Child brides give voice to their defiance in Yemen

Child brides give voice to their defiance in Yemen
By Robert F. Worth
Sunday, June 29, 2008

JIBLA, Yemen: One morning last month, Arwa Abdu Muhammad Ali walked out of her husband's house here and ran to a local hospital, where she complained that he had been beating and sexually abusing her for eight months.

That alone would be surprising in Yemen, a deeply conservative Arab society where family disputes tend to be solved privately. What made it even more unusual was that Arwa was 9 years old.

Within days, Arwa - a tiny, delicate-featured girl - had become a celebrity in Yemen, where child marriage is common but has rarely been exposed in public. She was the second child bride to come forward in less than a month; in April, a 10-year-old named Nujood Ali had gone by herself to a courthouse to demand a divorce, generating a landmark legal case.

Together, the two girls' stories have helped spur a movement to put an end to child marriage, which is increasingly seen as a crucial part of the cycle of poverty in Yemen and other developing countries.

Pulled out of school and forced to have children before their bodies are ready, many rural Yemeni women end up illiterate and with serious health problems. Their babies are often stunted, too.

The average age of marriage in Yemen's rural areas is 12 to 13, a recent study by Sana University researchers found. The country, at the southern corner of the Arabian Peninsula, has one of the highest maternal mortality rates in the world.

"This is the first shout," said Shada Nasser, a human rights lawyer who met Nujood, the 10-year-old, after she arrived at the courthouse to demand a divorce. Nasser decided instantly to take her case. "All other early marriage cases have been dealt with by tribal sheiks, and the girl never had any choice."

But despite a rising tide of outrage, the fight against the practice is not easy. Hard-line Islamic conservatives, whose influence has grown enormously in the past two decades, defend it, pointing to the Prophet Muhammad's marriage to a 9-year-old. Child marriage is deeply rooted in local custom here, and even enshrined in an old tribal expression: "Give me a girl of 8, and I can give you a guarantee" for a good marriage.

"Voices are rising in society against this phenomenon and its catastrophes," said Shawki al-Qadhi, an imam and opposition member in Parliament who has tried unsuccessfully to muster support for a legal ban on child marriage in Yemen in the past. "But despite rejections of it by many people and some religious scholars, it continues."

The issue first arose because of Nujood, a bright-eyed girl barely 1.2 meters, or 4 feet, tall. Her ordeal began in February, when her father took her from Sana, the Yemeni capital, to his home village for the wedding.

She was given almost no warning.

"I was very frightened and worried," Nujood recalled as she sat cross-legged on the floor in her family's bare three-room home in a slum not far from Sana's airport. "I wanted to go home."

As she told her story, Nujood gradually gained confidence, smiling shyly as if she were struggling to hold back laughter. Later, she removed her veil, revealing her shoulder-length brown hair.

The trouble started on the first night, when her 30-year-old husband, Faez Ali Thamer, took off her clothes as soon as the light was out. She ran crying from the room, but he caught her, brought her back and forced himself on her. Later, he beat her as well.

"I hated life with him," she said, staring at the ground in front of her. The wedding came so quickly that no one bothered to tell her how women become pregnant, or what a wife's role is, she added.

Her father, Ali Muhammad al-Ahdal, said he had agreed to the marriage because two of Nujood's older sisters had been kidnapped and forcibly married, with one of them ending up in jail. Al-Ahdal said he had feared the same thing would happen to Nujood, and early marriage had seemed a better alternative.

A gaunt, broken-looking man, Ahdal once worked as a street sweeper. Now he and his family beg for a living. He has 16 children by two women.

Poverty is one reason so many Yemeni families marry their children off early. Another is the fear of girls being carried off and married by force. But most important are cultural tradition and the belief that a young virginal bride can best be shaped into a dutiful wife, according to a comprehensive study of early marriage published by Sana University in 2006.

Nujood complained repeatedly to her husband's relatives and later to her own parents after the couple moved back to their house in Sana.

But they said they could do nothing. To break a marriage would expose the family to shame. Finally, her uncle told her to go to court. On April 2, she said, she walked out of the house by herself and hailed a taxi.

It was the first time she had traveled anywhere alone, Nujood recalled, and she was frightened. On arriving at the courthouse, she was told the judge was busy, so she sat on a bench and waited.

Suddenly he was standing over her, imposing in his dark robes.

"You're married?" he said, with shock in his voice.

Right away, he invited her to spend the night at his family's house, she said, since court sessions were already over for the day.

There, she spent hours watching television, something she had never known in her family's slum apartment, which lacks even running water.

When Nujood's case was called on the next Sunday, the courtroom was crowded with reporters and photographers, alerted by her lawyer. Her father and husband were also there; the judge had jailed them the night before to ensure that they would appear in court. (Both were released the next day.) "Do you want a separation, or a permanent divorce?" Qadhi asked the girl, after hearing her testimony and that of her father and her husband.

"I want a permanent divorce," she replied, without hesitation.

The judge granted it.

Afterward, Nasser, the lawyer, took Nujood to a celebratory party at the offices of a local newspaper, where she was showered with dolls and other toys. Nujood lived with her uncle for a time after the ruling but then insisted on returning to her father's house. "I have forgiven him," she said. She swears she will never marry again, and she wants to become a human rights lawyer, like Nasser, or perhaps a journalist.

Despite the victory, Nasser and other advocates say they are worried about the lack of legal means to fight early marriage. Nujood's case only reached the court because she took such a wildly unusual step and happened on a sympathetic judge.

"We were lucky with this judge," Nasser said. "Another judge might not have accepted her in court and would have asked her father or brother to come instead," and Nujood would probably still be married today.

A 1992 Yemeni law set the minimum legal age of marriage at 15. But in 1998 Parliament revised it, allowing girls to be married earlier as long as they did not move in with their husbands until they reached sexual maturity.

That change reflected the triumph of northern Yemen's more conservative Islamic culture over the secular and Marxist south after North and South Yemen united in 1990. In South Yemen, the government had passed a law in 1979 setting the age of marriage at 16 for women and 18 for men. An extensive public awareness campaign, including songs and television spots with titles like "The Victimized Daughter of the Tribe" and "Traditions and Rituals" helped educate people about the dangers posed by early marriage and pregnancy.

But in Yemen, as in Afghanistan - another country where child marriage is common - the fight against Communism ended with the triumph of a hard-line form of Islam. After war between the south and the north broke out in 1994, Ali Abdullah Saleh, then North Yemen's president, sent jihadists to fight South Yemen, and critics say he has become politically indebted to conservative Islamists.

After Nujood's case became public, Nasser said she received angry letters from conservative women denouncing her for her role. But she has also begun receiving calls about girls, some younger than Nujood, trying to escape their marriages.

One of them was Arwa, who was married last year at the age of 8 here in the ancient town of Jibla, four hours south of Sana. As with Nujood's case, Arwa's situation aroused a legal and social outrage.

Standing outside a relative's house here, her hands clasped in front of her, Arwa described how surprised she was when her father arranged her marriage to a 35-year-old man eight months ago. Like Nujood, she did not know the facts of life, she said. The man raped and beat her.

Finally, after months of misery, she ran to a hospital. Employees there took her to a police station, she said. A local judge, on receiving her case, briefly jailed the judge who had approved the marriage contract. Arwa is living with relatives while her case awaits a resolution. But her relatives rarely let her out of the house, fearing that her husband, who has refused the judge's demands that he appear in court, may take her again.

Asked what made her flee her husband after so many months, Arwa gazed up, an intense, defiant expression in her eyes.

"I thought about it," she said in a very quiet but firm voice. "I thought about it."



Copyright © 2008 The International Herald Tribune www.iht.com

Which way is north?

Which way is north?

Whether you're lost in the woods or you're trying to install a sundial in your yard, you're bound to want to find true north from time to time, and chances are when the time comes you won't have a compass. What's more, even if you do have a compass, it will point to magnetic north, which, depending on your location in the world, can vary a great deal from true north. So what's an intrepid explorer to do? Read this article to find several different ways to find your way.

Steps

The Shadow-Tip Method

Place a straight stick straight upright in the ground so that you can see its shadow. Alternatively, you can use the shadow of a fixed object that is perpendicular to the ground. Nearly any object will work, but the taller the object is, the easier it will be to see the movement of its shadow, and the narrower the tip of the object is, the more accurate the reading will be. Make sure the shadow is cast on a level, brush-free spot.

Mark the tip of the shadow with a small object, such as a pebble, or a distinct scratch in the ground. Try to make the mark as small as possible so as to pinpoint the shadow's tip, but make sure you can identify the mark later.

Wait 10-15 minutes. The shadow will move approximately from west to east in an arc which depends on your latitude and the season. Mark the new position of the shadow's tip with another small object or scratch. It will likely move only a short distance.

Draw a straight line in the ground between the two marks. This is an east-west line.

Stand with the first mark (west) on your left, and the other (east) on your right. You are now facing aproximately toward true north.

(Accuracy improves as your location approaches the equator, and as the time of year aproaches either equinox.)


Alternative Shadow-Tip Method for Increased Accuracy

Set up stick and mark first shadow-tip as above. For this method, take your first reading in the morning, at least an hour or so before midday.

Find an object or length of string, etc., exactly the same length as the shadow.

Continue taking measurements of the shadow's length every 10-20 minutes. The shadow will shrink until midday, when it is at its shortest. Then it will gradually grow longer.

Measure the shadow length as the shadow grows. Use the stick or object you used to measure the length of the initial shadow. When the shadow grows to exactly the same length as the stick (and hence exactly the same length as your first measurement), mark the spot.

Draw a line connecting the first and second marks as above. Once again, this is your east-west line, and if you stand with the first mark on your left and the second on your right, you will be facing in the aproximate direction of true north.

(Note: for an exact reading, your two marks need to be made at exact intervals before and after noon where you are, which means when the sun is at its highest point in the sky. Any deviation from this leads to inaccuracy.)


Watch Method: Northern Hemisphere

Find an analog watch (the kind with hour and minute hands) that is set accurately. Place it on a level surface, such as the ground, or hold it horizontal in your hand.

Point the hour hand at the sun. You can use a stick to cast a shadow to aid in your alignment if you wish, but it is not necessary.

Bisect (that is, find the center point of) the angle between the hour hand and the twelve o'clock mark (the number 12 on the watch). The center of the angle between the hour hand and twelve o'clock mark is the north-south line. If you don't know which way is north and which south, just remember that no matter where you are, the sun rises in the east and sets in the west. In the northern hemisphere the sun is due south at midday. If your watch is set to daylight saving time bisect the angle between the hour hand and the one o'clock mark instead.

Watch Method: Southern Hemisphere

Use an analog watch as above, and point the watch's twelve o'clock mark (the number 12) toward the sun. If your watch is set to daylight savings time, point the one o'clock mark toward the sun.

Bisect the angle between the twelve o'clock mark (or one o'clock mark if using daylight saving time) and the hour hand to find the north-south line. If you're unsure which way is north, remember that the sun rises in the east and sets in the west no matter where you are. In the southern hemisphere, however, the sun is due north at midday.

Using the Stars: Northern Hemisphere

Locate the North Star (Polaris) in the night sky. The North Star is the last star in the handle of the Little Dipper constellation. If you have trouble finding it, find the Big Dipper. The two lowest stars in the Big Dipper (the outermost stars of the cup of the dipper) form a straight line that "points" to the North Star. You may also find the constellation Cassiopeia, which is always opposite the Big Dipper. The North Star is located about midway between the central star of Cassiopeia and the Big Dipper (see figure).

Draw an imaginary line straight down from the North Star to the ground. This direction is true north, and if you can find a landmark in the distance at this point, you can use it to guide yourself.

Using the Stars: Southern Hemisphere

Find the Southern Cross constellation. In the southern hemisphere, the North Star is not visible, and no single star always indicates north or south, but you can use the Southern Cross as your guide. This constellation is formed by five stars, and the four brightest stars form a cross that is angled to one side.

Identify the two stars that make up the long axis of the cross. These stars form a line which "points" to an imaginary point in the sky which is above the South Pole. Follow the imaginary line down from the two stars five times the distance between them.

Draw an imaginary line from this point to the ground, and try to identify a corresponding landmark to steer by. Since this is true south, true north is directly opposite it (behind you as you are looking at the point).

Moon Method

Observe the moon. If it is not a full moon and rises before the sun sets, the illuminated side is west. If the moon rises after midnight (standard time) the illuminated side is east. This is true everywhere on Earth.

Approximate north and south based on the rough east-west line of the moon. No matter where you are, if you are standing with the west side to your left, true north will be straight ahead.

Tips

These methods may require practice to perfect, so it's a good idea to try them a couple times when you can check your readings. That way, you'll be able to rely on them if you're in a survival situation.

Warnings

The shadow-tip methods are not recommended in the polar regions, which are latitudes above 60° in either hemisphere.

The watch method is not recommended in lower latitudes, particularly below 20° in either hemisphere.

The North Star becomes higher in the sky the further north you travel, and it is not useful about 70° N latitude.

_______________

Clues from Homer classic help date 'Odyssey' slaughter

Clues from Homer classic help date 'Odyssey' slaughter

Story Highlights
Scholars may now know the date King Odysseus returned from the Trojan War
They believe the warrior slaughtered his rivals on April 16, 1178 B.C.
Experts use clues from star and sun positions cited by ancient Greek poet Homer
Scholars debate whether Homer's books reflect the actual history of the Trojan War


WASHINGTON (AP) -- Using clues from star and sun positions mentioned by the ancient Greek poet Homer, scholars think they have determined the date when King Odysseus returned from the Trojan War and slaughtered a group of suitors who had been pressing his wife to marry one of them.

It was April 16, 1178 B.C., that the great warrior struck with arrows, swords and spears, killing those who sought to replace him, a pair of researchers say in Monday's online edition of Proceedings of the National Academy of Science.

Experts have long debated whether the books of Homer reflect the actual history of the Trojan War and its aftermath.

Marcelo O. Magnasco of Rockefeller University in New York and Constantino Baikouzis of the Astronomical Observatory in La Plata, Argentina, acknowledge that they had to make some assumptions to determine the date Odysseus returned to his kingdom of Ithaca.

But interpreting clues in Homer's "Odyssey" as references to the positions of stars and a total eclipse of the sun allowed them to determine when a particular set of conditions would have occurred.

"What we'd like to achieve is to get the reader to pick up the 'Odyssey' and read it again and ponder," Magnasco said. "And to realize that our understanding of these texts is quite imperfect, and even when entire libraries have been written about Homeric studies, there is still room for further investigation."

Their study could add support to the accuracy of Homer's writing.

"Under the assumption that our work turns out to be correct, it adds to the evidence that he knew what he was talking about," Magnasco said. "It still does not prove the historicity of the return of Odysseus. It only proves that Homer knew about certain astronomical phenomena that happened much before his time."

Homer reports that on the day of the slaughter, the sun is blotted from the sky, possibly a reference to an eclipse. In addition, he mentions more than once that it is the time of a new moon, which is necessary for a total eclipse, the researchers say.

Other clues include:

• Six days before the slaughter, Venus is visible and high in the sky.

• Twenty-nine days before, two constellations -- the Pleiades and Bootes -- are simultaneously visible at sunset.

• And 33 days before, Mercury is high at dawn and near the western end of its trajectory. This is the researchers' interpretation, anyway. Homer wrote that Hermes, the Greek name for Mercury, traveled far west to deliver a message.

"Of course, we believe it's amply justified, otherwise we would not commit it to print. However, we do recognize there's less ammunition to defend this interpretation than the others," Magnasco said.

"Even though the other astronomical references are much clearer, our interpretation of them as allusions to astronomical phenomena is an assumption," he added via e-mail.

For example, Magnasco said, Homer writes that as Odysseus spread his sails out of Ogygia, "sleep did not weigh on his eyelids as he watched the Pleiades, and late-setting Bootes and the Bear."

"We assume he means that as Odysseus set sail shortly after sunset, at nautical twilight the Pleiades and Bootes were simultaneously visible and that Bootes would be the later-setting of the two," Magnasco explained.

"It is a good assumption, because every member of his audience would know what was being discussed, as the Pleiades and Bootes were important to them to know the passage of the seasons and would be very familiar with which times of the year they were visible. Remember, the only calendar they had was the sky."

Because the occurrence of an eclipse and the various star positions repeat over time, Magnasco and Baikouzis set out to calculate when they would all occur in the order mentioned in the "Odyssey."

And their result has Odysseus exacting his revenge April 16, 1178 B.C.



Copyright 2008 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed.
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Orion's Twin Stars Have Their Differences

Orion's Twin Stars Have Their Differences
Irene Klotz, Discovery News

June 18, 2008 -- Astronomers presumed that stars born at the same time, in the same parent cloud, and with the same mass would, like identical human twins, have the same physical attributes.

So it was a surprise to discover that a pair of twins in the Orion nebula, a popular stellar nursery about 1,500 light-years away, have different temperatures and luminosities. One star is apparently developmentally delayed, relative to its partner.

The twins are known as Par 1802.

"Par 1802 provides direct evidence that birth order in 'identical twin' stars can manifest itself as observable physical differences between the two stars -- at least when they are very young," writes Vanderbilt University astronomer Keivan Stassun in this week's issue of the journal Nature.

Stassun and colleagues found that the twins' surface temperatures differ by about 10 percent, or 300 degrees Kelvin (80 degrees Fahrenheit) and that one star is 50 percent brighter than its sibling. The scientists also strongly suspect one star is up to 10 percent bigger than the other.
"The easiest way to explain these differences is if one star was formed about 500,000 years before its twin," Stassun said. "That is equivalent to a human birth-order difference of about half of a day."

The discovery is more than a curiosity: Par 1802 is an eclipsing binary star system, meaning the twins periodically orbit in front of one another, relative to Earth, temporarily and regularly blocking its partner's light. Such phenomena are yardsticks for measuring stars' basic physical properties and for testing theories about stellar evolution.

"Very young eclipsing binaries like this are the Rosetta stones that tell us about the life history of newly formed stars," Stassun said.

Thousands of young stars may need to have their ages re-adjusted by as much as 20 percent for average-sized stars and 50 percent for low-mass stars like brown dwarfs, the scientists estimated.

"The lack of age synchronization in Par 1802 suggests a precision limit of several hundred thousand years," the scientists concluded.

Eclipsing binaries are very rare -- only about one in 1,000 stars. The researchers made the discovery after 15 years of collecting data on stars in Orion, during which time they found three eclipsing binary pairs.

Par 1802 is the only one of the three with equal-mass stars, and it is the only eclipsing binary ever found anywhere with same-mass stars young enough -- less than a million years old -- for physical differences to still be apparent, Stassun told Discovery News.

"We were pretty surprised when we first discovered the differences in temperature, brightness and diameter, but in truth maybe we should not have been," Stassun said.

"We naively expected stars born at the same time, with the same mass and of the same stuff to look the same, but our current theories of binary star formation don't actually make predictions," he said. "This is really an important new piece of information."

Copyright © 2008 Discovery Communications, LLC. The number-one nonfiction media company. -->

Red wine found to be more potent than thought at extending lifespan

Red wine found to be more potent than thought at extending lifespan
By Nicholas Wade
Thursday, June 5, 2008
Red wine may be much more potent than was thought in extending human life span, researchers say in a new report that is likely to give impetus to the rapidly growing search for longevity drugs.
The study is based on dosing mice with resveratrol, an ingredient of some red wines. Some scientists are already taking resveratrol in capsule form, but others believe it is far too early to take the drug, especially using wine as its source, until there is better data on its safety and effectiveness.
The report is part of a new wave of interest in drugs that may enhance longevity. On Monday, Sirtris, a startup founded in 2004 to develop drugs with the same effects as resveratrol, completed its sale to GlaxoSmithKline for $720 million.
Sirtris is seeking to develop drugs that activate protein agents known in people as sirtuins.
"The upside is so huge that, if we are right, the company that dominates the sirtuin space could dominate the pharmaceutical industry and change medicine," Dr. David Sinclair of the Harvard Medical School, a co-founder of the company, said Tuesday.
Serious scientists have long derided the idea of life-extending elixirs, but the door has now been opened to drugs that exploit an ancient biological survival mechanism, that of switching the body's resources from fertility to tissue maintenance. The improved tissue maintenance seems to extend life by cutting down on the degenerative diseases of aging.
The reflex can be prompted by a famine-like diet, known as caloric restriction, which extends the life of laboratory rodents by up to 30 percent, but is far too hard for most people to keep to and in any case has not been proved to work in humans.
Research started nearly 20 years ago by Dr. Leonard Guarente of the Massachusetts Institute of Technology showed recently that the famine-induced switch to tissue preservation may be triggered by activating the body's sirtuins. Sinclair, a former student of his, then found in 2003 that sirtuins could be activated by a number of natural compounds, including resveratrol, previously known as just an ingredient of certain red wines.
Sinclair's finding led in several directions. He and others have tested resveratrol's effects in mice, mostly at doses far higher than the minuscule amounts present in red wine.
One of the more spectacular results was obtained last year by Dr. John Auwerx of the Institute of Genetics and Molecular and Cellular Biology in Illkirch, France. He showed that resveratrol could turn plain vanilla couch-potato mice into champion athletes, making them run twice as far on a treadmill before collapsing.
Sirtris, meanwhile, has been testing resveratrol and other drugs that activate sirtuin. These drugs are small molecules, more stable than resveratrol, and can be given in smaller doses.
Separately from Sirtris's investigations, a research team led by Tomas Prolla and Richard Weindruch, of the University of Wisconsin, reports in the journal PLoS One on Wednesday that resveratrol may be effective in mice and people in much lower doses than previously thought necessary.
In earlier studies, like Auwerx's of mice running treadmills, the animals were fed such large amounts of resveratrol that to gain equivalent dosages people would have to drink more than 100 bottles of red wine a day.
The Wisconsin scientists used a dose on mice equivalent to just 35 bottles a day. But red wine contains many other resveratrol-like compounds that may also be beneficial. Taking these into account, as well as mice's higher metabolic rate, a mere four 5-ounce glasses of wine "starts getting close" to the amount of resveratrol they found effective, Weindruch said.
Resveratrol can also be obtained in the form of capsules marketed by several companies. Those made by one company, Longevinex, include extracts of red wine and of a Chinese plant called giant knotweed. The Wisconsin researchers conclude that resveratrol can mimic many of the effects of a caloric-restricted diet "at doses that can readily be achieved in humans."
The effectiveness of the low doses was not tested directly, however, but with a DNA chip that measures changes in the activity of genes. The Wisconsin team first defined the pattern of gene activity established in mice on caloric restriction, and then showed that very low doses of resveratrol produced just the same pattern.
Auwerx, who used doses almost 100 times greater in his treadmill experiments, expressed reservations about the new result. "I would be really cautious, as we never saw significant effects with such low amounts," he said Tuesday in an e-mail message.
Another researcher in the sirtuin field, Dr. Matthew Kaeberlein of the University of Washington in Seattle, said, "There's no way of knowing from this data, or from the prior work, if something similar would happen in humans at either low or high doses."
Notes:

Copyright © 2008 The International Herald Tribune www.iht.com

The science of sarcasm (not that you care)

The science of sarcasm (not that you care)
By Dan Hurley
Thursday, June 5, 2008
There was nothing very interesting in Katherine Rankin's study of sarcasm — at least, nothing worth your important time. All she did was use an M.R.I. to find the place in the brain where the ability to detect sarcasm resides. But then, you probably already knew it was in the right parahippocampal gyrus.
What you may not have realized is that perceiving sarcasm, the smirking put-down that buries its barb by stating the opposite, requires a nifty mental trick that lies at the heart of social relations: figuring out what others are thinking. Those who lose the ability, whether through a head injury or the frontotemporal dementias afflicting the patients in Rankin's study, just do not get it when someone says during a hurricane, "Nice weather we're having."
"A lot of the social cognition we take for granted and learn through childhood, the ability to appreciate that someone else is being ironic or sarcastic or angry — the so-called theory of mind that allows us to get inside someone else's head — is characteristically lost very early in the course of frontotemporal dementia," said Bradley Boeve, a behavioral neurologist at the Mayo Clinic in Rochester, Minnesota
"It's very disturbing for family members, but neurologists haven't had good tools for measuring it," he went on. "That's why I found this study by Kate Rankin and her group so fascinating."
Rankin, a neuropsychologist and assistant professor in the Memory and Aging Center at the University of California, San Francisco, used an innovative test developed in 2002, the Awareness of Social Inference Test, or Tasit. It incorporates videotaped examples of exchanges in which a person's words seem straightforward enough on paper, but are delivered in a sarcastic style so ridiculously obvious to the able-brained that they seem lifted from a sitcom.
"I was testing people's ability to detect sarcasm based entirely on paralinguistic cues, the manner of expression," Rankin said.
In one videotaped exchange, a man walks into the room of a colleague named Ruth to tell her that he cannot take a class of hers that he had previously promised to take. "Don't be silly, you shouldn't feel bad about it," she replies, hitting the kind of high and low registers of a voice usually reserved for talking to toddlers. "I know you're busy — it probably wasn't fair to expect you to squeeze it in," she says, her lips curled in derision.
Although people with mild Alzheimer's disease perceived the sarcasm as well as anyone, it went over the heads of many of those with semantic dementia, a progressive brain disease in which people forget words and their meanings.
"You would think that because they lose language, they would pay close attention to the paralinguistic elements of the communication," Rankin said.
To her surprise, though, the magnetic resonance scans revealed that the part of the brain lost among those who failed to perceive sarcasm was not in the left hemisphere of the brain, which specializes in language and social interactions, but in a part of the right hemisphere previously identified as important only to detecting contextual background changes in visual tests.
"The right parahippocampal gyrus must be involved in detecting more than just visual context — it perceives social context as well," Rankin said.
The discovery fits with an increasingly nuanced view of the right hemisphere's role, said Anjan Chatterjee, an associate professor in the Center for Cognitive Neuroscience at the University of Pennsylvania.
"The left hemisphere does language in the narrow sense, understanding of individual words and sentences," Chatterjee said. "But it's now thought that the appreciation of humor and language that is not literal, puns and jokes, requires the right hemisphere."
Boeve, at the Mayo Clinic, said that beyond the curiosity factor of mapping the cognitive tasks of the brain's ridges and furrows, the study offered hope that a test like Tasit could help in the diagnosis of frontotemporal dementia.
"These people normally do perfectly well on traditional neuropsychological tests early in the course of their disease," he said. "The family will say the person has changed dramatically, but even neurologists will often just shrug them off as having a midlife crisis."
Short of giving such a test, he said, the best way to diagnose such problems is by talking with family members about how the person has changed over time.
After a presentation of her findings at the American Academy of Neurology's annual meeting in April, Rankin was asked whether even those with intact brains might have differences in brain areas that explain how well they pick up on sarcasm.
"We all have strengths and weaknesses in our cognitive abilities, including our ability to detect social cues," she said. "There may be volume-based differences in certain regions that explain variations in all sorts of cognitive abilities."
So is it possible that Jon Stewart, who wields sarcasm like a machete on "The Daily Show," has an unusually large right parahippocampal gyrus?
"His is probably just normal," Rankin said. "The right parahippocampal gyrus is involved in detecting sarcasm, not being sarcastic."
But, she quickly added, "I bet Jon Stewart has a huge right frontal lobe; that's where the sense of humor is detected on M.R.I."
A spokesman for Stewart said he would have no comment — not that a big-shot television star like Jon Stewart would care about the size of his neuroanatomy.
Notes:

Copyright © 2008 The International Herald Tribune www.iht.com

Scientists discover macaque monkeys in Indonesia that fish

Scientists discover macaque monkeys in Indonesia that fish
The Associated Press
Tuesday, June 10, 2008
BANGKOK, Thailand: Long-tailed macaque monkeys have a reputation for knowing how to find food — whether it be grabbing fruit from jungle trees or snatching a banana from a startled tourist.
Now, researchers say they have discovered groups of the silver-haired primates in Indonesia that fish.
Groups of long-tailed macaques were observed four times over the past eight years scooping up small fish with their hands and eating them along rivers in Indonesia's East Kalimantan and North Sumatra provinces, according to researchers from The Nature Conservancy and the Great Ape Trust.
The species had been known to eat fruit and forage for crabs and insects, but never before fish from rivers.
"It's exciting that after such a long time you see new behavior," said Erik Meijaard, one of the authors of a study on fishing macaques that appeared in last month's International Journal of Primatology. "It's an indication of how little we know about the species."
Meijaard, a senior science adviser at The Nature Conservancy, said it was unclear what prompted the long-tailed macaques to go fishing. But he said it showed a side of the monkeys that is well-known to researchers — an ability to adapt to the changing environment and shifting food sources.
"They are a survivor species which has the knowledge to cope with difficult conditions," Meijaard said Tuesday. "This behavior potentially symbolizes that ecological flexibility."
The other authors of the paper, which describes the fishing as "rare and isolated" behavior, are The Nature Conservancy volunteers Anne-Marie E. Stewart, Chris H. Gordon and Philippa Schroor, and Serge Wich of the Great Ape Trust.
Some other primates have exhibited fishing behavior, Meijaard wrote, including Japanese macaques, chacma baboons, olive baboons, chimpanzees and orangutans.
Agustin Fuentes, a University of Notre Dame anthropology professor who studies long-tailed macaques, or macaca fascicularis, on the Indonesian island of Bali and in Singapore, said he was "heartened" to see the finding published because such details can offer insight into the "complexity of these animals."
"It was not surprising to me because they are very adaptive," he said. "If you provide them with an opportunity to get something tasty, they will do their best to get it."
Fuentes, who is not connected with the published study, said he has seen similar behavior in Bali, where he has observed long-tailed macaques in flooded paddy fields foraging for frogs and crabs. He said it affirms his belief that their ability to thrive in urban and rural environments from Indonesia to northern Thailand could offer lessons for endangered species.
"We look at so many primate species not doing well. But at the same time, these macaques are doing very well," he said. "We should learn what they do successfully in relation to other species."
Still, Fuentes and Meijaard said further research was needed to understand the full significance of the behavior. Among the lingering questions are what prompted the monkeys to go fishing and how common it is among the species.
Long-tailed macaques were twice observed catching fish by The Nature Conservancy researchers in 2007, and Wich spotted them doing it two times in 1998 while studying orangutans.
Wich said it wasn't until Meijaard told him about his fishing macaques that he realized he had overlooked the unique behavior altogether.
"I was astonished. I thought it was a normal observation," Wich said. "I was really surprised because it indicated to me that you keep on making these observation about primates but you only discover they are interesting when you compare them with others."
Meijaard said the fishing behavior could be prompted by food shortages, droughts resulting in lower water levels that make it easier to catch fish, or habitat destruction that eliminates a key food source.
"There have been studies on macaques from East Kalimantan in the past showing that during especially dry years they run out of food and switch to alternative food sources such as insects, leaves or even bark, which is not normally in their diet," he said.
Meijaard also said he felt the behavior was not isolated to a few macaques, noting that he observed younger monkeys watching their elders fish and then mimicking their behavior. He also said the behavior occurred in two unrelated groups.
Paul Garber, an expert on primate behavior at the University of Illinois who read the study, said there was not enough information to determine whether it was something that was part of the macaques' culture or an isolated event. But he said it warranted further study.
"What I feel is most interesting about the observations of fishing is the possibility of documenting whether and how this novel behavior is passed or transmitted through the population," he said.
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Copyright © 2008 The International Herald Tribune www.iht.com

Hair analysis deflates Napoleon poisoning theories

Hair analysis deflates Napoleon poisoning theories
By William J. Broad
Tuesday, June 10, 2008
Was Napoleon poisoned?
For decades, scholars and scientists have argued that the exiled dictator, who died in 1821 on the remote island of St. Helena in the South Atlantic, was the victim of arsenic, whether by accident or design.
The murder theory held that his British captors poisoned him; the accident theory said that colored wallpaper in his bedroom contained an arsenic-based dye that mold transformed into poisonous fumes.
The evidence behind both theories was that scientists had found arsenic in hairs from Napoleon's head, which diminished the idea that he had died of stomach cancer. Arsenic is highly toxic, and its poisoning symptoms include violent stomach pains.
"There is nothing improbable about the hypothesis of arsenic poisoning," wrote Frank McLynn in "Napoleon: A Biography" (Arcade, 2002). "Science gives it rather more than warranted assertibility."
But now, a team of scientists at Italy's National Institute of Nuclear Physics in Milan-Bicocca and Pavia has uncovered strong evidence to the contrary. They conducted a detailed analysis of hairs taken from Napoleon's head at four times in his life — as a boy in Corsica, during his exile on the island of Elba, the day he died on St. Helena, at age 51, and the day afterward — and discovered that the arsenic levels underwent no significant rises.
Casting a wide net, the scientists also studied hairs from his son, Napoleon II, and his wife, Empress Josephine. Here, too, they found that the arsenic levels were similar and uniformly high.
The big surprise was that the old levels were roughly 100 times the readings that the scientists obtained for comparison from the hairs of living people.
"The concentrations of arsenic in the hair taken from Napoleon after his death were much higher," the scientists wrote. But the levels were "quite comparable with that found not only in the hair of the emperor in other periods of his life, but also in those of his son and first wife."
The results, they added, "undoubtedly reveal a chronic exposure that we believe can be simply attributed to environmental factors, unfortunately no longer easily identifiable, or habits involving food and therapeutics."
A team of 10 scientists reported their results in a recent issue of the Italian journal Il Nuovo Saggiatore (The New Experimenter). The hair samples of Napoleon and his family came from the Glauco-Lombardi Museum in Parma, Italy, the Malmaison Museum in Paris and the Napoleonic Museum in Rome.
The scientists measured the arsenic levels with great precision by inserting the hairs into a nuclear reactor in Pavia, near Milan. The resulting activation let the team identify trace elements but did not harm the hairs, some more than two centuries old.
A basic element, arsenic in small doses can stimulate the metabolism. In 1780, when Napoleon was a boy, it debuted as a fashionable medicine.
"In the 19th century it was regarded as a popular cure-all, a general tonic and an aphrodisiac," writes John Emsley in "Nature's Building Blocks: An A-Z Guide to the Elements" (Oxford, 2002). "It was often prescribed by doctors to aid convalescence."
Scientists say the body can tolerate fairly large doses of arsenic if the poison is ingested regularly. That appears to be the case with Napoleon and his family.
"All the important people in those times received excessive contamination," said Ettore Fiorini, a team member at the University of Milan-Bicocca. "It was widely used in paints, tapestry, medicine and even the preservation of food."
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Copyright © 2008 The International Herald Tribune www.iht.com

Mediterranean shark populations collapsing, study finds

Mediterranean shark populations collapsing, study finds
By Andrew C. Revkin
Wednesday, June 11, 2008
Headline: Some
Summary: Numbers of five species of sharks in the Mediterranean Sea have declined by more than 96 percent over the last two centuries, a new study suggests.
Some shark populations in the Mediterranean Sea have completely collapsed, according to a new study, with numbers of five species declining by more than 96 percent over the last two centuries.
"This loss of top predators could hold serious implications for the entire marine ecosystem, greatly affecting food webs throughout this region," said the lead author of the study, Francesco Ferretti, a doctoral student in marine biology at Dalhousie University in Nova Scotia.
Particularly troubling, the researchers said, were patterns indicating a lack of mature females, which are essential if populations are to recover even with new conservation measures.
"Because sharks are long-lived and slow to mature, they need fully-grown females to keep their populations reproductively healthy," said Heike Lotze, a study author who is also at Dalhousie.
The study is scheduled for publication in the journal Conservation Biology and was posted online on Wednesday at www.lenfestocean.org by the Lenfest Ocean Program, a private group in Washington that paid for the research.
The study focused on five species for which there were sufficient records to chart a long-term trend - hammerhead, blue and thresher sharks and two types of mackerel sharks. The Mediterranean is home to some 47 shark species, and similar declines are presumed to have occurred in many of them.
Sharks take years to reach sexual maturity and, unlike most other fishes, produce small numbers of young, making them particularly vulnerable to overfishing. Populations have declined worldwide, but experts say the Mediterranean - bordered by many countries with diverse rules and fished intensively for centuries - has experienced bigger losses of sharks and other large predatory fish, including tuna.
The long-term decline in the region was revealed by sifting decades of catch records and other scattered sources of data, which showed that over time the Mediterranean ecosystem has been utterly transformed. With top-tier predators removed, the populations of other fish and invertebrates shift in unpredictable ways.
In November, the World Conservation Union warned that more than 40 percent of shark and ray species in the Mediterranean were threatened with extinction because of intense fishing pressure, including the continued use of drift nets. The nets kill many sharks and rays even when they are not the target of the fishing effort.
A ban on fishing in deep waters (more than about 3,200 feet, or 1,000 meters) and on cutting off shark fins, a delicacy in China, could help, but much more enforcement of laws is needed, the conservation union said.
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Loyal to its roots

Loyal to its roots
By Carol Kaesuk Yoon
Tuesday, June 10, 2008
From its diminutive lavender flowers to its straggly windblown stalks, there is nothing about the beach weed known as the Great Lakes sea rocket to suggest that it might be any sort of a botanical wonder.
Yet scientists have found evidence that the sea rocket is able to do something that no other plant has ever been shown to do.
The sea rocket, researchers report, can distinguish between plants that are related to it and those that are not. And not only does this plant recognize its kin, but it also gives them preferential treatment.
If the sea rocket detects unrelated plants growing in the ground with it, the plant aggressively sprouts nutrient-grabbing roots. But if it detects family, it politely restrains itself.
The finding is a surprise, even a bit of a shock, in part because most animals have not even been shown to have the ability to recognize relatives, despite the huge advantages in doing so.
If an individual can identify kin, it can help them, an evolutionarily sensible act because relatives share some genes. The same discriminating organism could likewise ramp up nasty behavior against unrelated individuals with which it is most sensible to be in claws- or perhaps thorns-bared competition.
"I'm just amazed at what we've found," said Susan Dudley, an evolutionary plant ecologist at McMaster University in Hamilton, Ontario, who carried out the study with a graduate student, Amanda File.
"Plants," Dudley said, "have a secret social life."
Since the research on sea rockets was published in August in Biology Letters, a journal of the United Kingdom's national academy of science, Dudley and colleagues have found evidence that three other plant species can also recognize relatives.
The studies are part of an emerging picture of life among plants, one in which these organisms, long viewed as so much immobile, passive greenery, can be seen to sense all sorts of things about the plants around them and use that information to interact with them.
Plants' social life may have remained mysterious for so long because, as researchers have seen in studies of species like sagebrush, strawberries and thornapples, the ways plants sense can be quite different from the ways in which animals do.
Some plants, for example, have been shown to sense potentially competing neighboring plants by subtle changes in light. That is because plants absorb and reflect particular wavelengths of sunlight, creating signature shifts that other plants can detect.
Scientists also find plants exhibiting ways to gather information on other plants from chemicals released into the soil and air. A parasitic weed, dodder, has been found to be particularly keen at sensing such chemicals.
Dodder is unable to grow its own roots or make its own sugars using photosynthesis, the process used by nearly all other plants. As a result, scientists knew that after sprouting from seed, the plant would fairly quickly need to begin growing on and into another plant to extract the nutrients needed to survive.
But even the scientists studying the plant were surprised at the speed and precision with which a dodder seedling could sense and hunt its victim. In time-lapse movies, scientists saw dodder sprouts moving in a circular fashion, in what they discovered was a sampling of the airborne chemicals released by nearby plants, a bit like a dog sniffing the air around a dinner buffet.
Then, using just the hint of the smells and without having touched another plant, the dodder grew toward its preferred victim. That is, the dodder reliably sensed and attacked the species of plant, from among the choices nearby, on which it would grow best.
"When you see the movies, you very much have this impression of it being like behavior, animal behavior," said Consuelo De Moraes, a chemical ecologist at Pennsylvania State University who was on the team studying the plant. "It's like a little worm moving toward this other plant."
Although a view of plants as sensing organisms is beginning to emerge, scientists have been finding hints of such capabilities and interactions for 20 years. But discoveries have continued to surprise scientists, because of what some describe as an entrenched disbelief that plants, without benefit of eyes, ears, nose, mouth or brain, can and do all they are seen to do.
"A lot of the examples of plant behavior are examples in which the phenomena are pretty easy to observe," said Richard Karban, a plant ecologist at the University of California, Davis.
The problem, for many scientists, is that as obvious as the behaviors sometimes are, they can seem just too complex and animal-like for a plant. "Maybe if we understood more mechanistically how it's happening," Karban added, "we'd feel more comfortable about accepting the results that we're finding."
It does not help credibility that scientists in the field often find themselves having to distinguish the results of careful experimental studies from decidedly nonscientific, even kook-fringe, discussions about phenomena like plant sentience and emotion.
Plants are not "sensitive new age guys who cringe when something around them gets hurt and who love classical music and hate rock," Dudley said as she referred to depictions in popular works of plants living tender, emotion-soaked existences, in particular the 1970s "The Secret Life of Plants."
Even mainstream researchers do not always completely agree on which ideas are clearly within the realm of science and which have gone a bit too far.
Recent debates have revolved around a longstanding question: which of the abilities and attributes that scientists have long considered the realm of just animals, like sensing, learning and memory, can sensibly be transferred to plants?
At the extreme of the equality movement, but still within mainstream science, are the members of the Society of Plant Neurobiology, a new group whose Web site describes it as broadly concerned with plant sensing.
The very name of the society is enough to upset many biologists. Neurobiology is the study of nervous systems — nerves, synapses and brains — that are known just in animals. That fact, for most scientists, makes the notion of plant neurobiology a combination of impossible, misleading and infuriating.
Thirty-six authors from universities that included Yale and Oxford were exasperated enough to publish an article last year, "Plant Neurobiology: No Brain, No Gain?" in the journal Trends in Plant Science. The scientists chide the new society for discussing possibilities like plant neurons and synapses, urging that the researchers abandon such "superficial analogies and questionable extrapolations."
Defenders point out that 100 years ago, some scientists were equally adamant that plant physiology did not exist. Today, that idea is so obviously antiquated that it could elicit a good chuckle from the many scientists in that field.
As for the "superficial analogies," the new wave botanists are well aware that plants do not have exact copies of animal nervous systems.
"No one proposes that we literally look for a walnut-shaped little brain in the root or shoot tip," five authors wrote in defense of the new group. Instead, the researchers say, they are asking that scientists be open to the possibility that plants may have their own system, perhaps analogous to an animal's nervous system, to transfer information around the body.
"Plants do send electrical signals from one part of the plant to another," said Eric Brenner, a botanist at the New York Botanical Garden and a member of the Society of Plant Neurobiology.
Although those signals have been known for 100 years, scientists have no idea what plants do with them.
"No one's asked how all that information is integrated in a plant, partly because we've convinced ourselves that it isn't," Brenner said. "People have been intimidated from asking that question."
The mention of the possibility of plant neurobiology elicits such visceral responses that Brenner said he had at times worried that it could harm his career.
"I see a lot of people waiting on the sidelines," he said, "to see how this all pans out."
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Malthus redux: Is doomsday upon us, again?

Malthus redux: Is doomsday upon us, again?
By Donald G. Mcneil Jr.
Sunday, June 15, 2008
During the last American food-and-gas-price crisis, in the 1970s, one of my colleagues on the Berkeley student newspaper told me that he and his semi-communal housemates had taken a vote. They'd calculated they could afford meat or coffee. They chose coffee.
The decision was slightly less effete than it sounds now — the Starbucks clone wars were still some years off, so he was talking about choosing Yuban over ground chuck. But it nonetheless said something about us as spoiled Americans. Riots were relatively common in Berkeley in those days. But they were never about food. (That particular revolution was starting without us on Shattuck Avenue, where Chez Panisse had just opened.)
However, elsewhere on the globe, people were on the edge of starvation. Grain prices were soaring, rice stocks plummeting. In Ethiopia and Cambodia, people were well over the edge, and food riots helped lead to the downfall of Emperor Haile Selassie and the victory of the Khmer Rouge.
Now it's happening again. While Americans grumble about gasoline prices, food riots have seared Bangladesh, Egypt and African countries. In Haiti, they cost the prime minister his job. Rice-bowl countries like China, India and Indonesia have restricted exports and rice is shipped under armed guard.
And again, Thomas Malthus, a British economist and demographer at the turn of the 19th century, is being recalled to duty. His basic theory was that populations, which grow geometrically, will inevitably outpace food production, which grows arithmetically. Famine would result. The thought has underlain doomsday scenarios both real and imagined, from the Great Irish Famine of 1845 to the Population Bomb of 1968.
But over the last 200 years, with the Industrial Revolution, the Transportation Revolution, the Green Revolution and the Biotech Revolution, Malthus has been largely discredited. The wrenching dislocations of the last few months do not change that, most experts say. But they do show the kinds of problems that can emerge.
The whole world has never come close to outpacing its ability to produce food. Right now, there is enough grain grown on earth to feed 10 billion vegetarians, said Joel Cohen, professor of populations at Rockefeller University and the author of "How Many People Can the Earth Support?" But much of it is being fed to cattle, the SUV's of the protein world, which are in turn guzzled by the world's wealthy.
Theoretically, there is enough acreage already planted to keep the planet fed forever, because 10 billion humans is roughly where the United Nations predicts that the world population will plateau in 2060. But success depends on portion control; in the late 1980s, Brown University's World Hunger Program calculated that the world then could sustain 5.5 billion vegetarians, 3.7 billion South Americans or 2.8 billion North Americans, who ate more animal protein than South Americans.
Even if fertility rates rose again, many agronomists think the world could easily support 20 billion to 30 billion people.
Anyone who has ever flown across the United States can see how that's possible: there's a lot of empty land down there. The world's entire population, with 1,000 square feet of living space each, could fit into Texas. Pile people atop each other like Manhattanites, and they get even more elbow room.
Water? When it hits $150 a barrel, it will be worth building pipes from the melting polar icecaps, or desalinating the sea as the Saudis do.
The same potential is even more obvious flying around the globe. The slums of Mumbai are vast; but so are the empty arable spaces of Rajasthan. Africa, a huge continent with a mere 770 million people on it, looks practically empty from above. South of the Sahara, the land is rich; south of the Zambezi, the climate is temperate. But it is farmed mostly by people using hoes.
As Harriet Friedmann, an expert on food systems at the University of Toronto, pointed out, Malthus was writing in a Britain that echoed the dichotomy between today's rich countries and the third world: an elite of huge landowners practicing "scientific farming" of wool and wheat who made fat profits; many subsistence farmers barely scratching out livings; migration by those farmers to London slums, followed by emigration. The main difference is that emigration then was to colonies where farmland was waiting, while now it is to richer countries where jobs are.
Malthus's world filled up, and its farmers, defying his predictions, became infinitely more productive. Admittedly, emptying acreage so it can be planted with genetically modified winter wheat and harvested by John Deere combines can be a brutal process, but it is solidly within the Western canon. My Scottish ancestors, for example, became urbanites thanks to the desire of English scientific farmers (for which read "landlords and bribers of clan chiefs") to graze more sheep in the highlands. Four generations later, I got to mull the coffee-meat dilemma while actually living on newsroom pizza.
So it ultimately worked out for one spoiled Scottish-American. But what about the 800 million people who are chronically hungry, even in riot-free years?
Friedmann argues that there is a Malthusian unsustainability to the way big agriculture is practiced, that it degrades genetic diversity and the environment so much that it will eventually reach a tipping point and hunger will spread.
Others vigorously disagree. In their view, the world is almost endlessly bountiful. If food became as pricey as oil, we would plow Africa, fish-farm the oceans and build hydroponic skyscraper vegetable gardens. But they see the underlying problem in terms more Marxian than Malthusian: the rich grab too much of everything, including biomass.
For the moment, simply ending subsidies to American and European farmers would let poor farmers compete, which besides feeding their families would push down American food prices and American taxes.
Tyler Cowen, a George Mason University economist, notes that global agriculture markets are notoriously unfree and foolishly managed. Rich countries subsidize farmers, but poor governments fix local grain prices or ban exports just when world prices rise — for example, less than 7 percent of the world's rice crosses borders. That discourages the millions of third world farmers who grow enough for themselves and a bit extra for sale from planting that bit extra.
Americans are attracted to Malthusian doom-saying, Cowen argues, "because it's a pre-emptive way to hedge your fear. Prepare yourself for the worst, and you feel safer than when you're optimistic."
Cohen, of Rockefeller University, sees it in more sinister terms: Americans like Malthus because he takes the blame off us. Malthus says the problem is too many poor people.
Or, to put it in the terms in which the current crisis is usually explained: too many hard-working Chinese and Indians who think they should be able to eat pizza, meat and coffee and aspire to a reservation at Chez Panisse. They get blamed for raising global prices so much that poor Africans and Asians can't afford porridge and rice. The truth is, the upward pressure was there before they added to it.
America has always been charitable, so the answer has never been, "Let them eat bean sprouts." But it has been, "Let them eat subsidized American corn shipped over in American ships." That may need to change.
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Diagnosis: When a strokelike spell isn't a stroke

Diagnosis: When a strokelike spell isn't a stroke
By Lisa Sanders, M.d.
Monday, June 16, 2008
1. Symptoms
The boy was sitting in his 10th-grade math class at a high school in Atlanta when he had his first attack. He does not remember what happened, but his classmates noticed that he seemed to be in some sort of trance. He stared straight ahead, eyes unfocused. His lips moved, but no words came out — just a few jumbled syllables. His face looked strangely lopsided.
As the school nurse hurried into the classroom, her first thought was that — as unlikely as it seemed — this 15-year-old boy was having a stroke. But as she examined the boy, he began to improve. The color seeped back into his face, and the asymmetry disappeared. His pulse and blood pressure were normal. By the time the boy's mother got to the school, he was back to his usual self.
His mother took him home, but she was worried. Her son had always been healthy. Certainly he'd never had anything like this happen before. At an event that night she described the strange symptoms to some friends. A man she didn't know, sitting nearby, leaned forward. "Your son could have had a stroke," he announced to the group of women. He apologized for eavesdropping but said something similar had happened to the teenage son of a friend. That boy had ended up completely paralyzed on one side of his body before they figured out what was going on.
When she got home that night, the now-terrified mother called Dr. Norman Harbaugh, her son's doctor. "Did my son have a stroke?" she asked after describing the incident. Maybe, he said. If he was all right now, they should come to his office first thing in the morning. If anything else happened, they should go directly to the emergency room.
Harbaugh had been their pediatrician since the boy was 3. The mother was confident that he would know what this was. But the next day the doctor had no answers, only worries. Although the boy's exam was completely normal, Harbaugh was concerned that this might not have been a stroke but a T.I.A. — a transient ischemic attack — the start of a stroke that somehow repairs itself. If it happened again, the boy might not be so lucky. He sent the boy to a neurologist and a cardiologist that morning. They found no risks for a stroke or evidence that he'd had one.
2. Investigation
Let's watch and wait, Harbaugh advised. Maybe this was just a fluke. And for six months nothing happened. Then in July, the boy had a second attack, and in September, a third. With each attack, the boy was lightheaded and dazed, and there was a new symptom — in addition to the facial droop, his right hand and sometimes his right leg would shake. He was taken to the emergency room each time, but when he arrived, the symptoms were gone. Harbaugh sent him to another neurologist, another cardiologist, a nephrologist, a gastroenterologist. Dozens of blood tests were done. An echocardiogram of his heart was normal. The EEG was normal. By every measure, the boy seemed fine.
And yet over the course of that fall, the attacks became more frequent. Once a week, sometimes twice, his mother would get a call from school saying that her son was being sent to the hospital. One neurologist thought these might be seizures and started the teenager on an antiseizure medication. But the attacks kept coming.
Harbaugh was stumped and frustrated, especially after the boy had spent a week in the hospital and was discharged — still without a diagnosis. At that point, Harbaugh mentioned to the family that perhaps they might need to find experts outside Atlanta. After much discussion, Harbaugh referred the boy to the Diagnostic Center at the Children's Hospital of Philadelphia, which specializes in diagnosing baffling illnesses in children. Harbaugh said he thought it seemed extreme to send this family from suburban Atlanta to a group of doctors in Philadelphia. Extreme but appealing. Coming at it with fresh eyes, a different perspective, these doctors might be able to find the answer.
And so, late that fall, the patient and his mother headed to the Children's Hospital of Philadelphia. They trooped from specialist's office to specialist's office, carrying the thick files of notes and tests that made up the boy's medical history. On their fourth and last day there, the boy and his mother went to see Dr. Rebecca Ichord, a young pediatric neurologist with a specialty in childhood stroke. Ichord greeted them in the waiting room. She was soft-spoken, with a serious but kind face. She sat down with mother and son and went through his thick chart — page by page — asking about each episode. Initially, Ichord, like the doctors before her, thought these "spells," as the boy called them, sounded like T.I.A.'s — ministrokes. But given the extensive work-up that had been done, it seemed clear that this had been ruled out. So what else could this be?
As Ichord went through each of the attacks with the teenager and his mother, she began to notice a pattern. "Were you always sitting down when these spells came on?" she asked. The patient thought for a moment. Yes, at the time of each of these episodes he had been sitting for a long time. They never occurred when he was active. It was the answer she was hoping for. "I think you have something called postural orthostatic tachycardia syndrome," she told the boy. This is a disorder that has only recently been described, but one she had seen a number of times during her years in practice. POTS, as it's called, is seen mostly in adolescents and is characterized by lightheadedness and confusion, usually upon standing up. Normally when you're sitting, blood pools in the legs. The blood vessels there constrict to help the blood return to the heart and stay in circulation. In patients with POTS, the vessels aren't constricting properly, and so too much blood stays in the legs, causing a decrease in the amount in circulation. An inadequate supply of blood to the brain causes the lightheadedness and confusion.
But what about these strokelike symptoms, the mother asked. That wasn't classic for POTS, but Ichord had seen it before too. She said she thought that in these patients the inadequate supply of blood triggered sensitive regions in the brain to overreact and cause these strange localized symptoms. And these symptoms, like the rest of them, got better when the patient lay down.
3. Resolution
A simple test could help her determine if her hunch was right. She had the lanky youth lie down on the examining table. She checked his pulse and his blood pressure. Both were normal. Then she had him sit up and measured his pulse and blood pressure again. Normally blood pressure doesn't change much and heart rate increases slightly as the body tries to get all the blood from the lower body, where it is pooled, to the rest of the body, which now needs more blood. In this patient, though his blood pressure remained normal, his heart began to race as his body tried to force the blood from his legs all the way up to his brain. Based on this test, Ichord thought it was quite likely that the teenager had POTS. She ordered a study, which confirmed her diagnosis.
POTS is often seen following a growth spurt. The thinking is that the nerves that tell the blood vessels to constrict haven't kept up with the rest of the body. Her patient had grown six inches over the last two years. Adolescents often grow out of this disease. Until then it is treated with a drug that constricts the blood vessels and salt tablets that increase the amount of fluid in the body. The boy was started on this regimen, and two years later, he is doing well.
"What's amazing to me," the patient told me recently, "is that I went to dozens of doctors, had hundreds of tests, had gallons of blood taken, and Ichord made this diagnosis with just one question and a blood-pressure cuff. I couldn't believe it." The difference was that, unlike the other doctors who had seen this patient, Ichord knew what she was looking for.
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A professor's food revolution starts with rice

A professor's food revolution starts with rice
By William J. Broad
Wednesday, June 18, 2008
ITHACA, New York: Many a professor dreams of revolution. But Norman Uphoff, working in a leafy corner of the Cornell University campus, is leading an inconspicuous one centered on solving the global food crisis. The secret, he says, is a new way of growing rice.
Rejecting old customs as well as the modern reliance on genetic engineering, Uphoff, 67, an emeritus professor of government and international agriculture with a trim white beard and a tidy office, advocates a management revolt.
Harvests typically double, he says, if farmers plant early, give seedlings more room to grow and stop flooding fields. That cuts water and seed costs while promoting root and leaf growth.
The method, called the System of Rice Intensification, or SRI, emphasizes the quality of individual plants over the quantity. It applies a less-is-more ethic to rice cultivation.
In a decade, it has gone from obscure theory to global trend — and encountered fierce resistance from established rice scientists. Yet a million rice farmers have adopted the system, Uphoff says. The rural army, he predicts, will swell to 10 million farmers in the next few years, increasing rice harvests, filling empty bellies and saving untold lives.
"The world has lots and lots of problems," Uphoff said recently while talking of rice intensification and his 38 years at Cornell. "But if we can't solve the problems of peoples' food needs, we can't do anything. This, at least, is within our reach."
That may sound audacious given the depths of the food crisis and the troubles facing rice. Roughly half the world eats the grain as a staple food even as yields have stagnated and prices have soared, nearly tripling in the past year. The price jolt has provoked riots, panicked hoarding and violent protests in poor countries.
But Uphoff has a striking record of accomplishment, as well as a gritty kind of farm-boy tenacity.
He and his method have flourished despite the skepticism of his Cornell peers and the global rice establishment — especially the International Rice Research Institute, which helped start the green revolution of rising grain production and specializes in improving rice genetics.
His telephone rings. It is the World Bank Institute, the educational and training arm of the development bank. The institute is making a DVD to spread the word.
"That's one of the irons in the fire," he tells a visitor, looking pleased before plunging back into his tale.
Uphoff's improbable journey involves a Wisconsin dairy farm, a billionaire philanthropist, the jungles of Madagascar, a Jesuit priest, ranks of eager volunteers and, increasingly, the developing world. He lists top SRI users as India, China, Indonesia, Cambodia and Vietnam among 28 countries on three continents.
In Tamil Nadu, a state in southern India, Veerapandi Arumugam, the agriculture minister, recently hailed the system as "revolutionizing" paddy farming while spreading to "a staggering" million acres.
Chan Sarun, Cambodia's agriculture minister, told hundreds of farmers at an agriculture fair in April that SRI's speedy growth promises a harvest of "white gold."
On Cornell's agricultural campus, Uphoff runs a one-man show from an office rich in travel mementos. From Sri Lanka, woven rice stalks adorn a wall, the heads thick with rice grains.
His computers link him to a global network of SRI activists and backers, like Oxfam, the British charity. Uphoff is SRI's global advocate, and his Web site (ciifad.cornell.edu/sri/) serves as the main showcase for its principles and successes.
"It couldn't have happened without the Internet," he says. Outside his door is a sign, "Alfalfa Room," with a large arrow pointing down the hall, seemingly to a pre-electronic age.
Critics dismiss SRI as an illusion.
"The claims are grossly exaggerated," said Achim Dobermann, the head of research at the international rice institute, which is based in the Philippines. Dobermann said fewer farmers use SRI than advertised because old practices often are counted as part of the trend and the method itself is often watered down.
"We don't doubt that good yields can be achieved," he said, but he called the methods too onerous for the real world.
By contrast, a former skeptic sees great potential. Vernon Ruttan, an agricultural economist at the University of Minnesota and a longtime member of the National Academy of Sciences, once worked for the rice institute and doubted the system's prospects.
Ruttan now calls himself an enthusiastic fan, saying the method is already reshaping the world of rice cultivation. "I doubt it will be as great as the green revolution," he said. "But in some areas it's already having a substantial impact."
Robert Chambers, a leading analyst on rural development, who works at the University of Sussex, England, called it a breakthrough.
"The extraordinary thing," he said, "is that both farmers and scientists have missed this — farmers for thousands of years, and scientists until very recently and then some of them in a state of denial."
The method, he added, "has a big contribution to make to world food supplies. Its time has come."
Uphoff grew up on a Wisconsin farm milking cows and doing chores. In 1966, he graduated from Princeton with a master's degree in public affairs and in 1970 from the University of California, Berkeley, with a doctorate in political science.
At Cornell, he threw himself into rural development, irrigation management and credit programs for small farmers in the developing world.
In 1990, a secret philanthropist (eventually revealed to be Charles Feeney, a Cornell alumnus who made billions in duty-free shops) gave the university $15 million to start a program on world hunger. Uphoff was the institute's director for 15 years.
The directorship took him in late 1993 to Madagascar. Slash-and-burn rice farming was destroying the rain forest, and Uphoff sought alternatives.
He heard that a French Jesuit priest, Father Henri de Laulanié, had developed a high-yield rice cultivation method on Madagascar that he called the System of Rice Intensification.
Uphoff was skeptical. Rice farmers there typically harvested two tons per hectare (an area 100 by 100 meters, or 2.47 acres). The group claimed 5 to 15 tons.
"I remember thinking, 'Do they think they can scam me?' " Uphoff recalled. "I told them, 'Don't talk 10 or 15 tons. No one at Cornell will believe it. Let's shoot for three or four.' "
Uphoff oversaw field trials for three years, and the farmers averaged eight tons per hectare. Impressed, he featured SRI on the cover of his institute's annual reports for 1996 and 1997.
Uphoff never met the priest, who died in 1995. But the success prompted him to scrutinize the method and its origins.
One clear advantage was root vigor. The priest, during a drought, had noticed that rice plants and especially roots seemed much stronger. That led to the goal of keeping fields damp but not flooded, which improved soil aeration and root growth.
Moreover, wide spacing let individual plants soak up more sunlight and send out more tillers — the shoots that branch to the side. Plants would send out upwards of 100 tillers. And each tiller, instead of bearing the usual 100 or so grains, would puff up with 200 to 500 grains.
One drawback was weeds. The halt to flooding let invaders take root, and that called for more weeding. A simple solution was a rotating, hand-pushed hoe, which also aided soil aeration and crop production.
But that meant more labor, at least at first. It seemed that as farmers gained skill, and yields rose, the overall system became labor saving compared with usual methods.
Uphoff knew the no-frills approach went against the culture of modern agribusiness but decided it was too good to ignore. In 1998, he began promoting it beyond Madagascar, traveling the world, "sticking my neck out," as he put it.
Slowly, it caught on, but visibility brought critics. They dismissed the claims as based on wishful thinking and poor record keeping, and did field trials that showed results similar to conventional methods.
In 2006, three of Uphoff's colleagues at Cornell wrote a scathing analysis based on global data. "We find no evidence," they wrote, "that SRI fundamentally changes the physiological yield potential of rice."
While less categorical, Dobermann of the rice research institute called the methods a step backward socially because they increased drudgery in rice farming, especially among poor women.
In his Cornell office, Uphoff said his critics were biased and knew little of SRI's actual workings. The method saves labor for most farmers, including women, he said. As for the skeptics' field trials, he said, they were marred by problems like using soils dead from decades of harsh chemicals and monocropping, which is the growing of the same crop on the same land year after year.
"The critics have tried to say it's all zealotry and religious belief," Uphoff sighed. "But it's science. I find myself becoming more and more empirical, judging things by what works."
His computer seems to hum with proof. A recent report from the Timbuktu region of Mali, on the edge of the Sahara Desert, said farmers had raised rice yields 34 percent, despite initial problems with SRI guideline observance.
In Laos, an agriculture official recently said SRI had doubled the size of rice crops in three provinces and would spread to the whole country because it provided greater yields with fewer resources.
"Once we get over the mental barriers," Uphoff said, "it can go very, very quickly because there's nothing to buy."
The opponents have agreed to conduct a global field trial that may end the dispute, he said. The participants include the rice institute, Cornell and Wageningen University, a Dutch institution with a stellar reputation in agriculture.
The field trials may start in 2009 and run through 2011, Uphoff said. "This should satisfy any scientific questions," he added. "But my sense is that SRI is moving so well and so fast that this will be irrelevant."
Practically, he said, the method is destined to grow.
"It raises the productivity of land, labor, water and capital," he said. "It's like playing with a stacked deck. So I know we're going to win."
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Copyright © 2008 The International Herald Tribune www.iht.com

Aging: Cue the lights and help dementia

Aging: Cue the lights and help dementia
By Eric Nagourney
Wednesday, June 18, 2008
Researchers who put brighter lights into nursing homes have found that residents with dementia appear to suffer fewer symptoms.
Improvements were modest, but the study showed a simple step that may improve life for many. The study, which appeared June 11 in The Journal of the American Medical Association, also found that giving dementia patients the hormone melatonin could help improve their sleep and mood, but only in conjunction with the increased lighting.
The researchers, led by Dr. Rixt F. Riemersma-van der Lek, spent up to three and a half years studying the effects of light and melatonin on more than 180 patients in 12 residences for the elderly in the Netherlands.
Dementia is often characterized by cognitive decline and changes in mood, sleep and activity levels. Changes in the part of the brain that helps regulate circadian rhythms may play a role.
For the study, the researchers added lights to the ceilings of some of the nursing homes. Some patients experienced brighter light, others were given melatonin, and some had both.
The light appeared to reduce cognitive declines and symptoms of depression.
Melatonin improved sleep and reduced aggression but appeared to make patients more withdrawn, although bright light appeared to take care of this.
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Eyes bloodshot, doctors vent their discontent

Eyes bloodshot, doctors vent their discontent
By Sandeep Jauhar, M.d.
Wednesday, June 18, 2008
"I love being a doctor but I hate practicing medicine," a friend, Saeed Siddiqui, told me recently. We were sitting in his office amid his many framed medical certificates and a poster of an illuminated lighthouse that read: "Success doesn't come to you. You go to it."
A doctor in his late 30s, he has been in practice for six years, mostly as a solo practitioner. But he told me he recently had decided to go into partnership with another cardiologist; his days, he said, will be "totally busy."
"Your days aren't busy enough already?" I asked.
The waiting room was packed. He had a full schedule of appointments, and after he was done with his office patients, he was going to round at two hospitals.
He smiled wanly. "Just look at my eyes."
They were bloodshot.
"This whole week I haven't slept more than about six hours a night."
I asked when his work usually got done.
"It is never done," he replied, shaking his head. "See this pile?"
He pointed to five large manila packages on a shelf above his desk. "These are reports I still have to finish."
As a physician, I could empathize. I too often feel overwhelmed with paperwork. But my friend's discontent seemed to run much deeper than that. Unfortunately, he is not alone. I have been hearing physician colleagues voice a level of dissatisfaction with medical practice that is alarming.
In a survey last year of nearly 2,400 physicians conducted by a physician recruiting firm, locumtenens.com, 3 percent said they were not frustrated by nonclinical aspects of medicine. The level of frustration has increased with nearly every survey.
"It will take real structural change in the work environment for physician satisfaction to improve," Dr. Mark Linzer, an internist at the University of Wisconsin who has done extensive research on physician unhappiness, told me. "Fortunately, the data show that physicians are willing to put up with a lot before giving up."
Not long ago, fed up with what he perceived as a loss of professional autonomy, Dr. Bhupinder Singh, 42, a general internist in New York, sold his practice and went to work part time at a hospital in Queens.
"I'd write a prescription," he told me, "and then insurance companies would put restrictions on almost every medication. I'd get a call: 'Drug not covered. Write a different prescription or get preauthorization.' If I ordered an M.R.I., I'd have to explain to a clerk why I wanted to do the test. I felt handcuffed. It was a big, big headache."
When he decided to work in a hospital, he figured that there would be more freedom to practice his specialty.
"But managed care is like a magnet attached to you," he said.
He continues to be frustrated by payment denials. "Thirty percent of my hospital admissions are being denied. There's a 45-day limit on the appeal. You don't bill in time, you lose everything. You're discussing this with a managed-care rep on the phone and you think: 'You're sitting there, I'm sitting here. How do you know anything about this patient?' "
Recently, he confessed, he has been thinking about quitting medicine altogether and opening a convenience store. "Ninety percent of doctors I know are fed up with medicine," he said.
And it is not just managed care. Stories of patients armed with medical knowledge gleaned from the Internet demanding antibiotics for viral illnesses or M.R.I. scans for routine symptoms are rife in doctors' lounges. Malpractice worries also remain at the forefront of many physicians' minds, compounded by increasing liability premiums that have forced many into early retirement.
In surveys, increasing numbers of doctors attest to diminishing enthusiasm for medicine and say they would discourage a friend or family member from going into the profession.
The dissatisfaction would probably not have reached such a fever pitch if reimbursement had kept pace with doctors' expectations. But it has not.
Doctors are working harder and faster to maintain income, even as staff salaries and costs of living continue to increase. Some have resorted to selling herbs and vitamins retail out of their offices to make up for decreasing revenue. Others are limiting their practices just to patients who can pay out of pocket.
There are serious consequences to this discontent, the most worrisome of which is that it is difficult for doctors who are so unhappy to provide good care.
Another is a looming shortage of doctors, especially in primary care, which has the lowest reimbursement of all the medical specialties and probably has the most dissatisfied practitioners.
Last year, residency programs in family practice took only 1,096 graduating medical students, the fewest in the last two decades. The number increased just slightly this year. Students who do choose internal medicine increasingly are forgoing primary care for subspecialty practices like cardiology and gastroenterology.
"For me it's an endless amount of work that I can never get through to do it properly," said Dr. Jeffrey Freilich, 38, a primary-care physician on Long Island. "I'm a bit compulsive. As an internist, I have to worry about working up so many conditions — anemia, thyroid problems and so forth. There is no time to do it all in a day.
"On top of all that, there are all the colonoscopies and mammograms you have to arrange, and all the time on the phone getting preauthorizations. Then you have to track the patient down. And none of it is reimbursed."
Many primary-care physicians have stopped seeing their patients when they are hospitalized, relying instead on hospitalists devoted to inpatient care. Internists have told me that it is prohibitively inefficient to drive to a hospital, find parking, walk to the wards, examine a patient, check laboratory tests and vital signs, talk to a nurse and write orders and a note — for just a handful of cases. They cannot afford to leave their offices long enough to do it.
The upshot is that the doctor who knows a patient best is often uninvolved in her care when she is hospitalized. This contributes to the poor coordination and wanton consultation that is so common in hospitals .
"Years ago you had one or two doctors," a hospitalized patient told me recently. "Now you've got so many people coming in it's hard to know who's who."
A 10.6 percent cut in Medicare payments to physicians is scheduled to take effect on July 1. Further cuts are planned in coming years. Many doctors have told lawmakers that if the cuts go through, they will stop seeing Medicare patients. But reimbursement cuts are only a small part of doctors' woes today.
"I was naïve," Saeed Siddiqui said. "When I was a resident I thought it was enough to take good care of patients. But the real world is totally different."
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Once-fatal cancers now treated as a chronic disease

Once-fatal cancers now treated as a chronic disease
By Jane E. Brody
Tuesday, June 17, 2008
To see Barry Cooper working out at the YMCA in Brooklyn, New York, every morning before going to work as a patent lawyer, you would be unlikely to guess that he has cancer. Cooper, 63 and a grandfather of two, is one of a small but growing number of patients for whom once-fatal cancer has become a chronic disease.
Through a better understanding of factors that distinguish cancer cells from normal ones and the development of more specific treatments that capitalize on those differences, cancers that just a decade ago would have been rapidly fatal are now being controlled for years while the patients conduct near-normal lives.
Although these cancers may never be curable, they can often be controlled for long periods by a succession of treatments. When one therapeutic approach no longer works, another one that has come along in the meantime might stop the disease from progressing, at least for a while.
Even patients whose cancers were already metastatic - spread beyond the site of origin - at the time of diagnosis are benefiting from this sequential approach. Others like Cooper have cancers of blood-forming organs that previously had a limited response to available therapies.
"We're seeing people being periodically treated and living year after year with advanced disease, with cancers that have spread to the lung, liver, brain or bone," Dr. Michael Fisch, director of the general oncology program at the M.D. Anderson Cancer Center in Houston, said in an interview. "In 1997, we wouldn't have guessed this would be possible."
In March 2007, Elizabeth Edwards, wife of former presidential hopeful John Edwards, joined this group of chronic cancer patients when she disclosed that the breast cancer she was treated for in 2004 had spread to her bones and, possibly, lung. Edwards described the disease as "no longer curable but completely treatable" and likened the situation to living with diabetes.
Speaking generally, Dr. Francisco Esteva, a breast cancer specialist at the Anderson center, said in an interview: "Our ultimate goal is not to make this a chronic disease, but to keep patients alive long enough until we can find the right treatment for the right patient and cure the disease. Unfortunately, we're not there yet, but meanwhile we try to keep patients alive with a good quality of life for as long as possible."
Fisch calls the new therapy for advanced cancer "the hitchhiker model."
Time is bought by going from point A, the first-line therapy, to point B, the second-line therapy, to point C, the third line of therapy, and so on. The approach can continue indefinitely, as long as new therapies become available and patients remain well enough to withstand the rigors of treatment.
But Fisch noted that adding meaningful years to the lives of patients with advanced cancer depends in part on avoiding the attitude, prevalent among some physicians, that cancer is hopeless after it has metastasized.
In December 2005, at age 61, Cooper seemed hale and hearty, though he was unusually tired. Then a routine checkup resulted in a shocking diagnosis - chronic myelogenous leukemia, commonly called CML. "My initial disbelief was followed by varying degrees of anger and denial," Cooper said. "I found it very difficult to accept my diagnosis."
His doctor reassured him that he was lucky. His disease, once a gradually progressive killer, was still in a chronic stage and of a type, Philadelphia positive, that could now be controlled by a drug, Gleevec, licensed just a year earlier. And if and when Gleevec, taken daily by mouth, no longer worked or caused intolerable side effects, the doctor told him, other drugs were in the pipeline that could take over.
Cooper lost no time from work, and Gleevec kept his cancer's runaway white blood cells in check for more than two years. When he developed resistance to it, he switched to a second-generation drug.
"For a majority of people with CML," Cooper said, "Gleevec is a wonder drug, making the disease something like diabetes - controllable even if not curable."
Although he said not a day went by when he did not think about his cancer, he and his wife, Naomi, are letting no grass grow under their feet. Since the diagnosis, they have traveled abroad several times, they visit their grandchildren often and celebrated their 40th anniversary with a lavish party that Cooper described as "a very life-affirming event."
Max Watson, who has multiple myeloma, a usually deadly blood system cancer, has been able to control his disease for six years through the hitchhiker approach. His succession of treatments has included stem cell transplants, radiation and drug therapies. When one treatment failed, another became available.
Although at first Watson did not think long-term survival was possible, he was quoted in OncoLog, an M.D. Anderson report to physicians, as saying, "Eventually, I realized that this was something I would be dealing with for a long time."
As Elizabeth Edwards's prospects show, some solid tumors in advanced stages are also behaving more like chronic diseases, a result of research that has discovered molecular characteristics of specific cancers and the development of drugs that take advantage of a cancer's Achilles' heel.
Esteva described a breast cancer patient first treated with a mastectomy and the antiestrogen tamoxifen in 1995. Five years later, cancer had spread to her lungs, prompting treatment with a newer anticancer drug, an aromatase inhibitor. When that no longer worked, her cancer was found to possess a molecular factor, HER-2, and she began treatment with Herceptin, a designer drug tailor made to attack HER-2-positive breast cancer.
Herceptin therapy was able to stabilize her metastases for years, "something we had not seen before," Esteva said.
The patient now receives a combination of Herceptin and another drug and enjoys a relatively normal quality of life, the doctor reported.
There has also been progress in prolonging survival in patients with metastatic kidney cancer.
Dr. Nizar Tannir, a specialist in genitourinary cancer at the Houston center, said that before 2005 there was not much to offer patients with advanced renal cell carcinoma. But within two years, three new drugs became available that have resulted in a 50 percent increase in overall survival.
Tannir recommends that patients given a bleak prognosis seek a second opinion from an expert at a major cancer center, in person if possible, or by phone or e-mail through their doctor's office.The New York Times
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