A new look at child abuse reports suggests there may have been a small but worrying rise in injuries to babies over the past decade or so. While most research suggests child abuse is down overall, the report published on Monday in the journal Pediatrics shows infants are far from safe.

The study contradicts government data collected over the same time, and it shows that health officials need to take a better look at whether child abuse is getting better, worse or staying the same, experts said.

“I think it’s premature to make any conclusions about whether it is going up or down,” says Dr. James Anderst, chief of the section on child abuse and neglect at Children's Mercy Hospitals and Clinics in Kansas City, Mo., who was not involved in the study. “Medical providers may be getting better at identifying abuse over time.”

Either way, it’s still happening and that’s a concern, says Dr. John Leventhal of Yale University, who led the study. “Maybe parents are doing better and hurting their children less in general, but there is a small group where there continue to be substantial injuries that end in hospitalization,” Leventhal said.

Leventhal and colleague Julie Gaither looked at statistics on children admitted to hospitals for serious injuries. Writing in the journal Pediatrics, they said they found a nearly 11 percent increase over 12 years in serious injuries to babies a year old and younger.

This is at the same time that two major national surveys of child abuse found decreases of between 55 percent and 23 percent in child abuse injuries overall, for all ages, between 1997 and 2009. It's important to point out that each study goes to different sources for data -- this week's study looks at hospital admissions, while the government studies examined reports of abuse filed to Child Protective Services and other agencies by doctors and other sources.

Child abuse is a serious problem in the United States. The Centers for Disease Control and Prevention says more than 740,000 children and youth are treated in hospital emergency departments for injuries resulting from violence every year.

“Child abuse, neglect or violence can actually affect the development of a child’s brain – impacting the child now and for years to come. Our Adverse Childhood Experiences (ACE) studyshows a connection between child maltreatment and some of the nation’s worst health problems, including depression and heart disease,” CDC child abuse expert Linda Degutis says in a blog on the agency’s website. 

CDC declined comment on Monday’s study in Pediatrics.

“I would say that the experts in this area are still trying to make sense of the various trends in physical abuse and explain why there are divergences,” said David Finkelhor of the University of New Hampshire, who led one of the studies showing a decrease in child abuse injuries between 1997 and 2009. “This new report is helpful but does not resolve any of the outstanding questions.”

Leventhal said it’s important to get better data, but says it’s difficult. “It is probably harder to substantiate a physical abuse case now than it was 15-20 years ago,” he says -- mostly because agencies have tightened the rules for classifying cases as child abuse. “My colleagues in child protective services say it is much harder.” Many, he says, classify abuse cases as neglect instead. But it would be important to get data to back this up.

Anderst and Leventhal both said education is an important way to help prevent child abuse. “Over 50 percent of the kids on my study were infants. Thirty to 40 percent of those infants had abusive head trauma, often known as shaken baby syndrome,” Leventhal said. That suggests parents are caretakers who are frustrated and don’t know how to cope with a wailing baby, he said.

“I think, regardless of the cause, the message is too many children, particularly very young children are  getting hurt,” he said. “And pediatricians and others who look after children need to craft clear messages so that children are not hurt by abuse.

Yale’s hospital has an approach called “Take Five.” “If you feel like you are going to lose it, put the baby in a safe place, namely a crib, step back and take five,” Leventhal says. Some states are also giving new parents information about not shaking their babies – even seemingly gentle shakes can cause traumatic brain injury. “There are now systematic efforts funded in part by the CDC to see whether education about crying infants, about stepping away, about not shaking a baby, change the likelihood that children end up in the hospital with those injuries,” Leventhal added.

Sometimes people were themselves beaten as children, and pass this behavior along, Anderst said. “Some people are just ill-prepared to be parents and don’t know how to handle children. Some people come from violent backgrounds and that is how they handle their problems.”

So how to change this behavior? “It’s the same way we get people to quit smoking. It is the same way we get people to wear seat belts. It is a combination of laws and enforcement of those laws and also supporting people so they can be better parents,” Anderst said.

He said government officials should think about those consequences when they cut programs to save money in state budgets.

Sometimes it's not the parents who are doing the harm but someone outside the family.

Dr. Suzanne Starling, a pediatrician at Eastern Virginia Medical School, has made intensive studies of who’s hurting kids, and found a consistent pattern: men are far more likely to hit, shake or batter young children. One study she published in the Southern Medical Journal found fathers committed 45 percent of attacks, and boyfriends of the mothers another 25 percent.

“Parents need to believe that the people close to them might have the potential to lose it with a frustrating circumstance such as a crying baby,” Leventhal advised. “They need to say each of the people who looks after their child, ‘my baby cries sometimes and it gets frustrating. If you feel that way, call me. I will come home from work. But don’t hurt my baby’.”

Other news on Vitals:

'Smiles': New street drug tied to 'Sons of Anarchy' death

Vomit outbreak strikes thousands of German children

Trampolines are no place for kids, docs warn

Matt Carr / Getty Images file

Actor Johnny Lewis, 28, who starred in the series "Sons of Anarchy."

Johnny Lewis, an actor in the popular “Sons of Anarchy” motorcycle-gang cable drama, died early Wednesday in Los Angeles, suspected of killing his 81-year-old former landlord, Catherine Davis, and possibly himself.   

Police think the 28-year-old rising star, who played Kip 'Half-sack' Epps on the FX show, may have been under the influence of a drug few have heard of, a substance known informally as “Smiles.” 

It’s part of a new wave of synthetic drugs finding their way onto America’s streets and into its clubs. With the chemical name 2,5-dimethoxy-4-iodophenethylamine, it is known by drug agents and chemists as 2C-I, part of a closely-related family of “2C” drugs.

While Smiles may seem obscure, it’s already done damage, and not just in drug-hip Hollywood.

When 18-year-old Adam Budge of East Grand Forks, Minn., gave a derivative of the Smiles drug to his buddy, 17-year-old Elijah Stai, of nearby Park Rapids this year, Stai wound up dead. The drug was supposed to be a cheap, harmless high. But within an hour of mixing the powder into some chocolate and eating it, Stai was convulsing, hallucinating, and eventually stopped breathing. Now Budge faces charges that could put him in prison for many years.

But what is Smiles?

Like all the 2C drugs, it’s a psychoactive, hallucinogenic chemical that alter the brain’s balance of dopamine and serotonin. Smiles is particularly powerful, binding to serotonin receptors in the brain at 20 times the rate of another drug used in schizophrenia research, according to an experiment performed by Purdue University chemists.

The effects of 2C-I, like those of LSD, can last up to eight hours. But because the effects can take time to appear, users may think they haven’t taken enough to get the desired high, and so take more, risking overdose.

The drug can be taken as small tablets, on pieces of blotter paper like LSD, or in powder form, often mixed with something else, like chocolate.

In June, as part of a Substances Control Act overhaul, Congress made 2C-I a schedule I drug -- highly restricted, like methamphetamine. But, explained Drug Enforcement Administration spokesperson Rusty Payne, trying to get government arms around these new drugs is “like playing whack-a-mole. There are just so many emerging chemicals.”

Labs, often located in Europe or Asia, can use legal, common chemicals to produce huge batches of the drugs. Once one formulation is discovered, and banned, all the chemists have to do is slightly alter the structure of the molecules to create another, potentially legal, substitute until that one is banned.

There is no known geographic hot spot for the 2C drugs, unlike, say, methamphetamine, which became known as a rural, small-town problem. The U.S. Drug Enforcement Administration believes that most, if not all, the 2C drugs are being imported to the country, not made domestically.  

Often, Payne said, teens rationalize the use of the drugs because they think, or are told, that it’s legal and if it’s legal, it’s safe. Another problem is that users often think they’re taking something else. 

“We are getting so many calls because people are dying abusing chemicals that nobody ever heard of,” Payne said. “They’re told it’s harmless. If you can just go buy it somewhere, or on the internet, then it must be safe, but nothing could be further from the truth.”

Users aren’t the only ones who are often in the dark. According to Payne, even the DEA’s own agents are behind the curve when it comes to designer synthetics.

“It’s tough for our agents to stay up to date,” he explained. “Chemicals that used to take years to synthesize now take months. And many chemicals are diverted” from legal uses to illicit ones.

Chemical and pharmacologic research appears in journals, is posted online, and becomes easily available to all. That is often a good thing, but it also allows rogue chemists to use the science to create new analogs of drugs like 2C-I.

The drug “Spice,” for example, which made headlines over the past two years as a marijuana substitute, began as a research project by a Clemson chemist named John W. Huffman. He was doing the research under the auspices of the National Institute for Drug Abuse.

“This synthetic stuff is the new frontier of drugs,” Payne said.

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com), now on sale.

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Women treated with hormone-blocking drugs to stave off breast cancer recurrences are often dissatisfied with their sex lives, a new study from Sweden has found.

More than half of older women treated with so-called aromatase inhibitors said sex was almost always painful and they frequently had "insufficient lubrication," researchers reported in the journal Menopause.

In contrast, less than one-third of women on tamoxifen, another anti-estrogen drug, reported painful sex.

"We've suspected that the aromatase inhibitors would be more likely to cause sexual dysfunction for quite a while," said Dr. Don Dizon, a gynecologic oncologist from Massachusetts General Hospital in Boston who has studied sexual health in cancer survivors.

Those drugs, he said, block women's bodies from producing estrogen. Tamoxifen, on the other hand, just stops the hormone from acting on cells in the breast. Both can be prescribed to women with hormone receptor positive breast cancer, the most common type.

Dizon said it stands to reason that without any estrogen production, women could see their sex lives suffer. But most don't mention those problems to their doctors, and many oncologists feel uncomfortable discussing sexual health, he told Reuters Health.

For the new study, researchers surveyed 82 women who'd had breast cancer and were taking aromatase inhibitors or tamoxifen to prevent the cancer from coming back. The women were all between 55 and 70 years old, and had been diagnosed two to six years earlier.

Dr. Juliane Baumgart of Orebro University Hospital and colleagues compared those women's responses to sexual health surveys from 102 women of the same age who hadn't had breast cancer.

Most women in both the cancer and non-cancer groups said they were sexually active.

Among those having sex, 74 percent of women taking aromatase inhibitors said they always or almost always had trouble with lubrication, compared to 40 to 42 percent of women who hadn't had breast cancer or those who were treated with tamoxifen.

Painful sex was reported by 57 percent of sexually active women on aromatase inhibitors, compared to 31 percent on tamoxifen and 21 percent or less in the comparison group.

There was not a substantial difference across groups in how many women reported trouble reaching orgasm, but more women taking aromatase inhibitors said they were generally dissatisfied with their sex lives.

Dizon, who wasn't involved in the new study, said it helps illustrate the different ways sexual health may be affected for women on aromatase inhibitors. Most women in the U.S. who get breast cancer after menopause are treated with a five-year course of those drugs, he said.

Oncologists at the very least should be ready to point women to resources where they can get help for sexual problems, according to Dizon.

He tells patients that using vaginal moisturizers and water- or silicone-based lubricants may help alleviate pain during sex. In addition, Dizon said he emphasizes the importance of intimacy in relationships.

"As women get treated for cancer we need to think about the toxicities and the long-term side effects, and sexual health is one of those areas that is really important," he said.

"The notion from an oncologist that you're just lucky to be alive is not acceptable."

SOURCE: http://bit.ly/Uyc8mn Menopause, online September 17, 2012.

BERLIN - More than 6,500 German children and teenagers have fallen ill with diarrhea and vomiting that health authorities say was likely caused by a food-borne virus in meals delivered to schools and daycare centers.

Regional health ministries and a top health research institute said youngsters from five of Germany's 16 states had been affected by the acute gastroenteritis, with the first cases registered on Tuesday. So far, those affected had not suffered any complications.

"All the institutions which have registered cases of the illness so far are probably being provided by the same caterer," wrote the Robert Koch Institute, which researches and advises the German health ministry on infectious diseases. "This suggests that it is an outbreak caused by food."

The German government and affected states have established a task force charged with looking for the reason for the illness in order to prevent it spreading any further.

(Reporting By Thorsten Severin, Writing by Sarah Marsh; Editing by Myra MacDonald)

The Food and Drug Administration is warning U.S. consumers that the vast majority of Internet pharmacies are fraudulent and likely are selling counterfeit drugs that could harm them.

The agency on Friday launched a national campaign, called BeSafeRx, to alert the public to the danger, amid evidence that more people are shopping for their medicine online, looking for savings and convenience.

Instead, they're likely to get fake drugs that are contaminated, are past their expiration date or contain no active ingredient, the wrong amount of active ingredient or even toxic substances such as arsenic and rat poison. They could sicken or kill people, cause them to develop a resistance to their real medicine, cause new side effects or trigger harmful interactions with other medications being taken.

"Our goal is to increase awareness," FDA Commissioner Dr. Margaret Hamburg told The Associated Press, "not to scare people away from online pharmacies. We want them to use appropriate pharmacies."

That means pharmacies that are located in the U.S., are licensed by the pharmacy board in the patient's state and have a licensed pharmacist available to answer questions. In addition, the pharmacy must require a valid doctor's prescription for the medicine. Online drugstores that claim none is needed, or that the site's doctor can write a prescription after the customer answers some questions, are breaking the law.

Research by the National Association of Boards of Pharmacy, which represents the state pharmacy boards, found that of thousands of online pharmacies it reviewed, only about 3 percent follow state and federal laws. In fact, the group's website lists only a few dozen Internet pharmacies that it has verified are legitimate and following the rules.

Most consumers don't know that. An Internet survey, conducted by the FDA in May, questioned 6,090 adults. It found that nearly one in four Internet shoppers has bought prescription drugs online, and nearly three in 10 said they weren't confident they could do so safely.

The campaign comes after some high-profile cases of counterfeit drugs reaching American patients earlier this year.

In February and again in April, the FDA warned doctors and cancer clinics around the country that it had determined they had bought fake Avastin, a pricey injectable cancer medicine, from a "gray market" wholesaler. The fake Avastin vials originated in Asia or Eastern Europe and were transferred through a network of shady wholesalers before being sold to clinics by a wholesaler claiming to be in Montana.

In another case, the FDA issued a warning in May after learning consumers shopping on the Internet had bought fake versions of generic Adderall, a popular medication for attention deficit hyperactivity disorder.

No deaths or serious injuries have been linked to those fakes, but Hamburg notes that when drugs don't help patients get better, doctors usually blame the disease or assume a different medicine is needed. That means most fakes aren't detected.

So the FDA, which has put increasing focus on the counterfeiting problem, on Friday launched a website, www.FDA.gov/BeSafeRx , that shows consumers how to determine if an online pharmacy is safe.

"Buying prescription medicine from a fake online pharmacy can be dangerous, or even deadly," the site warns.

It includes tips on how to spot illegal pharmacies, links to state databases of licensed pharmacies and explanations of all the dangers of rogue pharmacies. Besides likely getting fake drugs, that includes the risk that they will infect your computer with viruses, sell your personal and financial information to other rogue websites and Internet scammers, or charge you for products you never ordered or received.

Many rogue pharmacies claim to be in Canada — because Americans know medicines are cheaper there and assume that's why they're getting a deal. Many fraudulent sites even put the word Canada in their name, or display the Canadian flag prominently on the site. Their web storefronts are slick and look professional. And they all offer prices that are unbelievably low.

"If the low prices seem too good to be true, they probably are,' Hamburg said.

The FDA is collaborating with several other federal agencies and departments and even Interpol in the campaign, Hamburg said, and it has asked medical and pharmaceutical industry groups to join in.

It's also reaching out to doctors, pharmacists and medical facilities to spread the word. They'll get access to materials they can download, from patient fact sheets and discussion guides to sample blog items and web banners for a practice's own website. There's also a list of tips to help doctors determine if a patient may be buying medicine online.

The agency will do a follow-up survey to see if the campaign's message is reaching the public.

"What's truly important to us is that consumers know how to look for an online pharmacy that's legitimate and safe," Hamburg said.

Related stories: 

• FDA warns of fake agents scamming drug buyers
• Beware fake Adderall sold on the internet, FDA says

By MyHealthNewsDaily staff

Older adults taking psychiatric medications such as Valium or Xanax may be at increased risk of dementia, a new French study suggests.

In the reports, adults older than 65 who took drugs known as benzodiazepines were 50 percent more likely to develop dementia over a 15-year period, compared with those who did not take the drugs.

Benzodiazepines are widely prescribed medications, used to treat symptoms of anxiety and sleep disorders.

The study findings held true even when taking into account other factors that may affect people's dementia risk, such as age, gender, diabetes and early signs of dementia. The researchers also accounted for some factors that lead people to start taking benzodiazepines in the first place.

Researchers caution that the study only found an association between the drugs and dementia, and not a direct cause-and-effect link.

However, the findings agree with those of several earlier studies looking at the link between benzodiazepines and dementia. Use of the medications has also been tied to other serious events in older adults, such as falls.

"Considering the extent to which benzodiazepines are prescribed and the number of potential adverse effects of this drug class in the general population, [their] indiscriminate, widespread use should be cautioned against," the researchers said.

Whenever possible, use of the drugs should be limited to just a few weeks, the researchers said. Currently, despite evidence that the drugs work only over short periods, many people take them for years.

The study followed about 1,000 older adults living in France who, at the study's start, did not have dementia and were not taking benzodiazepines. Over the first five years of the analysis, 95 participants started taking benzodiazepines.

Fifteen years later, 253 cases of dementia were confirmed — 30 in benzodiazepine users and 223 in non-users. That puts the yearly rate of dementia among those taking benzodiazepines at 4.8 cases per 100 people, compared with 3.2 cases per 100 people in those who did not take the drugs.

The researchers noted that, in determining dementia risk, they were able to account for the possible effects of depression, which is associated with the development of dementia. However they were not able to determine whether anxiety and or sleep disorders, which may be early signs of dementia, played a role a in the results.

Future research should examine whether use of the drugs is linked to dementia in younger people, and whether the drug dosage affects the risk, the researchers said.

The study was published Sept. 28 in the British Medical Journal.

More from MyHealthNewsDaily:

7 Strange Facts About Insomnia

Top 10 Spooky Sleep Disorders

Hypersex to Hoarding: 7 New Psychological Disorders

Reinhard Fasching / FeaturePics Stock

Sitting has also been linked to chronic diseases, such as type II diabetes and now kidney disease.

Couch potatoes may have an increased risk of chronic kidney disease, even if they take time out from sitting to exercise vigorously, a new study suggests.

British researchers found that people who spent the least amount of time sitting were also the least likely to have chronic kidney disease. And that was especially true for women who spent less than three hours a day seated, according to the study published in the American Journal of Kidney Disease.

It’s not clear how sedentary behavior could lead to kidney disease, said study co-author Thomas Yates, a researcher at the University of Leicester and the University Hospitals of Leicester NHS Trust.

But, sitting has also been linked to other chronic diseases, such as type II diabetes, Yates said.

"Sitting jobs need to be broken up with periods of standing,” Yates said. “As these findings start trickling down to the public consciousness, it is hoped it will affect occupational health considerations.”

Yates and his colleagues surveyed 5,650 Britons, asking about lifestyle factors such as smoking, exercise and sitting time. They also examined the study volunteers for signs of kidney disease. The researchers found a link between hours spent sitting and kidney disease, even after they took into account factors such as smoking, age, gender, ethnicity, body-mass index, blood pressure, medications and hours spent exercising.

The researchers divided the volunteers into three groups: people who sat 8 to 24 hours a day were categorized as "high," those who sat 3.2 to 7.8 hours a day were considered "moderate," and those who sat 0 to 3 hours a day were categorized as "low."

Women with low amounts of sitting time had a 30 percent reduction in risk of kidney disease compared to those in the high category. Men who spent little time sitting got a 20 percent reduction in risk compared to those who sat the most.

Exercise seemed to reduce, but not eliminate, the heightened risk in men who were couch potatoes. Exercise did not appear to ameliorate the effects of sitting in women, though.

Does that mean we should all give up our office jobs and find something that requires more activity?

No, said kidney expert Dr. Jeffrey S. Berns, a professor of medicine at the University of Pennsylvania School of Medicine.

The researchers found an association between long hours sitting and a greater likelihood of having kidney disease, Berns explained. That doesn’t prove that sitting actually caused the kidneys to become diseased.

“Someone who sits around and doesn’t have risk factors for kidney disease shouldn’t worry,” Berns said. “While it’s certainly plausible to think that sitting may contribute to diabetes, obesity, and high blood pressure, it’s much harder to come up with a way that inactivity could be a direct cause of kidney disease. The flip side of this is that people with chronic kidney disease are known to be less active. And my suspicion is that these results are confounded by that.”

FRESNO, Calif. -- Yosemite National Park will offer testing to all employees at the site to determine if they have ever been infected with a deadly mouse-borne virus, officials said Thursday.

The testing to be done by state health officials will be voluntary and available to all workers for the National Park Service and its concessionaire, DNC Parks and Resort, park spokesman John Quinley said. He declined to say when the testing would start.

There have been no confirmed or suspected hantavirus cases among park employees so far, Quinley said. The park did not offer the testing earlier because public health officials did not recommend it, he said.

Nine people who visited the park this summer have been infected, the majority after staying overnight at the "Signature" cabins in Curry Village. Three of those people later died.

Between 2,500 and 3,000 people work in the park every year, depending on the season. A little less than half are National Park employees, and the rest work for the concessionaire. Many workers also live in the park.

The California Department of Public Health conducted a pilot testing program on Wednesday, taking blood samples and questionnaires from 96 employees who live or work in the El Portal area of the park.

Hantavirus is carried in the feces, urine and saliva of deer mice and other rodents, and carried on airborne particles and dust.

People can be infected by inhaling the virus or by handling infected rodents. They usually develop flu-like symptoms at first, including fever, shortness of breath, chills and muscle and body aches.

The illness can take six weeks to incubate before rapid acute respiratory and organ failure.

The tests for employees will cover all past infections, said Danielle Buttke, veterinary epidemiologist with the National Park Service. People who have been infected at any time in their lives and developed antibodies will test positive, but the test does not pinpoint time of the infection, or where the person was infected, she said.

The goal of the testing, which was proposed by public health officials, is to further the understanding of the rare virus. Park and public health officials hope to learn more about why no park employees have thus far been struck with the disease, even though many could have been exposed to it, Buttke said.

Officials also hope to learn whether there are any people who had the infection but never developed symptoms of the disease. And they plan to evaluate training or knowledge gaps employees might have about the disease.

It's possible that no employees have contracted hantavirus because they have received training about the illness and take more precautions because they are more aware of the risks than park visitors, Buttke said. Employees also don't stay in visitor facilities overnight, she said.

During the outbreak this summer, park officials say they sent all employee emails about the virus while increasing training and holding meetings about the disease.

Another reason for lack of worker infections could be the rarity of the disease. Previous studies of people who directly handle mice found that only a few had hantavirus antibodies, meaning few were infected by the disease during their careers, said Barbara Knust, an epidemiologist with the Centers for Disease Control and Prevention.

In rare cases, people who did develop antibodies never had any symptoms.

"We think it's actually quite rare that people get infected," Knust said. "And in most cases, people who do get infected with hantavirus show symptoms."

Employees tested in Wednesday's pilot program included maintenance and facilities workers, who open park buildings in the spring.

The effort included questions about employees' work activities and living environment; if and when they were exposed to mice; and what they remembered about hantavirus training.

While individual test results will remain confidential, overall results from the pilot testing could be available sometime next month. 

• Yosemite officials trap, kill mice after hantavirus outbreak
• Yosemite closes cabins after hantavirus deaths

Frederick A. Murphy / CDC handout via EPA file

A new virus that appears similar to rabies, but has the symptoms and lethality of Ebola, shown here, has been dubbed the Bas-Congo virus. It killed two teenagers in the Congo in 2009.

A virus that killed two teenagers in Congo in 2009 is a completely new type, related to rabies but causing the bleeding and rapid death that makes Ebola infection so terrifying, scientists reported on Thursday. They’re searching for the source of the virus, which may be transmitted by insects or bats.

The new virus is being named Bas-Congo virus, for the area where it was found.  Researchers are finding more and more of these new viruses, in part because new tests make it possible, but also in the hope of better understanding them so they can prevent pandemics of deadly disease.

The virus infected a 15-year-old boy and a 13-year-old girl in the same village in Congo in 2009. They didn’t stand a chance, says Joseph Fair of Metabiota, a company that investigates pathogens. Fair is in the Democratic Republic of Congo now, under contract to the U.S. Agency for International Development (USAID) to help battle an ongoing Ebola outbreak.

“They expired within three days,” Fair said in a telephone interview. “It was a very rapid killer.”

A few days later a male nurse who cared for the two teenagers developed the same symptoms and survived. Samples from the lucky nurse have been tested and it turned out a completely new virus had infected him, Fair and other researchers report in the Public Library of Science journal PLoS pathogens.

The genetic sequences went to Dr. Charles Chiu, of the University of California, San Francisco.

“We were astounded that this patient had sequences in his blood from a completely unknown and unidentified virus,” Chiu said. They weren’t expecting that.

“Congo is very much known for having Ebola and Marburg outbreaks. Yet about 20 percent of the time we have hemorrhagic fever outbreaks that are completely negative, which means unknown causes and they are not Ebola.”

The sequencing puts this new virus on its own branch of the bad virus family tree -- somewhat related to Ebola and the virus that causes Lassa fever, another horrific killer, and most closely related to the rhabdoviruses. This family usually only infects animals with one notable exception -- rabies.

But rabies is not known to cause hemorrhaging. It’s plenty horrible on its own, of course, killing virtually all patients if they aren’t vaccinated soon after infection. 

A nurse who took care of the first infected nurse had antibodies to the new virus. It doesn’t look like the teenagers infected one another, says Fair, but they probably infected the first nurse, who probably infected the second. Tests of other villagers have found no more evidence of the virus, however, which is good news.

“Although the source of the virus remains unclear, study findings suggest that Bas-Congo virus may be spread by human-to-human contact and is an emerging pathogen associated with acute hemorrhagic fever in Africa,” the researchers wrote.

Africa is loaded with nasty viruses. Lassa fever virus comes from a family known as arenaviruses and causes 500,000 cases of hemorrhagic fever a year. Crimean-Congo hemorrhagic fever and Rift Valley Fever viruses are in another family called bunyaviruses; Ebola and Marburg viruses are filoviruses that kill anywhere between 30 percent and 90 percent of victims. They’re also helping wipe out great apes such as gorillas in Central Africa. This adds a new one to the list.

It worries Chiu because its closest relative is spread by biting flies in Australia. “We think that is potentially a valuable clue. This virus may have come from an insect vector,” Chiu says. “What is scary about this virus is if it does happen to be spread by insects, it has the potential to be something like West Nile."

West Nile showed up in the United States for the first time in 1999, having never been seen here before. It causes regular outbreaks in Africa and parts of Europe, however, and some experts think a mosquito or an infected person carried it on a flight to New York. It’s killed 147 people in an especially bad U.S. outbreak this year, although more than 90 percent of people infected with West Nile never even know it.

New viruses often cause disease -- there was severe acute respiratory syndrome or SARS, which killed 800 people and infected 8,000 in 2003 before it was stopped. Scientists are now watching a similar virus that has emerged in the Middle east.

Chiu says there is not enough information to know how deadly the new Bas-Congo virus is.

“It  has probably been lurking out there in remote areas and causing sporadic cases of hemorrhagic fever and no one had the resources to discover it,” Chiu said. “This is probably the tip of the iceberg. I believe there are many, many more of these emerging viruses that have yet to be discovered,” he added.

“This points to the importance of being vigilant, especially these remote areas of Africa and Asia. This is the area that I believe the next generation of emerging viruses will come from.”

Fair agrees, and says his team will be looking. They’ll also be checking to see if bats or insects can spread it. “It is a frightening prospect. That is why the next step in this process is to look for the vector,” Fair said.

That’s not so easy. Fair’s team and hundreds of other scientists have been looking for the reservoir -- the animal or insect source --of Ebola. That would be a bat or other creature that can carry it without getting sick itself. So far they have had no luck, although fruit bats are a major suspect.

And for the new Bas-Congo virus, the trail is now three years old. “Everything we do will be as a forensic investigation,” Fair said. “We really have to go look for a needle in a sack of needles.”

And in the meantime, there’s an outbreak of Ebola to cope with. Fair says a coordinated effort is going on, although this isn’t the worst outbreak he has seen. It’s killing about 30 percent to 40 percent of patients -- not nearly as bad as some strains, which killed up to 90 percent of victims.

“If you had to get Ebola, this is the strain to get,” he said.

Related stories:

• West Nile cases jump
• New virus related to SARS
• Rabid animals on the rise as human vaccine supply tightens
• Health teams face real-life horror in Ebola battle
• Ebola out of control in Congo, WHO says

The manufacturer of the anesthetic blamed for Michael Jackson's death said Thursday it won't sell the drug for use in executions, a setback for Missouri and other states looking for an alternative after other drug makers also objected to their products' use in lethal injections.

Drug maker Fresenius Kabi USA, a German company with U.S. offices based in Schaumburg, Ill., says it is the only remaining domestic supplier of propofol. Earlier this year, Missouri adopted a new single-drug execution method that would make it the first state to use propofol as an execution drug.

Fresenius Kabi spokesman Matt Kuhn confirmed to The Associated Press that the company told its distributors in late August that such usage contradicts the drug's medical purpose and is "inconsistent" with the company's mission. It's also forbidden under European Union laws to export drugs that could be used in executions.

"Fresenius Kabi objects to the use of its products in any manner that is not in full accordance with the medical indications for which they have been approved by health authorities," a company statement reads. "Consequently, the company does not accept orders for propofol from any departments of correction in the United States. Nor will it do so."

Most of the 33 states with the death penalty had long used sodium thiopental as the first of a three-drug combination administered during lethal injections. But sodium thiopental became unavailable when its European supplier acknowledged pressure from death penalty opponents and stopped selling it for executions.

Supplies mostly ran out or expired, forcing states to consider alternatives. Most states have retained the three-drug method but turned to pentobarbital, a barbiturate used to treat anxiety and convulsive disorders such as epilepsy, as a replacement for sodium thiopental. But pentobarbital supplies also have shrunk after its manufacturer said it would try to prevent its use in executions.

Officials with the Missouri Attorney General's office and Department of Corrections didn't immediately respond Thursday to requests seeking comment about the propofol maker's stance. In August, the state Supreme Court declined Attorney General Chris Koster's request to set execution dates for six death-row inmates, calling it "premature" pending the uncertainty over propofol's availability.

Just about everyone is supposed to get a flu shot every year, and two groups are particular no-brainers -- pregnant women and health care workers. But new numbers released on Thursday show that fewer than half of pregnant women got vaccinated last year and just two-thirds of health care workers did.

Although they’ve been pushing flu vaccination hard for more than a decade, public health officials admit they are still finding it a hard sell. But it’s not necessarily resistance. It just may not yet be easy enough to get the vaccine. And recent mild flu seasons haven’t helped.

About 128 million people, or about 42 percent of the U.S. population, got immunized against influenza last year. Because flu viruses constantly mutate and evolve, people must get vaccinated with a fresh formula every year to be fully protected. This year’s vaccine protects against the three most common circulating strains.

The best vaccination rates are among babies aged up to 2, with nearly 75 percent vaccinated. That’s because babies make regular visits to pediatricians, and vaccinations are a routine part of those visits. And more than 63 percent of 2- to 4-year-olds were vaccinated last year. But just 29 percent of 18- to 49-year-olds had a flu shot.

Pregnant women are especially vulnerable to flu. Not only do they get sicker, because pregnancy suppresses the immune system, but the infection can lead to losing their babies. The vaccine also protects a woman’s newborn, who cannot get the vaccine until age six months.

“Influenza is five times more likely to cause severe illness in pregnant women than women who are not pregnant,” said Dr. Laura Riley of Massachusetts General Hospital in Boston and the American College of Obstetrics and Gynecology.

But a CDC survey released Thursday showed that just 47 percent of pregnant women had a flu vaccine last year. If their doctors both recommended and provided the vaccine, nearly 74 percent of pregnant women got the shot. Just 11 percent of women whose doctor said nothing got immunized.

Even though doctors have been stressing for years that flu vaccines cannot give people the flu, a full quarter of the pregnant women who refused the vaccine said they believed it would infect them. Another 13 percent thought their babies were at risk.

“Pregnant women worry about everything,” Riley said. “We spend a lot of time in this country talking about you can’t eat this, you can’t eat that. It takes us a little while to get the message out about how efficacious (the vaccine) is. We are preventing a very severe disease potentially and we are protecting your baby.” Vaccination does not raise the risk of miscarriages or birth defects.

Don Emmert / AFP - Getty Images file

A mild flu season last year and memories of the H1N1 pandemic that didn't turn out to be as serious as expected have made flu shots a hard sell to the general public.

Flu may be off many people’s radar because the last two years haven’t been especially bad, and because the 2009 H1N1 swine flu pandemic didn’t turn out to be as bad an initially feared.

Yet, 1,300 children died from H1N1 that year and about 100 U.S. children die every year from flu, half of them previously perfectly healthy, CDC says. The CDC estimates that anywhere between 3,000 to 49,000 people a year die from flu in the United States. A lot depends on the strains circulating.

“Flu is unpredictable. Just because we got off easy last season does not mean we will get off easy this season,” Riley said.

The other group that should have 100 percent vaccination is health care workers. The CDC data show that more than 86 percent of physicians are vaccinated, followed by more than three-quarters of nurses. But the numbers plummet to just half of workers in long-term care facilities, where patients are especially vulnerable to flu.

“I believe that the immunization of the health care provider community is both an ethical and professional responsibility,” said Dr. William Schaffner of Vanderbilt University in Nashville and the National Foundation for Infectious Diseases. “It’s a patient safety issue so that we do not transmit our influenza infection. When an outbreak strikes, we need to be vertical, not horizontal.”

As with the pregnant women, health workers were more likely to get vaccinated if it was easy for them. More than 78 percent of health care workers got immunized if free vaccine was made available for several days at work. And 21 percent of the health workers said getting flu vaccine was now a condition of employment. More employers should consider making it a requirement, said Litjen Tan of the American Medical Association.

This year, 135 million doses of flu vaccine will be available to the U.S. market. People can get vaccinated at pharmacies, at big-box stores, grocery stores, doctor’s offices and often at their places of employment. Most private insurance companies and Medicare pay for the whole cost of the vaccine.

And while the vaccines are not specifically formulated to protect against some new flu strains that a few people have caught from pigs, they may offer some help, health officials said.

So far, the three new variants identified this year --  H3n2v (the little v stands for “variant”), H1N1v and H1N2v -- don’t spread easily from person to person. Almost everyone infected has been close to pigs. One person has died from the new H3N2v virus, but everyone else has recovered.  The CDC’s Dr. Daniel Jernigan says people alive in the 1990s have some immunity to the H3N2 version, and the new H1N1v is close to the strain that the current vaccine targets, although the protection is not perfect.

Related stories: 

• Yet another new pig flu virus infects people at state fairs
• New pig flu spreads to more people
• H1N1 swine flu may have killed half a million

When Dr. Marty Makary was a medical student, staffers at the Boston hospital where he was training had a nickname for one of its most popular surgeons: Dr. Hodad.

"Hodad" is an acronym for "hands of death and destruction": Despite his Ivy League credentials and board certification, the surgeon had an unfortunate tendency to botch operations so badly that patients often suffered life-threatening complications.

But he was also one of the surgeons most requested by patients, including celebrities, thanks to his charming bedside manner and their lack of understanding about what caused their post-op problems.

Makary, 42, aims to end the professional code of silence that allows colleagues like Dr. Hodad to thrive. Now a cancer surgeon at Johns Hopkins Hospital in Baltimore, Makary has just published the book "Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care."

Why patients don't report medical errors

It outlines the extent to which doctors and hospitals suppress objective data about how patients fare in their hands and argues for clear, publicly accessible statistics to help people make the best choices when it comes to treatment. Hospitals and physicians, he argues, should collect "outcomes data" on everything from how many knee-replacement patients walk without a limp to how many prostatectomy patients become incontinent.

Without that, "patients are walking in blind" every time they choose a hospital, Makary said in an interview. With rare exception they have no way of knowing whether they will receive appropriate care or be one of the 100,000 patients killed or 9 million harmed every year in the United States because of medical mistakes.

"There is terrible guilt about keeping quiet, but there are strong social forces against speaking up when you think something doesn't look right: It can get you fired," said Makary. (HealthGrades, a Denver company that develops and markets quality and safety ratings of healthcare providers, rates Makary a "recognized doctor" based on his training and record of no disciplinary actions or malpractice claims.) "You realize as a young doctor that you've walked into an industry with a very dark side."

Clear as mud
In no U.S. state can patients find out what a surgeon's rate of complications is, how many mistakes a hospital makes, how many avoidable deaths it has or almost anything else about a provider's record of care.

Most ratings, from magazines to websites, reflect softer metrics. In the closely watched hospital rankings issued by U.S. News & World report, "reputation," or what specialists think of a hospital, counts 32.5 percent toward overall scores. Patient volume, number of nurses, use of advanced technologies and 30-day mortality rates also count.

The federal government collects and makes public some measures, such as hospitals' rates of complications and mortality after certain procedures, on the Hospital Compare website. About half the states require hospitals to make public what percentage of patients develop infections. While that's better than nothing, says Dr. John Santa of Consumers Union, publisher of Consumer Reports, providers have largely succeeded in hiding their records.

"Despite the best efforts, if hospitals don't have to report something they don't," said Santa.

For example, a regular survey by Johns Hopkins asks staffers at 60 hospitals about safety and teamwork. Studies show that hospitals scoring high on the surveys have fewer surgical complications and better patient outcomes. But hospitals participate "under the condition that the results remain top secret," said Makary.

Specialist groups also gather data, including the Society of Thoracic Surgeons, which tracks national heart-surgery outcomes. Only one-third of hospitals have agreed to post their results on the society's website.

Santa believes patients should have far more data on outcomes, such as what fraction of hip-replacement patients develop infections and what fraction of heart-bypass patients survive, not just currently available information on whether providers follow medical guidelines.

The reason? Good practices may not be a reliable proxy for good safety. A hospital's rate of providing antibiotics after surgery, for instance, does not always correlate with patients' infection rate, said Santa.

The Joint Commission, an independent non-profit that certifies and accredits hospitals and other providers, last week released its annual report summarizing how well 3,300 hospitals did on measures of quality and safety.

Patients can see that a particular hospital was a "top performer" in pneumonia care, meeting criteria such as taking blood cultures in the intensive care unit. But unless a hospital was specifically cited for exceptional care, patients have no way of knowing how good or bad relative to others it is.

More outcomes measures - whether that knee replacement patient walks again, or even dies on the operating table - will be made public in coming years, said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. Patients typically choose a hospital based on what their doctor or friends recommend, she notes, adding, "I think there is a lot of opportunity to enrich that process with hard data. The measures currently available are not as consumer-friendly as most of us would like."

The exceptions
Makary notes several models of transparency that have shown promise. New York, Oregon and California require hospitals to report death rates from heart bypass surgery, adjusted for how sick patients were and other factors to make the comparisons fair.

Transparency has benefited patients. After New York made its data public in 1989, hospitals scrambled to improve, and death rates from heart surgery fell 41 percent in four years.

Vitals.com, a doctor-reviews site launched in 2008, recently began incorporating outcomes for cancer and orthopedic surgery from a number of large hospitals into its ratings, said chief executive and co-founder Mitch Rothschild.

"Individual facilities recognize that if they don't weed out bad practitioners, they'll get creamed as Medicare starts penalizing hospitals for poor performance, so they collect these metrics and share them with us," he said.

For other outcome data that hospitals chose not to share, Vitals filed a Freedom of Information Act request to access the government's Medicare health program for the elderly.

"After a year and a half, as legal fees mounted, we gave up," Rothschild said. The government maintains the data cannot be made public for reasons of privacy and others.

In the meantime, the pitfalls for patients are many. When Makary looked Dr. Hodad up years later, he was still thriving and had a five-star rating on a popular review website.

Makary regrets keeping quiet during a residency at a university-affiliated community hospital that boasted of its "comprehensive breast cancer center" and "No. 1 ranking."

Both statements were inventions of the hospital's marketing department, which can make all sorts of claims as long as they are vague enough not to fall afoul of truth-in-advertising laws. The assertion that patients "may" or "often" do better at a particular hospital is allowed, for instance, as are subjective terms like "comprehensive."

Based on such claims, a young patient Makary calls "Gretchen" who needed breast-cancer surgery believed she would get superb care.

In reality, the small hospital did only a few dozen such surgeries per year compared with hundreds at major hospitals. It did not have the expertise to do breast-conserving and -reconstruction surgery, nor were its surgeons adept at the latest procedures.

Makary said he was bothered at the time by the hospital's disingenuous claims and worried for Gretchen, though he did not warn her. He did ask if she'd considered other hospitals, but even that placed him "on thin ice with my own job."

The operation was horribly botched, leaving Gretchen deformed. Not knowing any other outcome was possible, Makary said, she considered herself "very blessed" just for being alive.

Related:

No Snickers? Junk food may be banned in NYC hospitals

Should you fire your doctor? 4 warning signs

US health care: It's officially a mess, report says

Rita Desollar

Rita Desollar of Pekin, Ill., has launched a petition calling for retail stores to stop selling chicken jerky pet treats from China. She believes her 8-year-old dog, Heidi, died in May after eating tainted treats.

Rita Desollar’s black minivan has become a rolling warning about the possible dangers of chicken jerky pet treats from China.

Everywhere the 57-year-old Pekin, Ill., woman goes, her car carries a poster detailing the May death of her 8-year-old German shepherd, Heidi.

Desollar says she gave the dog two pieces of Waggin’ Train chicken jerky tenders on a Wednesday and by the next Monday, Heidi was dead.

“I didn't know what it was. I just couldn’t figure out what made her so sick,” said Desollar, who turned to the computer for answers. "It was breathtaking what came up."

Desollar found dozens of news stories and blog accounts detailing government cautions about possible links between Chinese-made chicken jerky treats and illnesses and deaths in hundreds of U.S. dogs.

Manufacturers have issued no recalls for the products and Food and Drug Administration officials say repeated testing and investigation has revealed no contaminants that would lead the agency to advise pulling the treats.

But Desollar said she never saw any warnings and didn’t know about a potential problem -- until it was too late.

Outraged, the retired paralegal said she had no choice but to take matters into her own hands.

“They’re leaving a product on the shelf that can potentially harm a dog. There was no warning. There was nothing to tell me this was under investigation. They just left it out there.”

She launched a Change.org petition Sept. 5 calling for stores to pull the products voluntarily; since then it has gathered more than 60,000 signatures. She stuck the fliers on her car and ordered magnets that say “Stop the Cycle of Death,” along with hundreds of business cards that say “Beware... Chicken Duck and Sweet Potato JERKY TREATS are not safe!” 

“I leave the cards on the shelves by the dangerous treats everywhere I see them,” she said. “I have distributed over 1,500 of these cards to date and I have another order of 1,000 on the way.”

Desollar is not alone. Across the U.S., some pet owners -- frustrated by what they say is a lack of government or industry action to get dangerous treats off the market --  have started warning others themselves.

Retailers, pet treat manufacturers and FDA officials all say that there’s no confirmed connection between the Chinese-made jerky treats and pet harm, despite reports of at least 2,200 illnesses and deaths of 360 dogs and 1 cat blamed on the products since 2007.

“This is a very complex public health investigation,” the FDA’s Steven Solomon, a veterinarian and deputy associate commissioner of compliance policy, told NBC News this week. “The tests have not demonstrated significant toxicants.”

Another FDA official, Tracy DuVernoy of the agency’s Coordinated Response and Evaluation Network, told a gathering of veterinarians this summer that the complaints should be put in perspective.

“Two thousand complaints since 2007 is an incredibly small subset of the 15 million animals estimated to consume these treats,” she said, according to an account of the American Veterinary Medical Association conference. “Therefore, it seems that this may very well be some sort of intermittent issue, or it might just be an idiosyncratic reaction within that individual animal.”

Officials with Nestle Purina PetCare Co., which sells the popular Waggin’ Train and Canyon Creek brands of treats, have repeatedly said that internal testing has found no problems with their product and that the treats are safe to feed as directed.

But that hasn’t stopped consumers like Susan Nichols, 64, of Grand Blanc, Mich. She believes that jerky treats caused kidney failure in her 11-year-old Cocker spaniel-dachshund mix, Lucy, last year. So she printed up fliers that she surreptitiously leaves in stores where the products are sold.

“If I’m in Walmart or wherever, I will take my little Scotch tape out of my purse and tape it there,” she said. “It’s just a little thing I do. I’ll just slap one up.”

Jeff Zolman

Jeff Zolman, 42, of Aurora, Colo., said his 9-year-old dog, Bandit, died after eating chicken jerky treats. He asked to put up fliers at a local store, but was turned down.

In Aurora, Colo., Jeff Zolman, 42, was so distraught about the death of his 9-year-old dog, Bandit, that he, too, made posters with the dog’s picture and headed to the Big Lots store where he bought the treats he believes led to her death.

“The manager said he couldn’t post anything up unless it came from corporate,” said Zolman. “I understand where he’s coming from, but I wanted to get it out there for other people.”

Despite such consumer passion, retailers across the country have resisted calls to remove the pet treats from commerce, saying they need more than anecdotal reports to justify the action.

“We’re really sticking with the science at this point,” said Craig Wilson, vice president of food safety and quality assurance at Costco, one of seven stores specifically targeted in Desollar’s petition.

The chain is known for its aggressive food safety monitoring system, which includes stringent tests on jerky treats, Wilson said. So far, repeated examinations have revealed no contaminants that can be linked to reports of animal illness, including kidney failure and Fanconi syndrome.

“I don’t think people understand how hard Costco looks at this,” he said. “If there’s a hole in this boat, I’d like to be the guy who finds it.”

The other stores named in Desollar’s petition include Walmart, Sam’s Club, Target, Safeway, Kroger and Walgreens.

An official with Target noted that the jerky treats are the subject of ongoing lawsuits and said the company could not respond. Several consumers have sued the manufacturers and sellers of the jerky treats in lawsuits filed from California to Connecticut.

Officials with Kroger and Walgreens said those stores abide by FDA guidance on the jerky treat issue. 

"If the FDA determines that these or any products are potentially unsafe, they would contact us and we would immediately pull the product," Kroger spokesman Keith Dailey said in an email to NBC News.

Dianna Gee, a spokeswoman for Walmart, added that in addition to FDA standards, that firm requires pet treats to meet requirements of the Global Food Safety Initiative. She said the firm was not aware that any consumers had left behind fliers or cards protesting the treats, but she said shoppers with questions about the products should consult the manufacturers, the FDA or a Walmart manager. 

Officials with Safeway did not respond to NBC News phone calls and emails.

One store not named in the latest petition, PetSmart, said in a statement that the firm is monitoring FDA and manufacturer guidance. “At this time, we have no immediate plans to remove product from shelves," they said.

The efforts of Desollar and others may pay off, said Tony Corbo, a lobbyist for the group Food & Water Watch.

“Consumer pressure can be instrumental in getting these treats out of the marketplace,” he said.

“The easiest way to get them out of commerce is for FDA to issue an import alert against these products.”

For their part, FDA officials said they’re continuing to investigate the production processes at the Chinese plants that make chicken jerky and other types of jerky products. A small number of complaints also have cited duck and yam jerky treats.  

Inspections of five Chinese plants in April yielded valuable information that has led to increased surveillance, said Solomon. Next month, FDA inspectors will visit Chinese plants that irradiate finished jerky treat products to investigate whether that process is tied to the reports of illness and death. Officials are also examining the sources of glycerin used by the Chinese manufacturers to make the treats.

Desollar is glad that the government is continuing to look into the problem. But she said she’ll continue to take personal action to warn fellow pet owners about the possible danger.

“The FDA is a huge government office,” she said. “Purina is a huge corporation. I can’t walk into the FDA and say, ‘Do something.’ But I can walk into Kroger and say, ‘These treats killed my dog.’”

Related stories: 

• Pet jerky treat death toll: 360 dogs, 1 cat, FDA says
• 3 big brands may be tied to chicken jerky illness in dogs, FDA reports show
• Jerky treats from China blamed for pet deaths; owners sue
• FDA data dump shows few toxins in treats; complaints rise to 1,800

For men diagnosed with prostate cancer, the decision about how to treat it -- or even whether to treat it -- can be agonizing. Surgery, radiation, or some  combination of both may lead to miserable side effects such incontinence, impotence and rectal damage. Doctors usually can’t predict whether a man will suffer all or none of those side effects. While some risk factors are well-known -- including age, diabetes and poor cardiovascular health -- whether a man suffers harsh side-effects is often chalked up to random luck.

So what if it were possible to know before treatment which men might be more likely to suffer complications?

New research, published Thursday in the International Journal of Radiation Oncology, discovered a set of genetic markers that appear to indicate a significantly greater risk of collateral damage from radiation treatment for prostate cancer. Knowing a man’s susceptibility to fallout from radiation may steer a doctor toward surgery instead of other potentially damaging therapy.

“More often than not, it’s not clear-cut which way to go,” explained Barry Rosenstein, professor of radiation oncology at Mt. Sinai School of Medicine in New York City. “If you see a surgeon, he’s likely to say surgery is best. If you see a radiation oncologist he’ll say oncology.”

Determining what type of treatment a man should receive is only part of the dilemma of prostate cancer. The debate whether to even test for it is ongoing. This early-stage study represents a big step toward doctors and their patients making that decision.

The researchers started with a pool of 841 men treated with radiation for prostate cancer. Patients were assessed every three to six months for signs of sexual dysfunction for up to five years. The number of men studied was eventually winnowed down to 260 patients with erectile dysfunction and 205 controls.

The scientists then performed DNA analyses on the men, looking for genetic variations called single nucleotide polymorphisms, or SNPs (pronounced snips), slight differences in the “spelling” of our DNA.  After sifting through hundreds of thousands of SNPs, they settled on 12 suspect genetic variations.

It turned out that when the SNPs were combined to create a score that could be used to measure individual risk of treatment complications, having just one of the 12 SNPs more than doubled the risk. The more of the 12 a man had, the greater his chances of radiation therapy complications.

“It is cumulative,” Rosenstein explained. “If a man has five or six, it increases his chances quite a bit.”

The research is still in the early stages, so doctors aren’t likely to be using the genetic markers to determine treatment any time soon. “This is still not nearly good enough, yet” he said.

But he’s part of an international consortium that is trying to make that very scenario a practical reality. The next step, he said, is for group members to validate the predictive power of the markers his team found.

If they can, then doctors really will be “able to assign patients to treatments and see if we maintain the same level of control of cancer and lower the incidence of complications,” he said. “And if we can do that, then there’ll be enough confidence to put it into use in the clinic.”

Even better, he suggested, it may one day be possible to use drugs to target the SNiPs, or the biological processes they influence, as a way to prevent damage from therapy.

That hope is evident to other researchers, such as Dr. Ithaar Derweesh, a urologic oncologist and associate professor of surgery at the University of California San Diego Moores Cancer Center.

"This is a study that in certain ways is groundbreaking and also elegantly performed," Derweesh said.

While Derweesh agreed with Rosenstein that such a technique will take time to validate, and be used to steer patients toward a particular therapy -- something he called the "holy grail" -- he suggested that in the nearer term, such markers might be used as a trigger to pre-emptively begin erectile rehabilitation or to take measures that might lessen the potential damage.     

This kind of work is important not just for prostate cancer, but all cancers. While there has been greater success in treating cancer, survivors may live many years with side effects after treatment. If Rosenstein’s hopes are fulfilled, it may one day be possible to prevent some of the damage before it’s done, and still effectively treat the cancer.       

Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young Ph.D., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com), now on sale.

Related:

• FDA approves new drug for advanced prostate cancer
• Pregnant women with cancer on the rise. Why?
• Radiation may up breast cancer risk in some women

Jim Gathany / Centers for Disesase Control via EPA

A Culex quinquefaciatus female mosquito feeds on human blood. This species is a known vector for West Nile Virus.

DALLAS —When Dr. Robert Haley spotted a dead blue jay lying in his neighbor's driveway early this summer he became suspicious. When he saw another blue jay dead in the birdbath at his Dallas home the next morning, he knew it was a bad omen of disease.

What he could not predict at the time was that the bird corpses heralded one of the worst U.S. outbreaks of West Nile virus on record, with nearly 40 percent of cases in Texas alone.

"It's unusual to see dead birds lying in the open," said Haley, chief of epidemiology at the University of Texas Southwestern Medical Center. "Typically, birds die in some out-of-sight place or they are carried off by animals if they die out in the open."

West Nile is transmitted from sick birds to humans and other mammals by mosquitoes and was first detected in the United States 13 years ago, in New York City. Texas declared a state of emergency last month after seeing the worst toll from West Nile this year, which has reached 3,545 total cases and 147 deaths nationwide, according to the U.S. Centers for Disease Control and Prevention. Other states with large outbreaks include Mississippi, Michigan, South Dakota, Louisiana, Oklahoma and California.

"From the beginning, I thought it could be a bad year," said Haley, who spent 10 years working for the CDC and now lives in the epicenter of the outbreak. "But it turned out to be much worse than anyone imagined. It was a public health disaster."

More than 400 new U.S. cases of West Nile virus emerged in the last week, in an outbreak that remains one of the worst of record but has begun to show signs of slowing down. Experts hope the outbreak has peaked as cooler weather sets in and widespread pesticide spraying takes effect. Now is the time to learn the lessons for the future.

Good weather for mosquitoes
Five counties within the Dallas-Fort Worth area — the fourth largest metropolitan area in the country — recorded 28 of the 63 deaths and 869 of the 1,429 cases reported to the Texas Department of State Health Services by Tuesday. Dallas County alone has recorded 16 deaths and 371 cases, according to county authorities.

CDC and state officials believe a year's worth of record high temperatures and intermittent rainfall this past spring contributed to the severity of the epidemic by affecting bird and mosquito populations. Following a record hot summer and drought conditions in 2011, Dallas-Fort Worth had a warm winter with fewer than normal freezes followed by bouts of rain in the spring, officials said.

"One of the things we are closely looking at is the effect of weather on this year's outbreak," said Lyle Petersen, director of the CDC's Division of Vector-Borne Infectious Diseases. "West Nile outbreaks tend to be difficult to predict. Why it occurred in Dallas more than other areas is a matter of speculation at this point, and it's something that we're going to be looking at very carefully."

In addition, health officials in the region have witnessed an especially large number of neuroinvasive cases, the more severe form of the disease that often leads to meningitis and encephalitis.

Haley estimates that about 25,000 people likely were infected with West Nile in Dallas County this summer. Of those, about 80 percent showed no symptoms at all, while many of the remaining residents came down with West Nile Fever, a mild form of the disease that is largely under-reported and only sporadically tested. State figures show only that Dallas County recorded 168 West Nile fever cases and 154 neuroinvasive cases.

Death toll may rise
Haley and others say the worst should be over in terms of new infections, but more cases are expected to be reported due to the lag time between infection, testing for the virus and reporting to state agencies and the CDC. The death toll is also likely to rise as it can take weeks to months for patients to deteriorate.

In the meantime, Dallas residents are still coming to terms with the ravages of the outbreak, which dwarfs the four deaths seen in the region in 2006.

With no vaccine to prevent West Nile in humans, the only defense is prevention — wearing insecticide outdoors and pesticide spraying by ground and air.

Dr. Don Read, a surgeon in Dallas who was infected by neuroinvasive West Nile in 2005 while walking in his Dallas neighborhood and now runs a support group for survivors, said people tend to think they are invincible. "I didn't think I would get it until I did. It only takes one mosquito bite."

Read, who was infected at age 63, spent almost five weeks in the intensive care unit. He now wears braces on his legs due to polio-like paralysis, but considers himself lucky to be alive.

The sound of a plane buzzing overhead spreading insecticide in the suburban community of Southlake was a welcome sound to Ann Dachniwsky, 47, who spent much of the summer so fatigued from neuroinvasive West Nile that her only activity was "going from the bed to the couch back to the bed."

At the height of her illness, her husband and three children took turns waking her up every few hours to force her to drink.

"My balance and sight were affected so I could barely work or see. I was flat on my back for weeks," she said. "I was a healthy, active person. I'm getting better but I can barely manage one activity without needing to lay down afterwards."

Dachniwsky's family had pleaded with the Southlake City Council to allow aerial spraying of pesticide for the first time since an encephalitis outbreak nearly 50 years ago. Dallas and nearby Denton counties conducted aerial spraying missions in August. Southlake, which is partially in Denton and Tarrant counties, was sprayed. Officials in Tarrant County, home of Fort Worth, chose to spray only by ground.

As the outbreak has slowed, Dallas County health officials continue to be criticized both for not moving fast enough to start spraying and also for going too far in the breadth of the aerial spraying program once it started.

"We had a protocol in place and we followed it," said Zach Thompson, director of the Dallas County Department of Health and Human Services. "We started with public education, followed by localized ground spraying, then enhanced ground spraying and finally aerial spraying."

As research and analysis of the outbreak continue, Thompson said officials will work diligently to avoid a repeat of history.

"We were surprised by the magnitude of the outbreak this year but we feel that our response was appropriate," Thompson said. "Hindsight is 20/20." 

More stories in Vitals

• Best ways to avoid West Nile virus as outbreak grows
• West Nile outbreak stresses lab testing limits, delays diagnosis
• Is spraying for West Nile virus safe?

Just like age-defying baby boomers, older folks have seen a surge in knee replacement surgeries, driven partly by a desire to stay active and by joint-damaging obesity.

The findings are in a study of more than 3 million Medicare patients, aged 65 and older, who got artificial knees from 1991 through 2010. Almost 10 percent of the operations were redos — replacing worn-out artificial joints.

The number of initial knee-replacement surgeries each year on these older patients more than doubled during that time, rising to nearly 244,000 in 2010. Patients were in their mid-70s on average when they had surgery; that age edged up slightly during the study.

The aging population and rising numbers of Medicare enrollees contributed to the increase. But the per capita rate also increased, from about 3 surgeries per 10,000 enrollees in 1991 to 5 per 10,000 in 2010.

"There's a huge percentage of older adults who are living longer and want to be active," and knee replacement surgery is very effective, said lead author Dr. Peter Cram, an associate professor of internal medicine at the University of Iowa.

The study appears in Wednesday's Journal of the American Medical Association.

The pace of growth slowed in more recent years — possibly because increasing numbers of younger adults have also been getting artificial knees, which typically last 15 to 20 years. The troubled economy may also have slowed demand for an operation that costs about $15,000, the study authors said.

About 600,000 knee replacement surgeries are done each year nationwide on adults of all ages, costing a total of $9 billion, the authors said. A journal editorial says measures are needed to control costs of these operations, noting that demand has been projected to rise to as many as almost 4 million knee operations annually by 2030.

Obese older patient getting their first operations accounted for almost 12 percent, up from 4 percent. The rate was about the same in those getting redos. Obesity takes a toll on joints and can contribute to arthritis, a leading reason for knee replacement surgery.

The average hospital stay dropped from almost eight days to 3 1/2 days, but many patients were sent to rehab centers, mostly outpatient centers in the most recent years. Readmission rates after first and second operations increased in recent years for reasons including infections and surgery complications.

The results suggest that shortening hospital stays doesn't always achieve the goal of reducing costs, since readmissions increased — a trend seen with other types of surgeries and illnesses.

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I was recently browsing through the nearly 200 stories we’ve compiled with our Patient Harm Questionnaire, when I was reminded again of a troubling truth. Many of the people who suffer harm while undergoing medical care do not file formal complaints with regulators. The reasons are numerous: They’re often traumatized, disabled, unaware they’ve been a victim of a medical error or don’t understand the bureaucracy.

That’s a problem for those individual patients and for the rest of us. There are many places to complain: a state licensing agency; a professional licensing board that monitors doctors or nurses; the Joint Commission, which accredits hospitals or a Medicare Quality Improvement Organization. But if there are no complaints, there are no independent investigations, and that means no outside accountability for providers who may have made mistakes, and no public inspection reports that documents the case -- assuming an agency makes reports public, which is not always the case. It’s a collective problem because patient safety flaws that remain hidden, if they are not corrected, may be repeated.

We have staggering estimates of the number of people harmed while undergoing medical treatment. A review of medical records by the U.S. Health and Human Services Department’s inspector general found that in a single month one in seven Medicare patients was harmed in the hospital, or roughly 134,000 people. “An estimated 1.5 percent of Medicare beneficiaries experienced an event that contributed to their deaths,” the IG found, “which projects to 15,000 patients in a single month.”

But there’s no central system in place to tally and track these events. There’s no way to know when and where patients are being harmed or to tell if the problem is worse in one place than another.

It’s not like keeping track of patient harm is a new idea. More than a decade ago the Institute of Medicine’s landmark “To Err Is Human” report called for a national system to capture cases of serious harm to patients or death. The report said accurate reporting provides accountability and knowledge that leads to learning. That’s information that could save lives.

“You really can’t improve what you don’t measure,” said Dr. Julia Hallisy, president of the Empowered Patient Coalition. “How do you know where to focus your improvement efforts if you haven’t measured what’s happening in the first place?”

Efforts at the state level appear to be falling short, according to federal inspectors. In many states, hospital are required by law to file a report every time a patient suffers unexpected harm -- often called  “sentinel” or “adverse” events. But a July report by the HHS inspector general’s office found that only 12 percent of harmful events identified by the office even met state requirements for reporting them. Compounding the problem: Hospitals themselves only reported 1 percent of the harmful events.

We found something similar when I was a reporter in Las Vegas. We used hospital billing records to identify 3,689 cases of patient harm at the city’s hospitals in a two-year period. Each of those cases would fit the state’s definition of a “sentinel event,” meaning the hospitals were required by law to report them. Yet in the same time period they reported to the state only 402 sentinel events.

The federal Agency for Healthcare Research and Quality is now accepting public comment about a proposed program to encourage consumers to complain about harm suffered while undergoing medical care. The goals include collecting information in a common format, developing prototype methods for gathering information on the phone and Internet and creating a follow-up questionnaire for medical providers. Patients will be asked what happened, who was involved and for permission to follow up with the providers involved in the event.

I recently referred the 1,000 members of the ProPublica Patient Harm Facebook Group to a story about the proposal in The New York Times. Many members of the group have suffered harm firsthand and filed complaints, so the article created lively discussion: 

• Robin Karr said that based on her experience, she’s skeptical about reporting harm directly to the government “but not without hope” about the proposed program.
• Debra Van Putten said she knows many people who have filed complaints about harm they suffered, but little came of their efforts. Patients want more than mere acknowledgement, she said. They want accountability for whoever is responsible.
• Martha Deed said there are so many barriers to a patient reporting harm -- emotional trauma and physical disabilities, feeling intimidated by providers, social pressure not to complain -- that a passive questionnaire is unlikely to elicit responses. Instead, the patient harm information should be gathered in a way that’s standardized, she said, like the national survey that’s administered to recently discharged hospital patients that has results publicly reported on Hospital Compare.

That’s food for thought for those developing the program. Official public comment is due Nov. 9 and can be sent to Doris Lefkowitz, the AHRQ reports clearance officer:doris.lefkowitz@AHRQ.hhs.gov.

We’d also love to hear your comments. How do those of you who work in the medical field feel about this type of reporting system? Patients, what do you think about it? And what would you recommend as characteristics that would be essential to such a program?

This article first appeared on ProPublica.org. 

Con artists posing as U.S. Food and Drug Administration agents are trying to extort money from people who buy medications online and over the telephone, the agency warned on Tuesday.

The FDA, which is charged with protecting consumers, says these fake government officials gather people's personal information from online transactions, questionnaires and consumer lists and then call them demanding fines.

The scammers tell victims that buying drugs over the Internet or telephone is illegal and threaten them with prosecution unless a fine or fee ranging from $100 to $250,000 is paid, the agency said in a statement.

"If you refuse to pay up, the caller threatens to search your properties, arrest or deport you, put you in jail, and even physically harm you," the FDA said.

The problem is being investigated by FDA agents with help from other federal agencies, including the Drug Enforcement Administration, Immigration and Customs Enforcement and the Department of Homeland Security.

Authorities acknowledge that scams of this kind are hard to trace. The crooks can sound convincing if they're armed with your address, phone number, Social Security number, date of birth, purchase history and credit card account number.

"The best thing they can do is ignore the caller and hang up," said Philip Walsky, special agent in charge at FDA's Office of Criminal Investigations. He stressed that true FDA agents do not call up consumers to demand payment.

The good news for frightened consumers is that no one is known to have been approached in person, so there is little danger of a physical threat. In fact, most of the fraudulent callers are overseas.

Nor is buying drugs online illegal, though the FDA has warned consumers that some websites peddle unsafe medicines and offered advice on how to identify trustworthy Internet pharmacies. 

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Global health officials are closely monitoring a new respiratory virus related to SARS that is believed to have killed at least one person in Saudi Arabia and left a Qatari citizen in critical condition in London.

The germ is a coronavirus, from a family of viruses that cause the common cold as well as SARS, the severe acute respiratory syndrome that killed about 800 people, mostly in Asia, in a 2003 epidemic.

In the latest case, British officials alerted the World Health Organization on Saturday of the new virus in a man who transferred from Qatar for treatment in London. He had recently traveled to Saudi Arabia and is now being treated in an intensive care unit after suffering kidney failure.

WHO said virus samples from the patient are almost identical to those from a 60-year-old Saudi national who died earlier this year. The agency isn't currently recommending travel restrictions and said the source of infection remains unknown. Still, the situation has raised concerns ahead of next month's annual Hajj pilgrimage, which brings millions of people to Saudi Arabia from around the world.

Health officials don't know yet whether the virus could spread as rapidly as SARS did or if it might kill as many people. SARS, which first jumped to humans from civet cats in China, hit more than 30 countries worldwide after spreading from Hong Kong.

"It's still (in the) very early days," said Gregory Hartl, a WHO spokesman. "At the moment, we have two sporadic cases and there are still a lot of holes to be filled in."

He added it was unclear how the virus spreads. Coronaviruses are typically spread in the air but Hartl said scientists were considering the possibility that the patients were infected directly by animals. He said there was no evidence yet of any human-to-human transmission.

"All possible avenues of infection are being explored right now," he said.

No other countries have so far reported any similar cases to WHO, he said, and so far there is no connection between the cases except for a history of travel in Saudi Arabia.

Hartl said the first patient may have had an underlying condition but it probably didn't make him more susceptible to catching the virus.

Other experts said it was unclear how dangerous the virus is.

"We don't know if this is going to turn into another SARS or if it will disappear into nothing," said Michael Osterholm, a flu expert at the University of Minnesota. He said it was crucial to determine the ratio of severe to mild cases.

Osterholm said it was worrying that at least one person with the disease had died. "You don't die from the common cold," he said. "This gives us reason to think it might be more like SARS." SARS killed about 10 percent of the people it infected.

Britain's Health Protection Agency and WHO said in statements that the 49-year-old Qatari became ill on Sept. 3, having previously traveled to Saudi Arabia. He was transferred from Qatar to Britain on Sept. 11 and is being treated in an intensive care unit at a London hospital for problems including kidney failure. Respiratory viruses aren't usually known to cause serious kidney problems.

In Qatar, Mohammed bin Hamid Al Thani of the Public Health Department said the patient was in Saudi Arabia for Ramadan during the summer and became ill after returning to Qatar. Doctors could not immediately identify the virus and decided he should be treated in London.

A public health official, Abdullakef al-Khal, said there is no indication that the patient's family or others were infected.

"There is no special alert for now," he said. "We are being vigilant."

David Heymann, chairman of the Health Protection Agency, said the new virus didn't appear that similar to SARS.

"It isn't as lethal as SARS and we don't know too much about its transmissibility yet," he said. "If people are getting infected, they aren't getting serious disease."

Heymann said none of the health workers involved in treating the Qatari patient had become ill.

Saudi officials said they were concerned that the upcoming Hajj pilgrimage next month could provide more opportunities for the virus to spread. They advised pilgrims to keep their hands clean and wear masks in crowded places.

Several disease outbreaks have occurred during The Hajj including the flu, meningitis and polio.

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A nurse who accidentally disposed of a living donor's kidney during a transplant said she didn't realize it was in chilled, protective slush that she removed from an operating room, took down a hall to a dirty utility room and "flushed down a hopper," according to a report released by health officials on Monday.

The nurse said she had been on a break when a surgeon told everyone the kidney had been put in the sterile, semi-frozen solution. That detail was in a review by the state for the federal Centers for Medicare and Medicaid Services (CMS) and obtained by The Associated Press through a records request. The transplant was Aug. 10 at the University of Toledo Medical Center.

Hospital administrative staff members interviewed on Aug. 21 hadn't determined how the nurse took the 13-gallon bag of slush, meant to extend the kidney's viability, past several members of the medical staff without them noticing a problem, the report said.

It said poor oversight and communication and insufficient policies were factors in the kidney's disposal, which prompted the voluntary, temporary suspension of the hospital's living-donor kidney transplant program and led to reviews by health officials and a consulting surgeon hired by the hospital.

The hospital, in northwest Ohio about 135 miles north of Columbus, "failed to provide adequate supervision and communication resulting in a donor's kidney being carried out of the operating room, down a hall, into a dirty utility room, and flushed down a hopper," the report stated.

The hospital has since enacted clearer policies to clarify communication between nurses who fill in for one another and to make sure nothing is removed from an operating room until the patient has been moved from it, the report said.

The surveyors determined the hospital wasn't in compliance with CMS conditions of participation for transplant and surgical services. CMS will authorize a full review of the conditions of participation for the hospital, and, if it's found out of compliance, it could be terminated from the Medicare program, CMS spokeswoman Elizabeth Surgener said in an email.

The hospital, which says it offers specialty care in areas including cardiology, cancer, surgery and kidney transplantation, also may submit a plan of correction.

A spokesman said he had no comment to provide from the hospital Monday.

The hospital hasn't said what happened to the intended kidney recipient, who was supposed to receive an organ donated by her brother. The intended recipient and her brother were released from the hospital, which didn't identify them and said it couldn't say whether she received a different kidney.

Hospital officials apologized and hired a Texas surgeon to evaluate their transplant procedures but have not released the results of that evaluation.

The medical center suspended two nurses after the incident; one was later fired, and the other resigned, the hospital said. A surgeon was stripped of his title as director of some surgical services, and a surgical services administrator put on paid leave has resumed work.

The hospital also notified 975 patients and potential organ donors and recipients that they might need to make other arrangements for services typically provided through the program under review.

People nervously waiting around in New York City hospitals for loved ones to come out of surgery can't smoke. In a few months from now, they can't have a supersized fast-food soda. And soon, they won't even be able to get a candy bar out of the vending machine or a piece of fried chicken from the cafeteria.

In one of his latest health campaigns, Mayor Michael Bloomberg is aiming to banish sugary and fatty foods from both public and private hospitals.

In recent years, the city's 15 public hospitals have cut calories in patients' meals and restricted the sale of sugary drinks and unhealthy snacks at vending machines. But now the city is tackling hospital cafeteria food, too. And the Healthy Hospital Food Initiative is expanding its reach: In the past year, 16 private hospitals have signed on.

Earlier this month, the city moved to ban the sale of big sodas and other sugary drinks at fast-food restaurants and theaters, beginning in March. Critics say the hospital initiative is yet another sign that Bloomberg is running a "nanny state," even though the guidelines are voluntary and other cities — including Boston — have undertaken similar efforts.

Hospitals say it would be hypocritical of them to serve unhealthy food to patients who are often suffering from obesity and other health problems.

"If there's any place that should not allow smoking or try to make you eat healthy, you would think it'd be the hospitals," Bloomberg said Monday. "We're doing what we should do and you'll see, I think, most of the private hospitals go along with it."

The cafeteria crackdown will ban deep fryers, make leafy green salads a mandatory option and allow only healthy snacks to be stocked near the cafeteria entrance and at cash registers. At least half of all sandwiches and salads must be made or served with whole grains. Half-size sandwich portions must be available for sale.

"People sometimes right now don't have healthy options," said Christine Curtis, the city Health Department's director of nutrition strategy. "So you are there at 2 in the morning and maybe your only choice is soda and chips."

Marcelle Scott brought her own chips and soda into the lobby of Manhattan's privately operated St. Luke's-Roosevelt Hospital — there was no vending machine in sight — as she waited for her daughter to give birth Monday. It wasn't the first time the unemployed security guard from the Bronx got the "munchies" for junk food to keep calm while awaiting the outcome of a loved one's medical procedure.

"I like my Snickers and my Mars Bars — especially if I'm nervous for somebody who's inside," she said.

Most hospitals have already overhauled their vending machines by allowing only two types of 12-ounce high-calorie beverages at each vending machine — and they must be featured on the lowest rack. Hospital vending machines have also swapped out most baked goods for snacks like granola bars and nuts.

At privately run Montefiore Medical Center, which operates several hospitals in the Bronx, changes have been under way for a couple of years.

"We took ice cream out of the cafeterias and began serving more whole grains," said Dr. Andrew Racine, chief medical officer. "We changed white rice to brown rice."

Herbert Padilla, a retired Manhattan hairdresser, was sitting a few feet from a giant coke machine Monday in an outpatient waiting area at St. Luke's-Roosevelt, where he was undergoing treatment for a nerve disorder. He said that in general, he supports efforts to keep people from overdosing on junk food, but "we shouldn't be forced into this by a hospital."

"The mayor is going too far with this. It's ridiculous," he said. "We're being told what to eat and what to drink. We're not living in a free country anymore."

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New York City quietly launched a pilot program last year that allows a school nurse or doctor to dispense free emergency contraceptive pills and birth control pills to girls at 13 public high schools. High schools nationwide have distributed condoms for years, but the New York City program may be one of the first to provide contraceptive pills.

The program, called CATCH, or Connecting Adolescents To Comprehensive Healthcare, is aimed at reducing unplanned teen pregnancy. It began in January 2011, but wasn't publicized until the New York Post reported it over the weekend.

“In any given every year there are about 7,000 pregnancies to girls ages 15 to 17 in New York City, about 90 percent of those are unintended,” said Deborah Kaplan, assistant commissioner at the city health department’s Bureau of Maternal, Infant and Reproductive Health. "We wanted to make sure young people who are sexually active have easy access to contraceptive services and general reproductive health services."

Oral contraceptives, including the morning-after Plan B pill, have been available to students at most of the 40 schools that have school-based health centers for the last one to four years, depending on the school, Kaplan said. The centers, which serve about one-quarter of New York City’s public high school students, provide primary care health services and are run privately by separate institutions like hospitals.

For the first time, with the CATCH program, the Health Department is making the contraceptives available in schools without the private health centers. The program began in January 2011 in five schools, and is now in 13 schools. The schools were chosen because they are in neighborhoods with high teen pregnancy rates or with limited resources for young people to get contraception. City high schools have long provided condoms.

Parents learned of the program through a letter that gave them a chance to opt out, which 1 percent to 2 percent of parents did, she said.

“We’ve had no negative reaction to the CATCH program,” Kaplan said. “We haven’t had one objection. We’ve just had the opt-outs.”

The pilot program offers pregnancy testing, along with the Plan B morning-after emergency contraceptive pill, which helps prevent pregnancy when taken within 72 hours, and traditional birth control pills. To get Plan B, girls must see a nurse, who would obtain a doctor’s order for the drug, Kaplan said. For oral contraceptives, they would need to see a Health Department doctor, Kaplan said.

The Health Department is studying to the program before deciding whether to expand. In the last school year, fewer than 1,200 of the 12,000 girls enrolled in the 13 schools obtained the oral contraceptives. For the 2011-2012 school year, 567 students received Plan B and 580 received birth control pills, Kaplan said. Of the unplanned teen pregnancies in the city, about 64 percent are terminated, the city says.

Dr. Cora Breuner, a member of the American Academy of Pediatrics Committee on Adolescence, called the program, “totally new. Totally awesome.”

Teens nationwide aren’t doing a good job using birth control to prevent pregnancy and sexually transmitted diseases, she said, and most do not have access to contraception at school.

“This is the first time that a school nurse can give both Plan B and oral contraceptives to their students,” Breuner said. “This is great because it improves access to contraception and promotes education on reproductive health.”

Dr. John Santelli, an adolescent medicine specialist and professor at Columbia University who studies contraception use, said the program sends a strong message to sexually active teens about the need for contraception.

“Kids that see that level of support for condoms and contraception are more likely to use it,” he said. “It’s a big deal in the sense that it’s going to help the young woman that comes in, or the young man in the case of condoms, and it’s a strong statement to young people that contraception is important.”

Santelli predicted that the program will be effective, and said it could be replicated elsewhere. “I could see other big cities doing this,” he said. “I hope they do.”

The program is not without critics, though.

Valerie Huber, president of the National Abstinence Education Association, saw the program as an expansion of sex education and said the school system is not providing “meaningful skill building for abstinence education.”

"This new service is kind of, no pun intended, a plan D for what to do if sex education doesn’t work," Huber said. “We think it normalizes teen sex and does nothing to prevent sexually transmitted diseases.”

Kaplan, from the Health Department, noted that 38 percent of teenagers are sexually active, and said the city is committed to keeping them safe.

“We’re proud to play that role in promoting and protecting the health of our young people,” she said.

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