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Law on Flu Vaccinations May Be Tested
By DERRICK HENRY, The New York Times, January 4, 2009
THE state’s new law requiring young children attending licensed pre-school and child care centers to get flu vaccinations will be tested this week when thousands of children return to classrooms and playrooms after the long holiday break.
New Jersey, the first state in the nation to require flu shots for young schoolchildren, set a Dec. 31 deadline for parents to obtain flu vaccinations for their children. It was part of a new policy requiring a total of four additional immunizations for schoolchildren over the objections of some parents who worry about possible risks from vaccinations.
The requirement applies to children between 6 months and 5 years who are attending licensed day care and preschool programs. State public health experts said that flu shots for young children are important for overall public health.
“Stopping flu transmission among kids will stop flu transmission in the community at large,” said Dr. Tina Tan, the state epidemiologist.
Health officials said they would not know until after the holiday how many children have met the requirement. The state relies on schools, preschools and day care centers to collect immunization records from parents and then forward the information to the state.
Children who have not received the flu vaccine are to be excluded from attending, unless they can provide proof that they are in the process of getting a dose of the vaccine within two weeks after the deadline, the state Health Department said.
“If parents are working to get it, they have just a little bit more time,” said Dawn Thomas, a Health Department spokeswoman.
Health officials and pediatricians say that vaccinating children against the flu makes sense because children can inadvertently infect each other at school, then carry the infection home and elsewhere.
“Children are very effective spreaders of infection-prone secretions,” mucus and saliva, said Dr. Robert W. Tolan, chief of the Division of Allergy, Immunology and Infectious Diseases at the Children’s Hospital at St. Peter’s University Hospital in New Brunswick. “It’s the kids that spread the infections, joyfully, as children do.”
Health officials said the flu season usually peaks in January or February each year. Young children are particularly vulnerable to the flu, as are the elderly, pregnant women and people with weakened immune systems.
Each year, more than 200,000 people are hospitalized from flu complications and about 36,000 people die from the flu, according to the federal Centers for Disease Control and Prevention. Of those hospitalized, about 20,000 are children. Last year, the C.D.C. received reports that 86 children had died from flu-related complications.
There have been about five cases of pediatric flu-related illnesses that required hospitalization this season in New Jersey, Dr. Tan said. A weekly report that tracks influenza in the state characterized influenza activity in mid-December as sporadic.
An advisory panel for the Centers for Disease Control and Prevention said that all children ages 6 months to 18 years should receive an annual flu shot.
In New Jersey, preschoolers are also required to get a vaccine against the germ that causes pneumonia. That vaccination was due at the beginning of the school year. Sixth graders are required to get a vaccine against meningitis and a booster against tetanus, diphtheria and pertussis. Children who enroll in school after the new year, perhaps from other states or countries, must also be vaccinated.
This fall, the New Jersey Coalition for Vaccination Choice held a rally in Trenton that drew hundreds of parents who said they should be the ones to decide if their children need flu shots, not the state.
“There’s a huge trust gap between parents and public health officials right now,” said Louise Kuo Habakus, who is a parent and spokeswoman for the New Jersey Coalition for Vaccination Choice. “These are our kids. We’re stakeholders. You have to give us a say in this debate.”
Many of these parents say they believe vaccines cause autism, even though multiple studies have found no such link. The New Jersey coalition supports proposed legislation that would provide an exemption for conscientious objectors to mandatory vaccinations for schoolchildren.
“The New Jersey Department of Health opposes philosophical exemptions only because influenza can cause destructive and serious illness among children,” Dr. Tan said.
Dr. Tolan said that vaccines are a matter of public health.
“If you don’t vaccinate your child, you’re putting my child at risk,” he said.
For Privacy’s Sake, Taking Risks to End Pregnancy
By JENNIFER 8. LEE and CARA BUCKLEY, The New York Times, January 5, 2009
Amalia Dominguez was 18 and desperate and knew exactly what to ask for at the small, family-run pharmacy in the heart of Washington Heights, the thriving Dominican enclave in northern Manhattan. “I need to bring down my period,” she recalled saying in Spanish, using a euphemism that the pharmacist understood instantly.
It was 12 years ago, but the memory remains vivid: She was handed a packet of pills. They were small and white, $30 for 12. Ms. Dominguez, two or three months pregnant, went to a friend’s apartment and swallowed the pills one by one, washing them down with malta, a molasseslike extract sold in nearly every bodega in the neighborhood.
The cramps began several hours later, doubling Ms. Dominguez over, building and building until, eight and a half hours later, she locked herself in the bathroom and passed a lifeless fetus, which she flushed.
The pills were misoprostol, a prescription drug that is approved by the Food and Drug Administration for reducing gastric ulcers and that researchers say is commonly, though illegally, used within the Dominican community to induce abortion. Two new studies by reproductive-health providers suggest that improper use of such drugs is one of myriad methods, including questionable homemade potions, frequently employed in attempts to end pregnancies by women from fervently anti-abortion cultures despite the widespread availability of safe, legal and inexpensive abortions in clinics and hospitals.
One study surveyed 1,200 women, mostly Latinas, in New York, Boston and San Francisco and is expected to be released in the spring; the other, by Planned Parenthood, involved a series of focus groups with 32 Dominican women in New York and Santo Domingo. Together, they found reports of women mixing malted beverages with aspirin, salt or nutmeg; throwing themselves down stairs or having people punch them in the stomach; and drinking teas of avocado leaf, pine wood, oak bark and mamon fruit peel.
Interviews with several community leaders and individual women in Washington Heights echoed the findings, and revealed even more unconventional methods like “juice de jeans,” a noxious brew made by boiling denim hems.
“Some women prefer to have a more private experience with their abortion, which is certainly understandable,” said Dr. Daniel Grossman, an obstetrician with Ibis Reproductive Health in San Francisco, which joined Gynuity Health Projects in New York in conducting the larger study. “The things they mention are, ‘It is easier.’ It was recommended to them by a friend or a family member.”
Dr. Carolyn Westhoff, an obstetrician at NewYork-Presbyterian/Columbia University Medical Center, said the trend fits into a larger context of Dominicans seeking home remedies rather than the care of doctors or hospitals, partly because of a lack of insurance but mostly because of a lack of trust in the health care system. “This is not just a culture of self-inducted abortion,” she said. “This is a culture of going to the pharmacy and getting the medicine you need.”
Physicians say that women can obtain the pills either through pharmacies that are willing to bend the rules and provide the medicine without a prescription or by having the drugs shipped from overseas.
It is impossible to know how many women in New York or nationwide try to end their pregnancies themselves, but in the vibrant, socially conservative Dominican neighborhoods of Upper Manhattan, the various methods are passed like ancient cultural secrets. In a study of 610 women at three New York clinics in largely Dominican neighborhoods conducted eight years ago, 5 percent said they had taken misoprostol themselves, and 37 percent said they knew it was an abortion-inducing drug. Doctors and community leaders say they have not seen any signs of the phenomenon disappearing, which they find worrisome because of concerns about the drug’s effectiveness and potential side effects.
Sold under the brand name Cytotec, misoprostol is approved to induce abortion when taken with mifepristone, or RU-486; doctors also sometimes use it to induce labor, though it is not approved for that use. A spokesman for Pfizer, which manufacturers Cytotec, declined to comment beyond saying that the company does not support the off-label use of its products and noting that the label includes “F.D.A.’s strongest warning against use in women who are pregnant.”
That warning, in capital letters, also notes that the drug “can cause abortion.”
But it does not always do so, not least because notions of how best to use it vary from inserting several pills into the vagina to letting them dissolve under the tongue. The side effects can be serious, and include rupture of the uterus, severe bleeding and shock.
“We do worry because we don’t know where women are getting the instructions from,” said Jessica Gonzalez-Rojas of the National Latina Institute for Reproductive Health, which was also a partner on the Ibis study. “We imagine that there is misinformation on how to take it, which is why it could be hit or miss.”
In 2007 in Massachusetts, an 18-year-old Dominican immigrant named Amber Abreu took misoprostol in her 25th week of pregnancy and gave birth to a 1-pound baby girl who died four days later; a judge sentenced her in June to probation and ordered her into therapy. In South Carolina in February, a Mexican migrant farm worker, Gabriela Flores, pleaded guilty to illegally performing an abortion and was sentenced to 90 days in jail for taking misoprostol while four months pregnant in 2004. A Virginia man, Daniel Riase, is serving a five-year prison sentence after pleading guilty in 2007 to slipping the pills into his pregnant girlfriend’s glass of milk.
Researchers studying the phenomenon cite several factors that lead Dominican and other immigrant women to experiment with abortifacients: mistrust of the health-care system, fear of surgery, worry about deportation, concern about clinic protesters, cost and shame.
“It turns an abortion into a natural process and makes it look like a miscarriage,” said Dr. Mark Rosing, an obstetrician at St. Barnabas Hospital in the Bronx who led the 2000 study, which was published in the Journal of the American Medical Women’s Association. “For people who don’t have access to abortion for social reasons, financial reasons or immigration reasons, it doesn’t seem like this horrible thing.”
Ms. Dominguez, for her part, said she had no insurance or money to pay for an abortion, and could not fathom getting one for fear her mother would find out. One of her friends had spent $1,200 on an abortion that left her with a uterine infection, and another friend endured the procedure without anesthesia, she said. In addition, Washington Heights is a tightknit community where abortion — as well as birth control — is shunned; if Ms. Dominguez were spotted entering a clinic, rumors could fly.
“There are scary moments, and you got to have a friend right next to you,” said Ms. Dominguez, now 30 and a mother of four. “It’s cheap but dangerous. Certain people are more delicate than others. But afterwards, I felt relief.”
A friend of Ms. Dominguez’s said her stepsister took the pills last year because she was in the country illegally, and worried that a doctor might turn her in. “She was just scared,” the woman said, speaking on the condition that her name not be published to protect the stepsister’s privacy. “She had no papers, no insurance, no nothing.”
The woman went to a free clinic afterward to make sure the pills had worked (they had). Health care workers and other community leaders say such visits are how they discovered widespread illicit use of the drug as well as homemade potions.
Dr. Rosing said he learned about Cytotec during his residency at NewYork-Presbyterian/Columbia hospital in Washington Heights, where he saw a lot of Dominican immigrants with incomplete abortions in the emergency room. They spoke of taking the “star pill,” a nickname for the hexagonal shape of one form of misoprostol. He suspected “that has to be the tip of the iceberg,” he said, “and it was.”
The pills allow pregnant women a degree of denial over what is taking place. Like Ms. Dominguez, many women in the neighborhood talk about the need to bring on — or “down” — their periods, not abortion. Afterward, they might tell doctors or relatives they had lost the baby.
The Planned Parenthood study concluded that women in both nations “seemed to see inducing the termination of pregnancy, or abortions, as a part of the reality of their lives,” in a community where, as one interview subject put it, “we are all doctors.” The report noted that in a culture steeped in machismo, birth control is generally seen as the woman’s responsibility.
“If I introduce the condom into a relationship, I’m basically saying I’ve had somebody else, and I’ve not been faithful to you,” said Haydee Morales, a vice president at Planned Parenthood of New York.
Debralee Santos, program director at Casa Duarte, a community arts organization in Washington Heights, said that while she had never had reason to distrust medical professionals, she understood the apprehensions that kept other women from seeking them out. “I get it, I really do,” she said.
“It’s a community that, even as it comes of age, always relies on itself first,” explained Ms. Santos, who was born in the United States to immigrant parents. “Women, in particular, continue to help each other in ways that speak to tradition and solidarity.”
Ms. Dominguez, who volunteers at Casa Duarte and is known as Flaca, Spanish for skinny, did not want her name or photograph published at first. But after some thought, she decided to allow it so more people would learn about the trap many pregnant Dominican women feel they are in.
“It’s a health risk,” she said. “There’s a lot of girls in situations like that, and they’re overwhelmed.”
Orbiter, Finishing a Mission, Offers a Peek at Mars’ Wrinkles
By KENNETH CHANG, The New York Times, January 6, 2009
Last month, NASA’s Mars Reconnaissance Orbiter wrapped up its two-year primary science phase, and Mars geologists are wallowing in a bounty of data.
“Technically and scientifically, it has certainly met our expectations,” said Alfred S. McEwen, a planetary geologist at the University of Arizona and principal investigator for the orbiter’s high-resolution camera.
Images taken by the camera, able to see features down to about a yard in size, have revealed details like rippled textures in what had looked like bland dusty regions, and researchers can now count tiny craters, enabling them to better estimate the age of terrains.
A sensitive spectrometer discovered rocks made of carbonate minerals, which may have formed when young Mars possessed a more benign environment: wet and maybe warm.
“That’s telling us something about the early history of Mars,” said Scott L. Murchie of the Johns Hopkins Applied Physics Laboratory and principal investigator for the spectrometer.
Most of the carbonates were washed away by acidic waters in later epochs.
The orbiter will continue its observations, which will allow places to be photographed more than once to capture changes in the landscape.
Meanwhile, the two Martian rovers, Spirit and Opportunity, mark their fifth anniversary this month, far outliving their original three-month mission. Spirit has recently begun moving again after sitting still through the winter while Opportunity is crossing the plains en route to a 13.7-mile-wide crater named Endeavour, a journey that could take at least another two years.
Steven W. Squyres, the principal investigator of the rovers, said it struck him as an odd milestone for people to mark. “It’s kind of like celebrating your birthday in Mars years,” he said. “Of course, I’d be younger that way.” (In Mars years, Dr. Squyres is 28.)
Food Dance Gets New Life When Bees Get Cocaine
By PAM BELLUCK, The New York Times, January 6, 2009
Buzz has a whole new meaning now that scientists are giving bees cocaine.
To learn more about the biochemistry of addiction, scientists in Australia dropped liquefied freebase cocaine on bees’ backs, so it entered the circulatory system and brain.
The scientists found that bees react much like humans do: cocaine alters their judgment, stimulates their behavior and makes them exaggeratedly enthusiastic about things that might not otherwise excite them.
What’s more, bees exhibit withdrawal symptoms. When a coked-up bee has to stop cold turkey, its score on a standard test of bee performance (learning to associate an odor with sugary syrup) plummets.
“What we have in the bee is a wonderfully simple system to see how brains react to a drug of abuse,” said Andrew B. Barron, a senior lecturer at Macquarie University in Australia and a co-leader in the bees-on-cocaine studies. “It may be that when we know that, we’ll be able to stop a brain reacting to a drug of abuse, and then we may be able to discover new ways to prevent abuse in humans.”
The research, published in The Journal of Experimental Biology, advances the knowledge of reward systems in insects, and aims to “use the honeybee as a model to study the molecular basis of addiction,” said Gene E. Robinson, director of the neuroscience program at the University of Illinois at Urbana-Champaign and a co-author with Dr. Barron, and Ryszard Maleszka and Paul G. Helliwell at Australian National University.
The researchers looked at honeybees whose job is finding food — flying to flowers, discovering nectar, and if their discovery is important enough, doing a waggle dance on a special “dance floor” to help hive mates learn the location.
“Many times they don’t dance,” Professor Robinson said. “They only dance if the food is of sufficient quality and if they assess the colony needs the food.”
On cocaine the bees “danced more frequently and more vigorously for the same quality food,” Dr. Barron said. “They were about twice as likely to dance” as undrugged bees, and they circled “about 25 percent faster.”
The bees did not dance at the wrong time or place. Cocaine only made them more excited about the food they found. That’s like “when a human takes cocaine at a low dose,” Dr. Barron said. “They find many stimuli, but particularly, rewarding stimuli, to be more rewarding than they actually are.”
Now, scientists are studying whether bees begin to crave cocaine and need more for the same effect, like humans.
The testing occurred in Australia, and, Dr. Barron said, “my dean got extremely twitchy about holding cocaine on campus. It’s in a safe bolted to a concrete floor within a locked cupboard in a locked room in a locked building with a combination code not known even to me. A technician from the ethics department has to walk across campus to supervise the release of the cocaine.”
That, Dr. Barron said, for a bee-size supply of “one gram, which has lasted me two years. One gram, a human would go through in one night. I’m not like the local drug lord.”
Well: With the Right Motivation, That Home Gym Makes Sense
By TARA PARKER-POPE, The New York Times, January 6, 2009
A year ago, I bought an elliptical trainer — a gym-quality machine that I felt certain would get a daily workout.
Today, my top-of-the-line exercise machine sits idle most of the time. But I’m not alone. Every year, consumers spend an estimated $4 billion on home treadmills, stationary bikes, Stairmasters and other equipment that ends up gathering dust. A Consumer Reports survey last year found that nearly 40 percent of those who buy home exercise machines say they use them less than they expected.
This may be discouraging to people like me, but it is a source of fascination for behavioral scientists. The hope is that by better understanding the behavior, they can help people make better buying decisions — and help them start exercising and stick with it.
Buying an exercise machine does seem to influence whether people start working out. But some research suggests that the same people are less likely to stick with exercise over time than people who don’t own home equipment.
In October, the journal Annals of Behavioral Medicine reported on a study of 205 sedentary adults who were encouraged to begin an exercise program. At 6 months, about half had done so, but by 12 months, about a third of those people had stopped.
People with a home exercise machine were 73 percent more likely to start exercising. But by the end of the year, they were also 12 percent more likely to have quit than people in the study who did not have home equipment.
This doesn’t mean a home exercise machine leads to less exercise. It just means that having home equipment is not the most important factor. What matters more is “self-efficacy” — a deep-seated belief that we really do have the power to achieve our goals. In the Annals study, those who scored high on psychological measures of self-efficacy were nearly three times as likely to be exercising after a year as those with lower self-efficacy scores, whether or not they owned an exercise machine.
Meeting your own expectations also influences whether you stick with exercise. Study participants who were satisfied with the results of their exercise plan were twice as likely to keep it up as those who were not.
While believing that you can do it and being happy with your results may seem to be obvious parts of success, researchers say that people often fail to take these psychological issues into account when they start an exercise plan.
“What is your confidence in your ability to stick to your exercise program when you’re on vacation, when you’re not feeling well, when you’re busy?” asked David M. Williams, assistant professor of psychiatry and human behavior at the Alpert Medical School of Brown University, who led the exercise study. “The message isn’t that home exercise equipment doesn’t work. It’s just one very small piece of the puzzle, because it might make it easier to exercise, but they still have to motivate themselves to do it.”
Dr. Williams said there were simple ways to increase the likelihood that you will keep exercising. Working out with friends or family members, mastering an exercise (like the proper way to use gym equipment), and working with someone who motivates you, like a personal trainer, all build confidence and bolster the chances of sticking with it.
But consumers need to distinguish between real motivation to exercise and the unrealistic optimism that often takes over when they are shopping for a new exercise machine.
“Most goals we set for ourselves tend to be unrealistically high,” said Ravi Dhar, director of the Yale Center for Customer Insights and a professor of marketing and psychology. “When you buy these machines, you probably end up focusing on one or two attributes, like how easy it is to use or having it in your home. You’re not thinking about the barriers, what you’re giving up, like the time with friends or the Internet.”
In experiments to be published next month in The Journal of Consumer Research, scientists at Duke and the University of Wisconsin studied ways to help people make more realistic buying decisions.
In one group, undergraduate students were asked how often they would exercise in a two-week period. They estimated five times, and then indicated they would pay about $610 for a treadmill.
In a second group, students were asked how often they would exercise under ideal conditions, with no constraints on their time, motivation and physical ability. The answer: 10 times. Then they were asked how often they would really exercise. They scaled it back to fewer than four times. Rooted in reality, this group was willing to pay just $480 for a treadmill.
When the participants recorded their actual exercise over a two-week period, it totaled about three days. That shows that the simple act of distinguishing between an ideal setting and the real world helped those in the second group make more realistic exercise estimates.
“We’re not telling people to stop buying treadmills,” said Kurt A. Carlson, assistant professor at the Fuqua School of Business at Duke. “The question is how to get the right people to buy them. Everyone else should recognize they don’t have the motivation, and take the money and use it on a personal trainer or something else that’s going to get them motivated.”
By DERRICK HENRY, The New York Times, January 4, 2009
THE state’s new law requiring young children attending licensed pre-school and child care centers to get flu vaccinations will be tested this week when thousands of children return to classrooms and playrooms after the long holiday break.
New Jersey, the first state in the nation to require flu shots for young schoolchildren, set a Dec. 31 deadline for parents to obtain flu vaccinations for their children. It was part of a new policy requiring a total of four additional immunizations for schoolchildren over the objections of some parents who worry about possible risks from vaccinations.
The requirement applies to children between 6 months and 5 years who are attending licensed day care and preschool programs. State public health experts said that flu shots for young children are important for overall public health.
“Stopping flu transmission among kids will stop flu transmission in the community at large,” said Dr. Tina Tan, the state epidemiologist.
Health officials said they would not know until after the holiday how many children have met the requirement. The state relies on schools, preschools and day care centers to collect immunization records from parents and then forward the information to the state.
Children who have not received the flu vaccine are to be excluded from attending, unless they can provide proof that they are in the process of getting a dose of the vaccine within two weeks after the deadline, the state Health Department said.
“If parents are working to get it, they have just a little bit more time,” said Dawn Thomas, a Health Department spokeswoman.
Health officials and pediatricians say that vaccinating children against the flu makes sense because children can inadvertently infect each other at school, then carry the infection home and elsewhere.
“Children are very effective spreaders of infection-prone secretions,” mucus and saliva, said Dr. Robert W. Tolan, chief of the Division of Allergy, Immunology and Infectious Diseases at the Children’s Hospital at St. Peter’s University Hospital in New Brunswick. “It’s the kids that spread the infections, joyfully, as children do.”
Health officials said the flu season usually peaks in January or February each year. Young children are particularly vulnerable to the flu, as are the elderly, pregnant women and people with weakened immune systems.
Each year, more than 200,000 people are hospitalized from flu complications and about 36,000 people die from the flu, according to the federal Centers for Disease Control and Prevention. Of those hospitalized, about 20,000 are children. Last year, the C.D.C. received reports that 86 children had died from flu-related complications.
There have been about five cases of pediatric flu-related illnesses that required hospitalization this season in New Jersey, Dr. Tan said. A weekly report that tracks influenza in the state characterized influenza activity in mid-December as sporadic.
An advisory panel for the Centers for Disease Control and Prevention said that all children ages 6 months to 18 years should receive an annual flu shot.
In New Jersey, preschoolers are also required to get a vaccine against the germ that causes pneumonia. That vaccination was due at the beginning of the school year. Sixth graders are required to get a vaccine against meningitis and a booster against tetanus, diphtheria and pertussis. Children who enroll in school after the new year, perhaps from other states or countries, must also be vaccinated.
This fall, the New Jersey Coalition for Vaccination Choice held a rally in Trenton that drew hundreds of parents who said they should be the ones to decide if their children need flu shots, not the state.
“There’s a huge trust gap between parents and public health officials right now,” said Louise Kuo Habakus, who is a parent and spokeswoman for the New Jersey Coalition for Vaccination Choice. “These are our kids. We’re stakeholders. You have to give us a say in this debate.”
Many of these parents say they believe vaccines cause autism, even though multiple studies have found no such link. The New Jersey coalition supports proposed legislation that would provide an exemption for conscientious objectors to mandatory vaccinations for schoolchildren.
“The New Jersey Department of Health opposes philosophical exemptions only because influenza can cause destructive and serious illness among children,” Dr. Tan said.
Dr. Tolan said that vaccines are a matter of public health.
“If you don’t vaccinate your child, you’re putting my child at risk,” he said.
For Privacy’s Sake, Taking Risks to End Pregnancy
By JENNIFER 8. LEE and CARA BUCKLEY, The New York Times, January 5, 2009
Amalia Dominguez was 18 and desperate and knew exactly what to ask for at the small, family-run pharmacy in the heart of Washington Heights, the thriving Dominican enclave in northern Manhattan. “I need to bring down my period,” she recalled saying in Spanish, using a euphemism that the pharmacist understood instantly.
It was 12 years ago, but the memory remains vivid: She was handed a packet of pills. They were small and white, $30 for 12. Ms. Dominguez, two or three months pregnant, went to a friend’s apartment and swallowed the pills one by one, washing them down with malta, a molasseslike extract sold in nearly every bodega in the neighborhood.
The cramps began several hours later, doubling Ms. Dominguez over, building and building until, eight and a half hours later, she locked herself in the bathroom and passed a lifeless fetus, which she flushed.
The pills were misoprostol, a prescription drug that is approved by the Food and Drug Administration for reducing gastric ulcers and that researchers say is commonly, though illegally, used within the Dominican community to induce abortion. Two new studies by reproductive-health providers suggest that improper use of such drugs is one of myriad methods, including questionable homemade potions, frequently employed in attempts to end pregnancies by women from fervently anti-abortion cultures despite the widespread availability of safe, legal and inexpensive abortions in clinics and hospitals.
One study surveyed 1,200 women, mostly Latinas, in New York, Boston and San Francisco and is expected to be released in the spring; the other, by Planned Parenthood, involved a series of focus groups with 32 Dominican women in New York and Santo Domingo. Together, they found reports of women mixing malted beverages with aspirin, salt or nutmeg; throwing themselves down stairs or having people punch them in the stomach; and drinking teas of avocado leaf, pine wood, oak bark and mamon fruit peel.
Interviews with several community leaders and individual women in Washington Heights echoed the findings, and revealed even more unconventional methods like “juice de jeans,” a noxious brew made by boiling denim hems.
“Some women prefer to have a more private experience with their abortion, which is certainly understandable,” said Dr. Daniel Grossman, an obstetrician with Ibis Reproductive Health in San Francisco, which joined Gynuity Health Projects in New York in conducting the larger study. “The things they mention are, ‘It is easier.’ It was recommended to them by a friend or a family member.”
Dr. Carolyn Westhoff, an obstetrician at NewYork-Presbyterian/Columbia University Medical Center, said the trend fits into a larger context of Dominicans seeking home remedies rather than the care of doctors or hospitals, partly because of a lack of insurance but mostly because of a lack of trust in the health care system. “This is not just a culture of self-inducted abortion,” she said. “This is a culture of going to the pharmacy and getting the medicine you need.”
Physicians say that women can obtain the pills either through pharmacies that are willing to bend the rules and provide the medicine without a prescription or by having the drugs shipped from overseas.
It is impossible to know how many women in New York or nationwide try to end their pregnancies themselves, but in the vibrant, socially conservative Dominican neighborhoods of Upper Manhattan, the various methods are passed like ancient cultural secrets. In a study of 610 women at three New York clinics in largely Dominican neighborhoods conducted eight years ago, 5 percent said they had taken misoprostol themselves, and 37 percent said they knew it was an abortion-inducing drug. Doctors and community leaders say they have not seen any signs of the phenomenon disappearing, which they find worrisome because of concerns about the drug’s effectiveness and potential side effects.
Sold under the brand name Cytotec, misoprostol is approved to induce abortion when taken with mifepristone, or RU-486; doctors also sometimes use it to induce labor, though it is not approved for that use. A spokesman for Pfizer, which manufacturers Cytotec, declined to comment beyond saying that the company does not support the off-label use of its products and noting that the label includes “F.D.A.’s strongest warning against use in women who are pregnant.”
That warning, in capital letters, also notes that the drug “can cause abortion.”
But it does not always do so, not least because notions of how best to use it vary from inserting several pills into the vagina to letting them dissolve under the tongue. The side effects can be serious, and include rupture of the uterus, severe bleeding and shock.
“We do worry because we don’t know where women are getting the instructions from,” said Jessica Gonzalez-Rojas of the National Latina Institute for Reproductive Health, which was also a partner on the Ibis study. “We imagine that there is misinformation on how to take it, which is why it could be hit or miss.”
In 2007 in Massachusetts, an 18-year-old Dominican immigrant named Amber Abreu took misoprostol in her 25th week of pregnancy and gave birth to a 1-pound baby girl who died four days later; a judge sentenced her in June to probation and ordered her into therapy. In South Carolina in February, a Mexican migrant farm worker, Gabriela Flores, pleaded guilty to illegally performing an abortion and was sentenced to 90 days in jail for taking misoprostol while four months pregnant in 2004. A Virginia man, Daniel Riase, is serving a five-year prison sentence after pleading guilty in 2007 to slipping the pills into his pregnant girlfriend’s glass of milk.
Researchers studying the phenomenon cite several factors that lead Dominican and other immigrant women to experiment with abortifacients: mistrust of the health-care system, fear of surgery, worry about deportation, concern about clinic protesters, cost and shame.
“It turns an abortion into a natural process and makes it look like a miscarriage,” said Dr. Mark Rosing, an obstetrician at St. Barnabas Hospital in the Bronx who led the 2000 study, which was published in the Journal of the American Medical Women’s Association. “For people who don’t have access to abortion for social reasons, financial reasons or immigration reasons, it doesn’t seem like this horrible thing.”
Ms. Dominguez, for her part, said she had no insurance or money to pay for an abortion, and could not fathom getting one for fear her mother would find out. One of her friends had spent $1,200 on an abortion that left her with a uterine infection, and another friend endured the procedure without anesthesia, she said. In addition, Washington Heights is a tightknit community where abortion — as well as birth control — is shunned; if Ms. Dominguez were spotted entering a clinic, rumors could fly.
“There are scary moments, and you got to have a friend right next to you,” said Ms. Dominguez, now 30 and a mother of four. “It’s cheap but dangerous. Certain people are more delicate than others. But afterwards, I felt relief.”
A friend of Ms. Dominguez’s said her stepsister took the pills last year because she was in the country illegally, and worried that a doctor might turn her in. “She was just scared,” the woman said, speaking on the condition that her name not be published to protect the stepsister’s privacy. “She had no papers, no insurance, no nothing.”
The woman went to a free clinic afterward to make sure the pills had worked (they had). Health care workers and other community leaders say such visits are how they discovered widespread illicit use of the drug as well as homemade potions.
Dr. Rosing said he learned about Cytotec during his residency at NewYork-Presbyterian/Columbia hospital in Washington Heights, where he saw a lot of Dominican immigrants with incomplete abortions in the emergency room. They spoke of taking the “star pill,” a nickname for the hexagonal shape of one form of misoprostol. He suspected “that has to be the tip of the iceberg,” he said, “and it was.”
The pills allow pregnant women a degree of denial over what is taking place. Like Ms. Dominguez, many women in the neighborhood talk about the need to bring on — or “down” — their periods, not abortion. Afterward, they might tell doctors or relatives they had lost the baby.
The Planned Parenthood study concluded that women in both nations “seemed to see inducing the termination of pregnancy, or abortions, as a part of the reality of their lives,” in a community where, as one interview subject put it, “we are all doctors.” The report noted that in a culture steeped in machismo, birth control is generally seen as the woman’s responsibility.
“If I introduce the condom into a relationship, I’m basically saying I’ve had somebody else, and I’ve not been faithful to you,” said Haydee Morales, a vice president at Planned Parenthood of New York.
Debralee Santos, program director at Casa Duarte, a community arts organization in Washington Heights, said that while she had never had reason to distrust medical professionals, she understood the apprehensions that kept other women from seeking them out. “I get it, I really do,” she said.
“It’s a community that, even as it comes of age, always relies on itself first,” explained Ms. Santos, who was born in the United States to immigrant parents. “Women, in particular, continue to help each other in ways that speak to tradition and solidarity.”
Ms. Dominguez, who volunteers at Casa Duarte and is known as Flaca, Spanish for skinny, did not want her name or photograph published at first. But after some thought, she decided to allow it so more people would learn about the trap many pregnant Dominican women feel they are in.
“It’s a health risk,” she said. “There’s a lot of girls in situations like that, and they’re overwhelmed.”
Orbiter, Finishing a Mission, Offers a Peek at Mars’ Wrinkles
By KENNETH CHANG, The New York Times, January 6, 2009
Last month, NASA’s Mars Reconnaissance Orbiter wrapped up its two-year primary science phase, and Mars geologists are wallowing in a bounty of data.
“Technically and scientifically, it has certainly met our expectations,” said Alfred S. McEwen, a planetary geologist at the University of Arizona and principal investigator for the orbiter’s high-resolution camera.
Images taken by the camera, able to see features down to about a yard in size, have revealed details like rippled textures in what had looked like bland dusty regions, and researchers can now count tiny craters, enabling them to better estimate the age of terrains.
A sensitive spectrometer discovered rocks made of carbonate minerals, which may have formed when young Mars possessed a more benign environment: wet and maybe warm.
“That’s telling us something about the early history of Mars,” said Scott L. Murchie of the Johns Hopkins Applied Physics Laboratory and principal investigator for the spectrometer.
Most of the carbonates were washed away by acidic waters in later epochs.
The orbiter will continue its observations, which will allow places to be photographed more than once to capture changes in the landscape.
Meanwhile, the two Martian rovers, Spirit and Opportunity, mark their fifth anniversary this month, far outliving their original three-month mission. Spirit has recently begun moving again after sitting still through the winter while Opportunity is crossing the plains en route to a 13.7-mile-wide crater named Endeavour, a journey that could take at least another two years.
Steven W. Squyres, the principal investigator of the rovers, said it struck him as an odd milestone for people to mark. “It’s kind of like celebrating your birthday in Mars years,” he said. “Of course, I’d be younger that way.” (In Mars years, Dr. Squyres is 28.)
Food Dance Gets New Life When Bees Get Cocaine
By PAM BELLUCK, The New York Times, January 6, 2009
Buzz has a whole new meaning now that scientists are giving bees cocaine.
To learn more about the biochemistry of addiction, scientists in Australia dropped liquefied freebase cocaine on bees’ backs, so it entered the circulatory system and brain.
The scientists found that bees react much like humans do: cocaine alters their judgment, stimulates their behavior and makes them exaggeratedly enthusiastic about things that might not otherwise excite them.
What’s more, bees exhibit withdrawal symptoms. When a coked-up bee has to stop cold turkey, its score on a standard test of bee performance (learning to associate an odor with sugary syrup) plummets.
“What we have in the bee is a wonderfully simple system to see how brains react to a drug of abuse,” said Andrew B. Barron, a senior lecturer at Macquarie University in Australia and a co-leader in the bees-on-cocaine studies. “It may be that when we know that, we’ll be able to stop a brain reacting to a drug of abuse, and then we may be able to discover new ways to prevent abuse in humans.”
The research, published in The Journal of Experimental Biology, advances the knowledge of reward systems in insects, and aims to “use the honeybee as a model to study the molecular basis of addiction,” said Gene E. Robinson, director of the neuroscience program at the University of Illinois at Urbana-Champaign and a co-author with Dr. Barron, and Ryszard Maleszka and Paul G. Helliwell at Australian National University.
The researchers looked at honeybees whose job is finding food — flying to flowers, discovering nectar, and if their discovery is important enough, doing a waggle dance on a special “dance floor” to help hive mates learn the location.
“Many times they don’t dance,” Professor Robinson said. “They only dance if the food is of sufficient quality and if they assess the colony needs the food.”
On cocaine the bees “danced more frequently and more vigorously for the same quality food,” Dr. Barron said. “They were about twice as likely to dance” as undrugged bees, and they circled “about 25 percent faster.”
The bees did not dance at the wrong time or place. Cocaine only made them more excited about the food they found. That’s like “when a human takes cocaine at a low dose,” Dr. Barron said. “They find many stimuli, but particularly, rewarding stimuli, to be more rewarding than they actually are.”
Now, scientists are studying whether bees begin to crave cocaine and need more for the same effect, like humans.
The testing occurred in Australia, and, Dr. Barron said, “my dean got extremely twitchy about holding cocaine on campus. It’s in a safe bolted to a concrete floor within a locked cupboard in a locked room in a locked building with a combination code not known even to me. A technician from the ethics department has to walk across campus to supervise the release of the cocaine.”
That, Dr. Barron said, for a bee-size supply of “one gram, which has lasted me two years. One gram, a human would go through in one night. I’m not like the local drug lord.”
Well: With the Right Motivation, That Home Gym Makes Sense
By TARA PARKER-POPE, The New York Times, January 6, 2009
A year ago, I bought an elliptical trainer — a gym-quality machine that I felt certain would get a daily workout.
Today, my top-of-the-line exercise machine sits idle most of the time. But I’m not alone. Every year, consumers spend an estimated $4 billion on home treadmills, stationary bikes, Stairmasters and other equipment that ends up gathering dust. A Consumer Reports survey last year found that nearly 40 percent of those who buy home exercise machines say they use them less than they expected.
This may be discouraging to people like me, but it is a source of fascination for behavioral scientists. The hope is that by better understanding the behavior, they can help people make better buying decisions — and help them start exercising and stick with it.
Buying an exercise machine does seem to influence whether people start working out. But some research suggests that the same people are less likely to stick with exercise over time than people who don’t own home equipment.
In October, the journal Annals of Behavioral Medicine reported on a study of 205 sedentary adults who were encouraged to begin an exercise program. At 6 months, about half had done so, but by 12 months, about a third of those people had stopped.
People with a home exercise machine were 73 percent more likely to start exercising. But by the end of the year, they were also 12 percent more likely to have quit than people in the study who did not have home equipment.
This doesn’t mean a home exercise machine leads to less exercise. It just means that having home equipment is not the most important factor. What matters more is “self-efficacy” — a deep-seated belief that we really do have the power to achieve our goals. In the Annals study, those who scored high on psychological measures of self-efficacy were nearly three times as likely to be exercising after a year as those with lower self-efficacy scores, whether or not they owned an exercise machine.
Meeting your own expectations also influences whether you stick with exercise. Study participants who were satisfied with the results of their exercise plan were twice as likely to keep it up as those who were not.
While believing that you can do it and being happy with your results may seem to be obvious parts of success, researchers say that people often fail to take these psychological issues into account when they start an exercise plan.
“What is your confidence in your ability to stick to your exercise program when you’re on vacation, when you’re not feeling well, when you’re busy?” asked David M. Williams, assistant professor of psychiatry and human behavior at the Alpert Medical School of Brown University, who led the exercise study. “The message isn’t that home exercise equipment doesn’t work. It’s just one very small piece of the puzzle, because it might make it easier to exercise, but they still have to motivate themselves to do it.”
Dr. Williams said there were simple ways to increase the likelihood that you will keep exercising. Working out with friends or family members, mastering an exercise (like the proper way to use gym equipment), and working with someone who motivates you, like a personal trainer, all build confidence and bolster the chances of sticking with it.
But consumers need to distinguish between real motivation to exercise and the unrealistic optimism that often takes over when they are shopping for a new exercise machine.
“Most goals we set for ourselves tend to be unrealistically high,” said Ravi Dhar, director of the Yale Center for Customer Insights and a professor of marketing and psychology. “When you buy these machines, you probably end up focusing on one or two attributes, like how easy it is to use or having it in your home. You’re not thinking about the barriers, what you’re giving up, like the time with friends or the Internet.”
In experiments to be published next month in The Journal of Consumer Research, scientists at Duke and the University of Wisconsin studied ways to help people make more realistic buying decisions.
In one group, undergraduate students were asked how often they would exercise in a two-week period. They estimated five times, and then indicated they would pay about $610 for a treadmill.
In a second group, students were asked how often they would exercise under ideal conditions, with no constraints on their time, motivation and physical ability. The answer: 10 times. Then they were asked how often they would really exercise. They scaled it back to fewer than four times. Rooted in reality, this group was willing to pay just $480 for a treadmill.
When the participants recorded their actual exercise over a two-week period, it totaled about three days. That shows that the simple act of distinguishing between an ideal setting and the real world helped those in the second group make more realistic exercise estimates.
“We’re not telling people to stop buying treadmills,” said Kurt A. Carlson, assistant professor at the Fuqua School of Business at Duke. “The question is how to get the right people to buy them. Everyone else should recognize they don’t have the motivation, and take the money and use it on a personal trainer or something else that’s going to get them motivated.”
