New York Times’ articles for first week of ENGL 202
Senate Approves Tight Regulation Over Cigarettes
Why I Now Support Gay Marriage
All-Night Care for Dementia’s Restless Minds
An A.D.H.D. Student Finds Confidence on the Track
Social Networks Spread Iranian Defiance Online
Tobacco Regulation Is Expected to Face a Free-Speech Challenge
New Glimpses of Life’s Puzzling Origins
Alcohol’s Good for You? Some Scientists Doubt It
Kid Goes Into McDonald’s and Orders ... Yogurt?
In Some Swimming Pools, a Nasty Intestinal Parasite
1952 Outbreak Has Echoes for 2009
June 12, 2009
1. Senate Approves Tight Regulation Over Cigarettes
By DUFF WILSON
WASHINGTON — More than four decades after the surgeon general declared smoking a health hazard, the Senate on Thursday cleared the final hurdle to empowering federal officials to regulate cigarettes and other forms of tobacco for the first time.
The legislation, which the White House said President Obama would sign as soon as it reached his desk, will enable the Food and Drug Administration to impose potentially strict new controls on the making and marketing of products that eventually kill half their regular users. The House, which passed a similar bill in April, may vote on the Senate version as soon as Friday.
“This is a historic step changing the nature of tobacco in society forever,” said Clifford E. Douglas, the director of the University of Michigan Tobacco Research Network, which has extensively studied the health effects of smoking and was one of many groups that have long pushed for tobacco regulation.
The Congressional Budget Office has estimated the new law would reduce youth smoking by 11 percent and adult smoking by 2 percent over the next decade, in addition to reductions already achieved through other actions, like higher taxes and smoke-free indoor space laws.
The Family Smoking Prevention and Tobacco Control Act, as it is called, stops short of empowering the F.D.A. to outlaw smoking or ban nicotine — strictures that even most antismoking advocates acknowledged were not politically feasible and might drive people addicted to nicotine into a criminal black market.
But the law would give the F.D.A. power to set standards that could reduce nicotine content and regulate chemicals in cigarette smoke. The law also bans most tobacco flavorings, which are considered a lure to first-time smokers. Menthol was deferred to later studies. Health advocates predict that F.D.A. standards could eventually reduce some of the 60 carcinogens and 4,000 toxins in cigarette smoke, or make it taste so bad it deters users.
The law would also tighten restrictions on the marketing and advertising of tobacco products. Colorful ads and store displays will be replaced by black-and-white-only text. Beginning next year, all outdoor advertising of tobacco within 1,000 feet of schools and playgrounds would be illegal.
And cigarette makers will be required to stop using terms like “light” and “low tar” by next year and to place large, graphic health warnings on their packages by 2012.
“This is a bill not for a one-year or two-year splash, but for a long-term impact,” said Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, a Washington advocacy group that took a lead in coordinating support for the legislation.
Industry analysts say that the imposition of fees on cigarette companies to pay for the creation and administration of a new F.D.A. tobacco oversight department, which could eventually reach 6 cents a pack, could further raise the cost of smoking.
Industry analysts, though, predict that federal regulation, like higher taxes, will be manageable for the tobacco companies. As long as they have a market of addicted customers, even if that clientele is dwindling, they can raise prices to remain profitable.
The law would be the first big federal step against smoking since the 1971 ban against tobacco advertising on television and radio and the 1988 rules against smoking on airline flights — but potentially much more sweeping than either of those moves.
The law might also address the perceived shortcomings of the $206 billion “master settlement” agreement that seven tobacco companies reached with 46 states in 1998 to resolve lawsuits and change their marketing practices. Afterward, cigarette companies nearly doubled their marketing spending and increased their advertising in stores.
Although the nation’s smoking rate has gradually declined in recent years, an estimated one in five people in this country still smoke. And more than 400,000 of them die each year from smoking-related disease.
For decades, though, despite influential studies in the early 1950s linking smoking to cancer and even after the surgeon general’s report in 1964, Congressional efforts to regulate tobacco met stiff opposition from lawmakers from tobacco-growing states and their political allies.
And when the F.D.A. tried on its own to start regulating nicotine as a drug, the Supreme Court struck down that effort in 2000, saying the agency could not take such a step without Congressional authority. Cigarettes remained less regulated than cosmetics or pet food.
But this time the antitobacco forces came into alignment, with broad bipartisan support in Congress, where Mr. Obama — himself a smoker who has acknowledged his trouble in quitting the habit — had been a sponsor of the legislation when he was still in the Senate. The Senate passed the bill Thursday by a vote of 79 to 17. The only Democrat voting against it was Kay Hagan of the North Carolina, the leading tobacco-growing state.
Another political factor was the willingness of the nation’s biggest tobacco company, Altria Group — owner of Philip Morris and its industry-leading Marlboro brands — to accede to federal regulation. No other tobacco company supported the legislation.
Publicly, Altria pushed the legislation for “the greater predictability and stability we think it will bring to the tobacco industry,” as a spokesman, Brendan J. McCormick, said this week.
But the impulse dates to the 1990s, when according to Philip Morris documents released during lawsuits, the company decided to remake its image as a responsible corporate citizen. Part of that strategy was to advocate legislation to reduce the risks in cigarettes, and avoid smoking’s being outlawed outright.
Moreover, as the industry’s richest company, with profits last year of more than $3 billion, Altria, based in Richmond, Va., has built an extensive scientific research operation. It may thus be the company best equipped to deal with the F.D.A.’s new review process for new, ostensibly safer tobacco products.
Under the law, new smokeless tobacco and other products pitched as having lower health risks could be approved only if makers could demonstrate health benefits to society as a whole — meaning the products would not induce too many nonsmokers or would-be quitters to try them, rather than abstaining.
As Altria’s competitors have repeatedly argued in opposing the legislation, Altria stands to retain more market share if the advertising crackdown makes it harder for other companies to improve their sales standing.
Yet, even Altria said Thursday the legislation, while “an important step forward,” was “not perfect.” The Association of National Advertisers says the act’s “unprecedentedly broad advertising restrictions” violate First Amendment protections for commercial speech. Legal experts say a court challenge on that ground is virtually certain.
June 13, 2009
Op-Ed Columnist
By BOB HERBERT
Stephen Johns, known as “Big John,” was opening the door for a man he thought was just an elderly visitor to the U.S. Holocaust Memorial Museum in Washington when he was shot dead on Wednesday afternoon. Mr. Johns was a security guard. The bullet that killed him was a reminder of the continuing menace of bigotry and violence that pervades this country — and that we insist on underestimating.
The authorities have identified an 88-year-old, hard-core white supremacist, James von Brunn, as the killer. Our knee-jerk tendency is to comfort ourselves by declaring that this guy is so freakish, so far out of the American mainstream, that he is not representative of much of anything. Sane people are not violently obsessed with blacks and Jews. The murder was a tragic aberration. After all, this is a country that only recently elected an African-American president.
So let’s mop up the blood from the museum floor, and try to keep matters in perspective.
The problem when we think in terms of freaks and aberrations is that there are so many of them, which calls into question just how freakish or aberrational they really are. Was it an aberration when, according to authorities, Scott Roeder went into the lobby of a Lutheran church in Wichita two weeks ago and shot Dr. George Tiller to death? Hardly. The murder of Dr. Tiller, who was the nation’s most prominent provider of so-called late-term abortions, was the fourth assassination of an abortion provider in the U.S. since 1993.
Three Pittsburgh police officers were murdered in April by a man with a high-powered rifle who, according to authorities, was later linked to racist and anti-Semitic items posted on white supremacist Web sites. The man was identified as 22-year-old Richard Poplawski. According to the Anti-Defamation League, Poplawski, who wore a Nazi-style tattoo, believed Zionists were running the world and that President Obama was planning to crack down on gun ownership.
The madness is not limited to white supremacists by any means. A 23-year-old U.S. Army private, William Andrew Long, who had just completed basic training, was shot to death on June 1 outside a recruiting center in a suburb of Little Rock. Investigators said the man accused of killing him, a Muslim convert named Abdulhakim Muhammad, asserted that the killing was justified because of the treatment of Muslims by the U.S. military.
In 2002, a pair of snipers — John Allen Muhammad and his teenage accomplice, Lee Boyd Malvo, both black — spread terror as they roamed the Washington, D.C., area cold-bloodedly killing people. Their motives were a jumble, but a primary motive, according to Malvo, was to kill white people. Ten people were murdered before the pair was captured.
The truth, of course, is that there is nothing aberrational about hatred and murderous violence in the U.S. They are two of the most prominent touchstones of the culture, monumentally tragic flaws that have permeated the nation’s history from its earliest moments and that plague us still today.
Americans kill each other at roughly the rate of 16,000 a year! From racial violence to family violence to gang warfare to street crime to mass murder — the blood never stops flowing.
The white supremacist crowd is up in arms, literally, in large part because the tide has turned against them. In addition to the presence of Mr. Obama in the White House, racism and anti-Semitism are no longer tolerated as overt factors in American life. And demographic trends show whites becoming a steadily smaller percentage of the overall population.
But we should not pretend that things are better than they are. Racism is still a powerful force in the U.S., so powerful that the president, an African-American, is barely willing to mention race unless he absolutely has to.
And murderous violence is as much of a problem as ever.
The social fabric is extremely delicate and fragile. Forces bent on destruction, even if they are a tiny portion of the population, can tear it to pieces. With a black president, an extreme economic crisis and the fear generated by the continuing threat of international terrorism, the United States is exceptionally vulnerable to these virulently destructive forces.
We need to be vigilant. When I first heard about the murder of Mr. Johns and the violent desecration of the Holocaust museum, I thought of the Rev. Dr. Martin Luther King Jr., and how much we miss his moral leadership. He fought not just for civil rights, but against violence and injustice of all kinds, and he warned us of the debilitating effects of unnecessary warfare.
“He who passively accepts evil is as much involved in it as he who helps to perpetrate it,” said Dr. King.
The bullet that silenced him seemed to come out of nowhere, suddenly, aberrationally, like the bullet that destroyed Stephen Johns.
June 13, 2009
Op-Ed Columnist
3. Hate in a Cocoon of Silence
By CHARLES M. BLOW
We were warned.
An April assessment by the Department of Homeland Security’s Office of Intelligence and Analysis said pointedly: “Lone wolves and small terrorist cells embracing violent rightwing extremist ideology are the most dangerous domestic terrorism threat in the United States.”
Slowly, but steadily, these bigots are slithering from beneath their rocks, armed and deadly.
The most recent was an octogenarian-hater named James von Brunn, who, officials said, opened fire this week in the U.S. Holocaust Memorial Museum in Washington, killing a security guard.
Just as disturbing as the incidents themselves are the lineups of family, friends and neighbors who emerge to talk about the vitriol they heard and the warning signs they saw. I always want the interviewer to stop and ask them this simple question: “And when he said or did that, how did you respond?”
I would ask: What did you say or do as the shooters retreated into their xenophobic silo and consumed the bile slouching about the Internet? What did you say or do as the darkness in their hearts obscured the light of their reasoning, and the vacuum of hate consumed them?
My suspicion is that far too many do far too little.
While many might say that they would be quick to condemn and excoriate such hatred, they can often passively condone and fail to expostulate the hater when they see it firsthand.
That’s the gist of a January study that was written about in ScienceDaily. It was led by Kerry Kawakami, a psychology professor at York University in Toronto, and it found that although people predicted “that they would be very upset by a racist act and would take action,” their actual reactions were “much more muted.” Why? Because people are “much less willing to pay the emotional cost” of the confrontation than they thought they would be.
The authorities won’t be able to stop every “lone wolf” with a gun and a gripe. But we, as a society, can do a much better job of creating an environment where hateful beliefs are never ignored and suspicious behavior never goes unreported.
In 1963, the Rev. Dr. Martin Luther King Jr. wrote in a letter from a Birmingham jail, “We will have to repent in this generation not merely for the hateful words and actions of the bad people but for the appalling silence of the good people.” That’s still true.
Hateful people are loud — to disguise their cowardice and shame. But good, decent people are by far the majority, and we dare not be silent. There can be no family too close and no friend too dear for hatred to go unchecked. Allowing it to do so diminishes the better, more noble parts of ourselves.
These confrontations won’t be easy, but doing the right thing rarely is. There is someone reading this column who knows someone who could be the next shooter. What will that reader do?
June 13, 2009
Op-Ed Contributor
4. Why I Now Support Gay Marriage
By TOM SUOZZI
Mineola, N.Y.
WHEN I ran in the Democratic primary for governor against Eliot Spitzer in 2006, I vocally supported civil unions for same-sex couples but did not endorse equal marriage. I understood the need to provide equal rights for gays and lesbians, but as a practicing Catholic, I also felt that the state should not infringe on religious institutions’ right to view marriage in accordance with their own traditions. I thought civil unions for same-sex couples would address my concerns regarding both equality and religious liberty.
I was wrong.
I have listened to many well-reasoned and well-intentioned arguments both for and against same-sex marriage. And as I talked to gays and lesbians and heard their stories of pain, discrimination and love, my platitudes about civil unions began to ring hollow. I have struggled to find the solution that best serves the common good.
I now support same-sex marriage. This is a subject of great debate before the New York State Legislature (although the legislators there are a little distracted right now), and I hope that same-sex civil marriage will be approved within the month.
Under current New York State law, same-sex couples are deprived of access to the employment benefits, life and health insurance and inheritance laws that heterosexual couples have. If the state were to institute civil unions for same-sex couples, that discrimination would end, but we’d still be creating a separate and unequal system.
Civil unions for both heterosexual and same-sex couples would be an equal system, but this compromise appears unlikely at the current time. Few heterosexual couples would give up their current civil marriage for a civil union. While some states would recognize civil unions for all, others would not, causing legal problems for New York couples. Advocates of same-sex marriage don’t seem in favor of such a compromise either.
According to the last census, there are an estimated 50,000 households headed by same-sex couples in New York, many who were married in other states. Those marriages are recognized by New York courts as valid. As a result, we have same-sex marriage for some in New York (albeit performed out of state) and no marriage at all for other same-sex couples.
Any change in the New York law can, and must, balance equality while making sure that religious institutions remain free to choose whether to marry same-sex couples. By following the example of Connecticut and Vermont, which included protections for religious institutions when they recently legalized same-sex marriage, we can ensure that churches are not forced to consecrate marriages they do not endorse. This will require a strong liberty clause allowing religious institutions to opt out of solemnizing same-sex marriage, which also applies to the provision of services and programs at religiously affiliated institutions.
Many civil marriages are not considered “holy matrimony” by religious institutions because they do not conform to the rules of the religious institution. Those marriages have not challenged religious liberty. We must see that civil marriage, which has always been separate from religious marriage, will remain so.
But most important, gays and lesbians have suffered too long from legal discrimination, social marginalization and even violence. They are entitled to clear recognition of their equal status as citizens of a country that is founded on the principle that we are all inherently worthy. By delivering a clear message that same-sex couples can no longer be treated as separate and unequal in New York, we will also reduce discrimination in everyday life. We will all be better for that.
Equal civil marriage should, and likely will, pass because of the public’s growing unwillingness to sustain inequality. Society will also be strengthened as more people take responsibility for one another in marriage. I now encourage others who oppose gay marriage to re-examine the reasons they do so, and to consider changing their minds too.
Tom Suozzi is the Nassau County executive.
June 14, 2009
5. All-Night Care for Dementia’s Restless Minds
By CARA BUCKLEY and JAMES ESTRIN
THE patients were on the loose again, moving their shrunken frames through the nursing home’s shadowy halls, chattering and giggling like children sneaking out of camp.
It was after midnight. Nearly everyone inside the Hebrew Home at Riverdale, which hugs the banks of the Hudson River in the northern Bronx, was fast asleep. The group crept past a large fish tank and rounded a corner, startling a security guard who jumped at the sight of them: seven tiny women with lights glinting off their silvery hair. Then the guard noticed a young employee pushing one of the women in a wheelchair, and relaxed. It was just the night-care group, out for a supervised stroll.
One of the ladies began singing a salsa song, creakily sashaying her hips. Another took note and grinned. “Shake it, don’t break it,” she called out.
The seven women all have Alzheimer’s disease or dementia, and are part of the Hebrew Home’s ElderServe at Night, a dusk-to-dawn drop-off program intended to strengthen their decaying minds while sating their thirst to be active after dark.
Alzheimer’s is an irreversible brain disease that destroys memory, and it is one form of dementia, a disorder marked by the loss of mental functions. Nighttime can be treacherous for people with dementia, who are often struck by sleeplessness or night terrors and prone to wandering about. This agitation and disorientation, called “sundowning,” is especially vexing for relatives trying to care for them at home, and often hastens their placement in nursing homes.
While there are countless day care programs for the nation’s estimated 5.3 million Alzheimer’s patients, some experts believe that ElderServe at Night, which began a decade ago, is the only one of its kind in the country.
Participants are fetched from their homes by vans and spend 7 p.m. to 7 a.m. painting, potting plants, dancing and talking — or, for those immobilized by their disease, relaxing amid music, massage and twinkling lights. The patients rest as they need, for a few minutes or a few hours, and return home the next morning fed, showered and, usually, tuckered out.
“At home we’re alone, with no one to talk to,” said Maria Viera, 73, who lives by herself in the Mott Haven neighborhood of the Bronx and has been in the program since 2007. “And it’s a good place to pass the night, because we can’t be alone in our houses.”
Friendships are forged, and at least one romance has bloomed: Luis Maldonado used to hold the hand of tiny Isabel Quevedo and kiss her cheek. Mr. Maldonado died in April at 83. When asked about boyfriends, she scoffed. Men want just one thing, said Ms. Quevedo, 79, “and I don’t want my reputation to go down.”
On a gloomy Thursday in May, the women drifted in and took their regular seats at round tables, waiting for dinner. Outside, gray clouds hung low and the darkening sky spat showers of chilly rain, but in the room, it felt as if the day had just dawned.
Attendants rolled down blackout shades to mute the effects of sundowning, flipped on incandescent lights in the hallway and lighted incense. A stereo swelled with Cher singing, of all things, “If I Could Turn Back Time.” Mrs. Viera began singing along.
THE program was born in 1998, after Daniel A. Reingold, now president and chief executive of the Hebrew Home, began hearing horror stories from people who jury-rigged alarm systems or slept on mattresses pulled across thresholds to stop their sleepless parents from wandering at night. Sleep deprivation, he learned, was causing many guardians to put relatively high-functioning patients into nursing homes rather than day care programs.
“How do we fix that?” he asked David V. Pomeranz, the home’s associate executive director. Mr. Pomeranz, who at the time had a toddler at home waking in the wee hours, replied: “What if we took the day program and ran it at night?”
The activities mirror those done during the day: arts, crafts, exercise, and holistic remedies like meditation and pet therapy. Rather than give agitated patients mood-altering drugs, ElderServe aides might lead them by the hand into a softly lighted room, slip off their shoes and socks and massage their feet with a warm washcloth.
The twin drop-off programs account for about 3 percent of the Hebrew Home’s $105 million budget; at night, 10 recreational therapists, nurses and aides tend to up to 40 clients, few of whom are Jewish. Most are covered by Medicaid; the private fee is $215 per night.
The staff indulges the urges that dementia and Alzheimer’s induce, walking with patients who crave a 2 a.m. adventure or taking evening trips to the circus or restaurants. “We’re kind of like the party house on the block,” said Deborah M. Messina, who is 32 and the director of both the day and night programs. “The lights are on all night and the music is going.”
Ms. Messina and Mr. Reingold have made presentations to professional associations, hoping others might copy the program. But a spokeswoman for the Alzheimer’s Association, a nonprofit research and education group based in Chicago, said she knew of no other nighttime drop-off program like it. Though it has not been independently evaluated, organizers say the program has helped patients maintain a discernible alertness even as their minds erode. It has also given their relatives desperately needed breaks.
Louise Yarin and her husband and teenage son were at their wits’ end caring for her mother, Catherine Fetonti, who is 90 and was found to have dementia in 2004. Mrs. Fetonti woke them up most nights, yelling Hail Marys and demanding to be taken home. Ms. Yarin tried to fix things by moving everyone into Mrs. Fetonti’s old, smaller house in Yonkers. But the nightly outbursts continued, even after Ms. Yarin began sleeping in her mother’s room.
Then last year, a social worker told Ms. Yarin, who is 52 and works part time in a day spa, about ElderServe, and everything changed.
“Our first night when she was down there, we woke up in the morning and it was like, ‘Huh, what was that?’ ” Ms. Yarin recalled. “It was like when your baby first sleeps through the night.”
Paul Navarro enrolled his 85-year-old mother, Maria, a year ago: Her memory had started to fail after her husband died in 2005, and she developed a paralyzing fear of being alone. Mrs. Navarro resisted the program at first, weeping every time the ElderServe van pulled up in front of their Bronx home. But like a kindergartner acclimating to school, she made new friends, and blossomed.
“It’s like her mind cleared up,” said Mr. Navarro, who works as a property manager for New York City. “She’s happier. She’s truly, truly happier.”
NOWADAYS, Mrs. Navarro calls Ms. Messina on speed dial if the van picking her up is even two minutes late. On the gray Thursday, she arrived early, her dark eyes magnified through bottle-thick lenses, and welcomed Mrs. Viera. Both women are relatively lucid, their forgetfulness surfacing in spurts. Together with Carmen Febres, 64, a woman with a mischievous streak, the Marias make up something of a clique, usually sharing the same table for dinner.
Mrs. Febres came lumbering in, her hair in rollers beneath a kerchief, and lowered herself heavily into a chair. She has grown heavier since she joined the program: She loves to eat but often forgets when she has, sometimes taking double or triple meals. A nurse came to prick her finger and test her blood sugar; like many of the patients, Mrs. Febres is diabetic and frequently fails to take her medicine or accidentally takes it twice.
Mrs. Febres said it was a good night for cuddling up with a man and some wine. “Because of the rain,” she said, her eyes sly beneath heavy lids. She reminisced about earlier, lusty escapades in her life. Mrs. Viera said she separated from her husband long ago. “I never got another man,” she said. “One was enough.”
Most patients eat in groups, but one, Miguel Colon, often sits alone; he coughs forcefully when he eats, spraying food. Mr. Colon is 70, bald and burly, rarely speaks and walks in a slow, pained shuffle. He entered the dining room in a wheelchair wearing a mask that covered his chin but showed his face (his daughter, with whom he lives, bundles him up even when it’s warm).
Mrs. Febres’s eyes widened as a plate was set before her: sole stuffed with seafood in a lemon-garlic sauce, with broccoli. For dessert, fresh strawberries. She dug in.
At 9:30 p.m., Al Smith, a local musician, set up his keyboard and began banging out blues and Motown tunes. The patients shook their maracas, moving their hips in their seats. On salsa nights, the dance floor fills, but Mr. Smith’s oldies brought out only a few nursing assistants and a lone patient, Carmen Hernandez, who is 82 and missing her front teeth; she wore a thick woolen cap over steel gray hair.
Mrs. Hernandez danced over to Mr. Colon — the lone man among the abler patients — and tapped her maraca against his. She wiggled her backside, leaned over, took his face between her hands and planted a kiss on his cheek. Then she danced over to the one-man band. “What a flirt,” a nurse’s assistant said.
NEXT door, a quieter sort of party unfolded in a darkened room filled with sensory delights: A yellow spotlight danced off a disco ball, New Age music purred softly, and a citrus smell filled the air. Three nursing assistants moved among a dozen patients, trying to coax movement out of frozen limbs.
The patients slumped in wheelchairs, arms contracted, Pharaoh-like, across their chests, or leaned heavily on tables, heads in hands. These were the ones whose advanced dementia, compounded by other afflictions, had ravaged body as well as mind, nudging them closer to death; the ones who would need their diapers changed and their limbs washed before being put to bed. One is a blind former pastor who spits, a habit the staff tempers by slipping gum into his mouth.
Early in the evening, Ms. Messina, the program director, worked the room, stopping to rub the back and shoulders of Fouad Moustafa, 82, whose various ailments have stolen his ability to walk and reduced most of his words to slurs. The night nurse supervisor, Mabel Hernandez, caressed Mr. Moustafa’s tufted pate as she passed. He exhaled softly. A smile played on his lips.
“Not everybody touches them,” said Karena Larrequi, the night recreation supervisor. “People think, ‘They don’t know, they don’t feel.’ We want to remind them that even though they can’t speak, that we know they’re there.”
A children’s pool filled with soapy water was set on a table, and a few people sat around it, playing with the suds, squeezing the soft toys.
Patients began nodding off as the nursing assistants massaged their arms with lotion, squeezing palms and wrists. Hilda Marcial, 93, took hold of a nurse’s hand and began massaging it back.
BACK in the active room, the music ended by 11 p.m. and it was guacamole time. Ms. Larrequi, the recreational therapist, handed out avocados, tomatoes, peppers, garlic and cilantro to chop up with plastic knives. Mr. Colon popped a raw garlic clove into his mouth, then some cilantro. Mrs. Febres, the diabetic overeater, asked if there was any rice. “No rice, Carmen, no rice,” Ms. Larrequi replied. Mrs. Febres tried another tack: “Do you have any Löwenbräu?”
Around 1:30 a.m., after their midnight walk, most of the women began drifting to beds, lined up dorm-style in a nearby room.
Mrs. Febres was still up. She sat at a table pulling a comb through Ms. Larrequi’s long raven hair; though she is decades younger than most of her patients, the therapist seems like an older sister, or a really cool counselor at camp.
Ms. Messina, the program director, sat across from them, and the place suddenly felt like a girlish slumber party: Mrs. Febres was talking, again, about men and sex, causing Ms. Larrequi to dissolve into giggles.
“Karena, don’t encourage her!” Ms. Messina said in mock indignation.
Mrs. Febres fixed her eyes on Ms. Messina. “Are you a virgin?” she asked.
“Carmen!” Ms. Messina replied, laughing. “You ask me this every time.”
The night melted by, and as dawn approached, the nurse assistants began hoisting patients from beds, stretching stiff arms and legs, slipping off pajamas and buttoning up street clothes. At first light, they groggily gathered around tables in the main room, waiting for coffee and breakfast and their eventual ride home.
Mrs. Fetonti sat with Mrs. Viera, who was wearing a fresh coat of peach lipstick. Mrs. Viera began speaking in Spanish, which Mrs. Fetonti does not understand; she replied anyway — in English. Mrs. Febres sat nearby, eyes closed, head back, mouth agape and emitting a soft snore.
The day nurse supervisor, Rina Ginat, breezed in and handed everyone elasticized bands for stretching, helping them one by one through elementary yoga moves and breathing techniques, holding their hands in hers.
“Miguel!” Ms. Ginat cried merrily, as she approached Mr. Colon, who was sitting by himself, “Cómo estás?”
Mr. Colon smiled shyly, and uttered his first word in at least 12 hours: “Bien.”
High school principal Michael Edwards struggled with A.D.H.D. in school but found success in running.
As a child, school for me was like being in Charlie Brown’s classroom. The other kids heard what was going on, and all I would hear was “Waa, waaa waaa, wa wa.” Words were spoken, and I knew them, but I couldn’t figure out exactly what it was I was supposed to be getting.
By the second grade, I was identified as learning disabled and hyperactive — today they would call it attention deficit hyperactivity disorder, or A.D.H.D. I had no idea what any of it meant, only that three times a week, my teacher told me it was time to go to my “other” classroom. Once I returned, my classmates would inevitably ask, “Why do you go there?” It was then that I learned I was different. By my late elementary years, one thing was clear to me — I was stupid.
The junior high years meant being driven across town to a special school. When I got off, kids asked me why I rode the “short bus.” I remember once being so tired of hearing it, I grabbed one kid by his coat, pulled him eye to eye and said, “Because I’m retarded!”
Everything changed in the seventh grade, when I decided to join the track team. School had been nothing but one failure after another and a constant reminder that I was inferior to the other kids. But when I stepped on the track it was different. I could keep up.
For my first race, I lined up with 15 other seventh and eighth graders to run the half mile. After two laps, my chest burned and my arms felt like rubber, but I found myself in seventh place. I was elated. Not only was I as good as everyone else, I was even better then half.
My coach suggested the mile. Lacing up my Converse basketball shoes, I started running. Suddenly I found myself at the front of the pack. Could it be possible that even a dummy like me could win a race? The faster I ran the more excited I got. No burning chest, no arms like rubber, I was winning a race! I came around that back stretch with the finish line in view. I gave it one last burst of speed and sure enough I was first. I raised my arms in victory.
It took me about 30 seconds to figure out I had only run three laps instead of four.
By that time, four or five guys had passed me by. I still managed to finish third, and more important, I found out I was actually good at something. I began to set my alarm for 5 a.m. to go running before school.
Running became my obsession. My mom bought me a subscription to Runner’s World magazine. I read it cover to cover. I don’t know if it was all my time spent reading that magazine or my new-found confidence, but after eighth grade, I was allowed to attend the regular school with the kids from my neighborhood.
High school was hard. I rode the line of eligibility nearly every track season. My mom, a special education teacher, helped me focus on homework. My math teacher, Mr. Caldwell, seemed to always know when I was totally lost in his class. Discreetly, he would call me up to his desk and ask me to solve the problem. He made me stay at his desk until I figured it out, guiding me along the way. Some days I was so lost I just wanted to go back to my desk and would tell him, “I understand it, Mr. Caldwell, really.” But he never fell for that line.
I graduated with an uninspiring 2.1 grade point average (thank goodness for band and physical education). Several of my teachers told my parents that sending me to college was a waste of money. I didn’t know if I could survive college either, but I wanted to run college track. I couldn’t let go of the only thing that made me feel good about myself.
I enrolled at Ohio University in Athens. Four years later, I had set stadium records and won many races on the track. And I won a different kind of race as well, graduating with a degree in education.
Since that time, I’ve also completed a master’s degree and have spent 17 years as a teacher. Now I’m a high school principal and special education director, with a beautiful wife and three great kids of my own. And I’m even thinking about pursuing a Ph.D.
When I first became a school principal, a mother came to my office in tears, worried that if her child was tested for a learning disability, he would be labeled as such and never be successful. For the first time, I shared my story with her. It was something I had never told anyone, not even my wife. Later, I decided to write it down as a way to encourage parents of children with learning disabilities.
I credit my mother, for helping me with homework, and my teacher, Mr. Caldwell, for having the patience to work with me. But I often wonder how my life would have been different if I hadn’t found my confidence on the track.
Michael Edwards is the principal of Riverside High School in DeGraff, Ohio. He’s also the former Beavercreek High School track and cross country teammate of Tara Parker-Pope.
June 16, 2009
7. Social Networks Spread Iranian Defiance Online
By BRAD STONE and NOAM COHEN
As the embattled government of President Mahmoud Ahmadinejad appears to be trying to limit Internet access and communications in Iran, new kinds of social media are challenging those traditional levers of state media control and allowing Iranians to find novel ways around the restrictions.
Iranians are blogging, posting to Facebook and, most visibly, coordinating their protests on Twitter, the messaging service. Their activity has increased, not decreased, since the presidential election on Friday and ensuing attempts by the government to restrict or censor their online communications.
On Twitter, reports and links to photos from a peaceful mass march through Tehran on Monday, along with accounts of street fighting and casualties around the country, have become the most popular topic on the service worldwide, according to Twitter’s published statistics.
A couple of Twitter feeds have become virtual media offices for the supporters of the leading opposition candidate, Mir Hussein Moussavi. One feed, mousavi1388 (1388 is the year in the Persian calendar), is filled with news of protests and exhortations to keep up the fight, in Persian and in English. It has more than 7,000 followers.
Mr. Moussavi’s fan group on Facebook has swelled to over 50,000 members, a significant increase since election day.
Labeling such seemingly spontaneous antigovernment demonstrations a “Twitter Revolution” has already become something of a cliché. That title had been given to the protests in Moldova in April.
But Twitter is aware of the power of its service. Acknowledging its role on the global stage, the San Francisco-based company said Monday that it was delaying a planned shutdown for maintenance for a day, citing “the role Twitter is currently playing as an important communication tool in Iran.”
Twitter users are posting messages, known as tweets, with the term #IranElection, which allows users to search for all tweets on the subject. On Monday evening, Twitter was registering about 30 new posts a minute with that tag.
One read, “We have no national press coverage in Iran, everyone should help spread Moussavi’s message. One Person = One Broadcaster. #IranElection.”
The Twitter feed StopAhmadi calls itself the “Dedicated Twitter account for Moussavi supporters” and has more than 6,000 followers. It links to a page on the photo-hosting site Flickr that includes dozens of pictures from the rally on Monday in Tehran.
The feed Persiankiwi, which has more than 15,000 followers, sends users to a page in Persian that is hosted by Google and, in its only English text, says, “Due to widespread filters in Iran, please view this site to receive the latest news, letters and communications from Mir Hussein Moussavi.”
Some Twitter users were also going on the offensive. On Monday morning, an antigovernment activist using the Twitter account “DDOSIran” asked supporters to visit a Web site to participate in an online attack to try to crash government Web sites by overwhelming them with traffic.
By Monday afternoon, many of those sites were not accessible, though it was not clear if the attack was responsible — and the Twitter account behind the attack had been removed. A Twitter spokeswoman said the company had no connection to the deletion of the account.
The crackdown on communications began on election day, when text-messaging services were shut down in what opposition supporters said was an attempt to block one of their most important organizing tools. Over the weekend, cellphone transmissions and access to Facebook and some other Web sites were also blocked.
Iranians continued to report on Monday that they could not send text messages.
But it appears they are finding ways around Big Brother.
Many Twitter users have been sharing ways to evade government snooping, such as programming their Web browsers to contact a proxy — or an Internet server that relays their connection through another country.
Austin Heap, a 25-year-old information technology consultant in San Francisco, is running his own private proxies to help Iranians, and is advertising them on Twitter. He said on Monday that his servers were providing the Internet connections for about 750 Iranians at any one moment.
“I think that cyber activism can be a way to empower people living under less than democratic governments around the world,” he said.
Global Internet Freedom Consortium, an Internet proxy service with ties to the banned Chinese spiritual movement Falun Gong, offers downloadable software to help evade censorship. It said its traffic from Iran had tripled in the last week.
Shiyu Zhou, founder of the organization, has no idea how links to the software spread within Iran. “In China we have sent mass e-mails, but nothing like in Iran,” he said. “The Iranian people actually found out by themselves and have passed this on by word of mouth.”
Jonathan Zittrain, a professor at Harvard Law School who is an expert on the Internet, said that Twitter was particularly resilient to censorship because it had so many ways for its posts to originate — from a phone, a Web browser or specialized applications — and so many outlets for those posts to appear.
As each new home for this material becomes a new target for censorship, he said, a repressive system faces a game of whack-a-mole in blocking Internet address after Internet address carrying the subversive material.
“It is easy for Twitter feeds to be echoed everywhere else in the world,” Mr. Zittrain said. “The qualities that make Twitter seem inane and half-baked are what make it so powerful.”
June 16, 2009
8. Tobacco Regulation Is Expected to Face a Free-Speech Challenge
By DUFF WILSON
The marketing and advertising restrictions in the tobacco law that Congress passed last week are likely to be challenged in court on free-speech grounds. But supporters of the legislation say they drafted the law carefully to comply with the First Amendment.
The law’s ban on outdoor advertising within 1,000 feet of schools and playgrounds would effectively outlaw legal advertising in many cities, critics of the prohibition said. And restricting stores and many forms of print advertising to black-and-white text, as the law specifies, would interfere with legitimate communication to adults, tobacco companies and advertising groups said in letters to Congress and interviews over the last week.
The controversy, legal experts say, involves tension between the right of tobacco companies to communicate with adult smokers and the public interest in preventing young people from smoking.
Opponents of the new strictures, including the Association of National Advertisers and the American Civil Liberties Union, predict that federal courts will throw out the new marketing restrictions. They say, for example, a 2001 Supreme Court decision struck down a Massachusetts rule that had imposed a similar ban on advertising within 1,000 feet of schools.
“Anybody looking at this in a fair way would say the effort here is not just to protect kids, which is a substantial interest of the country, but to make it virtually impossible to communicate with anybody,” Daniel L. Jaffe, executive vice president of the Association of National Advertisers, said in an interview Monday. “We think this creates very serious problems for the First Amendment.”
His group represents 340 companies spending more than $100 billion a year on marketing and ads.
But supporters of the law say studies conducted since 2001 provide evidence that young people respond to cigarette marketing even when it is aimed at adults, showing that new restrictions are needed to curb illegal, as well as highly addictive and harmful, under-age smoking.
“The bill has been carefully drafted, and I am confident that the provisions will be upheld,” Henry A. Waxman, Democrat of California and prime sponsor in the House of the legislation, said in a statement Monday.
Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, an advocacy group that was a leader in pushing for the law, said: “Frankly, the tobacco industry and the advertising industry have never heard of an advertising restriction that they thought was constitutional. In this case, great care was taken to permit black-and-white text advertising that permits them to communicate whatever truthful information they have.”
President Obama announced last week that he would sign the legislation. A signing ceremony has not yet been scheduled, a White House spokesman said Monday. The ad restrictions would go into effect about a year after the legislation becomes law.
Commercial free speech is not an absolute right, legal experts say. There are clear limits, for instance, on false advertising and on promotion of illegal activity. The issue grows more complicated if the advertising is both truthful and concerns a legal activity, like smoking by adults.
The Supreme Court in 1980 said such speech can be restricted only if it would directly advance a “substantial government interest” and the regulation was “narrowly tailored” to fit the interest. In the case of the new tobacco law, Congress specifically defined the government interest as a reduction in youth smoking.
But the tobacco industry denies that any of its advertising is aimed at young people.
The new restrictions, based on regulations the Food and Drug Administration tried to issue in 1996, would be broad and deep. There is the 1,000-foot ad-free radius around schools. The black-and-white ad strictures apply to stores and to print ads except in publications with an adult readership of 85 percent or more.
Tobacco companies would also be prohibited from sponsoring sporting or cultural events or giving away T-shirts or caps. Any form of audio advertising would be limited to words without music. (Radio and television ads of tobacco products have been banned since 1971.)
The A.C.L.U. wrote a letter to senators on June 1 arguing that the legislation’s limits on commercial speech were broader than needed to accomplish the goal of reducing under-age smoking. The group suggested stronger enforcement of false-advertising laws and continuing efforts to warn the public, including young people, of the harms of tobacco products.
“The answer here is to provide countervailing messages,” Michael Macleod-Ball, chief legislative and policy counsel for the A.C.L.U. in Washington, said Monday. “Discourage smoking, rather than restricting this form of speech that has not been shown to have a sufficiently close nexus with youth smoking.”
As for the tobacco companies, it was unclear which would initiate a lawsuit. “We are examining all of our options at this point,” said Michael W. Robinson, spokesman for Lorillard Tobacco, which brought the Massachusetts suit. “Stay tuned.”
R.J. Reynolds has not decided on legal challenges, spokeswoman Maura Payne said.
Altria Group, which owns Phillip Morris, the nation’s largest cigarette company, and was the only major tobacco company to endorse the legislation, said in a statement last week that it believed some of the marketing restrictions were illegal.
David Sylvia, an Altria spokesman, said Monday in an e-mail message, “Given that the bill has not yet been signed, and given that the legislation would require regulation writing on this issue, it is too early for us to be commenting on the constitutionality of the advertising related regulations.”
In the 2001 case, the Supreme Court struck down a Massachusetts ban on tobacco ads, including outdoor billboards and signs that could be seen within 1,000 feet of any public playground and elementary or secondary school. That ban, which would have eliminated tobacco advertising in about 89 percent of Boston, is virtually identical to one standard in the new federal law.
The Supreme Court found it to be an unconstitutional limit of the First Amendment right to free speech in part because it was simply too broad. The effect “will vary based on whether a locale is rural, suburban, or urban,” Justice Sandra Day O’Connor wrote for the majority. “The uniformly broad sweep of the geographical limitation demonstrates a lack of tailoring.”
Kathleen Dachille, a University of Maryland law professor and director of the Legal Resource Center for Tobacco Regulation, Litigation and Advocacy, said the Massachusetts case turned on a lack of evidence linking youth smoking, which is illegal, to tobacco marketing ostensibly aimed at adults. She said the link has been reinforced in recent years by reports of the Institute of Medicine, the National Cancer Institute, a federal appeals court ruling on a tobacco-company fraud case, and at least a dozen peer-reviewed studies.
A May 28 report by the Congressional Research Service, a branch of the Library of Congress, noted the difficulty of making advertising restrictions that are broad enough to be effective, yet narrow enough to be related to the government’s stated interest.
June 16, 2009
9. New Glimpses of Life’s Puzzling Origins
Some 3.9 billion years ago, a shift in the orbit of the Sun’s outer planets sent a surge of large comets and asteroids careening into the inner solar system. Their violent impacts gouged out the large craters still visible on the Moon’s face, heated Earth’s surface into molten rock and boiled off its oceans into an incandescent mist.
Yet rocks that formed on Earth 3.8 billion years ago, almost as soon as the bombardment had stopped, contain possible evidence of biological processes. If life can arise from inorganic matter so quickly and easily, why is it not abundant in the solar system and beyond? If biology is an inherent property of matter, why have chemists so far been unable to reconstruct life, or anything close to it, in the laboratory?
The origins of life on Earth bristle with puzzle and paradox. Which came first, the proteins of living cells or the genetic information that makes them? How could the metabolism of living things get started without an enclosing membrane to keep all the necessary chemicals together? But if life started inside a cell membrane, how did the necessary nutrients get in?
The questions may seem moot, since life did start somehow. But for the small group of researchers who insist on learning exactly how it started, frustration has abounded. Many once-promising leads have led only to years of wasted effort. Scientists as eminent as Francis Crick, the chief theorist of molecular biology, have quietly suggested that life may have formed elsewhere before seeding the planet, so hard does it seem to find a plausible explanation for its emergence on Earth.
In the last few years, however, four surprising advances have renewed confidence that a terrestrial explanation for life’s origins will eventually emerge.
One is a series of discoveries about the cell-like structures that could have formed naturally from fatty chemicals likely to have been present on the primitive Earth. This lead emerged from a long argument between three colleagues as to whether a genetic system or a cell membrane came first in the development of life. They eventually agreed that genetics and membranes had to have evolved together.
The three researchers, Jack W. Szostak, David P. Bartel and P. Luigi Luisi, published a somewhat adventurous manifesto in Nature in 2001, declaring that the way to make a synthetic cell was to get a protocell and a genetic molecule to grow and divide in parallel, with the molecules being encapsulated in the cell. If the molecules gave the cell a survival advantage over other cells, the outcome would be “a sustainable, autonomously replicating system, capable of Darwinian evolution,” they wrote.
“It would be truly alive,” they added.
One of the authors, Dr. Szostak, of the Massachusetts General Hospital, has since managed to achieve a surprising amount of this program.
Simple fatty acids, of the sort likely to have been around on the primitive Earth, will spontaneously form double-layered spheres, much like the double-layered membrane of today’s living cells. These protocells will incorporate new fatty acids fed into the water, and eventually divide.
Living cells are generally impermeable and have elaborate mechanisms for admitting only the nutrients they need. But Dr. Szostak and his colleagues have shown that small molecules can easily enter the protocells. If they combine into larger molecules, however, they cannot get out, just the arrangement a primitive cell would need. If a protocell is made to encapsulate a short piece of DNA and is then fed with nucleotides, the building blocks of DNA, the nucleotides will spontaneously enter the cell and link into another DNA molecule.
At a symposium on evolution at the Cold Spring Harbor Laboratory on Long Island last month, Dr. Szostak said he was “optimistic about getting a chemical replication system going” inside a protocell. He then hopes to integrate a replicating nucleic acid system with dividing protocells.
Dr. Szostak’s experiments have come close to creating a spontaneously dividing cell from chemicals assumed to have existed on the primitive Earth. But some of his ingredients, like the nucleotide building blocks of nucleic acids, are quite complex. Prebiotic chemists, who study the prelife chemistry of the primitive Earth, have long been close to despair over how nucleotides could ever have arisen spontaneously.
Nucleotides consist of a sugar molecule, like ribose or deoxyribose, joined to a base at one end and a phosphate group at the other. Prebiotic chemists discovered with delight that bases like adenine will easily form from simple chemicals like hydrogen cyanide. But years of disappointment followed when the adenine proved incapable of linking naturally to the ribose.
Last month, John Sutherland, a chemist at the University of Manchester in England, reported in Nature his discovery of a quite unexpected route for synthesizing nucleotides from prebiotic chemicals. Instead of making the base and sugar separately from chemicals likely to have existed on the primitive Earth, Dr. Sutherland showed how under the right conditions the base and sugar could be built up as a single unit, and so did not need to be linked.
“I think the Sutherland paper has been the biggest advance in the last five years in terms of prebiotic chemistry,” said Gerald F. Joyce, an expert on the origins of life at the Scripps Research Institute in La Jolla, Calif.
Once a self-replicating system develops from chemicals, this is the beginning of genetic history, since each molecule carries the imprint of its ancestor. Dr. Crick, who was interested in the chemistry that preceded replication, once observed, “After this point, the rest is just history.”
Dr. Joyce has been studying the possible beginning of history by developing RNA molecules with the capacity for replication. RNA, a close cousin of DNA, almost certainly preceded it as the genetic molecule of living cells. Besides carrying information, RNA can also act as an enzyme to promote chemical reactions. Dr. Joyce reported in Science earlier this year that he had developed two RNA molecules that can promote each other’s synthesis from the four kinds of RNA nucleotides.
“We finally have a molecule that’s immortal,” he said, meaning one whose information can be passed on indefinitely. The system is not alive, he says, but performs central functions of life like replication and adapting to new conditions.
“Gerry Joyce is getting ever closer to showing you can have self-replication of RNA species,” Dr. Sutherland said. “So only a pessimist wouldn’t allow him success in a few years.”
Another striking advance has come from new studies of the handedness of molecules. Some chemicals, like the amino acids of which proteins are made, exist in two mirror-image forms, much like the left and right hand. In most naturally occurring conditions they are found in roughly equal mixtures of the two forms. But in a living cell all amino acids are left-handed, and all sugars and nucleotides are right-handed.
Prebiotic chemists have long been at a loss to explain how the first living systems could have extracted just one kind of the handed chemicals from the mixtures on the early Earth. Left-handed nucleotides are a poison because they prevent right-handed nucleotides linking up in a chain to form nucleic acids like RNA or DNA. Dr. Joyce refers to the problem as “original syn,” referring to the chemist’s terms syn and anti for the structures in the handed forms.
The chemists have now been granted an unexpected absolution from their original syn problem. Researchers like Donna Blackmond of Imperial College London have discovered that a mixture of left-handed and right-handed molecules can be converted to just one form by cycles of freezing and melting.
With these four recent advances — Dr. Szostak’s protocells, self-replicating RNA, the natural synthesis of nucleotides, and an explanation for handedness — those who study the origin of life have much to be pleased about, despite the distance yet to go. “At some point some of these threads will start joining together,” Dr. Sutherland said. “I think all of us are far more optimistic now than we were five or 10 years ago.”
One measure of the difficulties ahead, however, is that so far there is little agreement on the kind of environment in which life originated. Some chemists, like Günther Wächtershäuser, argue that life began in volcanic conditions, like those of the deep sea vents. These have the gases and metallic catalysts in which, he argues, the first metabolic processes were likely to have arisen.
But many biologists believe that in the oceans, the necessary constituents of life would always be too diluted. They favor a warm freshwater pond for the origin of life, as did Darwin, where cycles of wetting and evaporation around the edges could produce useful concentrations and chemical processes.
No one knows for sure when life began. The oldest generally accepted evidence for living cells are fossil bacteria 1.9 billion years old from the Gunflint Formation of Ontario. But rocks from two sites in Greenland, containing an unusual mix of carbon isotopes that could be evidence of biological processes, are 3.830 billion years old.
How could life have gotten off to such a quick start, given that the surface of the Earth was probably sterilized by the Late Heavy Bombardment, the rain of gigantic comets and asteroids that pelted the Earth and Moon around 3.9 billion years ago? Stephen Mojzsis, a geologist at the University of Colorado who analyzed one of the Greenland sites, argued in Nature last month that the Late Heavy Bombardment would not have killed everything, as is generally believed. In his view, life could have started much earlier and survived the bombardment in deep sea environments.
Recent evidence from very ancient rocks known as zircons suggests that stable oceans and continental crust had emerged as long as 4.404 billion years ago, a mere 150 million years after the Earth’s formation. So life might have had half a billion years to get started before the cataclysmic bombardment.
But geologists dispute whether the Greenland rocks really offer signs of biological processes, and geochemists have often revised their estimates of the composition of the primitive atmosphere. Leslie Orgel, a pioneer of prebiotic chemistry, used to say, “Just wait a few years, and conditions on the primitive Earth will change again,” said Dr. Joyce, a former student of his.
Chemists and biologists are thus pretty much on their own in figuring out how life started. For lack of fossil evidence, they have no guide as to when, where or how the first forms of life emerged. So they will figure life out only by reinventing it in the laboratory.
June 16, 2009
10. Alcohol’s Good for You? Some Scientists Doubt It
By RONI CARYN RABIN
By now, it is a familiar litany. Study after study suggests that alcohol in moderation may promote heart health and even ward off diabetes and dementia. The evidence is so plentiful that some experts consider moderate drinking — about one drink a day for women, about two for men — a central component of a healthy lifestyle.
But what if it’s all a big mistake?
For some scientists, the question will not go away. No study, these critics say, has ever proved a causal relationship between moderate drinking and lower risk of death — only that the two often go together. It may be that moderate drinking is just something healthy people tend to do, not something that makes people healthy.
“The moderate drinkers tend to do everything right — they exercise, they don’t smoke, they eat right and they drink moderately,” said Kaye Middleton Fillmore, a retired sociologist from the University of California, San Francisco, who has criticized the research. “It’s very hard to disentangle all of that, and that’s a real problem.”
Some researchers say they are haunted by the mistakes made in studies about hormone replacement therapy, which was widely prescribed for years on the basis of observational studies similar to the kind done on alcohol. Questions have also been raised about the financial relationships that have sprung up between the alcoholic beverage industry and many academic centers, which have accepted industry money to pay for research, train students and promote their findings.
“The bottom line is there has not been a single study done on moderate alcohol consumption and mortality outcomes that is a ‘gold standard’ kind of study — the kind of randomized controlled clinical trial that we would be required to have in order to approve a new pharmaceutical agent in this country,” said Dr. Tim Naimi, an epidemiologist with the Centers for Disease Control and Prevention.
Even avid supporters of moderate drinking temper their recommendations with warnings about the dangers of alcohol, which has been tied to breast cancer and can lead to accidents even when consumed in small amounts, and is linked with liver disease, cancers, heart damage and strokes when consumed in larger amounts.
“It’s very difficult to form a single-bullet message because one size doesn’t fit all here, and the public health message has to be very conservative,” said Dr. Arthur L. Klatsky, a cardiologist in Oakland, Calif., who wrote a landmark study in the early 1970s finding that members of the Kaiser Permanente health care plan who drank in moderation were less likely to be hospitalized for heart attacks than abstainers. (He has since received research grants financed by an alcohol industry foundation, though he notes that at least one of his studies found that alcohol increased the risk of hypertension.)
“People who would not be able to stop at one to two drinks a day shouldn’t drink, and people with liver disease shouldn’t drink,” Dr. Klatsky said. On the other hand, “the man in his 50s or 60s who has a heart attack and decides to go clean and gives up his glass of wine at night — that person is better off being a moderate drinker.”
Health organizations have phrased their recommendations gingerly. The American Heart Association says people should not start drinking to protect themselves from heart disease. The 2005 United States dietary guidelines say that “alcohol may have beneficial effects when consumed in moderation.”
The association was first made in the early 20th century. In 1924, a Johns Hopkins biologist, Raymond Pearl, published a graph with a U-shaped curve, its tall strands on either side representing the higher death rates of heavy drinkers and nondrinkers; in the middle were moderate drinkers, with the lowest rates. Dozens of other observational studies have replicated the findings, particularly with respect to heart disease.
“With the exception of smoking and lung cancer, this is probably the most established association in the field of nutrition,” said Eric Rimm, an associate professor of epidemiology and nutrition at the Harvard School of Public Health. “There are probably at least 100 studies by now, and the number grows on a monthly basis. That’s what makes it so unique.”
Alcohol is believed to reduce coronary disease because it has been found to increase the “good” HDL cholesterol and have anticlotting effects. Other benefits have been suggested, too. A small study in China found that cognitively impaired elderly patients who drank in moderation did not deteriorate as quickly as abstainers. A report from the Framingham Offspring Study found that moderate drinkers had greater mineral density in their hipbones than nondrinkers. Researchers have reported that light drinkers are less likely than abstainers to develop diabetes, and that those with Type 2 diabetes who drink lightly are less likely to develop coronary heart disease.
But the studies comparing moderate drinkers with abstainers have come under fire in recent years. Critics ask: Who are these abstainers? Why do they avoid alcohol? Is there something that makes them more susceptible to heart disease?
Some researchers suspect the abstainer group may include “sick quitters,” people who stopped drinking because they already had heart disease. People also tend to cut down on drinking as they age, which would make the average abstainer older — and presumably more susceptible to disease — than the average light drinker.
In 2006, shortly after Dr. Fillmore and her colleagues published a critical analysis saying a vast majority of the alcohol studies they reviewed were flawed, Dr. R. Curtis Ellison, a Boston University physician who has championed the benefits of alcohol, hosted a conference on the subject. A summary of the conference, published a year later, said scientists had reached a “consensus” that moderate drinking “has been shown to have predominantly beneficial effects on health.”
The meeting, like much of Dr. Ellison’s work, was partly financed by industry grants. And the summary was written by him and Marjana Martinic, a senior vice president for the International Center for Alcohol Policies, a nonprofit group supported by the industry. The center paid for tens of thousands of copies of the summary, which were included as free inserts in two medical journals, The American Journal of Medicine and The American Journal of Cardiology.
In an interview, Dr. Ellison said his relationship with the industry did not influence his work, adding, “No one would look at our critiques if we didn’t present a balanced view.”
Dr. Fillmore and the co-authors of her analysis posted an online commentary saying the summary had glossed over some of the deep divisions that polarized the debate at the conference. “We also dispute Ellison and Martinic’s conclusions that more frequent drinking is the strongest predictor of health benefits,” they wrote.
(Dr. Fillmore has received support from the Alcohol Education and Rehabilitation Foundation of Australia, a nonprofit group that works to prevent alcohol and substance abuse.)
Dr. Ellison said Dr. Fillmore’s analysis ignored newer studies that corrected the methodological errors of earlier work. “She threw out the baby with the bathwater,” he said.
Meanwhile, two central questions remain unresolved: whether abstainers and moderate drinkers are fundamentally different and, if so, whether it is those differences that make them live longer, rather than their alcohol consumption.
Dr. Naimi of the C.D.C., who did a study looking at the characteristics of moderate drinkers and abstainers, says the two groups are so different that they simply cannot be compared. Moderate drinkers are healthier, wealthier and more educated, and they get better health care, even though they are more likely to smoke. They are even more likely to have all of their teeth, a marker of well-being.
“Moderate drinkers tend to be socially advantaged in ways that have nothing to do with their drinking,” Dr. Naimi said. “These two groups are apples and oranges.” And simply advising the nondrinkers to drink won’t change that, he said.
Some scientists say the time has come to do a large, long-term randomized controlled clinical trial, like the ones for new drugs. One approach might be to recruit a large group of abstainers who would be randomly assigned either to get a daily dose of alcohol or not, and then closely followed for several years; another might be to recruit people who are at risk for coronary disease.
But even the experts who believe in the health benefits of alcohol say this is an implausible idea. Large randomized trials are expensive, and they might lack credibility unless they were financed by the government, which is unlikely to take on the controversy. And there are practical and ethical problems in giving alcohol to abstainers without making them aware of it and without contributing to accidents.
Still, some small clinical trials are already under way to see whether diabetics can reduce their risk of heart disease by consuming alcohol. In Boston, researchers at Beth Israel Deaconess Medical Center are recruiting volunteers 55 and over who are at risk for heart disease and randomly assigning them to either drink plain lemonade or lemonade spiked with tasteless grain alcohol, while scientists track their cholesterol levels and scan their arteries.
In Israel, researchers gave people with Type 2 diabetes either wine or nonalcoholic beer, finding that the wine drinkers had significant drops in blood sugar, though only after fasting; the Israeli scientists are now working with an international team to begin a larger two-year trial.
“The last thing we want to do as researchers and physicians is expose people to something that might harm them, and it’s that fear that has prevented us from doing a trial,” said Dr. Sei Lee of the University of California, San Francisco, who recently proposed a large trial on alcohol and health.
“But this is a really important question,” he continued. “Because here we have a readily available and widely used substance that may actually have a significant health benefit — but we just don’t know enough to make recommendations.”
June 16, 2009
Well
11. Kid Goes Into McDonald’s and Orders ... Yogurt?
The eating habits of American children appear to be shifting. And for a change, the news is good.
Chicken nuggets, burgers, fries and colas remain popular with the under-13 set, of course. But new market research shows that consumption of these foods at restaurants is declining, while soup, yogurt, fruit, grilled chicken and chocolate milk are on the rise.
The findings, based on survey data by the Chicago market research firm NPD Group, follow a report last year that childhood obesity appears to have hit a plateau after rising for more than two decades. That finding, reported by The Journal of the American Medical Association, has been greeted with guarded optimism, and it remains unclear whether efforts to limit junk food and increase physical activity in schools have had a meaningful effect on the way children eat.
But the new data suggest that a number of factors, from the economic downturn to new offerings from fast-food giants, may be influencing a general shift in eating preferences among children.
The data, from NPD’s Consumer Reports on Eating Share Trends, are collected from a representative sample of 3,500 households and 500 teenagers who give detailed information on their restaurant habits. The figures are considered highly reliable because the researchers collect answers daily, asking participants what they and their family ate and ordered at restaurants the day before. While this recall method is never 100 percent reliable, the data, collected since 1976, provide a consistent look at long-term trends.
Clearly, the economy is playing a big part in these trends. Orders for kids’ meals that included a toy were down 11 percent last year, for example, while “value menu” orders were up 9 percent. More recently, children’s orders for cold-cut sandwiches are up 11 percent, a surge that appears to be driven largely by the fast-food chain Subway’s “$5 foot-long” campaign. And after more than three years of growth, restaurant birthday parties for children dropped 5 percent in the quarter ending in February, compared with the same quarter last year.
But economics cannot explain the entire shift, said Bonnie Riggs, a restaurant analyst for NPD. Cheeseburgers, fries and colas are all on value menus, but their consumption among children under 13 has fallen while healthier foods are on the rise.
Among the losers in the year ending March 31 were colas (down 10 percent), chicken nuggets and strips (8 percent), French fries (7 percent) and hot dogs (6 percent). Winners included soup (29 percent), grilled chicken sandwiches (26 percent), yogurt (21 percent), carrots (9 percent) and fruit (6 percent).
Even pizza is losing favor. While it is still the most popular food for children in quick-service restaurants, its year-to-year growth is flat, according to NPD. And in full-service restaurants, it has been replaced by pasta as the most popular food among children.
“Kids’ tastes and preferences are changing,” Ms. Riggs said, adding that they want “more choices and sophisticated fare.”
To be sure, pizza, burgers, fries and kids’ meals are still the most popular items ordered by children; the percentage gains for items like soup and yogurt are from a smaller base. But the trends bolster an argument that children’s health researchers have made for years: if you offer more healthful food, kids will eat it.
And many restaurants are taking the hint. Last month, Burger King announced three new kids’ meals that include small burgers, sliced apples that look like French fries, reduced-sodium chicken tenders, calcium-fortified apple juice and fat-free chocolate milk. McDonald’s offers apples and yogurt, and Wendy’s kids’ meals include mandarin oranges.
“The food industry is always saying, ‘We’re giving people want they want; that’s why we’re giving you chicken nuggets, burgers and fries for your kids,’ ” said Leann L. Birch, director of the Center for Childhood Obesity Research at Penn State. “That’s not really true. If kids are given different options and if parents make them available and let them choose some of those things, I think quite often we see you do get shifts in eating.”
Not every choice is resulting in a more healthful meal. For instance, the NPD data show that breaded chicken sandwiches are on the rise while burgers are declining. On the Wendy’s kids’ menu, the breaded chicken has 340 calories, and a junior cheeseburger has 270.
Among beverage orders, milk consumption is on the rise and colas are down. But orange and grapefruit sodas and root beer are rising.
“The perception might be that orange and grapefruit soda are better for you,” Ms. Riggs said.
Still, it is noteworthy that the NPD data are based on orders in restaurants, where children are often allowed to make their own choices.
“We don’t know how many choices kids really make,” Dr. Birch said. “But my sense is that parents are much more likely to be hands-off in a restaurant situation and allow kids the freedom to make more choices.
“You go to these places where they offer healthy options for adults. But until recently, kids haven’t had the opportunity to choose the right thing.”
Join the discussion: nytimes.com/well.
June 16, 2009
12. In Some Swimming Pools, a Nasty Intestinal Parasite
By SARAH ARNQUIST
A swimming pool can offer relief from summer heat, but swimmers should know what they are jumping into. It could be a soup of nasty parasites.
Reports of gastrointestinal illness from use of public pools and water parks have risen sharply in recent years, according to the Centers for Disease Control and Prevention. The leading culprit is a microscopic organism that lives in human feces.
Called cryptosporidium, it is a parasite transmitted in an egglike shell that can survive as long as 10 days even in chlorinated water. In 2007, the last year for which statistics are available, it was responsible for 31 recreational water outbreaks involving 3,726 people, according to the disease centers — up from 7 outbreaks and 567 people in 2004.
Health officials say the reasons are unclear. “We’re not sure whether it’s a true increase in incidence or an increase in reporting,” said Michele C. Hlavsa, an epidemiologist with the healthy swimming program at the C.D.C.
Ms. Hlavsa noted that detection and reporting had probably improved since a treatment for the diarrheal illness — called cryptosporidiosis, or crypto for short — became available in 2002. And the recent large outbreaks, she said, have raised awareness and led to better reporting.
Officials are not recommending that people avoid public pools. “We want people to swim, but be healthy about it,” said Dr. Sharon Balter, an epidemiologist with the Department of Health and Mental Hygiene in New York City, which has not had any outbreaks.
Crypto and other pool-associated illnesses are mostly caused by parasites and bacteria found in feces. The illnesses spread when people ingest contaminated water.
People should not swim or allow their children to swim when they have diarrhea, Ms. Hlavsa said. “The water you swim in is shared with everyone,” she said. “So what one swimmer does has consequences for all the swimmers.”
The symptoms of crypto resemble those of food poisoning. Though most cases clear up on their own, the illness can require hospitalization, particularly in small children and people with weakened immune systems.
One of the largest recent crypto outbreaks occurred in Utah in 2007. There were 2,000 confirmed cases, but that number vastly underestimates the illness’s total impact, said Dr. Robert T. Rolfs, the Utah state epidemiologist.
The cases started in early summer. But slow detection and reporting delayed intervention by public health officials, who struggled to contain the illness. Multiple waves of control strategies, including temporarily barring all children 5 and younger from pools, eventually helped slow the outbreak, which subsided after the swimming season, Dr. Rolfs said.
He and other officials say swimmers can take measures to protect themselves. Water in pools should not be cloudy, tiles should not be slick and filtration machines should hum in the background. When in doubt about water quality, people should notify the pool operator and, if necessary, call the local health department, which is typically responsible for pool inspection and health code enforcement, said Ms. Hlavsa of the C.D.C.
In addition to not swimming while ill with diarrhea, health experts say people should shower before swimming and never use the pool as a toilet. Parents should wash young children before they enter the pool and take them on frequent bathroom breaks. Children in diapers require vigilant attention.
“Healthy swimming,” Ms. Hlavsa said, “is no accident.”
June 16, 2009
13. 1952 Outbreak Has Echoes for 2009
Edward Schecter remembers overhearing the doctors saying he was going to die.
His fever had spiked to 106 degrees. Doctors put him in a bathtub full of ice, then gave him a last-ditch antibiotic whose side effects could have killed him. Before his ordeal was over, he would lose more than 20 pounds.
It was August 1952, and Eddie Schecter, then a 6-year-old camper at the Hi-Li Jewish day camp in the Far Rockaway section of Queens, was the sickest survivor of one of New York City’s last major outbreaks of typhoid fever — an event that has haunting echoes, and useful lessons, for today’s pandemic of H1N1 swine influenza.
The initial diagnosis of typhoid, a bacterial disease characterized by fever, lethargy, abdominal pain and a rash, was something of a piece of luck. While hardly unheard of, it was disappearing from most American cities by that time, a casualty of improved sanitation. Parents sending their children to camp were much more anxious about polio.
That August morning, when Eddie was too feverish to go to camp, his parents called their family physician, Dr. Sidney Rothstein.
A Polish Jew who had escaped the Holocaust, Dr. Rothstein had seen a lot of the disease in wartime Europe. He personally drove his patient to a hospital, and ultimately insisted that the boy be given chloramphenicol, a controversial antimicrobial that in rare cases caused fatal suppression of bone marrow — but probably saved Eddie’s life.
As Eddie became ill, so did dozens of other Hi-Li campers. Doctors notified the New York City Department of Health, which, working with colleagues from Nassau County, began an epidemiological investigation on Aug. 12.
The outbreak ultimately infected 51 people. It was big news, reviving memories of the notorious “Typhoid Mary” Mallon, a cook who had spread the disease earlier in the century and caused the deaths of three people.
Health officials suspected that, like Mary Mallon, someone preparing food at Hi-Li was a carrier of the typhoid fever bacterium. While healthy, such individuals harbored the germ in their intestines and could inadvertently spread it to food via their hands. By Aug. 15, the Department of Health had found the culprit: a 45-year-old woman who had worked as a cook at Hi-Li since 1950.
By all accounts, the department did an excellent job of stemming the outbreak. It closed the camp and sent nurses to the homes of all sick campers, administering doses of preventive vaccine to family members when indicated.
Even though the death rate for typhoid fever was as high as 10 percent, all of the patients survived. And unlike Typhoid Mary, the cook appears to have followed the advice of health officials and stopped working with food.
Over all, the episode was a forerunner of the aggressive but measured response that New York’s Department of Health and Mental Hygiene has employed in the swine flu crisis. Still, back then, officials could not quiet the fear that gripped Far Rockaway and nearby communities, even though they reminded people that the disease was not spread casually. Carol Schwartz, Eddie’s sister, recalls going to a friend’s house to bake brownies. “I was completely healthy,” she said recently, “but her mother screamed at me to get out.”
Thankfully, some aspects of health care have changed since 1952. At Meadowbrook Hospital on Long Island, where doctors established a makeshift quarantine ward for the Hi-Li campers, Eddie was allowed no direct contact with his family. His parents could only wave to him from a nearby window.
“The doctors even told me that if I cried when I had my blood drawn, my parents would not visit anymore,” he recalled not long ago.
But good memories have persisted, too. When the rabbi who ran Hi-Li invited Eddie back for the summer of 1953, he and his parents accepted.
He returned for several summers afterward, and by age 12 he had decided on his own career. Today, at 63, he is the rabbi at Temple Beth Shalom in Hastings-on-Hudson, N.Y. (I am a member of the synagogue.)
“After that summer,” he said, “my mother would always tell me I had been saved for a purpose.”
Dr. Barron H. Lerner teaches medicine and public health at Columbia University Medical Center.