HealthLawProf Blog

Violations Reported at 94% of Nursing Homes

The New York Times reports that federal investigators said, in a report issued on September 29, that more than 90% of nursing homes were cited for violations of federal health and safety standards last year, and for-profit homes were more likely to have problems than other types of nursing homes.  Robert Pear writes,

About 17 percent of nursing homes had deficiencies that caused “actual harm or immediate jeopardy” to patients, said the report, by Daniel R. Levinson, the inspector general of the Department of Health and Human Services.

Problems included infected bedsores, medication mix-ups, poor nutrition, and abuse and neglect of patients.

Inspectors received 37,150 complaints about conditions in nursing homes last year, and they substantiated 39 percent of them, the report said. About one-fifth of the complaints verified by federal and state authorities involved the abuse or neglect of patients.

About two-thirds of nursing homes are owned by for-profit companies, while 27 percent are owned by nonprofit organizations and 6 percent by government entities, the report said.

The inspector general said 94 percent of for-profit nursing homes were cited for deficiencies last year, compared with 88 percent of nonprofit homes and 91 percent of government homes.

“For-profit nursing homes had a higher average number of deficiencies than the other types of nursing homes,” Mr. Levinson said. “In 2007, for-profit nursing homes averaged 7.6 deficiencies per home, while not-for-profit and government homes averaged 5.7 and 6.3, respectively.”

On Monday, Mr. Levinson issued a compliance guide for nursing homes that says some homes “have systematically failed to provide staff in sufficient numbers and with appropriate clinical expertise to serve their residents.”

Researchers have found that people receive better care at homes with a higher ratio of nursing staff members to patients.

The inspector general said he had found some cases in which nursing homes billed Medicare and Medicaid for services that “were not provided, or were so wholly deficient that they amounted to no care at all.”

Bruce A. Yarwood, president of the American Health Care Association, a trade group, said: “We know we have to do a better job. We have been doing a better job, in treating pressure sores, managing pain and reducing the use of physical restraints.”

Mr. Yarwood said that the inspection system was broken. “It does not reliably measure quality,” he said. “It does not create any positive incentives.”

More than 1.5 million people live in the nation’s 15,000 nursing homes. The homes are typically inspected once a year and must meet federal standards as a condition of participating in Medicaid and Medicare, which cover more than two-thirds of their residents, at a cost of more than $75 billion a year.

Deficiency rates varied widely among states. The proportion of nursing homes cited for deficiencies ranged from 76 percent in Rhode Island to 100 percent in Alaska, Idaho, Wyoming and the District of Columbia.

The average number of deficiencies also varied, from 2.5 deficiencies per nursing home in Rhode Island to 13.3 per home in Delaware.

Mr. Yarwood said: “Inspectors are subjective and inconsistent. They interpret federal standards in different ways.”

In December, the Bush administration plans to begin using a five-star system to describe the overall quality of care. The best homes will get five stars. The rankings will be published on a federal Web site.

Medicare pays a fixed daily amount for each nursing home resident, with higher payments for patients who are more severely ill. Mr. Levinson said some nursing homes had improperly classified patients or overstated the severity of their illnesses so the homes could claim larger Medicare payments.

Tuskegee, a Cloud Over Clinical Research

The Washington Post reports that today, minority patients are underrepresented in clinical trials. African American, Latino and Asian populations account for about one-third of all Americans, but less than one-tenth of U.S. clinical trial participants come from these groups.  Ken Getz and Doug Peddicord write,

As vice president for community and external affairs at the University of Chicago Hospitals, Michelle Obama has driven real change in relations between the institution and the mostly black neighborhoods surrounding it, working to lessen the distance between the hospital system and African American patients, neighbors and local businesses.

But when university researchers proposed enrolling local girls in a clinical trial testing the HPV (human papillomavirus) vaccine, which can prevent cervical cancer, Obama stopped the project. According to the New York Times, "The prospect of white doctors performing a trial with black teenage girls summoned the specter of the Tuskegee syphilis experiment of the mid-20th century, when white doctors let hundreds of black men go untreated to study the disease."

The legacy of Tuskegee is etched on the landscape of clinical research. In 1932, U.S. Public Health Service doctors enticed 399 poor black men into a study whose aim was to observe the natural progression of untreated syphilis. At the time, most treatments for syphilis were ineffective and dangerous. But by the late 1940s penicillin had become the standard treatment for syphilis -- yet the study, inexcusably, continued until 1972. Twenty-five years later, President Clinton publicly apologized to the eight surviving participants of the shocking and unethical study, saying, "What the United States government did was shameful."

Acknowledging the fact that Tuskegee remains a touchstone of African American mistrust of the medical system is essential. Yet, as Democratic presidential candidate Barack Obama has suggested about other aspects of relations between Americans of all colors, it also deserves "a serious and thoughtful conversation."

Today, African Americans have one of the highest rates of high blood pressure in the world; they are twice as likely to have diabetes than are whites; they have the highest asthma rate of any racial or ethnic group; they have the highest mortality rate for all cancers combined; and the black population is the most likely to be afflicted with sickle-cell anemia.

There is a desperate need to develop new medicines for diseases that disproportionately affect African Americans, and there is a growing body of evidence that minority and ethnic populations respond differently to certain medications. In fact, in 2005 the Food and Drug Administration for the first time approved a drug specifically intended for use by African Americans with congestive heart failure, who responded less effectively to available medicines.

Today minority patients are underrepresented in clinical trials. African American, Latino and Asian populations account for about one-third of all Americans, but less than one-tenth of U.S. clinical trial participants come from these groups.

Why?

In large measure, it's because too few minority physicians participate in clinical research. Black and Latino physicians are more likely to treat patients of similar race and ethnicity, and there is considerable evidence that a physician's race is an important factor in influencing patient participation in a clinical trial.

The first step in addressing the underrepresentation of black Americans in research, then, is to recruit more minority physicians into clinical research. Government agencies and research companies must proactively reach out to physicians practicing in minority communities and reduce the barriers of time, money and training that make it difficult to incorporate clinical research into the general practice of medicine.

It's important, too, to reach out directly to African Americans and to demonstrate that participation in high-quality, ethical clinical research is in the best interest of their community. And here the news may be better than expected; a review of recent clinical research studies showed that younger African Americans are as willing to take part in clinical research as are non-African Americans, and the legacy of Tuskegee was not cited as a major deterrent to enrolling in a study.

Without clinical study participants of all races and ethnicities, promising new drugs cannot be fully evaluated for safety and effectiveness. It is time for the clinical research community and the public together to move beyond the inexcusable history of Tuskegee.

All our communities -- black and white, Latino and Asian -- need new treatments for cancer, heart disease, Alzheimer's, HIV, obesity and high blood pressure.

We should encourage our family, friends and neighbors to "give back" to the community by taking part in clinical trials where appropriate. And when young women of any race are willing to be part of a study for a vaccine against cervical cancer, they should be saluted as medical heroes in the fight against diseases that affect us all.

Infant Formula: FDA Says What's Sold Legally in the U.S. is Safe

The Los Angeles Times reports on the FDA's assurance that infant formula is safe as the tainted products that sickened Chinese babies aren't allowed in the US, where formula-making is tightly regulated.  Jill Adams writes,

Babies in China are obviously at risk from tainted infant formula. More than 54,000 children in that nation have been sickened and at least four have died in recent weeks after drinking contaminated milk products. But despite recent contamination of other Chinese products consumed by Americans, the threat from such products to children and infants in the U.S. appears minimal.

The Chinese formula in question is contaminated with melamine, a chemical powder high in nitrogen that is used in making fertilizers and durable plastics, including the unbreakable dinnerware known as melamine. The investigation in China is ongoing, but evidence suggests that melamine was deliberately added to boost, in lab tests, the apparent protein content of milk products used to make formula. The compound can cause kidney failure if ingested in large quantities.

Last week, more contaminated products turned up beyond mainland China, in Hong Kong and Macau, creating concern about how far afield contaminated goods might have traveled. The International Food Safety Authorities Network, an arm of the World Health Organization, is working to track the export of suspect products and to inform recipient countries.

Americans who rely on U.S.-made formula have little to worry about. Although pet food and toothpaste made in China and sold to Americans have been found to be contaminated, the formula bought by American consumers is more tightly regulated by the U.S. Food and Drug Administration than those products.

The FDA issued an advisory earlier this month saying that infant formula sold in the U.S. is safe. The big names, such as Similac and Enfamil, are manufactured here and they have met FDA standards for what goes into them and how they are made. Further, in response to the situation in China, the FDA has examined where formula makers get their ingredients and found none from China, said FDA spokeswoman Judy Leon.

A total of five companies are licensed to sell milk-based formula products in the U.S., and all are U.S.-based. In addition to nutritional content of infant formula, the FDA regulates the manufacturing process and record-keeping by the companies. The FDA also performs annual facilities inspections and product analyses.

That's not to say consumers couldn't get their hands on tainted formula. Federal officials remain concerned about imported formula that has not met FDA regulations. Technically it's illegal to sell Chinese formula in the U.S., but that doesn't mean it can't happen. An investigation turned up a can of Chinese-made infant formula in 2004, but at that time, low protein content was the concern, not contamination.

Search of Asian markets

THIS month the FDA has dispatched investigators to look for foreign-made infant formula in small specialty stores that cater to Asian Americans. "The FDA has a national field force of inspectors. In a situation like this, we also reach out to local and state officials," Leon said. Those officials include inspectors with the Los Angeles County Department of Health Services and the California Department of Public Health.

In Los Angeles County, field inspectors started visiting Asian markets earlier this month. No Chinese infant formula has been found, either on the shelves or in storage, according to Jesus Urrutia, chief of the food and milk program within the health department's Environmental Health Program, who oversaw the investigation for L.A. County. The initial field survey consisted of 15 stores and in all but one of those, shopkeepers were aware of the contamination risk. Now Urrutia has added Chinese infant formula to the list of items to be checked by county environmental health inspectors, who monitor food markets, warehouses and restaurants for sanitation, food-handling procedures and the like. This will effectively expand the search countywide -- food establishments are inspected at least annually -- and keep it going over time.

San Francisco and Los Angeles, along with New York City, were at the top of the list of more than a dozen areas where the FDA urged store-by-store inspections, based on their large Asian populations. More than 1,000 stores across the nation have been canvassed so far and no Chinese-made infant formula has been found, Leon said.

Consumers who buy formula online could also potentially be at risk if they don't stick to U.S. companies.

Leon said her office has been flooded with e-mails and calls from consumers. "We had to let people know, unless it has Chinese writing on it, don't worry about it. If it's Similac [or similar products], you're fine."

In an update of its advisory about melamine contamination, the FDA also cautions against purchasing other products imported from China that may contain milk, such as candies, desserts and beverages.

Melamine has also been found in a frozen yogurt dessert and a canned coffee drink made in China, but so far found only in countries outside the U.S., according to the WHO.

The FDA's Leon advises that if it's made in China and contains dairy products, don't eat it. "That's the safest position that people can take right now. Nobody knows yet how far and wide this will go."

Dairy products can take many forms, including milk protein concentrate, nonfat milk powder, whey powder, lactose powder and casein. "It's not the way we usually think of milk -- as fresh cow's milk. It's derivatives and powders that get reconstituted as a milk product," she said.

The FDA continues to expand its investigation. Not only is the agency warning against Chinese foods that may contain milk, but it's also inspecting bulk shipments of milk derivatives coming into U.S. ports and not only from China -- typically powdered milk products that are used to make other things besides formula, such as baking mixes or coffee creamer. It's an extra precaution and so far, no contamination has been found.

Scientists Report Advance in Stem Cell Alternative

The Washington Post reports that scientists stated, on September 25, that they have overcome a major obstacle to using a promising alternative to embryonic stem cells, bolstering prospects for bypassing the political and ethical tempest that has embroiled hopes for a new generation of medical treatments.  Rob Stein writes,

The researchers said they found a safe way to coax adult cells to regress into an embryonic state, alleviating what had been the most worrisome uncertainty about developing the cells into potential cures.

"We have removed a major roadblock for translating this into a clinical setting," said Konrad Hochedlinger, a Harvard University stem cell researcher whose research was published online yesterday by the journal Science. "I think it's an important advance."

The development is the latest in the rapidly advancing and politically charged field of stem cell research.

"This is a huge step forward -- it could be the breakthrough we've been looking for," said Robert Lanza, a stem cell researcher at Advanced Cell Technology in Worcester, Mass.

Embryonic stem cells are believed capable of becoming any type of cell in the body. Researchers hope to eventually use them to create replacement tissue and body parts tailored to individual patients. But the work has run into moral objections because the cells were originally obtained by destroying early-stage embryos. As a result, President Bush has restricted federal funding for such work.

Scientists last year shook up the scientific and political landscape by discovering how to manipulate the genes of adult cells to convert them into the equivalent of embryonic cells -- entities dubbed "induced pluripotent stem cells," or iPS cells -- which could then be transformed into any type of cell in the body. Subsequent work has found that the cells can alleviate symptoms of Parkinson's disease and sickle cell anemia in mice.

But the first iPS cells were created by ferrying four genes into the DNA of adult cells using retroviruses, which can cause cancer in animals. There was also concern because the viruses integrated their genes into the cells' DNA. In the new work, Hochedlinger and his colleagues used a different type of virus, known as an adenovirus, to carry the same four transformative genes into the DNA of mouse skin and liver cells. The adenovirus does not integrate its genes into a cell's DNA and therefore is believed to be harmless.

"The adenovirus will infect the cells but then will clear themselves from the cells. After a few cell divisions there are no traces of the virus in the cell," Hochedlinger said. "You can't tell the virus was ever there."

As with iPS cells produced using retroviruses, tests showed that the new cells were indistinguishable from embryonic stem cells and could be transformed into any type of tissue, including lung, brain, heart and muscle; unlike the retrovirus-engineered cells, they do not produce cancerous tumors.

"What our experiment shows is you can do this without an integrating virus. You do not need integration of the DNA into the genome to produce iPS cells," Hochedlinger said.

Rudolf Jaenisch, a professor of biology at the Whitehead Institute in Cambridge, Mass., praised the work but noted that the process is 100 times less efficient than using retroviruses.

Continue reading "Scientists Report Advance in Stem Cell Alternative"

Health Insurance Costs to Spike an Average 8 Percent

The Washington Post reports that the Office of Personnel Management announces Thursday, September 25, that health insurance premiums for federal employees will jump almost 8 percent, on average, in 2009, a sharp increase over the 2.9 percent increase this year and the 2.3 percent increase in 2007.  Joe Davidson writes,

Premiums for most workers, however, will climb even more next year -- about 13 percent -- which is the increase for enrollees in the Blue Cross and Blue Shield plans. Sixty percent of federal workers are enrolled in one of the Blue Cross and Blue Shield plans.

"We worked very hard to contain premium costs, and we were more successful with some health plans than with others," said Nancy Kichak, OPM's associate director for strategic human resources policy. The rates, she said, are the lowest possible in keeping with preservation of benefits and stability in the program.

She blamed next year's steep increase on "the cost of services" and previous estimates on health-care costs that were too low. She cited utilization of services, technology and medical inflation as contributing to the increase. "It's important for employees to shop around," Kichak said.

An OPM statement said the agency uses "firm negotiation with the health carriers to keep cost increases as reasonable as possible."

Colleen M. Kelley, president of the National Treasury Employees Union, was not impressed. "It is very discouraging to see average increases of this magnitude," she said, "particularly given the bargaining power OPM should be able to exercise as manager of the nation's largest group health plan."

The OPM wasn't successful in keeping costs down with Blue Cross and Blue Shield, the 800-pound gorilla in the field. Out-of-pocket biweekly premiums for those with the standard option will rise to $70.18 for self-coverage and $164.58 for families. Basic coverage is cheaper: $42.66 for self and $99.91 for families.

Jena Estes, vice president of federal employment programs for the Blue Cross and Blue Shield Association, blamed a relatively slow shift to generic drugs by enrollees as one reason its increases are higher than average.

As a result, she said, Blue Cross and Blue Shield will offer generic incentives, including a small discount for the purchase of generics at pharmacies. Also, those who order generic maintenance drugs by mail will get the first four orders free. If each order is a three-month supply, as is often the case, four free orders would cover the amount needed for one year.

There are 269 health-plan options, although some are limited by region or employee group, covering 8 million federal workers, retirees and dependents. Open season, when employees will be able to change their health insurance selections, runs from Nov. 10 to Dec. 8.

On average, enrollees with family coverage will pay an extra $11.12 out of pocket at each biweekly pay period next year, or $4.83 for those with individual coverage. Those amounts represent about 30 percent of the plan's total cost. The government picks up the remaining 70 percent.

"These premium increases keep eating into the wallets of federal employees. Something has to be done to keep these increases in check," said Richard N. Brown, president of the National Federation of Federal Employees. "It's difficult enough as it is for government agencies to recruit and retain quality workers. This increase is only going to make the problem worse."

One thing many employees will get for their money next year is hearing benefits, including hearing aids, for adults, following the improvement in hearing coverage for children this year.

The dental and vision programs have shown significant growth. Enrollment in dental coverage grew 48 percent this year over last, and the vision program increased 41 percent.

Water Chlorination and 12 Other Lifesaving Innovations That Rarely Get Credit

In an interesting article from US News, a series of innovations is highlighted as revolutionizing health and sanitation for people all over the world.  But although these innovations are largely attributed to successfully improving the quality of living for people, might they also be attributed to creating inadvertant health risks?  Adam Voiland writes,

On Sept. 26, 1908, Jersey City, N.J., made public-health history when it became the first American city to chlorinate its drinking water supply. Had other municipalities not followed suit, the nation's drinking water might still be swirling with life-threatening bacterial and viral pathogens, such as cholera and typhoid. After Jersey City added chlorine to its Boonton Reservoir, deaths caused by waterborne disease plunged. The death rate from typhoid fever, for example, fell by more than 92 percent between 1906 and 1926, city records show. "There's no question that chlorinating our drinking water was one the greatest public-health advances our nation has seen," says Joan Brunkard, a researcher at the Centers for Disease Control and Prevention.

In honor of chlorination's 100th birthday, U.S. News dredged up 12 other innovations that, though often taken for granted, are constantly saving lives. Some, such as flushable toilets, haven't changed a whole lot since they were first introduced, while others, such as medical imaging, seem to evolve faster than fruit flies.

Traffic Lights

Most years, more than 40,000 people are killed in traffic accidents, making driving one of our riskiest daily activities. The number, however, would be far higher without traffic lights, the first of which was installed in 1868 in front of the British House of Commons to control the flow of pedestrians and horse buggies. For a look at the future of traffic, see this U.S. News cover story.

Toilets

Flush toilets protect us from an onslaught of fecal-borne diseases by whisking pathogens away before they can infect us. An Englishman, John Harington, the godson of Queen Elizabeth I, is credited with making the first prototype in 1596. Urban myth maintains that another Englishman, Thomas Crapper, invented the flush toilet. He did not, though Crapper did hold patents to other plumbing products and may have helped publicize flush toilets.

Sterile Surgery

Before an English surgeon by the name of Joseph Lister published a series of cases highlighting the importance of washing his hands, instruments, and bandages with carbolic acid in 1867, most surgeons wouldn't have dreamed of washing their bloodied hands between operations. Even after Lister showed his carbolic acid spray could reduce the mortality rate of major surgery from about 45 to 15 percent, many surgeons were skeptical. Today, fortunately, health professionals acknowledge the importance of using antiseptic agents, but that doesn't mean hospital hygiene problems have been licked: Sixty percent of caregivers still don't wash their hands before touching patients, U.S. News's On Quality blog recently reported.

Canning of Food and Drink

In 1795, with its troops languishing in the field from hunger and scurvy, the French government offered a prize of 12,000 francs to anyone who invented a new method of preserving food. Within 15 years, Nicolas Appert of Paris had done just that. His method involved first cooking food, then sealing it in a glass bottle with a cork, and then dipping the bottle in boiling water—creating what amounted to the first canned or bottled food. Metallic cans, now ubiquitous, recently have come under scrutiny for containing a controversial chemical called bisphenol A in their linings.

Vaccination

Vaccines have saved hundreds of millions of lives—more, arguably, than any other innovation. Edward Jenner helped kicked off the vaccine era by introducing the first one, a vaccine against smallpox, in 1796. Later researchers developed vaccines for a wide range of diseases, from cholera and anthrax to mumps and measles. Recently, however, critics have howled that certain vaccines may increase a child's risk of developing autism, a controversial idea that U.S. News health editor Bernadine Healy weighed in on.

Continue reading "Water Chlorination and 12 Other Lifesaving Innovations That Rarely Get Credit"

F.D.A. Reviewing Deaths in Anemia Drug Study

The New York Times reports that federal health officials, on September 26, said that they were reviewing a higher rate of deaths among patients treated with a Johnson & Johnson anemia drug in a German study of stroke patients.  The New York Times writes,

Sixteen percent of patients who were treated with the drug, Eprex, had died three months after the study began, compared with 9 percent who were given a placebo, the Food and Drug Administration said in a statement.

The study was testing whether Eprex could improve brain function in stroke patients, an unapproved use of the drug.

The 522 patients were given relatively high doses of Eprex for three days or a placebo. Most were not anemic, the drug agency said.

Eprex is known generically as epoetin alfa. Johnson & Johnson also sells epoetin alfa under the name Procrit. Amgen sells a version under the name Epogen.

The blockbuster drugs are part of a class called erythropoiesis-stimulating agents, or ESAs, which are approved for treating patients with kidney disease and cancer.

The safety of ESAs came under scrutiny in recent years after other studies found tumor growth or shorter survival for some patients given high doses.

The drug agency ordered strong new warnings on the medicines in July.

The agency said Friday that it was aware of other trials testing the potential neurological effects of epoetin alfa.

The higher death rate in the German study “suggests the need to closely monitor patients enrolled in other ongoing trials for adverse outcomes and to evaluate whether the potential benefits for enrolled patients outweigh the risks in these trials,” the agency said.

Johnson & Johnson reported last week that early data showed Eprex patients in the German study died more frequently than placebo patients, and said it was doing additional analyses to better understand the findings. The company alerted the drug agency to the findings, a Johnson & Johnson spokesman, Mark Wolfe, said Friday.

The study was initiated by the researcher, Mr. Wolfe said. Johnson & Johnson provided financing and supplies of the drug but was not involved in the trial’s design or conduct, he said.

China’s Milk Scandal Now Seen as Risk in Europe

The New York Times reports that European Union regulators, on September 25, ordered rigorous testing of imports containing at least 15 percent milk powder after concluding that food containing tainted milk powder from China may well be circulating in Europe and putting children at risk.  Elisabeth Rosenthal writes,

The action, announced by the European Food Safety Authority and the European Commission, significantly expands the potential geographic reach of a milk adulteration scandal in China to now include a range of foods sold around the world. The Europeans said cookies, toffees and chocolates were the major concerns.

The World Health Organization and the Unicef also expressed concern on Thursday about the Chinese milk contamination and the implications for other foods. In the United States, some consumer groups called on the Food and Drug Administration to restrict imports of foods that may contain suspected dairy ingredients from China.

In China, milk products contaminated with the industrial chemical melamine have sickened more than 50,000 young children in recent weeks and created a spiraling government scandal.

While it is illegal to import dairy products and baby formula from China into the European Union, European nations can and do import many processed foods containing milk powder as an ingredient that are manufactured outside of Europe. Such products could contain milk powder from China.

In 2007, the European Union imported from China about 19,500 tons of confectionary products, including pastries, cake and cookies, and about 1,250 tons of chocolate and other prepared foods containing cocoa.

“Children who consume both biscuits and chocolate could potentially exceed the T.D.I. by up to more than three times,” the European Food Safety Authority said Thursday, referring to the tolerable daily intake of melamine that the agency regards as safe. Levels above that could result in kidney stones, Ian Palombi, a spokesman for the agency, said in a telephone interview.

In Brussels, the European Commission was trying to assess the extent of the risk. “The problem is with the composite food products, which can be imported, even if they contain milk powder from China,” said Nina Papadoulaki, a spokeswoman for the commission. She said the Commission did not know how many companies sell snacks in Europe that were manufactured in China or included ingredients from China.

She said that member states and food companies in the European Union had been asked to test products for melamine in the past 10 days and so far had not detected a problem, although the testing was continuing.

In the United States, some consumer groups called for stricter regulation as well.

“It is now clear that China has exported dairy products like powdered milk and milk protein products around the globe and we know that some of them came to the United States,” said Wenonah Hauter, executive director of Food and Water Watch. “It is time for the F.D.A. to take this issue seriously and stop the import of dairy products from China until this situation is under control.”

The United States has imported two million pounds of a milk protein called casein this year, along with other powdered milk proteins that are used as ingredients in many processed foods, according to figures from the United States Department of Agriculture. This includes 293,000 pounds that were imported in July. The Food and Drug Administration did not immediately return calls for comment on Thursday.

Melamine is a chemical used in plastic manufacturing that can be added to foods to artificially increase their protein content in testing. Its presence was detected in pet foods originating from China last year.

Even if present in foods in Europe, milk powder contaminated with melamine is not likely to cause the kind of public health disaster that is occurring among Chinese infants. In China, babies drank contaminated milk powder as their sole source of nutrition for weeks if not months, and a handful have died.

Because the harm caused by melamine is related to someone’s weight, it is far less harmful to older children and not likely to be dangerous for adults. Also, for children and adults in Europe, melamine-contaminated milk powder is one small component of a broader diet. The toxic effects of melamine are cumulative, creating kidney stones that can in severe cases lead to kidney failure. Still, children who eat very large quantities of sweets could be at risk.

This week, a number of countries and companies that had previously removed Chinese dairy products from supermarket shelves have started removing snack foods containing milk powder as well. On Thursday, members of the Philippine Association of Supermarkets removed Chinese food products with milk ingredients.

In an increasingly globalized food economy, manufacturers use raw ingredients from all over the world, often making it difficult to track the origins.

For example, Kraft Foods, the maker of Oreo cookies, recently moved one of its large cookie factories from Australia to China. But Claire Regan, a spokeswoman for the company, said that most of the products Kraft made in China were distributed within China, although a limited number were exported. Most do not contain milk products from China, she said, and, when they do, the levels of such ingredients are very low. The Oreo product line does not contain milk ingredients from China, Ms. Regan said.

Goal of CDC Vaccine Program Sets Record: 86% of Americans Told to Get Flu Shot

The Washington Post reports that the CDC is targeting 86% of the population for flu vaccination, a record setting number of people, with a similar record breaking number of flu vaccines made available this fall.  David Brown writes,

A record-setting amount of influenza vaccine is available this fall for a record-setting number of people being advised to get it.

That was the message yesterday from officials at the Centers for Disease Control and Prevention and several private organizations, who convened in Washington to urge Americans to get flu shots.

The number of people targeted for flu vaccination has grown steadily in recent years and now constitutes 86 percent of the population.

For the first time, the federal government is recommending this year that children 5 to 18 years old get vaccinated, along with the previously targeted group of 6 months to 5 years. That will add about 30 million children to the number advised to get the shots.

CDC recommends that children ages 6 months to 8 years get two flu shots a month apart, because a single shot may not be enough to fully protect them.

Over the last decade, flu seasons have been marred sporadically by shortages or excesses of vaccine and, in the case of last year, relatively poor protection against the strains of influenza causing illness.

None of those problems is anticipated this year, said Julie Louise Gerberding, CDC's director.

"I have a smile on my face this year because we are looking at a wonderful supply of flu vaccine," she said at news conference at the National Press Club.

Manufacturers will make about 145 million doses. While the number of people targeted is substantially higher -- 261 million -- not everyone will choose to or be able to get vaccinated.

The targeted groups also include pregnant women, people 50 and older; younger adults with chronic illnesses such as diabetes and asthma; health-care workers; people in contact with children younger than 6 months; and people in contact with those who are at high risk of flu's complications, such as those with AIDS.

The vaccine consists of three killed flu viruses -- two from the influenza A family and one from influenza B. The components are dropped and replaced by updated ones each year as influenza viruses circulating the world evolve. This season, all three of the components are new, an unusual event.

Last year, the vaccine was poorly matched to the strains of flu virus in circulation. It was 58 percent effective in preventing infection with influenza A strains and did not protect against infection by influenza B at all. Its overall effectiveness was 44 percent -- about half what it is when the vaccine is well matched to the season's viruses.

Continue reading "Goal of CDC Vaccine Program Sets Record: 86% of Americans Told to Get Flu Shot"

Aid Plan Aims to Help Poor Farmers Reach Markets

The Washington Post reports that The Bill and Melinda Gate Foundation has created the Purchase for Progress Program that will transform rural agriculture in undernourished parts of Africa and Latin America by helping small farmers sell their surplus crops at competitive prices.  Philip Rucker writes,

In an ambitious move to combat the global food crisis, the Bill and Melinda Gates Foundation on Wednesday unveiled an experimental public-private initiative that could transform rural agriculture in undernourished parts of Africa and Latin America by helping small farmers sell their surplus crops at competitive prices.

Rather than only delivering food to hungry nations, this partnership between the world's richest philanthropy and the U.N. World Food Program promises to help build a sustainable farming infrastructure across the developing world.

The Purchase for Progress program will give poor farmers, many of them women with little or no access to commercial markets, a chance to move beyond subsistence living with opportunities to sell their milk, grains, produce and other products to reliable buyers. During a five-year pilot period, it hopes to increase the incomes of 350,000 farmers in 21 countries and give them a path out of poverty.

"This is not your grandmother's food aid," said Josette Sheeran, executive director of the World Food Program. "This is a revolution in food aid, where food aid becomes a productive investment that not only feeds today but produces solutions for tomorrow."

Funded largely by the Gates Foundation, the program is part of the foundation's broader $900 million investment in agricultural development, with many of its efforts made in concert with foreign states and public institutions. The initiative is the latest example of how software giant Bill Gates, who stepped down this summer from Microsoft, is committing his time and fortune to trying to create a results-oriented brand of philanthropy focused on taking risks to achieve lasting impact.

Announcing the Purchase for Progress program here flanked by the presidents of three African nations, Gates said he hopes the effort linking poor farmers to commercial markets will be successful enough that it becomes "self-sustaining," no longer needing private funding.

"It transforms the way that small holders are able to get to market, whether it's helping them with guaranteed purchase, helping them with their storage, understanding crop quality," Gates said. "It will increase the supply of food, and it will increase the well-being of these farmers."

Purchase for Progress is one of several public-private hunger initiatives expected to be announced this week in New York, as world leaders converge at the U.N. General Assembly to draw attention to the Millennium Development Goals, a series of benchmarks aimed at slashing the poverty levels in the world's poorest countries by 2015.

Former president Bill Clinton will announce at his philanthropy conference on Thursday that Yum! Brands, the parent company of such fast-food chains as KFC, Pizza Hut and Taco Bell, is donating $80 million over five years to purchase 200 million meals for school-age children.

This is part of a five-year campaign by the restaurant behemoth to provide hunger relief to the poorest people in the United States and worldwide. The company's 35,000 restaurants in 111 countries are pledging to donate $200 million worth of prepared foods to community soup kitchens and food banks, Yum! Brands chief executive David Novak said.

"We're inspired by the fact that there are so many kids out there who die because they can't eat," Novak said. "It's a huge problem and has only gotten worse, so it's even more timely that we commit."

The company will roll out a marketing campaign Thursday in its restaurants to persuade its customers to donate toward anti-hunger causes, and pop star Mariah Carey is releasing a single with sale proceeds going toward the cause.

Hunger around the world is so chronic, scholars say, that it far outstrips the financial resources committed to fight it. The number of hungry people worldwide has ballooned over the past year to 923 million and threatens to grow further, Sheeran said.

The problem is growing against the backdrop of a food price shock that is roiling world markets and igniting street riots. Over the past three years, world food prices were estimated to have surged by 80 percent, outpacing the 78 percent jump during the Soviet grain emergency of 1972-75.

"There's a need for a much larger international response," said Jeffrey D. Sachs, an economist and founder of the Millennium Promise Alliance, an anti-poverty nonprofit organization. "The Gates Foundation is playing an important role in helping people become aware of this, but in this case no single action is going to be decisive."

The Purchase for Progress program, to be administered by the U.N. World Food Program, is being funded by $66 million from the Gates Foundation, $9.1 million from the Howard G. Buffett Foundation and $750,000 from the Belgian government. Program planners said that if the pilot program is successful, it will be expanded.

The presidents of Rwanda, Tanzania and Uganda and the first lady of Guatemala hailed the initiative as a catalyst to help poor farmers in their countries who are cut off from markets, roads, transportation and storage for their surplus crops.

"This will go a long way in building the capacities of the farmers," said Rwandan President Paul Kagame.

About 1.1 billion people live on $1 a day or less, and more than seven in 10 people around the world depend on work in agriculture for food and income, said Rajiv Shah, agricultural development director of the Gates Foundation.

"In order to help farmers and small farmers in part move out of poverty, you need to help them improve productivity," Shah said. "But you also need to improve access to markets and create the financial and commercial incentives so that farmers are rewarded for their additional efforts."

In a preliminary test of the program last year in Uganda, poor farmers achieved dramatic results, Shah said.

Buffett, an environmentalist and businessman whose father, investor Warren Buffett, has pledged much of his fortune to the Gates Foundation, said the program provides "a critical link" to existing efforts to boost crop production.

"Agriculture development is the most effective way to combat poverty and pull these people in these populations up into a higher level of food security," Buffett said. "It's important to realize that we can all work on the production of the supply side, but without something to pull that through to the market, we'll never be successful in our efforts."