Health Fans

A Photographic Blast From the Past

2012-01-04T23:38:00.000-08:00

In January 1972, the Environmental Protection Agency asked nearly 100 freelance photographers to roam the country in the pursuit of a single goal: documenting “the environmental happenings and non-happenings” of the decade. By 1977, the photographers had submitted more than 80,000 images for the project, known as Documerica. About one-quarter of the photographs were shown in public exhibitions but then filed away and largely forgotten.

Rediscovered by Jerry Simmons, an archives specialist at the National Archives and Records Administration, the collection has been unearthed in time for its 40th anniversary. More than 15,000 images have been digitized and posted at the National Archives Web site, and a selection is also available on Flickr.

“I was completely fascinated with the photographs,” said Mr. Simmons, who discovered them during a catalog update that quickly deviated from the routine. He embarked on independent research and started up a blog on the project, seeking out people and places that had in many cases been nameless for decades. In one such instance, he had the town librarian in New Ulm, Minn., post fliers inquiring after the identity of a young half-smiling bride.

“I can’t stop thinking about the pictures,” said Mr. Simmons, whose New Year’s resolution is to complete his second article on the project.

The E.P.A. was only 13 months old at the project’s start, and the photo collection captures the transition between an era of nearly unrestrained resource use and industrial pollution and another of aspirational environmental legislation and conservation.

“Documerica was the visual echo of the mission of the E.P.A.,”said Chester Higgins Jr., who was hired in 1973 to capture images in New York City and is now a photographer for The New York Times. “At the time, New York City was captured in a soup of pollution that ranged from bad air, which caused horrific heat inversions, to chemically polluted waters, which depopulated the healthy fish.”

Gifford Hampshire, a press officer at the young agency, came up with the idea for the project and urged the agency’s first administrator, William Ruckelshaus, to make it a reality. Mr. Hampshire drew inspiration from a similar program initiated by the 1930’s Farm Security Administration.

“Future Americans should understand our successes and failures,” Mr. Hampshire wrote in laying out guidelines on goals and expectations for the photographers.

In its early years, particularly under Mr. Ruckelshaus’s tenure, Documerica received ample financing and support. But before long the rising urgency of other issues like the military drawdown in Vietnam and the oil crisis of 1973-74 siphoned budgetary support from the program. By 1977, Documerica was a peripheral project with “no more fire in the belly,” Mr. Hampshire wrote. The last public showing of photographs from the project closed in August 1978.

To mark the 40th anniversary of the project, the E.P.A. started a second, more populist photodocumentary project last year that enlists people around the globe to submit current photographs of “life and our environment.”

Genome Study Points to Adaptation in Early African-Americans

2012-01-04T20:34:00.000-08:00

Researchers scanning the genomes of African-Americans say they see evidence of natural selection as their ancestors adapted to the harsh conditions of their new environment in America.

The scientists, led by Li Jin of the Chinese Academy of Sciences in Shanghai, report in the journal Genome Research that certain disease-causing variant genes became more common in African-Americans after their ancestors reached American shores — perhaps because they conferred greater, offsetting benefits. Other gene variants have become less common, the researchers say, like the gene for sickle cell hemoglobin, which in its more common single-dose form protects against malaria. The Shanghai team suggests the gene has become less common in African-Americans because malaria is much less of a threat.

The purpose of studying African-American genomes is largely medical. Most searches for variant genes that cause disease take place in people of European ancestry, and physicians want to make sure they have not missed variants that may be more common in African-Americans and helpful for developing treatments or diagnosis.

Such searches often reveal events in a population’s history by pinpointing genes that have changed under the pressure of natural selection.

The unusually common variants identified by the Shanghai team are associated with higher risk of hypertension, prostate cancer, sclerosis and bladder cancer.

“Most of the genes associated with African-American ethnic diseases,” they write, “may have played an important role in African-Americans’ adaptation to local environment.” But the authors have not yet been able to identify the benefits they believe such genes conferred.

Mark D. Shriver, a geneticist at Penn State, said it was plausible that some versions of a gene would become more common as African-Americans adjusted to a new environment. “It’s very valid to expect that there will be factors subject to genetic adaptation and that are now more prevalent in contemporary African-Americans than in the ancestral group,” he said.

But Alkes L. Price, a geneticist at the Harvard School of Public Health, said the Shanghai team’s results, though plausible, fell short of proof. “This paper does not provide evidence of selection having occurred post-Africa,” he said.

The Shanghai researchers used a method for studying admixture, a geneticist’s term for when two populations or races intermarry; China has several such populations, perhaps accounting for the team’s interest. Using gene chips that analyze common variations in the human genome, researchers can deconstruct the chromosomes of an African-American, say, assigning each chunk of DNA to an African or European origin.

The scientists found that of the African-American genomes in their sample, 22 percent of the DNA came from Europeans, on average, and the rest from African ancestors, a figure in line with other estimates.

They then looked for sites along the genome where either European or African ancestry was present at statistically significant levels above the average, finding four regions with very common European ancestry and two with very common African ancestry. Most of these sites harbored genes of unknown function, but one, of European origin, holds a gene that combats influenza, suggesting it has become more common in African-Americans by conferring protection from the disease.

Dr. Price, however, said that two other research teams had applied the same method to African-American genomes without finding any statistically significant excess of European or African ancestry. The Chinese team, in his view, should have applied a correction factor to their statistics and, had they done so, would have obtained the same result.

In another approach, the Shanghai team focused on all the DNA segments of the African origin in the African-American genomes, discarding all the European DNA. They then compared the African component of African-American genomes with the DNA of the Yoruba of Nigeria, a well-studied population that happens to be genetically very close to the West African population from which many slaves were taken.

The Shanghai team then asked how the African genome had changed after Africans arrived in the United States. They found that versions of some genes had become more common and others less so. The less common genes included several known to be involved in protection against malaria.

Dr. Price, however, said the decrease in gene frequency might have another explanation — the fact that resistance to malaria varies in strength in different regions of West Africa. The Shanghai team may be looking at the difference in malaria resistance between the Yoruba and other African populations, not the difference between today’s African-Americans and their African ancestors, he said.

Researchers can analyze the ancestry of admixed populations because of the way the hereditary material is shuffled between generations. People have a double set of chromosomes, of which one member of each pair comes from the mother and one from the father. When the egg or sperm is made, the maternal and paternal copies of a chromosome line up and swap large chunks of DNA.

The swapped segments are so large that it takes many generations before they are whittled down to a length too small to be recognized. Meanwhile, the ancestry of each segment can be identified from its pattern of single-nucleotide polymorphisms, or SNPs, the sites on the human genome where there is commonly variation in the A, T, C and G units that make up DNA.

Among human populations, there are very few absolute differences, meaning those in which all members of one population will have, for example, unit T at a site and all members of another will have unit G. But populations do have characteristic percentages. Among Europeans, 70 percent may have C and 30 percent A at a particular SNP site, whereas in Africans the ratio may be 40 percent C and 60 percent A. So a section of genome with C at this SNP site is somewhat more likely to be European.

This is hardly decisive in itself. But take a row of 10 SNPs, and if European ancestry is more likely for most of them, then that section of DNA is probably European in origin.

Geneticists can thus deconstruct the genomes of admixed populations into a mosaic in which each segment can be traced back to one or the other of the two parent populations. This is the basis of the Shanghai team’s approach. But proving that natural selection has been at work in very recent times — in this case, the last 300 years — is very difficult, because the traces of selection are still small. To be sure of detecting such weak selection signals, Dr. Jin and his colleagues conclude, researchers in the future should analyze many thousands of genomes.

Power in Numbers

2012-01-04T16:28:00.000-08:00

CAMBRIDGE, Mass. — His Ph.D. is in pure mathematics, in a subfield so esoteric and specialized that even if someone gets a great result, it can be appreciated by only a few dozen people in the entire world. But he left that world behind and, with no formal training, entered another: the world of molecular biology, medicine and genomics.

As founding director of the Broad Institute of Harvard and M.I.T., he heads a biology empire and raises money from billionaires. He also teaches freshman biology (a course he never took) at M.I.T., advises President Obama on science and runs a lab.

Eric Lander — as a friend, Prof. David Botstein of Princeton, put it — knows how to spot and seize an opportunity when one arises. And he has another quality, says his high school friend Paul Zeitz: bravery combined with optimism.

“He was super smart, but so what?” said Dr. Zeitz, now a mathematics professor at the University of San Francisco. “Pure intellectual heft is like someone who can bench-press a thousand pounds. But so what, if you don’t know what to do with it?”

Eric Lander, he added, knew what to do. And he knew how to carry out strong ideas about where progress in medicine will come from — large interdisciplinary teams collaborating rather than single researchers burrowed in their labs.

So how did he end up at the Broad Institute, going from the most solitary of sciences to forging new sorts of collaborations in a field he never formally studied? What sort of person can make that journey?

Dr. Lander’s story can be told as a linear narrative of lucky breaks and perfect opportunities. But he doesn’t subscribe to that sort of magical thinking. To him, biography is something of a confection: “You live your life prospectively and tell your story retrospectively, so it looks like everything is converging.”

Yet given that limitation to recreating a personal history, Dr. Lander’s story is, at the very least, unusual.

A Math Club Standout

Now 54, Eric Steven Lander grew up in Flatlands, a working-class neighborhood in Brooklyn, raised by his mother — his father died of multiple sclerosis when Eric was 11.

“Nobody in the neighborhood was a scientist,” Dr. Lander said. “Very few had gone to college.”

His life changed when he took an entrance exam and was accepted at the elite Stuyvesant High School in Manhattan. He joined the math team and loved it — the esprit de corps, the competition with other schools, the social aspect of being on the team.

“I found other kids, ninth graders, who also loved math and loved having fun,” he said.

He was so good that he was chosen for the American team in the 1974 Mathematics Olympiad. To prepare, the team spent a summer training at Rutgers University in New Brunswick, N.J.

This was the first time the United States had entered the competition, and the coaches were afraid the team would be decimated by entrants from Communist countries. (Indeed, the Soviet Union placed first, but the Americans came in second, just ahead of Hungary, which was known for its mathematics talent.)

Dr. Zeitz was Dr. Lander’s roommate that summer. The two recall being the only teammates who did not come from affluent suburban families, and who did not have fathers. But Eric stood out for other reasons.

“He was outgoing,” Dr. Zeitz recalled. “He was, compared to the rest of us, definitely more ambitious. He was enthusiastic about everything. And he had a real charisma.” Team members decided that Dr. Lander was the only one among them whom they could imagine becoming a United States senator one day.

At first, though, it looked as if the young mathematician would follow a traditional academic path. He went to Princeton, majoring in mathematics but also indulging a passion for writing. He took a course in narrative nonfiction with the author John McPhee and wrote for the campus newspaper.

He graduated as valedictorian at age 20, won a Rhodes scholarship, went to Oxford and earned a mathematics Ph.D. there in record time — two years. Yet he was unsettled by the idea of spending the rest of his life as a mathematician.

“I began to appreciate that the career of mathematics is rather monastic,” Dr. Lander said. “Even though mathematics was beautiful and I loved it, I wasn’t a very good monk.” He craved a more social environment, more interactions.

“I found an old professor of mine and said, ‘What can I do that makes some use of my talents?’ ” He ended up at Harvard Business School, teaching managerial economics.

He had never studied the subject, he confesses, but taught himself as he went along. “I learned it faster than the students did,” Dr. Lander said.

Yet at 23, he was growing restless, craving something more challenging. Managerial economics, he recalled, “wasn’t deep enough.”

He spoke to his brother, Arthur, a neurobiologist, who sent him mathematical models of how the cerebellum worked. The models “seemed hokey,” Dr. Lander said, “but the brain was interesting.”

His appetite for biology whetted, he began hanging around a fruit-fly genetics lab at Harvard. A few years later, he talked the business school into giving him a leave of absence.

He told Harvard he would go to M.I.T., probably to learn about artificial intelligence. Instead, he ended up spending his time in Robert Horvitz’s worm genetics lab. And that led to the spark that changed his life.

Making the Leap

It was 1983, and while Dr. Lander was hanging around the worm lab, Dr. Botstein, at the time a professor at M.I.T., was growing increasingly frustrated. He had spent five fruitless years looking for someone who knew mathematics to take on a project involving traits like high blood pressure that were associated with multiple genes. For these diseases, the old techniques for finding traits caused by single genes would not work.

“I literally went around looking for someone who could help,” Dr. Botstein said. Finally, at a conference, another biologist said, “There’s this fellow, Lander, at Harvard Business School who wanted to do something with biology.”

Dr. Botstein hunted Dr. Lander down at a seminar at M.I.T., and pounced. The two connected immediately. “We went to a whiteboard,” Dr. Lander said, “and started arguing.”

Within a week, Dr. Lander had solved the problem. Then the two researchers invented a computer algorithm to analyze maps of genes in minutes instead of months. Soon, Dr. Lander had immersed himself in problems of mapping human disease genes.

He had long discussions with Dr. Botstein about the future of human genomics. It was a time, Dr. Botstein said, “when talk of sequencing the human genome was just beginning to get traction.” Dr. Lander wanted to know if there was any use for a mathematician in biology, and Dr. Botstein, who knew the challenges ahead, assured him there was.

“He had a sufficiently high opinion of himself,” Dr. Botstein said. “He thought that if anyone could do it, he could. He took a chance and dropped his Harvard job. It was clear that teaching economics would no longer be his career path.”

David Baltimore, a Nobel laureate who was then the head of the Whitehead Institute for Biomedical Research at M.I.T., was taken with Dr. Lander’s passion and abilities. He enabled Dr. Lander to become a fellow there and then an assistant professor in 1986.

That same year, Dr. Lander went to a meeting at the Cold Spring Harbor Laboratory on Long Island where leading scientists held the first public debate on the idea of mapping the human genome. Dr. Lander raised his hand and joined the discussion, impressing the others so much they invited him into their circle.

“It is very easy to be an expert in a new field where there are no experts,” Dr. Lander said. “All you have to do is raise your hand.”

Meanwhile, Dr. Botstein and Dr. Baltimore wrote to the MacArthur Foundation recommending Dr. Lander for a “genius” grant. He received it in 1987. He was 30.

“I tried to help him over the years in realizing his dreams.” Dr. Baltimore said. “And he’s been very successful in making that happen.”

Soon, Dr. Lander had become a central figure in the effort to sequence the human genome, leading the largest of the three centers that did most of the work. He combined his mathematics and the biology and chemistry he’d learned hanging out in labs. And he added insights about industrial organization, achieved in his business school days, to streamline the effort and control costs.

What he loved most about the work was the community he had craved, the team effort he had been searching for.

Even before the Human Genome Project ended, Dr. Lander was thinking of how to keep what he saw as a wonderful collaboration among scientists going. There were, by his count, about 65 collaborations among young scientists in Cambridge and Boston, all outside the usual channels.

“Something magical had happened,” Dr. Lander said. “People were coming together and taking on really bold problems.”

It may have had something to do with Dr. Lander’s personality. Gus Cervini, an administrator at Brigham and Women’s Hospital in Boston who worked for him for four years, used to call him “the sun.”

“He has this amazing influence or power on people,” Mr. Cervini said. “He had this ability to get people to really think big.

“When the sun shines on you, you feel like you can do anything.”

Persistence Rewarded

That power may have helped when Dr. Lander approached the presidents of Harvard and M.I.T. and proposed creating a permanent institute to continue the collaborative process that groups of scientists had been improvising. At first, he met with resistance, but he persisted.

Then Dr. Baltimore introduced him to the philanthropists Eli and Edythe Broad, who had made their fortune in real estate. The Broads (the name rhymes with code) visited Dr. Lander’s lab one Saturday morning in October 2002. A few months later, they agreed to invest $10 million a year for a decade, so Dr. Lander could start what he thought of as an experiment with a new kind of research institute.

The Broad Institute was to become a joint effort between Harvard and M.I.T., headed by Dr. Lander, that would encourage scientists to collaborate to solve big problems in biology, genetics and genomics.

Within 18 months, the Broads doubled their gift, to $200 million. In 2008, they contributed another $400 million as an endowment to make the institute permanent. Today the institute has about 1,800 collaborating scientists from the two universities and Harvard’s hospitals.

Its aims sound audacious: “Assemble a complete picture of the molecular components of life. Define the biological circuits that underlie cellular responses. Uncover the molecular basis of major inherited diseases. Unearth all the mutations that underlie different cancer types. Discover the molecular basis of major infectious diseases. Transform the process of therapeutic discovery and development.”

“Half the place is devoted to finding the basis of disease and half is devoted to trying to transform and accelerate the development of therapeutics,” Dr. Lander said. “It’s different from what you find in many university settings where you have many labs, each of whom does its own thing.”

The Broad is an experiment, Dr. Lander said, one that involves an institution and how to do scientific research. “This is in a sense a protected space to see if it works,” Dr. Lander said.

The institute is Dr. Lander’s passion, but hardly his only one. His days start and end in a gym on the second floor of his house, where he has an elliptical cross-trainer. He uses it for two 40-minute sessions, one in the morning and one at night, watching Netflix videos and burning — according to the machine — 1,000 calories a day. He reports that he lost 42 pounds last summer without changing his diet.

They bought the place, a converted schoolhouse, when his wife, Lori Lander, who is an artist, pointed out that it had a basketball court on the top floor — it could be a kind of neighborhood hangout, so the Landers would always know where their three children were.

After his morning workout, he sometimes goes to a local bakery where he can work quietly. He arrives at the Broad between 8 and 10 a.m. In the fall, he teaches introductory biology to a class of 700 M.I.T. students on Monday, Wednesday and Friday mornings. He often meets with graduate students and postdoctoral fellows in the afternoon to discuss their work.

Then he has his administrative duties and his meetings with philanthropists, trying to raise more money. He also spends 20 percent of his time in yet another role, as co-chairman of President Obama’s Council of Advisers on Science and Technology, which deals with topics like influenza vaccines, health information technology, science education and energy policy.

In the evening, around 6:30 or 7, he has dinner with his family. His wife cooks — Dr. Lander loves to cook but says he just does not have time.

He also reads — fiction, nonfiction, New Yorker articles — but has no patience with poor writing.

“I am very eclectic in my reading, but it has to be really well written,” he said. “That’s a huge barrier.”

On weekends he and his wife try to get to New York for the theater, another of his passions.

And he marvels at how his life has turned out. “I feel like it’s so incredibly lucky to end up here,” he said. “I could not have planned this. What if I hadn’t met David Botstein? What if I hadn’t gone to a meeting where the human genome was discussed? I have no idea. This is as random as it gets.

“It’s a very weird career.”

Animal Studies Cross Campus to Lecture Hall

2012-01-04T13:28:00.000-08:00

Once, animals at the university were the province of science. Rats ran through mazes in the psychology lab, cows mooed in the veterinary barns, the monkeys of neuroscience chattered in their cages. And on the dissecting tables of undergraduates, preserved frogs kept a deathly silence.

On the other side of campus, in the seminar rooms and lecture halls of the liberal arts and social sciences, where monkey chow is never served and all the mazes are made of words, the attention of scholars was firmly fixed on humans.

No longer.

This spring, freshmen at Harvard can take “Human, Animals and Cyborgs.” Last year Dartmouth offered “Animals and Women in Western Literature: Nags, Bitches and Shrews.” New York University offers “Animals, People and Those in Between.”

The courses are part of the growing, but still undefined, field of animal studies. So far, according to Marc Bekoff, an emeritus professor of ecology and evolutionary biology at the University of Colorado, the field includes “anything that has to do with the way humans and animals interact.” Art, literature, sociology, anthropology, film, theater, philosophy, religion — there are animals in all of them.

The field builds partly on a long history of scientific research that has blurred the once-sharp distinction between humans and other animals. Other species have been shown to have aspects of language, tool use, even the roots of morality. It also grows out of a field called cultural studies, in which the academy has turned its attention over the years to ignored and marginalized humans.

Some scholars now ask: Why stop there? Why honor the uncertain boundary that separates one species from all others? Is it time for a Shakespearean stage direction: Exit the humanities, pursued by a bear? Not quite yet, although some scholars have suggested it is time to move on to the post-humanities.

The Animals and Society Institute, itself only six years old, lists more than 100 courses in American colleges and universities that fit under the broad banner of animal studies. Institutes, book series and conferences have proliferated. Formal academic programs have appeared.

Wesleyan University, together with the Animals and Society Institute, began a summer fellowship program this year. A program at Michigan State allows doctoral and master’s students in different fields to concentrate their work in animal studies. At least two institutions offer undergraduate majors in the field. And just this fall, New York University started an animal studies initiative, allowing undergraduates to minor in the field.

Dale Jamieson, director of that program, said that activity in animal studies had been “somewhat inchoate” up to now, but that he hoped N.Y.U. could help “to make it a more cohesive and rigorous scholarly field.”

Animals have never been ignored by scholars, of course. Thinkers and writers of all ages have grappled with what separates humans from the other animals and how we should treat our distant and not-so-distant cousins. The current burst of interest is new, however, and scholars see several reasons for the growth of the field.

Kari Weil, a philosophy professor at Wesleyan whose book “Thinking Animals: Why Animal Studies Now?” will be published in the spring, said that behavioral and environmental science had laid a foundation by giving humans “the sense that we are a species among other species” — that we, like other animals, are “subject to the forces of nature.”

Think of the effect Jane Goodall had when she first showed the world a social and emotional side of chimpanzees that made it almost impossible to keep them on the other side of the divide. Or watch the popular YouTube video of a New Caledonian crow bending a wire into a tool to fish food out of a container, and ask yourself how old a child would have to be to figure out the problem.

The most direct influence may have come from philosophy. Peter Singer’s 1975 book “Animal Liberation” was a landmark in arguing against killing, eating and experimenting on animals. He questioned how humans could exclude animals from moral consideration, how they could justify causing animals pain.

Lori Gruen, head of the philosophy department at Wesleyan and coordinator of the summer fellowship program in animal studies there, said one of the major questions in philosophy was “Who should we direct our moral interest to?” Thirty years ago, she said, animals were at the margins of philosophical discussions of ethics; now “the animal question is right in the center of ethical discussion.”

And of public interest.

Jane Desmond of the University of Illinois, a cultural anthropologist who organized a series of talks there about animals, says that what goes on in the public arena, beyond the university, has had a role in prompting new attention to animals. There are worries about the safety of the food chain, along with popular books about refusing to kill and eat animals.

Animals as food are a major subject of academic interest, Dr. Gruen said, adding, “Given that the way most people interact with animals is when they’re dead and eaten, that becomes a big question.”

The animals humans live with and love are also a major subject.

Another strain of philosophy, exemplified by the French writer Jacques Derrida, has had an equally strong influence. He considered the way we think of animals, and why we distance ourselves from them. His writing is almost impossible to capture in a quotation, since it constantly circles around on itself, building intensity as he toys with the very language he is using to write about what he is trying to understand. His approach has been adapted in a lot of academic work.

In “The Animal That Therefore I Am,” for example, he discusses at length not only what he thinks of his cat, but what his cat thinks of him. In a fairly simple sentence — and thought — for him, he writes about his cat: “An animal looks at me. What should I think of this sentence?”

What animals think — in fact, what animals have to say — is something scholars now take quite seriously, recognizing of course that there are limits to that approach. As Dr. Weil of Wesleyan said, referring to the gulf between animals and previous outsiders (“others”), like women or African-Americans, “Unlike the other others, these others can’t speak back or write back in language that the academy recognizes.”

The academy does, it seems, recognize and understand Derrida and, sometimes, follow in his word tracks. Consider, for instance, “Animal, Vegetable, Mineral: Ethics as Extension or Becoming? The Case of Becoming-Plant” in a recent issue of The Journal for Critical Animal Studies. Other writing is quite approachable. The moral arguments about eating animals are clear. And there are studies that any urban dweller could profit from, like “How Pigeons Became Rats: The Cultural-Spatial Logic of Problem Animals.”

The great variety of subjects, methods, interests and assumptions in animal studies does raise questions about how it holds together. Law schools, for instance, routinely have courses in animals and the law. Veterinary schools have courses about the human connection to animals. Some people group courses in how to use animals in therapy as part of animal studies.

None of this variety diminishes the energy or importance of what is going on, but at least some people who work on subjects that would be included under the animal studies rubric, like Dr. Jamieson at N.Y.U. and Dr. Desmond at Illinois, think the scholarly ferment has a way to go before it can clearly see itself as an academic field.

Dr. Desmond says it is “not yet a field.” It is, she says, “an emergent scholarly community.” One thing it does not lack is energy.

Fighting Cervical Cancer With Vinegar and Ingenuity

2011-12-30T21:10:00.000-08:00

Anuree Talasart, a nurse provider in Roi Et Province, Thailand, teaches a group of women about the female reproductive system.

POYAI, Thailand — Maikaew Panomyai did a little dance coming out of the examination room, switching her hips, waving her fists in the air and crowing, in her limited English: “Everything’s O.K.! Everything’s O.K.!”

Translation: The nurse just told me I do not have cervical cancer, and even the little white spot I had treated three years ago is still gone.

What allowed the nurse to render that reassuring diagnosis was a remarkably simple, brief and inexpensive procedure, one with the potential to do for poor countries what the Pap smear did for rich ones: end cervical cancer’s reign as the No. 1 cancer killer of women. The magic ingredient? Household vinegar.

Every year, more than 250,000 women die of cervical cancer, nearly 85 percent of them in poor and middle-income countries. Decades ago, it killed more American women than any other cancer; now it lags far behind cancers of the lung, breast, colon and skin.

Nurses using the new procedure, developed by experts at the Johns Hopkins medical school in the 1990s and endorsed last year by the World Health Organization, brush vinegar on a woman’s cervix. It makes precancerous spots turn white. They can then be immediately frozen off with a metal probe cooled by a tank of carbon dioxide, available from any Coca-Cola bottling plant.

The procedure is one of a wide array of inexpensive but effective medical advances being tested in developing countries. New cheap diagnostic and surgical techniques, insecticides, drug regimens and prostheses are already beginning to save lives.

With a Pap smear, a doctor takes a scraping from the cervix, which is then sent to a laboratory to be scanned by a pathologist. Many poor countries lack high-quality labs, and the results can take weeks to arrive.

Women who return to distant areas where they live or work are often hard to reach, a problem if it turns out they have precancerous lesions.

Miss Maikaew, 37, could have been one of them. She is a restaurant cashier on faraway Ko Chang, a resort island. She was home in Poyai, a rice-farming village, for a brief visit and was screened at her mother’s urging.

The same thing had happened three years ago, and she did have a white spot then. (They resemble warts, and are caused by the human papillomavirus.) It was frozen off with cryotherapy, which had hurt a little, but was bearable, she said.

Since she has been screened twice in her 30s, her risk of developing cervical cancer has dropped by 65 percent, according to studies by the Alliance for Cervical Cancer Prevention, a coalition of international health organizations funded by the Bill & Melinda Gates Foundation.

The procedure, known as VIA/cryo for visualization of the cervix with acetic acid (vinegar) and treatment with cryotherapy, can be done by a nurse, and only one visit is needed to detect and kill an incipient cancer.

Thailand has gone further than any other nation in adopting it. More than 20 countries, including Ghana and Zimbabwe, have done pilot projects. But in Thailand, VIA/cryo is now routine in 29 of 75 provinces, and 500,000 of the 8 million women, ages 30 to 44, in the target population have been screened at least once.

Dr. Bandit Chumworathayi, a gynecologist at Khon Kaen University who helped run the first Thai study of VIA/cryo, explains that vinegar highlights the tumors because they have more DNA, and thus more protein and less water, than other tissue.

It reveals pre-tumors with more accuracy than a typical Pap smear. But it also has more false positives — spots that turn pale but are not malignant. As a result, some women get unnecessary cryotherapy.

But freezing is about 90 percent effective, and the main side effect is a burning sensation that fades in a day or two.

By contrast, biopsies, the old method, can cause bleeding.

“Some doctors resist” the cryotherapy approach, said Dr. Wachara Eamratsameekool, a gynecologist at rural Roi Et Hospital who helped pioneer the procedure. “They call it ‘poor care for poor people.’ This is a misunderstanding. It’s the most effective use of our resources.”

At a workshop, nurse trainees pored over flash cards showing cervixes with diagnosable problems. They did gynecological exams on lifelike mannequins with plastic cervixes. They performed cryotherapy on sliced frankfurters pinned deep inside plastic pipes. Then, after lunch, they broke into small groups and went by minibus to nearby rural clinics to practice on real women.

Because cervical cancer takes decades to develop, it is too early to prove that Thailand has lowered its cancer rate. In fact, Roi Et Province, where mass screening first began, has a rate higher than normal, but doctors attribute that to the extra testing. But of the 6,000 women recruited 11 years ago for the first trial, not a single one has developed full-blown cancer.

VIA/cryo was pioneered in the 1990s simultaneously by Dr. Paul D. Blumenthal, an American gynecologist working in Africa, and Dr. Rengaswamy Sankaranarayanan in India.

Dr. Blumenthal said he and colleagues at the Johns Hopkins medical school had debated ways to make cervical lesions easier to see, and concluded that whitening them with acetic acid would be effective. Freezing off lesions is routine in gynecology and dermatology; the challenge was making it cheap and easy. Liquid nitrogen is hard to get, but carbon dioxide is readily available.

Thailand seems made for the vinegar technique. It has more than 100,000 nurses and a network of rural clinics largely run by them.

Also, while poor rural villagers in many countries go to shamans or herbalists before they see doctors, poor Thais do not. Thailand has a 95 percent literacy rate, and doctors are trusted. The king is the son of a doctor and a nurse; his father trained at Harvard. One of the royal princesses has a doctorate in chemistry and an interest in cancer research.

But the real secret, Dr. Wachara said, is this: “Thailand has Lady Kobchitt.”

Dr. Kobchitt Limpaphayon to her colleagues at Bangkok’s Chulalongkorn University medical school and “Kobbie” to her classmates long ago at New York’s Albany Medical College, she is the gynecologist to the Thai royal family. “Kobbie is a force of nature,” said Dr. Blumenthal, who has taught with her. In 1971, as a young doctor, she moved from Albany to Baltimore to help start the Johns Hopkins Program for International Education in Gynecology and Obstetrics.

In 1999, she read one of Dr. Blumenthal’s papers and asked him to introduce VIA/cryo in Thailand. Without her connections and powers of persuasion, said Dr. Bandit, it would have been impossible to get the conservative Royal Thai College of Obstetricians and Gynecologists to give up Pap smears, or to persuade Parliament to allow nurses to do cryotherapy, a procedure previously reserved for doctors.

The free screenings at public clinics are crucial to people like Yupin Promasorn, 36, who was part of Miss Maikaew’s group.

She sells snacks in Bangkok, and her husband drives a tuk-tuk motorcycle taxi. With two children, she has no time to wait at Bangkok’s jammed public hospitals, and she is too poor to see a private doctor. So she and her husband drove the 12 hours here, to her native village, in his tuk-tuk. When she found out she was negative, she sat in a chair fanning herself.

“I feel like a heavy mountain is gone from my chest,” she said.

The Hormone Surge of Middle Childhood

2011-12-30T02:08:00.000-08:00

VIEWED superficially, the part of youth that the psychologist Jean Piaget called middle childhood looks tame and uneventful, a quiet patch of road on the otherwise hairpin highway to adulthood.

Said to begin around 5 or 6, when toddlerhood has ended and even the most protractedly breast-fed children have been weaned, and to end when the teen years commence, middle childhood certainly lacks the physical flamboyance of the epochs fore and aft: no gotcha cuteness of babydom, no secondary sexual billboards of pubescence.

Yet as new findings from neuroscience, evolutionary biology, paleontology and anthropology make clear, middle childhood is anything but a bland placeholder. To the contrary, it is a time of great cognitive creativity and ambition, when the brain has pretty much reached its adult size and can focus on threading together its private intranet service — on forging, organizing, amplifying and annotating the tens of billions of synaptic connections that allow brain cells and brain domains to communicate.

Subsidizing the deft frenzy of brain maturation is a distinctive endocrinological event called adrenarche (a-DREN-ar-kee), when the adrenal glands that sit like tricornered hats atop the kidneys begin pumping out powerful hormones known to affect the brain, most notably the androgen dihydroepiandrosterone, or DHEA. Researchers have only begun to understand adrenarche in any detail, but they see it as a signature feature of middle childhood every bit as important as the more familiar gonadal reveille that follows a few years later.

Middle childhood is when the parts of the brain most closely associated with being human finally come online: our ability to control our impulses, to reason, to focus, to plan for the future.

Young children may know something about death and see monsters lurking under every bed, but only in middle childhood is the brain capable of practicing so-called terror management, of accepting one’s inevitable mortality or at least pushing thoughts of it aside.

Other researchers studying the fossil record suggest that a prolonged middle childhood is a fairly recent development in human evolution, a luxury of unfolding that our cousins the Neanderthals did not seem to share. Still others have analyzed attitudes toward middle childhood historically and cross-culturally. The researchers have found that virtually every group examined recognizes middle childhood as a developmental watershed, when children emerge from the shadows of dependency and start taking their place in the wider world.

Much of the new work on middle childhood was described in a recent special issue of the journal Human Nature. As a research topic, “middle childhood has been very much overlooked until recently,” said David Lancy, an anthropologist at Utah State University and a contributor to the special issue. “Which makes it all the more exciting to participate in the field today.”

The anatomy of middle childhood can be subtle. Adult teeth start growing in, allowing children to diversify their diet beyond the mashed potatoes and parentally dissected Salisbury steak stage. The growth of the skeleton, by contrast, slows from the vertiginous pace of early childhood, and though there is a mild growth spurt at age 6 or 7, as well as a bit of chubbying up during the so-called adiposity rebound of middle childhood, much of the remaining skeletal growth awaits the superspurt of puberty.

“Adulthood is defined by being skeletally as well as sexually mature,” said Jennifer Thompson of the University of Nevada, Las Vegas. “A girl may have her first period at 11 or 12, but her pelvis doesn’t finish growing until about the age of 18.”

The 18-year time frame of human juvenility far exceeds that seen in any other great ape, Dr. Thompson said. Chimpanzees, for example, are fully formed by age 12. With her colleague Andrew J. Nelson of the University of Western Ontario, Dr. Thompson analyzed fossil specimens from Neanderthals, Homo erectus and other early hominids, and concluded that their growth pattern was more like that of a chimpanzee than a modern human: By age 12 or 14, they had reached adult size.

Life for Neanderthals was nasty and short, Dr. Thompson said, and Neanderthal children had to get big fast, which is why they hurtled through adolescence at the equivalent of today’s chapter-book age. Our extreme form of dilated childhood didn’t appear until the advent of modern Homo sapiens roughly 150,000 years ago, Dr. Thompson said, when adults began living long enough to ease pressure on the young to hurry up and breed.

And what an essential luxury item middle childhood has proved to be. “It’s consistent across societies,” Benjamin Campbell, an anthropologist at the University of Wisconsin in Milwaukee said. “In middle childhood, kids start making sense.”

Parental expectations rise accordingly. “Kids can do something now,” said Dr. Campbell, who edited the special issue. “They can do tasks. They have economic value.”

Boys are given goats to herd and messages to deliver. They hunt and fish. Girls weave, haul water, grind corn, chop firewood, serve as part-time mothers to their younger siblings; a serious share of baby care in the world is performed by girls not yet in their teens.

Workloads and expectations vary substantially from one culture to the next. Karen Kramer and Russell Greaves of Harvard compared the average number of hours that girls in 16 different traditional cultures devoted each day to “subsistence” tasks apart from child care. Girls of the Ariaal pastoralists in northern Kenya worked the hardest, putting in 9.6 hours daily. Agriculturalist girls in Nepal worked 7.5 hours a day.

Then you come to the more laid-back lives of the foragers. The researchers focused on the Pumé, a foraging group in west-central Venezuela, where preadolescent girls do almost nothing. They forage less than an hour a day, significantly less than their brothers, and are very inefficient in what little they do. They prefer hanging out at the campsite. “Pumé girls spend their time socializing, talking and laughing with their friends, beading and resting,” Dr. Kramer said.

But most cultures mark the beginning of middle childhood with some new responsibility. Kwoma children of Papua New Guinea are given their own garden plots to cultivate. Berber girls of northern Africa vie to prove their worth by preparing entire family meals unassisted.

In the Ituri forest of Central Africa, Mbuti boys strive to kill their first “real animal,” for which they will be honored through ritualized facial scarring. And in the United States, children enter elementary school, for which they will be honored through ritualized gold starring.

In middle childhood, the brain is at its peak for learning, organized enough to attempt mastery yet still fluid, elastic, neuronally gymnastic. Children have lost the clumsiness of toddlerhood and can become physically gymnastic, too, and start practicing their fine motor skills. And because they are still smaller than adults, they can grow adept at a skill like, say, spear-tossing, without fear of threatening the resident men.

Middle childhood is the time to make sense and make friends. “This is the period when kids move out of the family context and into the neighborhood context,” Dr. Campbell said.

The all-important theory of mind arises: the awareness that other people have minds, plans and desires of their own. Children become obsessed with social groups and divide along gender lines, girls playing with girls, boys with boys. They have an avid appetite for learning the local social rules, whether of games, slang, style or behavior. They are keenly attuned to questions of fairness and justice and instantly notice those grabbing more than their share.

The mental and kinesthetic pliancy of middle childhood can be traced at least in part to adrenarche, researchers said, when signals from the pea-size pituitary at the base of the brain prod the adrenal glands to unleash their hormonal largess. Adrenal hormones like DHEA are potent antioxidants and neuroprotectants, Dr. Campbell said, and may well be critical to keeping neurons and their dendritic connections youthfully spry.

Evidence also suggests that the adrenal hormones divert glucose in the brain to foster the maturation of the insula and anterior cingulate cortex, brain regions vital to interpreting social and emotional cues.

In middle childhood, the brain is open for suggestions. What do I need to know? What do I want to know? Well, you could take up piano, chess or juggling, learn another language or how to ski. Or you could go outside and play with your friends. If you learn to play fair, friends will always be there.

Cauliflower and Red Onion Tacos With Cotija Cheese

2011-12-29T17:05:00.000-08:00

Cauliflower and Red Onion Tacos With Cotija Cheese

Vegetables bathed in vinegar are typical condiments in Mexico, but you can bring them to the center of the plate as a filling for a taco. If you want spice, add the chipotle, or garnish with some salsa. If salt is an issue, use ranchero rather than cotija cheese.

1 large or 2 small or medium cauliflowers, broken into florets (about 6 cups)

1 red onion, cut in half lengthwise, then sliced crosswise across the grain

1 to 2 garlic cloves (to taste), minced

1/4 cup chopped cilantro

2 tablespoons capers, drained and rinsed

1/4 cup white wine vinegar or Champagne vinegar (to taste)

3 tablespoons extra virgin olive oil

Salt and freshly ground pepper

1 or 2 chipotle chilies in adobo or pickled jalapeños, drained and thinly sliced (optional)

12 corn tortillas

1 romaine heart, cut crosswise in thin strips (chiffonade)

3 ounces cotija or ranchero cheese

1. Place the cauliflower and onion in a steaming basket over 1 inch of boiling water. Cover and steam 1 minute. Lift the lid for 15 seconds, then cover again and steam for 5 to 8 minutes, until the cauliflower is tender. Refresh with cold water and drain on paper towels.

2. In a large bowl, mix together the garlic, cilantro, capers, vinegar and olive oil. Season with salt and pepper. Add the cauliflower and onion and toss together. Marinate, stirring from time to time, for 30 minutes if possible before serving. For an added kick, stir in the chili or chilies. Transfer the mixture to a skillet and heat through over medium heat.

3. Warm the tortillas. Top with the marinated vegetables and a handful of romaine, sprinkle on the cheese and serve.

Yield: 6 servings.

Advance preparation: You can make the cauliflower and onion mixture up to a day ahead, but omit the cilantro until shortly before serving so that its color doesn’t fade. The filling keeps well in the refrigerator for up to 5 days.

Nutritional information per serving (6 servings): 282 calories; 4 grams saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 15 milligrams cholesterol; 34 grams carbohydrates; 6 grams dietary fiber; 375 milligrams sodium (does not include salt to taste); 8 grams protein

Lucky Foods to Ring in the New Year

2011-12-29T04:02:00.000-08:00

Baked Giant Limas with Winter Squash and Sage

I love the fact that beans, lentils and greens symbolize prosperity in the New Year in places as disparate as the American South and the South of France. I wonder if it’s really because lentils and beans are round like coins and swell when they cook, or if it’s because that’s about all anybody can afford to eat after the excesses of the holiday season.

The notion of thrift wouldn’t apply to some of the other foods that symbolize good luck or prosperity in certain cultures – fish, for instance, or saffron. I’ve taken traditions from different places this week and thrown some of them together, focusing mainly on lentils, beans, greens and fish. These are simple dishes that I hope will help you to begin 2012 on a happy, healthy note. Look for more New Year’s dishes in the Recipes for Health index.

Baked Giant Limas With Winter Squash and Sage

Baking in a slow oven is the best way to cook large lima beans, which can fall apart easily if boiled too hard. This dish is luxuriously creamy (though there’s no cream in it) and comforting.

2 tablespoons extra virgin olive oil

1 medium onion, chopped

4 garlic cloves, minced

1 pound (about 2 1/2 cups) dried giant lima beans, rinsed

2 quarts plus 1 cup water

A bouquet garni made with a bay leaf, a Parmesan rind and a sprig each of sage, thyme and parsley

1 pound winter squash, peeled and cut in small dice

Salt to taste

Freshly ground pepper

2 tablespoons slivered fresh sage leaves

Freshly grated Parmesan for serving (optional)

1. Preheat the oven to 325 degrees. Heat the olive oil over medium heat in a large, heavy ovenproof casserole or Dutch oven and add the onion. Cook, stirring often, until it is tender, about 5 minutes. Stir in half the garlic and cook, stirring, until it is fragrant, 30 seconds to a minute. Add the beans, water and bouquet garni and bring to a simmer. Cover and place in the oven for 45 minutes.

2. Remove the casserole from the oven and stir in the remaining garlic, the winter squash, and salt to taste. If the mixture seems dry, add a little more water. Return to the oven and bake an hour longer, or until the beans and squash are very tender. Remove from the heat and remove the bouquet garni. Adjust salt, add pepper to taste and stir in the slivered sage.

Yield: 4 to 6 servings.

Advance preparation: The dish will keep for 3 or 4 days in the refrigerator, but it changes, as the limas fall apart and the dish turns into a sort of semi-mashed bean and squash dish. It’s still delicious, but it will be thick enough to eat with a fork.

Nutritional information per serving (4 servings): 436 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 0 milligrams cholesterol; 72 grams carbohydrates; 22 grams dietary fiber; 12 milligrams sodium (does not include salt to taste); 24 grams protein

Nutritional information per serving (6 servings): 291 calories; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 48 grams carbohydrates; 15 grams dietary fiber; 8 milligrams sodium (does not include salt to taste)l 16 grams protein

How Tanning Changes the Brain

2011-12-28T18:58:00.000-08:00

The brains of frequent tanners may be similar to those of addicts.

People who frequently use tanning beds experience changes in brain activity during their tanning sessions that mimic the patterns of drug addiction, new research shows.

Scientists have suspected for some time that frequent exposure to ultraviolet radiation has the potential to become addictive, but the new research is the first to actually peer inside the brains of people as they lay in tanning beds.

What the researchers found was that several parts of the brain that play a role in addiction were activated when the subjects were exposed to UV rays. The findings, which appear in the coming issue of the journal Addiction Biology, may help explain why some people continue to tan often despite awareness about risks such as skin cancer, premature aging and wrinkles.

“What this shows is that the brain is in fact responding to UV light, and it responds in areas that are associated with reward,” said Dr. Bryon Adinoff, a professor of psychiatry at the University of Texas Southwestern Medical Center and an author of the study. “These are areas, particularly the striatum, that we see activated when someone is administered a drug or a high-value food like sugar.”

Despite all the public warnings about skin cancer, tanning remains as popular as ever, with nearly 30 million Americans tanning indoors every year, and more than a million visiting tanning salons on an average day. Frequent users say they simply enjoy the way they look with darker skin.

But in recent years, scientists also began to wonder whether deliberately ignoring the potentially lethal side effects of regular UV exposure was a sign that the motivation for frequent tanners was more than skin-deep. Could habitual tanning be an addictive behavior?

A study in 2005 did show that a large proportion of sunbathers met the psychiatric definition of a substance abuse disorder, based on their answers to a variation of a test often used to help diagnose alcohol addiction.

But Dr. Adinoff and his colleagues decided to go a step further. They recruited a small group of people from tanning salons who said that they liked to tan at least three times a week and that maintaining a tan was important to them. The frequent tanners agreed to be injected with a radioisotope that allowed researchers to monitor how tanning affected their brain activity.

On one occasion, the study subjects experienced a normal tanning session. But on another occasion, the researchers used a special filter that blocked only the UV light, although the tanners weren’t told of the change.

Brain images later showed that during regular tanning sessions, when the study subjects were exposed to UV rays, several key areas of the brain lighted up. Among those areas were the dorsal striatum, the left anterior insula and part of the orbitofrontal cortex – all areas that have been implicated in addiction. But when the UV light was filtered out, those areas of the brain showed far less activity.

The researchers also found evidence that the tanners appeared to know — on a subconscious level, at least — when they had undergone sham tanning sessions and not received their usual dose of UV rays. The tanners, questioned after each session, expressed less desire to tan after the real sessions, indicating they had gotten their fill. But on days when the tanners were unknowingly deprived of the UV rays, their desire to tan after the session remained as high as it was before the session began.

“They all liked the session where they got the real UV light,” said Dr. Adinoff. “There was some way people were able to tell when they were getting the real UV light and when they were not.”

Dr. Adinoff said the research suggests that some people appear addicted to tanning, a finding bolstered by the fact that many longtime tanners have a difficult time stopping or even just cutting back on tanning sessions. He said the research was inspired by a colleague, based on her experiences with dermatology patients.

“She approached me because of her concern about young adults who were coming to see her with these beautiful bronze tans,” he said. “And she would cut out skin cancers, and they would immediately go back to tanning.”

The Year in Fitness

2011-12-28T06:42:00.000-08:00

If all the Phys Ed columns published this year have a single message, it is that now is a fine time to own a body. The diverse exercise-related experiments published in 2011 and covered in this space each week suggest that it’s possible to retain your cognitive powers, muscle mass, running speed and waistline, even as you age, and that a little exercise can go a long way in terms of physiological benefit. Recent, important science even tells us that coffee, chocolate and beer enhance exercise performance, which is fortunate, since I have no plans to give up any of those. As most of us prepare our exercise resolutions for 2012, now seems an ideal time to review the past year in fitness science and the lessons it contained, both encouraging and cautionary.

Perhaps the most inspiring exercise science published in 2011 involved the effects that working out can have on the brain. By studying both lab rodents and people, scientists this year showed that exercise increases cognitive sharpness, even if the amount of exercise is small. In a representative experiment involving mice, which I wrote about in September, scientists at the University of South Carolina found that the equivalent of about 30 minutes of jogging a day changed the animals’ brain cells at a molecular level. After a few months of running, their neurons contained more mitochondria, a cell component that produces energy, than did the neurons of sedentary mice. In effect, their brain cells had become more robust and physically fit, thanks to the jogging.

Similarly, other studies published this year found that even in volunteers who were not distance runners or mice, activity significantly improved cognitive function. One fascinating study of elderly Canadians that I wrote about this summer showed that those who regularly walked around the block, gardened, cleaned the house, cooked or otherwise remained active without formally exercising, scored much better on tests of memory and other mental skills than older people who were almost completely inactive.

This study and the many others now linking activity and improved mental functioning represent “a wake-up call,” Dr. Eric Larson, the vice president of research at Group Health Research Institute in Seattle and author of an editorial that accompanied the study, told me.

“None of us wants to lose our minds,” he said — a sentiment with which I fervently agree — so we “have to find ways to get everybody moving.”

One means might be to direct people to the most popular column I wrote this year, in terms of both the number of page views and the number of comments, about the effect of exercise on aging. In the study highlighted in that column, Dr. Mark Tarnopolsky, a professor of pediatrics at McMaster University in Hamilton, Ontario, took rats bred to age at an accelerated rate and had them start running.

After a few months, by which time the non-running control rats were frail, bald and dying, the runners still had virtually all of their youthful muscle mass, balance, mental acuity and fur and, unlike the sedentary animals, had not developed shrinkage in their hearts, brains or gonads. I have rarely skipped an exercise session since reading that study, and am happy to report that I still have a full head of fur.

Not all of the exercise science this year was quite so encouraging, however. Another column that inspired considerable interest and comments involved several new studies intimating that too much running might – and I would stress the word “might” – produce scarring or other damage in the heart. In one study, M.R.I. scans of a small group of lifelong elite male endurance athletes found signs of scarring in some of the men’s heart muscles.

A separate study of rats that had undergone the equivalent of years of marathon training showed similar signs of scarring within their hearts.

But these results, although certainly provocative, are preliminary and may turn out to be meaningless, as the scientists who conducted the studies acknowledge. There is no evidence that heart muscle scarring, if it occurs, leads to heart problems. And as Dr. Paul Thompson, the chief of cardiology at Hartford Hospital in Connecticut and an expert on sports cardiology, told me, “Too much exercise has not been a big problem in America. Most people just run to stay in shape, and for them, the evidence is quite strong that endurance exercise is good” for the heart.

Just as the evidence is increasingly strong that it is good for your brain, muscles, mitochondria and gonads.

Which is why I plan to continue running — and biking, hiking, walking, gardening and weight training — in 2012, although I may leave the housecleaning to my husband. In reviewing the year in fitness, in fact, what struck me most strongly was that, although this column covers science, it is also sneakily about me. I’m a middle-aged lifelong exerciser with an increasingly leaky memory and sometimes-wavering resolve. I’ve found inspiration and encouragement in the fitness science this year, although I do wish that it could have discovered that typing constitutes a workout. At least fidgeting counts.

Debate Persists on Deadly Flu Made Airborne

2011-12-27T23:55:00.000-08:00

Ron Fouchier led a team that took one of the most dangerous flu viruses ever known and made it even more dangerous.

The young scientist, normally calm and measured, seemed edgy when he stopped by his boss’s office.

“You are not going to believe this one,” he told Ron Fouchier, a virologist at the Erasmus Medical Center in Rotterdam. “I think we have an airborne H5N1 virus.”

The news, delivered one afternoon last July, was chilling. It meant that Dr. Fouchier’s research group had taken one of the most dangerous flu viruses ever known and made it even more dangerous — by tweaking it genetically to make it more contagious.

What shocked the researchers was how easy it had been, Dr. Fouchier said. Just a few mutations was all it took to make the virus go airborne.

The discovery has led advisers to the United States government, which paid for the research, to urge that the details be kept secret and not published in scientific journals to prevent the work from being replicated by terrorists, hostile governments or rogue scientists.

Journal editors are taking the recommendation seriously, even though they normally resist any form of censorship. Scientists, too, usually insist on their freedom to share information, but fears of terrorism have led some to say this information is too dangerous to share.

Some biosecurity experts have even said that no scientist should have been allowed to create such a deadly germ in the first place, and they warn that not just the blueprints but the virus itself could somehow leak or be stolen from the laboratory.

Dr. Fouchier is cooperating with the request to withhold some data, but reluctantly. He thinks other scientists need the information.

The naturally occurring A(H5N1) virus is quite lethal without genetic tinkering. It already causes an exceptionally high death rate in humans, more than 50 percent. But the virus, a type of bird flu, does not often infect people, and when it does, they almost never transmit it to one another.

If, however, that were to change and bird flu were to develop the ability to spread from person to person, scientists fear that it could cause the deadliest flu pandemic in history.

The experiment in Rotterdam transformed the virus into the supergerm of virologists’ nightmares, enabling it to spread from one animal to another through the air. The work was done in ferrets, which catch flu the same way people do and are considered the best model for studying it.

“This research should not have been done,” said Richard H. Ebright, a chemistry professor and bioweapons expert at Rutgers University who has long opposed such research. He warned that germs that could be used as bioweapons had already been unintentionally released hundreds of times from labs in the United States and predicted that the same thing would happen with the new virus.

“It will inevitably escape, and within a decade,” he said, though he added that security measures like restricting possession of the virus to fewer scientists and fewer laboratories would lower the chances of that happening so soon.

But Dr. Fouchier and many public health experts argue that the experiment had to be done.

If scientists can make the virus more transmissible in the lab, then it can also happen in nature, Dr. Fouchier said.

Knowing that the risk is real should drive countries where the virus is circulating in birds to take urgent steps to eradicate it, he said. And knowing which mutations lead to transmissibility should help scientists all over the world who monitor bird flu to recognize if and when a circulating strain starts to develop pandemic potential.

“There are highly respected virologists who thought until a few years ago that H5N1 could never become airborne between mammals,” Dr. Fouchier said. “I wasn’t convinced. To prove these guys wrong, we needed to make a virus that is transmissible.”

Other virologists differ. Dr. W. Ian Lipkin of Columbia University questioned the need for the research and rejected Dr. Fouchier’s contention that making a virus transmissible in the laboratory proves that it can or will happen in nature. But Richard J. Webby, a virologist at the St. Jude Children’s Research Hospital in Memphis, said Dr. Fouchier’s research was useful, with the potential to answer major questions about flu viruses, like what makes them transmissible and how some that appear to infect only animals can suddenly invade humans as well.

“I would certainly love to be able to see that information,” Dr. Webby said, explaining that he has a freezer full of bird flu viruses from all over the world. “If I detect a virus in our activities that has some of these changes, it could change the direction of what we do.”

Some scientists dismiss fears of bioterrorism via influenza, because flu viruses would not make practical weapons: they cannot be targeted, and they would also infect whoever deployed them.

Dr. Fouchier said it would be easier to weaponize other germs. Which ones? He would not answer.

“That should tell you something,” he said. “I won’t tell you what I as a virologist would use, but I would publish this work.”

However, some experts argue that appeals to logic are useless.

“You can’t know who might try to re-create H5N1,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

The A(H5N1) bird flu was first recognized in Hong Kong in 1997, when chickens in poultry markets began dying and 18 people fell ill, 6 of them fatally. Hoping to stamp out the virus, the government in Hong Kong destroyed the country’s entire poultry industry — killing more than a million birds — in just a few days. Buddhist monks and nuns in Hong Kong prayed for the souls of the slaughtered chickens, and world health officials praised Hong Kong for averting a potential pandemic.

But the virus persisted in other parts of Asia, and reached Europe and Africa; that worries scientists, because most bird flus emerge briefly and then vanish. Millions of infected birds have died, and many millions more have been slaughtered. Since 1997, about 600 humans have been infected, and more than half died.

Dr. Donald A. Henderson, a leader in the eradication of smallpox and now a biosecurity expert at the University of Pittsburgh, noted that even the notorious flu pandemic of 1918 killed only 2 percent of patients.

“This is running at 50 percent or more,” Dr. Henderson said. “This would be the ultimate organism as far as destruction of population is concerned.”

Dr. Fouchier was working on AIDS when the first bird flu outbreak occurred. He immediately became fascinated by the new disease and gave up AIDS to study it. He has worked on bird flu for more than a decade.

The medical center in Rotterdam built a special 1,000-square-foot virus lab for this work, a locked-down place where people work in spacesuits in sealed chambers with filtered air and multiple precautions to keep germs in and intruders out and to protect the scientists from infection. Dr. Fouchier said that even more security measures had been added recently because of the publicity about his work.

The Dutch government and the United States Centers for Disease Control and Prevention approved the laboratory, and the National Institutes of Health gave the Erasmus center a seven-year contract for flu research.

Because a government advisory panel has recommended that the full recipe for mutating the bird flu virus not be published, Dr. Fouchier declined to explain much about how it was done.

But he previously described the work at a public meeting, and various publications have reported that the experiment involved creating mutations in the virus and then squirting it into the respiratory tracts of ferrets. When the ferrets got sick, the researchers would collect their nasal secretions and expose other ferrets to the virus. After repetitions of this process, a strain of virus emerged from sick ferrets last summer that could infect animals in nearby cages without being squirted into them — just by traveling through the air.

The published reports say five mutations were all it took to transform the virus. Dr. Fouchier declined to confirm or deny that, and would say only that it took “a handful” of mutations.

Looking back on that day in July with Sander Herfst, the member of his team who told him the virus had gone airborne, Dr. Fouchier said, “We both needed a beer to recover from the shock.”

Then they planned their next step, repeating the experiment to make sure the results were reliable. There was one major obstacle: they had run out of ferrets. They ordered a new shipment from Scandinavia. So they had to wait several weeks to find out whether their discovery was real. Dr. Herfst took a vacation, timed to end the day the ferrets arrived.

They ran the tests again. Once more, A(H5N1) went airborne.

Seeing Terror Risk, U.S. Asks Journals to Cut Flu Study Facts

2011-12-26T09:24:00.000-08:00

National Institute for Biological Standards and Control/Photo Researchers

The A(H5N1) virus largely affects birds and rarely infects people, but it is highly deadly when it does.

For the first time ever, a government advisory board is asking scientific journals not to publish details of certain biomedical experiments, for fear that the information could be used by terrorists to create deadly viruses and touch off epidemics.

In the experiments, conducted in the United States and the Netherlands, scientists created a highly transmissible form of a deadly fluvirus that does not normally spread from person to person. It was an ominous step, because easy transmission can lead the virus to spread all over the world. The work was done in ferrets, which are considered a good model for predicting what flu viruses will do in people.
The virus, A(H5N1), causes bird flu, which rarely infects people but has an extraordinarily high death rate when it does. Since the virus was first detected in 1997, about 600 people have contracted it, and more than half have died. Nearly all have caught it from birds, and most cases have been in Asia. Scientists have watched the virus, worrying that if it developed the ability to spread easily from person to person, it could create one of the deadliest pandemics ever.
A government advisory panel, the National Science Advisory Board for Biosecurity, overseen by the National Institutes of Health, has asked two journals, Science and Nature, to keep certain details out of reports that they intend to publish on the research. The panel said conclusions should be published, but not “experimental details and mutation data that would enable replication of the experiments.”
The panel cannot force the journals to censor their articles, but the editor of Science, Bruce Alberts, said the journal was taking the recommendations seriously and would probably withhold some information — but only if the government creates a system to provide the missing information to legitimate scientists worldwide who need it.
The journals, the panel, researchers and government officials have been grappling with the findings for several months. The Dutch researchers presented their work at a virology conference in Malta in September.
Scientists and journal editors are generally adamant about protecting the free flow of ideas and information, and ready to fight anything that hints at censorship.
“I wouldn’t call this censorship,” Dr. Alberts said. “This is trying to avoid inappropriate censorship. It’s the scientific community trying to step out front and be responsible.”
He said there was legitimate cause for the concern about the researchers’ techniques falling into the wrong hands.
“This finding shows it’s much easier to evolve this virus to an extremely dangerous state where it can be transmitted in aerosols than anybody had recognized,” he said. Transmission by aerosols means the virus can be spread through the air via coughing orsneezing.
Ever since the tightening of security after the terrorist attacks on Sept. 11, 2001, scientists have worried that a scientific development would pit the need for safety against the need to share information. Now, it seems, that day has come.
“It’s a precedent-setting moment, and we need to be careful about the precedent we set,” Dr. Alberts said.
Both studies of the virus — one at the Erasmus Medical Center in Rotterdam, in the Netherlands, and the other at the University of Wisconsin-Madison — were paid for by the National Institutes of Health. The idea behind the research was to try to find out what genetic changes might make the virus easier to transmit. That way, scientists would know how to identify changes in the naturally occurring virus that might be warning signals that it was developing pandemic potential. It was also hoped that the research might lead to better treatments.
Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said the research addressed important public health questions, but added, “I’m sure there will be some people who say these experiments never should have been done.”
Dr. Fauci said staff members at the institutes followed the results of the research and flagged it as something that the biosecurity panel should evaluate.
The lead researcher at the Erasmus center, Ron Fouchier, did not respond to requests for an interview. The center issued a statement saying that researchers there had reservations about the panel’s recommendation, but would observe it.
The Wisconsin researcher, Yoshihiro Kawaoka, was out of the country and “not responding to queries,” according to a spokesman for the university. But the school said its researchers would “respect” the panel’s recommendations.

David R. Franz, a biologist who formerly headed the Army defensive biological lab at Fort Detrick, Md., is on the board and said its decision to intervene, made in the fall, was quite reasonable.

“My concern is that we don’t give amateurs — or terrorists — information that might let them do something that could really cause a lot a harm,” he said in an interview.

“It’s a wake-up call,” Dr. Franz added. “We need to make sure that our best and most responsible scientists have the information they need to prepare us for whatever we might face.”

Amy Patterson, director of the office of biotechnology activities at the National Institutes of Health, in Bethesda, Md., said the recommendations were a first.

“The board in the past has reviewed manuscripts but never before concluded that communications should be restricted in any way,” she said in a telephone interview. “These two bodies of work stress the importance of public health preparedness to monitor this virus.”

Ronald M. Atlas, a microbiologist at the University of Louisville and past president of the American Society for Microbiology, who has advised the federal government on issues of germ terrorism, said the hard part of the recommendations would be creating a way to move forward in the research with a restricted set of responsible scientists.

He said that if researchers had a better understanding of how the virus works, they could develop better ways to treat and prevent illness. “That’s why the research is done,” he said.

The government, Dr. Atlas added, “is going to struggle with how to get the information out to the right people and still have a barrier” to wide sharing and inadvertently aiding a terrorist. “That’s going to be hard.”

Given that some of the information has already been presented openly at scientific meetings, and that articles about it have been sent out to other researchers for review, experts acknowledged that it may not be possible to keep a lid on the potentially dangerous details.

“But I think there will be a culture of responsibility here,” Dr. Fauci said. “At least I hope there will.”

The establishment of the board grew out of widespread fears stemming from the 2001 terrorist attacks on the United States and the ensuing strikes with deadly anthrax germs that killed or sickened 22 Americans.

The Bush administration called for wide controls on biological information that could potentially help terrorists. And the scientific community firmly resisted, arguing that the best defenses came with the open flow of information.

In 2002, Dr. Atlas, then the president-elect of the American Society for Microbiology, objected publicly to “anything that smacked of censorship.”

The federal board was established in 2004 as a compromise and is strictly advisory. It has 25 voting members appointed by the secretary of health and human services, and has 18 ex officio members from other federal agencies.

Federal officials said Tuesday that the board has discussed information controls on only three or four occasions. The first centered on the genetic sequencing of the H1N1 virus that caused the 1918 flu pandemic, in which up to 100 million people died, making it one of the deadliest natural disasters in human history.

“We chose to recommend publication without any modifications,” Dr. Franz, the former head of the Army lab, recalled. “The more our good scientists know about problems, the better prepared they are to fix them.”

This fall, federal officials said, the board wrestled with the content of H5N1 papers to Science and Nature, and in late November contacted the journals about its recommendation to restrict information on the methods that the scientists used to modify the deadly virus.

“The ability of this virus to cross species lines in this manner has not previously been appreciated,” said Dr. Patterson of the National Institutes of Health. “Everyone involved in this matter wants to do the proper thing.”

Metal Hips Failing Fast, Report Says

2011-12-26T09:18:00.000-08:00

A British registry found that the highest failure rates involved the Articular Surface Replacement device, which was recalled.

In a troubling development for people with all-metal artificial hips, a registry that tracks orthopedic implants in Britain reported on Thursday that the failure rate of the devices was increasing.

The National Joint Registry for England and Wales said that an all-metal artificial hip once sold by Johnson & Johnson had failed in an estimated one-third of the patients who had been followed for the longest time. The device was recalled by the company last year.

The British registry also found that the early failure rate of some other “metal-on-metal” hips — ones in which both the ball and the socket components of an artificial joint are made of metal — was significantly higher than for those made from other materials, including a combination of metal and plastic.

While the patients tracked by the British registry are not in the United States, doctors and patients here pay close attention to the registry’s findings because no such body exists in this country, where there is far greater use of artificial hips and knees. Australia also keeps a registry.

There was already heightened concern in the United States about the all-metal hips. In the first six months of this year, the Food and Drug Administration received more reports about problems with the all-metal hips than it had in the previous four years combined, according to an analysis by The New York Times. In May, the F.D.A. took the unusual step of ordering producers of the devices to study how frequently they were failing and to examine the health implications for patients.

While traditional artificial hips typically last 15 years or more before they need to replaced, some of the all-metal models are failing in large numbers of patients within just a few years. Early failure rates for all-metal devices were far higher in women than in men, the British report found.

According to the report, the highest failure rates involved the Johnson & Johnson device, which is known as the Articular Surface Replacement, or the A.S.R. The registry is following about 2,100 patients who received a version of the device that is used as a traditional hip implant. That is also how the A.S.R. was used in this country.

Of those patients in the British group who received the device six years ago, about 29 percent have since had it replaced.

The percentage is slightly lower, about 17 percent, in patients who got the device five years ago, but that number could rise over the next year.

Asked for a comment about the report, Lorie Gawreluk, a spokeswoman for DePuy, the division of Johnson & Johnson that made the device, said in an e-mail that the six-year replacement rate “should be interpreted with caution because it is based on a small number of cases.”

DePuy officials recalled the A.S.R. last year around the time that the previous report of the British registry was released.

Along with a traditional hip model, another version of the device was sold outside this country for use in an alternative hip replacement technique known as “resurfacing.” It was also recalled.

While it is difficult to draw direct comparisons between device failure rates in Britain and in the United States, the new registry findings appear to bode ill for patients here who received an A.S.R. About 40,000 of the 90,000 units sold worldwide were used in this country.

The British data suggests that complaints will continue to grow in the United States in coming years because the A.S.R. was used overseas before its adoption here.

The British data also shows that the failure rate for all-metal devices as a group, even when the A.S.R. is excluded, is accelerating faster than for traditional hip replacements.

Though immediate problems with the hip implants are not life-threatening, some patients have suffered crippling injuries caused by tiny particles of cobalt and chromium that were shed by the metal devices as they wore.

Such debris generation is also believed to be a cause of earlier device failure.

Until a recent sharp decline in their use, all-metal hip implants accounted for nearly one-third of the estimated 250,000 replacements performed in this country each year. According to one estimate, some 500,000 patients in this country have received an all-metal replacement hip.

In the case of devices used for hip resurfacing, which is popular among younger patients, a model known as the Birmingham Hip Resurfacing device had the lowest replacement rate at five years, the registry found.

However, the report noted that further studies needed to be performed to determine whether hip resurfacing conferred true advantages over standard hip replacement.

Health Fears Over Suspect French Breast Implants Spread Abroad

2011-12-26T09:06:00.000-08:00

A breast implant manufactured with substandard silicone by a French company was removed from a patient at a hospital in Nice, France, on Wednesday.

PARIS — Health officials in at least a half-dozen countries are grappling with the intense anxiety of tens of thousands of women who received breast implants that were made in France with substandard silicone — and that have been rupturing at unusually high rates.

It is unclear whether there are health risks posed by the substandard silicone used in the implants, and the French government is expected to decide soon whether to require as many as 30,000 women in France to have their implants removed.

If the government mandates the removals, it will also pay for the procedures, though not for replacements. Regulators will have to weigh whether the known risks associated with removing the implants outweigh the uncertain risks and anxieties associated with leaving them intact.

The British health authorities on Wednesday sought to calm women’s fears, saying that there was no evidence that the suspect implants, which were manufactured by Poly Implant Prothèse, a company known as PIP, had caused cancer. They urged women who had received them to take any concerns to their surgeons, but they also said, “There is currently no evidence to support routine removal” of the implants.

Britain’s surgical associations also tried Wednesday to soothe anxiety. “The message here is not to panic,” said a consultant plastic surgeon, Douglas McGeorge, who spoke for the British Association of Aesthetic Plastic Surgeons.

Silicone implants have had a contentious history, with the United States imposing a 14-year moratorium on their use that ended in 2006, after years of lawsuits contending that they had caused cancer. None of PIP’s implants appear to have been sold in the United States.

The Institute of Medicine and the Food and Drug Administration eventually determined that there was no evidence that silicone implants were harmful.

Concerns over the silicone in the suspect implants began to build last year, when PIP was shut down and prosecutors began investigating the company for possible fraud. The French authorities said the implants had been rupturing at a rate double the industry average, the French media reported.

But the concerns over the company’s implants caught the attention of European health officials after a woman whose implant had ruptured died last month from a rare cancer called anaplastic large-cell lymphoma.

The French media reported that she was the eighth woman with an implant manufactured by the company to have died of cancer, although the statistical significance of that is unclear.

French prosecutors have said that Poly Implant Prothèse substituted a cheap, industrial-grade silicone for medical-grade silicone that is the industry standard. The French authorities have said the substandard product causes inflammation to body tissues when implants are compromised. But so far, they have emphasized, there is no evidence linking it to cancer.

“In case of rupture, you’d have a dangerous quantity of silicone in your body,” said Laurent Lantieri, a plastic surgeon at a hospital near Paris.

Hélène Guillois, 29, a nutrition student who lives in northern France, said she had the company’s devices implanted seven years ago.

“I’m worried, because of the possible damage this could cause,” Ms. Guillois said. “No one is really capable of saying what will be the effects. Maybe we’ll see in 10 years or so. Like all the big French medical scandals.”

Breast implants, which are essentially small silicone rubber bags filled with a material, typically silicone or a saline solution, are used after breast cancer surgery or simply for cosmetic purposes.

More than 1,000 of the estimated 30,000 French women fitted with the devices have experienced ruptures or leakage. Tens of thousands more in other countries have had the company’s devices implanted, because PIP exported 80 percent of its products, many of them to Britain, Spain and Latin America.

More than 40,000 British women are estimated to have received the company’s implants.

The implants were also used in Brazil, Argentina, Chile, Colombia and Venezuela. In Brazil, the National Agency of Sanitary Vigilance prohibited the importation and use of the implants in April 2010, after concerns about their safety emerged in France.

Chile’s Public Health Institute asked the estimated 1,000 or so women thought to have implants from the French company to contact their doctors so the implants could be removed if ruptures occurred. Otherwise, Chilean officials asked women with the implants to undergo annual exams.

Sebastião Guerra, the director of the Brazilian Society of Plastic Surgery, said, “We do not have significant reports of either ruptures or rejections or even cancer associated with those PIP implants, and we don’t know why there is this difference with respect to the French news.”

Prosecutors in Marseille have been investigating the company for possible fraud and reckless endangerment. They say it cut costs over the last decade by using an industrial silicone gel that was not approved for medical use and that cost a fraction of the medical-grade material.

Several hundred thousand of the implants had been manufactured by the time issues were raised early last year about their quality.

Yves Haddad, a lawyer for the company’s founder and chairman, Jean-Claude Mas, said there was no evidence that the product, “even if it was unapproved, is dangerous for health.”

The Marseille prosecutor’s office declined to comment.

Reporting was contributed by Ravi Somaiya from London; Simon Romero from São Paulo, Brazil; Gardiner Harris from Washington; and Lis Moriconi from Rio de Janeiro.

A Medical School More Like Hogwarts

2011-12-26T09:03:00.000-08:00

Students and faculty from Vanderbilt School of Medicine compete in the Spirit Showdown against other colleges for the College Cup, an Olympic-style competition spanning two days in the fall semester. (From left: Jacob Ark, Beau Kelly, Megan Culler, Conrad Myler and Allison Martin.)

It’s been clear for several years now that while aspiring doctors may start medical school as happy and as healthy as their non-doctoring peers, four years later they aren’t.

More than 20 percent end up with depression, more than half suffer from burnout, and in any given year, as many as 11 percent contemplate suicide. All of these statistics, of course, bode poorly for patients. Doctors who are burned out are more likely to make errors and to lose sight of the altruism that led them to go into medicine in the first place.

Fortunately, the subtext of this growing body of data — that there is something toxic about the medical education process — has not been lost on the educators who run this country’s medical schools. Some have hired mental health experts for their institutions, created counseling centers and set up confidential Web sites and hot lines; others have developed elective courses in meditation and mindfulness, switched from letter grades to pass-fail systems and revamped class schedules to foster better work-life balance.

Despite the good intentions, their efforts continue to be stymied by one thing: Students aren’t participating. As one educator recently told me, “I keep seeing the same 10 students at all these events, and I’m not even sure they’re the ones we need to be reaching.”

But one medical school, Vanderbilt, in Nashville, appears to be succeeding, with a Student Wellness Program that includes activities like yoga classes, community service events, healthy cooking classes, forums on nutrition and sleep, and a mentoring program that pairs senior students with newer ones. The key to its success? Empowering and partnering with those who have the most at stake — the medical students themselves.

Aside from an annual daylong retreat and a weekly medical humanities course, “most of the ideas are generated by the students themselves,” said Dr. Scott M. Rodgers, the associate dean of medical student affairs, who started the program with a group of students six years ago and continues to be its guiding force. “We just try to come up with any necessary money.”

One example of this unique collaboration is the program’s college system, which assigns students to one of four “colleges,” each with its own set of faculty advisers. Instituted nearly five years ago and intended simply as an improvement over a traditional but more random advising program, the new system was also set up in a way that allowed Vanderbilt students to introduce innovations.

They ran with it. Drawing on cultural cues that resonated with their peers — in this case the Harry Potter stories — they took an active role in naming the colleges after former medical school deans and imbued each with a particular personality. Completing the picture were artfully designed crests, designated college colors and devised mottos in Latin that range from the more noble (“Primus Inter Pares,” or “First Among Equals”) to the tongue-in-cheek put-down (“Commodum Habitus Es,” or “You Have Just Been Owned”).

As college loyalties began to develop, students organized friendly competitions that promoted healthy habits and community service. These events culminated four years ago in the first College Cup, a now annual weekend affair where pride runs deep. Amid bagpipes and a marching band, colleges vie to outdo one another in events like a 5-K run, an “Iron Chef”-style cooking competition and a trivia contest.

“These programs keep you from putting your whole self-worth on the next exam,” said Kathleen Weber, a first-year student who was also quick to point out the superiority of her own college, Batson.

There are critics, however, who charge that with so much to learn in so little time, medical students — and their future patients — would be better served if they expended more, not less, effort on studies. Others have voiced concern that students end up feeling a “reverse pressure” to choose extracurricular activities over studying.

But proponents are quick to counter that medical students in general aren’t people who must be persuaded to study. What they need is encouragement to balance academic dedication with the self-care that will sustain them in the long run. “You can’t keep running on fumes,” said Dr. Johanna N. Riesel, a former medical student at Vanderbilt now in her second year of surgical training at Massachusetts General Hospital in Boston. “You have to learn how to maintain some sense of equilibrium and sanity in a relatively insane process.”

While no one yet knows the long-term effect of Vanderbilt’s innovations – or, for that matter, of any programs designed to promote “wellness” — Dr. Rodgers and his colleagues and students at Vanderbilt remain committed to their initiatives. For them, the implications of medical student depression and burnout are simply too important to ignore.

“It’s a challenge for anyone to stay healthy and happy,” Dr. Rodgers said. “But when doctors are able to stay healthy and happy, that means patients get physicians who are more compassionate and selfless. They end up with doctors who really have the energy to invest time in them.”

The Haves’ Children Are Healthier Than the Have-Nots’

2011-12-26T08:59:00.000-08:00

Every Monday, Sycamore Valley Elementary in Danville challenges its students to run a “Smile Mile” together after school. Some parents even run with their children. Photos of the student joggers’ grinning faces are posted in the cafeteria. On a recent Monday afternoon, there were 41 smiling faces on the wall.

Students at Sycamore Valley have a lot to be happy about when it comes to their physical fitness. Fifth graders there got the best scores among all of their Bay Area peers on the 2011 statewide Physical Fitness Test.

Eighty-three percent of the fifth graders tested at Sycamore Valley aced the test by receiving healthy scores on all six different measurements — of aerobic capacity, abdominal strength, upper body strength, trunk strength, body composition and flexibility, most of them gauged through physical activity. One part of the Physical Fitness Test measures a child’s body composition, usually through body mass index, which is calculated using weight and height and is used to determine who is overweight.

Statewide, only 31 percent of public school students performed as well, according to the California Department of Education.

An analysis of state data by The Bay Citizen revealed a large variation in how fifth graders in Bay Area elementary schools perform on the test. The schools that performed the best have few students from low-income families, for reasons that experts say are not surprising. At Sycamore Valley Elementary, in an affluent suburban community, not a single student was eligible to receive a free or reduced-price lunch because of low family income last year, according to the state’s data.

Across the Bay, in San Francisco’s Mission district, none of the fifth graders at Cesar Chavez Elementary School received six healthy scores on the test. More than a quarter of them were found to “need improvement” on every measure of fitness.

At Cesar Chavez, where Spanish is the first language for many, more than 85 percent of the students are eligible to receive free or reduced-price school lunches. In the school district that includes Cesar Chavez, Hispanic and black students are less likely to receive healthy scores than their Asian and white peers, the state data show.

Students at Sycamore Elementary have a dedicated “physical education specialist” on campus to help them train for the test. Those at Cesar Chavez do not.

“There is an inequity problem with the availability of quality physical education between schools of varying socioeconomic status,” said Drisha Leggitt, executive director of the California Association for Health, Physical Education, Recreation and Dance, a nonprofit organization.

Robert O’Brien, Sycamore Valley’s physical education specialist, who favors shorts even when the temperature dips into the 40s, is fond of slogans like “exercise, not extra fries.” He leads students as young as 6 in sit-ups, jumping jacks, push-ups and running, striving to get all of them moving, while giving their classroom teachers time to prepare other lessons.

All 21 of the elementary schools in the San Ramon Valley Unified School District, in which Sycamore Valley is located, have a physical education specialist like Mr. O’Brien.

“Having dedicated physical education teachers can make a big difference in students’ performance on the test,” said Linda Hooper, an education, research and evaluation consultant for the California Department of Education.

The San Francisco Unified School District has just 15 physical education specialists for all 76 of its elementary schools. Spread thin, they work with about half the schools at any time. According to Michelle Zapata, the physical education program administrator for the district, Cesar Chavez was among the 38 schools that had no physical education specialist on campus.

Advocates for child health warn that failing to teach children how to be active and healthy will have long-term consequences.

“It comes as no surprise whatsoever that such enormous inequities would be present,” said Dr. Harold Goldstein, executive director of the California Center for Public Health Advocacy, a nonprofit organization. “It is grossly unjust and will have health and economic impacts on the state of California for generations to come.”

Sycamore Valley Elementary maintains a focus on health outside of physical education class time. Parents are not allowed to bring in cupcakes or other potentially fattening treats to celebrate birthdays. Instead, gifts of pencils or erasers to classmates are substituted.

Obesity Rate Falls for New York Schoolchildren

2011-12-26T08:49:00.000-08:00

Schools have been emphasizing salads over high-fat foods. In September, Eric Goldstein, the Education Department's chief executive of School Support Services, showed off a salad bar in the cafeteria of P.S. 20 on the Lower East Side.

3:23 p.m. | Updated The number of obese New York City schoolchildren fell by 5.5 percent over five years, federal and city officials said Thursday, offering a glimmer of optimism about one of the country’s intractable health scourges.

The decline, documented by annual fitness exams given to most of the city’s kindergarten through eighth-grade students, was the biggest reported by any large city. Over all, the rate of obesity dropped in New York City to 207 children per 1,000 in the 2010-11 school year, down from 219 five years earlier, meaning that 20.7 percent were still considered obese.

“This comes after decades of relentless increases,” Dr. Thomas A. Farley, the city’s health commissioner, said Thursday. While the 5.5 percent drop may seem slight, he said, “What’s impressive is the fact that it’s falling at all.”

The results, published Thursday in a report by the federal Centers for Disease Control and Prevention, showed that the declines in obesity were sharply higher among middle-class children than among poor children. They were also higher among white and Asian children compared with black and Hispanic children, and among very young children — those entering kindergarten or first grade — compared with older children.

Still, the drops held up to some extent across all grades, races and economic levels.

“Because of coordinated, sustained action I am happy to say our children are benefiting from our campaign against obesity, which has plagued communities here in New York and across the nation for nearly three decades,” Mayor Michael R. Bloomberg said.

Mr. Bloomberg said the 5.5 percent drop translated into roughly 6,500 fewer obese children in the public schools. He said that an overwhelming majority of parents think their children are fit and at a healthy weight, but that “the facts tell a different story.”

Dr. Farley attributed the progress partly to the city’s aggressive advertising campaign against sugary sodas, which he said may have altered what parents were providing to their children. The city has also tried to add healthier options to school lunch menus, enacted strict rules on the calorie and sugar content of snacks and drinks in school vending machines, and even put limits on bake sales, a move that caused some grumbling.

Buoyed by the results, city officials also announced Thursday that the restrictions on school vending machines were being expanded to machines in all city buildings, and that they were forming a multiagency task force to recommend further initiatives to combat obesity. Dr. Farley also noted that salad bars were now in cafeterias at many schools, including Public School 218, near Yankee Stadium, where the mayor and the commissioner announced the results at a news conference.

Across the country, recent studies have shown childhood obesity rates remaining flat or slightly increasing. Los Angeles County, which has also conducted a campaign against sugary drinks, had a decline of 2.5 percent during the same period, according to a study by the U.C.L.A. Center for Health Policy Research and the California Center for Public Health Advocacy.

The study was cautious in its language, warning, “A causal relationship cannot be inferred between the fitness interventions implemented by New York City in schools and the decrease in prevalence of child obesity described in this report.” But it said the decreases in obesity “might” indicate that changes in the school or home environment were important.

Obesity experts said that given the stubbornness of the problem, even a small reduction in obesity was an affirmation of public health initiatives.

“We’ve seen nothing but bad news for the last 10 years,” said Marlene Schwartz, deputy director of the Rudd Center for Food Policy and Obesity at Yale University. “I feel like that’s finally starting to turn around.” Dr. Schwartz said younger children, who respond better to adult direction, and children in more affluent families, which have the resources to change, were the easiest to reach, so it was not surprising that they improved the most.

Dr. Farley said the fact that obesity had declined more among younger children was not surprising because it is easier to prevent weight gain than to lose weight. The city has trained 4,000 elementary school teachers to provide in-class physical activity breaks, the study said, and has tried to limit video and TV time in child care programs.

The decline in obesity was documented by the city in FitnessGrams, annual physical education tests that are now completed by most of the city’s kindergarten through eighth-grade students.

Adult men and women are considered obese if their body mass index is 30 or higher, but children are calculated differently because of their constant physical changes. A 7-year-old boy, for example, who is 3-foot-9 would be considered obese with a body mass index of 19.4, or a weight of 56 pounds. A 12-year-old girl who is 5-foot-2 is considered obese with an index of 25.2, a weight of 138 pounds.

By age group, the decline was highest among 5- and 6-year-olds, at 9.9 percent. By race, the drop was highest among white children, at 12.5 percent, and Asian children, at 7.6 percent, and lower for Hispanic children, at 3.4 percent, and black children, at 1.9 percent.

Cauliflower and Red Onion Tacos With Cotija Cheese

2011-12-26T08:44:00.000-08:00

1 large or 2 small or medium cauliflowers, broken into florets (about 6 cups)
1 red onion, cut in half lengthwise, then sliced crosswise across the grain
1 to 2 garlic cloves (to taste), minced
1/4 cup chopped cilantro
2 tablespoons capers, drained and rinsed
1/4 cup white wine vinegar or Champagne vinegar (to taste)
3 tablespoons extra virgin olive oil
Salt and freshly ground pepper
1 or 2 chipotle chilies in adobo or pickled jalapeños, drained and thinly sliced (optional)
12 corn tortillas
1 romaine heart, cut crosswise in thin strips (chiffonade)
3 ounces cotija or ranchero cheese

3. Warm the tortillas. Top with the marinated vegetables and a handful of romaine, sprinkle on the cheese and serve.

Yield: 6 servings.