Poll: Obesity's a crisis but we want our junk food

WASHINGTON (AP) — We know obesity is a health crisis, or every new year wouldn't start with resolutions to eat better and get off the couch. But don't try taking away our junk food.
Americans blame too much screen time and cheap fast food for fueling the nation's fat epidemic, a poll finds, but they're split on how much the government should do to help.
Most draw the line at policies that would try to force healthier eating by limiting food choices, according to the poll by The Associated Press-NORC Center for Public Affairs Research.
A third of people say the government should be deeply involved in finding ways to curb obesity, while a similar proportion want it to play little or no role. The rest are somewhere in the middle.
Require more physical activity in school, or provide nutritional guidelines to help people make better choices? Sure, 8 in 10 support those steps. Make restaurants post calorie counts on their menus, as the Food and Drug Administration is poised to do? Some 70 percent think it's a good idea.
"That's a start," said Khadijah Al-Amin, 52, of Coatesville, Pa. "The fat content should be put up there in red letters, not just put up there. The same way they mark something that's poisonous, so when you see it, you absolutely know."
But nearly 6 in 10 people surveyed oppose taxes targeting unhealthy foods, known as soda taxes or fat taxes.
And when it comes to restricting what people can buy — like New York City's recent ban of supersized sodas in restaurants — three-quarters say no way.
"The outlawing of sugary drinks, that's just silly," said Keith Donner, 52, of Miami, who prefers teaching schoolchildren to eat better and get moving.
"People should just look at a Big Gulp and say, 'That's not for me.' I think it starts when they are young and at school," he added.
Indeed, while three-quarters of Americans consider obesity a serious health problem for the nation, most of those surveyed say dealing with it is up to individuals. Just a third consider obesity a community problem that governments, schools, health care providers and the food industry should be involved in. Twelve percent said it will take work from both individuals and the community.
That finding highlights the dilemma facing public health experts: Societal changes over recent decades have helped spur growing waistlines, and now a third of U.S. children and teens and two-thirds of adults are either overweight or obese. Today, restaurants dot more street corners and malls, regular-sized portions are larger, and a fast-food meal can be cheaper than healthier fare. Not to mention electronic distractions that slightly more people surveyed blamed for obesity than fast food.
In the current environment, it's difficult to exercise that personal responsibility, said Jeff Levi of the nonprofit Trust for America's Health, which has closely tracked the rise in obesity.
"We need to create environments where the healthy choice becomes the easy choice, where it's possible for people to bear that responsibility," he said.
The new poll suggests women, who have major input on what a family eats, recognize those societal and community difficulties more than men do.
More than half of women say the high cost of healthy food is a major driver of obesity, compared with just 37 percent of men. Women also are more likely than men to blame cheap fast food and to say that the food industry should bear a lot of responsibility for helping to find solutions.
Patricia Wilson, 53, of rural Speedwell, Tenn., says she must drive 45 minutes to reach a grocery store — passing numerous burger and pizza joints, with more arriving every year.
"They shouldn't be letting all these fast-food places go up," said Wilson, who nags her children and grandchildren to eat at home and watch their calories. She recalls how her own overweight grandmother lost both her legs and then her life to diabetes.
More than 80 percent of people in the AP-NORC poll said they had easy access to supermarkets, but just as many could easily get fast food. Another 68 percent said it was easy for kids to purchase junk food on their way to school, potentially foiling diet-conscious caregivers like Wilson, who doesn't allow her grandchildren to eat unhealthy snacks at home.
"If they say they're hungry, they get regular food," she said.
Food is only part of the obesity equation; physical activity is key too. About 7 in 10 people said it was easy to find sidewalks or paths for jogging, walking or bike-riding. But 63 percent found it difficult to run errands or get around without a car, reinforcing a sedentary lifestyle.
James Gambrell, 27, of Springfield, Ore., said he pays particular attention to diet and exercise because obesity runs in his family. He makes a point of walking to stores and running errands on foot two to three times a week.
But Gambrell, a fast-food cashier, said he eats out at least once a day because of the convenience and has changed his order at restaurants that already have begun posting calorie counts. He's all for the government pushing those kinds of solutions.
"I feel that it's a part of the government's responsibility to care for its citizens and as such should attempt to set regulations for restaurants that are potentially harmful to its citizens," he said.
On the other side is Pamela Dupuis, 60, of Aurora, Colo., who said she has struggled with weight and has been diagnosed as pre-diabetic. She doesn't want the government involved in things like calorie-counting.
"They should stay out of our lives," she said.
The AP-NORC Center survey was conducted Nov. 21 through Dec. 14. It involved landline and cellphone interviews with 1,011 adults nationwide and has a margin of sampling error of plus or minus 4.2 percentage points.

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High School Basketball Star Must Tan to Treat Rare Disease

When the Shawnee High School basketball team is down on the scoreboard, players know to throw the ball to Josh Borelli. Borelli is not only the team's star player, but also the player most adept at overcoming adversity.

Borrelli, a senior at the Medford, N.J., school, has a condition called Mucha-Habermann, an extremely rare skin disorder that causes lesions to develop all over the body.

Borrelli developed the autoimmune disease out-of-the-blue in eighth grade.

"One day I woke up in the eighth grade and I had red lesions all over my body so I went to the doctors," he told ABC News. "It was the first or second case he's seen in his 40 year practice."

According to the NIH, Mucha-Habermann strikes males more often than females and occurs more frequently in children, specifically between the ages of five to 10. Borrelli's father told the Philadelphia Inquirer that he was believed to be the only person in the country to have the disease at the time he was diagnosed.

"This disease is so rare that most dermatologists don't see it in their entire practice," Dr. Doris Day, clinical associate professor of dermatology at New York University Medical, who does not treat Borrelli, told ABC News. "It's something that we read about but don't see."

Borrelli's own case went into remission as he entered high school, only to return at the start of his senior season. This time, his doctor ordered a new treatment in addition to his prescribed medication: daily visits to the tanning salon.

"My dad went with me the first couple of times to the tanning salon because I was a bit nervous," he said of the first of his now-routine eight minutes per day in the tanning booth.

The treatment worked and Borrelli's skin is now smooth, although enhanced with a Coppertone complexion. Doctors say the ultraviolet technique is so effective that Borrelli cannot miss a single day of tanning, especially since the disease can resurface at any time and cause life-threatening complications in adults.

The treatment has not hurt his basketball game. He continues to average nearly 20 points per game and is just two points shy of scoring 1,000 points in his career.

"If anything it's probably helped," Borrelli said. "There's people out there worse off than I am so I'm real lucky."

Borrelli's year-round tan has even inspired his fans to create a tagline of their own, donning "Fear the Tan" t-shirts at the school's basketball games.

"It's a tough situation and it's been very challenging for him but I've seen him rise to the occasion," Borrelli's father, David Borrelli, told ABC News.

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Racial gaps in access to robotic prostate surgery

NEW YORK (Reuters Health) - Minority and Medicaid cancer patients are less likely to have their prostates removed at hospitals that use robot-assisted surgery, according to a new study that stops short of suggesting the robotic technique represents better care.
"People who are poor - frequently Hispanic, African American or black, and Medicaid patients - tend to get what is considered to be less high-quality care than those who are middle class and wealthy," said Dr. Otis Brawley, chief medical and scientific officer of the American Cancer Society.
But Brawley, who wasn't involved in the new study, also said there is no evidence that removing a prostate with a robot is better than the old-fashioned way, with "open" surgery that requires an incision across a man's stomach.
Those are two of several treatment options available for prostate cancer, including radiation as well as active surveillance, also known as watchful waiting.
The American Cancer Society estimates approximately 250,000 men were diagnosed with prostate cancer in 2012, and about 28,000 died from it.
Despite a lack of evidence showing its superiority, robot-assisted prostate removal has become the predominant method since being approved by the U.S. Food and Drug Administration in 2000, according to the researchers, led by Dr. Simon Kim at the Mayo Clinic in Rochester, Minnesota.
Robotic surgical tools allow doctors to operate through small incisions with the aid of a tiny video camera, an approach that is considered less invasive but also tends to be more expensive.
Kim and his colleagues write in The Journal of Urology that evidence does exist to show that black patients are already less likely to get radiation or to have their prostates removed, but there is less data on whether they and other minorities have equal access to robot-assisted prostate removal.
For the study, Kim's group used two national databases to compare the differences between the approximately 20,500 cancer patients who had their prostates removed at hospitals offering robotic surgery, and the 9,500 who had their surgery at hospitals without robots between 2006 and 2008.
Overall, the researchers found, the proportion of all prostate removals shifted from about 56 percent taking place at hospitals with robots in 2006 to 76 percent in 2008.
They also found that hospitals offering robotic surgery removed more than four times the number of prostates as other hospitals during that time.
That's important because hospitals that remove more prostates tend to report better patient outcomes after surgery.
In addition, black patients were 19 percent less likely to have their surgery at a hospital using robots compared to white patients, and Hispanic patients were 23 percent less likely.
Medicaid patients were also 30 percent less likely to go to a hospital offering robotic surgery, compared to patients with private insurance.
Dr. Michael Barry, who was not involved in the new research but has studied prostate cancer treatment and outcomes, pointed out that the new work shows a gap in who is able to access the hospitals that perform the greatest number of prostate removals.
"The issue here is not access to robot (surgery) but high-volume hospitals," said Barry, a clinical professor of medicine at Boston's Harvard Medical School.
The study authors, who were not available for comment by press time, similarly conclude that gaps in access to robotic surgery hospitals may also indicate limited access to high-volume hospitals.
"More effective health care policies focusing on incentives to provide better access for minorities or for patients primarily insured by Medicaid may reduce disparities in access to high volume hospitals with robotic surgery," they write.

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Eli Lilly banks on cost controls for higher 2013 profit

Eli Lilly and Co said on Friday it expects profit in 2013 to increase by more than Wall Street had been forecasting, primarily due to cost controls and improved productivity.
Lilly, whose shares were up nearly 4 percent on Friday, said 2013 sales will be flat to a bit higher, despite the loss of patent on its $5 billion-a-year antidepressant, Cymbalta, in December.
The Indianapolis-based drugmaker is coming off a particularly difficult 2012 when sales declined sharply because of competition from cheaper generics.
It expects 2013 earnings to increase to $3.75 to $3.90 per share excluding items, from a forecast of $3.30 to $3.40 per share in 2012. In 2011, its adjusted earnings were $4.41 per share.
Analysts on average forecast earnings of $3.71 for 2013 and $3.36 per share for 2012, according to Thomson Reuters I/B/E/S.
"Overall, it was better than anyone expected," said Barclays Capital analyst Tony Butler. "From an earnings perspective, no one believed that operating expenses would be kept in check."
Morningstar analyst Damien Conover said, "They're cutting costs at a pace that's maybe a little quicker than people were anticipating, and that was one of the reasons for the outperformance in their guidance."
The company said 2013 net profit would benefit from a tax credit that had been pushed into this year because of the late signing of the American Taxpayer Relief Act of 2012 - the legislation that prevented the so-called fiscal cliff.
The company said it is not sure yet of the amount of the tax credit, which is related to research and development accounting, and said it would provide more information during its January 29 earnings conference call. Lilly said it excluded the impact from all of its financial guidance.
Similar uncertainty could face other drugmakers, as well as other corporate sectors with extensive research budgets, such as technology and defense. However, "It could be resolved by the time everybody else reports," Butler said of the pharmaceutical industry. "We've got another three weeks before anyone reports."
Lilly said the adjusted earnings forecast also excludes payment and income for revenue sharing with Bristol-Myers Squibb Co's Amylin unit on Byetta, a diabetes drug, and restructuring charges. Lilly severed ties with Amylin when it agreed to collaborate with Boehringer Ingelheim on diabetes drug development.
HELP ON THE WAY
Lilly forecast 2013 revenue of $22.6 billion to $23.4 billion, driven by sales of its drugs for diabetes, osteoporosis, cancer, erectile dysfunction and animal health. The company said it also expects significant revenue growth from Japan and emerging markets, such as China.
Analysts are looking for 2013 revenue of $22.82 billion.
While Cymbalta is not expected to start facing generic competition until the end of the year, the company cautioned that sales declines could begin sooner if wholesalers start to reduce inventory supplies prior to the patent expiration.
As a result, it said, the fourth quarter could look significantly different than the first three.
Lilly has already been battered by generic competition for its once top-selling schizophrenia drug, Zyprexa, and will face generic competition for its $1 billion-a-year Evista osteoporosis drug in early 2014.
But help is on the way. Lilly said it now has 13 drugs in late-stage testing, the most at any one time in its history. It could seek approvals this year for drugs for Type 1 and Type 2 diabetes, gastric cancer and for a type of lymphoma.
Chief Financial Officer Derica Rice told analysts on a conference call that the company was firmly focused on replenishing the developmental pipeline. "This is our future and it's our first priority."
The company also vowed to maintain its dividend payout and complete its share repurchase plan.
"Lilly has financially done a really good job. Obviously, you need the pipeline to come through," said Barclay's Butler, adding that positive late-stage data on ramucirumab in breast cancer could signal an important new product for Lilly. The drug is also in late-stage testing for the smaller gastric cancer market.
Other key events for Lilly in 2013 include the start of a new Phase III trial of solanezumab in patients with mild Alzheimer's disease after an earlier study failed but showed some signs of hope for the memory-robbing condition, and an August trial challenging a method of use patent on the $3 billion-a-year lung cancer drug Alimta.
Should Lilly prevail in court, the company could have patent protection on the medicine into 2022 even though the basic patent lapses in 2016.
Asked if the company would consider settling the case before it comes to trial, Phil Johnson, Lilly's vice president for investor relations, said: "Nothing is off the table, but we have not historically entered into those kinds of agreements."
Eli Lilly shares were up 3.8 percent at $51.60 on Friday afternoon on the New York Stock Exchange.

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Researchers Discover New Strategy to Fight Obesity

After decades of achieving little long-term success with medications, Belgian scientists have come up with a new strategy to fight obesity. They're targeting food sensors in the stomach.
Researchers from the Catholic University of Leuven have reported that the digestive tract "tastes" what a person eats. It uses signaling devices similar to those found in the tongue to detect bitter, sweet, fat, and savory taste, according to Medical News Today.
Thanks to these mechanisms, the gut release hormones that control blood sugar levels and feelings of being satisfied once food reaches the stomach. A malfunction in the sensors could have a role in developing obesity-associated illnesses.
The Mayo Clinic offers a simple definition of obesity: having an excessive amount of body fat. This boosts the risk of developing a number of adverse health conditions, among them heart disease, high blood pressure, and diabetes.
A diagnosis of obesity is the result of calculating body mass index (BMI), which considers weight and height. Individuals with a BMI of less than 18.5 are considered underweight. A range of 18.5 to 24.9 is normal. Overweight patients score between 25.0 and 29.9, while a BMI of 30.0 or more signals obesity. The extremely obese score at least 40.0. The National Heart Lung and Blood Institute posts a free BMI calculator on its site.
More than 35 percent of U.S. adults are obese, according to the Centers for Disease Control and Prevention. Medical costs linked to the condition cost a whopping $147 billion in 2008. In 2011, a dozen states had obesity prevalence rates of at least 30 percent: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia.
The Belgian researchers reported that an increasing amount of data suggests that obesity and related conditions could be treated or even prevented by targeting taste receptors on gut cells. Causing them to release hormones that make the patient feel full would mirror the effects of eating.
They also suggested that successful bariatric surgeries might somehow be related to a release of hormones in the digestive tract. However, they stress that more studies are necessary to determine which receptors in the gut should be targeted.
I come from a family of obese people. I've tried dozens of times to reach a BMI of less than 25. The longest I succeeded was six months. I am constantly plagued by feelings of hunger, not just appetite. I am not sufficiently overweight to consider surgery, and due to food restrictions linked to Crohn's disease, many so-called healthy snacks like fresh fruits and vegetables are off limits.
I remain in an orbit of being overweight and sometimes obese. Given the lack of success of current medications for obesity and the Crohn's restrictions I have, fooling the body into sensing satiety to fight obesity could provide a valuable treatment.

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APNewsBreak: Texas cancer probe draws NCI scrutiny

The National Cancer Institute confirmed Friday that federal officials are taking a closer look at a troubled $3 billion cancer-fighting effort in Texas that is under a criminal investigation over a lucrative taxpayer-funded grant awarded by the state agency.
The Cancer Prevention and Research Institute of Texas touts its status as an NCI-approved funding entity — an exclusive group headlined by the nation's most prominent cancer organizations. The list is fewer than two dozen and includes the American Cancer Society, Susan G. Komen for the Cure and federal entities like the Center for Disease Control and Prevention.
The designation is a federal seal-of-approval that signals high peer review standards and conflict of interest policies. Yearlong turmoil within the Texas institute, or CPRIT, reached a new peak this week when the agency's beleaguered chief executive asked to resign and prosecutors opened cases following an $11 million grant to a private company that was revealed to have bypassed an independent review.
NCI spokeswoman Aleea Farrakh Khan told The Associated Press that officials are "evaluating recent events" at CPRIT. She said officials have not made decisions or contacted the agency directly.
Members of CPRIT's governing board did not immediately return an email seeking comment.
An NCI designation is not required for CPRIT to continue running the nation's second-largest pot of cancer research dollars, Khan said. But jeopardizing that status — and especially losing it — would be a severe blow to CPRIT's reputation, which already has been battered by sweeping resignations, internal accusations of politics trumping science and now a criminal investigation.
A recent internal audit at CPRIT discovered an $11 million funding request from Dallas-based Peloton Therapeutics was approved without the agency ever scrutinizing the proposal's merits. The revelation came only months after two Nobel laureates and other top scientists left the agency in protest over a $20 million grant some accused of being rushed to approval without a proper peer review.
While CPRIT is funded by taxpayers, donors to cancer nonprofits might look to an NCI designation for assurance that their money is in good hands.
"It says, 'If I'm donating money to this agency, if NCI is approving them, that means NCI says it's handling its money well,'" Khan said.
Khan added that CPRIT's inclusion on the list does not mean all of its funding mechanisms are NCI-approved.
There is no funding relationship between the NCI and CPRIT.
An entire page of CPRIT's website is devoted to boasting its NCI designation. The agency says the status is important because it means cancer centers in Texas seeking its own NCI designation — so as to reassure patients or bolster recruitment — can include CPRIT research dollars in their calculations to maintain levels needed to be NCI approved.
"This enhances Texas' ability to leverage additional federal funding for cancer research and raises Texas' profile as a center for cancer research," according to the website.
Executive Director Bill Gimson submitted his resignation letter Tuesday but offered to stay on through January. He has described Peloton's improper funding as an honest mistake and said no one associated with CPRIT stood to personally profit from the company's award.
Prosecutors have not made any specific criminal allegations. Launching separate investigations into CPRIT are the Texas attorney general's office and the Travis County district attorney's public integrity unit, which investigates criminal misconduct within state government.

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Mental health toll emerges among Sandy survivors

The image of his brother trapped in a car with water rising to his neck, his eyes silently pleading for help, is part of a recurring nightmare that wakes Anthony Gatti up, screaming, at night.
Gatti hauled his brother out of the car just in time, saving his life at the height of Superstorm Sandy. The two men rode out the hurricane in their childhood Staten Island home and survived. But weeks afterward, Gatti still hasn't moved on.
Now he's living in a tent in the backyard, burning pieces of furniture as firewood, refusing to leave until the place is demolished. Day and night, he is haunted by memories of the storm.
"My mind don't let me get past the fact that I can't get him out of the car. And I know I did," Gatti said, squeezing his eyes tightly shut at the memory. "But my mind don't let me think that. My mind tells me I couldn't save him, he dies."
As communities battered by Sandy clear away the physical wreckage, a new crisis is emerging: the mental and emotional trauma that storm victims, including children, have endured. The extent of the problem is difficult to measure, as many people are too anxious to even leave their homes, wracked by fears of wind and water and parting from their loved ones. Others are too busy dealing with losses of property and livelihood to deal with their grief.
To tackle the problem, government officials are dispatching more than 1,000 crisis counselors to the worst-hit areas in New York and New Jersey, helping victims begin the long work of repairing Sandy's emotional damage.
Counselors are assuring people that anxiety and insomnia are natural after a disaster. But when the trauma starts to interfere with daily life, it's probably time to seek help. And in a pattern that played out in New Orleans and the Gulf Coast after Hurricane Katrina in 2005, symptoms may only get worse as victims transition from the initial shock to the disillusionment phase of the recovery.
"Folks are starting to realize that they may be in this for the long haul," said Eric Hierholzer, a commander in the U.S. Public Health Service. "And things aren't necessarily going to get better tomorrow or next week."
At St. John's Episcopal Hospital in Far Rockaway, the psychiatry department has recorded a 20 percent increase in walk-in patients since the storm hit, with residents reporting the whole gamut of stress-related symptoms. Anxiety. Insomnia. Panic attacks.
Local schools have referred 25 percent more children than usual to the hospital's outpatient mental health programs.
"The children are very, very traumatized," said Fern Zagor, who runs the Staten Island Mental Health Society. "They have a hard time making sense of this sudden change in their world. It's frightening to them."
A 5-year-old girl who was pulled from floodwaters clinging to her father hasn't been able to attend kindergarten since the storm, Zagor said, because she's too traumatized to be parted from him now. An 11-year-old boy is working with counselors after floating in water up to his neck on the second floor of his home for several hours before being rescued.
"This child has said he worries about rain," Zagor said. "He worries about whether he'll ever want to swim in a swimming pool again."
The society is among many mental health providers who are working with Project Hope, a New York crisis counseling program funded by an $8.2 million Federal Emergency Management Agency grant that has just begun sending counselors to local communities. New York Gov. Andrew Cuomo's office estimates the program will help more than 200,000 people.
Project Hope Counselor Yomira Natera has been seeking out storm victims who don't speak English as their first language.
"We've seen an increase in substance abuse with folks who may have language barriers," she said, "who may be frustrated with the system, who find it difficult to communicate."
At least 20,000 people have so far made contact with counselors from the New Jersey Hope and Healing Program, which has dispatched hundreds of state-trained disaster crisis response counselors into the storm zone. The state also launched a hotline for people to call and talk to a counselor.
In Union Beach, N.J., a working-class enclave on Raritan Bay, Kathy Parsells volunteered at a FEMA recovery center on a recent afternoon, helping to coordinate deliveries. Her daughter and grandchildren had to be rescued during the storm.
"I'm OK," she said, stifling tears. "My grandsons have nightmares. My grandson, the first night, was screaming: 'It's coming up the stairs.'"
Jeannette Van Houten, who lost her home in Union Beach, said in a telephone interview that she feels like she's going through the same stages of grief that she endured when her niece was murdered in 2008.
"I have days that I can't put a thought together. Like you start talking and you forget what you're saying," said Van Houten, who sleeps just two or three hours on a good night nowadays. "And the numbness, like you look at things that are happening around you, but you're not part of it."
The Rev. Matthew Dowling, a pastor at the Monmouth Church of Christ in Tinton Falls, N.J., volunteered as a crisis counselor in the days after the storm and heard a lot of survivor's remorse from people who were more fortunate than their neighbors. But there was also a great deal of frustration.
"When FEMA arrives, they think everything is going to be fixed," Dowling said. "The reality is it's going to take months and months to get back to normal. Just like the steps of grief there's anger at the new normal."
Distress calls to LifeNet, New York City's local crisis hotline, doubled during the first few weeks after the storm hit, averaging more than 2,000 calls per week from people who were angry and worried that basic needs — food, clothing, shelter — had not been met.
Officials are now preparing for a new wave of calls from people struggling with depression and other mental health issues, said Christian Burgess, director of the Disaster Distress Helpline, a national crisis hotline run by the federal government that provides a network of trained counselors in the aftermath of a major disaster.
Coming to grips with the loss of everything she owned has been difficult for Carol Stenquist, who stood outside borough hall in Union Beach, nervously dragging on a cigarette and crying.
"I have anxiety over it. Even when I lay down at night I feel my heart palpitating with the loss of everything," said Stenquist, whose home was destroyed. "I was there for 20 years."
She thinks she needs to talk to a professional counselor, but hasn't sought one out yet.
"I'm kind of afraid that the emotional stuff I feel now is just part of what I'm going to feel when it's over," she said. "I've had my breakdowns, cries, feelings of depression. I've had all of that."
On Staten Island, volunteers have been quietly stopping by Anthony Gatti's tent to check in on him during his long vigil, dropping off boxes of cereal and cans of coffee. A volunteer therapist tried to talk him into leaving, but to no avail. He spends his days patrolling the property for looters and gazing at photos of the storm's destruction on his laptop.
"I keep trying to make him understand. It's a lot of wood and metal and pipes, that's all it is," said his mother, Marge Gatti. "You've got to get numb. You gotta get tough. If I'm not numb, I can't function.

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GlaxoSmithKline wins U.S. approval for new flu vaccine

U.S. health regulators have approved a new four-strain seasonal influenza vaccine made by GlaxoSmithKline Plc, the company said on Monday.
The U.S. Food and Drug Administration has approved Fluarix Quadrivalent to immunize children age 3 and older and adults against flu virus subtypes A and B contained in the vaccine.
It is the first intramuscular vaccine to protect against four influenza strains. Three-strain flu vaccines currently administered help protect against the two most common A virus strains and the B strain expected to be predominant in a given year, the company said.
Since 2000, however, two B virus strains have circulated to varying degrees each season, meaning patients infected with the B virus not contained in the vaccine were not immunized.
Fluarix Quadrivalent helps protect against the two A strains and adds coverage against a second B strain, the company said.
Three-strain vaccines "have helped protect millions of people against flu, but in six of the last 11 flu seasons, the predominant circulating influenza B strain was not the strain that public health authorities selected," said Dr. Leonard Friedland, head of clinical development and medical affairs for Glaxo's North American vaccines program.
"Fluarix Quadrivalent will help protect individuals against both B strains and from a public-health standpoint, can help decrease the burden of disease."
Glaxo said it will make the vaccine available in time for the 2013-14 flu season and plans to fulfill orders for its trivalent, or three-strain, vaccines. Healthcare providers traditionally order flu vaccines about a year in advance of each flu season.
Fluarix Quadrivalent is not currently approved or licensed in any country outside of the United States.

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Inherited colon cancer risk tied to certain foods

Among people who have a genetic susceptibility to colon cancer, those whose diets are heavy in junk food have an even higher risk, according to a new study.
"These patients have this very high risk because of this (genetic) mutation they have, but it might be that they could reduce the number of (tumors) by having a more healthy lifestyle," said Akke Botma, the lead author of the study.
Botma's study is just the first to find a link between certain foods and a higher colon cancer risk in this group, and it can't prove that the diet is to blame.
All of the people in the study had Lynch syndrome, a genetic disorder that predisposes people to cancer at younger ages and that affects up to one in 660 people.
In Western countries, colorectal and endometrial cancers are the dominant cancers to turn up in people with the syndrome, while in Asia it's mostly stomach cancer, Botma said.
Up to 70 percent of people with Lynch syndrome will develop colon cancer. Among people without Lynch syndrome, such cancers are thought to be influenced by diet, particularly alcohol and red and processed meat, the authors note in their study, published in the journal Cancer.
Botma and her colleagues at Wageningen University in the Netherlands contacted 486 people with Lynch syndrome from a national database of families with inherited risks for cancer.
At the beginning of the study they surveyed the participants about what they ate, and they ranked each person on whether he ate low, medium or high amounts of foods within four dietary categories.
The food groups included one that was dominated by fruits, vegetables and whole grains; another that was high in meat and coffee; a third dietary group that resembled a Mediterranean diet - fish, leafy greens, pasta, sauces and wine; and a fourth group that was heavy on fried snacks, fast food and diet soda.
Botma and her colleagues found that, over 20 months of follow up, 56 of the participants -- or 12 percent -- screened positive for tumors in the colon, a precursor to cancer.
Of the four dietary groupings, only the junk food category showed any link with a different risk for developing colon tumors.
Of the 160 people who scored low on the junk food diet, 17 developed tumors, while 18 out of the 160 people who ate the most junk food developed tumors.
The numbers initially seemed similar, but after taking into account smoking and other risk factors, the researchers determined that those in the high junk food group were twice as likely to develop colon tumors.
HOW TO MANAGE RISKS?
"It's hard to say why" junk food is linked with a greater risk for these tumors, said Dr. Mala Pande, an instructor at the University of Texas MD Anderson Cancer Center in Houston who was not involved in the research.
She said some researchers have suggested that high fat might have something to do with it, but it's impossible to conclude that from this study.
Although the findings are too preliminary to be used in making dietary recommendations to people with Lynch Syndrome, the study was valuable in launching research into the possible role of certain foods on cancer risk, said Christopher Amos, a professor at the Geisel School of Medicine at Dartmouth College.
"People with Lynch Syndrome are at higher risk, and we'd really like to know how to manage their risks better," Amos, who was not part of the study, told Reuters Health.
Certain foods have been shown to be linked with different types of cancer, but many of those studies contradict each other and sow confusion (see Reuters Health report of December 5, 2012 here: http://reut.rs/YPuDcs).

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Global malaria battle stalls as financing gets tight

Global funding for the fight against malaria has stalled in the past two years, threatening to reverse what the World Health Organisation (WHO) says are "remarkable recent gains" in the battle to control one of the world's leading infectious killers.
After rapid expansion between 2004 and 2009, funding for malaria prevention and control leveled off between 2010 and 2012 - meaning there were fewer life-saving steps taken in hard- hit malarial regions such as sub-Saharan Africa.
"If we don't scale up vector control activities in 2013 we can expect major resurgences of malaria," said Richard Cibulskis, lead author of the WHO's World Malaria Report, which was published on Monday.
"Vector control" means stopping transmission of the disease with tools such as treated mosquito nets. The report found that deliveries of such nets to endemic countries in sub-Saharan Africa dropped from 145 million in 2010 to an estimated 66 million in 2012.
"This means that many households will be unable to replace existing bed nets when required, exposing more people to the potentially deadly disease," the report said.
Malaria is caused by a parasite carried in the saliva of mosquitoes and kills hundreds of thousands of people a year, mainly babies and children under the age of five in Africa.
According to WHO data, the disease infected around 219 million people in 2010, killing around 660,000 of them. Robust figures are, however, hard to establish and other health experts say the annual malaria death toll could be double that.
GLOBAL TARGETS
An estimated $5.1 billion a year is needed between 2011 and 2020 to get malaria medicines, prevention measures and tests to all those who need them in the 99 countries which have on-going transmission of the disease.
"Essentially, with the tools that we've got, we need to make sure that we continue the investments in the control measures that we have," Cibulskis told a news conference in Geneva.
"If we don't do that, malaria will bounce back. As soon as you take bed nets away, malaria will come back. If you stop indoor residual spraying, it will come back, and with a vengeance. So yes, we need to keep on investing in malaria ultimately until new tools are developed."
The WHO says while many countries have increased financing for malaria, the total available global funding remained at $2.3 billion in 2011 - less than half of what is needed.
"Global targets for reducing the malaria burden will not be reached unless progress is accelerated in the highest burden countries," Robert Newman, director of the WHO Global Malaria Programme, said in statement with the report.
"These countries are in a precarious situation and most of them need urgent financial assistance to procure and distribute life-saving commodities."
The WHO report found that by far the greatest impact of malaria is concentrated in 14 endemic countries which account for an estimated 80 percent of malaria deaths.
Nigeria and the Democratic Republic of the Congo are the most affected countries in sub-Saharan Africa, while India is the hardest hit in South East Asia.
WHO director general Margaret Chan wrote in a forward to the report that there is now an urgent need to identify new sources of funding to boost and sustain malaria control.
"We also need to examine new ways to make existing funds stretch further by increasing the value for money of malaria commodities and the efficiency of service delivery," she said.
The Roll Back Malaria Partnership, which includes the WHO, UNICEF and the World Bank, said it was already exploring several options, including financial transaction taxes, airline ticket taxes and a potential "malaria bond" to encourage more involvement from private sector investors.
Fatoumata Nafo-Traore, executive director of the Roll Back Malaria Partnership, said Mozambique and one other African country were preparing to pilot such a bond in 2013, with the hope that other countries would follow their example.

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The Importance of Being Self-Reliant in Retirement

Most baby boomers are at various stages of preparing for retirement, depending on whether they were born at the beginning or end of their generation. The smart ones realize that effective planning starts well before retirement age. Important calculations need to be made to determine what it will take to survive financially throughout the retirement years. Post-work lifestyles and passions also need to be defined, and consideration for unexpected events should be taken into account whenever possible.

Counting on others to provide for us in our old age is a risky proposition. In the U.S., the ratio of working-age citizens between ages 15 and 64 supporting those over 64 is currently 5:1. By the year 2050 this ratio will drop to 3:1, according to United Nations data. In China things are even worse. They will move from the current 9:1 ratio to 3:1. And in Japan the ratio will be 1:1 in 2050.

It is important to rely on ourselves and our own resourcefulness. Society is changing to deal with the aging demographic with less generous pension plans, longer working hours, and an increase in the retirement age. Back in the 1980s, 38 percent of people had traditional pensions. By 2008 the number dropped to 20 percent. If a traditional pension will not be part of our retirement equation, we need to fill in the blank with other investments and savings alternatives.

Don't count on Social Security to foot your entire retirement bill either. With an average monthly amount of $1,230 paid at the beginning of 2012, it should only be viewed as a supplement to your other sources of retirement income. It is a piece of the puzzle, but should not be considered the entire solution.

Health demands and expenses will increase as we age. Fidelity estimates that a 65-year-old couple retiring in 2011 will need $230,000 to cover likely out-of-pocket medical expenses in retirement. And this estimate does not even include the cost of long-term care. Such burdens could prove catastrophic if we do not plan ahead with additional savings, health insurance, and long-term care coverage.

Most people approaching retirement would like the option to stay in their current home if they choose to and remain healthy enough to safely do so. Paying down your mortgage over the years provides flexibility, and the equity can be available for emergencies. Whether a decision is made to stay in the existing home or sell, having the option empowers senior citizens.

Remaining independent in retirement requires planning ahead, realistically evaluating your situation, and taking appropriate action to provide for your retirement needs. You can't count on the government or your former employer to finance your retirement years. It's something you need to take care of yourself.

Dave Bernard is not yet retired but has begun his due diligence to plan for a fulfilling retirement. With a focus on the non-financial aspects of retiring, he shares his discoveries and insights on his blog Retirement-Only the Beginning.

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Trio of chefs nominated in 'Time' magazine's 100 most influential people list

Chefs René Redzepi, David Chang and José Andrés have been nominated in Time magazine’s annual list of the 100 most influential people in the world.

The trio of world renowned chefs joins a pool of politicians, heads of state, actors, musicians and human rights activists as candidates in the publication’s Time 100 list.

Last year, Chef Grant Achatz was the only food personality among nominees like Jamie Oliver, US food writer Mark Bittman and Redzepi to break through the final round.

Voting is now open and closes April 6. The poll winner will be included in the Time 100 list, and the remaining people chosen by the magazine editors. The winners will be announced April 17.

Here’s how the food personalities are being described in the nominations:

José Andrés
Age: 42
Activist Chef
Andrés is a decorated chef for his Washington DC restaurants Jaleo and Minibar. Last year, he was named Outstanding Chef at the James Beard Foundation Awards. But it’s for his anti-hunger and anti-poverty efforts that he’s been singled out by Time this year. His World Central Kitchen, for instance, is described as an international think tank that tries to find creative solutions for feeding the world’s hungry.

David Chang
Age: 34
Occupation: Chef
In addition to expanding his Momofuku restaurant empire to Sydney and Toronto, Chang --  described as the “enfant terrible" of the New York dining scene -– has become a publishing mogul with a cookbook and foodie magazine Lucky Peach. But mostly, it’s his gourmet pan-Asian cooking that has diners raving.

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How to Avoid a High Tax Bracket in Retirement

We spend many years saving and investing in our retirement portfolios. And when we retire, there is still more work to be done. You probably have many accounts in your retirement portfolio including a 401(k), traditional IRA, Roth IRA, after-tax brokerage account, annuity, Social Security benefits, and perhaps even a traditional pension. You will need to use all of these sources of income efficiently to best replace the paychecks you used to get from your job.

One of the most important strategies is to keep tax to a minimum. Due to tax-deferred retirement accounts, many of us have delayed paying taxes on much of our retirement income. And that tax bill becomes due when we withdraw the money in retirement. Aiming to stay in a low tax bracket can help retirees to minimize the tax they pay on their retirement savings. Here's a look at the current tax brackets:
Tax Brackets 2012     Single     Married Filing Jointly     Head of Household
10 percent bracket     $0-$8,700     $0-$17,400     $0-$12,400
15 percent bracket     $8,700-$35,350     $17,400-$70,700     $12,400- $47,350
25 percent bracket     $35,350-$85,650     $70,700-$142,700     $47,350- $122,300
28 percent bracket     $85,650-$178,650     $142,700-$217,450     $122,300- $198,050
33 percent bracket     $178,650-$388,350     $217,450- $388,350     $198,050- $388,350
35 percent bracket     $388,350+     $388,350+     $388,350+

In retirement, we should strive to avoid the 25 percent tax rate (or higher) as much as possible. To stay in the 15 percent bracket, we will have to make sure our adjusted gross income stays under $35,000. There are several things we can do to accomplish this.

Let's say a single retiree needs $3,000 per month after taxes to cover expenses. Can a retiree bring in this income, but still avoid the 25 percent tax rate? It depends on where the income comes from.

Annuity, pension, and Social Security income are each taxed differently than regular earned income. In this example, let's assume the taxable portion of these types of income is around $15,000 per year.

Then we could withdraw $20,000 from a 401(k) or traditional IRA and still stay in a low tax bracket. These are both pre-tax accounts and any withdrawals are taxed at the earned income rate.

So far this retiree has an adjusted gross income of $35,000, which allows him to avoid the 25 percent tax bracket, and instead pay an effective tax rate of around 13.75 percent. This is about $2,500 per month in after-tax income. But we are still $500 short of $3,000 per month for expenses.

We can then tap an after-tax account for this shortfall. The current long-term capital gains tax rate is 0 percent for people in the 10 or 15 percent tax bracket. You could also withdraw the money from a Roth IRA or Roth 401(k). No income tax is due on these withdrawals because you already pre-paid the income tax up front.

If you want to remain in a low tax bracket in retirement, generate $35,000 or less from taxable income sources including a 401(k), IRA, Social Security, annuity, and pension. Once you hit $35,000 worth of taxable income, switch to after-tax accounts like the Roth IRA to generate the rest of your target income.

This flexibility is why it is important to invest in a Roth IRA and after-tax accounts. While you don't get an immediate tax break, these accounts add tax diversification to your portfolio that can be extremely useful when it's time to withdraw the money. While employers often encourage us to contribute to traditional 401(k) accounts, don't ignore the future tax benefit of the Roth IRA. It's best to contribute to both a traditional and Roth 401(k) or IRA, and an after-tax brokerage account.

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Is a Rural Retirement Right for You?

Would you be willing to exchange Thai restaurants and unwavering wireless Internet for homegrown produce and birdsong?

If so, a rural retirement may suit you well. The bonus: Rural acreage is a rare segment of the real estate market that weathered the Great Recession.

[See 10 New Retirement Hotspots.]

According to a report from the Lincoln Institute of Land Policy, residential land values in the United States are down nearly 70 percent since peaking in the second quarter of 2006. During that same period, the value of cropland in the contiguous United States rose some 20 percent, according to the U.S. Department of Agriculture. That's also the downside; higher values mean higher points of entry for would-be buyers looking to get into the rural market.

But the category looks poised to grow even more (individual markets may vary, of course.) Higher overall commodities prices lift land values. And while commodities prices can be volatile, a rising global middle class population that's sure to eat better and drive more could keep a floor under the market. That helps land prices.

"Idyllic lifestyle-seekers" want a fresh start and a tangible investment, says Dan Duffy, CEO at the rural and coastal real-estate search network United Country, based in Kansas City, Mo.

"You can't create more land--it's a finite investment. And during the downturn, agricultural land produced a dividend-like yield in the 5 percent to 8 percent range, plus capital appreciation. This, while some bond yields hovered at zero or worse," Duffy says. Land is also broadly characterized as a "real" asset. It's tangible, and that makes it an inflation-fighter.

Land investment can be two-pronged: The land itself is worth something, and what it might produce has a separate value. There are other money-making possibilities: rental income, such as for livestock grazing, cash crops from corn to timber, lodging fees for cabins or a bed-and-breakfast, organic-vegetable selling, fishing and hunting rights, wind power or natural gas rights, and profiting from eco-tourism.

Crickets can be louder than traffic. A trend of retirees leaving the suburbs for small town and country life--a move that demographers call "out-migration"--was underway before the economic downturn. It held up relatively well during that period, although was slowed somewhat by weak home-selling markets that kept retirees and soon-to-be retirees in their existing homes. But with the number of baby boomers exiting the workforce, it's a trend that looks to continue.

[See the 10 Sunniest Places to Retire.]

USDA data show a "deconcentration" of population near metro centers. Urban areas will see a net loss of people age 55 to 75, while in non-metro areas, that age group will increase by 1.6 million nationally during the next 10 years.

Remember the Alpaca farm craze a few years back? Turning into a rancher overnight isn't for everyone. Luckily, there are dozens of ways to extend your "career" in the country. If remote life isn't quite your aim, small-town retirement hubs may allow for a service-focused second career--think restaurant or real estate office proprietor, or perhaps hanging out a tax-preparation shingle after a long accounting career at a Fortune 500 company.

Many retirees want land they can develop or recreate, at least partially, for their own residential or hobby use. A land purchase can be a wise "mini step" toward retirement: Buy the land while still working in a populous setting, rent it out, move there eventually, says Duffy.

Prime school districts may no longer top the list of real estate must-haves, but retirees want a certain level of service and cultural amenities, whether they're in population centers or not. This need may help drive their decision-making. Plus, there are potentially heavy maintenance costs and overall land management responsibilities that may turn off some buyers. An acreage is a big purchase, one that requires a considerable amount of due diligence. (Real estate firms are increasingly getting into the land-management business, so property owners can pay for help.)

Curtis Seltzer, a rural land investor and author of How to Be a Dirt-Smart Buyer of Country Property, says rural buying should start at the ground up, literally, with a focus on dirt. "Most buyers from the city and suburbs, including me, focus first and almost exclusively on the country house, whether existing or planned," writes Seltzer. "This comes at the expense of paying attention to the dirt on which the house stands and which surrounds it. We do this, I think, because all of us have a passing familiarity with houses. So we evaluate country property in terms of what we know rather than what we don't."

[See 10 Places to Buy a Retirement Home for Under $100,000.]

Seltzer offers these tips:

-- Look first at how the land lays--its topography. Which direction do its slopes face? How steep are they? If the land is flat, will it drain quickly or hold water because the subsurface contains a lot of clay? The surface vegetation and the feel of the dirt in your hands will give you an initial reading. Topographically interesting land is usually more interesting to spend time on, but it's also more expensive to work with and much harder to work against.

-- Second, look at your soils. Different soils have different characteristics and capabilities which will determine what you can do with your property at a reasonable cost. Your first stop in scoping property is to pick up a copy of the county's Soil Survey at the local U.S. Department of Agriculture office. County-level aerial maps and soil-survey information are available for some states and counties, and can be found at soils.usda.gov/survey.

-- Third, look at the location of your dirt. Will it be hard to get to in bad weather? Is it subject to flooding, earthquakes, mudslides, windstorms, fires, and prevailing weather? If you have shoreline, is the land low (bad) or high (good)? Is the shoreline eroding? Is the land facing in the right compass direction for your plans?

-- Finally, look at your dirt in terms of proximity to local goods and bads--hospital, fire station, public water and sewerage, rescue squad, floodplain, job opportunities, and distance from your current residence, post office, bank, supermarket, and objectionable facilities--however you care to define them.

Trending now. United Country's Duffy says rural destinations in the Mid-Atlantic are drawing rising interest for their temperate climate, mix of mountains and shoreline, and reasonable distance to centers such as Washington, D.C. This way, retirees may maintain consulting positions and ease into their retirement. One micro-trend is what he terms the "half-backers." It's a population that spent their working years in the Northeast, then retired to Florida, but are now finding unattractive pricing (or lack of housing or elbow room there) and are moving halfway back to the Northeast.

Duffy says "small" ranches of a few hundred acres in Texas are popular searches on his firm's website. He also notes increasing migration from California to the "unspoiled" and less-expensive mountain retreats of Colorado, Montana, and Idaho.

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Keeping Cartier contemporary: the jewelry house discusses modern art, mass market collaborations and the revival of classics

Ahead of the launch of Cartier, Jeweler of the Arts, the latest expo from Cartier's art museum the Fondation Cartier, which begins April 3 in Paris, Relaxnews met up with Cartier Europe's managing director Cyrille Vigneron to discuss how a prestigious maison stays ahead in an ever evolving luxury market.

Relaxnews: Cartier, Jeweler of the Arts brings together four artworks commissioned by Cartier and made by four very different artists (David Lynch, Takeshi Kitano, Alessandro Mendini, Beatriz Milhazes) using precious and semi-precious stones no longer deemed suitable for the brand's jewelry. What makes a luxury house decide to team up with contemporary artists?

Cyrille Vigneron: The artists can see what others don't see in terms of trends, arts, design, all forms of expression. They see a different way to represent the world and the foundation doesn't think about what Cartier is doing -- it just thinks about the art world. The Fondation won't become a design studio for Cartier products. Some other brands are doing that, calling artists or designers and saying 'sign our products' or making something that is co-branded. I won't say who but you can easily see. It becomes a hybrid which has some value but it changes the orientation and perception. A brand should be true to its own creative past, its own patrimony, and the designer should serve that as a purpose. When it comes to a designer working for himself it's something different.

RN: The Fondation Cartier is known for championing emerging contemporary artists from across the globe, but where does Cartier stand on rising US jewelry designers such as Alexis Bittar and Pamela Love? Do you feel a challenge to compete or consider them separate?

CV: For jewelry I say the more players the better. Having more famous designers gets people interested and creates stimulation and diversity. But each has to find its own style. For example, Hermès is moving into it and exploring its own way with the famous Hermès handbags being transformed into jewelry for the luxury market. This is something exploratory, something no one has done before. As long as we have many designers doing something genuine it's fine, when a designer starts to copy another one that's not fine.

RN: Cartier was one of the main luxury jewelers in the limelight following last year's Elizabeth Taylor jewelry auction, and some of the opulent designs inspired by the star's collection have been reinterpreted on a mass scale. What is your take on this?

CV: When you are copied it means that you're interesting, but if some brands just come and copy others without making any innovation or developments then it's counterfeit. You should respect others. If you just say, "We'll copy this and make it cheaper and it will be fine," it's just disgusting. But if you really go further and try something new and I'll find clients for that then it's great, then it stimulates everyone's creativity and inspires us to do things better.

RN: So would Cartier ever collaborate with a more affordable brand?

CV: No, never. There can be room for premium jewelry or costume jewelry; it can all be something interesting as far it is what it is. Then there is fine jewelry, then there is high jewelry and it's a different world. We can have simple designs; for example the trinity ring is very simple, a wedding band is a wedding band -- simple, straight, symbolic -- we're happy to do it.  But a lower end collaboration to diffuse via a mass production -- never. Projects such as the recent Cartier Odyssey movie make Cartier universal. Whether you intend to buy or not doesn't matter.

RN: How does Cartier maintain a balance between keeping traditional clients happy and attracting new ones?

CV: The maison has a stature and has been endorsed by really famous people from past and present: Liz Taylor, the Duchess of Windsor, Grace Kelly. But this can only continue if our contemporary creations are rejuvenated. Now the most demanded pieces come from the Tutti Frutti collection, each of them is new but has been inspired by the 1920s. We can make new ones out of the same inspired style and then have something really daring and new in terms of shape and style and ways to wear. Classics are the kind of designer pieces or products which can talk to anyone at anytime -- a design that has been outstanding whether made in the 1930s or 1970s or this generation. That's why collections go through generations; whether it's a trinity ring or a love bracelet. At some point they were daring and then they become classic because someone wears them. Our creations are constantly kept alive, adding new variants to the same model but also keeping the initial model alive itself and that's why we have many variants on the Tank watch collection or the trinity collection.

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