Another Look at a Drink Ingredient, Brominated Vegetable Oil

James Edward Bates for The New York Times

Sarah Kavanagh, 15, of Hattiesburg, Miss., started an online petition asking PepsiCo to change Gatorade’s formula.

Sarah Kavanagh and her little brother were looking forward to the bottles of Gatorade they had put in the refrigerator after playing outdoors one hot, humid afternoon last month in Hattiesburg, Miss.

But before she took a sip, Sarah, a dedicated vegetarian, did what she often does and checked the label to make sure no animal products were in the drink. One ingredient, brominated vegetable oil, caught her eye.

“I knew it probably wasn’t from an animal because it had vegetable in the name, but I still wanted to know what it was, so I Googled it,” Ms. Kavanagh said. “A page popped up with a long list of possible side effects, including neurological disorders and altered thyroid hormones. I didn’t expect that.”

She threw the product away and started a petition on Change.org, a nonprofit Web site, that has almost 200,000 signatures. Ms. Kavanagh, 15, hopes her campaign will persuade PepsiCo, Gatorade’s maker, to consider changing the drink’s formulation.

Jeff Dahncke, a spokesman for PepsiCo, noted that brominated vegetable oil had been deemed safe for consumption by federal regulators. “As standard practice, we constantly evaluate our formulas and ingredients to ensure they comply with federal regulations and meet the high quality standards our consumers and athletes expect — from functionality to great taste,” he said in an e-mail.

In fact, about 10 percent of drinks sold in the United States contain brominated vegetable oil, including Mountain Dew, also made by PepsiCo; Powerade, Fanta Orange and Fresca from Coca-Cola; and Squirt and Sunkist Peach Soda, made by the Dr Pepper Snapple Group.

The ingredient is added often to citrus drinks to help keep the fruit flavoring evenly distributed; without it, the flavoring would separate.

Use of the substance in the United States has been debated for more than three decades, so Ms. Kavanagh’s campaign most likely is quixotic. But the European Union has long banned the substance from foods, requiring use of other ingredients. Japan recently moved to do the same.

“B.V.O. is banned other places in the world, so these companies already have a replacement for it,” Ms. Kavanagh said. “I don’t see why they don’t just make the switch.” To that, companies say the switch would be too costly.

The renewed debate, which has brought attention to the arcane world of additive regulation, comes as consumers show increasing interest in food ingredients and have new tools to learn about them. Walmart’s app, for instance, allows access to lists of ingredients in foods in its stores.

Brominated vegetable oil contains bromine, the element found in brominated flame retardants, used in things like upholstered furniture and children’s products. Research has found brominate flame retardants building up in the body and breast milk, and animal and some human studies have linked them to neurological impairment, reduced fertility, changes in thyroid hormones and puberty at an earlier age.

Limited studies of the effects of brominated vegetable oil in animals and in humans found buildups of bromine in fatty tissues. Rats that ingested large quantities of the substance in their diets developed heart lesions.

Its use in foods dates to the 1930s, well before Congress amended the Food, Drug and Cosmetic Act to add regulation of new food additives to the responsibilities of the Food and Drug Administration. But Congress exempted two groups of additives, those already sanctioned by the F.D.A. or the Department of Agriculture, or those experts deemed “generally recognized as safe.”

The second exemption created what Tom Neltner, director of the Pew Charitable Trusts’ food additives project, a three-year investigation into how food additives are regulated, calls “the loophole that swallowed the law.” A company can create a new additive, publish safety data about it on its Web site and pay a law firm or consulting firm to vet it to establish it as “generally recognized as safe” — without ever notifying the F.D.A., Mr. Neltner said.

Read More..

Another Look at a Drink Ingredient, Brominated Vegetable Oil

James Edward Bates for The New York Times

Sarah Kavanagh, 15, of Hattiesburg, Miss., started an online petition asking PepsiCo to change Gatorade’s formula.

Sarah Kavanagh and her little brother were looking forward to the bottles of Gatorade they had put in the refrigerator after playing outdoors one hot, humid afternoon last month in Hattiesburg, Miss.

But before she took a sip, Sarah, a dedicated vegetarian, did what she often does and checked the label to make sure no animal products were in the drink. One ingredient, brominated vegetable oil, caught her eye.

“I knew it probably wasn’t from an animal because it had vegetable in the name, but I still wanted to know what it was, so I Googled it,” Ms. Kavanagh said. “A page popped up with a long list of possible side effects, including neurological disorders and altered thyroid hormones. I didn’t expect that.”

She threw the product away and started a petition on Change.org, a nonprofit Web site, that has almost 200,000 signatures. Ms. Kavanagh, 15, hopes her campaign will persuade PepsiCo, Gatorade’s maker, to consider changing the drink’s formulation.

Jeff Dahncke, a spokesman for PepsiCo, noted that brominated vegetable oil had been deemed safe for consumption by federal regulators. “As standard practice, we constantly evaluate our formulas and ingredients to ensure they comply with federal regulations and meet the high quality standards our consumers and athletes expect — from functionality to great taste,” he said in an e-mail.

In fact, about 10 percent of drinks sold in the United States contain brominated vegetable oil, including Mountain Dew, also made by PepsiCo; Powerade, Fanta Orange and Fresca from Coca-Cola; and Squirt and Sunkist Peach Soda, made by the Dr Pepper Snapple Group.

The ingredient is added often to citrus drinks to help keep the fruit flavoring evenly distributed; without it, the flavoring would separate.

Use of the substance in the United States has been debated for more than three decades, so Ms. Kavanagh’s campaign most likely is quixotic. But the European Union has long banned the substance from foods, requiring use of other ingredients. Japan recently moved to do the same.

“B.V.O. is banned other places in the world, so these companies already have a replacement for it,” Ms. Kavanagh said. “I don’t see why they don’t just make the switch.” To that, companies say the switch would be too costly.

The renewed debate, which has brought attention to the arcane world of additive regulation, comes as consumers show increasing interest in food ingredients and have new tools to learn about them. Walmart’s app, for instance, allows access to lists of ingredients in foods in its stores.

Brominated vegetable oil contains bromine, the element found in brominated flame retardants, used in things like upholstered furniture and children’s products. Research has found brominate flame retardants building up in the body and breast milk, and animal and some human studies have linked them to neurological impairment, reduced fertility, changes in thyroid hormones and puberty at an earlier age.

Limited studies of the effects of brominated vegetable oil in animals and in humans found buildups of bromine in fatty tissues. Rats that ingested large quantities of the substance in their diets developed heart lesions.

Its use in foods dates to the 1930s, well before Congress amended the Food, Drug and Cosmetic Act to add regulation of new food additives to the responsibilities of the Food and Drug Administration. But Congress exempted two groups of additives, those already sanctioned by the F.D.A. or the Department of Agriculture, or those experts deemed “generally recognized as safe.”

The second exemption created what Tom Neltner, director of the Pew Charitable Trusts’ food additives project, a three-year investigation into how food additives are regulated, calls “the loophole that swallowed the law.” A company can create a new additive, publish safety data about it on its Web site and pay a law firm or consulting firm to vet it to establish it as “generally recognized as safe” — without ever notifying the F.D.A., Mr. Neltner said.

Read More..

State of the Art: Google Maps App for iPhone Goes in the Right Direction - Review

It was one of the biggest tech headlines of the year: in September, Apple dropped its contract with Google, which had always supplied the data for the iPhone’s Maps app. For various strategic reasons, Apple preferred to write a new app, based on a new database of the world that Apple intended to assemble itself.

As everybody knows by now, Apple got lost along the way. It was like a 22-car pileup. Timothy Cook, Apple’s chief executive, made a quick turn, publicly apologizing, firing the executive responsible and vowing to fix Maps. For a company that prides itself on flawless execution, it was quite a detour.

Rumors swirled that Google would create an iPhone app of its own, one that would use its seven-year-old, far more polished database of the world.

That was true. Today, Google Maps for the iPhone has arrived. It’s free, fast and fantastic.

Now, there are two parts to a great maps app. There’s the app itself — how it looks, how it works, what the features are. In this regard, few people complain about Apple’s Maps app; it’s beautiful, and its navigation mode for drivers is clear, uncluttered and distraction-free.

But then there’s the hard part: the underlying data. Apple and Google have each constructed staggeringly complex databases of the world and its roads.

The recipe for both companies includes map data from TomTom, satellite photography from a different source, real-time traffic data from others, restaurant and store listings from still more sources, and so on. In the end, Apple says that it incorporated data from at least 24 different sources.

Those sources always include errors, if only because the world constantly changes. Worse, those sources sometimes disagree with one another. It takes years to fix the problems and mesh these data sources together.

So the first great thing about Google’s new Maps is the underlying data. Hundreds of Google employees have spent years hand-editing the maps, fixing the thousands of errors that people report every day. (In the new app, you report a mistake just by shaking the phone.) And since 2006, Google’s Street View vehicles have trawled 3,000 cities, photographing and confirming the cartographical accuracy of five million miles of roads.

You can sense the new app’s polish and intelligence the minute you enter your first address; it’s infinitely more understanding. When I type “200 W 79, NYC,” Google Maps drops a pin right where it belongs: on the Upper West Side of Manhattan.

Apple’s Maps app, on the other hand, acts positively drunk. It asks me to clarify: “Did you mean 200 Durham Road, Madison, CT? Or 200 Madison Road, Durham, CT?”

Um, what?

And then there’s the navigation. Lots of iPhone owners report that they’ve had no problem with Apple’s driving instructions, and that’s great. But I’ve been idiotically misdirected a few times — and the trouble is, you never know in advance. You wind up with a deep mistrust of the app that’s hard to shake. Google’s directions weren’t great in the app’s early days either, and they’re still not always perfect. But after years of polishing and corrections, they’re right a lot more often.

The must-have features are all here: spoken driving directions, color-coded real-time traffic conditions, vector-based maps (smooth at any size). But the new app also offers some incredibly powerful, useful features that Apple’s app lacks.

Street View, of course, lets you see a photograph of a place, and even “walk” down the street in any direction. Great for checking out a neighborhood before you go, scoping out the parking situation or playing “you are there” when you read a news article.

Along with driving directions, Google Maps gives equal emphasis to walking directions and public transportation options.

This feature is brilliantly done. Google Maps displays a clean, step-by-step timeline of your entire public transportation adventure. If you ask for a route from Westport, Conn., to the Empire State Building, the timeline says: “4:27 pm, Board New Haven train toward Grand Central Terminal.” Then it shows you the names of the actual train stops you’ll pass. Then, “5:47 pm, Grand Central. Get off and walk 2 min.” Then, “5:57 pm, 33rd St: Board the #6 Lexington Avenue Local towards Brooklyn Bridge.” And so on.

Even if public transportation were all it did, Google Maps would be one of the best apps ever. (Apple kicks you over to other companies’ apps for this information.)

E-mail: pogue@nytimes.com

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John Silva, Maker of ‘Telecopter’ Camera, Dies at 92

Helicopter news footage is common today. But until myriad problems in sending live pictures from a moving aircraft were solved, television broadcasters could not show an eagle’s-eye view of a forest fire, or contemplate aerial coverage of, say, a famous man fleeing the police in a white Ford Bronco.

John Silva made that now-familiar vantage possible in 1958, when he converted a small helicopter into the first airborne virtual television studio.

The KTLA “Telecopter,” as it was called by the Los Angeles station where Mr. Silva was the chief engineer, became the basic tool of live television traffic reporting, disaster coverage and that most famous glued-to-the-tube moment in the modern era of celebrity-gawking, the 1994 broadcast of O. J. Simpson leading a motorcade of pursuers on Los Angeles freeways after his former wife and a friend of hers were killed.

Mr. Silva, who later earned two Emmy Awards for his pioneering technical work, died in Camarillo, Calif., on Nov. 27. His death was confirmed by a spokesman for KTLA-TV, where he worked from 1946 until leaving to become an electronics design consultant in 1978. He was 92.

Mr. Silva, an electronics engineer trained in radar science during World War II, faced three main roadblocks to transmitting black-and-white images live from helicopters. Rotor vibrations distorted the pictures, and sometimes even cracked the transmitter’s vacuum tubes. Directional antennas went haywire when helicopters changed direction suddenly, as helicopters sometimes do. And the camera equipment weighed a ton.

With help from fellow KTLA engineers, though mainly working alone to keep the project secret from competitors, Mr. Silva stabilized onboard cameras with a system of shock absorbers and cushions, designed aluminum parts to replace heavier metals in his equipment and commissioned an antenna that would extend below the chopper and rotate to maintain uninterrupted contact with KTLA’s mountaintop transmitter. By paring and remachining a basic set of broadcast equipment, he reduced it to 368 pounds from 2,000 pounds and distributed the load with precise symmetry throughout the tiny Bell 47G2 chopper leased for the project to prevent listing.

KTLA, the first commercially licensed television station west of the Rockies, faced growing competition in the late ’50s. New network-affiliated stations were scoring scoops with mobile broadcast units like ones Mr. Silva had pioneered, and everyone was fighting to get through increasingly clogged Los Angeles freeways.

The Telecopter was intended to kill the competition.

“If we could build a news mobile unit in a helicopter,” Mr. Silva recalled in a 2002 interview for the Archive of American Television, “we could get over it all, get there first, avoid the traffic and get to all the stories before anybody in the competition.”

“It’d be a wonderful thing,” he said.

By the time he began work on his airborne live television, Mr. Silva had already achieved a landmark in ground-level television history. In 1949, he was the technical director at KTLA who rigged the electronic connections — using duct-tape ingenuity and a borrowed generator — that carried what historians consider the first live television broadcast of a breaking news event.

The 27-hour rescue operation in San Marino, Calif., to save Kathy Fiscus, a 3-year-old trapped in an abandoned water pipe 94 feet below ground, was unsuccessful; but the station’s coverage was the precursor to every wall-to-wall television event broadcast since.

The Telecopter’s first flight took place at Los Angeles City Hall on July 24, 1958. It re-established KTLA’s dominance (until competitors put their own helicopters up). And for better and worse, it brought a Hollywood-style excitement to television news.

In the archive interview, Mr. Silva was asked what the first live helicopter pictures showed. They were panning shots, he said — zooming in and out of the L.A. landscape between the station’s Sunset Boulevard studio and City Hall.

Most of what they showed, he added, “was the freeway.”

John Daniel Silva was born in San Diego on Feb. 20, 1920, the youngest of three children of a commercial fisherman, Guy Silva, and his wife, Lottie, a homemaker. He attended M.I.T. for two years, and graduated with a bachelor’s degree after two years more at Stanford.

During World War II, he was a Naval officer who positioned radar defenses in the Pacific.

After the war, he worked for Paramount Pictures as an engineer for an experimental television station, W6XYZ, that later became KTLA.

Mr. Silva’s survivors include his wife, Mary Lou Steinkraus-Silva; three daughters, Patricia Vawter, Kathleen Silva and Karen Samaha; and a granddaughter.

The Telecopter had its greatest moments, predictably, at news events of Cecil B. DeMille dimensions: The 1963 dam break at the Baldwin Hills Reservoir in Los Angeles that sent 250 million gallons of water into surrounding neighborhoods, destroying many homes and claiming five lives. The 1965 Watts riots. The 1961 brush fire that swept through Bel Air, sending Hollywood stars scrambling to their roofs with garden hoses.

In his three-hour interview with the television archive, Mr. Silva never mentioned the 1994 O. J. Simpson freeway pursuit footage he made possible. But in answering a question about the future of helicopter reporting, he made clear that he had no regrets about the Telecopter’s role in creating an increasingly graphic television sensibility.

He would just like the lenses to get longer and the close-ups tighter, he said.

“When they’re doing freeway chases, they need to have a system that can come down in front, and be able to get pictures of suspects in the front windshield,” he said, describing one improvement he hoped to see.

Smiling, he added, “To fill the screen with their wonderful faces.”

Read More..

Mind: A Compromise on Defining and Diagnosing Mental Disorders

They plotted a revolution, fell to debating among themselves, and in the end overturned very little except their own expectations.

But the effort itself was a valuable guide for anyone who has received a psychiatric diagnosis, or anyone who might get one.

This month, the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual — the so-called bible of mental disorders — ending more than five years of sometimes acrimonious, and often very public, controversy.

The committee of doctors appointed by the psychiatric association had attempted to execute a paradigm shift, changing how mental disorders are conceived and posting its proposals online for the public to comment. And comment it did: Patient advocacy groups sounded off, objecting to proposed changes in the definitions of depression and Asperger syndrome, among other diagnoses. Outside academic researchers did, too. A few committee members quit in protest.

The final text, which won’t be fully available until publication this spring, has already gotten predictably mixed reviews. “Given the challenges in a field where objective lines are hard to draw, they did a solid job,” said Dr. Michael First, a psychiatrist at Columbia who edited a previous version of the manual and was a consultant on this one.

Others disagreed. “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry,” wrote Dr. Allen Frances, the chairman of a previous committee who has been one of the most vocal critics, in a blog post about the new manual, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM5.

Yet many experts inside and outside the process said the final document was not radically different from the previous version, and its lessons more mundane than the rhetoric implied. The status quo is hard to budge, for one. And when changes do happen, they are not necessarily the ones that were intended.

The new manual does extend the reach of psychiatry in some areas, as many critics feared it might. Hoarding is now a mental disorder (previously it was considered a symptom of obsessive-compulsive behavior). “Premenstrual dysphoric disorder,” a severe form of premenstrual syndrome, is also new (it was previously in the appendix).

And binge-eating disorder (also formerly in the appendix), a kind of severe, highly distressing gluttony, is now a full-blown diagnosis. This one by itself could tag millions of people considered healthy, if often overindulgent, with a psychiatric label, some experts said.

But the deeper story is one of compromise. It is most evident in how the committee handled three of the thorniest diagnoses in psychiatry: autism, depression and pediatric bipolar disorder.

The group working on depression declared early on that it wanted to eliminate the so-called bereavement exclusion, which stated that grieving the loss of a loved one should not be considered a clinical disorder, though it shares many of the same outward signs. Grief has always been a normal reaction to death, not a kind of depression.

Advocacy and support groups, such as those representing people who have lost a child, objected furiously to the idea that the bereaved might be given a diagnosis of depression.

“This was just astonishing, that they would eliminate the exclusion, and a distortion of the research on the subject,” said Jerome Wakefield, a professor of social work and psychiatry at New York University, who did not work on the manual.

In the end the committee cut a deal. It eliminated the grief exclusion but added a note in the text, reminding doctors that any significant loss — of a job, a relationship, a home — could cause depressive symptoms and should be carefully investigated.

“It’s like they took it all back,” Dr. Wakefield said. “I don’t like the way it was done — in a footnote — but it’s there.”

The debate over autism was even more furious, and it resulted in a similar rapprochement.

From the outset, the committee intended to tighten the definition of autism and simplify it, eliminating related labels like Asperger syndrome and “pervasive developmental disorder not otherwise specified,” or PDD-NOS. The rate of diagnosis of such conditions has exploded over the past decade, in part due to the vagueness of the definitions, and the committee wanted to draw clearer boundaries.

It proposed a single “autism spectrum disorder” category, with stricter requirements.

Some outside researchers raised concerns. In January one of them, Dr. Fred Volkmar of the Yale School of Medicine, who had quit the committee in protest, presented research suggesting that 45 percent or more of people who currently had an autism or related diagnosis would not have one under the proposed revision.

Autism groups reacted immediately, fearing that the change in the diagnosis would deny services to children and families who need them.

The committee countered with its own study, suggesting that the new definition would exclude about 10 percent of people currently with a diagnosis. And again, the experts took a half step back.

The new, streamlined definition was approved, but with language that took into account a person’s diagnostic history. “It’s explicit that anyone who’s had an Asperger’s or autism or PDD-NOS diagnosis before is now included,” said Catherine Lord, a committee member who worked on the new definition and who is director of the Center for Autism and the Developing Brain in New York. “Essentially everyone gets in.”

Pediatric bipolar disorder posed a different challenge.

In the 1990s and 2000s, psychiatrists began giving aggressive, explosive children a diagnosis of bipolar disorder in increasing numbers. The trend appalled many patient advocates and doctors.

Bipolar disorder, which is characterized by episodes of depression and mania, had previously been an adult problem; now the diagnosis is given to children as young as 2 — along with powerful psychiatric drugs and tranquilizers that also cause rapid weight gain. The committee wanted to stop the trend in its tracks, said experts who were involved.

Most of the children treated for bipolar disorder did not have it, recent research found. The committee settled on an alternative label: “disruptive mood dysregulation disorder,” or D.M.D.D., which describes extreme hostility and outbursts beyond normal tantrums.

“They essentially wanted to have some place for these kids, and D.M.D.D. was all they had in their kit,” said Dr. Gabrielle Carlson, a child psychiatrist at Stony Brook University Medical Center, who provided some outside consultation. “These are mostly kids who have A.D.H.D. or what we would call oppositional defiant disorder, but with this explosive feature. They need help; you can’t wait forever. The question was what to call it, without pretending we know enough to saddle them with a lifelong diagnosis” like bipolar disorder.

D.M.D.D. has its own problems, as many experts were quick to point out. It could be a symptom of an underlying condition, as Dr. Carlson argues. It could “medicalize” frequent temper tantrums. It’s brand new, and no one knows how it will play out in practice.

But it is now in the book — because it was the best solution available, experts inside and outside of the revision process said.

From beginning to end, many experts said, the process of defining psychiatric diagnoses is very much like finding the right one for an individual: it’s a process of negotiation, in many cases.

“That’s one of the take-aways from all this, and I think it’s a good one,” Dr. Carlson said. “A diagnosis is a hypothesis. It’s a start, and you have to start somewhere. But that’s all it is.”

One of the committee’s most ambitious proposals was perhaps the least noticed: a commitment to update the book continually, when there’s good reason to, rather than once every decade or so in a giant heave. That was approved without much fanfare.

Read More..

Mind: A Compromise on Defining and Diagnosing Mental Disorders

They plotted a revolution, fell to debating among themselves, and in the end overturned very little except their own expectations.

But the effort itself was a valuable guide for anyone who has received a psychiatric diagnosis, or anyone who might get one.

This month, the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual — the so-called bible of mental disorders — ending more than five years of sometimes acrimonious, and often very public, controversy.

The committee of doctors appointed by the psychiatric association had attempted to execute a paradigm shift, changing how mental disorders are conceived and posting its proposals online for the public to comment. And comment it did: Patient advocacy groups sounded off, objecting to proposed changes in the definitions of depression and Asperger syndrome, among other diagnoses. Outside academic researchers did, too. A few committee members quit in protest.

The final text, which won’t be fully available until publication this spring, has already gotten predictably mixed reviews. “Given the challenges in a field where objective lines are hard to draw, they did a solid job,” said Dr. Michael First, a psychiatrist at Columbia who edited a previous version of the manual and was a consultant on this one.

Others disagreed. “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry,” wrote Dr. Allen Frances, the chairman of a previous committee who has been one of the most vocal critics, in a blog post about the new manual, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM5.

Yet many experts inside and outside the process said the final document was not radically different from the previous version, and its lessons more mundane than the rhetoric implied. The status quo is hard to budge, for one. And when changes do happen, they are not necessarily the ones that were intended.

The new manual does extend the reach of psychiatry in some areas, as many critics feared it might. Hoarding is now a mental disorder (previously it was considered a symptom of obsessive-compulsive behavior). “Premenstrual dysphoric disorder,” a severe form of premenstrual syndrome, is also new (it was previously in the appendix).

And binge-eating disorder (also formerly in the appendix), a kind of severe, highly distressing gluttony, is now a full-blown diagnosis. This one by itself could tag millions of people considered healthy, if often overindulgent, with a psychiatric label, some experts said.

But the deeper story is one of compromise. It is most evident in how the committee handled three of the thorniest diagnoses in psychiatry: autism, depression and pediatric bipolar disorder.

The group working on depression declared early on that it wanted to eliminate the so-called bereavement exclusion, which stated that grieving the loss of a loved one should not be considered a clinical disorder, though it shares many of the same outward signs. Grief has always been a normal reaction to death, not a kind of depression.

Advocacy and support groups, such as those representing people who have lost a child, objected furiously to the idea that the bereaved might be given a diagnosis of depression.

“This was just astonishing, that they would eliminate the exclusion, and a distortion of the research on the subject,” said Jerome Wakefield, a professor of social work and psychiatry at New York University, who did not work on the manual.

In the end the committee cut a deal. It eliminated the grief exclusion but added a note in the text, reminding doctors that any significant loss — of a job, a relationship, a home — could cause depressive symptoms and should be carefully investigated.

“It’s like they took it all back,” Dr. Wakefield said. “I don’t like the way it was done — in a footnote — but it’s there.”

The debate over autism was even more furious, and it resulted in a similar rapprochement.

From the outset, the committee intended to tighten the definition of autism and simplify it, eliminating related labels like Asperger syndrome and “pervasive developmental disorder not otherwise specified,” or PDD-NOS. The rate of diagnosis of such conditions has exploded over the past decade, in part due to the vagueness of the definitions, and the committee wanted to draw clearer boundaries.

It proposed a single “autism spectrum disorder” category, with stricter requirements.

Some outside researchers raised concerns. In January one of them, Dr. Fred Volkmar of the Yale School of Medicine, who had quit the committee in protest, presented research suggesting that 45 percent or more of people who currently had an autism or related diagnosis would not have one under the proposed revision.

Autism groups reacted immediately, fearing that the change in the diagnosis would deny services to children and families who need them.

The committee countered with its own study, suggesting that the new definition would exclude about 10 percent of people currently with a diagnosis. And again, the experts took a half step back.

The new, streamlined definition was approved, but with language that took into account a person’s diagnostic history. “It’s explicit that anyone who’s had an Asperger’s or autism or PDD-NOS diagnosis before is now included,” said Catherine Lord, a committee member who worked on the new definition and who is director of the Center for Autism and the Developing Brain in New York. “Essentially everyone gets in.”

Pediatric bipolar disorder posed a different challenge.

In the 1990s and 2000s, psychiatrists began giving aggressive, explosive children a diagnosis of bipolar disorder in increasing numbers. The trend appalled many patient advocates and doctors.

Bipolar disorder, which is characterized by episodes of depression and mania, had previously been an adult problem; now the diagnosis is given to children as young as 2 — along with powerful psychiatric drugs and tranquilizers that also cause rapid weight gain. The committee wanted to stop the trend in its tracks, said experts who were involved.

Most of the children treated for bipolar disorder did not have it, recent research found. The committee settled on an alternative label: “disruptive mood dysregulation disorder,” or D.M.D.D., which describes extreme hostility and outbursts beyond normal tantrums.

“They essentially wanted to have some place for these kids, and D.M.D.D. was all they had in their kit,” said Dr. Gabrielle Carlson, a child psychiatrist at Stony Brook University Medical Center, who provided some outside consultation. “These are mostly kids who have A.D.H.D. or what we would call oppositional defiant disorder, but with this explosive feature. They need help; you can’t wait forever. The question was what to call it, without pretending we know enough to saddle them with a lifelong diagnosis” like bipolar disorder.

D.M.D.D. has its own problems, as many experts were quick to point out. It could be a symptom of an underlying condition, as Dr. Carlson argues. It could “medicalize” frequent temper tantrums. It’s brand new, and no one knows how it will play out in practice.

But it is now in the book — because it was the best solution available, experts inside and outside of the revision process said.

From beginning to end, many experts said, the process of defining psychiatric diagnoses is very much like finding the right one for an individual: it’s a process of negotiation, in many cases.

“That’s one of the take-aways from all this, and I think it’s a good one,” Dr. Carlson said. “A diagnosis is a hypothesis. It’s a start, and you have to start somewhere. But that’s all it is.”

One of the committee’s most ambitious proposals was perhaps the least noticed: a commitment to update the book continually, when there’s good reason to, rather than once every decade or so in a giant heave. That was approved without much fanfare.

Read More..

Moroccans Fear That Flickers of Democracy Are Fading

TANGIER, Morocco — Until recently, politics in Morocco involved red carpets and speeches in high Arabic that the average citizen could not understand. But on a campaign swing this fall through a working-class area of this port city, Prime Minister Abdelilah Benkirane stood on a makeshift podium in a muddy vacant lot.

He spoke without notes, kissed babies passed forward by the crowd and promised, as he has done all along, to fight corruption and return the government to the people.

“We will get stronger with the help of God and accomplish what we wanted,” he told the crowd, which roared its approval.

But more and more Moroccans are questioning his ability to do that, wondering whether Morocco’s version of the Arab Spring brought anything more than cosmetic changes to this impoverished country, which has been one of America’s most stable and staunch allies in a region marked by turmoil.

A year ago, it seemed Moroccans were giddy with the sense that they had found a gentle, negotiated answer to the popular uprisings in the streets. The country’s king, Mohammed VI, 49, defused angry protesters by volunteering to share his power. Within months, Morocco had a new Constitution.

Mr. Benkirane’s moderate Islamist party, the Justice and Development Party, won a plurality in parliamentary elections in November. Western governments heaped praise on the election process, satisfied that this strategically important country, just 12 miles south of Spain and atop a changing and uncertain continent, was settling in to a new more democratic order. (This week Secretary of State Hillary Rodham Clinton is scheduled to visit Morocco for a meeting of the Friends of Syria.)

But these days, many here are questioning whether the king and his entourage really gave up anything at all. Telquel, perhaps the country’s most influential magazine, ran a cover story this fall saying that the palace had gradually taken back its concessions: the king’s shadow cabinet was interfering at will and was even sending its own emissaries to the United States and Brussels when Moroccan interests needed tending to. Mr. Benkirane, the magazine pointed out, had publicly admitted that the king’s advisers sometimes met with government officials without consulting him.

Some also point to a quiet clamping down on political activists. In October, the United Nations said there was evidence of a recent spike in reports of torture in Morocco. About 70 protesters associated with the pro-democracy February 20 Movement are still in prison. In May, a popular rapper was sentenced to a year in jail for a song about police corruption. And six political activists testified at a hearing in September that they had been physically — and sexually — abused after being arrested for protesting in July.

In other countries rocked by Arab Spring uprisings, tensions today are being felt largely over the role of Islam in government. These issues have come up in Morocco, too. But here, the larger tensions appear to be over the power of the old guard. Many Moroccans will not criticize the king, instead focusing on the network of power and privilege that surrounds him and the corruption that they believe sucks any hope of prosperity from this country.

The problems Morocco faces are enormous. The country has invested heavily in infrastructure: superhighways are everywhere and there are plans for a high-speed train, too. But 40 percent of the population cannot read or write. Forbes has estimated the king’s fortune to be more than $2 billion. But the average income here is low, roughly half of what it was in Tunisia, where the Arab Spring first took off.

Mr. Benkirane took office showing a flare for the dramatic. He quickly slashed ministerial salaries and perquisites, and he refused to move to the prime minister’s mansion. He also took on Morocco’s notorious cronyism. To widespread amazement, his government published the names of those who had been given lucrative bus licenses. Since then, however, his efforts have foundered.

Some critics say the prime minister has been outmaneuvered at every turn. Once last spring, Mr. Benkirane seemed to lash out at the king and his entourage, suggesting that protesters could easily return to the streets. But soon after, he said the remarks had been misunderstood.

Aida Alami contributed reporting.

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Many Mobile Apps for Children Fall Short on Disclosure to Parents, F.T.C. Report Says

Hundreds of mobile apps for children fail to provide parents with basic information on the kinds of sensitive information the apps collect and share about their children, said a new federal report Monday.

Only 20 percent of children’s apps provided disclosures about their data collection practices, according to a staff report from the Federal Trade Commission released on Monday. The apps that did offer disclosures often provided links to long, dense, technical privacy policies “filled with irrelevant information,” according to the report. Other apps, it said, gave misleading information about their practices.

The agency’s study examined the privacy policies of 400 popular children’s apps — half of them available through the Apple App Store and the other half through Google’s Android Market — and compared the apps’ disclosures to their actual data collection practices.

“Most apps failed to provide any information about the data collected through the app, let alone the type of data collected, the purpose of the collection, and who would obtain access to the data,” the F.T.C. report said. “Even more troubling, the results showed that many of the apps shared certain information” — like a device’s phone number, precise location or unique identification code — with third parties, according to the report.

More than half of the apps studied were transmitting children’s data, often to marketers. The researchers also reported that most apps failed to tell parents when they involved interactive features like advertising, social network sharing or allowing children to make purchases for virtual goods within the app. For instance, while 9 percent of the children’s apps disclosed to parents that they contained advertising, F.T.C. researchers found that 58 percent actually contained ads. Moreover, of the 24 apps that stated they did not contain in-app advertising, 10 actually contained ads, the report said.

The report added that some of these practices could violate the F.T.C.’s prohibition against unfair or deceptive practices. The practices could also violate a federal law, called the Children’s Online Privacy Protection Act of 1998, known as Coppa for short. That law requires Web site operators to obtain parental permission before collecting or sharing the names, phone numbers, addresses or other personal information about children under 13.

Regulators said they were starting “numerous nonpublic investigations” to determine whether the discrepancies between the children’s apps’ disclosures and their actual practices violated the law.

The report is part of the F.T.C.’s preparations to strengthen the children’s online privacy rule.

Over the last few months, however, some prominent media companies, app developer and advertising industry groups have pressed F.T.C. commissioners to water down the agency’s proposed updates to the Coppa rule. The timing of the report suggests that the F.T.C. may be trying to lay the groundwork for broader children’s online privacy protections.

The agency hopes to update them to keep up with developments in mobile apps, voice recognition, facial recognition and comprehensive online data collection by marketers. The agency has proposed, for example, a longer list of data about children that would require prior parental consent to collect: photos, voice recordings and unique mobile device serial numbers that could be used to track children and compile information about their activities across apps.

In the report, regulators said their concern was that marketers and data collection companies could potentially use information from children’s apps to develop detailed profiles of children without their parents’ knowledge or consent. Children’s advocates have argued that such detailed profiling could potentially present a safety hazard — like the ability for strangers to contact or locate a child — as well as a risk that children could be unfairly discriminated against or influenced by marketers.

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The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carol Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

Editor’s Note:

Correction: An earlier version of this post contained an incorrect spelling of the first name of the director of the Families and Health Care Project of the United Hospital Fund. She is Carol Levine, not Carole Levine.

Read More..

The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carol Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

Editor’s Note:

Correction: An earlier version of this post contained an incorrect spelling of the first name of the director of the Families and Health Care Project of the United Hospital Fund. She is Carol Levine, not Carole Levine.

Read More..