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Well: Worry? Relax? Buy Face Mask? Answers on Flu
By TARA PARKER-POPE, The New York Times, May 5, 2009
Confused about swine flu? It’s no wonder, with all the seemingly mixed messages coming out of health agencies and news organizations.
Last week, the World Health Organization raised the alert level for the virus, whose formal name is H1N1, indicating that a “pandemic is imminent.” Now, health officials report that although the virus is widespread, most cases seem to be mild. People are being told not to panic, but schools in some communities remain closed.
It’s good news that the imminent threat appears to be abating, but questions remain about the virus and whether it will re-emerge in the Southern Hemisphere or back in North America next fall. Here are some answers.
Regular flu kills 150 people a day during flu season. Why is everyone so concerned about this one?
This is a new and unusual virus. Most flu viruses have two genetic elements, but H1N1 has four: two types of swine flu, a bird flu and some human flu genes, said Dr. Neil O. Fishman, an infectious-disease specialist at the University of Pennsylvania. The virus has also shown that it can quickly infect large numbers, as it did at a school in Queens.
But it is a historical precedent that fuels most of the present concern. In the 1918 pandemic, the virus was relatively mild when it first appeared in the spring, but it came back with a vengeance in the fall. “That’s what has a lot of the experts frightened,” Dr. Fishman said. “When it recurs, there’s the possibility it could be more virulent.”
Flu typically preys on the old and on those whose immune systems are compromised. This one seems to be infecting more young people. Why?
It may be related to spring-break travel patterns or the fact that older people have more natural immunity after years of exposure to a variety of flu viruses, according to officials from the Centers for Disease Control and Prevention. In the 1918 flu pandemic and in the SARS outbreak in Asia this decade, the viruses appeared most deadly to young, healthy adults. The reason may be that the immune system of a healthy person responds with too much force when it detects a new virus, filling the lungs with fluid. This overreaction is called a “cytokine storm.”
In 1918, there were reports of people dying within hours of developing symptoms. “That doesn’t happen because you have a virulent flu,” said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations and the author of “The Coming Plague: Newly Emerging Diseases in a World Out of Balance ” (Penguin, 1995). “That happens because the whole body went bananas.”
She added that even though many SARS patients were housed in the AIDS wards of hospitals, patients with H.I.V. and AIDS apparently did not contract the disease, suggesting that the real threat was a strong immune response rather than the symptoms of the virus itself.
I am coughing and feverish. Should I be tested for swine flu?
Most people who exhibit flu symptoms will not be tested for H1N1. There are a limited number of testing sites that can confirm a case, and whether you have swine flu or another type of flu, the medical advice is the same. Call your doctor to see if he or she considers you a candidate for an antiviral treatment like Tamiflu. In some cases, a doctor may order a rapid test.
“Are you getting better or are you getting worse?” said Dr. Michael R. Anderson, chief medical officer for the University Hospitals Case Medical Center in Cleveland. “If you’ve got a low-grade temp and a cough for a few days, wait it out. If you’re into that second day of symptoms and your fever is 103, you’re coughing every five minutes to the point of respiratory distress, shortness of breath and you can’t keep things down, I don’t care what the virus is. I would seek medical treatment.”
Don’t confuse flu with other respiratory illnesses. One characteristic of flu is that it does not creep up on you over a few days. “Give yourself the sledgehammer test,” Ms. Garrett said. “Are you vaguely off and then all of the sudden it feels like someone just whacked you over the head? That’s flu.”
Are there reasons to be less worried about swine flu now than a week ago?
Yes. In recent days, genetic sequencing analyses of this flu have suggested it is not as virulent as suspected. It lacks certain proteins and amino acids that would make it as deadly as other flus. And it appears similar enough to other common strains that most people may have some immunity. Researchers have even begun to speculate whether this year’s flu vaccine, which protected against a form of H1N1 flu, may have offered partial protection against the swine version.
Should I buy a face mask just in case?
The public health officials I interviewed are not stocking up on personal supplies of face masks for family members. “I haven’t brought any home,” Dr. Fishman said.
Face masks aren’t particularly effective against the spread of flu. The main effect may be “social distancing”: masks scare people away from one another.
If the flu does progress to a pandemic, the most effective response will be to limit public gatherings. In 1918, for example, the outbreak in St. Louis was mild, because the authorities closed schools, churches and theaters. Meanwhile, Philadelphia, which had one of the highest death rates, held a war bond parade at the start of the outbreak.
“That’s circumstantial, but it’s the type of thinking that’s behind the community mitigation strategies,” Dr. Fishman said.
Now that the swine flu scare seems to have died down, does this mean we all overreacted?
“It’s the classic problem in public health, trying to prove a negative,” Ms. Garrett said. “If, after an intervention, nothing happens, then everybody says, ‘What was the big deal?’ ”
But the course swine flu will take in the Southern Hemisphere — and, this coming fall, in the Northern Hemisphere — still isn’t clear. And it’s worth considering what might have happened if public health officials hadn’t sounded the alarm.
“I think the whole world should be saying, ‘Gracias, amigos,’ to the Mexicans for the tremendous sacrifice they have made,” Ms. Garrett said. “That may have stopped what otherwise would have been a serious pandemic.
“Some people will look back and say: ‘Wasn’t that ridiculous? Didn’t we overreact?’ But in New Orleans, wouldn’t we have preferred an overreaction that built too many levees too tall, than doing nothing and allowing the city to be flooded?”
A Battle to Preserve a Visionary’s Bold Failure
By WILLIAM J. BROAD, The New York Times, May 5, 2009
In 1901, Nikola Tesla began work on a global system of giant towers meant to relay through the air not only news, stock reports and even pictures but also, unbeknown to investors such as J. Pierpont Morgan, free electricity for one and all.
It was the inventor’s biggest project, and his most audacious.
The first tower rose on rural Long Island and, by 1903, stood more than 18 stories tall. One midsummer night, it emitted a dull rumble and proceeded to hurl bolts of electricity into the sky. The blinding flashes, The New York Sun reported, “seemed to shoot off into the darkness on some mysterious errand.”
But the system failed for want of money, and at least partly for scientific viability. Tesla never finished his prototype tower and was forced to abandon its adjoining laboratory.
Today, a fight is looming over the ghostly remains of that site, called Wardenclyffe — what Tesla authorities call the only surviving workplace of the eccentric genius who dreamed countless big dreams while pioneering wireless communication and alternating current. The disagreement began recently after the property went up for sale in Shoreham, N.Y.
A science group on Long Island wants to turn the 16-acre site into a Tesla museum and education center, and hopes to get the land donated to that end. But the owner, the Agfa Corporation, says it must sell the property to raise money in hard economic times. The company’s real estate broker says the land, listed at $1.6 million, can “be delivered fully cleared and level,” a statement that has thrown the preservationists into action.
The ruins of Wardenclyffe include the tower’s foundation and the large brick laboratory, designed by Tesla’s friend Stanford White, the celebrated architect.
“It’s hugely important to protect this site,” said Marc J. Seifer, author of “Wizard,” a Tesla biography. “He’s an icon. He stands for what humans are supposed to do — honor nature while using high technology to harness its powers.”
Recently, New York State echoed that judgment. The commissioner of historic preservation wrote Dr. Seifer on behalf of Gov. David A. Paterson to back Wardenclyffe’s preservation and listing in the National Register of Historic Places.
On Long Island, Tesla enthusiasts vow to obtain the land one way or another, saying that saving a symbol of Tesla’s accomplishments would help restore the visionary to his rightful place as an architect of the modern age.
“A lot of his work was way ahead of his time,” said Jane Alcorn, president of the Tesla Science Center, a private group in Shoreham that is seeking to acquire Wardenclyffe.
Dr. Ljubo Vujovic, president of the Tesla Memorial Society of New York, said destroying the old lab “would be a terrible thing for the United States and the world. It’s a piece of history.”
Tesla, who lived from 1856 to 1943, made bitter enemies who dismissed some of his claims as exaggerated, helping tarnish his reputation in his lifetime. He was part recluse, part showman. He issued publicity photos (actually double exposures) showing him reading quietly in his laboratory amid deadly flashes.
Today, his work tends to be poorly known among scientists, though some call him an intuitive genius far ahead of his peers. Socially, his popularity has soared, elevating him to cult status.
Books and Web sites abound. Wikipedia says the inventor obtained at least 700 patents. YouTube has several Tesla videos, including one of a break-in at Wardenclyffe. A rock band calls itself Tesla. An electric car company backed by Google’s founders calls itself Tesla Motors.
Larry Page, Google’s co-founder, sees the creator’s life as a cautionary tale. “It’s a sad, sad story,” Mr. Page told Fortune magazine last year. The inventor “couldn’t commercialize anything. He could barely fund his own research.”
Wardenclyffe epitomized that kind of visionary impracticality.
Tesla seized on the colossal project at the age of 44 while living in New York City. An impeccably dressed bon vivant of Serbian birth, he was widely celebrated for his inventions of motors and power distribution systems that used the form of electricity known as alternating current, which beat out direct current (and Thomas Edison) to electrify the world.
His patents made him a rich man, at least for a while. He lived at the Waldorf-Astoria and loved to hobnob with the famous at Delmonico’s and the Players Club.
Around 1900, as Tesla planned what would become Wardenclyffe, inventors around the world were racing for what was considered the next big thing — wireless communication. His own plan was to turn alternating current into electromagnetic waves that flashed from antennas to distant receivers. This is essentially what radio transmission is. The scale of his vision was gargantuan, however, eclipsing that of any rival.
Investors, given Tesla’s electrical achievements, paid heed. The biggest was J. Pierpont Morgan, a top financier. He sank $150,000 (today more than $3 million) into Tesla’s global wireless venture.
Work on the prototype tower began in mid-1901 on the North Shore of Long Island at a site Tesla named after a patron and the nearby cliffs. “The proposed plant at Wardenclyffe,” The New York Times reported, “will be the first of a number that the electrician proposes to establish in this and other countries.”
The shock wave hit Dec. 12, 1901. That day, Marconi succeeded in sending radio signals across the Atlantic, crushing Tesla’s hopes for pioneering glory.
Still, Wardenclyffe grew, with guards under strict orders to keep visitors away. The wooden tower rose 187 feet over a wide shaft that descended 120 feet to deeply anchor the antenna. Villagers told The Times that the ground beneath the tower was “honeycombed with subterranean passages.”
The nearby laboratory of red brick, with arched windows and a tall chimney, held tools, generators, a machine shop, electrical transformers, glass-blowing equipment, a library and an office.
But Morgan was disenchanted. He refused Tesla’s request for more money.
Desperate, the inventor pulled out what he considered his ace. The towers would transmit not only information around the globe, he wrote the financier in July 1903, but also electric power.
“I should not feel disposed,” Morgan replied coolly, “to make any further advances.”
Margaret Cheney, a Tesla biographer, observed that Tesla had seriously misjudged his wealthy patron, a man deeply committed to the profit motive. “The prospect of beaming electricity to penniless Zulus or Pygmies,” she wrote, must have left the financier less than enthusiastic.
It was then that Tesla, reeling financially and emotionally, fired up the tower for the first and last time. He eventually sold Wardenclyffe to satisfy $20,000 (today about $400,000) in bills at the Waldorf. In 1917, the new owners had the giant tower blown up and sold for scrap.
Today, Tesla’s exact plan for the site remains a mystery even as scientists agree on the impracticality of his overall vision. The tower could have succeeded in broadcasting information, but not power.
“He was an absolute genius,” Dennis Papadopoulos, a physicist at the University of Maryland, said in an interview. “He conceived of things in 1900 that it took us 50 or 60 years to understand. But he did not appreciate dissipation. You can’t start putting a lot of power” into an antenna and expect the energy to travel long distances without great diminution.
Wardenclyffe passed through many hands, ending with Agfa, which is based in Ridgefield Park, N.J. The imaging giant used it from 1969 to 1992, and then shuttered the property. Silver and cadmium, a serious poison, had contaminated the site, and the company says it spent some $5 million on studies and remediation. The cleanup ended in September, and the site was put up for sale in late February.
Real estate agents said they had shown Wardenclyffe to four or five prospective buyers.
Last month, Agfa opened the heavily wooded site to a reporter. “NO TRESPASSING,” warned a faded sign at a front gate, which was topped with barbed wire.
Tesla’s red brick building stood intact, an elegant wind vane atop its chimney. But Agfa had recently covered the big windows with plywood to deter vandals and intruders, who had stolen much of the building’s wiring for its copper.
The building’s dark interior was littered with beer cans and broken bottles. Flashlights revealed no trace of the original equipment, except for a surprise on the second floor. There in the darkness loomed four enormous tanks, each the size of a small car. Their sides were made of thick metal and their seams heavily riveted, like those of an old destroyer or battleship. The Agfa consultant leading the tour called them giant batteries.
“Look up there,” said the consultant, Ralph Passantino, signaling with his flashlight. “There’s a hatch up there. It was used to get into the tanks to service them.”
Tesla authorities appear to know little of the big tanks, making them potential clues to the inventor’s original plans.
After the tour, Christopher M. Santomassimo, Agfa’s general counsel, explained his company’s position: no donation of the site for a museum, and no action that would rule out the building’s destruction.
“Agfa is in a difficult economic position given what’s going on in the global marketplace,” he said. “It needs to maximize its potential recovery from the sale of that site.”
He added that the company would entertain “any reasonable offer,” including ones from groups interested in preserving Wardenclyffe because of its historical significance. “We’re simply not in a position,” he emphasized, “to donate the property outright.”
Ms. Alcorn of the Tesla Science Center, who has sought to stir interest in Wardenclyffe for more than a decade, seemed confident that a solution would be worked out. Suffolk County might buy the site, she said, or a campaign might raise the funds for its purchase, restoration and conversion into a science museum and education center. She said the local community was strongly backing the preservation idea.
“Once the sign went up, I started getting so many calls,” she remarked. “People said: ‘They’re not really going to sell it, are they? It’s got to be a museum, right?’ ”
Sitting at a reading table at the North Shore Public Library, where she works as a children’s librarian, Ms. Alcorn gestured across a map of Wardenclyffe to show how the abandoned site might be transformed with not only a Tesla museum but also a playground, a cafeteria and a bookshop.
“That’s critical,” she said.
Ms. Alcorn said the investigation and restoration of the old site promised to solve one of the big mysteries: the extent and nature of the tunnels said to honeycomb the area around the tower.
“I’d love to see if they really existed,” she said. “The stories abound, but not the proof.”
In Mercury Images, Remarkable Features in a Crater
By KENNETH CHANG, The New York Times, May 5, 2009
On its second flyby of the planet Mercury last October, NASA’s Messenger spacecraft beamed back 1,200 pictures, revealing 30 percent of the planet’s surface that had never been seen up close before. Among the images was a view of the second-largest crater on Mercury, as wide as the distance from Boston to Washington.
Called the Rembrandt basin — by convention, Mercurian craters are named after painters, authors, composers and other creative artists — the crater is surprising more for the geological features within its rim than for its size, planetary scientists said last week.
Much of the terrain inside Rembrandt remains pristine from the time of impact, about 3.9 billion years ago, near the end of the “heavy bombardment” period of the early solar system. The basin is young compared with most of the giant ancient impact craters in the solar system.
“In most large impact basins on Mercury, the Moon and the other inner planets, this terrain is completely buried by volcanic flows erupted after the basin formed,” Thomas R. Watters, a senior scientist at the Smithsonian Institution’s Center for Earth and Planetary Studies, said during a NASA news conference last week. Scientists also reported their findings in articles published in the current issue of the journal Science.
In Rembrandt’s central region where lava did flow, the terrain has deformed into ridges and troughs that radiate outward in a wheel-and-spoke pattern — “unlike any we have seen in any other impact basin in the solar system,” Dr. Watters said.
Ridges form when planetary crust is pressed together, troughs when the crust is pulled apart. Therefore, scientists will have to devise an explanation of how the crust within the Rembrandt basin could have been both pressed together and pulled apart to form the ridges and troughs next to one another.
Another remarkable feature is a line of cliffs 620 miles long that cuts into the Rembrandt crater. Mercury’s surface cracked as its interior cooled and shrank, and this fault — perhaps the longest of these cracks — shows that Mercury was still shrinking at the time of the impact.
More globally, Messenger’s images indicate that smooth plains, most probably consisting of hardened lava flows, make up 40 percent of the surface, compared with 20 percent on the Earth’s Moon.
“This indicates that volcanism was a really important process on Mercury,” said Brett Denevi, a postdoctoral researcher at Arizona State University. “Which is pretty exciting, because before Messenger’s flybys of Mercury, just a year and a half or so ago, we were really not even sure that volcanism existed on Mercury.”
She said that comparison of different terrains suggested that although Mercury was similar to the Moon in appearance, its geological history may have been more like that of Mars.
In one of the articles, scientists reported the first detection of magnesium in Mercury’s tenuous atmosphere by a Messenger instrument that samples its surroundings. Since much of Mercury’s “air” consists of molecules knocked off the surface, this discovery helps confirm the presence of magnesium in the crust, which is not a surprise.
“What is surprising is the distribution of magnesium,” said William McClintock of the University of Colorado’s Laboratory for Atmospheric and Space Physics and a co-investigator of the mission.
Hydrogen, helium, sodium, calcium and potassium had been detected before. Calcium and magnesium are similar chemically, and the distribution of the two elements was expected to be similar. Instead, calcium peaked near the equator, while the distribution of magnesium was more uniform.
Messenger will make one more flyby of Mercury, on Sept. 29, before entering orbit around the planet in March 2011.
Women Sue Over Device to Stop Urine Leaks
By RONI CARYN RABIN, The New York Times, May 5, 2009
It was the promise of a quick fix that appealed to Amber Suriani.
She had just turned 40 and was very fit, but whenever she went running or practiced karate — she was working on a black belt — she leaked a bit of urine.
The diagnosis was stress urinary incontinence, and her surgeon recommended a simple procedure to plug the leak by inserting a hammock made of a strip of synthetic meshlike material, called a vaginal sling, under her urethra.
“It was supposed to be a simple ‘in one day and out the next’ kind of thing,” said Ms. Suriani, now 43, who lives in a suburb of Syracuse.
And so it seemed, at least at first. The surgery went smoothly, and the leakage stopped. But several months later, Ms. Suriani developed a persistent, painful and often bloody vaginal discharge.
She was convinced that she had cancer. It did not occur to her that the sling was the source of the problem until a piece of the meshlike tape started working its way through her vaginal wall.
Since then, she has had five operations, each one removing bits of the sling but not the entire thing; another operation is scheduled. She still has chronic discharge and says her sex life with her husband has been affected. She relies on Motrin to get through the day and a sleeping pad to get through the night.
“I feel like I’m never going to be the same again,” Ms. Suriani said, adding: “I’m beginning to feel like this has ruined my life. Not just ruining my life, as in ‘It will get better,’ but ruined, as in ‘I’m stuck with this for the rest of my life.’ I try to stay positive, but it’s getting harder and harder.”
Ms. Suriani’s lawyer, Matthew Metz of Seattle, said she was one of dozens of women suing the maker of the vaginal sling, called ObTape.
The company, Mentor Corporation, based in Santa Barbara, Calif., and recently acquired by Johnson & Johnson, stopped selling ObTape in 2006 but says there is nothing wrong with the product, which was cleared for sale by the Food and Drug Administration.
John Q. Lewis of Cleveland, a lawyer with the firm Jones Day, which represents Mentor, said that there were risks to any surgical procedure and that doctors should have warned patients. He noted that early European studies reported low rates of complications with ObTape.
“It’s very unfortunate when anyone reports a complication,” Mr. Lewis said. “That being said, these are complications that are well known, that patients are warned about, and are inherent to a surgical procedure that has helped thousands and thousands of people live a better life.”
He continued, “The overall benefits of the procedure and this product outweighed the potential risks.”
The lawsuits raise new questions about the process by which the F.D.A. reviews new medical devices. While it “approves” drugs, it merely “clears” medical devices with minimal testing if they are deemed “substantially equivalent” to devices already in use.
The process has been criticized by the agency’s scientists and in a recent Government Accountability Office report concluding that most devices on the market have never been proved safe and effective.
In ObTape’s case, the chain of similarity claims can be traced back to an older product that caused so much harm it was taken off the market. That recall did not stop the F.D.A. from clearing a new generation of vaginal slings whose only claim to safety was their similarity to the flawed device.
A reverse chronology, put together with help from plaintiffs’ lawyers and researchers at Public Citizen’s Health Research Group, a nonprofit consumer advocacy group, illustrates the pitfalls of the process.
In 2003, Mentor asked the food and drug agency to clear ObTape for the United States market, saying there was essentially no difference between its product and two other vaginal slings already widely in use — Johnson & Johnson’s Tension Free Vaginal Tape System and American Medical Systems’ Sparc Sling System.
Those slings had been cleared earlier, based on claims that they, too, were much like earlier products — in Johnson & Johnson’s case, the Protegen sling, made by Boston Scientific. But that sling had been recalled in 1999, four years before ObTape made its appearance. At the time, the F.D.A. called the Protegen sling an “adulterated and misbranded” product.
Officials at the F.D.A. declined requests for an interview, providing only answers to e-mailed questions. Asked why the agency would clear a product based on a recalled predecessor, they replied, “Any legally marketed device can serve as a predicate for a premarket submission.”
In fact, there were significant differences between ObTape and the earlier slings, and once Mentor had cleared ObTape for marketing based on its similarity to other devices, the company promoted its unique features. It obtained a patent and emphasized to surgeons that its new design, based on a European product called Uratape, allowed for a surgical approach that reduced the risk of puncturing the bladder.
Dr. Andrew L. Siegel, a urologist in Hackensack, N.J., who now serves as an expert witness for the plaintiffs suing ObTape, was one of the first surgeons to start using the device. “I was delighted about it,” Dr. Siegel said. “It was a great innovation.”
But ObTape was different from earlier slings in another way, which became clear only later and had to do with the type of material it was made of.
Many experts say the sling was too dense — not porous enough to allow tissue and capillaries to grow through it so it is fully incorporated in the body, rather than becoming encapsulated and expelled.
Reports of adverse events linked to ObTape soon started pouring in to the F.D.A. — 266 in all, starting in 2004, many of them describing problems similar to Ms. Suriani’s complaints.
Surgeons like Dr. Siegel started publishing case reports in medical journals and reporting negative experiences with the device. Several described the “malodorous discharge” patients developed after surgery, and said the tape started extruding.
In 2006, doctors at the Virginia Mason Medical Center in Seattle reported in The Journal of Urology that they had stopped using ObTape after observing a 13.4 percent rate of vaginal extrusion.
But Mr. Lewis, the lawyer for Mentor, said the material was tested by company engineers as part of an extensive premarketing process. The 266 reported adverse events represent a small fraction of the 16,000 ObTape slings implanted in the United States, he added, and he pointed to studies finding high complication rates for other slings.
Indeed, the F.D.A. alerted health care providers last year that it had received more than 1,000 reports of complications from nine surgical mesh manufacturers about devices for incontinence and organ prolapse. “Physicians should inform patients about the potential for serious complications and their effect on quality of life, including pain during sexual intercourse, scarring” and other complications, the notice said.
Mr. Lewis said clinical data from Europe supported the ObTape sling’s safety and efficacy, and suggested that American surgeons’ lack of familiarity with the new surgical technique was responsible for any problems. He noted that in California, a jury recently rejected a claim of negligence against Mentor by Lisa Ann Seeno, now 51, who was hospitalized with an abscess shortly after the device was implanted. (She has requested a new trial.)
Another plaintiff, Suzanne Crews, 69, of Washington State, said she was suing Mentor to spread the word about the risks of trying to repair what was, in hindsight, a problem she could have lived with — minor leaking when she coughed too hard or laughed too loud.
Ms. Crews said she has undergone four operations to remove portions of the tape.
“I’m not like I’m supposed to be,” she said. “I just really would be happier if more and more people knew about the problem, and didn’t just sit back and say, ‘Oh my gosh, I don’t know what’s happening.’ ”
By TARA PARKER-POPE, The New York Times, May 5, 2009
Confused about swine flu? It’s no wonder, with all the seemingly mixed messages coming out of health agencies and news organizations.
Last week, the World Health Organization raised the alert level for the virus, whose formal name is H1N1, indicating that a “pandemic is imminent.” Now, health officials report that although the virus is widespread, most cases seem to be mild. People are being told not to panic, but schools in some communities remain closed.
It’s good news that the imminent threat appears to be abating, but questions remain about the virus and whether it will re-emerge in the Southern Hemisphere or back in North America next fall. Here are some answers.
Regular flu kills 150 people a day during flu season. Why is everyone so concerned about this one?
This is a new and unusual virus. Most flu viruses have two genetic elements, but H1N1 has four: two types of swine flu, a bird flu and some human flu genes, said Dr. Neil O. Fishman, an infectious-disease specialist at the University of Pennsylvania. The virus has also shown that it can quickly infect large numbers, as it did at a school in Queens.
But it is a historical precedent that fuels most of the present concern. In the 1918 pandemic, the virus was relatively mild when it first appeared in the spring, but it came back with a vengeance in the fall. “That’s what has a lot of the experts frightened,” Dr. Fishman said. “When it recurs, there’s the possibility it could be more virulent.”
Flu typically preys on the old and on those whose immune systems are compromised. This one seems to be infecting more young people. Why?
It may be related to spring-break travel patterns or the fact that older people have more natural immunity after years of exposure to a variety of flu viruses, according to officials from the Centers for Disease Control and Prevention. In the 1918 flu pandemic and in the SARS outbreak in Asia this decade, the viruses appeared most deadly to young, healthy adults. The reason may be that the immune system of a healthy person responds with too much force when it detects a new virus, filling the lungs with fluid. This overreaction is called a “cytokine storm.”
In 1918, there were reports of people dying within hours of developing symptoms. “That doesn’t happen because you have a virulent flu,” said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations and the author of “The Coming Plague: Newly Emerging Diseases in a World Out of Balance ” (Penguin, 1995). “That happens because the whole body went bananas.”
She added that even though many SARS patients were housed in the AIDS wards of hospitals, patients with H.I.V. and AIDS apparently did not contract the disease, suggesting that the real threat was a strong immune response rather than the symptoms of the virus itself.
I am coughing and feverish. Should I be tested for swine flu?
Most people who exhibit flu symptoms will not be tested for H1N1. There are a limited number of testing sites that can confirm a case, and whether you have swine flu or another type of flu, the medical advice is the same. Call your doctor to see if he or she considers you a candidate for an antiviral treatment like Tamiflu. In some cases, a doctor may order a rapid test.
“Are you getting better or are you getting worse?” said Dr. Michael R. Anderson, chief medical officer for the University Hospitals Case Medical Center in Cleveland. “If you’ve got a low-grade temp and a cough for a few days, wait it out. If you’re into that second day of symptoms and your fever is 103, you’re coughing every five minutes to the point of respiratory distress, shortness of breath and you can’t keep things down, I don’t care what the virus is. I would seek medical treatment.”
Don’t confuse flu with other respiratory illnesses. One characteristic of flu is that it does not creep up on you over a few days. “Give yourself the sledgehammer test,” Ms. Garrett said. “Are you vaguely off and then all of the sudden it feels like someone just whacked you over the head? That’s flu.”
Are there reasons to be less worried about swine flu now than a week ago?
Yes. In recent days, genetic sequencing analyses of this flu have suggested it is not as virulent as suspected. It lacks certain proteins and amino acids that would make it as deadly as other flus. And it appears similar enough to other common strains that most people may have some immunity. Researchers have even begun to speculate whether this year’s flu vaccine, which protected against a form of H1N1 flu, may have offered partial protection against the swine version.
Should I buy a face mask just in case?
The public health officials I interviewed are not stocking up on personal supplies of face masks for family members. “I haven’t brought any home,” Dr. Fishman said.
Face masks aren’t particularly effective against the spread of flu. The main effect may be “social distancing”: masks scare people away from one another.
If the flu does progress to a pandemic, the most effective response will be to limit public gatherings. In 1918, for example, the outbreak in St. Louis was mild, because the authorities closed schools, churches and theaters. Meanwhile, Philadelphia, which had one of the highest death rates, held a war bond parade at the start of the outbreak.
“That’s circumstantial, but it’s the type of thinking that’s behind the community mitigation strategies,” Dr. Fishman said.
Now that the swine flu scare seems to have died down, does this mean we all overreacted?
“It’s the classic problem in public health, trying to prove a negative,” Ms. Garrett said. “If, after an intervention, nothing happens, then everybody says, ‘What was the big deal?’ ”
But the course swine flu will take in the Southern Hemisphere — and, this coming fall, in the Northern Hemisphere — still isn’t clear. And it’s worth considering what might have happened if public health officials hadn’t sounded the alarm.
“I think the whole world should be saying, ‘Gracias, amigos,’ to the Mexicans for the tremendous sacrifice they have made,” Ms. Garrett said. “That may have stopped what otherwise would have been a serious pandemic.
“Some people will look back and say: ‘Wasn’t that ridiculous? Didn’t we overreact?’ But in New Orleans, wouldn’t we have preferred an overreaction that built too many levees too tall, than doing nothing and allowing the city to be flooded?”
A Battle to Preserve a Visionary’s Bold Failure
By WILLIAM J. BROAD, The New York Times, May 5, 2009
In 1901, Nikola Tesla began work on a global system of giant towers meant to relay through the air not only news, stock reports and even pictures but also, unbeknown to investors such as J. Pierpont Morgan, free electricity for one and all.
It was the inventor’s biggest project, and his most audacious.
The first tower rose on rural Long Island and, by 1903, stood more than 18 stories tall. One midsummer night, it emitted a dull rumble and proceeded to hurl bolts of electricity into the sky. The blinding flashes, The New York Sun reported, “seemed to shoot off into the darkness on some mysterious errand.”
But the system failed for want of money, and at least partly for scientific viability. Tesla never finished his prototype tower and was forced to abandon its adjoining laboratory.
Today, a fight is looming over the ghostly remains of that site, called Wardenclyffe — what Tesla authorities call the only surviving workplace of the eccentric genius who dreamed countless big dreams while pioneering wireless communication and alternating current. The disagreement began recently after the property went up for sale in Shoreham, N.Y.
A science group on Long Island wants to turn the 16-acre site into a Tesla museum and education center, and hopes to get the land donated to that end. But the owner, the Agfa Corporation, says it must sell the property to raise money in hard economic times. The company’s real estate broker says the land, listed at $1.6 million, can “be delivered fully cleared and level,” a statement that has thrown the preservationists into action.
The ruins of Wardenclyffe include the tower’s foundation and the large brick laboratory, designed by Tesla’s friend Stanford White, the celebrated architect.
“It’s hugely important to protect this site,” said Marc J. Seifer, author of “Wizard,” a Tesla biography. “He’s an icon. He stands for what humans are supposed to do — honor nature while using high technology to harness its powers.”
Recently, New York State echoed that judgment. The commissioner of historic preservation wrote Dr. Seifer on behalf of Gov. David A. Paterson to back Wardenclyffe’s preservation and listing in the National Register of Historic Places.
On Long Island, Tesla enthusiasts vow to obtain the land one way or another, saying that saving a symbol of Tesla’s accomplishments would help restore the visionary to his rightful place as an architect of the modern age.
“A lot of his work was way ahead of his time,” said Jane Alcorn, president of the Tesla Science Center, a private group in Shoreham that is seeking to acquire Wardenclyffe.
Dr. Ljubo Vujovic, president of the Tesla Memorial Society of New York, said destroying the old lab “would be a terrible thing for the United States and the world. It’s a piece of history.”
Tesla, who lived from 1856 to 1943, made bitter enemies who dismissed some of his claims as exaggerated, helping tarnish his reputation in his lifetime. He was part recluse, part showman. He issued publicity photos (actually double exposures) showing him reading quietly in his laboratory amid deadly flashes.
Today, his work tends to be poorly known among scientists, though some call him an intuitive genius far ahead of his peers. Socially, his popularity has soared, elevating him to cult status.
Books and Web sites abound. Wikipedia says the inventor obtained at least 700 patents. YouTube has several Tesla videos, including one of a break-in at Wardenclyffe. A rock band calls itself Tesla. An electric car company backed by Google’s founders calls itself Tesla Motors.
Larry Page, Google’s co-founder, sees the creator’s life as a cautionary tale. “It’s a sad, sad story,” Mr. Page told Fortune magazine last year. The inventor “couldn’t commercialize anything. He could barely fund his own research.”
Wardenclyffe epitomized that kind of visionary impracticality.
Tesla seized on the colossal project at the age of 44 while living in New York City. An impeccably dressed bon vivant of Serbian birth, he was widely celebrated for his inventions of motors and power distribution systems that used the form of electricity known as alternating current, which beat out direct current (and Thomas Edison) to electrify the world.
His patents made him a rich man, at least for a while. He lived at the Waldorf-Astoria and loved to hobnob with the famous at Delmonico’s and the Players Club.
Around 1900, as Tesla planned what would become Wardenclyffe, inventors around the world were racing for what was considered the next big thing — wireless communication. His own plan was to turn alternating current into electromagnetic waves that flashed from antennas to distant receivers. This is essentially what radio transmission is. The scale of his vision was gargantuan, however, eclipsing that of any rival.
Investors, given Tesla’s electrical achievements, paid heed. The biggest was J. Pierpont Morgan, a top financier. He sank $150,000 (today more than $3 million) into Tesla’s global wireless venture.
Work on the prototype tower began in mid-1901 on the North Shore of Long Island at a site Tesla named after a patron and the nearby cliffs. “The proposed plant at Wardenclyffe,” The New York Times reported, “will be the first of a number that the electrician proposes to establish in this and other countries.”
The shock wave hit Dec. 12, 1901. That day, Marconi succeeded in sending radio signals across the Atlantic, crushing Tesla’s hopes for pioneering glory.
Still, Wardenclyffe grew, with guards under strict orders to keep visitors away. The wooden tower rose 187 feet over a wide shaft that descended 120 feet to deeply anchor the antenna. Villagers told The Times that the ground beneath the tower was “honeycombed with subterranean passages.”
The nearby laboratory of red brick, with arched windows and a tall chimney, held tools, generators, a machine shop, electrical transformers, glass-blowing equipment, a library and an office.
But Morgan was disenchanted. He refused Tesla’s request for more money.
Desperate, the inventor pulled out what he considered his ace. The towers would transmit not only information around the globe, he wrote the financier in July 1903, but also electric power.
“I should not feel disposed,” Morgan replied coolly, “to make any further advances.”
Margaret Cheney, a Tesla biographer, observed that Tesla had seriously misjudged his wealthy patron, a man deeply committed to the profit motive. “The prospect of beaming electricity to penniless Zulus or Pygmies,” she wrote, must have left the financier less than enthusiastic.
It was then that Tesla, reeling financially and emotionally, fired up the tower for the first and last time. He eventually sold Wardenclyffe to satisfy $20,000 (today about $400,000) in bills at the Waldorf. In 1917, the new owners had the giant tower blown up and sold for scrap.
Today, Tesla’s exact plan for the site remains a mystery even as scientists agree on the impracticality of his overall vision. The tower could have succeeded in broadcasting information, but not power.
“He was an absolute genius,” Dennis Papadopoulos, a physicist at the University of Maryland, said in an interview. “He conceived of things in 1900 that it took us 50 or 60 years to understand. But he did not appreciate dissipation. You can’t start putting a lot of power” into an antenna and expect the energy to travel long distances without great diminution.
Wardenclyffe passed through many hands, ending with Agfa, which is based in Ridgefield Park, N.J. The imaging giant used it from 1969 to 1992, and then shuttered the property. Silver and cadmium, a serious poison, had contaminated the site, and the company says it spent some $5 million on studies and remediation. The cleanup ended in September, and the site was put up for sale in late February.
Real estate agents said they had shown Wardenclyffe to four or five prospective buyers.
Last month, Agfa opened the heavily wooded site to a reporter. “NO TRESPASSING,” warned a faded sign at a front gate, which was topped with barbed wire.
Tesla’s red brick building stood intact, an elegant wind vane atop its chimney. But Agfa had recently covered the big windows with plywood to deter vandals and intruders, who had stolen much of the building’s wiring for its copper.
The building’s dark interior was littered with beer cans and broken bottles. Flashlights revealed no trace of the original equipment, except for a surprise on the second floor. There in the darkness loomed four enormous tanks, each the size of a small car. Their sides were made of thick metal and their seams heavily riveted, like those of an old destroyer or battleship. The Agfa consultant leading the tour called them giant batteries.
“Look up there,” said the consultant, Ralph Passantino, signaling with his flashlight. “There’s a hatch up there. It was used to get into the tanks to service them.”
Tesla authorities appear to know little of the big tanks, making them potential clues to the inventor’s original plans.
After the tour, Christopher M. Santomassimo, Agfa’s general counsel, explained his company’s position: no donation of the site for a museum, and no action that would rule out the building’s destruction.
“Agfa is in a difficult economic position given what’s going on in the global marketplace,” he said. “It needs to maximize its potential recovery from the sale of that site.”
He added that the company would entertain “any reasonable offer,” including ones from groups interested in preserving Wardenclyffe because of its historical significance. “We’re simply not in a position,” he emphasized, “to donate the property outright.”
Ms. Alcorn of the Tesla Science Center, who has sought to stir interest in Wardenclyffe for more than a decade, seemed confident that a solution would be worked out. Suffolk County might buy the site, she said, or a campaign might raise the funds for its purchase, restoration and conversion into a science museum and education center. She said the local community was strongly backing the preservation idea.
“Once the sign went up, I started getting so many calls,” she remarked. “People said: ‘They’re not really going to sell it, are they? It’s got to be a museum, right?’ ”
Sitting at a reading table at the North Shore Public Library, where she works as a children’s librarian, Ms. Alcorn gestured across a map of Wardenclyffe to show how the abandoned site might be transformed with not only a Tesla museum but also a playground, a cafeteria and a bookshop.
“That’s critical,” she said.
Ms. Alcorn said the investigation and restoration of the old site promised to solve one of the big mysteries: the extent and nature of the tunnels said to honeycomb the area around the tower.
“I’d love to see if they really existed,” she said. “The stories abound, but not the proof.”
In Mercury Images, Remarkable Features in a Crater
By KENNETH CHANG, The New York Times, May 5, 2009
On its second flyby of the planet Mercury last October, NASA’s Messenger spacecraft beamed back 1,200 pictures, revealing 30 percent of the planet’s surface that had never been seen up close before. Among the images was a view of the second-largest crater on Mercury, as wide as the distance from Boston to Washington.
Called the Rembrandt basin — by convention, Mercurian craters are named after painters, authors, composers and other creative artists — the crater is surprising more for the geological features within its rim than for its size, planetary scientists said last week.
Much of the terrain inside Rembrandt remains pristine from the time of impact, about 3.9 billion years ago, near the end of the “heavy bombardment” period of the early solar system. The basin is young compared with most of the giant ancient impact craters in the solar system.
“In most large impact basins on Mercury, the Moon and the other inner planets, this terrain is completely buried by volcanic flows erupted after the basin formed,” Thomas R. Watters, a senior scientist at the Smithsonian Institution’s Center for Earth and Planetary Studies, said during a NASA news conference last week. Scientists also reported their findings in articles published in the current issue of the journal Science.
In Rembrandt’s central region where lava did flow, the terrain has deformed into ridges and troughs that radiate outward in a wheel-and-spoke pattern — “unlike any we have seen in any other impact basin in the solar system,” Dr. Watters said.
Ridges form when planetary crust is pressed together, troughs when the crust is pulled apart. Therefore, scientists will have to devise an explanation of how the crust within the Rembrandt basin could have been both pressed together and pulled apart to form the ridges and troughs next to one another.
Another remarkable feature is a line of cliffs 620 miles long that cuts into the Rembrandt crater. Mercury’s surface cracked as its interior cooled and shrank, and this fault — perhaps the longest of these cracks — shows that Mercury was still shrinking at the time of the impact.
More globally, Messenger’s images indicate that smooth plains, most probably consisting of hardened lava flows, make up 40 percent of the surface, compared with 20 percent on the Earth’s Moon.
“This indicates that volcanism was a really important process on Mercury,” said Brett Denevi, a postdoctoral researcher at Arizona State University. “Which is pretty exciting, because before Messenger’s flybys of Mercury, just a year and a half or so ago, we were really not even sure that volcanism existed on Mercury.”
She said that comparison of different terrains suggested that although Mercury was similar to the Moon in appearance, its geological history may have been more like that of Mars.
In one of the articles, scientists reported the first detection of magnesium in Mercury’s tenuous atmosphere by a Messenger instrument that samples its surroundings. Since much of Mercury’s “air” consists of molecules knocked off the surface, this discovery helps confirm the presence of magnesium in the crust, which is not a surprise.
“What is surprising is the distribution of magnesium,” said William McClintock of the University of Colorado’s Laboratory for Atmospheric and Space Physics and a co-investigator of the mission.
Hydrogen, helium, sodium, calcium and potassium had been detected before. Calcium and magnesium are similar chemically, and the distribution of the two elements was expected to be similar. Instead, calcium peaked near the equator, while the distribution of magnesium was more uniform.
Messenger will make one more flyby of Mercury, on Sept. 29, before entering orbit around the planet in March 2011.
Women Sue Over Device to Stop Urine Leaks
By RONI CARYN RABIN, The New York Times, May 5, 2009
It was the promise of a quick fix that appealed to Amber Suriani.
She had just turned 40 and was very fit, but whenever she went running or practiced karate — she was working on a black belt — she leaked a bit of urine.
The diagnosis was stress urinary incontinence, and her surgeon recommended a simple procedure to plug the leak by inserting a hammock made of a strip of synthetic meshlike material, called a vaginal sling, under her urethra.
“It was supposed to be a simple ‘in one day and out the next’ kind of thing,” said Ms. Suriani, now 43, who lives in a suburb of Syracuse.
And so it seemed, at least at first. The surgery went smoothly, and the leakage stopped. But several months later, Ms. Suriani developed a persistent, painful and often bloody vaginal discharge.
She was convinced that she had cancer. It did not occur to her that the sling was the source of the problem until a piece of the meshlike tape started working its way through her vaginal wall.
Since then, she has had five operations, each one removing bits of the sling but not the entire thing; another operation is scheduled. She still has chronic discharge and says her sex life with her husband has been affected. She relies on Motrin to get through the day and a sleeping pad to get through the night.
“I feel like I’m never going to be the same again,” Ms. Suriani said, adding: “I’m beginning to feel like this has ruined my life. Not just ruining my life, as in ‘It will get better,’ but ruined, as in ‘I’m stuck with this for the rest of my life.’ I try to stay positive, but it’s getting harder and harder.”
Ms. Suriani’s lawyer, Matthew Metz of Seattle, said she was one of dozens of women suing the maker of the vaginal sling, called ObTape.
The company, Mentor Corporation, based in Santa Barbara, Calif., and recently acquired by Johnson & Johnson, stopped selling ObTape in 2006 but says there is nothing wrong with the product, which was cleared for sale by the Food and Drug Administration.
John Q. Lewis of Cleveland, a lawyer with the firm Jones Day, which represents Mentor, said that there were risks to any surgical procedure and that doctors should have warned patients. He noted that early European studies reported low rates of complications with ObTape.
“It’s very unfortunate when anyone reports a complication,” Mr. Lewis said. “That being said, these are complications that are well known, that patients are warned about, and are inherent to a surgical procedure that has helped thousands and thousands of people live a better life.”
He continued, “The overall benefits of the procedure and this product outweighed the potential risks.”
The lawsuits raise new questions about the process by which the F.D.A. reviews new medical devices. While it “approves” drugs, it merely “clears” medical devices with minimal testing if they are deemed “substantially equivalent” to devices already in use.
The process has been criticized by the agency’s scientists and in a recent Government Accountability Office report concluding that most devices on the market have never been proved safe and effective.
In ObTape’s case, the chain of similarity claims can be traced back to an older product that caused so much harm it was taken off the market. That recall did not stop the F.D.A. from clearing a new generation of vaginal slings whose only claim to safety was their similarity to the flawed device.
A reverse chronology, put together with help from plaintiffs’ lawyers and researchers at Public Citizen’s Health Research Group, a nonprofit consumer advocacy group, illustrates the pitfalls of the process.
In 2003, Mentor asked the food and drug agency to clear ObTape for the United States market, saying there was essentially no difference between its product and two other vaginal slings already widely in use — Johnson & Johnson’s Tension Free Vaginal Tape System and American Medical Systems’ Sparc Sling System.
Those slings had been cleared earlier, based on claims that they, too, were much like earlier products — in Johnson & Johnson’s case, the Protegen sling, made by Boston Scientific. But that sling had been recalled in 1999, four years before ObTape made its appearance. At the time, the F.D.A. called the Protegen sling an “adulterated and misbranded” product.
Officials at the F.D.A. declined requests for an interview, providing only answers to e-mailed questions. Asked why the agency would clear a product based on a recalled predecessor, they replied, “Any legally marketed device can serve as a predicate for a premarket submission.”
In fact, there were significant differences between ObTape and the earlier slings, and once Mentor had cleared ObTape for marketing based on its similarity to other devices, the company promoted its unique features. It obtained a patent and emphasized to surgeons that its new design, based on a European product called Uratape, allowed for a surgical approach that reduced the risk of puncturing the bladder.
Dr. Andrew L. Siegel, a urologist in Hackensack, N.J., who now serves as an expert witness for the plaintiffs suing ObTape, was one of the first surgeons to start using the device. “I was delighted about it,” Dr. Siegel said. “It was a great innovation.”
But ObTape was different from earlier slings in another way, which became clear only later and had to do with the type of material it was made of.
Many experts say the sling was too dense — not porous enough to allow tissue and capillaries to grow through it so it is fully incorporated in the body, rather than becoming encapsulated and expelled.
Reports of adverse events linked to ObTape soon started pouring in to the F.D.A. — 266 in all, starting in 2004, many of them describing problems similar to Ms. Suriani’s complaints.
Surgeons like Dr. Siegel started publishing case reports in medical journals and reporting negative experiences with the device. Several described the “malodorous discharge” patients developed after surgery, and said the tape started extruding.
In 2006, doctors at the Virginia Mason Medical Center in Seattle reported in The Journal of Urology that they had stopped using ObTape after observing a 13.4 percent rate of vaginal extrusion.
But Mr. Lewis, the lawyer for Mentor, said the material was tested by company engineers as part of an extensive premarketing process. The 266 reported adverse events represent a small fraction of the 16,000 ObTape slings implanted in the United States, he added, and he pointed to studies finding high complication rates for other slings.
Indeed, the F.D.A. alerted health care providers last year that it had received more than 1,000 reports of complications from nine surgical mesh manufacturers about devices for incontinence and organ prolapse. “Physicians should inform patients about the potential for serious complications and their effect on quality of life, including pain during sexual intercourse, scarring” and other complications, the notice said.
Mr. Lewis said clinical data from Europe supported the ObTape sling’s safety and efficacy, and suggested that American surgeons’ lack of familiarity with the new surgical technique was responsible for any problems. He noted that in California, a jury recently rejected a claim of negligence against Mentor by Lisa Ann Seeno, now 51, who was hospitalized with an abscess shortly after the device was implanted. (She has requested a new trial.)
Another plaintiff, Suzanne Crews, 69, of Washington State, said she was suing Mentor to spread the word about the risks of trying to repair what was, in hindsight, a problem she could have lived with — minor leaking when she coughed too hard or laughed too loud.
Ms. Crews said she has undergone four operations to remove portions of the tape.
“I’m not like I’m supposed to be,” she said. “I just really would be happier if more and more people knew about the problem, and didn’t just sit back and say, ‘Oh my gosh, I don’t know what’s happening.’ ”
