At the risk of being labeled obsessed myself, I’m still on the Gibbons et al article [Suicidal Thoughts and Behavior With Antidepressant Treatment] published on-line this month in the Archives of General Psychiatry about treatment emergent suicidality with the SSRIs. They said of their data sources for this meta-analysis, "we obtained complete longitudinal data for RCTs of fluoxetine hydrochloride conducted by Eli Lilly and Co, the Treatment for Adolescents With Depression Study of fluoxetine in children by the National Institute of Mental Health, and adult studies for venlafaxine hydrochloride conducted by Wyeth." In the abstract, they say, "Data Sources: All intent-to-treat person-level longitudinal data of major depressive disorder from 12 adult, 4 geriatric, and 4 youth randomized controlled trials of fluoxetine hydrochloride and 21 adult trials of venlafaxine hydrochloride." I wasn’t interested in the adult data, but went looking for the mentioned studies for children and adolescents other than TADS. There are four studies listed and reviewed in the FDA Medical Review for Prozac’s approval for MDD and OCD for children and adolescents in January 2003 and also in the FDA Hammonds Review in August 2004 prior to the black box warning [published full text on-line]:
STUDY DX SPONSOR YEAR N PBO FLX DURATION HCCJ MDD Lilly 1984 40 19 21 6 weeks X065 MDD NIMH? 1991 96 48 48 8 weeks HCJE MDD Lilly 1998 219 110 109 13 weeks HCJW OCD Lilly 1999 103 71 32 9 weeks subtotal 458 248 210 TADS MDD NIMH 2000 433 206 227 36 weeks total 891 454 437
… subtotal 458 248 210 TADS MDD NIMH 2000 439 216 223 12 weeks total 897 464 433
Feels like an orchestrated campaign to me. A biostatistics driven article with no data? full text on-line? data coming soon? a Medscape piece titled No Link Between Antidepressant and Suicide in Kids? with commentary and glossy photos?…
“Babies born just a few weeks early have a higher risk of poor health,” The Guardian reported today. According to the newspaper, new research has found that being born just a few weeks early can raise their risk of conditions such as asthma.
It is already known that babies born prematurely (before 37 weeks of pregnancy may have a higher risk of immediate or longer-term health problems, and the earlier a baby is born, the higher the risk. To examine the issue researchers followed the health of over 14,000 children born between 2000 and 2002, and examined their health at the ages of three and five years old. Outcomes including growth, hospital admissions, use of medication, asthma and long-standing illnesses were looked at particularly in relation to whether the children were moderately premature (32-36 weeks of pregnancy or born at what the researchers called “early” full term (37-38 weeks . Babies born moderately prematurely or at early term were more likely to have been re-admitted to hospital in the first few months of life than babies born at 39-41 weeks. Babies born moderately prematurely also had a higher risk of asthma symptoms than full-term babies.
These findings are broadly in line with what is already known about the effects of prematurity, and do not change the UK’s current definition of full-term pregnancy as 37 weeks and over. However, the study does show how different degrees of prematurely may affect health. Further study of the issue would be valuable, to explore longer-term health outcomes that may be caused by prematurity and the factors that may influence the likelihood of these poor health outcomes.
Where did the story come from?
The study was carried out by researchers from the University of Leicester and other UK institutions. It was funded by the Bupa Foundation and published in the peer-reviewed British Medical Journal.
The media generally covered this research in a balanced way.
What kind of research was this?
In the UK, the normal length of a pregnancy is classed as 37 weeks or above. It is already known that babies born prematurely (before 37 weeks may be at increased risk of immediate and longer-term health problems, and that the risks are higher the earlier a baby is born. However, the authors say that there has been minimal research into the longer-term health outcomes of infants specifically born moderately preterm (which this study defines as 32-36 weeks and at what the researchers termed as ‘early full term’ (37-38 weeks .
To investigate this, the researchers used a cohort study. This is a good way to follow up and compare health outcomes in groups of people that have been exposed to different factors. In this case, the exposure was the number of weeks of pregnancy at which the babies were born. However, a cohort study that looks at a group’s health relies on the accuracy of reported health outcomes and diagnoses. For example, one condition this study looked at was asthma, and the researchers asked parents about whether their child had wheezing symptom or asthma. However, this does not necessarily equate to a medical diagnosis of asthma.
This type of study also needs to take into account potential factors that could be related to both risk of prematurity and risk of the health outcome. For example, parental smoking is linked to an increase risk of prematurity, and also to an increased risk of asthma in the child.
What did the research involve?
This study involved participants of the Millennium Cohort Study (MCS , a piece of research in which the subjects were gathered by random sampling of child benefit registers. It featured 18,818 infants born in the UK between 2000 and 2002. The number of weeks of pregnancy at birth was calculated from the mother’s report of her expected due date. Births were grouped into:
- very preterm (defined by the authors as 23-31 weeks
- moderate preterm (32-33 weeks
- late preterm (34-36 weeks
- early term (37-38 weeks
- full term (39-41 weeks
These are not the standard accepted definitions. For example, the charity BLISS, for “babies born too soon”, defines full-term pregnancy as 37 weeks or more, moderately premature as 35-37 weeks, very premature as 29-34 weeks, and extremely premature as birth before 29 weeks.
Child health outcomes were monitored over five years of follow-up. Outcomes assessed included:
- child height, weight and body mass index at three and five years
- parental reports of the number of hospital admissions (not related to accidents since birth or the previous interview, collected at nine months and at three and five years.
- parental reports of any longstanding illness or disability of more than three months’ duration and diagnosed by a health professional, collected at three and five years (a limiting longstanding illness was defined as one which limited activities that are normal for the child’s age group
- parental reports of wheezing within the previous 12 months, and parental reports of asthma collected at three and five years
- parental reports of the use of prescribed drugs, collected at five years
- parents’ ratings of child health, defined as excellent, very good, good, fair or poor, collected at five years
The researchers used statistical methods to look at the outcomes in groups groups born at different stages of pregnancy and compared them to (their definition of full-term babies. Analyses were adjusted to account for various potential confounding factors, principally numerous social and demographic factors. The researchers also estimated “population attributable fractions” (PAFs associated with preterm and early term birth, which is an estimate of the contribution that a particular risk factor has to a health outcome. PAF represents the reduction in the proportion of people in the population with a particular health problem that could be expected if the exposure to a risk factor were reduced to the ideal exposure. In this case, it would represent the proportion of children that would no longer have a particular health problem if all babies were born at full term rather than preterm.
What were the basic results?
After the researchers excluded participants in the MCS study with incomplete data on time in the womb at birth, they interviewed the parents of 14,273 children at 3 years of age and 14,056 at 5 years. They found certain sociodemographic factors, such as lower maternal educational status and maternal smoking, to be associated with prematurity, as is already known.
The researchers generally found a “dose response” effect of prematurity, meaning that the more premature a baby was, the higher the likelihood of general health problems, hospital admissions and longstanding illnesses. They calculated the odds of each outcome compared to children born at 39-41 weeks. The full details of these outcomes are as follows:
The odds for three or more hospital admissions by five years of age were:
- 6.0 times higher for children born at 23-31 weeks
- 3.0 times higher for children born at 32-33 weeks
- 1.9 times higher for children born at 34-36 weeks
- 1.4 times higher for children born at 37-38 weeks
The odds for any longstanding illness at five years of age were:
- 2.4 times higher for children born at 23-31 weeks
- 2.0 times higher for children born at 32-33 weeks
- 1.5 times higher for children born at 34-36 weeks
- 1.1 times higher for children born at 37-38 weeks
The odds for the child’s health being rated as only fair or poor by parents at five years of age were:
- 2.3 times higher for children born at 23-31 weeks
- 2.8 times higher for children born at 32-33 weeks
- 1.5 times higher for children born at 34-36 weeks
- 1.3 times higher for children born at 37-38 weeks
The odds for asthma and wheezing at five years of age were:
- 2.9 times higher for children born at 23-31 weeks
- 1.7 times higher for children born at 32-33 weeks
- 1.5 times higher for children born at 34-36 weeks
- 1.2 times higher for children born at 37-38 weeks
The greatest contribution to the burden of disease at three and five years was among children born at late/moderate preterm or early term. The calculated PAFs for being admitted to hospital at least three times between the ages of 9 months and 5 years were:
- 5.7% for children born at 32-36 weeks (i.e. you would expect a 5.7% reduction in the number of young children admitted three or more times if babies were born at full term rather than moderate preterm
- 7.2% for children born at 37-38 weeks (you would expect a 7.2% reduction in the number of young children being admitted if babies were born at full term rather than early term
- 3.8% for children born before 37 weeks (you would expect a 3.8% reduction in the number of young children being admitted if babies were born at full term rather than very preterm
Similarly, PAFs for longstanding illnesses were:
- 5.4% for early term births
- 5.4% for moderate or late preterm births
- 2.7% for very preterm births
How did the researchers interpret the results?
The researchers concluded that “the health outcomes of moderate/late preterm and early term babies are worse than those of full term babies.” They say that it would be useful for further research to look into how much of the effect is due to prematurity itself, and how much is due to other factors such as maternal or foetal complications.
Conclusion
This valuable research examined childhood health outcomes in a large group of children born at different stages of pregnancy.
Important points to consider when interpreting this research include:
- The authors generally found that the likelihood of poorer health outcomes was higher with increasing prematurity (a dose response effect . This is in line with what is already known about the generally poor immediate and longer-term health outcomes among babies born increasingly prematurely.
- The greatest contribution to overall burden of disease at ages three and five years was calculated to be among children born at 32-36 weeks or at 37-38 weeks. Though a gestation of less than 32 weeks might be expected to have a greater influence on the burden of disease, it must be remembered that many more babies are born above 32 weeks of gestation than below it. Therefore, in the population as a whole, the greater number of babies born within the 32-38 week range would have a greater effect than the small number of babies born extremely early.
- The definitions that the authors used for the purposes of this study are not standard definitions. For example, the standard definition of full-term pregnancy is birth at 37 weeks or more, and it is not split into “early term” at 37-38 weeks and “full term” only at 39-41 weeks. Similarly, definitions of prematurity differ from those used by other UK health organisations.
- There is a possibility of inaccuracy as both age at birth and health outcomes were reported by parents, rather than assessed through medical records. For example, a parental report of wheezing or asthma does not necessarily constitute a confirmed medical diagnosis of asthma.
Overall, the study found that the more premature a baby is, the greater the likelihood of health problems in childhood, and that some effect of prematurity may even be seen in pregnancies approaching full term. Further study in this area would be valuable, both to explore the wider range of longer-term health outcomes that may be caused by prematurity, and to look into associated factors (medical or sociodemographic, for example that may influence the likelihood of these outcomes.
Analysis by Bazian
Links To The Headlines
Infancy health risk linked to early birth by research. BBC News, March 2 2012
Babies born a few weeks early 'suffer health risks'. The Guardian, March 2 2012
Links To Science
Boyle EM, Poulsen G, Field DJ et al. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. BMJ 2012; 344
Press release: Population-based cohort study of the effects of gestational age at birth on health outcomes at three and five years of age. BMJ, March 1 2012
"The evidence suggests that Californians who do not speak English very well are at a disadvantage in terms of accessing health care reform programs," said Daphna Gans, a research scientist at the UCLA Center for Health Policy Research and the lead author of the study. The UC model shows that if language is not a barrier, participation by LEP adults could increase to 53 percent, a difference of approximately 110,000 individuals.
"These are difficult times for California families, and ensuring every Californian has access to quality, affordable health care is vital for our economic recovery," said California Assembly Speaker John A. Pérez, who authored legislation (AB 1602 in 2010 establishing the exchange. "The Health Benefit Exchange will help lower the cost of health insurance for every Californian, but it's vital for every eligible Californian to enroll to ensure we bring health care costs down as much as possible for California's working families."
In California, more than 15 million residents speak a language other than English at home and nearly half (7 million of them have limited proficiency in English. The study shows the importance of adopting a diverse strategy for outreach and education.
"The exchange is a key opportunity to make Californians healthier," said Ellen Wu, executive director of the California Pan-Ethnic Health Network. "We have to do this right. Our success in implementing this new program will be measured not just by the number of people enrolled but by the state's ability to reach those who are most often left behind. We have to target resources through multicultural and multilingual outreach to ensure that communities of color who are eligible, particularly people who speak English less than very well, enroll in coverage."
The study was conducted based on analyses using the California Simulation of Insurance Markets model, a micro-simulation developed by UCLA and UC Berkeley researchers, which uses a range of official data sources (including the California Health Interview Survey to estimate the impact of various elements of the Patient Protection and Affordable Care Act on employer decisions to offer insurance coverage and on individual decisions to obtain coverage in California. The development of the model was supported through funding by The California Endowment, the California Health Benefit Exchange and the California Pan-Ethnic Health Network. Read the study, "Achieving Equity by Building a Bridge From Eligible to Insured."
The California Pan-Ethnic Network (CPEHN , celebrating 20 years as a champion for health equity, works to eliminate health disparities by advocating for public policies and sufficient resources to address the health needs of communities of color. The UC Berkeley Center for Labor Research and Education is a public service and outreach program of the UC Berkeley Institute for Research on Labor and Employment that conducts research and education on issues related to labor and employment. The UCLA Center for Health Policy Research is one of the nation's leading health policy research centers and the premier source of health policy information for California. For more news, visit the UCLA Newsroom and follow us on Twitter.
From the multimillionaire chefs who claim to be just like the rest of us to the multinationals making public health policy, there's something a bit iffy about the new food culture
In the second half of the 20th century, western consumers were treated to an unprecedented array of high-quality, low-cost food. Monochrome national cuisines were spiced up by immigration, globalisation and holidays abroad. Increased disposable income turned a restaurant pilgrimage into an everyday jaunt. You could have pain au chocolat for breakfast, a Mexican tortilla wrap for lunch and a Thai green curry for dinner. Farmers' markets popularised heritage tomatoes. Celebrity chefs took up residence in gastropubs.
Now, I think it's great that in recent years we've woken up to the wonders of fresh, local, home-cooked food. But this new food culture is not quite as it seems. The spectacle of Jamie Oliver, a cheeky lad from Essex, tearing basil leaves on to spaghetti was in some ways a step forward for equality, but in other ways it was a sneaky step back – because it made it that much harder to notice the dodgy doublespeak that has come to dominate the way we talk about food.
A lot of celebrity chefs claim to be just like you and me. "I lead a normal life," Nigella Lawson writes in the introduction to Nigella Express, "the sort we all share." So that means living in a ?12m house in Chelsea and sharing an estimated fortune of more than ?100m with her husband, the art collector Charles Saatchi? Or there's this, from Jamie At Home: "Like most people these days, with a busy family life and a hectic working schedule, I began to struggle with finding a balance between the two. I seem to have evened things up a bit now, and it's all thanks to my veg garden." That would be the veg garden that enjoys the attentions of a personal gardener.
Reality, normality, hard-working families: this is the mantra of the multimillionaire celebrity chef. But the recipes have trouble sticking to it because, despite the homely trappings, they are essentially restaurant food. Take Nigella Express, the book of the TV show promising "fabulous fast food and incredible short cuts". The recipes are quick to make, it's true, but look at the ingredients: mirin, poussin, pomegranate juice, quail, harissa, sake, garlic oil. It would take an afternoon to track them down. I have for many years wrestled with the matter of fresh herbs. They improve simple dishes no end: most of Jamie's 30-Minute Meals rely on them. But I always find myself rummaging impatiently through a supermarket's highly selective herb selection to find the one I need.
Every time I've tried to grow them on my balcony, they've lasted about three weeks. My shrivelled, dried-up herbs seem to me to encapsulate a broader problem, because they are the very baseline minimum of the grow-your-own business, the entry-level stage. And even that doesn't seem to work. The glossy new food revolution that's advertised on our TV screens and in our beautiful recipe books purports to be democratic, accessible, available to everyone, but it's not. I'm fine with Heston Blumenthal's baroque creations, his frog's leg blancmange and exploding cakes. He is not for a minute suggesting that we should try those at home. But if the others really wanted to come up with a quick and easy cookbook for "hard-working families", they'd write one that used only the kind of ingredients I can buy at my local Costcutter: potatoes, tomatoes, onions and carrots.
Yet there's an obsessive emphasis on teachability, on getting your hands dirty, on This Will Change Your Life. I remember recipe programmes on TV in the 80s that paused, politely, while you grabbed a pen to note down the ingredients list. Now, supposedly real-time cookalongs are a frantic marathon, and full ingredients lists are to be found only in the accompanying book, priced at ?19.99. And to me it's extraordinary that celebrity cookbooks rarely announce their gastronomical allegiance. A lot of celebrity cheffery blends into a modern European, pan-Asian melange. It's beyond fusion. It's category meltdown. I find it odd that, for all today's flag-waving about the wonder of different cuisines, our modern chefs are so coy about their culinary brand. And for all the apparent kitchen-sink empowerment, I also find it somewhat patronising. These are often connoisseurs who've been trained to distinguish Spanish from Catalan tapas, or trace the genealogy of haute cuisine; but don't you worry your little heads about such finer points, they seem to say. It's the food equivalent of the modern post-ideological politician who gives speeches saying right and left are over, but back at Oxford made damned sure he mastered the taxonomy of political theory. Today's TV chefs claim to be making food accessible, but they don't give ordinary people the vocabulary, the building blocks, to get a handle on food. Just as art schools today don't teach much drawing, there's no going back to food-type basics, techniques or the elements of different cuisines: no culinary periodic table.
Now, you might be thinking, what's wrong with a little recreational food porn? I'm not averse to a bit of Nigella myself. But while these fantasies may be fun, they are not harmless. We lap them up, but they ultimately leave us still more famished. The more time we spend watching cookery programmes and reading restaurant reviews, the less we spend actually cooking. According to the Food Standards Agency, in 1980 the average meal took an hour to prepare. By 1999, it took 20 minutes. And a 2002 Mintel report found that only one in five viewers tries a recipe after watching a chef on TV and only one in seven buys new ingredients. A large proportion of apparently handmade gastropub meals are actually trucked in by catering giants such as Brakes or 3663, which provide microwaveable or boil-in-the bag versions of old-fashioned rustic classics such as venison and pork sausages "infused with sloe gin and served in a rich and sweet bramble berry and red wine sauce", or, for dessert, an "apricot, apple and stem ginger crumble... heaped with hand-placed golden oaty all-butter crumble". The "authenticity" of these dishes is a fib impossible to spot. We may be aware there's been a huge rise in sales of ready meals, but now they're being disguised as home cooking.
My problem is our refusal to admit that reality is obscured by illusory ideals. It's not only that Jamie employs around 5,000 staff and is reportedly worth ?65m, it's that he foregrounds his lovely-jubbly persona and rapport with dinner ladies. TV executives try to get around these contradictions with the help of that weasel word "aspirational". But it just doesn't wash. This is not just food. This is 100% mock-authentic, mock-egalitarian class hierarchy. Supermarket labels such as "organic", "finest" and "taste the difference", or "economy", "basics" and "everyday", are euphemisms for food apartheid. I am addicted to the genius TV series Come Dine With Me, but the butt of the jokes are the wannabe foodies in Luton who serve starters of "microsalads", main courses in "towers" on large square plates and desserts that always come as a trio. Jamie's Ministry Of Food claimed to bring home cooking to the ordinary British family, but the series was riddled with undeclared class dynamics. Those mothers who passed chips through the fence at Rawmarsh school in South Yorkshire after it started serving Jamie's healthy school dinners were protesting against paternalism. As one of them explained, "This isn't about us against healthy food, like they've been saying… It's about how people change the rules." I believe Jamie's gastronomical good intentions, but his outrage at seeing mothers bottle-feeding Coke to their babies has a class dimension that is never explicitly addressed. Because he himself doesn't sound posh, there's a sense that if he's made it good, so can they. Jamie raises the stakes for middle-class fans by presenting expensive, cheffy food as barrow-boy basics ("Tear up yer tarragon, drizzle yer top-quality olive oil" . And he raises the stakes for working-class mums by implying that there's no excuse for not pulling themselves up by their culinary bootstraps.
It's not only class inequality that lurks beneath the new food culture, it's gender inequality, too. When Jamie debuted on British TV as The Naked Chef in 1999, he was credited with encouraging the most male-chauvinistic of oafs to try their hand at a fairy cake. And indeed, this has come to pass in some households. But very often it's the men who are flambeeing the bananas at the Saturday night dinner party, while the women are plotting how to stretch the Sunday roast leftovers into day three. Female TV chefs are filmed in a cosy kitchen, male chefs in some kind of rustic outhouse or on a beach with an improvised barbecue. In 2010, Waitrose spent ?10m on an advertising campaign featuring two people: "Britain's best chef" and "Our best-loved cook". No prizes for guessing which was Heston Blumenthal and which was Delia Smith.
It's a new backlash sexism, I believe, that accounts for the fact that so many famous chefs' wives are prominent foodies themselves. Their role is to absorb the feminine connotations of their husbands' cookery. "The trick to Christmas," says Tesco Magazine Celebrity Mum of the Year Tana Ramsay, being interviewed for said magazine, "is making things in advance as much as you can, such as chopping the vegetables on Christmas Eve." After the Ramsays have opened their stockings, the article continues, "Gordon and son Jack, eight, whizz off to Claridge's to wish his restaurant staff a merry Christmas. At home, under Tana's watchful guidance, daughters Megan, 10, Holly, eight, and Matilda, six, help their mum keep an eye on the turkey."
The end result is that celebrity chefs and their wives – Tana'n'Gordon, Jamie'n'Jools – end up modelling in the media traditional gender stereotypes that undercut the right-on rhetoric. Take Jools Oliver's Minus Nine To One: The Diary Of An Honest Mum, which contains children's recipes: "A few months before our wedding," she confides in the book, "Jamie asked if I wanted to become his PA. I agreed, as it meant that I would get to see him every day and I thought it would be fun, plus I was never really a career girl anyway. (Who was I kidding? I wanted the babies, the baking and the roses round the door. " For all the metrosexual class-busting bluster, it's this message we are left with.
My local Waitrose offers a choice of four different kinds of salmon fillet: standard fillets; "Wild Alaskan Sockeye" fillets, "caught in Alaska's well managed, sustainable fishery, certified to Marine Stewardship Council standard"; "Select Farm" fillets from "dedicated farms in locations carefully chosen for their highly oxygenated, fast-flowing tidal waters"; and "Duchy from Waitrose Organic" fillets, "organically farmed to Soil Association standards on Shetland and Orkney". It's a classic example of totally uninformative information. If I were a salmon, I think I'd appreciate highly oxygenated, fast-flowing tidal waters; so how come Duchy from Waitrose organic salmon don't get to swim in them? And how come wild Alaskan salmon are caught in a fishery? That shelf of salmon fillets appeared to offer a diverse range of tasty, affordable, environmentally-friendly fish. But the reality of which kind of fillet would be best for me, best for the fishermen and best for our oceans is simply impossible to make out.
The same goes for seasonal fruit and veg. Seasonality is a virtue heavily promoted by Jamie and the rest. It has the advantage of being an enjoyable virtue, too: I love summery, flavoursome tomatoes and sweet blackberries. But if I go to the supermarket or the local grocer, it's just not that easy to work out what's on nature's menu.
Then there's organic food. The tech spec of organic food – the fact that nothing synthetic is used in its production – suggests flavour, nutritional value and agricultural ethics. But it has become a devalued, mass-market symbolic indicator. Organics are promoted as both available to all and a luxury treat, but often they're more expensive and they taste the same. And they're not even necessarily good for the environment, either. Increasing demand has led to organic meat being raised on vast industrial feed lots, and the scarcity of organic ingredients means they are flown around the world. Research sponsored by the Department for Environment, Food and Rural Affairs showed that the production of a litre of organic milk requires 80% more land than conventional milk. And that organically reared cows burp and fart twice as much methane as conventionally reared cattle, which would be amusing if it weren't for the fact that methane is 20 times more powerful a greenhouse gas than CO2.
Overall, the research on environmental impact is contradictory, which only makes it harder for consumers to work out what to do. The marketing of organic food taps into our innermost drives and ambitions: to be good, to be good to ourselves, to be worth the extra cost. But the only people for whom it definitively seems to be good are managers of multinationals. Ben & Jerry's is owned by Unilever. Coca-Cola has a majority stake in Innocent smoothies. Back To Nature is owned by Kraft. Supermarkets may display their organic food in rustic-looking baskets, and Starbucks may camouflage its corporate brand under local "community personality", but farmers in the developing world suffer from diminishing profits, and our soil, sea and atmosphere are ever more degraded.
The food industry successfully hides its influence behind persuasive talk of the power of the individual. The industry and government alike argue that it is consumer choice and consumer demand that really drive change. Yet a Royal Society report published in 2010 revealed that, although consumers consulted 10 years earlier about whether they wanted GM food had responded with a resounding "no", GM has nevertheless thoroughly penetrated the food supply in the form of soya animal feed and cooking oil. The notion that consumers are in control of the food industry is a myth, as is the notion that they are at liberty to make well-informed decisions about the food they buy. One of the Cornish pasty company Ginsters' favourite slogans is "Keeping it local". But its pasties are taken on a 250-mile round trip by lorry before being delivered to the Tesco next door to its Cornwall plant (they insist it's more efficient that way . A slice of Cranks seeded farmhouse bread has twice the amount of salt as a packet of Walkers ready-salted crisps. McVitie's light digestive biscuits have less fat than McVitie's original digestives, but more sugar, so the difference between the biscuits is just four calories. But then a 2009 article in the New Scientist pointed out that even calorie labelling is unhelpful, because the body digests different foods at different rates. "Consumers aren't stupid" is the stock industry response when challenged on their campaigns of misdirection. Yet in her 2010 book Green Gone Wrong, the environmental writer Heather Rogers quotes the director of an organic conglomerate noting that "most consumers are simple minds [who] look at the label and nothing else". But with labels that are this misleading, intelligence is a red herring.
The industry insists that in selling the sugary, fatty, salty foods that are contributing so much to rates of obesity, heart disease and type 2 diabetes, it is simply giving people what they want. In reality, of course, the industry doesn't just respond to desires: it shapes them. Richard Thaler and Cass Sunstein talk a lot about food choices in their book Nudge: Improving Decisions About Health, Wealth And Happiness. Their proposals, which include placing fruit at eye level in school canteens, are an acknowledgment that people aren't very good at choosing healthy food. They're an acknowledgment, in other words, of the fallacy of the much-trumpeted notion of the rational consumer, although the governments that are in thrall to the politics of nudge seem untroubled by this contradiction. For all their good intentions, Thaler and Sunstein underestimate just how energetically the food industry is working to prevent healthy choices. Often what is needed is some basic information, some rudimentary transparency, rather than a nudge. A traffic light system for labelling healthy and unhealthy food would be a start – research shows it's the most helpful one for consumers – but that would mean giving consumers real power to choose.
One of Tory health secretary Andrew Lansley's first moves in office was to promise that "government and FSA promotion of traffic light labelling will stop" as part of a big shake-up of public health. Out went regulation, legislation and "top-down lectures"; in came voluntary corporate action and individual responsibility. Lansley set up a series of "responsibility deal networks" designed to get public health officials to "work with business". The idea of McDonald's, KFC and Pepsi designing public health policy outdoes Orwell's Nineteen Eighty-Four. And one of the networks, in charge of "public health behaviour change", was to work with the government's newly set up "nudge unit". There it is again, the real payoff of nudge policy: to nudge us into buying from big corporations.
There's a huge denial of inequality here: between consumers and corporations, and also between different kinds of consumers. In reality, there is one group of shoppers that can afford to be ethical and another that can't. The fact is, people on low incomes are more likely to buy food that is bad for them and bad for the environment. But corporations and governments take advantage of the taboos of false consciousness and inequality in order to protest that they are simply letting consumers choose what they want. We are labouring under the delusion not only of freely available, low-cost, great-quality, nutritional food, but also of a level playing field of money, power and information.
The fact that we tolerate this delusional state of affairs does not speak well of us. It makes us seem passive, blinkered and bovine. The cheapness of food has provided us with a false sense of security, allowing us to believe we're getting the best of both worlds. But food prices are rising. In some ways that will make food choices more conscious, and more consciously political. But there's also a danger that we'll focus more attention on price alone. It's not really our fault. It's hard to make good choices when the marketing of products is so opaque and befuddling. It's hard to detect the silent promotion of inequality by mainstream food culture when the headlines are all about democratisation and demographic change. But we are like orally fixated toddlers, transfixed by Nigella's cupcakey bosom, Starbucks' vanilla frappuccinos and Michelin-starred creamy, frothy sauces. We need to wise up to the rhetoric of food and start tasting reality.
This is an edited extract from Get Real: How To Tell It Like It Is In A World of Illusions, by Eliane Glaser, published by Fourth Estate at ?14.99. To order a copy for ?11.99, including mainland UK p&p, visit the Guardian Bookshop.
Read on to get the scoop on what the petite, spunky, sexy star eats every day (well, almost to keep her figure so fit and fab!
“Oatmeal tastes so good on its own, you don’t even need to add sugar,” Chenoweth says. “Starbucks oatmeal is perfect for me because I’m always on the go.”
“As much as you can eat healthy, it’s also important to remember to drink healthy too,” she says. “Tea is very healing.”
“Little packages of almonds are so great for on the go… I just pop them in my purse,” she says.
“I like to order low-cal wraps with turkey, lettuce, tomato, and pickles,” Chenoweth says. “Subway can be a great choice to find something healthy and fast.”
“Apples, grapes… any kind of fruit gives me the energy I need to get through my busy day.”
“We are what we eat, so I eat as many veggies as I can!” she says.
“I don’t have it that often, but I’m definitely trying to watch it because it causes acid reflux,” she says. “A little 90-calorie can from the grocery store is a great way for me to indulge without feeling like I’m completely blowing it!”
The Broadway beauty radiates as much good health as she does pure positive energy.
“Always keep moving! Little things like taking the stairs, taking a dance class, mixing it up if you get bored… make the most of your workouts, even if you only have 20 minutes,” she says.
Catch Chenoweth starring in the new series GCB, Sundays at 10/9c on ABC.
UN Population Fund
Ethiopia
Finding ways to deliver for women where doctors are in short supply
TIGRAY REGION, Ethiopia — “We are all looking to you to be a window of hope to reduce the unnecessary death of mothers and newborns during pregnancy and delivery in rural Ethiopia,” said Dr.Tedros Adhanom, the Minister of Health, as he handed over diplomas to the first graduates of his country’s programme in integrated emergency surgery and obstetrics.
The first graduating class of the new three-year Masters of Science, established by the Ministries of Health and Education with the support of UNFPA, included 16 health professional graduates at Ayder Hospital who will now be able to carry out Ceasarean sections and other procedures that were once strictly relegated to medical doctors. This strategy for dealing with the significant shortages of trained health workers, particularly in rural areas, is called task-shifting.
Aiming to deploy a trained clinician to every district
The Government’s ambitious goal is to deploy one trained obstetric clinician to each Ethiopian health district, as the country graduates 800 to 1,000 such professionals in the years ahead. Thirty-seven sites have been designated by the Ministry of Health using data from the emergency obstetric care survey conducted in 2009.
Though Ethiopia has had considerable success in reducing maternal deaths in the last decade, a huge gap remains. Ethiopian women, the majority of whom live in rural areas, face multiple challenges in getting adequate care, however, as they often live far from health centres and transportation options are limited. Limitations on resources, including health workers, pose additional challenges.
Filling the gap in trained health workers
Only 51 per cent of hospitals in the country provide comprehensive emergency obstetric and neonatal care, while 14 per cent of health centres offer basic emergency obstetric and neonatal care. Only 10 per cent of women have access to a skilled birth attendant, and the country needs nearly 9,000 more to achieve 95 per cent coverage, according to the State of World Midwifery report.
Overcoming these challenges requires integrated policies and innovative programmes mandated by the highest level of government. The emergency surgery and obstetric programme is critical in filling the gaps in rural health services and ultimately improving the well-being of mothers and their chances of survival during pregnancy and childbirth.
The MSc Programme is operating in five universities, Gondar, Hawassa, Haromaya, Jimma and Mekele, with 282 students enrolled. The programme shifts medical tasks from doctors to non-doctor clinicians to address the shortages and inequalities in emergency obstetrics and neonatal care between rural and urban areas and rich and poor communities. UNFPA has contributed nearly $2 million worth of financial, technical and material support to the programme.
Dealing with ‘brain drain’
Across most of sub-Saharan Africa, medical doctors are leaving their jobs for more lucrative work outside their countries. This ‘brain drain’ has resulted in non-physician clinicians increasingly taking on specialized or upper-level clinical functions, performing such vital procedures as surgery, work normally done by doctors. Midwives and nurse-midwives are also teaming up with the new health clinicians to provide more emergency obstetric and newborn care.
Task-shifting from doctors and other highly qualified personnel to health workers with less training and fewer qualifications aims to make more efficient use of the resources available in Ethiopia. Studies have shown that the surgical outcomes of properly trained and supported clinicians are comparable to those of doctors. Moreover, by performing the emergency interventions at rural health centres, the clinicians can help cut the cost of referrals to regional hospitals.
More than half of African countries have programmes that train non-physicians in integrated emergency surgery and obstetrics. In Malawi, Mozambique, Tanzania and Zambia, the programmes have shown such mid-level professionals are more likely to stay in their communities and countries than obstetricians, gynaecologists or general practitioners. In addition, the cost of training, deployment and salaries of these clinicians was much lower than for physicians, making it the best option for many African nations in reducing maternal deaths.
--Abraham Gelaw
Rush Limbaugh has betrayed his audience. I won't pretend that I write without an angle, but I know that it is possible to do so without lying and distorting the facts. This is not the case for Limbaugh, as it became clear on his show on Wednesday night, during which he again lashed out against student and contraception coverage mandate supporter Sandra Fluke.
Fluke, a third-year student at Georgetown Law School, came before an unofficial hearing led by House Minority Leader Nancy Pelosi (D-California to argue in favor of insurance coverage for birth control at religious institutions. Pelosi, it bears noting, had made arrangements to hear Fluke testify after the student was barred from the official hearing by presiding Republicans, who said her name had been submitted too late. According to the Washington Post, Democrats involved disagreed with this justification. Unsurprisingly, all the women present at the official hearing were opposed to the measure.
Fluke, who finally got her opportunity to share the views of Georgetown Law's Students for Reproductive Justice, told those in attendance about the plight faced by women who need birth control not only to prevent pregnancy, but also to treat illness such as polycystic ovarian syndrome and endometriosis.
On his show, Limbaugh ignored the terrifying stories shared by Fluke about women who suffered hardship after being denied birth control, suggesting that the only reason students care about contraception is because they're oversexed.
Credit Image: © Andrea Renault/Globe Photos/ZUMAPRESS.com
During her testimony, Fluke related the story of a woman suffering from polycystic ovarian syndrome, whose doctor prescribed her the birth control pill as a means of treating her condition. Despite the fact that Georgetown allows contraceptive coverage when it is not intended to prevent pregnancy, this woman never received coverage for her prescription. She was forced to stop taking the pill due to financial strain after months of paying for it out-of-pocket. During finals week, she was admitted to the emergency room after a massive cyst overtook one of her ovaries. Her ovary had to be removed.
To illustrate the point that not only heterosexual women need access to the pill, Fluke shared that the woman whose story she had shared is gay. "So clearly polycystic ovarian syndrome was a much more urgent concern than accidental pregnancy for her," Fluke said at the hearing.
If Limbaugh listened to her testimony, he chose to ignore it in its entirety. In an exchange with his pseudonymous call screener "Bo Snedley," Limbaugh made the following remarks about Fluke and anyone who supports this measure:
We assume they're having sex with guys. Well, we're talking about birth control, Snerdley. So you gotta assume having sex with guys. So, do they not have some responsibility? Well, two women... I have to ask sex expert Snerdley on this, but I'm not aware that two women without another device can get pregnant on their own using naturally endowed accoutrements. I don't think times have changed that much. [Chuckles.]
Now, I am 61. Maybe something I haven't heard about that two women together would need contraception. That's a whole new ball game if that's the case. But I don't think we're talking about that. So it means there are men involved and that would mean there's some responsibility on the part of the men. Do they not have condoms? Why don't these women go ask the men to buy them contraception? Why go before a congressional committee and demand that all of us -- because they want to have sex any time, as many times and as often as they want, with as many partners as they want -- should pay for it? Whatever, no limits on this. I mean, they're going broke having to buy contraception! They're getting back-alley pills, folks. That's what this leads up to.
Limbaugh refuses to accept that birth control has any other purpose than preventing pregnancy and he will not allow his listeners to even entertain the possibility.
Time and time again, Limbaugh refers to a story published by Craig Bannister at Cybercast News Service titled "Sex-Crazed Co-Eds Going Broke Buying Birth Control, Student Tells Pelosi Hearing Touting Freebie Mandate," which features the clearly misleading lede: "A Georgetown co-ed told Rep. Nancy Pelosi's hearing that the women in her law school program are having so much sex that they're going broke, so you and I should pay for their birth control."
Initially, it is unclear whether Limbaugh repeatedly cites this article as a means to justify his dishonest tirade or if he truly failed to do the appropriate research regarding Fluke's remarks, choosing to run with Bannister as his primary source instead. But as his follow-up show continues and Limbaugh plays more clips from Fluke's congressional hearing, it becomes evident that he is picking and choosing what he wants his listeners to hear, in order to corroborate the allegation he made in a previous show that Fluke is nothing but a slut who wants everyone else to pay for her birth control.
Again, Limbaugh calls Fluke and any women who believe they have the right to receive contraceptive coverage from insurance companies sluts and prostitutes, dismissing any concerns these women may have about their health as thinly veiled attempts to be paid for sex:
What does it say about the college co-ed Susan [sic] Fluke who goes before a congressional committee and essentially says that she must be paid to have sex? What does that make her? It makes her a slut, right? It makes her a prostitute. She wants to be paid to have sex. She's having so much sex she can’t afford the contraception. She wants you and me and the taxpayers to pay her to have sex.
Rush Limbaugh is an enemy of women, an embarrassment to conservatives and a disgrace to everyone in his profession. I am unsurprised by the petition going around asking his advertisers to pull their content from his fraudulent show and I am inspired by the move on the part of Sleep Train and Sleep Number mattresses and Quicken Loans to pull their ads from his show (other advertisers have been identified, if you are interested in following up on their status with regard to his show .
For those of you who believe in getting your news straight from the source, I include a video below of the original testimony given by Sandra Fluke. A complete transcript follows.
Leader Pelosi, members of Congress, good morning and thank you for calling this hearing on women’s health and for allowing me to testify on behalf of the women who will benefit from the Affordable Care Act contraceptive coverage regulation. My name is Sandra Fluke and I’m a third year student at Georgetown Law School. I’m also a past president of Georgetown Law Students for Reproductive Justice or LSRJ and I’d like to acknowledge my fellow LSRJ members and allies and all of the student activists with us and thank them so much for being here today.
We as Georgetown LSRJ are here today because we’re so grateful that this regulation implements the non-partisan medical advice of the institute of medicine. I attend a Jesuit law school that does not provide contraceptive coverage in its student health plan. And just as we students have faced financial, emotional and medical burdens as a result, employees at religiously affiliated hospitals and institutions and universities across the country have suffered similar burdens. We are all grateful for the new regulation that will meet the critical health care needs of so many women. Simultaneously, the recently announced adjustment addresses any potential conflict with the religious identity of Catholic and Jesuit institutions.
When I look around my campus, I see the faces of the women affected by this lack of contraceptive coverage and especially in the last week I have heard more and more of their stories. On a daily basis I hear from yet another woman from Georgetown or from another school or who works for a religiously affiliated employer and they tell me that they have suffered financially, emotionally and medically because of this lack of coverage. And so I’m here today to share their voices. And I want to thank you for allowing them – them, not me – to be heard.
Without insurance coverage, contraception as you know, can cost a woman over $3,000 over law school. For a lot of students who, like me, are on public interest scholarships, that’s practically an entire summer salary. Forty percent of the female students at Georgetown Law that they struggled financially as a result of this policy. One told us just how embarrassed and powerless she felt when she was standing at the pharmacy counter and learned for the first time that contraception was not covered on her insurance and she had to turn and walk away because she couldn’t afford that prescription. Women like her have no choice but to go without contraception.
Just last week, a married female student told me that she had to stop using contraception because she and her husband just couldn’t fit it into their budget anymore. Women employed in low-wage jobs without contraceptive coverage face the same choice. Some might respond that contraception is accessible in lots of other ways. Unfortunately that’s just not true. Women’s clinics provide a vital medical service, but as the Guttmacher Institute has definitively documented, these clinics are unable to meet the crushing demand for these services. Clinics are closing and women are being forced to go without the medical care they need.
How can Congress consider the Fortenberry, Rubio, and Blunt legislation that would allow even more employers and institutions to refuse contraceptive coverage and then respond that the non-profit clinics should step up to take care of the resulting medical crisis – particularly when so many legislators are attempting to defund those very same clinics?
These denials of contraceptive coverage impact real people. In the worst cases, women who need this medication for other medical reasons suffer very dire consequences. A friend of mine, for example, has polycystic ovarian syndrome and has to take prescription birth control to stop cysts from growing on her ovaries. Her prescription is technically covered by Georgetown’s insurance because it’s not intended to prevent pregnancy. Unfortunately, under many religious institutions’ insurance plans, it wouldn’t be. There would be no exception for other medical needs and under Senator Blunt’s amendment, Senator Rubio’s bill, or Representative Fortenberry’s bill, there’s no requirement that such an exception be made for these medical needs.
When this exception does exist, these exceptions don’t accomplish their well-intended goals because when you let university administrators or other employers, rather than women and their doctors, dictate whose medical needs are legitimate and whose are not, a woman’s health takes a backseat to a bureaucracy focused on policing her body.
In sixty-five percent of the cases at our school, our female students were interrogated by insurance representatives and university medical staff about why they needed prescriptions and whether they were lying about their symptoms. For my friend, and 20% of women in her situation, she never got the insurance company to cover her prescription, despite verification of her illness from her doctor her claim was denied repeatedly on the assumption that she really wanted the birth control to prevent pregnancy. She’s gay, so clearly polycystic ovarian syndrome was a much more urgent concern than accidental pregnancy for her.
After months of paying over $100 out of pocket, she just couldn’t afford her medication anymore and she had to stop taking it. I learned about all of this when I walked out of a test and got a message from her that in the middle of the night in her final exam period she’d been in the emergency room – she’d been there all night in terrible, excruciating pain. She wrote to me, “It was so painful, I woke up thinking I’d been shot.” Without her taking the birth control, a massive cyst the size of a tennis ball had grown on her ovary. She had to have surgery to remove her entire ovary. On the morning I was originally scheduled to give this testimony, she was sitting in a doctor’s office, trying to cope with the consequences. Since last year’s surgery, she’s been experiencing night sweats, weight gain, and other symptoms of early menopause as a result of the removal of her ovary. She’s 32 years old. As she put it: “If my body indeed does enter early menopause, no fertility specialist in the world will be able to help me have my own children. I will have no chance at giving my mother her desperately desired grandbabies, simply because the insurance policy that I paid for totally unsubsidized by my school wouldn’t cover my prescription for birth control when I needed it.”
Now, in addition to potentially facing the health complications that come with having menopause at an early age– increased risk of cancer, heart disease, and osteoporosis, she may never be able to conceive a child. Some may say my friend’s tragic story is rare. It’s not. I wish it were. One woman told us doctors believe she has endometriosis, but that can’t be proven without surgery, so the insurance has not been willing to cover her medication, the contraception she needs to treat her endometriosis.
Recently, another woman told me that she also has polycystic ovarian syndrome and she’s struggling to pay for her medication and is terrified not to have access to it. Due to the barriers erected by Georgetown’s policy, she hasn’t been reimbursed for her medication since last August. I sincerely pray that we don’t have to wait until she loses an ovary or is diagnosed with cancer before her needs and the needs of all of these women are taken seriously.
Because this is the message that not requiring coverage of contraception sends. A woman’s reproductive healthcare isn’t a necessity, isn’t a priority. One woman told us that she knew birth control wasn’t covered on the insurance, and she assumed that’s how Georgetown’s insurance handled all of women’s reproductive and sexual healthcare, so when she was raped, she didn’t go to the doctor even to be examined or tested for sexually transmitted infections because she thought insurance wasn’t going to cover something like that, something that was related to a woman’s reproductive health.
As one other student put it, “this policy communicates to female students that our school doesn’t understand our needs.” These are not feelings that male fellow students experience. And they’re not burdens that male students must shoulder. In the media lately, some conservative Catholic organizations have been asking: what did we expect when we enrolled at a Catholic school? We can only answer that we expected women to be treated equally, to not have our school create untenable burdens that impede our academic success. We expected that our schools would live up to the Jesuit creed of cura personalis, to care for the whole person, by meeting all of our medical needs. We expected that when we told our universities of the problems this policy created for us as students, they would help us. We expected that when 94% of students opposed the policy, the university would respect our choices regarding insurance students pay for completely unsubsidized by the university.
We did not expect that women would be told in the national media that we should have gone to school elsewhere. And even if that meant going to a less prestigious university, we refuse to pick between a quality education and our health and we resent that, in the 21st century, anyone thinks it’s acceptable to ask us to make this choice simply because we are women.
Many of the women whose stories I’ve shared today are Catholic women, so ours is not a war against the church. It is a struggle for access to the healthcare we need. The President of the Association of Jesuit Colleges has shared that Jesuit colleges and universities appreciate the modification to the rule announced recently. Religious concerns are addressed and women get the healthcare they need. I sincerely hope that is something we can all agree upon. Thank you.
AV Flox is the section editor of Love & Sex and Health on BlogHer. You can connect with her on Twitter @avflox, Google Plus +AV Flox, or e-mail her directly at av.flox AT BlogHer.com
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February 29, 2012 If I get sick or injured, I want to know that the antibiotics that I need to take are going to work. Unfortunately, with all the antibiotics that industrial agriculture feeds to livestock, today's antibiotics are at risk of becoming ineffective. Take action today to keep antibiotics working in the future!According to the U.S. Food & Drug Administration (FDA , 80 percent of antibiotics in the U.S. are sold for use in livestock production. Often, antibiotics are fed to entire flocks or herds of animals to prevent illnesses they may never acquire or have little risk of contracting. The overuse of antibiotics encourages the development of antibiotic-resistant bacteria. This is a global threat to human health and must be stopped. Bacteria, like everything else in nature, mutate naturally and do so in such a way to continue their own existence. Not all bacteria are destroyed by antibiotics, and the surviving bacteria then multiply, creating a new strain that the antibiotics cannot kill. We're seeing more and more types of antibiotic-resistant bacteria, but we can help stop this. The FDA is seeking comments on the use of one specific type of antibiotic in livestock. The deadline for comments is Tuesday. Will you submit a comment today? Send an email to the FDA today to stop the overuse of antibiotics: http://action.foodandwaterwatch.org/p/dia/action/public/?action_KEY=9495 Thanks for taking action,  Meredith Begin Education & Outreach Organizer Food & Water Watch mbegin(at fwwatch(dot org | |||||||||||||
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Serves: 16
Prep time: 35 minutes
Cook time: 10-30 minutes
Ingredients:
1 ? cups Bircher mueslix (recipe to follow
2 cups all-purpose flour
1 cup whole-wheat flour
1 tbsp. baking soda
1 tsp Maldon salt
1 tbsp. caraway seeds
2 oz. butter
? cup Granny Smith apple, grated
? cup dried apricots, julienned
? cup dried currants
? cup walnuts, toasted and chopped
2 oz. honey
8 oz. low-fat buttermilk
For the Bircher mueslix:
Adapted from New York Central restaurant at Grand Hyatt New York
1 container Quaker Rolled Oats
1 quart apple cider
1 ? quarts skim milk
1 tsp. Ceylon cinnamon, ground
1/2 tsp. nutmeg, ground
1 ? tsp. Tahitian vanilla extract
?6 oz. honey
Directions:
For the mueslix combine above ingredients and let sit overnight. Use for up to one week.
1. Preheat oven 380 degrees Fahrenheit.
2. Sift flours with baking soda and place in mixer fitted with the paddle attachment. Add salt and caraway seeds.
1. Add diced butter and paddle until butter is pea sized. Add mueslix and paddle until very shaggy.
2. Add apple, apricots, and currants, paddle for 10 seconds to distribute.
3. Whisk together honey and buttermilk. Add to dough, mix until just combined.
4. Form 16 rolls with a scoop or large spoon and floured hands, or form 2 loaves and place on a parchment lined sheet tray.
5. Brush with egg wash and sprinkle with sugar and salt.
6. Cut an X on top of each roll or loaf
7. Bake rolls 10 minutes and loaves 30 minutes, until golden.
Nutrition score per serving (one roll or 1/16 of loaf :
Calories: 189
Fat: 6g
Carbs: 39g
Protein: 6g
Recipe courtesy of Executive Pastry Chef of the New York Central restaurant at Grand Hyatt Katzie Guy-Hamilton.
Serves: 6
Prep time: 30 minutes
Cook time: 60 minutes
Ingredients:
For the filling:
3 tbsp. extra virgin olive oil
1-? lbs lean ground beef
1 medium onion, finely chopped
2 medium carrots, finely chopped
2 celery stalks, finely chopped
3 cloves of garlic, chopped
? tsp. cayenne pepper
2 tbsp. all-purpose or whole-wheat flour
2 tsp. soy sauce
1 tbsp. tomato paste
1 cup low sodium chicken stalk
1 cup chopped canned tomatoes
1 cup frozen peas
salt and pepper to taste
For the sweet potato puree:
4 large sweet potatoes, peeled and cut into large equal sized chunks
2 tbsp. honey
1 ? tbsp. soy sauce
? tsp. cinnamon
2 tbsp. unsalted butter
1 tbsp. olive oil
salt and pepper to taste
Directions:
For the filling:
Heat 3 tablespoons of olive oil in a pan and saute the chopped onions, celery, and carrots for 5 minutes. Add in the finely chopped garlic and saute for another 2 minutes. Season with salt and pepper. Add the ground beef to the vegetables. Mix in and season again with salt and pepper. Let the meat release its juices.
When the meat starts to brown on the bottom add in the flour, cayenne pepper, soy sauce, chopped tomatoes, chicken stalk, and tomato paste. Mix and let simmer on medium low covered for 10 minutes. Take the lid off and simmer for another 10 minutes. Make sure to keep stirring because the meat can stick to the bottom. Check seasoning and stir in the frozen peas. Turn off heat and keep to the side until ready to assemble.
For the sweet potato puree:
Fill a large pot with water add the sweet potato chunks. Bring the water to a boil and reduce the heat to a simmer. When the potatoes are fork tender, strain them from the water.
Mash the potatoes with butter, olive oil, cinnamon, soy sauce, honey, salt, and pepper.
Heat the oven to 350 degrees Fahrenheit.
Fill the bottom of a 9-inch by 11-inch baking dish with the meat mixture. Top with the sweet potato puree and spread evenly getting all the way to the edges. Place on top of a baking tray (in case it spills over and bake in the oven for 30 minutes. Remove from the oven and serve right away.
Nutrition score per 4-inch square serving or 1/6 of the recipe:
Calories: 400
Fat: 18.2g
Saturated Fat: 3.6g
Carbohydrates: 34.4g
Protein: 27.9g
Iron: 3.2g
Fiber: 6g
Calcium: 94g
Sodium: 526 g
Recipe courtesy of Eden Grinshpan, host of Eden Eats on the Cooking Channel.
Serves: 8
Prep time: 30 minutes
Cook time: 55 minutes
Ingredients:
3 tbps. canola oil
1 lb. lean beef stew meat, preferably top sirloin
1 tsp. fine sea salt
? tsp. finely ground fresh pepper
? cup pearl barley
28 fl. oz. water
12 fl. oz. Guinness
? lb. carrots
? lb. yellow onion
1 tsp. dried thyme
2 tbps. Inglehoffer Extra Hot Horseradish
Directions:
Trim all outer fat and cut the beef into ?-inch cubes. Season the beef with salt & pepper
Rinse the barley in cold water and strain.Thoroughly wash the carrots in cold water & cut into 1-inch lengths. Remove the outer layer of onion skin and finely mince. On medium high heat, in a cast iron or enameled Dutch oven, saute the beef in the canola oil. Add the onion and saute until caramelized. Add the water, 6 ounces of Guinness, and the barley. Cover the pot with baking parchment and place the lid over the parchment to seal. Bring to a boil and reduce the heat to medium low.
Continue to cook for half an hour. Remove the parchment and lid .Add the carrots, remaining 6 ounces of Guinness and replace the lid. Cook for an additional 15 minutes on low heat. Return the stew to a rapid boil and add the thyme and horseradish. Stir to thoroughly incorporate the ingredients.
Nutrition score per one cup serving:
Calories: 200
Fat: 8g
Satruarted fat: 2g
Sodium: 270mg
Sugar: 4g
Protein: 11g
Recipe courtesy of Beaverton Foods.
Serves: 6
Prep time: 50 minutes
Cook time: 30 minutes
Ingredients:
For the fish
1/2 cup all-purpose flour
1/2 tsp.salt
1?4 cup hot sauce
1/4 cup buttermilk
4 cups corn flakes, crushed to make about 1 2/3 cups
6 Alaskan wild cod fillets (4-6 oz. each
2 tbsp. canola oil
For the chips
48 small potatoes, red bliss, Yukon gold, or Peruvian blue
3 tbsp. olive oil
3/4 tsp. kosher salt, divided
ground pepper to taste
1?4 cup fresh herbs including chives, parsley, rosemary, thyme; minced
Directions:
For the fish
1. In a shallow dish mix flour and salt. In another shallow dish, beat buttermilk and hot sauce with a fork. Place crushed cereal in a third shallow dish.
2. Dip fish in flour, coating well. Shake off excess.
3. Dip floured fish in buttermilk mixture and then in cereal, coating all sides completely. Place coated fish on an ungreased plate.
4. In a 12-inch skillet, heat oil over medium heat until hot. Keeping at least 1-inch between fish fillets, cooking in batches, if needed. Cook fish in oil 3 to 4 minutes on each side, turning once, until well browned and fish flakes easily with a fork.
5. If needed, place cooked fish on paper towels on a cookie sheet and keep warm in a 225 degrees Fahrenheit oven while cooking the remaining fish.
For the chips
Preheat oven to 425 degrees Fahrenheit. Wash and scrub potatoes. Cut potatoes in half. Pat potatoes dry with paper towels. Place potatoes on a sheet pan and drizzle with 1 1/2 tablespoons of oil, 1/2 teaspoons kosher salt and pepper. Toss potatoes to evenly coat in oil and salt.
Place potatoes cut side down and put into preheated oven. Roast for 30 minutes until the bottoms are browned and the potatoes are soft.
While potatoes roast make an herb oil by mincing your herbs very fine and stir into the remaining oil with the last 1/2 teaspoon of salt and pepper. Stir well.
Once potatoes are roasted remove from the sheet pan and place in a bowl. Drizzle the herb oil over top and toss.
Nutrition score per serving (one cod fillet and eight potatoes :
Calories: 281
Fat: 6.5 grams
Carbs: 25.9 grams
Protein: 28.1 grams
Recipe courtesy of Chef Maxcel Hardy author of Recipes of Life.
Serves: 2
Prep time: 5 minutes
Cook time: 25 minutes
Ingredients:
1 tsp olive oil
1 small sweet onion, thinly sliced
4 egg whites
2 eggs
1 1/2 cups tightly packed baby arugula or spinach leaves, or a combination
2 tbsp. grated Parmesan
salt
red pepper
Directions:
Coat a medium non-stick skillet with a thin layer of olive oil, and saute the onions over a medium flame, stirring very infrequently. Once they soften and begin to brown on each side, return the flame to low and allow to slowly caramelize. During this time, it is important to make sure the onions are spread as evenly as possible across the pan.
Slowly crisp the onions for about 20 minutes. Every few minutes, scrape the bottom and redistribute the onions so each gains the maximum amount of surface area. The onions will sweeten by condensing in their own juices. If you stir too often, the onions will turn to mush.
Beat the eggs and egg whites together with ? teaspoon of salt and a pinch of red pepper. Push the onions to the side of the pan, and pour the eggs in the middle. Slowly scramble over low heat, scooping up the partially cooked pieces from the bottom and redistributing the raw egg. When the egg is almost entirely cooked, add the arugula and the cheese. Stir to combine and cook for another minute or so until the eggs are cooked, but not overdone. Taste for salt and serve immediately.
Nutrition score per serving (about ? cup :
Calories: 152
Fat: 8g
Saturated fat: 2g
Carbs: 5g
Protein: 15g
Iron: 3mg
Fiber: 1g
Calcium: 90mg
Sodium: 325mg
Recipe courtesy of Big Girls, Small Kitchen.
Serves: 4
Prep time: 15 minutes
Cook time: 25 minutes
Ingredients:
1 tsp. olive oil
1/2 cup onion, diced
1 cup cabbage, chopped
6 cups chicken broth
1 cup ham, cut in 1/2-inch dices
1 cup parsnips, cut in 1/2-inch dices
1/2 cup sunshine rutabagas, cut in 1/2-inch cubes
1 15 oz. can mixed vegetables, drained
Directions:
In a medium size heavy-bottomed pot, heat the oil over medium heat and saute the onions until transparent. Add the cabbage and stir briefly, then add the broth and bring it to a boil. Add the ham, parsnips and rutabagas. Return the liquid to a boil. Reduce heat to a simmer and cook 15 minutes. Add the mixed vegetables, and simmer another 5 minutes. Serve very hot with crusty bread.
Nutrition score per serving (1/4 of recipe :
Calories: 119
Fat: 1g
Carbs: 19g
Protein: 6g
Recipe courtesy of www.allens.com.
Serves: 15
Prep time: 15 minutes
Cook time: 30 minutes
Ingredients:
500g baby spinach, washed, drained (hint: 1 large container of baby spinach
3 eggs
1/4 cup melted coconut oil, plus additional for oiling pan
1 1/4 cup honey
Juice and rind of 1 lemon
1 tsp vanilla extract
2 1/2 cups spelt flour, sifted
1 tsp baking powder
1 tsp baking soda (note: this is to offset the acidity of the honey
Plain nonfat Greek yogurt for garnish, optional
Directions:
1. Preheat the oven to 375F.
2. Puree spinach in a food processor; set aside. Whisk egg and honey. Add oil, lemon juice and rind, vanilla and pureed spinach. Then add flour, baking powder and baking soda. Mix for a few minutes. Pour into an oiled rectangular cake pan.
3. Bake in oven for approximately 30 minutes. (TIP: Check with a toothpick to test doneness; bake until toothpick comes out clean. Remove from oven and set aside to cool.
4. Once cooled, remove cake from pan. As an optional garnish, cut off sides of cake (about 1 inch wide and process in food processor to create a powder; set aside. Slice cake when ready to serve and spread with Greek yogurt. Then sift cake powder over top.
Nutrients per serving:
Calories: 124
Fat: 5g
Saturated fat: 3.5g
Cholesterol: 33mg
Sodium: 150mg
Carbs: 17g
Fiber: 3g
Sugars: 2g
Protein: 4.5
Recipe courtesy of Sammie Kennedy, CEO & Creator of Booty Camp Fitness.
You don’t have to pass on Irish classics like soda bread, and beef stew, or your annual St. Paddy’s Day kegs and eggs with these healthy twists on traditional St. Patrick’s Day recipes.
DOMINIC COYLE
Blockbuster drugs coming off patent will knock a major hole in our export figures and tax revenues
PHARMACEUTICALS HAVE been a driving force for Ireland’s export success in recent years. Even through the darkest days of our financial collapse and recession, the sector, dominated by the large multinational players, continued to deliver export growth and a glimmer of hope of economic recovery.
However, the most recent trade figures point to a looming problem for the Government. Reporting a 9 per cent fall in exports in December, the Central Statistics Office was unusually frank and detailed in stating that “a substantial part of the decline in the value of exports was due to a high value product in the chemicals and related products sector coming off patent”.
The drug is Lipitor, Pfizer’s blockbuster cholesterol lowering therapy and the world’s best-selling drug in recent years, accounting for revenues of $10.7 billion in 2010. Pfizer’s Cork plant produces 100 per cent of the company’s global requirements for the active pharmaceutical ingredient in the drug and a significant portion of the finished tablets.
Coming off patent will knock a major hole in the future revenues Pfizer can expect to get from the drug as generic competition kicks in. As a rule, loss of patent protection can hit the value of sales by anything between 40 and 70 per cent over time – and not much time at that.
For Ireland, the concern in the December figures was that, for now, generic competition to Lipitor is limited. If that was enough to skew the export figures so dramatically, the worry is what damage future, more intense competition will do to our trade balance.
And Lipitor is just one of a number of key drugs in which Ireland has a commercial interest and which are coming off patent. Chris van Egeraat, a lecturer in economic geography at NUI Maynooth, says seven of the 10 largest-selling drugs worldwide which are losing patent protection are currently produced in Ireland. They include the best-selling drug worldwide in 2010 after Lipitor; Sanofi/Bristol Myers Squibb’s blood clotting treatment Plavix, with sales of $9.43 billion. It comes off patent in May.
Globally, it is estimated that as much as $100 billion in sales will be lost to drug companies between 2009 and 2014 as a result of drugs coming off patent. Expected pipeline delivery in terms of market revenue over the same time amounts to about $30 billion, Dr van Egeraat says.
While he doesn’t expect the loss of patents to lead to huge imminent job losses, it does highlight the ambition of the Government’s new Action Plan for Jobs, which has targeted the health and life sciences sector for significant growth in the coming years to help reach the Government’s 100,000 job target.
However, loss of market sales will clearly impact on trade figures and tax revenues. The Irish Pharmaceutical Healthcare Association (IPHA notes that the pharmaceuticals sector accounts for roughly half of all exports and is the largest contributor to corporation tax, accounting for roughly 50 per cent of the ˆ3.5 billion collected last year.
In employment terms, IPHA president and Pfizer country manager David Gallagher says that about 25,000 people are employed directly in the industry, with a roughly similar number working in related sectors. He notes that pharmaceuticals has been more resilient than other sectors of the economy during recent “economically challenging times”.
The message is pointed, especially at a time when the sector is locked in a dispute with the Government over access to market for its new drugs and the contribution it can make to savings in the health budget sought by the State.
David Gallagher noted recently that an increasing number of innovative medicines are currently not being reimbursed by the Department of Health, despite being approved by regulators and meeting health technology assessments.
He recently accused the department of acting in bad faith by refusing to approve drugs for reimbursement as provided for under the industry’s current pricing agreement with the Department, even though the industry had delivered savings of about ˆ540 million over the past five years, a figure he says equates to a 20 per cent cut.
Even before the latest row, the IPHA said the delay between approval and market access had jumped by over 50 per cent to 157 days in recent years, and only 64 per cent of drugs that received market authorisation in the EU between 2007 and 2009 were made available to patients here.
Matt Moran, director of Ibec group PharmaChem Ireland, said Government policy “needs to urgently recognise the very serious challenges facing the industry”.
“A number of blockbuster drugs are coming off patent and healthcare spending in Ireland has been cut by ˆ600 million in the last five years,” he said. “The future success of the sector must not be taken for granted.”
In a speech last year, Gallagher said further price concessions were “simply untenable”, citing preliminary 2011 figures pointing to a 5.2 per cent decline in the value of the Irish market. “There is a limit to the amount which can be taken out of a market without its effective operation and employment being jeopardised,” he said.
Ireland is not alone. The commercial prospects for big pharma were also thrown into sharp focus with a report on the UK’s pharmaceuticals price regulation scheme, which reported collective industry losses of ?142 million in 2009 despite rising sales.
For its part, the Department of Health needs to find cuts in its budget. In a recent report on pharma pricing, the Economic and Social Research Institute (ESRI said that drug costs account for about 17.5 per cent of public health expenditure in Ireland, up from 14 per cent in 2000.
In 2009, the ESRI says, spending per head of population in Ireland on pharmaceuticals was “amongst the highest in the OECD”.
It is understood the Department of Health is targeting a saving of about ˆ112 million from the drugs bill – either in terms of pricing and access for new medicines or pricing of generics.
The ESRI report recommended a number of approaches. These included pricing drugs on the basis of the lowest cost in a basket of European markets rather than the average, and more regular price updates to capture the impact of falling prices earlier.
The industry says that, despite the small physical size of the Irish market, such a move would be negative in two ways. First, Ireland is itself a component of pricing baskets in eight other larger EU markets. A “match the lowest” price here will inevitably further eat into prices in other more important markets.
Secondly, the industry points to Ireland’s importance as a base of operations for most of the main players in the sector. An increasingly adversarial approach with the State will only damage the prospects for future investment, they say, with one industry source saying the recent approach of the department to market access for new drugs was creating a very poor impression in a number of important boardrooms State-side.
The seriousness with which the pharmaceutical sector views the current price negotiations in Ireland – where eight of the top 10 global players have operations – is highlighted by the engagement of some of the industry’s leading figures with the Government.
The chief executive of one major global player has made a point of briefly visiting Ireland next week. The message in his first visit to the State will not be lost on ministers. The following week, leading executives from another top 10 drug manufacturers gather in Dublin for a meeting at which the attitude of the State to the sector is certain to figure.
On the Government’s side, there is concern too at any adverse impact on such a major employer and contributor to the exchequer. Taoiseach Enda Kenny has recently engaged directly in private meetings with top industry figures here to assure them of the Government’s support despite the ongoing budgetary squeeze.
For their part, the drug companies say that current pricing pressures are restricting innovations. Without adequate compensation, they say, companies simply will not be able to invest in new products given the costs involved and the risk of failure.
This isn’t unique to Ireland. Reporting annual results earlier this month, Bayer chief executive Marijn Dekkers expressed concern “about the side-effects” of health service reforms taking place around the world “because the money we earn from today’s medicines pays for the development of tomorrow’s medicines”.
Pointing to the ˆ2 billion research and development cost of Xarelto, a new drug developed with Johnson Johnson to prevent blood clotting, he said: “We need innovative pharmaceuticals more than ever, because so many known diseases still cannot be treated adequately, or at all, with medicines.”
But that’s part of the problem for the major pharmaceutical companies. Many of the easy treatment areas are now well catered for. A good portion of the drugs that do so are shortly coming off patent and are easily accessible to generic competition.
The opportunities of the future lie in increasingly niche conditions or very high risk areas such as oncology and, especially, neurology. Added to this is the move to biologics and the trend towards more personalised medicines.
The challenge is evident in the fact that, last year, the US drug regulator, the Food and Drug Administration, licensed just a handful of new pharmaceutical therapies. Getting this more select group of drugs to as many markets as possible is increasingly critical for big pharma.
The age of the blockbuster is fading, along with the fat profit margins it offered. That presents major issues for the sector. Over time, through consolidation and acquisition, they have grown into massive unwieldy entities with poorly directed research failing to deliver sufficient pipeline.
In recent years, much effort has been devoted to streamlining operations and increasing productivity, especially on the research side. Thousands of jobs have been shed worldwide, and greater emphasis placed on outsourcing much of the early-stage RD work.
A case in point is Elan’s prospective Alzheimer’s treatment bapineuzumab. Originally developed by the company in association with Wyeth, it is now controlled by Pfizer (which acquired Wyeth to fill a perceived weakness in its biopharmaceuticals operations and Johnson Johnson, which bought an 18.4 per cent stake in Elan in 2009 in a deal valued at $1 billion. Its interest was driven largely by the Irish company’s pipeline – particularly bapineuzumab which is seen as one of the more promising candidates to address a disease with limited treatment options at present and which reports critical Phase III trial data later this year.
The second focus is on developing new markets. But that presents its own problems, not least with business practices that have reflected poorly on the industry.
Several of the largest drug companies have been implicated in an ongoing legal action in Serbia in which a group of 10 doctors and drug company officials were charged with taking, or offering, more than ˆ500,000 in bribes to use specific products. While all deny guilt in this case, an examination of US Securities and Exchange Commission (SEC filings by the world’s top 10 drug companies has found that eight of them recently warned of potential costs related to charges of corruption in overseas markets.
Life is unlikely to get any easier for the sector over the coming two or three years. That raises the stakes in the ongoing price negotiations. The new accord was due to come into force yesterday and, as the leaked Commission assessment this week illustrated, pressure on the Government to deliver the necessary savings to ensure their budgetary projections is only likely to intensify.
The study, published in the March 2012 Emerging Infectious Diseases, found that the increased use of testing for Shiga toxin in Washington between 2005 and 2010 directly correlated with increased diagnoses of non-O157 infection. Still, as of 2010, only 40 percent of stool samples tested in state labs were screened for both O157 and non-O157 strains.
E. coli O157 is the most well-known strain of Shiga toxin-producing E. coli (STEC , but many other strains have gained prominence in recent years after causing illness outbreaks of their own. Infections from many of these other strains, often referred to as "non-O157" STEC, are considered clinically indistinguishable from O157 infections, which can lead to severe diarrhea, hospitalization, kidney failure and even death. Recently, the U.S. Department of Agriculture has targeted six additional strains of non-O157 STEC to join O157 as a banned contaminant in meat.
But while indistinguishable from the others in its health impacts, O157 does require its own specific type of culture test to identify it. And up until 2005, it was largely the only type of E. coli strain being tested in clinical labs. A different test for Shiga toxin can detect any of type of STEC, including O157, but it takes longer to perform than the 24-hour O157 test.
In 2009, the Centers for Disease Control and Prevention published official STEC testing recommendations for labs, suggesting that all stool samples be tested for O157 with the culture test and all STEC strains with the Shiga toxin test simultaneously. Even though the Shiga toxin test also detects O157, the CDC recommends performing both tests to more rapidly detect O157, which is still the most common strain of STEC.
Testing for more strains of STEC beyond O157 is the only way to more accurately diagnose E. coli infection and foster more effective epidemiology, the study's authors argued.
"Detecting a larger proportion of cases means we're able to run PFGE [genetic fingerprinting] at Washington Public Health laboratories and detect clusters of infection so we can remove the common source," said Kathleen Stigi, lead author of the study and an epidemiologist at the Washington State Department of Health. "With more detection comes a better understanding of the virulence factors of these strains."
The authors surveyed each of the 57 clinical labs in Washington that test stool samples, all but one of which routinely performed at least one type of STEC test.
As mentioned already, 40 percent of stool samples in Washington were tested according to the CDC's recommendation of dual O157 and STEC tests at the end of 2010. Labs that tested only for O157 screened 47 percent of samples, while 13 percent were only screened with the STEC test.
From 2005 through 2010, the number of labs testing for non-O157 strains rose from two to 19. During that same time, the number of detected non-O157 infections shot from eight in 2005 to 76 in 2010. The increases in non-O157 detections happened most sharply from 2008 to 2010, corresponding to the years in which the majority of the labs began testing for STEC beyond O157.
The correlation between increased testing and increased diagnoses is self-apparent, the authors said: If more labs test for non-O157 STEC, more people infected will be properly diagnosed and more outbreaks might be detected.
The authors estimated that in 2010, half of all non-O157 STEC infections that could have been detected were not, simply because the labs testing potentially infected stool samples did not perform the Shiga toxin test.
Stigi said the biggest factors holding back labs from performing both types of tests were costs, procedural changes and staffing constraints. Along with that, more STEC cases result in more epidemiology work: Every reported STEC infection requires an epidemiological investigation for local health officials. Testing for more pathogens means requiring more man-hours on the investigation side during a time when agencies are pulling their purse strings tighter.
Regardless, the authors recommended labs adopt the CDC's dual testing strategy for the sake of public health.
"The potential virulence of non-O157 STEC infections underscores the need for enhanced laboratory testing and epidemiologic research," the study read. "To encourage adherence to STEC testing recommendations, healthcare providers should request Shiga toxin testing if it is not routinely performed at their laboratory."
To the authors' knowledge, their study is the first of its kind to specifically proportion STEC testing rates in terms of stool samples tested.
Washington had 945 confirmed STEC infections between 2005 and 2010, with 83 percent of them O157 and 17 percent non-O157. The percentage of those infected, however, rose each year during the six-year study period, from 6 percent of infections in 2005 to 41 percent in 2010. Again, these results correlated with the increase in non-O157 STEC testing. The authors predicted that non-O157 infections would have accounted for 60 percent of all STEC infections in 2010 if all labs had the infrastructure to test for them.
Four strains of STEC accounted for the large majority of all non-O157 infections in the state: O26 (48 percent , O103 (18 percent , O121 (12 percent and O111 (5 percent .
Stigi said she believes more labs have implemented Shiga toxin testing procedures since the surveys were conducted in early 2011, and she expects the number to grow, as epidemiologists recognize that accurately tracking disease trends will rely on more complete data.
"These enhanced testing practices have likely contributed to the increased detection of STEC in Washington," she said. "It's important for public health professionals to assess laboratory STEC testing practices in order to correctly interpret disease trends."
“We've had bird flu and swine flu - now scientists have found BAT FLU,” says the Daily Mail. The newspaper reports that the strain “could pose a risk to humans if it mingled with more common forms of flu”.
The Mail has got in a flap over the flying mammals based on new research that found type A flu virus in fruit bats captured in Guatemala in Central America. The discovery in bats is new as the virus is typically found in winged birds, and not winged mammals.
Researchers collected 316 bats of 16 different Latin American species. Types of flu virus were found in three bats of the little yellow-shouldered species, which is a fruit eating variety common across Central and South America. After analysing the genetic code of the bat flu virus the scientists concluded it contained segments that were significantly different from those found in known influenza A viruses. They also found that some aspects of the bat flu virus could work inside human lung cells grown in the lab. This led them to conclude that the virus has the potential to mix with human flu virus, which could, in rare circumstances, lead to the creation of a new flu strain that is capable of causing a flu pandemic, like bird flu or swine flu.
Despite this warning, scientists have not been able to grow the new bat virus in chicken eggs or human cells, which is possible with existing flu strains. This suggests that the immediate risk of infection to humans is small. Rather than highlighting a danger to human health, this study is likely to guide further research that may improve the understanding of potential pandemic flu threats to humans in the future.
Where did the story come from?
The study was carried out by researchers from Centres for Disease Control and Prevention outposts in Atlanta and Guatemala, and was funded by the agency’s Global Disease Detection Program.
The study was published in the peer-reviewed science journal Proceedings of the National Academy of Sciences USA (PNAS .
The story has appeared on several online news sites and in the Daily Mail. In its headline the newspaper suggests that bat flu “could pose a threat to humans”. While the inclusion of the word “could” makes this a fair statement, the article does not make clear that the immediate risk to humans is very low. Generally, the tone of the piece emphasises a potential risk from the virus. It says there is a hypothetical risk of transmission to humans if they eat food contaminated with traces of the virus. Again, the risk of this happening seems low.
What kind of research was this?
This study was laboratory research looking at the genetics of a specific strain of type A flu virus found in bats captured in Guatemala. Originally, the bats had been examined as part of a study looking at rabies, which revealed that bats were able to carry certain forms of the flu virus.
As their names suggest, new pandemic flu strains such as the high-profile bird flu and swine flu strains often originate in animals, typically waterfowl and pigs. Usually, non-human flu strains do not cause serious harm in the original host, for instance, bird-flu does not cause death to most birds and human flu is not usually fatal to healthy humans. However, animal flu strains have the potential to swap genetic material with human strains and create a new virus strain capable of infecting and harming humans. It is the mixing of genetic material and the creation of these new viruses that represents the main danger of new flu pandemics.
The researchers say that early detection, characterisation and risk assessment of flu viruses in their animal hosts before they spread to humans is “critical” to protect public health.
What did the research involve?
Researchers collected 316 bats from 21 different species from eight locations in southern Guatemala over the course of two years.
Researchers swabbed the bats’ bottoms to gather traces of any influenza virus A. The swabs were tested in the laboratory for signs of flu genetic material using standard molecular biology techniques. Tissue samples from the bats’ mouths, livers, intestines, lungs and kidneys were also tested for flu virus.
Researchers then examined the genetic code of the viral material that had been detected in the bats and looked at how similar they were to other flu viruses that have previously been decoded.
To demonstrate ‘proof of theory’ that the bat virus could function within human cells the scientists created a mini version of the flu virus’ genetic material. They placed this into human lung cells in the laboratory and assessed whether certain functions of the bat virus could be carried out within a human cell.
The researchers attempted to grow the virus strains in a variety of mammalian cells (including bat cells and human lung cells grown in the laboratory to study how infectious the strains were to these different types of cells.
What were the basic results?
Three of the 316 bats tested positive for influenza virus A from their swabs. All three samples were collected from little yellow-shouldered bats, which is a fruit-eating bat that is abundant throughout Central and South America.
In these three bats, all of the further samples taken from the liver, intestine, lung and kidney tissue tested positive for flu virus genetic material.
Researchers found that a specific genetic sequence within the virus, containing the code for making a vitally important flu protein called haemagglutinin, showed differences from the previously documented strains. In one of the bats the genetic material coding for a second crucially important flu protein, called neuraminidase, showed “extraordinary” differences from other known flu viruses.
In influenza A viruses the forms of haemagglutinin (H and neuraminidase (N proteins on the surface of each virus provide the main basis for the way it will be named and classified. For example, the combination of these proteins found in the recent swine flu outbreak meant it was known as H1N1, while the latest bird flu scare was caused by a virus known as H5N1. There are many influenza A virus subtype combinations circulating in animals in the wild. In this research the H proteins found in the samples were so different from other types of influenza that the authors say it could be classified as a new subtype, which they called “H17”. In one of the samples the researchers say they could not classify its N type as there were so many different and unusual types of N proteins.
The scientists reported that attempts to grow the virus in human cells in the laboratory and chicken embryos were unsuccessful. This suggested the virus differed from other known viruses, which can be grown under these conditions.
The researchers demonstrated that some functions of the bat flu virus had the potential to work inside laboratory-cultured human lung cells.
How did the researchers interpret the results?
The researchers conclude that “despite its divergence from known in?uenza A viruses, the bat virus is compatible for genetic exchange with human in?uenza viruses in human cells”. This leads them to suggest that there is potential for the bat virus to mix with existing human flu viruses creating a “new pandemic” virus that could pose a threat to human health.
Conclusion
This study of the genetic material of flu virus A in three fruit bats in Guatemala provides important new information to those involved in flu research and pandemic awareness. Previously, non-human flu strains were thought to be confined largely to birds and pigs, but this study highlights the potential for bats also to harbour flu viruses that could potentially threaten humans, given the correct sequence of rare events. The awareness this research provides may lead to a better understanding of the potential risks posed by bat flu to humans in the future.
The following points should be considered when interpreting the results of the study:
- It is important to realise that the researchers have found a new segment of genetic material in the bat flu virus that is different from other flu strains sequenced. They have not discovered a completely new virus in bats that is capable of infecting humans, and so the immediate threat to humans is likely to be minimal.
- As yet, scientists have not been able to grow the bat flu virus in chicken eggs or human cells, which is possible with all other commonly occurring flu strains. Given that they were actively trying to grow the virus and failed, this also suggests the immediate risk of infection and harm to humans is small.
- The potential threat the authors and the media warn against for the future is that the new bat virus genetic material could mix with other flu strains to create a new strain that will be capable of infecting and harming humans, like swine flu and bird flu. To date, there is no evidence that this has happened so there is no cause for immediate concern.
- Fruit bats in Guatemala do not bite people, so direct transmission of the bat virus to humans is unlikely. A suggested route of virus transmission has been if bat droppings contaminate food that is then eaten by people. This could allow the bat flu and human flu genetic material to mix, potentially creating a new strain capable of a pandemic.
This study provides no evidence to support or refute the implication that if someone were infected with the bat virus now it would be harmful, and the risk of this bat strain causing a pandemic is not known at the present time. However, a series of rare events would need to happen in sequence for a pandemic to occur. Despite the rarity, this has happened before in the case of other pandemic flu strains including swine and bird flu, although the initial transmission from these species has generally occurred through sustained close contact with livestock, such as sleeping among the droppings of chickens reared in the home.
Following the discovery of this new form of flu it will surely be explored further by agencies such as the Centers for Disease Control and Prevention, which would report any evidence of risk to the World Health Organization and its flu surveillance teams, which constantly monitor and evaluate any potential flu-based threat.
Analysis by Bazian
Links To The Headlines
We've had bird flu and swine flu - now scientists have found BAT FLU (and it could pose a threat to humans . Daily Mail, March 1 2012
Scientists report first evidence of flu in bats. The Daily Telegraph, March 1 2012
Links To Science
Tong S, Li Y, Rivailler P et al. A distinct lineage of influenza A virus from bats. PNAS, Published online before print February 27, 2012
The World Health Organization has confirmed that India has gone a whole year without having a new case of polio -- a major milestone in a country that was once plagued by the crippling disease. BBC's Fergus Walsh explains that the country won't formally be regarded as polio-free until it's gone another two years without a case of the disease, but reaching the one-year mark is still an occasion for celebration. In an earlier piece, Walsh describes the massive polio vaccination effort that has allowed the country to achieve this success; India's government partnered with the World Health Organization, Rotary, UNICEF, and the Bill and Melinda Gates foundation.
Public health successes like this one require a sustained commitment from institutions (governmental and non and participation from support from entire populations. And when it comes to viruses, we can't truly declare victory until they've been eradicated worldwide. Last fall, Maryn McKenna highlighted disturbing findings from an indpendent monitoring board, which warned that global polio eradication efforts need to address negative news and criticisms more productively in order to get back on track. And Walsh notes that nearly one-third of the polio cases reported last year were in Pakistan, which shares a border with India and could lead to reintroduction of the virus there.
For the moment, though, it's worth congratulating India on its success and remembering that ambitious public health goals are attainable and worth reaching.
Read the comments on this post...Patients with a common type of metal hip implant should have annual health checks for as long as they have the implant, according to the UK body for regulating medical devices. The all-metal devices have been found to wear down at an accelerated rate in some patients, potentially causing damage and deterioration in the bone and tissue around the hip. There are also concerns that they could leak traces of metal into the bloodstream, which the annual medical checks will monitor.
Hours before critical coverage from the British Medical Journal and the BBC, the Medicines and Healthcare products Regulatory Agency (MHRA issued new guidelines on larger forms of ‘metal-on-metal’ (MoM hip implants. Advice on smaller metal devices or those featuring a plastic or ceramic head has not changed. Previously, guidelines suggested larger MoM implants should only be checked annually for five years after surgery. The agency now says the annual check-ups should be continued for the life of the implant. Check-ups, they say, are a precautionary measure to reduce the “small risk” of complications and the need for further surgery.
Together with the recent controversy over PIP breast implants, the news has caused the media and patient groups to call for tighter regulation of medical devices, perhaps bringing the approval process into line with that of medicines. Before they can be approved for wider use drugs must undergo several years of laboratory, animal and human testing .
What types of implants are involved?
There are numerous designs and materials used to make hip implants. In recent days the MHRA has issued major updates to its advice on a type of metal-on-metal (MoM hip replacement. As the name implies, MoM implants feature a joint made of two metal surfaces – a metal ‘ball’ that replaces the ball found at the top of the thigh bone (femur and a metal ‘cup’ that acts like the socket found in the pelvis.
The MHRA’s updated advice concerns the type of MoM implant in which the head of the femur is 36mm or greater. This is often referred to as a ‘large head’ implant. The agency now says that patients fitted with this type of implant should be monitored annually for the life of the implant, and that they should also have tests to measure levels of metal particles (ions in their blood. Patients with these implants who have symptoms should also have MRI or ultrasound scans, and patients without symptoms should have a scan if their blood levels of metal ions are rising. The previous guidance on this type of hip implant, issued in April 2010, advised that patients should be monitored annually for no fewer than five years.
What about other types of hip implants?
Advice on monitoring patients with other types of hip implants remains the same, and guidance has not changed on:
- MoM hip resurfacing implants – where the socket and ball of the hip bone has a metal surface applied to it rather than being totally replaced.
- Total MoM implants where the replacement ball is less than 36mm wide.
- A particular range of hip replacements called DePuy ASR – these hip replacements were recalled by their manufacturer, DePuy, in 2010 because of high failure rates. The company made three types of ASR implant.
- Implants featuring plastic or ceramic heads.
How many people are affected?
It is estimated that, in total, 49,000 people in the UK have been given metal-on-metal implants with a width of 36mm or above. This represents a minority of the patients given hip replacements, who mostly have devices featuring plastic, ceramics or smaller metal heads.
In 2010 there were 68,907 new hip replacements fitted, and approximately 1,300 of these surgeries used an MoM implant sized 36mm or above – a rate of around 2%.
What exactly is the problem with MoM implants?
All hip implants will wear down over time as the ball and cup slide against each other during walking and running. Although many people live the rest of their lives without needing their implant to be replaced, any implant may eventually need surgery to remove or replace its components. Surgery to remove or replace part of the implant is known as ‘revision’ and, of the 76,759 procedures performed in 2010, some 7,852 were revision surgeries.
However, data now suggest that large head MoM hip implants (those with a width of 36mm or greater wear down at a faster rate than other types of implants. As friction acts upon their surfaces it can cause tiny metal particles (medically referred to as ‘debris’ to break off and enter the space around the implant. Individuals are thought to react differently to the presence of these metal particles, but, in some people, they can trigger inflammation and discomfort in the area around the implant. Over time this can cause damage and deterioration in the bone and tissue surrounding the implant and joint. This, in turn, may cause the implant to become loose and cause painful symptoms, meaning that further surgery is required.
News coverage has also focused on the MHRA’s recommendation to check for the presence of metal ions in the bloodstream, potentially released either from debris or the implant itself. Ions are electrically charged molecules. Levels of ions in the bloodstream, particularly of the cobalt and chromium used in the surface of the implants, may, therefore, indicate how much wear there is to the artificial hip.
There has been no definitive link between ions from MoM implants and illness, although there has been a small number of cases in which high levels of metal ions in the bloodstream have been associated with symptoms or illnesses elsewhere in the body, including effects on the heart, nervous system and thyroid gland.
The MHRA points out that most patients with MoM implants have well functioning hips and are thought to be at low risk of developing serious problems. However, a small number of patients with these hip implants develop soft tissue reactions to the debris associated with some MoM implants.
How are medical devices regulated?
In the UK, the MHRA is the government agency responsible for ensuring that medical devices work and are safe. The MHRA audits the performance of private sector organisations (called notified bodies that assess and approve medical devices. Once a product is on the market and in use, the MHRA has a system for receiving reports of problems with these products, and will issue warnings if these problems are confirmed through their investigations. It also inspects companies that manufacture products to ensure they comply with regulations.
This system differs greatly from that for testing and approving drugs. Drugs require several years of research testing and trials before they can be approved for clinical use.
What action have regulators taken?
The MHRA has convened an expert advisory group to look at the problems associated with MoM implants. This meets regularly to assess new scientific evidence and reports from doctors and medical staff treating patients. The agency says it is continuing to monitor closely all the latest evidence about these devices and may issue further advice in the future.
In the US, the Food and Drug Administration (FDA says it is gathering additional information about adverse events in patients with MoM implants. In the meantime, it advises patients with MoM hip implants who have no symptoms to attend follow-up appointments as normal with their surgeon. Patients who develop symptoms should see their surgeon promptly for further evaluation.
What actions have critics called for?
In light of the PIP breast implant controversy and this new information on hip implants, there is currently intense scrutiny on the way medical devices are regulated in the UK and Europe, with patient groups and the media arguing that medical devices should be regulated in a similar way to medicines.
Clearing a medicine for use in the UK is a lengthy process involving several stages of laboratory and animal testing, and then carefully controlled and monitored tests in humans. Only once there is enough evidence to suggest that a medicine is reasonably safe can it enter clinical use, and even then patients will be monitored to look at the longer-term effects of the drug.
However, medical devices are not required to go through human trials before entering use, and can currently be approved on the basis of mechanical tests and animal research. While certain devices, such as hip implants, have been monitored through systems such as the National Joint Registry, in light of the recent health concerns over PIP breast implants, patient groups are calling for more testing before devices are allowed into clinical use, and closer mandatory monitoring schemes to ensure their safety once they enter the market.
Links To The Headlines
Annual blood tests for hip patients over poison fears. The Daily Telegraph, February 29 2012
Hip replacement toxic risk could affect 50,000. The Independent, February 29 2012
MHRA: Metal hip implant patients need life-long checks. BBC News, February 29 2012
Metal scare over hip replacement joints. The Guardian, February 29 2012
Toxic metal hip implants 'could affect thousands more people than PIP breast scandal. Daily Mail, February 29 2012
To find out which companies are mentioned in the PV Quarterly go to PatientView's blog http://bit.ly/i9GSD6
A 400-page report, What do patients think of doctors?, published in early-March 2011 by UK research organisation PatientView, finds that patient groups in many countries believe pharma and medical device companies have a role to play in improving doctor-patient relationships. In the global survey of 2,500 groups although only 29% believe pharma have a role to play in improving doctor-patient relationships, over half of the groups surveyed in Canada, Eastern Europe, Italy, New Zealand, Spain and the USA consider that pharma initiatives have the ability to help improve doctor-patient relations. Patient groups from across the world representing the interests of patients with neurological conditions, Parkinson’s disease, respiratory conditions, and rheumatological conditions agree. The countries in which a significant majority of patient groups do not think that pharma has a role to play in helping to improve doctor-patient relations are Germany, the Netherlands, and the UK. In the case of disease areas, most groups specialising in heart and circulatory conditions, or in gastrointestinal conditions, are opposed to pharma playing a role. The report contains examples of corporate best practice in the subject area of helping to improve doctor-patient relations, categorised for 12 countries/regions, and for 12 conditions. 70 companies are named at least once.
Poor doctor-patient relationships: What do patients think of doctors? focuses on patient groups’ views of the current state of doctor-patient relationships, and looks at how they can be improved. The report finds that less than a third of groups representing patients believe GPs and consultants remain traditional and patriarchal in their attitudes to patients. On the other hand, only 15% of groups believe that doctors treat patients as equals (and act on that belief —the rest of the patient groups believe that the situation varies from doctor to doctor, or that doctors may intend to take a partnering role, but fail to live up to it. Relationships between doctors and patients are undoubtedly in need of considerable improvement, especially in some of the less well-performing countries [see figures in sample pages at weblink]. The state of doctor-patient relations has an important bearing on how well patients respond to treatment. In the report, patient groups are quoted as saying that poor doctor-patient relationships prevent patients from coming forward for medical treatment and care—even when treatment and care is needed.
Why industry matters: Many of the comments offered to the survey by the 2,500 respondent patient groups emphasise their understanding that pharma and medical device companies are closely linked to the doctor-patient relationship—whether through access, or through the provision of after-prescription support, information, medicines, services and technology. Pharma’s capacity to influence doctor-patient relationships for the better is the reason why patient groups do support greater pharma involvement. A minority of groups believe that pharma’s vested interests should prevent the industry from getting involved in helping to improve doctor-patient relations.
Positive case studies of what industry has done to support doctor-patient relations:
Some 70 healthcare companies from around the world are named by the respondent patient groups as having had a positive impact upon doctor-patient relations. The groups provide many examples of the types of activities and strategies that the companies have brought to bear to effect positive change, including:
? Programmes that generally emphasise the importance of improving doctor-patient relations. ? Conducting research. ? Producing new technologies to help patient engagement. ? Monitoring the performance of products used by patients. ? Encouraging greater patient participation in the doctor-patient relationship. ? Training and educating health professionals in the patient perspective. ? Training and educating patients in how to better engage with the healthcare system. ? Providing information to patients to enable better engagement with the healthcare system. ? Providing information to patients that can enable better self-management. ? Providing information to doctors, so that they can better understand and talk to patients. ? Supporting patient groups. ? Providing compassionate access to medicines. ? Gathering data on patient perspectives. ? Providing materials to support patients in areas other than medical treatment and care. ? Raising awareness of specific patient problems (such as stigma . ? Supporting integrated care. ? Running patient-partner programmes that gather all stakeholders together.
About the survey: What do patients think of doctors? is based on the results of a November 2010 PatientView survey of 2,500 patient groups from around the world. The survey asked the respondent groups what they think of current doctor-patient relationships, and how they believe those relationships might be improved. The report covers most subject areas in which patients would like doctor-patient relations to be improved, including: l Access to health professionals l Access and choice during diagnosis and treatment l Patient information provided by health professionals l Doctor-patient communication l Gaining patient trust l Respecting patients’ valuable time l Accountability of health professionals l Improving prevention practices l Which single action do patients want from government and payers to improve doctor-patient relationships? l Which pharmaceutical companies are having a positive effect on doctor-patient relationships? l Why pharma can have a negative impact on doctor-patient relationships. The report analyses doctor-patient relations in 11 countries and one region of the world: Australia [number of completed responses = 60]; Canada [138]; Eastern Europe [105]; France [80]; Germany [100]; Italy [110]; the Netherlands [30]; New Zealand [55]; Spain [80]; Sweden [56]; the UK [566]; and the USA [292]. Doctor-patient relations are also analysed for the following 12 specialties: cancer [160]; diabetes [55]; gastro-intestinal [40]; heart and circulatory conditions [70]; HIV/AIDS [72]; mental health [170]; multiple sclerosis [35]; neurological [195]; Parkinson’s disease [30]; rare diseases [70]; respiratory [35]; and rheumatological conditions [55].
Cases of the deadly Schmallenberg virus sweeping across Europe have loomed large in the media in recent weeks. The virus, reported to be “killing thousands of lambs”, has spawned alarming headlines.
These reports are of significant interest to farmers who are likely to be concerned about their animals’ welfare and potential financial loss. Following major incidents of livestock diseases spreading to humans, including foot and mouth, BSE and bluetongue, any possible link between farm animal diseases and human health is a serious concern.
However, the fact that Schmallenberg virus is almost certainly confined to livestock has been quite widely reported.
Why is Schmallenberg virus in the news?
Schmallenberg virus causes transient fever, diarrhoea and reduced milk yield in adult animals. It has also caused stillbirths and foetal abnormalities in lambs, cows and goats. Because the virus has only just been identified, the long-term consequences for infected animals are not yet known.
The virus was first detected in Germany in August 2011,and has since spread through Europe, reaching the UK in late 2011. The full extent of Schmallenberg virus spread is currently unknown. However, according to the Department for Environment, Food and Rural Affairs (Defra , 83 farms (78 sheep farms, five cattle farms in 14 English counties are now confirmed to have animals that tested positive for the virus (to February 27 .
Insects such as midges or mosquitoes are the most likely carriers of the disease, according to the Health Protection Agency. Agriculture and health officials in the UK and other European countries are monitoring the disease to see how it spreads. Defra has said that further spread of the virus to new farms will depend on the seasonal temperature and how many midges migrate as a result.
Is it a risk to human health?
As yet, no human cases of Schmallenberg virus have been detected in any country, and the most closely related viruses only cause animal disease. Early assessments of the virus suggest that it is unlikely that it can spread to humans.
German researchers have looked at the virus’ DNA and found it lacking genetic sequences that would make it a threat to people. However, human implications cannot be ruled out completely until there is a better understanding of the virus.
Because this risk cannot be ruled out, pregnant women are advised to avoid close contact with animals that are giving birth, as there is a theoretical risk of infection from sheep, goats and cattle that could harm a woman’s own health and that of her unborn child.
Very few pregnant women are likely to come into contact with an infected animal. However, pregnant women who do so are advised to seek medical advice if they’re concerned that they could have been infected by farm livestock.
Can I still eat lamb?
The Food Standards Agency has said that on current evidence there is little health risk for consumers from meat. No illness has been reported to date in humans exposed to animals infected with Schmallenberg virus.
The agency advises people to follow normal food hygiene precautions when handling, preparing and cooking all foods, to reduce the risk of food-poisoning.
What’s being done to stop it spreading further?
There is currently no vaccine or treatment for SBV. However, countries affected by Schmallenberg virus are monitoring the situation and considering the impact it might have on farms. Researchers are trying to understand how the virus spreads and how it can be treated.
The animal and human health authorities in the UK, other countries and at EU level are collaborating to ensure any changes in the disease are detected quickly. Farmers have been told to report signs of congenital deformities in newborn lambs to their vets. This will help to aggregate information and inform governments and the EU of any impact.
Some researchers are exploring how the Schmallenberg virus is transmitted and are developing a test to improve detection. If such a test is successfully developed, far larger numbers of infected animals could be found in British farms.
Links To The Headlines
Schmallenberg virus cases reach 83. The Daily Telegraph, March 2 2012
Birth defect disease kills thousands. The Sun, March 2 2012
Killer sheep virus 'may last for a year': Deadly disease spreading at alarming rate, experts warn. Daily Mail, March 2 2012
Schmallenberg virus: Climate 'raising UK disease risk'. BBC News, March 1 2012
Farmers on alert for Schmallenberg virus. BBC News, February 27 2012
To gather data, volunteers equipped with digital cameras took 200 photos from 70 menus at 12 chains in New York City.
“For melanoma patients with a BRAF V600 mutation, this drug is a breakthrough. Not a cure, but a major breakthrough,” says Karl Lewis, MD, investigator at the University of Colorado Cancer Center, associate professor at the University of Colorado School of Medicine, and one of the study’s authors.
Lewis notes that until about 18 months ago, no drug existed for metastatic melanoma — the most dangerous form of skin cancer — that was proven to extend survival past that of patients who chose not to treat the disease. The CU Cancer Center is a leading treatment center for metastatic melanoma, and has been instrumental in enrolling patients in trials of this new category of melanoma drugs — BRAF inhibitors.
The BRAF mutation is a known oncogene – a gene that when mutated causes cancer. Specifically, the BRAF V600 mutation signals a cell to grow without bounds. Vemurafenib is a BRAF inhibitor. The mutation turns cancer on and Vemurafenib turns it off.
And turning off BRAF in the approximately 100,000 patients diagnosed worldwide each year with BRAF-positive metastatic melanoma more than doubles their time of survival.
“Rarely do we see results this dramatic,” says Lewis. “This represents a new standard of care for patients with metastatic melanoma harboring a BRAF mutation.”
Funded by Hoffmann–La Roche; ClinicalTrials.gov number, NCT00949702.
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On the Net:
Former Medtronic CEO Bill Hawkins signs on as the inaugural chair for a new private-public med-tech regulatory science partnership for LifeScience Alley.
Former Medtronic (NYSE:MDT CEO Bill Hawkins will serve as the first chairman of a new private-public partnership aimed at improving development and testing of medical devices.
The partnership includes the Minnesota med-tech community, the FDA's Center for Devices & Radiological Health and the University of Minnesota to establish a regulatory science center in the North Star State.
A new study has found that women who stay seated for long periods of time every day are more prone to developing type 2 diabetes, but that a similar link wasn't found in men.
Researchers from the University of Leicester Departments of Health Sciences and Cardiovascular Sciences revealed that women who are sedentary for most of the day were at a greater risk from exhibiting the early metabolic defects that act as a precursor to developing type 2 diabetes than people who tend to sit less.
The team assessed over 500 men and women of the age of 40 or more about the amount of time spent sitting over the course of a week, helped out by tests on the level of specific chemicals in their bloodstream that are linked to diabetes and metabolic dysfunction. It was found that the women who spent the longest time sitting had higher levels of insulin, as well as higher amounts of C-reactive protein and chemicals released by fatty tissue in the abdomen, leptin, and interleukin6, and which indicate problematic inflammation.
The study, published in the American Journal of Preventive Medicine, revealed that the link between sitting time and diabetes risk was much stronger in women than men, but could not pinpoint why there was a gender difference, although it was suggested that women might snack more often than men during sedentary behavior, or because men tend to take part in more robust activity when they do get up and about.
Dr Thomas Yates who led the study said: "This study provides important new evidence that higher levels of sitting time have a deleterious impact on insulin resistance and chronic low-grade inflammation in women but not men and that this effect is seen regardless of how much exercise is undertaken. This suggests that women who meet the national recommendations of 30 minutes of exercise a day may still be compromising their health if they are seated for the rest of the day.
'It therefore suggests that enabling women to spend less time sitting may be an important factor in preventing chronic disease.' The paper calls for further experimental research investigating the effect of reduced sitting time on human volunteers
Dr Yates added: "If these results are replicated, they have implications for lifestyle recommendations, public health policy, and health behavior change interventions, as they suggest that enabling women to spend less time sitting is an important factor in preventing chronic disease."
The study was supported by the National Institute for Health Research Collaboration in Applied Health Research and Care for Leicestershire, Northamptonshire, and Rutland. The researchers are: Thomas Yates, PhD, Kamlesh Khunti, PhD, MD, Emma G. Wilmot, MBChB, Emer Brady, PhD, David Webb, MBChB, Bala Srinivasan, MBBS, Joe Henson, MSc, Duncan Talbot, BSc, Melanie J. Davies, MD.
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On the Net:
Because of President Obama's frantic approach, health care has run off the rails. For the sake of 47 million uninsured Americans, we need to get it back on track.And what were those lessons?
Health care cannot be handled the same way as the stimulus and cap-and-trade bills. With those, the president stuck to the old style of lawmaking: He threw in every special favor imaginable, ground it up and crammed it through a partisan Democratic Congress. Health care is simply too important to the economy, to employment and to America's families to be larded up and rushed through on an artificial deadline. There's a better way. And the lessons we learned in Massachusetts could help Washington find it.
First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages "free riders" to take responsibility for themselves rather than pass their medical costs on to others.That, my friends, is the individual mandate. And Mitt was proud of it:
The Massachusetts reform aimed at getting virtually all our citizens insured. In that, it worked: 98% of our citizens are insured, 440,000 previously uninsured are covered and almost half of those purchased insurance on their own, with no subsidy.And if President Obama had been willing to move forward without the public option (which he was , then Mitt Romney said he was ready to move forward with a national plan:
Republicans will join with the Democrats if the president abandons his government insurance plan, if he endeavors to craft a plan that does not burden the nation with greater debt, if he broadens his scope to reduce health costs for all Americans, and if he is willing to devote the rigorous effort, requisite time and bipartisan process that health care reform deserves.And, as Mitt Romney made clear at the top of his op-ed, the plan he supported was one built around what he said worked in Massachusetts—including the individual mandate.
Yet despite his clear embrace of the individual mandate as part of federal health care reform, Mitt Romney has faced such a weak set of rival candidates that not a single one of them has brought this up in the twenty Republican debates.
But as fortunate as Mitt Romney has been to face such a staggeringly incompetent Republican field, he won't be so lucky next fall. And you can bet your bottom dollar that the very first time he tries to attack President Obama over health care reform in the debates, he's going to get this thrown right back in his face. And he' s not going to like how it turns out.
Filed under: Cats, Animal Nutrition
whitetrashtexas, Flickr
Q. I'm a vegan for health, environmental and animal cruelty reasons, and I'd like my pets to be vegans too. There's a huge debate on several Internet sites about this subject. What's your take?
A. If your pets are rabbits or other herbivores, no problem. If you have dogs, it's possible, but I really can't advise it. If you have a cat, however, it's my view that you'll be putting your pet's health in jeopardy. Knowing how your cat's nutritional needs differ from your own may help put her very distinctive dietary requirements in perspective:
SEE ALSO: 'Dancing With the Stars' Judge Debuts New Cat Show
Cats must have meat. The feline system is designed to depend on the consumption of other animals to survive and thrive. Unlike humans and dogs, who are omnivores and can stay healthy on a variety of different kinds of diets, cats are "strict" or "obligate" carnivores. Just like their distant cousins the lion, tiger and cheetah, housecats not only prefer meat, they can't maintain good health without it.
Pound for pound, cats need far more protein. A cat needs more than double the amount of protein per pound of body weight than a person requires. And even though we omnivores can meet our protein requirements with nonmeat foods like dairy products, nuts and beans, cats don't have that luxury - animal protein is the only kind that fulfills their nutritional needs. If a cat doesn't get enough protein in his diet, his body will actually break down its own muscle tissue to get the nutrients he needs.
Cats sponge vitamins and amino acids from their prey. There are some nutrients that an omnivore can produce or convert from food that cats have to get ready-to-use from their diet. Among these are vitamin A, niacin, and the amino acids arginine and taurine. Each of these nutrients is essential for good health. Without usable vitamin A, for example, a cat can suffer vision problems and a weakened immune system. Taurine is critical for heart health and also for healthy eyes. Unless your cat is dining on a fresh catch several days a week, you need to provide a diet that provides these nutrients in usable form. That means meat.
SEE ALSO: Why Does My Cat... Stare at Me?
My colleague Dr. Ernie Ward has likewise written on this topic, if you need more food for thought. As for your pets, please discuss their dietary needs with their veterinarian. No one is in a better position to advise you.
See More on Vetstreet.com:
* Top 10 Trendiest Pet Names
* 4 Games Cats Enjoy the Most
* 10 Truly Embarrassing Veterinary Moments
Join the Conversation on Facebook
Source of Original Article: Is a Vegan Diet Safe for My Cat?
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