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More Wii Warriors Are Playing Hurt
By ANDREW DAS, The New York Times, April 21, 2009
In the moments after I felt the pop in my left shoulder, the sensation I felt was not pain. It was panic. How exactly does a 40-year-old man explain to his wife that he might have torn his rotator cuff during a midnight game of Wii tennis?
Dr. Charles Young made me feel better without even examining me.
Late last year, Dr. Young, an orthopedic surgeon, spent about an hour experimenting with the balance games and strength-training exercises on his new Wii Fit. Running on a virtual trail. Slalom skiing. Walking on a tightrope. “They have this hula-hoop one where you’re supposed to spin yourself in a circle and try to get a high score,” said Dr. Young, who is completing a sports medicine fellowship at the Cleveland Clinic. “I was really hurting.”
In the operating room the next day he commiserated with several nurses who confessed that they had, at least figuratively, already felt his pain.
To say that Wii injuries are an epidemic would be an overstatement, but they are proliferating along with the popular video-game system. Interviews with orthopedists and sports medicine physicians revealed few serious injuries, but rather a phenomenon more closely resembling a spreading national ache: patients of all ages complaining of strains and swelling related to their use — and overuse — of the Wii.
Call it Wii Shoulder. Or Wii Knee. If there is an epidemic of anything, it probably falls under a broader label: Nintendinitis.
“Skateboarding, snowboarding, you name it,” said Dr. William N. Levine, the director of sports medicine at NewYork-Presbyterian Hospital/Columbia University Medical Center. “Take the newest fad, and there’s always a slew of specific orthopedic injuries associated with it.”
The difference now is that the surging sales of the Wii system mean that misery gets more company every day. Nintendo, which introduced the Wii in November 2006, sold more than 10 million of the game systems in the United States last year, including a record 2.1 million in December. The complementary Wii Fit exercise program has been nearly as popular, with more than 6.5 million sold since its introduction last May.
Consumers who avoided sedentary video-game systems have flocked to the Wii, which lures users off the couch with a handheld, wireless remote and a selection of familiar, free-swinging games like tennis, boxing and bowling. For some parents, and even grandparents, the games are a way to connect with children on their own turf. The fact that everyone gets a little exercise along the way is an added plus.
“It’s great in the concept that it gets people active and involved,” said Dr. Brian Halpern, a sports medicine physician at the Hospital for Special Surgery in Manhattan. “It’s not great in that you get lost in that and are overloading areas that you haven’t worked out in a long time, if ever.”
Dr. Halpern said he had treated two types of injuries: traumatic injuries like twisted knees and sprained ankles from playing the games in confined spaces, and repetitive stress problems from playing too long. A common problem is the realization by players that a full swing is not required; a flick of the wrist is often enough to return a serve or bowl a strike. As several doctors pointed out, that is the exact motion — concentrating the force of a swing in the muscles of the forearm — that can cause tennis elbow.
The Wii system was built with warnings about prolonged use, and electronic prompts interrupt players regularly to urge them to take a break.
Denise Kaigler, a vice president for marketing and corporate affairs at Nintendo of America, said in an e-mail message that “as consumers adapt to this new style of play, there have been a few reports of minor incidents during overly enthusiastic game play,” but that more health and safety warnings — about playing in an area free of obstructions, for example — had been added.
“As with any new activity, people playing the Wii system should pace themselves and not overdo it,” Ms. Kaigler said.
Dr. John Sperling, a physician at the Mayo Clinic in Rochester, Minn., called the aches and pains a sign of the times. “It’s a syndrome of injuries and people presenting with complaints that we couldn’t have imagined three years ago,” he said.
Dr. Levine said the youngest patient he had treated was 12. Dr. Young, who overworked his core muscles using the Wii Fit, is 32. Dr. Sperling’s patients have included a 22-year-old whose arm swelled to twice its size after a marathon Wii session, and a man in his 60s.
“I was asking him what happened,” Dr. Sperling said of the older patient, “and he said, ‘Well, we bought a Wii system for the grandkids. Next thing I know, my shoulder’s killing me.’ ”
Dr. Halpern, a former assistant team physician for the Mets, compared some Wii injuries to those sustained by professional athletes.
“It’s like if you have a pitcher who has gone to spring training and hasn’t worked hard in the off-season and starts throwing too much and kind of overloads his shoulder or elbow,” he said.
And just as that pitcher might have to take several days off, a person experiencing pain from a session of Wii games should do the same. While “the rush of beating kids a fraction of your age in Wii Sports far outweighs the discomforts of getting older,” Ms. Kaigler said, moderation is just as important. That may be especially true for older players.
My shoulder recovered with time away from the Wii, not a problem in a household with three children who were all eager to play and who are apparently more durable than their father. The lasting image of Christmas at my family’s home was that of my 5-year-old daughter in a velvet dress, blond hair tucked behind one ear, raining punches on a hulking man with a goatee. She knocked him out, but quickly moved on to baseball and bowling and golf.
Dr. Halpern said the shorter attention spans of younger children were probably preventing them from developing overuse injuries, describing their exposure to a variety of Wii games as “cross-training without even thinking about it.” Sore-shouldered and gimpy-kneed adults could be victims of their better focus, but also of their innate competitiveness.
“It’s good to be a kid at heart,” said Dr. Susan Joy, the director of the Cleveland Clinic’s women’s sports health program. “But sometimes when you start a new exercise program, it’s good to remember that you’re not a kid.”
Sex Ratio Seen to Vary by Latitude
By NICHOLAS BAKALAR, The New York Times, April 21, 2009
More boys than girls are born all over the world, but a new study has found that the closer people live to the equator, the smaller the difference becomes. No one knows why.
The skewed sex ratio at birth has been known for more than a hundred years, and researchers have found a large variety of social, economic and biological factors that correlate with it — war, economic stress, age, diet, selective abortion or infanticide and more. Teasing out the contribution of any single cultural or political variable has proved an almost infinitely complicated exercise.
But latitude is a natural phenomenon, unaffected by cultural or economic factors. To look at its effect, Kristen J. Navara of the University of Georgia used the latitude of the capital city in 202 countries, as well as 10 years of data on sex ratio at birth and annual variations in day length and temperature.
To estimate socioeconomic status for each country, she used statistics on unemployment and gross national product. She also calculated a political instability index using an analysis of state failure and conflict published by the Fund for Peace, a research organization that combines 12 social, economic and political indicators to estimate the relative stability of the world’s nations.
Then Dr. Navara performed a statistical analysis to figure out which variables affect sex ratio. The report appeared online April 1 in Biology Letters.
The number of boys born was not related to socioeconomic and political factors, but there was a significant correlation between sex ratios skewed in favor of boys and latitude and the climate variables that go with it. African countries produced the lowest sex ratios — 50.7 percent boys — and European and Asian countries had the highest with 51.4 percent.
The effect of latitude, Dr. Navara found, persisted across wide variations in lifestyle and socioeconomic status. There were large differences in sex ratio between tropical regions within 23 degrees of the equator and the temperate regions 23 to 50 degrees north or south, but no difference between the temperate regions and the subarctic north of 50 degrees. The population of people living south of 50 degrees was too small to be included in the analysis.
The correlation with latitude was unchanged even after excluding data from Asian and African countries that might have been skewed by abortion or the killing of baby girls. So sex selection by parents before or at birth does not explain the correlation.
One expert not involved in the study questioned the validity of Dr. Navara’s statistical technique.
“There is no question that the vast majority of people in the tropics live in relatively poor and stressful societies,” said Ralph Catalano, a professor of public health at the University of California, Berkeley. “If you control for the stresses of poverty, who have you got left that the test turns on?”
Dr. Navara defended her analysis. “Statistical analyses involving human populations are always tricky,” she said, “but the analyses used here are robust and did not eliminate any variation that we would see in these populations.”
There are some possible explanations, but none entirely satisfactory. It could be that there is some survival value in producing more girls in warmer regions, but it is unclear what this might be. There may be genetic or racial differences that could explain it, but the correlation persists over so many varied populations that this seems unlikely. Hamsters, mice and meadow voles also produce more male offspring during shorter days or colder weather, but the reasons in these animals are just as mysterious as they are in humans.
No one even knows whether human sex ratios are skewed before or after conception. Could the quality of sperm at different temperatures cause the variation at the moment of conception? Or is there some event during gestation at warmer temperatures that causes more male fetuses, or fewer female, to spontaneously abort?
“There’s a possibility that humans might be responding to factors they were programmed to respond to a long time ago — not cultural or socioeconomic, but climate and things like latitude,” Dr. Navara said. “What’s interesting is that we may be seeing something that attests to our animal ancestry.”
A First Look at the Bones of a ‘Hobbit’
By JOHN NOBLE WILFORD, The New York Times, April 21, 2009
A “hobbit” will be making its public debut on Tuesday at Stony Brook University on Long Island. A cast of the skull and bones of the hominid Homo floresiensis, its diminutive size inspiring the hobbit nickname, will be displayed for the first time at a public symposium on human evolution, titled “Hobbits in the Haystack.”
Researchers at the university made the cast from 3-D images of a skeleton of one of these “little people,” who lived as recently as 18,000 years ago in caves on the Indonesian island of Flores. The original skeleton remains in an Indonesian laboratory.
The discovery, announced in 2004, set off heated debate among scientists. The Australian and Indonesian scientists who found bones of at least eight specimens pronounced them evidence of a separate human species. The individuals were small, not much more than three feet tall, and apparently had brains the size of chimpanzees’. Other experts have contended that the hobbits are Homo sapiens who evolved small stature in isolation and hypothesized that genetic or pathological disorders accounted for their abnormally small brains.
William Jungers, a paleoanthropologist at Stony Brook, said casts of the hobbit skull had been displayed at a few scientific meetings, but this was the first time both skull and skeleton would be “displayed anywhere, inside or outside of Indonesia.”
Ill From Food? Investigations Vary by State
By GARDINER HARRIS, The New York Times, April 20, 2009
In just about every major contaminated food scare, Minnesotans become sick by the dozens while few people in Kentucky and other states are counted among the ill.
Contaminated peanuts? Forty-two Minnesotans were reported sick compared with three Kentuckians. Jalapeño peppers last year? Thirty-one in Minnesota and two in Kentucky became ill. The different numbers arise because health officials in Kentucky and many other states fail to investigate many complaints of food-related sickness while those in Minnesota do so diligently, safeguarding not only Minnesotans but much of the rest of the country, as well.
Congress and the Obama administration have said that more inspections and new food production rules are needed to prevent food-related diseases, but far less attention has been paid to fixing the fractured system by which officials detect and stop ongoing outbreaks. Right now, uncovering which foods have been contaminated is left to a patchwork of more than 3,000 federal, state and local health departments that are, for the most part, poorly financed, poorly trained and disconnected, officials said.
The importance of a few epidemiologists in Minnesota demonstrates the problem. If not for the Minnesota Department of Health, the Peanut Corporation of America might still be selling salmonella-laced peanuts, Dole might still be selling contaminated lettuce, and ConAgra might still be selling dangerous Banquet brand pot pies — sickening hundreds or thousands more people.
In these and other cases, epidemiologists from Minnesota pinpointed the causes of food scares while officials in other states were barely aware that their residents were getting sick. From 1990 to 2006, Minnesota health officials uncovered 548 food-related illness outbreaks, while those in Kentucky found 18, according to an analysis of health records.
The surveillance system is vital because even with reforms intended to prevent outbreaks, food-related disease will remain among the most common sources of illness. One-quarter of the nation’s population is sickened every year by contaminated food, 300,000 are hospitalized and 5,000 die, and decades of steady improvements in the safety of the nation’s food supply have ended in recent years.
“The longer it takes you to nail an outbreak, the more people are going to get sick,” said Dr. David Acheson, associate commissioner for foods at the Food and Drug Administration. “And if it’s a pathogen that causes death, the more people are going to die.”
With states cutting back in the face of budget crises, disease surveillance is worsening, several officials said.
“Just $50 million spread over the entire country would make a huge difference,” said Dr. Timothy Jones, the state epidemiologist in Tennessee.
Take the case of Lauren Threlkeld, who went to a Kroger grocery store in Lexington, Ky., in August 2007 and bought a bag of Dole baby spinach contaminated with E. coli O157. She became violently ill with bloody diarrhea and was hospitalized for nearly a week.
When Ms. Threlkeld finally went home to recuperate in Madisonville, Ky., a county health worker called only to verify that she had fallen ill in another county. No one asked about the foods she had eaten or what might have made her so ill, she said. Later efforts by her lawyer pinpointed the source of her illness — far too late to help others avoid similar fates.
Dr. William D. Hacker, the public health commissioner in Kentucky, blamed tight budgets. “We have had a historically poor record of reporting” food-borne illnesses, Dr. Hacker said. “We are working hard to change our culture even with limited resources.”
In Minnesota and a few other states, victims of food-related illnesses tell very different stories. Sarah Kirchner of Belle Plaine, Minn., said health workers called her three separate times and spent hours discussing her children’s diet almost immediately after a laboratory test verified that one had fallen ill with salmonella. Officials in Minnesota traced the outbreak to peanut butter in part because of Ms. Kirchner’s responses.
“There is no question that some states take this far more seriously than others,” Dr. Acheson said.
Even when county and state health departments investigate, their methods often differ so greatly that federal officials have difficulty uncovering patterns. This leads to terrible delays.
“Everybody does things differently, even within many states,” Dr. Acheson said. “It’s a huge challenge.”
Some delay is inevitable. Most people sickened by food do not bother to see a doctor. Many of those who do are not asked to provide a stool sample, and when asked, some refuse.
When patients are willing, laboratories may not be. In Utah, for instance, only 18 of the state’s 1,388 medical laboratories process stool tests, said Dr. Pat Luedtke, director of the Utah public health laboratory. Well-meaning doctors who wish to send stool samples sometimes must pay the postage because insurers often refuse to pay for a test that largely serves a public health function; many doctors do not bother.
By the time public health officials notice that a growing number of such samples carry the same genetic fingerprint — a clear sign that a popular food is contaminated — weeks have passed. By then, victims’ memories of what they ate have faded. So rapid and thorough responses by health officials, a rarity in many states, are crucial.
“I’ve learned in the last few months that the real secret to our success is that we have urgency,” said Dr. Kirk Smith, supervisor of the food-borne diseases unit for the Minnesota Department of Health.
Dr. Acheson of the F.D.A. said federal authorities had been meeting with state health officials to seek ways to improve the surveillance system, including standardizing menu questionnaires and improving response times. But he said more federal financing was crucial.
Dr. Robert Tauxe, deputy director of the Centers for Disease Control and Prevention’s division of food-borne diseases, said the agency planned immediate investments “to increase the capacity of several health departments.”
Ruth Ann Merrick of Somerset, Ky., said she was still bitter about how her case was handled. She went with friends to a local Chinese restaurant on June 26, 2004. Within 45 minutes, she was vomiting so violently that she passed out and her heart stopped. After her husband performed C.P.R., she was taken to Lake Cumberland Regional Hospital, where she remained in intensive care for four days.
Although four of the eight people in her party were sickened, the state never investigated, she said.
“I thought I was going to die,” Ms. Merrick said.
By ANDREW DAS, The New York Times, April 21, 2009
In the moments after I felt the pop in my left shoulder, the sensation I felt was not pain. It was panic. How exactly does a 40-year-old man explain to his wife that he might have torn his rotator cuff during a midnight game of Wii tennis?
Dr. Charles Young made me feel better without even examining me.
Late last year, Dr. Young, an orthopedic surgeon, spent about an hour experimenting with the balance games and strength-training exercises on his new Wii Fit. Running on a virtual trail. Slalom skiing. Walking on a tightrope. “They have this hula-hoop one where you’re supposed to spin yourself in a circle and try to get a high score,” said Dr. Young, who is completing a sports medicine fellowship at the Cleveland Clinic. “I was really hurting.”
In the operating room the next day he commiserated with several nurses who confessed that they had, at least figuratively, already felt his pain.
To say that Wii injuries are an epidemic would be an overstatement, but they are proliferating along with the popular video-game system. Interviews with orthopedists and sports medicine physicians revealed few serious injuries, but rather a phenomenon more closely resembling a spreading national ache: patients of all ages complaining of strains and swelling related to their use — and overuse — of the Wii.
Call it Wii Shoulder. Or Wii Knee. If there is an epidemic of anything, it probably falls under a broader label: Nintendinitis.
“Skateboarding, snowboarding, you name it,” said Dr. William N. Levine, the director of sports medicine at NewYork-Presbyterian Hospital/Columbia University Medical Center. “Take the newest fad, and there’s always a slew of specific orthopedic injuries associated with it.”
The difference now is that the surging sales of the Wii system mean that misery gets more company every day. Nintendo, which introduced the Wii in November 2006, sold more than 10 million of the game systems in the United States last year, including a record 2.1 million in December. The complementary Wii Fit exercise program has been nearly as popular, with more than 6.5 million sold since its introduction last May.
Consumers who avoided sedentary video-game systems have flocked to the Wii, which lures users off the couch with a handheld, wireless remote and a selection of familiar, free-swinging games like tennis, boxing and bowling. For some parents, and even grandparents, the games are a way to connect with children on their own turf. The fact that everyone gets a little exercise along the way is an added plus.
“It’s great in the concept that it gets people active and involved,” said Dr. Brian Halpern, a sports medicine physician at the Hospital for Special Surgery in Manhattan. “It’s not great in that you get lost in that and are overloading areas that you haven’t worked out in a long time, if ever.”
Dr. Halpern said he had treated two types of injuries: traumatic injuries like twisted knees and sprained ankles from playing the games in confined spaces, and repetitive stress problems from playing too long. A common problem is the realization by players that a full swing is not required; a flick of the wrist is often enough to return a serve or bowl a strike. As several doctors pointed out, that is the exact motion — concentrating the force of a swing in the muscles of the forearm — that can cause tennis elbow.
The Wii system was built with warnings about prolonged use, and electronic prompts interrupt players regularly to urge them to take a break.
Denise Kaigler, a vice president for marketing and corporate affairs at Nintendo of America, said in an e-mail message that “as consumers adapt to this new style of play, there have been a few reports of minor incidents during overly enthusiastic game play,” but that more health and safety warnings — about playing in an area free of obstructions, for example — had been added.
“As with any new activity, people playing the Wii system should pace themselves and not overdo it,” Ms. Kaigler said.
Dr. John Sperling, a physician at the Mayo Clinic in Rochester, Minn., called the aches and pains a sign of the times. “It’s a syndrome of injuries and people presenting with complaints that we couldn’t have imagined three years ago,” he said.
Dr. Levine said the youngest patient he had treated was 12. Dr. Young, who overworked his core muscles using the Wii Fit, is 32. Dr. Sperling’s patients have included a 22-year-old whose arm swelled to twice its size after a marathon Wii session, and a man in his 60s.
“I was asking him what happened,” Dr. Sperling said of the older patient, “and he said, ‘Well, we bought a Wii system for the grandkids. Next thing I know, my shoulder’s killing me.’ ”
Dr. Halpern, a former assistant team physician for the Mets, compared some Wii injuries to those sustained by professional athletes.
“It’s like if you have a pitcher who has gone to spring training and hasn’t worked hard in the off-season and starts throwing too much and kind of overloads his shoulder or elbow,” he said.
And just as that pitcher might have to take several days off, a person experiencing pain from a session of Wii games should do the same. While “the rush of beating kids a fraction of your age in Wii Sports far outweighs the discomforts of getting older,” Ms. Kaigler said, moderation is just as important. That may be especially true for older players.
My shoulder recovered with time away from the Wii, not a problem in a household with three children who were all eager to play and who are apparently more durable than their father. The lasting image of Christmas at my family’s home was that of my 5-year-old daughter in a velvet dress, blond hair tucked behind one ear, raining punches on a hulking man with a goatee. She knocked him out, but quickly moved on to baseball and bowling and golf.
Dr. Halpern said the shorter attention spans of younger children were probably preventing them from developing overuse injuries, describing their exposure to a variety of Wii games as “cross-training without even thinking about it.” Sore-shouldered and gimpy-kneed adults could be victims of their better focus, but also of their innate competitiveness.
“It’s good to be a kid at heart,” said Dr. Susan Joy, the director of the Cleveland Clinic’s women’s sports health program. “But sometimes when you start a new exercise program, it’s good to remember that you’re not a kid.”
Sex Ratio Seen to Vary by Latitude
By NICHOLAS BAKALAR, The New York Times, April 21, 2009
More boys than girls are born all over the world, but a new study has found that the closer people live to the equator, the smaller the difference becomes. No one knows why.
The skewed sex ratio at birth has been known for more than a hundred years, and researchers have found a large variety of social, economic and biological factors that correlate with it — war, economic stress, age, diet, selective abortion or infanticide and more. Teasing out the contribution of any single cultural or political variable has proved an almost infinitely complicated exercise.
But latitude is a natural phenomenon, unaffected by cultural or economic factors. To look at its effect, Kristen J. Navara of the University of Georgia used the latitude of the capital city in 202 countries, as well as 10 years of data on sex ratio at birth and annual variations in day length and temperature.
To estimate socioeconomic status for each country, she used statistics on unemployment and gross national product. She also calculated a political instability index using an analysis of state failure and conflict published by the Fund for Peace, a research organization that combines 12 social, economic and political indicators to estimate the relative stability of the world’s nations.
Then Dr. Navara performed a statistical analysis to figure out which variables affect sex ratio. The report appeared online April 1 in Biology Letters.
The number of boys born was not related to socioeconomic and political factors, but there was a significant correlation between sex ratios skewed in favor of boys and latitude and the climate variables that go with it. African countries produced the lowest sex ratios — 50.7 percent boys — and European and Asian countries had the highest with 51.4 percent.
The effect of latitude, Dr. Navara found, persisted across wide variations in lifestyle and socioeconomic status. There were large differences in sex ratio between tropical regions within 23 degrees of the equator and the temperate regions 23 to 50 degrees north or south, but no difference between the temperate regions and the subarctic north of 50 degrees. The population of people living south of 50 degrees was too small to be included in the analysis.
The correlation with latitude was unchanged even after excluding data from Asian and African countries that might have been skewed by abortion or the killing of baby girls. So sex selection by parents before or at birth does not explain the correlation.
One expert not involved in the study questioned the validity of Dr. Navara’s statistical technique.
“There is no question that the vast majority of people in the tropics live in relatively poor and stressful societies,” said Ralph Catalano, a professor of public health at the University of California, Berkeley. “If you control for the stresses of poverty, who have you got left that the test turns on?”
Dr. Navara defended her analysis. “Statistical analyses involving human populations are always tricky,” she said, “but the analyses used here are robust and did not eliminate any variation that we would see in these populations.”
There are some possible explanations, but none entirely satisfactory. It could be that there is some survival value in producing more girls in warmer regions, but it is unclear what this might be. There may be genetic or racial differences that could explain it, but the correlation persists over so many varied populations that this seems unlikely. Hamsters, mice and meadow voles also produce more male offspring during shorter days or colder weather, but the reasons in these animals are just as mysterious as they are in humans.
No one even knows whether human sex ratios are skewed before or after conception. Could the quality of sperm at different temperatures cause the variation at the moment of conception? Or is there some event during gestation at warmer temperatures that causes more male fetuses, or fewer female, to spontaneously abort?
“There’s a possibility that humans might be responding to factors they were programmed to respond to a long time ago — not cultural or socioeconomic, but climate and things like latitude,” Dr. Navara said. “What’s interesting is that we may be seeing something that attests to our animal ancestry.”
A First Look at the Bones of a ‘Hobbit’
By JOHN NOBLE WILFORD, The New York Times, April 21, 2009
A “hobbit” will be making its public debut on Tuesday at Stony Brook University on Long Island. A cast of the skull and bones of the hominid Homo floresiensis, its diminutive size inspiring the hobbit nickname, will be displayed for the first time at a public symposium on human evolution, titled “Hobbits in the Haystack.”
Researchers at the university made the cast from 3-D images of a skeleton of one of these “little people,” who lived as recently as 18,000 years ago in caves on the Indonesian island of Flores. The original skeleton remains in an Indonesian laboratory.
The discovery, announced in 2004, set off heated debate among scientists. The Australian and Indonesian scientists who found bones of at least eight specimens pronounced them evidence of a separate human species. The individuals were small, not much more than three feet tall, and apparently had brains the size of chimpanzees’. Other experts have contended that the hobbits are Homo sapiens who evolved small stature in isolation and hypothesized that genetic or pathological disorders accounted for their abnormally small brains.
William Jungers, a paleoanthropologist at Stony Brook, said casts of the hobbit skull had been displayed at a few scientific meetings, but this was the first time both skull and skeleton would be “displayed anywhere, inside or outside of Indonesia.”
Ill From Food? Investigations Vary by State
By GARDINER HARRIS, The New York Times, April 20, 2009
In just about every major contaminated food scare, Minnesotans become sick by the dozens while few people in Kentucky and other states are counted among the ill.
Contaminated peanuts? Forty-two Minnesotans were reported sick compared with three Kentuckians. Jalapeño peppers last year? Thirty-one in Minnesota and two in Kentucky became ill. The different numbers arise because health officials in Kentucky and many other states fail to investigate many complaints of food-related sickness while those in Minnesota do so diligently, safeguarding not only Minnesotans but much of the rest of the country, as well.
Congress and the Obama administration have said that more inspections and new food production rules are needed to prevent food-related diseases, but far less attention has been paid to fixing the fractured system by which officials detect and stop ongoing outbreaks. Right now, uncovering which foods have been contaminated is left to a patchwork of more than 3,000 federal, state and local health departments that are, for the most part, poorly financed, poorly trained and disconnected, officials said.
The importance of a few epidemiologists in Minnesota demonstrates the problem. If not for the Minnesota Department of Health, the Peanut Corporation of America might still be selling salmonella-laced peanuts, Dole might still be selling contaminated lettuce, and ConAgra might still be selling dangerous Banquet brand pot pies — sickening hundreds or thousands more people.
In these and other cases, epidemiologists from Minnesota pinpointed the causes of food scares while officials in other states were barely aware that their residents were getting sick. From 1990 to 2006, Minnesota health officials uncovered 548 food-related illness outbreaks, while those in Kentucky found 18, according to an analysis of health records.
The surveillance system is vital because even with reforms intended to prevent outbreaks, food-related disease will remain among the most common sources of illness. One-quarter of the nation’s population is sickened every year by contaminated food, 300,000 are hospitalized and 5,000 die, and decades of steady improvements in the safety of the nation’s food supply have ended in recent years.
“The longer it takes you to nail an outbreak, the more people are going to get sick,” said Dr. David Acheson, associate commissioner for foods at the Food and Drug Administration. “And if it’s a pathogen that causes death, the more people are going to die.”
With states cutting back in the face of budget crises, disease surveillance is worsening, several officials said.
“Just $50 million spread over the entire country would make a huge difference,” said Dr. Timothy Jones, the state epidemiologist in Tennessee.
Take the case of Lauren Threlkeld, who went to a Kroger grocery store in Lexington, Ky., in August 2007 and bought a bag of Dole baby spinach contaminated with E. coli O157. She became violently ill with bloody diarrhea and was hospitalized for nearly a week.
When Ms. Threlkeld finally went home to recuperate in Madisonville, Ky., a county health worker called only to verify that she had fallen ill in another county. No one asked about the foods she had eaten or what might have made her so ill, she said. Later efforts by her lawyer pinpointed the source of her illness — far too late to help others avoid similar fates.
Dr. William D. Hacker, the public health commissioner in Kentucky, blamed tight budgets. “We have had a historically poor record of reporting” food-borne illnesses, Dr. Hacker said. “We are working hard to change our culture even with limited resources.”
In Minnesota and a few other states, victims of food-related illnesses tell very different stories. Sarah Kirchner of Belle Plaine, Minn., said health workers called her three separate times and spent hours discussing her children’s diet almost immediately after a laboratory test verified that one had fallen ill with salmonella. Officials in Minnesota traced the outbreak to peanut butter in part because of Ms. Kirchner’s responses.
“There is no question that some states take this far more seriously than others,” Dr. Acheson said.
Even when county and state health departments investigate, their methods often differ so greatly that federal officials have difficulty uncovering patterns. This leads to terrible delays.
“Everybody does things differently, even within many states,” Dr. Acheson said. “It’s a huge challenge.”
Some delay is inevitable. Most people sickened by food do not bother to see a doctor. Many of those who do are not asked to provide a stool sample, and when asked, some refuse.
When patients are willing, laboratories may not be. In Utah, for instance, only 18 of the state’s 1,388 medical laboratories process stool tests, said Dr. Pat Luedtke, director of the Utah public health laboratory. Well-meaning doctors who wish to send stool samples sometimes must pay the postage because insurers often refuse to pay for a test that largely serves a public health function; many doctors do not bother.
By the time public health officials notice that a growing number of such samples carry the same genetic fingerprint — a clear sign that a popular food is contaminated — weeks have passed. By then, victims’ memories of what they ate have faded. So rapid and thorough responses by health officials, a rarity in many states, are crucial.
“I’ve learned in the last few months that the real secret to our success is that we have urgency,” said Dr. Kirk Smith, supervisor of the food-borne diseases unit for the Minnesota Department of Health.
Dr. Acheson of the F.D.A. said federal authorities had been meeting with state health officials to seek ways to improve the surveillance system, including standardizing menu questionnaires and improving response times. But he said more federal financing was crucial.
Dr. Robert Tauxe, deputy director of the Centers for Disease Control and Prevention’s division of food-borne diseases, said the agency planned immediate investments “to increase the capacity of several health departments.”
Ruth Ann Merrick of Somerset, Ky., said she was still bitter about how her case was handled. She went with friends to a local Chinese restaurant on June 26, 2004. Within 45 minutes, she was vomiting so violently that she passed out and her heart stopped. After her husband performed C.P.R., she was taken to Lake Cumberland Regional Hospital, where she remained in intensive care for four days.
Although four of the eight people in her party were sickened, the state never investigated, she said.
“I thought I was going to die,” Ms. Merrick said.
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Date: 2009-04-21 02:37 pm (UTC)