A new line of caffeinated chewing gum is causing jitters among health advocates and prompting federal officials to take a new look at the proliferation of jolt-infused foods, including those marketed to children and teens.

Wrigley on Monday announced the launch of its new Alert Energy Caffeine Gum, which contains 40 milligrams of caffeine per piece – about the same as a half cup of coffee.  “The right energy, right now,” is the product’s slogan, according to the website of the company that is a subsidiary of Mars, Inc. The gum comes in blister packs of eight pieces. 

In response, Food and Drug Administration officials said they would review the cumulative effect of caffeine in an environment in which it’s being added more often to sodas, snacks and other foods.

“FDA is taking a fresh look at the potential impact that the totality of new and easy sources of caffeine may have on the health of children and adolescents, and if necessary, will take appropriate action,” Mike Taylor, the FDA’s deputy commissioner for foods and veterinary medicine, said in a statement.

Wrigley

Wrigley introduced its new Alert Energy Caffeine Gum Monday. Each piece contains 40 milligrams of caffeine, about the same as half a cup of coffee.

The move follows growing concern over caffeine-containing energy drinks, which have been mentioned in connection with at least 25 deaths and 150 illnesses over several years, according to FDA reports. (The filing of a report does not mean that a death or illness was attributed to the product or that the product caused it, however.) 

At the same time, other foods  ranging from caffeine-spiked water to amped-up popcorn have been introduced to a market largely aimed at children and teens, according to the Center for Science in the Public Interest, a health watchdog group.

“Could caffeinated macaroni and cheese or breakfast cereal be next?” CSPI executive director Michael F. Jacobson said in a statement.

One serving of caffeinated foods isn’t likely to hurt anyone, he added. But the concern is that it will become too easy to consume copious amounts of caffeine throughout the day, sometimes unwittingly. CSPI said a vigorous social media campaign indicated the new gum was being marketed to young people. 

On its website, Wrigley says that the gum is aimed at adults looking for an energy boost and that it’s not recommended for children or people sensitive to caffeine. Because the gum is not a dietary supplement, the company will not have to submit any reports of adverse events to the FDA, said agency spokeswoman Shelly Burgess. 

The American Academy of Pediatrics discourages the use of caffeinated energy drinks, saying “they have no place in the diet of children and adolescents,” according to a 2011 paper.

It’s not that caffeine should be “demonized,” said Dr. Steven Abrams, a professor of pediatrics at the Baylor College of Medicine and a member of the AAP’s committee on nutrition.

But too much caffeine from too many sources could cause problems including anxiety, restlessness and sleepnesses in mild cases to rare problems such as rapid heartbeat and seizures in severe cases.

“You’ll get a cumulative effect that’s hard to control,” Abrams said.

Related stories: 

• Monster says its drink didn't kill girl, 14
• When caffeine kills: Energy drinks under the spotlight

Elaine Thompson / AP

Officials in Washington and Colorado are struggling to come up with new health and safety rules to cover new markets after those states legalized recreational marijuana use.

Marijuana may soon become mainstream for adults in Colorado and Washington state, but before it reaches that point, regulators face a tall task: making sure that newly available pot products don’t become a hazard to public health.

Months before legal sales of the drug begin, officials in both states are struggling to come up with health and safety rules to govern a menu of marijuana offerings ranging from leafy greens to food and drinks.

Pot, like other agricultural commodities, could be subject to problems ranging from mold, mites and pesticide residue in the raw plants to solvents, E. coli, salmonella and run-of-the mill food safety risks in prepared products, experts say.

Government agencies such as the Food and Drug Administration won’t weigh in because marijuana remains illegal under federal law. That leaves state officials to come up with a framework for policing production and distribution for an entirely new industry.

“It’s important for us to do it because it’s public safety and there’s no U.S. FDA oversight here,” said Randy Simmons, the Washington State Liquor Control Board project manager in charge of implementing Initiative 502. “Things that would be FDA rules don’t exist.”

Voters in both states legalized recreational marijuana use for adults last fall. Washington is set to issue producer, processor and retail licenses by Dec. 1; Colorado is set to start sales by January. 

As it stands now, laws in both states skirt the public health issues of medical pot production. No quality control tests are required; there’s no mechanism for recalling contaminated pot products. And the framework for new rules remains a work in progress.

“Currently, there’s really nothing codified,” said Julie Postlethwait, spokeswoman for the Colorado Department of Revenue, which will run a new adult marijuana program. Under that state’s existing law, medical marijuana products were explicitly excluded from state rules governing food and drugs.

In Washington state, a burgeoning market for “medibles” -- foods infused with medical marijuana -- has flown almost entirely under any regulatory radar.

Producers like Karen Brower, co-owner of Puff n Stuf products, say they’ve taken it upon themselves to make sure that food safety is a top priority.

“I’m concerned about it, of course, because that’s huge for us,” says the 54-year-old Tacoma woman. “If the health department came into my kitchen, I’m sure that I would pass.”

Marijuana susceptible to mold, pests
Still, there are no tests for Brower or her partner, Julie Guterson, 54, to take, no inspectors to review her stainless steel sinks or to review the sanitizing cycle of her dishwasher. She sees the need for new regulations for the larger recreational pot market, but she’s worried it might create stricter standards that her small operation will be unable to meet.

“We just put our nose to the grindstone and we just keep pumping out medibles for patients,” she said. “That’s what we’re going to do right now.”

John Brecher / NBC News

Julie Guterson sells cannabis-infused foods at the Puff n Stuf booth in one of the two locations of the NW Cannabis Market in Seattle. "I'm working out of my home. We have no pets - we tie our hair back and wear clean shirts."

Some larger producers, however, didn’t wait for government officials to impose health and safety standards. Tripp Keber, chief executive of Dixie Elixirs & Edibles in Denver, says his multiple product lines of pot-infused mints, candies, snacks and sodas already adhere to federal standards for quality.

“Anyone can make a pot brownie, but fewer can make a dozen,” he said. “Even fewer can make 5,000 with the same consistency.”

Keber claims to be the largest tester of medical cannabis in Colorado, sending samples of raw material and finished products to CannLabs Inc., a medical marijuana testing laboratory.

Genifer Murray, the lab’s chief executive, says she conducts tests now for potency and for the presence of solvents, but adds that there’s so much more that could be detected.

“We will offer pesticide and microbial testing,” she said. “A lab previous to mine has found E. coli and salmonella in the flowers.”

Marijuana is susceptible to pests and to mold, which can pose a health hazard. There have been at least two cases of fungal lung diseases linked to consuming moldy marijuana, according to a 2011 report in the Mediterranean Journal of Hematology and Infectious Diseases.

'Someone's going to cut a corner'
Simmons, the Washington state project leader, says that officials there have done the research they need to create a new system for regulation, one that likely will be modeled on existing state Department of Agriculture food safety regulations. Draft rules are scheduled to be issued in mid-May and refined after public comment.

The new standards will have to provide methods not only to detect impurities, but also to confirm the strength of the active ingredients. Plus, they will need to provide rules for reflecting those findings on the labels, experts say.

With testing and quality control in place, the available marijuana may become even more attractive to consumers seeking the assurance of regulation, said Mark Kleiman, a professor of public policy at the University of California, Los Angeles, who is advising Washington about its new law.

“The commercial system will be able to compete with the medical market and the illicit market if it offers not only legality, but a product of known content and an absence of harmful contaminants,” he said.

The prospect of an expanded adult marijuana market also leaves advocates eager for mandatory testing – and new certification for the labs that do it.

“There’s never been a death from cannabis use,” says Murray, “but my worst fear is a death down the road from cannabis contamination.”

That view is shared by Randy Oliver, chief scientist at Analytical 360, a Seattle laboratory that tests marijuana. He’s seen his share of insects, mites and powdery mold on improperly tended marijuana.  

“My feeling is that whoever’s producing it, they’re responsible for making sure that it’s safe for their customers,” he said. “But you know someone’s going to cut a corner.”

Related stories: 

• Marijuana pill may be better for relieving pain
• Does pot really lower IQ? It's not so simple
• Pot may increase stroke risk in younger adults

At least 73 people in 18 states have been sickened with salmonella poisoning after eating cucumbers imported from Mexico, government health officials said Thursday.

The potentially tainted cukes have been removed from the market and the two firms involved -- Daniel Cardenas Izabal and Miracle Greenhouse of Culiacan, Mexico -- were placed on import alert Thursday, according to the Centers for Disease Control and Prevention. The cucumbers were distributed by Tricar Sales Inc. of Rio Rico, Ariz.

Cucumbers from the firms will be denied access to the United States until the suppliers show that they are not contaminated with salmonella, including the salmonella Saintpaul strain detected in the current outbreak.

The biggest concentrations of victims were clustered in Western states, including 28 from California and nine from Arizona. Fourteen people have been hospitalized. Reports show that illnesses occurred between Jan. 12 and April 6, though more could still be detected.

Most people infected with salmonella bacteria develop diarrhea, fever and abdominal cramps within one to three days of eating contaminated food. The illness typically lasts four to seven days, and most people recover without treatment. However, some people may require hospitalization. Most at risk are children younger than 5, older adults and people with weakened immune systems.

Related stories: 

• Food poisoning on rise in U.S., study finds
• The surprising foods that make people sick

A new report on three of the first patients in China to contract a novel strain of bird flu has U.S. officials worried about a grim scenario that includes severe illness with pneumonia, septic shock, brain damage and multi-organ failure.

All three of the patients died, according to a Thursday report by a group of Chinese scientists in the New England Journal of Medicine.

“It is possible that these severely ill patients represent the tip of the iceberg,” wrote Dr. Timothy Uyeki and Dr. Nancy Cox, both of the influenza division at the Centers for Disease Control and Prevention, in a perspective piece accompanying the article.

The reports chronicle the early days of an outbreak of a new influenza A virus, H7N9, which has never before been seen in humans. As of Friday, Chinese officials said it had infected at least 43 people in four Chinese provinces and killed 11 in the past two months.

On Saturday, China's center for disease control confirmed the first case of the new bird flu strain in Beijing: A seven-year-old girl whose parents work in the live poultry trade has been infected.

The patients described in the report included two men, ages 87 and 27, both from Shanghai, and a 35-year-old woman from Anhui. All had preexisting health conditions and two had been exposed to chickens at live poultry markets in the previous week. They became ill between Feb. 18 and March 13 and died between March 4 and April 9 of severe complications, the report said. 

The virus, which has been traced to a reassortment of genes from wild birds in east Asia and chickens in east China, “raises many urgent questions and global public health concerns,” the U.S. researchers wrote.

It’s particularly concerning because the virus clearly has the potential to cause severe disease, it has genetic characteristics that suggest that it might be better adapted than other bird flu strains to infect mammals -- including humans -- and people have no resistance to it, the U.S. scientists reported.

The virus doesn’t make birds sick, so it may spread widely and remain undetected until people become ill.

In addition, previous vaccines developed to fight other H7 strains did not invoke strong immune responses in humans, the U.S. scientists wrote. Even so, researchers at the Centers for Disease Control and Prevention said they received an isolate of the virus from China on Thursday and were continuing to rush efforts to create a vaccine, a process that could take several months.

Scientists are expected to start growing more of the virus to share for use in several ways, including not only developing a vaccine, but also creating a blood test that can detect previous human immune system protection against the virus, and testing to see whether the virus remains susceptible to antiviral drugs.

CDC officials also will use it to create a diagnostic test that could be used to detect infection in travelers who return to the U.S. from China with symptoms of flu, or those who’ve been in contact with someone who’s been sick.

Officials with CDC and the Food and Drug Administration are working to quickly expedite approval and manufacture of the kits, said Mike Shaw, associate director of laboratory science for the CDC's flu division. About 400 diagnostic kits, which each can perform 1,000 tests, may be complete by Monday, he said. They could be shipped as early as next week to public health labs across the country. 

The CDC has urged local public health officials to watch for signs of sick travelers from China. So far, about 10 people who recently traveled from China to the U.S. have been tested for the H7N9 virus because of suspicious symptoms, officials said.

"So far, everyone that has been tested in the U.S. has been negative," Shaw said. 

The virus remains contained to China and there is no evidence of sustained person-to-person transmission, both good signs, scientists said.

But as the U.S. researchers concluded, vigilance remains high.

“We cannot rest our guard,” they wrote.

Related: 

US rushes to make vaccine against new bird flu -- just in case

Don't panic over new bird flu outbreak, CDC cautions

New H7N9 bird flu has officials worried about skimpy resources

This story was originally published on Fri Apr 12, 2013 7:40 AM EDT

Grace Wang

Ethan Remmel with his boys, from left, Miles, then 3, and Seth, then 8, in a family photo. Remmel, a cancer patient, opted to use Washington's Death with Dignity Act.

Ethan Remmel was only 41 when he died on June 13, 2011, barely a year after being diagnosed with terminal colon cancer that quickly spread to his bone.

The Bellingham, Wash., psychology professor and father of two young sons took a lethal dose of crushed prescription sedatives, becoming one of 255 terminally ill people to exercise that option so far under the state’s 2009 Death with Dignity Act.

“One of the things that Ethan kept saying is he didn’t want to deteriorate to the point where he couldn’t interact with his kids,” recalls his partner, Grace Wang, 44.

Now, nearly two years later, the hospital program that aided Remmel is offering an inside look at what it means when a medical center devoted to curing cancer also decides to help people die.

Dr. Elizabeth Trice Loggers, medical director of the Seattle Cancer Care Alliance's Supportive and Palliative Care Service, said the report published in this week’s New England Journal of Medicine is helpful at a time when at least a half dozen U.S. states are considering right-to-die measures.

“There is value in having a structured program and that is why the program is structured the way it is,” she said. “If you look at the way most Americans say they want to die, it is in their home, with their family members present, not in pain, and with their mental faculties intact.”

Washington and Oregon are the only states with voter-approved laws allowing what critics call “assisted suicide” and what proponents call “aid in dying” for terminally ill people with less than six months to live.

Since 1998, 1,050 patients in Oregon have requested lethal medication under the law and 673 have died using it. In Washington, 255 have requested the drugs; 241 have died after ingesting them.

Loggers said she’s fielded recent inquiries from Montana, where state lawmakers have tabled a Death with Dignity bill at the same time a vote is expected this week on a law that would ban physician-assisted death.

The Seattle hospital found that overall, the law was rarely used -- only 2.4 percent of annual deaths at SCCA -- but when it was, it was well-received by all concerned.

“Both patients and families frequently express gratitude after the patient receives the prescription, regardless of whether it is ever filled or ingested,” the report said.

Between 2009 and 2011, 114 SCCA patients inquired about the hospital’s Death with Dignity program, Loggers’ report showed. Of those, 44 didn’t pursue the program, 30 started the process but either died or didn’t complete it, and 40 actually received lethal doses of the prescription sedative secobarbital, the report said.

Of those 40, all died, including 24 who ingested the medication.

That included Ethan Remmel, who chronicled his fight with cancer in “Living While Dying,” a blog published online by Psychology Today.  Remmel, who obtained the drugs months before he died, wrote that simply having access to them helped.

“So I have the medication now,” he wrote, months before his death. “It is safely locked up. I have not decided if or when I will use it, but it gives me great relief to know that I have some control over my dying process.”

Retaining that sense of control was important to nearly all of the SCCA participants, Loggers’ study found.

More than 97 percent of patients cited loss of autonomy as reason for participating in the Seattle hospital’s program, while nearly 89 percent pointed to the inability to engage in enjoyable activities and 75 percent were concerned about losing dignity.

SCCA's results were very similar to those previously found in Washington and Oregon, the paper showed. Overall, nearly 80 percent of patients who choose doctor-assisted deaths have been diagnosed with cancer. They're usually older than 65, white, well-educated and well-insured.

Starting a program aimed at helping people die wasn’t easy, Loggers acknowledges. Heated town hall-style meetings generated intense debate about whether staff would be forced to participate and how patients would be informed about the process.

“At SCCA, our goal is primarily to cure cancer,” she said. “What we did not want to do was scare any patient or family member.”

Grace Wang

Ethan Remmel, far left, in an undated family photo. Remmel died in 2011 after using a lethal prescription through Washington's Death with Dignity Act.

A confidential survey in March 2009 found that nearly 36 percent of SCCA doctors who answered were willing to act as prescribing or consulting physicians, 26 percent were willing to consult only -- and more than 38 percent were either unwilling or undecided about participating, the paper showed.

Developing a protocol that honored staff preferences and patient wishes was crucial, Loggers noted. In some ways, the SCCA program is stricter than the state law, requiring, for instance, that participants agree not to take lethal drugs in a public area or manner.

The program turned away one participant who couldn’t agree to that stipulation, the paper showed.

Overall, however, SCCA officials felt that developing the program was necessary in a state where 85 percent of voters turned out to weigh in on the measure -- and nearly 60 percent approved it.

“There was a substantial portion of the population who felt this was an appropriate end-of-life option,” Loggers noted.

That’s not the case in other states, of course. Last fall, a Massachusetts proposal to allow physician-assisted suicide was narrowly defeated thanks in part to substantial funding from the Catholic church and right-to-life groups, which oppose the action on moral and ethical grounds. But it was also tipped by a sharp focus on perceived flaws in the wording of the proposed law, a tactic that may pay off in other states, said Joe Baerlein, president of Rasky Baerlein Strategic Communications, whose firm was brought in to defeat the measure.

“You have to find some way to appeal to someone’s secular brain to say this isn’t a good idea and idea and here’s why,” he told NBC News.

But from Ethan Remmel’s point of view, having access to the lethal drugs allowed him to finish his life on his own terms, said Wang, his partner of five years and mother of their 5-year-old son, Miles.

“It was just really hard,” she said.

Remmel, an associate professor of psychology at Western Washington University, was able to finish the school year, teaching until 10 days before he died. He was able to spend time with his parents, with his friends and with his sons, Seth, then 8, and Miles, then 3, before becoming too incapacitated by chemotherapy and pain drugs.

Remmel didn’t regard taking the lethal drugs as suicide, said Wang, an associate professor of environmental studies at Western.

“We obviously didn’t want him to die,” she said, “but he was dying anyway.”

Related stories: 

• Ethicist: Mass. should legalize physician-assisted suicide
• Assisted suicide on legal agenda in several states
• What is your opinion of assisted suicide of the terminally ill?

A deadly outbreak of a new kind of bird flu has now sickened 16 people in China and killed six, but U.S. health officials on Friday cautioned that there’s no cause for widespread alarm.

The new influenza A H7N9 virus has not been seen before in humans, but it doesn’t appear to be transmitted easily among people, and there have been no cases detected in the United States, said Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention.

“There are no specific steps people in this country can take. People can go about their daily lives,” he said.

Still, he said CDC officials are in close contact with Chinese authorities as they track the spread of the novel virus, which has been found in people from four Chinese provinces.

Victims have included 15 adults and a 4-year-old child, all of whom appeared to have clear ties to live poultry markets. They all became ill between Feb. 19 and March 31. Two of the 16 had other people in their families fall ill, but whether it was related is still being assessed. 

“At this point, there are several things that give us confidence that this is not spreading widely from person to person,” Frieden said.

For example, Chinese authorities have tracked 100 close contacts of people who got sick, and none of them became ill. With typical influenza, perhaps 20 percent to 30 percent of family members could be expected to develop the flu, Frieden said.

CDC is working with vaccine manufacturers to develop a seed strain to produce a vaccine to protect against the H7N9 virus, but that would only occur if there appeared to be widespread transmission. If that were necessary, it would not disrupt production of the seasonal vaccine, CDC officials said.

The agency issued a health alert for U.S. clinicians urging them to be alert for recent travelers from China who could show signs of the novel flu. CDC is also developing a diagnostic test that could quickly detect the virus.

No travel advisories have been issued, but CDC officials are reminding U.S. tourists in China to stay away from live poultry markets. That's the same advice the agency has issued for about a decade, since outbreaks of SARS and H5N1 flu. The World Health Organization said it was not advising screening at points of entry or any trade restrictions in connection with the outbreak.

China's neighboring countries are closely monitoring people for signs of flu. A 7-year-old girl in Hong Kong was being tested Friday in a local hospital for signs of the virus, according to the official Chinese news outlet Xinhua. Tougher surveillance also has started in Laos, Cambodia, Thailand and Taiwan, CDC officials said.

Though no source of the outbreak has been identified, Chinese officials have detected the virus in chickens and in pigeons and are now culling flocks to prevent further spread of the virus.

Health officials can't yet say whether this virus is especially virulent. Wider population tests will need to be conducted to tell whether many people may have become infected with virus without becoming seriously ill, or whether those who got infected developed severe illness. 

The virus appears to be common in animals, where it causes only mild illness. Doctors closely monitor cases of animal flu that pass into humans. Seasonal flu kills tens of thousands of people globally every year. But a new virus that starts passing from animals to people could cause far more serious disease. 

For instance, H5N1 bird flu kills about 60 percent of the people it infects. But it doesn't pass easily among people, either, and most of those who've gotten appeared to be directly infected by sick chickens. 

Still, Frieden noted that flu can mutate very quickly and there's no way to tell whether this new virus will soon become more transmissible. The H1N1 swine flu in 2009 didn't cause serious illness, but it spread very quickly. And that bug was a descendant of the 1918 "Spanish flu," which killed between 50 million and 100 million people worldwide. 

Related stories: 

• Six more diagnosed with new bird flu in China
• New bird flu strain: Little evidence of global threat so far

A federal judge on Friday reversed a contentious Food and Drug Administration ruling and ordered the agency to make the so-called "morning-after pill" available without a prescription to all girls of reproductive age, including those younger than 17.

The ruling by U.S. District Judge Edward Korman in Brooklyn, New York, comes in a lawsuit brought by reproductive-rights groups that had sought to remove age and other restrictions on emergency contraception.

Currently, only women aged 17 and or older can obtain emergency contraception without a prescription. For those women, the medication is available only at health clinics or pharmacies and they're required to show identification to obtain it.

The rule requiring girls younger than 17 to obtain a doctor's prescription was confirmed in December 2011, when Health and Human Services Secretary Kathleen Sebelius overruled an FDA recommendation -- and Commissioner Margaret Hamburg -- to force the agency to limit access to emergency contraception for young girls.

In her decision, Sebelius said she wasn't convinced that drug makers had proven that access should be broadened and she expressed concern that girls who reached reproductive maturity at ages as young as 11 could have access to the medication. 

At the time, that decision drew intense criticism from medical and women's rights groups, who said that denying access defied strong scientific data that showed that emergency contraception is safe and effective for girls and women of all ages. Sebelius' action was widely seen as a move to protect President Barack Obama's administration from the appearance of encouraging sexual activity in such young girls.

Korman said the FDA's rejection of requests to remove age restrictions to obtain the pill had been "arbitrary, capricious and unreasonable." The 59-page ruling says that Sebelius' actions were "politically motivated, scientifically unjustified and contrary to agency precedent."

The ruling orders the FDA to make levonorgestrel-based emergency contraception available without age or so-called "point of sale" restrictions within 30 days. It appears to apply to all brands of the morning-after pill, although Korman gave FDA the option of limiting the expanded access to the Plan B One-Step single-pill product if the agency "actually believes there is any significant difference between the one- and two-pill products."

Nancy Northup, president of the Center for Reproductive Rights, hailed the ruling. "Women all over the country will no longer face arbitrary delays and barriers just to get emergency contraception," she said.

The group was among those that brought the lawsuit, the culmination of more than a decade of political and legal wrangling. 

"Today's court order has swept away all the FDA stalling, all the interference and all the gamesmanship," Northup told reporters in a conference call. 

Anti-abortion activists reacted swiftly to the ruling, saying it provided access for vulnerable young girls to drugs that the groups believe induce abortions.

“Teen girls need parents, not unfettered access to abortion-inducing drugs,” said Marjorie Dannenfelser, president of the Susan B. Anthony List. “Judge Korman’s decision is reckless and denies girls the protection that comes along with the involvement of parents and doctors."

The U.S. Conference of Catholic Bishops also opposed the change, saying the court acted "irresponsibly" by making powerful hormonal drugs available without prescription to minors. 

"Plan B does not prevent or treat any disease, but makes young adolescent girls more available to sexual predators," said Deirdre McQuade, spokeswoman for the conference, in a statement. "The court's action undermines parents' ability to protect their daughters from such exploitation and from the adverse effects of the drug itself." 

Meanwhile, news of the ruling was applauded by a range of medical, women's rights and reproductive rights groups. 

Dr. Cora Collette Breuner, a Seattle pediatrician and professor of adolescent medicine, said the American Academy of Pediatrics regards the ruling as a victory of science over politics.

"Finally, my children and their children will have access to a product they didn't have before," she said. 

Cecile Richards, president of the Planned Parenthood Federation of America, also praised the move. 

“Lifting the age restrictions on over-the-counter emergency contraception is a significant and long-overdue step forward for women’s health that will benefit women of all ages," she said in a statement. 

The ruling would particularly benefit immigrant women by removing requirements to show identification to buy the drugs, and also by making them available in a wide range of settings, advocates said.

"It's getting EC right on the store shelves, right next to the condoms and the cough medicines, where it belongs," said Kimberly Inez McGuire of the National Latina Institute for Reproductive Health.

FDA spokeswoman Erica Jefferson declined to comment on the ruling, saying it was an ongoing legal matter.

It wasn't immediately clear if the U.S. Department of Justice would appeal the judge's ruling. Allison Price, a department spokeswoman, told NBC News the agency was reviewing the opinion.

In the past, druggists and store owners who regarded the morning-after pill as a form of abortion had refused to dispense or sell the products. It's not yet clear whether some stores would refuse to stock the drugs, or whether they would keep them behind locked counters to dissuade shoplifting. The drugs typically sell for about $50 a package. 

Emergency contraception uses high doses of the same hormones used in birth control to prevent pregnancy when taken within 72 hours of unprotected sexual intercourse. Taken in one- or two-pill doses, the product can prevent or delay ovulation, prevent fertilization or, in some cases, prevent implantation of a fertilized egg into the lining of the uterus. It does not cause miscarriages or abortions and would have no effect if a woman were already pregnant, medical experts say. 

Related: 

• Plan B won't be available OTC to younger teens, HHS says
• Bioethicist: It's high time for 'morning-after pill' ruling

A New York snack food maker now says it is recalling more than 10 million pounds of frozen pizza, mozzarella bites, Philly cheese steaks and other products linked to a rare and potentially dangerous outbreak of E. coli poisoning. Three million pounds of the products remain in the marketplace, a company spokesman said Friday.

Rich Products Corp. of Buffalo, N.Y., is pulling all products manufactured at its Waycross, Ga., plant. The  snacks have best buy dates from Jan. 1 2013 through Sept. 29, 2014, according to a press release. For a full list of products, click here.

Spokesman Dwight Gram originally told NBC News that 3 million pounds of the products were recalled, but he later confirmed that the company also had control of 7 million pounds of the frozen items that had not reached stores.

The foods may be contaminated with the bacterium E. coli O121, which already has sickened 27 people in 15 states who ate certain Farm Rich and Market Day frozen chicken quesadillas, pizza slices and other snack foods. Eight people have been hospitalized, according to the Centers for Disease Control and Prevention, which updated cases on Friday.

However, many more people may have been made ill by the products without knowing it because of complexities involved in identifying  E. coli O121, a strain that can be just as dangerous as the better-known E. coli O157:H7 frequently tied to outbreaks caused by hamburger.

The Thursday announcement expands a March 28 recall of 196,222 pounds of Farm Rich brand frozen chicken quesadillas and other frozen mini meals and snack items because they could be contaminated with E. coli O121.

The strain is among a potentially lethal group of bacteria known as Shiga-toxin producing E. coli or STECs. The bacteria, which include E. coli O157, create poisons that can lead to severe illness and disease, including bloody diarrhea, kidney failure and death.

In 2011, U.S. Department of Agriculture officials banned E. coli O121 and five other strains -- known as “the big six” -- from the nation’s beef supply. This outbreak is the first time Food Safety and Inspection Service officials have recalled products potentially tainted with E. coli O121.

The bacteria are tough to identify in outbreaks because clinical laboratories typically test only for the E. coli O157 strains. To detect the other strains, labs must screen for the presence of Shiga toxins and then send positive samples to public health laboratories to find any non-E. coli O157 STECs.

The strain involved in this outbreak is so rare, its genetic fingerprint has been seen less than 30 times in PulseNet, the CDC’s network of laboratories that track bacteria involved in foodborne illness.

The New York state Department of Health identified the outbreak strain of E. coli O121 in an opened package of Farm Rich brand frozen mini chicken and cheese quesadillas from an ill person’s home, the CDC said.

People usually become sick from Shiga-toxin producing E. coli within two to eight days after eating contaminated food.  Symptoms include bloody diarrhea and abdominal cramps. Most people recover within a week, but others can become severely ill with a complication called hemolytic uremic syndrome, or HUS, which causes kidney failure.

Children and the elderly are most vulnerable to the worst effects of the illness.

Related stories: 

• Mini quesadillas, pizza slices recalled over E. coli fears
• Six new E. coli strains banned from beef supply

This story was originally published on Thu Apr 4, 2013 3:57 PM EDT

Marisa Guzman-Aloia

Melissa Melms, 25, and Jonathan Mills, 29, moved into her Hoboken, N.J., apartment 18 months ago. Now they're engaged. Living together was an expected part of the journey, says Melms, who blogged about her experience.

More women are choosing to live with men first without marriage and more of those relationships are lasting longer, according to a new government study that tracks the continuing climb of cohabitation in the U.S.

Nearly half of women in what researchers call "first unions" with men -- 48 percent -- moved in with no wedding vows according to interviews conducted between 2006 and 2010, up from 43 percent in 2002 and 34 percent in 1995.

About 40 percent of those relationships became marriages after three years, but about 32 percent continued as cohabitations, suggesting an important new role for the arrangement once known as “shacking up,” says one researcher.

“It’s becoming more acceptable to be in a long-term, committed relationship without a legal document,” says Pamela J. Smock, director and research professor at the Population Studies Center at the University of Michigan-Ann Arbor.

By the time they’re 20, 1 in 4 women ages 15 to 44 in the U.S. have lived with a man, and by the time they’re 30, that ratio climbs to 3 in 4, the new study shows.

“The question becomes not who cohabits, but who doesn’t?” Smock says.

The survey relies primarily on information from a sample of 12,279 women interviewed between 2006 and 2010 as part of the federal National Survey of Family Growth, with data from previous reports in 1995 and 2002.

But it doesn’t take figures from the National Center for Health Statistics to prove that living together is rapidly becoming a standard relationship milestone, says Melissa Melms, 25, of Hoboken, N.J., who moved in with boyfriend Jonathan Mills, 29, 18 months ago.

“It was definitely a no-brainer for me. It was always something I planned to do,” said Melms, a blogger wrote about the move -- and the couple’s subsequent engagement -- in her Smitten column for Glamour.com.

Cohabiting was a way to make sure they were ready the daily rewards and challenges of marriage, says Melms, who adds that most of the young women she knows feel the same.

“I think it would be weird to me to have a friend who would wait to move in together until after they got married,” she said.

Melms, who is planning a July 2014 wedding in Aruba, is part of a rising trend toward cohabitation among women of most races and education levels.

Between 1995 and 2006 to 2010, first-time cohabitation jumped by 43 percent for white women, 57 percent for Hispanic women and 39 percent for black women, the study showed. Only Asian women stayed the same, with about 22 percent cohabiting during both time periods.  

About 70 percent of women with less than a high-school education moved in with a man as a first union in 2006 to 2010, up from 46 percent in 1995. For women with a bachelor’s degree or higher, 47 percent now live together first, up from about 34 percent in 1995, the study shows.

For all women in the study, cohabitation relationships lasted longer: They averaged 22 months in 2006 to 2010, up from 13 months in 1995.

Those longer relationships include the nearly 20 percent of women who became pregnant in their first year of living with a man outside of marriage. Nearly a quarter of recent births among women ages 15 to 44 occurred while they were cohabiting, up from about 14 percent in 2002.

Such figures are likely unsettling to traditionalists in society. “People will see this as a continued displacement of the importance of marriage,” Smock says.

Indeed, the percentage of women whose first union was a marriage fell to 23 percent in the recent figures, down from 39 percent in 1995, the study shows.

But Smock says that the fact that more cohabiting relationships are continuing, even when they don’t lead to marriage, is a significant finding.

“One take on these data would be that cohabiting families are choosing to stay together, they are becoming more committed and they are seeing their families, many with children, as a legitimate family form and are feeling less pressure to marry,” Smock says. “It’s the new normal.”

The study authors, led by Casey E. Copen of the Center for Disease Control and Prevention's vital statistics division, put it this way: 

"Cohabitation is a common part of family formation in the United States and serves as both a step toward marriage and as an alternative to marriage."

For Melms, as for many educated young women, living together was a logical progression on a path of increasing commitment.

“If anything, it’s just cemented things a little bit more,” she said. “We’re talking about getting a puppy now. That’s the next step.”

Related stories: 

• Straight married couples happier than gay couples
• CDC: Only half of first marriages last 20 years
• Fertility math? Most women flunk, study finds

In the wake of Europe’s horse meat scandal, the U.S. is increasing so-called “species testing” on imported meats to screen for any signs of fraudulent products, agriculture officials said.

Inspectors have been ordered to boosts species tests of meat products imported from Iceland, Ireland, Poland, the United Kingdom and Northern Ireland, according to a new U.S. Department of Agriculture directive issued this week.

In addition, inspectors will increase tests of all imported raw ground beef or veal, including products that already are being tested for certain Shiga toxin-producing E. coli bacteria that can cause serious illness.

“We are confident that the inspection system at ports of entry ensures the safety of products that come into our country every day,” said Catherine Cochran, a spokeswoman for the USDA’s Food Safety and Inspection Service. “However, in response to recent events and consumer concerns, we are increasing species testing to enhance current safeguards and prevent fraudulently labeled products from entering the country.”

The U.S. action follows the scandal that erupted earlier this year after testing in Ireland revealed that some beef products contained traces of horse meat. More than a dozen European countries and several prominent international brands have been caught up in the controversy.

None of the European countries implicated in the scandal imports beef to the U.S., but USDA officials said the increased scrutiny recognizes that those countries are part of the global food supply chain.

The new directive, signed by Rachel Edelstein, an FSIS acting assistant administrator, doesn’t include a specific schedule for species testing. Previously, USDA officials acknowledged that species testing for meat imported into the U.S. has been performed typically only when there’s a reason to question a shipment.

Concerns about horse meat hidden in beef have been two-fold. First, meats taken from store shelves in Britain and Germany had traces of a powerful equine painkiller, phenylbutazone, or “bute,” which can cause serious problems in humans.

The larger issue, however, has been one of trust. While diners in some European countries routinely eat horse meat, the idea makes most U.S. consumers shudder.

Related stories: 

• Horse meat in the US? Unlikely, but tests are rare
• No horse in IKEA meatballs in the US, store says 

Darron Cummings / AP

Louisville head coach Rick Pitino and trainers tend to injured guard Kevin Ware during the first half of the Midwest Regional final in the NCAA college basketball tournament against Duke, on March 31, 2013, in Indianapolis. Ware badly injured his lower right leg and had to be taken off the court on a stretcher.

The gruesome break that shattered Louisville Cardinals guard Kevin Ware’s right lower leg during Sunday’s Elite Eight playoff game was a “freak accident” rare outside of car accidents or other high-velocity trauma, a sports medicine expert said.

The 20-year-old sophomore from the Bronx apparently landed awkwardly in the heat of the NCAA Midwest Final game against the Duke Blue Devils, perhaps exacerbating an undetected stress fracture, said Dr. Frederick Azar, a vice president and spokesman for the American Academy of Orthopaedic Surgeons and chief of staff at Campbell Clinic in Germantown, Tenn., who consults for the Memphis Grizzlies NBA basketball team.

“He may have just landed funny and torqued his tibia,” said Azar, who was watching the game. “It was a freak accident.”

Such injuries, don’t often happen at the low velocity of even high-level basketball, which raises the possibility that Ware had a preexisting stress fracture, Azar said.

The bone in Ware’s lower right leg apparently broke in two places and could be seen sticking out through Ware’s skin, observers said.

“To actually see it happen like that is rare,” Azar said. “A bone sticking out of the skin is really, really unusual.”

The injury, which occurred with 6:33 minutes left in the first half of the game, sent 6-foot-2 Ware to floor, stunned his teammates into sickened sobs and silenced the crowd at Lucas Oil Stadium in Indianapolis.

The Cardinals went on to win the game 85-63.

Known as a compound fracture or open fracture, the injury occurs when the bone protrudes through the skin, Azar said. Doctors likely washed out the injury to prevent infection and then quickly performed surgery to place a titanium or stainless steel rod in Ware’s leg.

“They’ll get him up and get him going by tomorrow,” Azar said. “You would hope he gets fixed tonight.”

Cardinals coach Rick Pitino told reporters that Ware would be out of  commission for a year, but Azar said that if surgery went well and there were no nerve complications or infections, the young, healthy player could be back on the court in time for next season, or within six months.

“That’s the good news: We have the technology to fix this,” said Azar.

Related:

• PhotoBlog: Louisville player after horrific injury: 'Don't worry about me. I'll be OK. You guys go win this thing'
• Louisville guard suffers gruesome compound fracture