.

Jean Halloran of Consumers Union said while the FDA mulls its options, ''this dangerous material is still being fed to the cows.''

The FDA strengthened feed rules in 1997 and proposed new rules banning the feeding of potentially infectious material to cattle in November 2002. The proposals included bans on feeding cattle restaurant leftovers, poultry litter and dried cattle blood.

Mad cow disease, known to scientists as bovine spongiform encephalopathy, is spread when the infected animals are recycled into feed. People who eat infected meat risk contracting a rare but fatal human condition, variant Creutzfeldt-Jakob disease.

''The Bush administration has reneged on its pledge to take additional steps to protect human and animal health from BSE,'' says Carol Tucker Foreman of the Consumer Federation of America.

But Sundlof says the broader feed rule on which the FDA is seeking comment may supercede the prohibitions it proposed earlier. By removing specified risk materials (brain, skull, eyes, spinal cord, small intestine, tonsils), ''you take about 90% of all the infectivity out of the system altogether,'' he says.

The FDA hopes to have the new feed rules in place within eight months, Sundloff says. ''Focusing our attention on the highest-risk materials and eliminating those from the animal feed supply will take us very far, and then we can sort through the rest.''

Study: Not all kids with glasses need them Many will outgrow mild farsightedness

A study released today finds that up to 25% of children with normal eyes who have comprehensive vision exams may be prescribed glasses they don't need.

In an article published online in the Journal of the American Association of Pediatric Ophthalmology and Strabismus, researchers examined the records of more than 100,000 preschoolers who were screened through a statewide program in Tennessee.

More than 3,600 children were referred to specialists for follow-ups because of suspected disorders, such as lazy eye, according to the study. About one-quarter, or 890, were found to have no eye problems. Yet nearly one in five of these children were prescribed glasses.

Some health professionals were more likely to misdiagnose kids than others, says Sean Donahue, lead study author and an associate professor of ophthalmology, pediatrics and neurology at Vanderbilt University School of Medicine. Optometrists prescribed glasses 35% of the time; general ophthalmologists, 12%; and pediatric ophthalmologists, 2%, the study shows.

To Donahue, that suggests optometrists and ophthalmologists who usually treat adults may not have as much expertise with children. Many youngsters are slightly farsighted, he says, although most will grow out of the condition without glasses.

Though many doctors recommend that preschoolers should be screened for vision problems, experts disagree about the best approach. Kentucky requires that youngsters undergo comprehensive eye exams before beginning school.

Donahue says states should carefully examine such expenses before following Kentucky's example. Given the high level of misdiagnoses, Donahue says, such laws could be expensive. Glasses cost about $150; exams add another $100.

Instead of forcing all preschoolers to get a formal exam, he says, kids could be screened by doctors, teachers, nurses or others, then referred to eye specialists for further examination.

Susan Taub, an assistant professor of ophthalmology at Northwestern University, says she is concerned that many children have undiagnosed eye disorders, which can cause permanent damage or hurt their ability to learn.

Doctors still do not know which tests or technology work best, Taub says. ''This does need further study. We don't want kids to fall through the cracks.''

Toxic attack on cows points to reporting problems Time lag called disturbing in light of Sept. 11 and food supply concerns

An attack in which Washington state cows were coated with a toxic substance went unreported to federal officials for 10 days, a performance that local and national officials say is unacceptable when there are concerns about the safety of the nation's food supply.

The incident involved 10 dairy cows in Enumclaw, 35 miles southeast of Seattle. The animals were painted June 5 with a sticky red substance that caused welts, oozing sores and internal bleeding.

Three of the cows died; seven are recovering. Food and Drug Administration testing later identified the substance as chromium, used in dyes and as a wood preservative. No milk from the cows entered the food supply, the FDA said Wednesday.

It is unknown who attacked the cows. Initial news reports said it was related to a labor dispute. But whatever the motivation, officials say the incident represents a failure to take potential agriculture contamination seriously, particularly in the wake of the Sept. 11 terrorist attacks.

''If this were a first test case, the system failed,'' says a senior federal government official familiar with the incident. ''If there were to be a real event, God help us all, because this just demonstrates how little has really been done'' to make local officials aware of potential problems.

Farmer John Koopman discovered that his animals were ailing the morning of June 6, and immediately called his veterinarian and the King County Sheriff's office. It took the sheriff's department ''two, three, four days'' to contact the state Agriculture Department, says Sgt. John Urquhart of the sheriff's office. It then took another week, until June 16, for someone to tell Ken Parrish, the state Agriculture Department's liaison to the U.S. Department of Homeland Security. He then followed emergency procedures, setting in motion the chain of events that brought in Homeland Security, FDA and the U.S. Department of Agriculture.

What took place over 10 days should have happened soon after the farmer discovered the sick cows, according to officials. The incident is under investigation by the federal agencies involved.

''Any time something like that happens, we want to find out about things as soon as possible,'' says Robert Brackett, FDA's director of food safety. ''People want to make sure that they're not giving a false alarm and causing disruption when it's not needed. But now with the increased awareness, everybody has a role to play in securing the country,'' he says.

''Since Sept. 11, we just have to start thinking about things in a new way. And we're not very good at it yet,'' says Kate Sandboe of the state Agriculture Department. ''Our minds don't run to (potential bioterrorism) immediately.''

There has been no cohesive homeland-security plan involving agriculture and funding has been haphazard, resulting in ''lots of little pieces in place,'' says Orlo Ehart of the National Association of State Departments of Agriculture in Washington, D.C.

Before the Sept. 11 attacks, federal authorities likely wouldn't have been involved until the toxic substance was identified, says Ehart. ''Washington state is a long way from the East Coast. And while you may think you're doing your job, you may not be in tune with the new issues,'' he says.

Officials say the incident is particularly disturbing because Washington state has been ground zero for other food safety issues in the past 10 years, including the E. coli outbreak in 1993 and last year's discovery of the nation's first case of mad cow disease.

''The food system is complex, and it takes a complex response to make sure that these delays don't happen,'' says Steve Cain, homeland security project director for the Extension Disaster Education Network, a national group of agricultural extension workers.

TRAVEL Cruise-ship stomach virus picking up steam again

Remember all the hubbub over stomach illness on cruise ships? It's back.

Industry newsletter Cruise Week reports that 1,355 cases of norovirus-like illness occurred on 12 ships during the first five months of the year. That's almost double the 700 cases recorded on seven ships during the same period a year ago.

The latest outbreak occurred last week when 66 passengers on an Alaskan cruise aboard the Island Princess came down with the illness. It followed a wider breakout on the ship the week before that affected 425 -- the industry's largest recorded incident since 1994. Other ships reporting outbreaks this year include the Norwegian Crown, Holland America's Veendam and Ryndam, Celebrity's Zenith and Horizon, Cunard's Queen Mary 2, Carnival's Celebration and Royal Caribbean's Brilliance of the Seas.

Outbreaks made headlines in late 2002 when the disease ran through seven ships, causing 1,340 reported cases. The U.S. Centers for Disease Control, which tracks outbreaks on cruise ships, says the illness is common nationwide during the winter.

05/18/2004

Autism's surge mystifies Broader definition of disorder fails to explain dramatic rise in number of children afflicted

Autism, once a rare and mysterious disorder, is no longer so rare. A generation ago, only two to four of every 10,000 children were labeled autistic. Today, it's more like 60 per 10,000 by some estimates.

But no one knows why. Experts cite a much greater awareness of autism and related conditions, grouped as Autism Spectrum Disorders (ASD), and a broader definition that has allowed children who might otherwise have been overlooked to receive a diagnosis. But they also say there has been an actual increase, and the reasons for that are not entirely clear -- though there are plenty of theories.

ASD, usually noticed by the time a child is 3, is four times more common in boys than girls. It affects social interaction, communication and behavior, but there is wide variety in symptoms. Some children don't speak. Some are talkative, but don't make eye contact. Some are clingy, while others hate being held.

''Years ago autism was a very rare diagnosis,'' says embryologist Patricia Rodier of the University of Rochester Medical Center, partly because there was no impetus for doctors to label a child as autistic. ''It did not qualify you for special education. No one in good conscience could give that diagnosis, because you couldn't get special education.''

That has changed. The number of children identified by schools as having ASD has risen by nearly 18% since the early 1990s.

Susie Kelly of Laurel, Del., says she and her husband, Tom, suspected very early that their second child, Mark, now 9, was not like other toddlers. The first clue was his reaction to surprises.

''If someone came into the house he would cry, or when he was visiting his grandmother, if his aunt came in, he'd have a fit because that wasn't what his expectation was,'' she says.

She was certain something was wrong one day when she stopped off to buy doughnuts as she was driving him to day care. ''It blew his mind because I took a different route.''

Mark was finally diagnosed at age 3, and to the Kellys, ''it was almost a relief, because we had a name for it.'' Almost.

''It was devastating,'' she says, choking up. ''And I didn't even know what it meant then. It was continuous grieving.''

The Kellys moved from Maryland to Delaware, where a comprehensive program of care is available for Mark through age 20.

The rising incidence of autism and effective lobbying by parent groups have sped the pace of research into causes and treatments for developmental disorders.

The National Institutes of Health has allocated $65 million in funding for a network of eight ''centers of excellence,'' where top researchers are narrowing in on genes that may play a role and are working to understand what causes them to go awry.

A mysterious disability

Evidence of a genetic basis for autism is strong. If one of a pair of identical twins is autistic, 90% of the time the other is too, says Eric Hollander of the Seaver Center for Autism Research and Treatment at Mount Sinai School of Medicine. Researchers have found genetic mutations linked to autism, and most believe several such mutations must occur before autism results. In an April report in the American Journal of Psychiatry, Mount Sinai researchers reported the discovery of a gene that doubles the odds of autism in those who carry it, or one of its variants.

''We know there are genetic factors,'' Hollander says, but something else may also be involved. ''It is possible there are environmental factors'' that trigger the genes.

Several possibilities have been investigated, from junk-food diets, which are high in fatty acids that could interfere with the coating of nerve cells in the brain, to a drug used to induce labor in pregnant women. But no environmental link has been found.

Embryologist Patricia Rodier of the University of Rochester Medical Center and her colleagues say whatever happens to the developing brain may occur very early in pregnancy. ''We're fascinated by the fact that symptoms of autism appear in a number of congenital conditions that we know arise a few weeks after conception,'' she says. In addition, maternal exposure to some substances known to cause birth defects, such as the German measles virus and alcohol, also increases the risk of autism.

Another area of interest is the possible link between autism and immune-system disorders.

An immune-system link is supported by some doctors and parents of children with autism who believe that a mercury-based preservative that has been used in childhood vaccines is at the core of the problem.

Thimerosal is being phased out of most vaccines for children, but some lots that contain the preservative are thought to be on doctor's shelves. Some studies have suggested that children with autism are less able than others to expel mercury from their systems, and some parent groups think multiple vaccines given to young children weaken the immune system and allow a build-up of mercury in developing brains.

Other scientists say this theory has been thoroughly investigated, but no conclusive evidence has been found. They say a continued focus by activists on thimerosal may undermine confidence in vaccines and divert funding from more promising theories. The Institute of Medicine, which provides advice on science and health to government, is expected to release a report today that conclusively dismisses the theory of thimerosal as a cause of autism.

'False hopes' for an affected child

Today, Mark Kelly is an affectionate, talkative boy. He loves his sister Laura, 10, and likes to play, though he doesn't play with other children, his mother says. He's in a special school for autistic children.

Progress is being made and there is more information available to parents than there was even five years ago, Susie Kelly says.

''We had false hopes he'd be cured,'' she says. ''That didn't happen. He's clearly autistic. He's able to talk about what he needs or wants to do, but he can't really hold conversations. . . . Now we're looking toward a future where I don't think he'll be able to live on his own. I don't think he'll ever have a driver's license or a girlfriend.''

04/15/2004

Cattle feed rules unchanged New regulations tied up in red tape

Early this year the U.S. Food and Drug Administration, fearing the spread of mad cow disease, made a highly publicized announcement of major changes to materials that can be fed to cattle.

But almost three months later, the rules have yet to be changed, and potentially dangerous materials can still legally be fed to cows.

The agency has yet to write or publish new rules. ''We're still working on it,'' FDA spokesman Brad Stone says. ''We don't have a set time frame. We hope it will come up very soon.''

Cattle can get the brain-wasting disease only by eating food that contains protein from infected bovines. People who eat infected materials can contract a human version that also is deadly.

Industry critics and scientists applauded when the FDA announced on Jan. 26 that it was going to get rid of three loopholes in the feed ban it enacted in 1997 to protect the U.S. cattle supply from bovine spongiform encephalopathy.

One was the practice of feeding poultry litter to cattle, because poultry feed can include cattle remains. Another was feeding them restaurant-plate waste, which might contain beef. And another was giving feed and formula made from the blood of ruminants (cattle, sheep and goats) to cattle and calves.

Stone says that although the rules don't go into effect until they're published in the Federal Register, ''the purpose of our announcement was to give a strong indication of the fact that this is a practice on its way out. We anticipate that that's a message that was received by the industry.''

Not so, says Rex Runyan of the American Feed Industry Association. ''It's business as usual until they publish those rules. I don't know of any companies that have made any major changes based on rumors or speculation.''

''There's significant work being done on these FDA regulations . . . at the White House level,'' says Caroline Smith DeWaal of the Center for Science in the Public Interest. ''The Bush administration is catering to industry concerns.''

Smith DeWaal notes that the USDA implemented its own preventive measures -- including keeping disabled cows out of the food supply -- eight days after the discovery of the first U.S. case of mad cow. ''FDA isn't writing a regulation out of whole cloth here; they're merely strengthening and amending an existing one.''

04/12/2004

Help 'happy pill' patients separate hype and science

Is the honeymoon for ''happy pills'' finally over?

The recent warning from the Food and Drug Administration (FDA) that physicians need to closely monitor patients for suicide risk when first prescribing certain antidepressants sent shock waves through the 34 million Americans who suffer from depression. It also shook up the pharmaceutical giants that manufacture the drugs.

Ten drugs may be linked, the FDA says, to an increased suicide risk. Six of the drugs belong to a genre known as SSRIs, which are believed to