Men Free Blog

Got milk? No? No biggie–just zip to your local supermarket and pick up a carton. Got raw milk? Now that’s trickier. Carol Peterson, an IT manager at Xerox, drives almost two hours each month to her favorite farm in upstate New York for her unpasteurized supply. Susan Mueller, a mother of two in Ithaca, N.Y., bought shares in a dairy farm so she could pick up her raw milk and yogurt at a drop-off point closer to home. And they consider themselves lucky. In Manhattan some raw-milk drinkers hire a mule to bring the white stuff to an agreed-upon location in the city, where they stock up during a strictly enforced two-hour window. “Sometimes I just can’t believe this is all about milk,” says Peterson.Believe it. Since 1987, the Food and Drug Administration (FDA) has required that milk sold and distributed between states for human consumption be pasteurized, meaning it must first be heated to kill off most of the bacteria that might be lurking in the barn or flourishing in the cow. But a growing contingent of natural-food fans is demanding the right to bring milk from teat to table, convinced that pasteurization strips away the very stuff that makes milk so nutritious to begin with. Farmers are more than willing to meet the demand, since raw-milk products–milk, cheese, yogurt and cream–can be sold at a thick premium. But both buyer and seller may be at odds with the law. Though the FDA allows the sale of raw-milk cheese that has been aged for 60 days, it doesn’t permit the sale of raw milk over state lines. Six states allow the sale of raw milk in stores, and 28 let consumers buy the straight stuff only on the farm where it is produced. In the rest, raw milk exists only on the black market.

Why drink raw milk at all? Fans are convinced that heating destroys the good bacteria–the same probiotic critters that retailers now add back into some yogurts–as well as enzymes that can be beneficial to your health. They claim that drinking raw milk can relieve asthma and eczema as well as give flagging immune systems a boost. Mueller started her daughter on raw milk last winter as an experiment. “The previous year, she had bronchitis, an ear infection, a urinary-tract infection and three or four colds,” Mueller says. “This year she missed two days of school all winter.” That’s why Mueller joined the cow-share program, in which members pay quarterly fees of $100 to $200 for the upkeep of the animals and get raw milk in return. As an owner, her family receives its raw milk as dividends. No state or federal authority can prevent you from drinking milk from a cow you own, right?

Not everyone is sold on raw milk. The growing consumption of unpasteurized products has food-safety authorities warning about a potential uptick in the milk-borne illnesses that pasteurization was designed to prevent. Disputes over the safety of raw milk are being waged on websites like Realmilk.com and increasingly in the courts. California food and agriculture officials began battling with farmers last month over a new state law requiring raw milk to meet the same safety standards as pasteurized milk. John Sheehan, director of dairy-food safety at the FDA, has likened drinking raw milk to “playing Russian roulette with your health”; advocates accuse the agency of relying on outdated information and harassing raw-milk producers in order to protect the pasteurizing industry. “The heat from the government against us is just palpable,” says Mark McAfee, founder of Organic Pastures Dairy in Fresno, Calif., which produces and ships raw milk across the country.

So who’s right? The available evidence suggests that without a bug-killing step like pasteurization, even the cleanest dairy with the healthiest cows cannot always expect to produce safe milk. In testimony before Maryland state delegates, the FDA’s Sheehan stressed that raw milk in any form “should not be consumed by anyone, at any time, for any reason.” He cited 45 outbreaks of disease from 1998 to 2005 that were traced to unpasteurized milk or cheese–and pointed to the dangers of exposing the vulnerable immune systems of young children, the elderly and those with immune disorders to the colonies of bugs that can populate untreated dairy. Raw milk makes up less than half of 1% of milk sales in the U.S. but accounts for twice as many disease outbreaks as pasteurized milk.

Farmers like McAfee counter that all raw milk is not created equal. Government surveys, they claim, lump together raw milk that is destined for pasteurization–and therefore doesn’t have to be table-ready–along with milk, like McAfee’s, that is produced for human consumption. But that doesn’t convince Kathryn Boor, chair of food science at Cornell University, who grew up on a farm drinking raw milk–but won’t do it now. “You can’t always tell when a cow is sick,” she says. “And cows can sometimes kick the milking machine off. Generally, what’s on the barn floor is not something I want in a glass.”

So could raw milk ever be made safer to drink? Maybe. It would help to mandate that it meet the same bacteria-count standards as pasteurized milk, as Washington and Maine currently do. But even with regulations, consumers would still be putting a lot of trust in the farmer and the health of the cow. In the end, that may be too much work for a glass of milk.

Women for Women International helps women recover from the ravages of war and gain a voice POWER OF ONE, PAGE 140

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By ELIANE ENGELER, Associated Press Writer

GENEVA - The world still faces a substantial threat of a flu pandemic and countries need to speed up preparations for a global outbreak, health experts said Tuesday.

“We can’t delude ourselves. The threat of a pandemic influenza has not diminished,” said Keiji Fukuda, coordinator for the World Health Organization’s Global Influenza Program.

Fukuda spoke to a meeting of around 150 health experts from governments, WHO and other agencies to update WHO’s pandemic influenza preparedness plan.

Scientists fear that the H5N1 strain of bird flu virus — which began ravaging Asian poultry stocks in late 2003 — could mutate into a form that spreads easily among humans, potentially sparking a pandemic that kills millions. So far, most human cases have been linked to contact with infected birds.

Fukuda said more than 150 countries had some kind of national preparedness plans but some of them were merely a piece of paper acknowledging the risk.

He said it was crucial that all levels of society were involved in the preparations and that everyone knows where to go for information.

“If somebody is sick in the family for example and it’s difficult to get to hospital, they need to know what sort of advice might be available,” Fukuda told The Associated Press.

WHO says 382 people have come down with bird flu since 2003, and that 241 of them have died. Indonesia, with 108 of the deaths, is seen by experts as a potential hotspot for a pandemic.

WHO is updating its 2005 preparedness plan to include progress in research on flu viruses, stronger international cooperation and experience with human cases of bird flu.

“Our understanding of the virus, the effects on people, the epidemiology how viruses move around the world, is much greater than it was a few years ago and this continues,” Fukuda said.

Stockpiles of antivirals have been built since 2005, he said. WHO has stockpiled a total of 5 million antiviral treatment courses ready to be handed out if a pandemic breaks out.

He said the development of a possible pandemic vaccine have made significant strides.

“A few years ago it would not have been possible to talk about pandemic vaccines,” he said. “All of a sudden we have new things to work with.”

Experience and research over the last few years have led experts to believe that it is possible to stop a pandemic influenza right at the beginning of the outbreak, said Fukuda, adding that they recognized it will be difficult.

Fukuda said WHO will take into account the revised International Health Regulations in updating its pandemic preparedness plan, which is expected to be published by the end of the year.

Max Hardiman from WHO’s secretariat for the health regulations said the agreement, which took effect in 2007, should help the world to know about a pandemic outbreak as soon as possible.

The health regulations oblige countries to report new disease threats with global public health significance, such as new flu subtypes. They also allow the WHO to act on credible information sources, rather than being reliant strictly on official government channels.

Hardiman said measures to contain a pandemic should avoid unnecessary travel restrictions.

Under the health regulations countries are putting in place measures to curb the spread of a pandemic, he said. These include assuring access to medical centers, control of airports and other points of entry and preparations to isolate sick people and quarantine contacts.

“One day we will face a pandemic but we don’t know when,” Fukuda said.

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By ANITA CHANG, Associated Press Writer
Wed May 7, 1:35 AM ET
 
BEIJING - China’s drug safety agency accused the United States on Tuesday of blocking Beijing’s inquiry into a blood thinner linked to 81 deaths by refusing to provide details on victims and specifics about production.
 
Two Chinese experts who attended a conference on the drug, heparin, in suburban Washington, D.C., last month said the U.S. determined a contaminant was likely to blame without considering other possible factors.

“We need to resolve this in a scientific matter, not just by blaming a contaminant,” said Jin Shaohong, a member of the drug evaluation committee of China’s Food and Drug Administration. “I think it is too early to say that.”

Besides the deaths, hundreds of patients have suffered severe allergic reactions to large doses of heparin, which is used in dialysis and other treatments.

The U.S. Food and Drug Administration said it suspects the problems stem from a contaminant the agency discovered in supplies of raw heparin coming from China — a compound derived from animal cartilage that so closely mimics heparin that routine tests can’t detect it.

The Chinese experts said U.S. officials and Baxter International refused to give them information to probe the possibility that drug interactions, patients’ medical histories or safety issues after the raw material left China may have played a role.

FDA spokeswoman Karen Riley said Tuesday that she could not recall China asking for medical histories.

“We’ve not received a request from China about patient records,” Riley said.

Li Xuewang, a professor at Peking Union Medical College who attended last month’s conference, said he asked for information such as how many of the patients had medical issues like kidney disease or heart problems and was told it was not available and could take several months to provide.

Federal law prevents the FDA from sharing individual patient information that contains identifying information.

“Some of the level of detail that China is asking for would likely have to be removed to comply with our patient privacy laws,” Riley said.

She added that when adverse events are reported, the patient records involved in those cases will be posted on the FDA’s Web site with the personal detail withheld. She expected detail involving the Heparin cases to be posted in June.

Riley noted that individual case reports did not prompt the heparin investigation in the first place. Rather, it was clusters of reports coming in from providers, lawyers and relatives showing that patients were experiencing similar adverse reactions. A subsequent inquiry identified Baxter’s heparin as the likely cause of the allergic reactions.

Members of the Chinese delegation also visited the Baxter plant in Cherry Hill, N.J., where the finished drug is made, but said they were denied details on how specific batches of the medicine were produced last fall.

Jin said Baxter International told the visitors that samples from the batches had either been taken by the FDA or destroyed.

Officials at Baxter International, the maker of heparin, disagreed.

“We’ve cooperated with all parties involved in the heparin situation and we will seek to understand any concerns to the contrary,” said Erin Gardiner, a company spokeswoman.

She said Baxter had agreed to provide Chinese officials with contaminated heparin samples when they visited the New Jersey plant two weeks ago, but first needed to assure it had samples to spare. That has now been confirmed and samples will be provided, she said.

China has said the contaminant, over-sulfated chondroitin sulfate, may not be responsible because some patients who received the tainted heparin did not get sick. Other patients received doses that did not contain the contaminant but still became ill, officials said.

The investigation into heparin comes as China has been working to improve the safety of its exports after allegations that many of its products — from toys to fish — are shoddy or dangerous.

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BOSTON - A Massachusetts study suggests that restaurant smoking bans may play a big role in persuading teens not to become smokers. Youths who lived in towns with strict bans were 40 percent less likely to become regular smokers than those in communities with no bans or weak ones, the researchers reported in the May issue of the Archives of Pediatrics & Adolescent Medicine.

The findings back up the idea that smoking bans discourage tobacco use in teens by sending the message that smoking is frowned upon in the community, as well as simply by reducing their exposure to smokers in public places, said Dr. Michael Siegel, of Boston University School of Public Health, and the study’s lead author.

“When kids grow up in an environment where they don’t see smoking, they are going to think it’s not socially acceptable,” he said. “If they perceive a lot of other people are smoking, they think it’s the norm.”

Siegel and his colleagues tracked 2,791 children between ages 12 and 17 who lived throughout Massachusetts. There were no statewide restrictions when the study began in 2001 but about 100 cities and towns had enacted a hodgepodge of laws restricting smoking in workplaces, bars or restaurants.

The teens were followed for four years to see how many tried smoking and how many eventually became smokers.

Overall, about 9 percent became smokers — defined as smoking more than 100 cigarettes.

In towns without bans or where smoking was restricted to a designated area, that rate was nearly 10 percent. But in places with tough bans prohibiting smoking in restaurants, just under 8 percent of the teens became smokers.

The study found that having a smoker as a parent or a close friend was a factor in predicting whether children experiment with cigarettes. But strong bans had a bigger influence on whether smoking grew into a habit, reducing their chances of becoming smokers by 40 percent.

“There is really no other smoking intervention program that could cut almost in half the rate of smoking,” Siegel said.

Age was also a factor. Smoking bans had a greater effect on younger teens than on older teens.

The researchers said it’s not clear whether strong bans would have the same effect in other states since local towns adopted their restrictions as part of an aggressive anti-smoking campaign throughout the state.

A statewide workplace smoking ban that included restaurants went into effect in mid-2004. Since then, high school smoking rates in Massachusetts have continued to decline, from about 21 percent of students in 2005 to about 18 percent in 2007.

Many restaurant owners fought the ban, saying it could drive away diners, according to Janine Harrod, director of government affairs for the Massachusetts Restaurant Association, which represents 2,000 restaurant owners.

While some restaurants were hurt initially, the effects have eased over time since the ban applies to everyone, she said.

Bill Phelps, a spokesman for Altria, parent company of cigarette-maker Philip Morris USA, said the study shows that the reasons teens take up smoking are complex.

“There is no single reason why young people engage in risky behaviors like smoking,” he said. “We believe that there should be a multifaceted approach to address youth smoking.”

At least 23 states, the District of Columbia and Puerto Rico require most public places and workplaces, including restaurants and bars, to be smoke free, according to the National Conference of State Legislatures.

Another nine states ban smoking in workplaces but have various exemptions for restaurants or bars.

“We already have more than enough evidence why we should pass these smoke-free laws, but certainly this study should help push them along,” said Danny McGoldick of the Campaign for Tobacco Free Kids.

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By SHAYA TAYEFE MOHAJER, Associated Press Writer
Tue May 6, 9:06 PM ET
 
LOS ANGELES - Rana Parker tells pudgy police they have the right to remain chubby, but it can and will be used against them on the streets of Los Angeles. The dietitian lays down the law for recruits, veterans and top brass, letting them know that eating right can help them do a better job and could even save their lives.
 
“I joke with them that I’m not the food police, that I’m just here to give them information, education and hopefully give them motivation to help themselves,” she said.

While overweight officers aren’t unique to Los Angeles, the police department believes it’s the first to hire a full-time diet coach. Parker joined in July, leaving behind decidedly less macho clients at Head Start, the federal aid program for children.

Faced with a need for more officers in recent years, the LAPD briefly relaxed body fat limits from a maximum of 22 percent for men and 30 percent for women, drawing recruits who mirrored a plumper American public.

By targeting recruits, Parker is trying to instill good eating habits before the rigors of the field make it difficult to find time for balanced meals. She’s provided one-on-one counseling to about 90 recruits, taught a nutrition course to about 500 others and made presentations to more than 400 officers.

Though Parker’s met some resistance to her belt-tightening measures, she’s also found followers.

Recruit Ashley Goodroe has dropped four dress sizes since they started working together in September. Goodroe said the lessons she’s learned include giving up sugary fruit punch and regularly eating breakfast. The hardest part was cutting back on the fat-laden weekly meal that takes her home to Georgia: fried pork chops, collard greens and corn bread.

“I feel skinny,” Goodroe, 23, said with a laugh. “I actually had to get my uniforms fitted again.”

Doughnuts may be the punch line for many cop jokes, but they’re not the problem, Parker said. Long hours and the on-the-go nature of police work make it hard to find time to eat well and stay in shape, she said.

“They may be sitting in their car and all of a sudden they need to go for a sprint, which might end in a fight as well,” Parker said. “They need to be in good shape so their body can handle that kind of stress.”

But officers who don’t plan their meals are reduced to nutritional bottom-feeding: drive-thru burgers, microwave burritos and greasy slices of pizza.

Parker believes officers can better take a bite out of crime if they aren’t hungry on their shifts. She encourages stashing energy bars, fruit and peanut butter sandwiches in squad cars and desks, to stave off hunger when getting a full meal is hard.

Fit officers are more confident, project strength and give the department a good image, she added. A suspect may think twice about trying to outrun a physically fit officer.

Kevin Sommers, national chairman of safety and technology for the Fraternal Order of Police, applauded the LAPD for recognizing diet as an important issue.

“For the longest time in law enforcement we trained our people in policing, but we didn’t teach our people about how to maintain their mental and physical well-being,” he said.

Francisco Rubio Jr., a 30-year-old recruit, said diabetes and high cholesterol run in his family. But it was the recent death of a 40-year-old friend, an officer who had a heart attack on the job, that really drove home the need to get fit.

With Parker’s guidance and a regimen that replaces sweets with fresh oranges and strawberries, Rubio has dropped from 195 to 175 pounds. He vows to be wary of the fatty food that lurks around every corner.

“What catches our eyes unless we discipline ourselves is pizza, hamburgers — all the food that’s out there that’s easy-access,” Rubio said. “Now I tend to look at it as a heart attack waiting to happen.”

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By AUDRA ANG, Associated Press Writer
1 hour, 35 minutes ago
 
BEIJING - China has made it mandatory for health care providers to report all cases of a viral illness that has sickened thousands of young children across the country, as the death toll rose Wednesday to 28.

So far there have been 15,799 cases of hand, foot and mouth disease this year, the official Xinhua News Agency said, cropping up in areas ranging from the tropical island province of Hainan in the south to Jilin province in the northeast and Yunnan province in the southwest.

The number and scope of cases in recent years, along with the need for increased surveillance, prompted the Health Ministry to enforce the new reporting rules, spokesman Mao Qun’an said.

“This demonstrates our commitment to people’s health,” Mao said at a rare news conference held jointly with the World Health Organization.

Under the mandate that took effect Tuesday, health care providers need to report cases to the ministry within 24 hours.

Hand, foot and mouth disease spreads through contact with saliva, feces, fluid secreted from blisters or mucus from the nose and throat. There is no vaccine or specific treatment, but most children affected by the disease typically recover quickly without problems. It is unrelated to the foot and mouth disease that affects livestock.

The rocketing number of cases burgeoning across a large area of China brings up parallels with the Communist leadership’s handling of previous infectious outbreaks, especially that of SARS in 2003.

Government attempts to conceal the emergence of severe acute respiratory syndrome — a new disease at the time — contributed to its spread, ultimately causing 774 deaths worldwide and forcing Beijing to apologize amid international criticism.

Xinhua reported this week that 10 people had been punished for failing to properly tackle hand, foot and mouth in the hard-hit central province of Anhui, where 22 children have died. Mao said they had been “criticized” for how they handled the situation but did not give any details.

The outbreaks are the latest headache for authorities as they gear up for this summer’s Beijing Olympics. Preparations have already been upset by unrest in Tibet and protests during the global torch run.

Mao insisted there would not be any impact on the games, which begin Aug. 8. Already embassies and foreign schools have sent out notices urging vigilance against the disease.

Both Mao and WHO China representative Hans Troedsson said they expected more cases to emerge because of the tighter reporting requirements and because the disease will likely peak with warmer weather in June and July.

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BEIJING - A viral outbreak in China has sickened more than 6,300 people and killed another child, raising the death toll to 26 children, authorities said Monday.
The latest fatality from enterovirus 71 was in coastal Zhejiang province, the provincial Health Ministry said. It said 1,198 other children have been stricken in the province with the virus, also known as EV-71.

It appealed for any sick children “to be sent immediately to health clinics” and for the cases to be reported “immediately to health and education departments.”

An additional 5,151 cases have been reported in neighboring Anhui province, where 22 children have died, according to the official Xinhua News Agency. Most of the cases were near Fuyang, a fast-growing city in the central province’s rural heartland.

Xinhua also reported three deaths in the southern province of Guangdong.

Enterovirus 71 causes a severe form of hand, foot and mouth disease with symptoms including fever, mouth sores and rashes with blisters. It is easily spread by sneezing or coughing. The virus mainly strikes children aged 10 or younger. Some cases lead to paralysis and fatal swelling of the brain.

The illness is not related to foot and mouth disease, which afflicts livestock.

There is no vaccine or specific treatment, but most children affected by mild forms of the disease typically recover quickly without problems.

The World Health Organization says the virus normally peaks in June and July so there could still be an increase in infections as the weather warms.

The outbreak is another headache for China’s Communist government as it prepares to host this summer’s Olympic Games, already tarnished by unrest among Tibetans in western China and an international torch relay disrupted by protests.

WHO’s China representative, Hans Troedsson, said the disease was not a threat to the Beijing Olympics because the disease mostly sickens young children.

China’s Health Ministry has sent teams to Anhui to coordinate treatment of the disease and prevent its spread.

State-run television showed workers spraying disinfectant around houses in rural areas outside Fuyang and medical teams visiting families with small children.
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By TANALEE SMITH, Associated Press Writer
2 hours, 48 minutes ago
SYDNEY, Australia - An Australian doctor proposed Monday that the government pay up to $47,000 for kidney donations to overcome a chronic shortage.
The suggestion touched off debate around the country on the idea, which critics say will end in the poor selling their organs to the rich.

Kidney specialist Gavin Carney said allowing the sale of organs would save thousands of lives and billions of dollars in care for patients on transplant waiting lists. He also said it would stop people from buying organs on the black market in developing countries, where they pursue risky, unregulated surgeries.

Australia has one of the lowest rates of organ donation in the developed world, about 10 donors per 1 million people, according to a federal health task force.

“We’ve tried everything to drum up support for organ donation and the rates have not risen in 10 years,” Carney was quoted as saying in Fairfax newspapers. “People just don’t seem to be willing to give their organs away for free. … Let’s pay people some money for a new car or a house deposit and those waiting lists will be halved within about five years.”

Carney, a professor at the Australian National University, could not immediately be reached by The Associated Press.

Carney’s proposal was immediately criticized by transplant groups, who fear it would exploit poor people.

The idea was dismissed by Health Minister Nicola Roxon, who said Australians would not be allowed to market their organs. “But we do know that we need urgent action in this area of organ donation,” Roxon told Australia Broadcasting Corp. radio.

Rather than paying people for organs, Roxon said her ministry would act on some of the recommendations of a federal task force that recently completed a review of the organ donation system. She did not specify its recommendations.

The task force attributed Australia’s low organ donor rate to a decrease in road accidents and strokes, lack of public awareness, and poor identification of donors in hospitals, among other factors. In comparison, Germany has 15 donors per 1 million people, the Netherlands has 25, the United States 27, and Spain 35, it said.

Selling or buying organs is illegal in Australia, as in most countries, and carries a penalty of six months in jail and a fine of up to $4,130.

More than 1,800 people are waiting for kidney transplants in the country but only 343 kidneys were donated last year, Fairfax reported. Transplant Australia, a national charity and organ support group, said the average wait for a kidney transplant is four years.

The group’s chief executive Chris Thomas said his organization rejects paying for organs and instead is working with the government to change the donation system. He said Carney’s proposal would leave poor people vulnerable.

“It really focuses on the poor and people who are least able to pay for things in society. They get attracted to these types of things,” he told ABC Radio. “We’d reject that.”

Kidney Health Australia also rejected Carney’s proposal, saying it would be open to “many ethical issues and abuse.”

“In my opinion it is inappropriate for the Australian medical system to consider, and is counter to the Australian culture which promises an equitable approach in all things,” KHA medical director Tim Mathew told The Associated Press. “The commercial trade in organs is not something we can support.”

Carney said the suggestion that paid donation would exploit poor people was “a red herring,” telling ABC radio that government regulation of organ commercialization would ensure high ethical standards and medical safeguards.

“I don’t support (illegal trade),” Carney said. “But I also do not agree with the fact that we should let people just rot on dialysis until they have been on dialysis so long they are untransplantable.”

Last week, health officials in the Philippines announced that foreigners will be banned from receiving kidneys for transplant there in an attempt to crack down on a thriving black market in organs sold by poor people.

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By LINDSEY TANNER, AP Medical Writer
1 hour, 2 minutes ago

CHICAGO - Doctors know some patients needing lifesaving care won’t get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.

Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn’t be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.

The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control and Prevention and the Department of Health and Human Services.

The proposed guidelines are designed to be a blueprint for hospitals “so that everybody will be thinking in the same way” when pandemic flu or another widespread health care disaster hits, said Dr. Asha Devereaux. She is a critical care specialist in San Diego and lead writer of the task force report.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way, task force members said.

Their recommendations appear in a report appearing Monday in the May edition of Chest, the medical journal of the American College of Chest Physicians.

“If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing,” the report states.

To prepare, hospitals should designate a triage team with the Godlike task of deciding who will and who won’t get lifesaving care, the task force wrote. Those out of luck are the people at high risk of death and a slim chance of long-term survival. But the recommendations get much more specific, and include:

_People older than 85.

_Those with severe trauma, which could include critical injuries from car crashes and shootings.

_Severely burned patients older than 60.

_Those with severe mental impairment, which could include advanced Alzheimer’s disease.

_Those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes.

Dr. Kevin Yeskey, director of the preparedness and emergency operations office at the Department of Health and Human Services, was on the task force. He said the report would be among many the agency reviews as part of preparedness efforts.

Public health law expert Lawrence Gostin of Georgetown University called the report an important initiative but also “a political minefield and a legal minefield.”

The recommendations would probably violate federal laws against age discrimination and disability discrimination, said Gostin, who was not on the task force.

If followed to a tee, such rules could exclude care for the poorest, most disadvantaged citizens who suffer disproportionately from chronic disease and disability, he said. While health care rationing will be necessary in a mass disaster, “there are some real ethical concerns here.”

James Bentley, a senior vice president at American Hospital Association, said the report will give guidance to hospitals in shaping their own preparedness plans even if they don’t follow all the suggestions.

He said the proposals resemble a battlefield approach in which limited health care resources are reserved for those most likely to survive.

Bentley said it’s not the first time this type of approach has been recommended for a catastrophic pandemic, but that “this is the most detailed one I have seen from a professional group.”

While the notion of rationing health care is unpleasant, the report could help the public understand that it will be necessary, Bentley said.

Devereaux said compiling the list “was emotionally difficult for everyone.”

That’s partly because members believe it’s just a matter of time before such a health care disaster hits, she said.

“You never know,” Devereaux said. “SARS took a lot of folks by surprise. We didn’t even know it existed.”

___

On the Net:

CHEST: http://www.chestjournal.org

U.S. Govt.: http://www.pandemicflu.gov

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By CARLA K. JOHNSON, Associated Press Writer
Mon May 5, 12:16 AM ET
 CHICAGO - Insulin pumps are used by tens of thousands of teenagers worldwide with Type 1 diabetes, but they can be risky and have been linked to injuries and even deaths, a review by federal regulators finds.
Parents should be vigilant in watching their children’s use of the pumps, researchers from the Food and Drug Administration wrote. They didn’t advise against using the devices. But they called for more study to address safety concerns in teens and even younger children who use the popular pumps.

The federal review of use by young people over a decade found 13 deaths and more than 1,500 injuries connected with the pumps. At times, the devices malfunctioned, but other times, teens were careless or took risks, the study authors wrote.

Some teens didn’t know how to use the pumps correctly, dropped them or didn’t take good care of them. There were two possible suicide attempts by teens who gave themselves too much insulin, according to the analysis.

“The FDA takes pediatric deaths seriously,” said the agency’s Dr. Judith Cope, lead author of the analysis. “Parental oversight and involvement are important. Certainly teenagers don’t always consider the consequences.”

The pumps are popular because they allow young people to live more normal lives, giving themselves insulin discreetly in public and getting pizza with friends late at night. And they’re a growing segment of diabetes care, with $1.3 billion in annual sales worldwide, said Kelly Close, a San Francisco-based editor of a patient newsletter. She said 100,000 teenagers may be using them.

The pumps are used for those with Type 1 diabetes, which accounts for about 5 to 10 percent of all diabetes cases and used to be called “juvenile diabetes.” The more common form is Type 2, which is often linked to obesity and more often affects adults.

Type 1 affects an estimated 12 million to 24 million people worldwide and occurs when the body attacks insulin-producing cells in the pancreas. Insulin regulates blood sugar levels, which when too high, can lead to heart disease, blindness and kidney damage.

Insulin pumps are the size of a cell phone and worn on a belt or pocket. They send insulin into the body through a plastic tube with a small tip that inserts under the skin and is taped in place. They cost about $6,000 and supplies run $250 a month. Most health insurers cover much of the cost.

Users must tell the device how much insulin to give before each meal, based on the estimated carbohydrates in the meal. The devices also deliver a continuous low level of insulin.

In the FDA study, appearing in the May issue of the journal Pediatrics, the reports of adverse events and deaths in adolescents using the pumps occurred from 1996-2005.

The FDA requires manufacturers to report injuries that could be linked to medical devices. The authors analyzed reports from patients 12 to 21 years old. They emphasized that the reports aren’t always clear about the cause of death or injury.

The devices provide an alternative to multiple daily injections of insulin by syringe; some come with glucose monitors that reduce the number of times the finger must be pricked to test blood sugar.

While some teenagers want to switch from insulin injections to pump therapy to gain more flexibility in their lives, doctors said device problems such as a blocked tube can lead quickly to dangerous episodes of high blood sugar.

“In a matter of a few hours, all the insulin in the body disappears. Metabolically, the child starts to spiral out of control,” said Dr. John Buse, the American Diabetes Association’s president for medicine and science. Kids need to be aware of the risk, monitor their blood sugar and be ready to give themselves an insulin injection.

Dr. Christina Luedke of Children’s Hospital Boston said she carefully screens teenagers and their families before prescribing a pump. She has refused it for some young patients.

“Without appropriate glucose monitoring, the pumps can increase the risk of getting sick more quickly compared to injections,” Luedke said. However, she said, proper use makes life more bearable and can improve glucose control.

Teenagers also have problems keeping their diabetes under control with multiple daily insulin injections, doctors and manufacturers said.

“It is a constant struggle for a patient who is an adolescent to stay in control of any therapy,” said Steve Sabicer, a spokesman for Minneapolis-based Medtronic Inc., which makes the top-selling insulin pump. The company stands behind the product’s safety and “the many years of clinical evidence that support the benefits of insulin pump therapy,” he said.

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On the Net:

Pediatrics: http://www.aap.org

Report device problems: http://www.fda.gov/medwatch

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