Monday, June 16, 2008

Too much television 'is an asthma risk'

Children who watch more than five hours of television a day are at an increased risk of developing asthma, scientists have found.

Researchers concluded that the danger of them developing the respiratory condition was raised by more than half compared with children who watch just one hour.

This could be attributed to the fact that children who lead a "couch potato" lifestyle sigh much less than their healthier counterparts. Deep inspirations play a significant role in helping lungs to function but sitting for hours leads to shallow breathing.

Dr Giuseppe Corbo, who led the research carried out by the Catholic University, Rome, said: "Prolonged sitting is associated with a decrease in spontaneous sighs, which regulate airways."

The study of 20,000 six and seven-year-olds, published in the medical journal Epidemiology, confirmed a strong link with asthma and obesity, but found that salt was the biggest risk. Those with the highest intake were two and a half times more likely to develop asthma.

Children who played more computer games and watched more television were also found to be less active and had poorer diets.

The British Lung Foundation said: "Obesity, high TV viewing and a high salt diet get children off to a bad start in life."

More than a million children in Britain have asthma.

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Should Government Aircraft Spray Chemicals on Residential Areas?

Note to the government: When you unilaterally send aircraft to spray unfamiliar chemicals over residential areas, the public will get very worried.

Environmental activists will pick through mounds of official documents in an attempt to make sense of what you are doing: Will it affect our health?

Since material safety data sheets can make even the most benign molecules sound terrifically dangerous, vigilant citizens will express their concern about rather innocuous substances -- damaging their credibility with the scientists who should listen to their objections -- and making it hard to sort out any real threats. In some cases, the wording of those documents is so alarming that it could give activists reason to believe that the spraying is part of a mind control program.

Excerpt from

Check this MSDS from Dupont one of the 3 ingredients listed includes "1,2-BENZISOTHIAZOLIN-3-ONE" which is in LBAM-F. See Page 2 under "Potential Health Effects" "SIGNS AND SYMPTOMS EFFECTS OF ACUTE OVEREXPOSURE: High oral doses can cause apathy (lack of feeling or emotion)."

Even if you have the best intentions, to eradicate a tiny moth that could destroy dozens of fruit crops, be prepared to explain your plans, and seek the approval of the public, before getting started with such a controversial program.


Early last year, the California Department of Food and Agriculture became aware that light brown apple moths, Australian pests, had reached twelve counties around the San Francisco Bay Area. Citing studies that the creatures could devastate fruit crops, they launched an aggressive and multifaceted effort to eradicate them.

In addition to spraying the natural pesticide spinosad, covering infested plants in a bacteria that destroys the moth larvae, and releasing wasps that prey upon their eggs, the agency began dropping tiny plastic pellets from low-flying aircraft. Those capsules are infused with two pheromones, chemicals that can confuse the moths and prevent them from mating.

From an academic point of view, the government approach is a textbook case of integrated pest management, which has the best of intentions -- to get rid of the bugs without using the most toxic types of pesticide. But activists regard the unchecked release of chemicals over their homes as a violation of their civil liberties and a potential threat to their health.

"This issue is about our rights," says John Russo of Stop the Spray. "It is our body, and our decision. We have a right to determine what happens to our own bodies."

On Tuesday, the California Senate Agriculture Committee will review a bill that could put a halt to the spraying. Russo and other activists will be there.

Photo: ColorSync / flickr

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Can’t Find The G-Spot? You’re Not Alone: The Science of Sex

As much as I am inspired and impressed by modern medical and scientific advancements—nanotechnology, laparoscopic surgery, and genome sequencing to name a few—I’m also a bit shocked by the fact that we haven’t yet mastered some of the basics. Take human anatomy for instance. Yes, we’ve identified the twenty-six bones of the foot and the ventricles of the brain, but when it comes to deciphering the female urogenital tract, scientists are still at the drawing board. In fact, they have the same questions you might—does the G-spot exist, and if so, where the heck is it? Do women really have a prostate, and if so, can they ejaculate?

The Hotly Debated G-Spot
The G-spot, named after the gynecologist Ernest Gräfenberg, is an alleged erogenous zone located a few centimeters inside the vagina on the anterior wall. Its rise to popularity is usually attributed to the 1982 book, The G Spot and Other Recent Discoveries About Human Sexuality, co-authored by Beverley Whipple, a professor at Rutgers. Though the book describes how to find and stimulate this region, and sent intrepid women to try to locate theirs, it also gave the yet-to-be-classified area an almost mythical status—many have heard of it, and can generally describe what it’s supposed to do, but the majority haven’t actually seen its effects. Currently, there is no recognized part of the female anatomy labeled as the “G-spot.” In fact, researchers debate as to whether it exists at all.

Part of the problem stems from the general lack of research into women’s sexual health, which has hampered the ability to make anatomic generalizations. A review published in the American Journal of Obstetrics and Gynecology in 2001 states “the evidence is far too weak to support the reality of the G-spot” and that “anecdotal observations and case studies based on a small number of subjects are not supported by anatomic and biochemical studies.”

Skeptics of the G-spot also contend there is no neural pathway to signify a physiologic mechanism. A study published in the Journal of Sexual Medicine in 2006 took 101 vagina biopsy samples from twenty-one women and found that although nerves were located regularly throughout the vagina, there is no one location that has more nerve density than others, dispelling the notion of a single erogenous zone inside the vagina.

Recent research, however, indicates variation rather than absence. A study done in 2008 by Emmanuele Jannini and colleagues at the University of L’Aquila in Italy used ultrasound to measure anatomical differences between women who report vaginal orgasms (orgasm due to stimulation of the vaginal walls and not the clitoris) and those who don’t. The researchers scanned the genital area of nine women who reported vaginal orgasms and eleven who didn’t and found that those with orgasms have thicker tissue in the “urethrovaginal space.” The authors conclude that the size of this space is correlated with the ability to have a vaginally-activated orgasm; without evidence of what they call the G-spot, women won’t have this type of orgasm.

However, critics on both sides of the debate question the results of this small study. G-spot detractors contend that this place could just be an extension of the clitoris, which was found in 1998 by Helen O’Connell to be much larger than previously thought—the part we can see externally is really just the tip of the iceberg. Because the clitoris extends all the way into the vagina, perhaps vaginal orgasms occur because they are actually stimulating the part of the clitoris, or the glands, nerves, and tissue surrounding this area.

On the other side of the debate are the G-spot believers who question why the study showed only some women to have G-spots and not all.

Prostate and Ejaculation, for Women?
Part of the confusion regarding the G-spot may also have to do with the unclear characterization of female “ejaculation” and the Skene’s glands. The Skene’s glands are paraurethral glands thought to be homologous to the male prostate, and are sometimes referred to as the female prostate.

Some researchers claim that the Skene’s glands and the G-spot work in conjunction—or perhaps are one in the same. According to the Kinsey Institute, during sexual arousal, the vagina and the Skene’s glands swell so that you can feel them in the interior of the vagina—around the same area that the G spot is supposed to be. For some women, pressure here is pleasurable; for others it is not.

Stimulation of this area in some women can cause the Skene’s glands to produce fluid, like its homologous male counterpart. In men, the prostate produces secretions, which mix with sperm to produce semen. In some women, the Skene’s glands may produce the fluid that is the source of female ejaculate. Although it comes out the urethra, the ejaculate is not urine. Biochemical analysis shows the presence of prostatic acid phosphatase and prostate specific antigen, further indicating the role of a prostate-like structure in women.

However, it is estimated that only about 10 percent of women experience ejaculation, so it is unclear how the glands function—or whether they exist in significant size—in all women. Most think they are a remnant of the embryonic stage, when we had the ability to be either sex. Males went on to have a penis and a prostate, while females developed a clitoris and in some, the Skene’s gland, or female prostate.

Just for Fun
Whether you want to refer to the anterior wall of the vagina as the G-spot, the clitoral urethrovaginal complex, or the female prostate, it is clear that some women derive pleasure from stimulating this area and some don’t. Unfortunately, anatomical differences are often interpreted, by the pharmaceutical industry and others looking to make a buck, as dysfunctions. Already there are G-spot “parties,” where women inject collagen into their vagina supposedly to make this region larger and enhance their sexual function. Drug companies are eager to find a female equivalent of blockbuster drugs like Viagra, and part of marketing a drug means creating the apparent need for it.

While exploring this area might be fun, there’s no need to get hung up on the idea that it isn’t producing explosive orgasms. In fact, studies indicate that 70 to 75 percent of women don’t orgasm through vaginal intercourse. Even those that contend every woman has a G-spot, like Beverly Whipple, aren’t trying to point to it as the crème de la crème of orgasm; rather, it seems they are trying to explain the experiences and physiology of women who do ejaculate and derive pleasure from stimulation in this region.

Long Time Coming
All the anatomical and physiology debate is ultimately good because it means more research into women’s sexual health. Scientists continue to redefine textbooks and hypotheses, trying to figure out the form and function of the female erogenous areas as accurately as possible. What they can agree on so far is that the female genitalia, like her arousal, is certainly more complex and diverse than previously thought.

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Million-Dollar Babies

The cost of care for preemies is sky-high—some 15 times the expense of full-term infants and rising. Is there such a thing as too young?

A baby transporter used to move preemies by helicopter. Cost: $115,000 Chris Crisman

Ryan Cole weighed 1 pound 15 ounces when he was born on May 3, 2005, after just 28 weeks in the womb. He spent his first 70 days in a neonatal intensive care unit, or NICU, kept alive by an array of specialized ventilators, intravenous feeding pumps, and advanced diagnostic gear, as well as round-the-clock attention from the hospital staff. Like many "preemies," or babies born earlier than 37 weeks, Ryan was a handful. Afflicted with two different brain abnormalities, he threw up constantly, and his parents had to care for him amid a tangled nest of wires that snaked out of his crib, helping him breathe and eat.

One evening, a few weeks after he arrived home, Ryan stopped breathing. His parents, Eric and Andrea, came running when his respiratory monitor sounded an alarm. "We went into his room, and he was turning blue," says Eric. He immediately dialed 911, and when the ambulance reached the family's home in Kensington, Md., Andrea hopped in the back with Ryan, and Eric jumped in his car to follow them to Children's National Medical Center in Washington, D.C. At the hospital, doctors hooked Ryan to a machine that helped him breathe and upped his dose of a drug to stimulate lung function. In coming weeks, there would be other life-threatening events, but this time, Ryan was able to return home after one night in the NICU.

Preemies are a quickly expanding class of patients in the U.S., Britain, and other advanced nations. And the costs and technical challenges of caring for them are a growing source of controversy. Nearly 13% of all babies in the U.S. are preemies, a 20% increase since 1990. A 2006 report by the National Academy of Sciences found that the 550,000 preemies born each year in the U.S. run up about $26 billion in annual costs, mostly related to care in NICUs. That represents about half of all the money hospitals spend on newborns. But the number, large as it is, may understate the bill. Norman J. Waitzman, a professor of economics at the University of Utah who worked on the National Academy report, says the study considered just the first five years of the preemies' lives. Factor in the cost of treating all of the possible lifelong disabilities and the years of lost productivity for the caregivers, and the real tab may top $50 billion, Waitzman says.


In the U.S., corporations handle most of the financial burden. Employers generally cover some or all of the hospital charges in their health plans, and they also must deal with lost work hours of staff who spend weeks, sometimes months, attending to their premature infants. Corporations pay out nearly 15 times as much for babies born prematurely in their first year of life as for full-term babies, at an average cost of about $41,000 per child. For the earliest of the preemies, who are born in fewer than 28 weeks and spend up to three months in the hospital, the tab is higher. Says Waitzman: "The million-dollar babies are there."

Ryan was not a million-dollar baby, but he wasn't far from it. The cost for his first two months in the hospital exceeded $400,000, not including certain surgeries and procedures. Because Eric is a technology security expert at the U.S. Energy Dept. and Andrea is an intelligence analyst for a government contractor, the family had good health insurance through the Blue Cross Blue Shield Federal Employee Program. They could also navigate the government bureaucracy and get Ryan qualified for Medicaid, which covered the bills that Blue Cross didn't. To help pay for a nurse, they applied for another state program in Maryland. "We used to play a game: How many bills would we get?" says Eric. "We got up to 12 per day."

A combination of economic factors assures there will be many more couples like the Coles. Hospitals want NICUs because they are profit centers, like cardiac units. Health-care giants such as General Electric (GE) and Abbott Laboratories (ABT) are eager to stock NICUs with devices and drugs. And parents and doctors want to do everything possible for their infants.

Their concerns have already led to action in Congress. In 2006 the U.S. passed a law, the Preemie Act, to increase federal support for research into prematurity. The goal is to reduce rates of infant mortality due to preterm births and to improve care for pregnant women who may be at risk. As part of this legislation, the Surgeon General is hosting the office's first-ever conference on preemie care on June 16 in Rockville, Md.

Health issues are the main focus of the conference, but debates are swirling around the costs and risks of early intervention. Technological breakthroughs are allowing physicians to save babies at younger and younger ages. Births at 28 weeks are now routine, and the outer edge of viability is 22 weeks. In the next three to five years, doctors could push the threshold to as low as 20 weeks, at which age the infants would weigh about 1 pound, measure 10 inches long, and require even more costly and complicated treatments.

Does this relentless push to care for ever younger infants serve the interests of the babies, their parents, or society? Critics of the trend note that about one-third of preemies suffer from severe disabilities such as cerebral palsy, chronic lung disease, and blindness. A 2006 report from the Nuffield Council on Bioethics, an independent British group, recommended that preemies struggling for their lives after 22 weeks of gestation should not be given intensive care.

The Nuffield report ignited a firestorm over the ethics of early interventions and the impact on the children and their families. The ProLife Alliance, an anti-abortion lobby, urged hospitals to lower the viability threshold for preemies to 20 weeks. But that doesn't sit well with many experts in preterm births. In an April, 2008, report in The New England Journal of Medicine, researchers at the National Institute of Child Health & Human Development in Washington concluded that "extending intensive care to the most immature infants would entail considerable suffering, resource use, and cost in order to benefit only a small proportion of infants." Elderly patients who are subjected to painful, drawn-out hospital procedures can urge doctors not to take further drastic measures; preemies who suffer through heroic interventions have no such voice.

The cost calculations are just as controversial, but most health-care economists seem to agree that spending on preemies offers a high rate of return for all but the earliest-stage infants. The reason? The money improves both the quality and length of life, which yields big economic benefits. Between 1960 and 2000, the U.S. infant mortality rate—the rate at which babies less than 1 year of age die—dropped 73%. It fell from 26.0 to 6.9 deaths per 1,000 live births, according to the Centers for Disease Control & Prevention. The staff at Children's National consider this a huge triumph. Billie Lou Short, NICU director at Children's National, says the typical 28-week-old preemie had a 20% rate of survival in the 1980s. Now those infants "have a 90% survival rate and considerably reduced side effects." The percentage of such children with permanent disabilities has dropped to about 15% from as high as 40%, she says. Ciaran S. Phibbs, an associate professor at Stanford University's Health Research & Policy Dept., adds, "NICUs have had a dramatic positive effect."

The money society invests in low-birthweight infants who survive produces a high rate of return, according to Harvard professors David M. Cutler and Ellen Meara. They argue it is much more cost-effective than, say, coronary bypass surgery. Admittedly, it is hard to calculate the value of a life in terms of financial returns. Regardless, "the benefits [of preemie care] are substantially greater than the rise in costs," insists Meara, assistant professor of health-care policy at Harvard Medical School. She also notes that innovations in preemie care, such as ventilator technologies and surgical procedures, can be applied to full-term infants, greatly amplifying their social impact.

Experts can debate the merits and morality of earlier interventions.

Either way, NICUs are likely to flourish because the business proposition is so compelling. When you add up the million-dollar imaging machines, the incubators, the expensive drugs, diagnostics, nutritional products, and physician services, neonatology is a multibillion-dollar market.

For hospitals struggling with cost overruns in other areas, NICUs can be havens of healthy revenue growth and profits. Children's National sets the goal of 4% profit margins overall, but NICU profits can be double that. Last November the hospital unveiled a $75 million tower that features various specialty units to treat heart and brain problems of preemies. Its expansion plans include a second NICU that will open in 2009. It will have 54 beds, boosting Children's total preemie capacity by 25%. All of the rooms will be private and will be equipped with Internet systems that allow neurologists to monitor brain function from their homes.


New technology suffuses every corner of Children's NICU. On a sunny day in late February, the hospital is abuzz, with nurses and doctors scurrying around the floor, hovering over the various cribs and warmers that contain the preemies. Tara Taylor, the hospital's 30-year-old nurse manager, patrols the unit and points to the latest use of ventilators that preemies with underdeveloped lungs depend on. One preemie born at 24 weeks is hooked up to a ventilator and a computer that controls nine intravenous pumps to dole out antibiotics, sedatives, and other drugs.

One of the frontiers in obstetrics involves spotting a likely premature birth before it occurs. Over the past few years many women have begun taking a test that allows their obstetricians to predict with 99% accuracy if they are at risk for having early labor. Produced by Adeza Biomedical, the fetal fibronectin test predicts preterm birth by measuring the presence of a protein found in vaginal fluid. Women who test negative gain peace of mind, while those who test positive may have the option of taking steroids or other drugs that accelerate the fetus' development.

Parents such as Eric and Andrea Cole are often ill prepared for the challenges of caring for preemies in the first few years of life. "When Ryan came out, I don't recall him making any noise," says Eric Cole. "I didn't appreciate the situation until two doctors came in and started talking about survivability." Then came Ryan's breathing crisis. And three weeks later, Ryan let out a strange cry of pain that spooked his parents. They drove him back to the hospital, and doctors rushed him into radiology, where X-rays revealed air bubbles trapped in his intestine. Ryan had necrotizing enterocolitis, an intestinal disease that can cause destruction of the bowel. It is common in preemies, many of whom have underdeveloped digestive systems. Babies who aren't treated quickly can die from malnutrition or infection. The doctors saved Ryan by draining the air and fluid through a tube down his nose. It took him six weeks to heal.

In the course of these procedures, Eric and Andrea learned more than they ever wanted to know about ultrasound, CT scanners, MRI machines, and emergency surgeries of all sorts. By the spring of 2006, Ryan Cole was suffering the frightening effects of one of his birth defects, hydrocephalus. Fluid was accumulating under his skull, pushing the bone outward and putting pressure on his brain. Doctors inserted a shunt to drain fluid from the brain into the abdomen, but it failed within 48 hours, requiring more brain scans and a second operation. As he recovered from this operation, Ryan was struck with a new affliction. It began with a twitch, but in a matter of hours, the entire left side of his body was paralyzed. For the fourth time in less than a month, the Coles packed their child, drooling and vomiting, into their car and took him to the ER. Ryan was having seizures, which doctors eventually quelled with prescription drugs.

Eric and Andrea don't question whether the high emotional and financial costs of keeping Ryan alive were worth it. They hope the care Ryan receives at Children's National will one day allow him to lead a normal life. Developmentally, Ryan still lags his peer group. He uses sign language to communicate. But every day he's talking more, adding phrases. "His new word is doo-doo,'" says Eric proudly.

The Coles have started a foundation to help raise awareness and funding for one of Ryan's handicaps, a brain disorder called Dandy-Walker syndrome. In May, President George W. Bush honored Eric by making him a member of the President's Committee on People with Intellectual Disabilities. This June the Coles hope to take Ryan off of his seizure medication and remove the feeding tube from his stomach. And in the fall, Ryan will enter a special-education preschool. These days, "the challenge is to keep Ryan from running through the living room and jumping," says Eric. "I'm not so naive as to believe he is doing what his peers are doing. But I believe he will catch up. He can achieve any milestones and surpass them."

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Bill could bring relief

— Richard Williams smokes marijuana regularly.

But he doesn’t consider himself a criminal, and doesn’t think he should be treated like one.

The 46-year-old Richmondville resident has been HIV positive for two decades. Smoking marijuana, he said, relieves the pain in his joints and helps him cope with persistent bouts of nausea. He has hepatitis C and a damaged liver, so he doesn’t want to take pain medication, which is processed by the liver.

Williams supports legalizing the use of medical marijuana in New York. He’s hoping the state Legislature will pass a law that does so before adjourning later this month.

“I don’t use other drugs,” Williams said. “I’m not a drug addict. … I’m speaking out because someone has to stand up for what’s right.”

Last year the Assembly passed a bill that would legalize medical marijuana; a new version of the bill has moved out of the codes committee, and another version is pending in the Senate. Those who support the bill are optimistic that this is the year New York legalizes medical marijuana.

The Assembly bill, sponsored by Rep. Richard Gottfried, D-Manhattan, would allow patients to use marijuana only if they have life-threatening or debilitating conditions, and only if their doctors believe it would be the most effective treatment. Patients and caregivers would register with the state and receive identification cards that would allow them to legally purchase marijuana for medicinal use. They would be allowed to grow up to 12 plants and to possess up to 2.5 ounces of marijuana, though a state-regulated distribution system would eventually replace home cultivation. This transition would hinge on the federal government’s approval of the state-regulated distribution system.

Last year, the Assembly passed legislation legalizing medical marijuana for the first time, and this year’s version of the bill attempts to address the concerns that derailed its chances in the Senate. Some legislators felt that last year’s bill did not provide for adequate regulation; the new bill mandates that registered organizations such as pharmacies, nonprofit organizations created for the purposing of selling marijuana to chronically sick people and local health departments handle sale and distribution of the drug.

Twelve states have legalized medical marijuana, with New Mexico, which legalized medical marijuana last summer, the most recent to do.

The Marijuana Policy Project, a Washington, D.C., advocacy group that supports legalizing medical marijuana and overall reform of the country’s marijuana laws, is pushing the state to pass the Assembly legislation. Right now, television advertisements created by the group are running in the Capital Region, Long Island and the Buffalo area.


Burton Aldrich, 45, a quadriplegic from Kingston, appears in the 30-second television advertisement. “I don’t know if I would be around if it wasn’t for marijuana,” he says, in the advertisement. “It shouldn’t be a crime to treat pain and suffering.”

Aldrich became a quadriplegic in 1999, when he crushed his spinal cord in a diving accident. He has limited use of his arms and fingers, can wiggle his toes, and remains confined to a wheelchair. “I’m very fortunate,” he said, in a phone interview. “It could have been worse.” His body is wracked by intense spasms, and he experiences searing pain in his extremities, as well as pounding headaches that disrupt his sleep. He said he can’t take painkillers because they cause constipation. But through marijuana and meditation, he said he’s found a solution.

Aldrich tried marijuana around two years ago, while returning from a sailing trip with a friend. He was in pain, and his friend offered him some marijuana. “My spasms went away,” he said. “My pain went away like a bucket of water dropped on me.”

“I don’t flaunt it,” Aldrich said, of smoking marijuana. “I’m only pushing it because I don’t think it should be illegal. It’s a medicine.”

Williams and Aldrich both said they would rather grow their own marijuana than go to state-regulated distribution centers to acquire their drugs. They said they think the federal government is more likely to raid state-designated distribution centers than individuals growing marijuana for their own use.

The Marijuana Policy Project would like the federal government to legalize the use of medical marijuana. In lieu of that, the group supports efforts to legalize medical marijuana at the state level.

“As long as the federal government is opposed, the states are left to deal with it themselves,” said Dan Bernath, the assistant director of communications for the Marijuana Policy Project. He said the federal government has made it clear that it will not target and raid sick individuals who are using marijuana to reduce symptoms and pain.

“There are sick people in New York who are relying on medical marijuana,” Bernath said. “They’re using it with a doctor’s recommendation, and right now they’re criminals for doing so. Arrest is always on their minds. It’s a real fear. They’re forced to go on the street and deal with drug dealers.” People who grow their own marijuana also risk running into trouble with the law, he said. “One of the maddening things about the illegality of medical marijuana is that its safety and efficacy has been established. … Real people really do need this. It’s just unconscionable to let them suffer when we could be doing something to help them.”

‘best treatment’

Treatments for cancer and HIV are always improving — for instance, the side effects from AIDS drugs are not nearly as debilitating as they once were — but that doesn’t mean there’s no need for medical marijuana, Bernath said. “There’s always going to be a subpopulation that finds medical marijuana to be the best treatment,” he said. “I don’t think anybody sees medical marijuana as a cure for everybody. But there are always going to be some people who will benefit.”

Williams, who has purchased marijuana for himself and friends who are chronically ill, is all too familiar with the risks of buying marijuana. On one excursion to the Bronx, a friend was arrested after buying marijuana for him.

He said marijuana also provides him with mental relief. “There are so many good things it does, and so few bad things,” Williams said. Because he is on disability, he buys marijuana when he can afford to, “not all the time.” He said he’s been living on disability since being forced to retire from his job as a press room supervisor.

“When I was working, marijuana helped me work and deal with the pain,” Williams said. “If I could afford it, and I didn’t have to worry about being busted, I’d probably use it more.”

Bernath said it’s difficult to determine how many New Yorkers would register as users of medical marijuana if it was legalized. In Rhode Island, he noted, fewer than 200 people have registered, but New York is a bigger state.

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Most cancer doctors avoid saying it's the end

Cancer patient Eileen Mulligan, 68, rests in the backyard of her Washington home on Thursday, June 12. She started making a "bucket list" after her doctor told her there were no good options left.
Kevin Wolf / AP

One look at Eileen Mulligan lying soberly on the exam table and Dr. John Marshall knew the time for the Big Talk had arrived.

He began gently. The chemotherapy is not helping. The cancer is advanced. There are no good options left to try. It would be good to look into hospice care.

"At first I was really shocked. But after, I thought it was a really good way of handling a situation like that," said Mulligan, who now is making a "bucket list" — things to do before she dies. Top priority: getting her busy sons to come for a weekend at her Washington, D.C., home.

Many people do not get such straight talk from doctors, who often think they are doing patients a favor by keeping hope alive.

New research shows they are wrong.

Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care.

Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died.

Law requires straight talk
Convinced of such benefits and that patients have a right to know, the California Assembly just passed a bill to require that health care providers give complete answers to dying patients who ask about their options. The bill now goes to the state Senate.

Some doctors' groups are fighting the bill, saying it interferes with medical practice. But at an American Society of Clinical Oncology conference in Chicago earlier this month, where the federally funded study was presented, the society's president said she was upset at its finding that most doctors were not having honest talks.

"That is distressing if it's true. It says we have a lot of homework to do," said Dr. Nancy Davidson, a cancer specialist at Johns Hopkins University in Baltimore.

Doctors mistakenly fear that frank conversations will harm patients, said Barbara Coombs Lee, president of the advocacy group Compassionate Choices.

"Boiled down, it's 'Talking about dying will kill you,'" she said. In reality, "people crave these conversations, because without a full and candid discussion of what they're up against and what their options are, they feel abandoned and forlorn, as though they have to face this alone. No one is willing to talk about it."

The new study is the first to look at what happens to patients if they are or are not asked what kind of care they'd like to receive if they were dying, said lead researcher Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston.

It involved 603 people in Massachusetts, New Hampshire, Connecticut and Texas. All had failed chemotherapy for advanced cancer and had life expectancies of less than a year. They were interviewed at the start of the study and are being followed until their deaths. Records were used to document their care.

Eileen Mulligan, Bob Mulligan
Kevin Wolf / AP
Cancer patient Eileen Mulligan, 68, walks across the living room of her Washington home with the assistance of her husband, Bob Mulligan.

Of the 323 who have died so far, those who had end-of-life talks were three times less likely to spend their final week in intensive care, four times less likely to be on breathing machines, and six times less likely to be resuscitated.

About 7 percent of all patients in the study developed depression. Feeling nervous or worried was no more common among those who had end-of-life talks than those who did not.

That rings true, said Marshall, who is Mulligan's doctor at Georgetown University's Lombardi Comprehensive Cancer Center. Patients often are relieved, and can plan for a "good death" and make decisions, such as do-not-resuscitate orders.

"It's sad, and it's not good news, but you can see the tension begin to fall" as soon as the patient and the family come to grips with a situation they may have suspected but were afraid to bring up, he said.

From an ethics point of view, "it's easy — patients ought to know," said Dr. Anthony Lee Back of the Fred Hutchinson Cancer Center in Seattle. "Talking about prognosis is where the rubber meets the road. It's a make-or-break moment — you earn that trust or you blow it," he told doctors at a training session at the cancer conference on how to break bad news.

People react differently, though, said Dr. James Vredenburgh, a brain tumor specialist at Duke University.

"There are patients who want to talk about death and dying when I first meet them, before I ever treat them. There's other people who never will talk about it," he said.

"Most patients know in their heart" that the situation is grim, "but people have an amazing capacity to deny or just keep fighting. For a majority of patients it's a relief to know and to just be able to talk about it," he said.

Sometimes, talk is hardest for doctor
Sometimes it's doctors who have trouble accepting that the end is near, or think they've failed the patient unless they keep trying to beat the disease, said Dr. Otis Brawley, chief medical officer at the American Cancer Society."I had seven patients die in one week once," Brawley said. "I actually had some personal regrets in some patients where I did not stop treatment and in retrospect, I think I should have."

James Rogers, 67 of Durham, N.C., wants no such regrets. Diagnosed with advanced lung cancer last October, he had only one question for the doctor who recommended treatment.

"I said 'Can you get rid of it?' She said 'no,'" and he decided to simply enjoy his final days with the help of the hospice staff at Duke.

"I like being told what my health condition is. I don't like beating around the bush," he said. "We all have to die. I've had a very good life. Death is not something that was fearful to me."

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Is a raw food diet good for you?

Can our bodies survive the raw food revolution?

Soft cashew chese with sundried tomato, olive & herbs on ac crisp flatbread.

In Los Angeles, raw food is nothing new. The actress Demi Moore allegedly lost 1st five years ago when she started following what is essentially an uncooked vegan regimen. If you exist on uncooked vegetables, seaweed, fruits, nuts, seeds and little else, it is not surprising that excess pounds will fall away.

Its followers also say that switching to raw food makes you feel more energised. This may be true. Losing weight can give you a high, and weeding out sweets, cakes, biscuits, fast food and takeaways will smooth out your blood sugar levels, leaving you more energised throughout the day. However, a raw food regimen is not just another diet, it's a way of life that requires serious commitment to reap the health benefits, and the long-term implications need to be considered carefully.

Replacing nutrients

Cutting out meat, fish, eggs, dairy foods and cereal grains would result in the loss of many nutrients. My advice is first to master a healthy and nutritionally complete vegan diet before progressing to raw food. This means making sure that you get enough protein from nuts, seeds and pulses. For bone-strengthening calcium you need plenty of sesame seeds, almonds, figs and dark green vegetables. Soy beans are also a reasonable source.

For iron you can turn to watercress, spinach, cashew nuts, peanuts, dried figs and prunes. The large amounts of fruit and vegetables eaten mean that you will easily hit your “five a day” target (one portion is about 80g of fruit or veg: an apple or pear, for example, or a couple of tablespoons of veg such as broccoli or cauliflower), so you will be fine for vitamin C and E. For vitamin D, in the UK you need to ensure that you get enough sunlight in summer to build up your body's stores for the winter.

As for micronutrients such as zinc, selenium and vitamin B12, I would take a general, vegan-approved vitamin and mineral supplement, although this is probably frowned on by raw food purists.

Young and old

Susan Price, a spokeswoman for the British Dietetic Association, says that she has concerns over a raw food way of life being suitable for children, the elderly and for pregnant and breast-feeding women. Price, a specialist in gastroenterology, says the high fibre intake could exacerbate IBS.

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