Current Events in October 2010

hen dieters in a recent study got a full night's sleep, they lost the same amount of weight as when they slept less. When dieters got adequate sleep, however, more than half of the weight they lost was fat. When they cut back on their sleep, only one-fourth of their weight loss came from fat.

They also felt hungrier. When sleep was restricted, dieters produced higher levels of ghrelin, a hormone that triggers hunger and reduces energy expenditure.

The report shows that each year more than 33 million adults have reported binge drinking -- defined as having four or more drinks for women and five or more drinks for men over a short period of time, usually a couple of hours. And the report said levels of binge drinking have not declined during the past 15 years.

The CDC report found men are more than twice as likely to binge drink than women (21 percent versus 10 percent). It said binge drinking is more common among non-Hispanic whites (16 percent) than among non-Hispanic blacks, (10 percent).

Taking risks

"Binge drinking increases many health risks, including fatal car crashes, contracting a sexually transmitted disease, dating violence, and drug overdoses," said CDC Director Thomas R. Frieden, M.D., M.P.H. "Excessive alcohol use remains the third leading preventable cause of death in the United States and leads to a wide range of health and social problems."

In this report, CDC scientists analyzed data on self-reports of binge drinking within the past 30 days for about 412,000 U.S. adults aged 18 years and older from the 2009 Behavioral Risk Factor Surveillance System (BRFSS), and for approximately 16,000 U.S. high school students from the 2009 National Youth Risk Behavior Survey (YRBS).

Shocking numbers

"Alarmingly, almost 1 in 3 adults and 2 in 3 high school students who drink alcohol also binge drink, which usually leads to intoxication," said Dr. Robert Brewer, M.D., M.P.H., alcohol program leader at CDC and one of the authors of the report. "Although most binge drinkers are not alcohol-dependent or alcoholics, they often engage in this high-risk behavior without realizing the health and social problems of their drinking. States and communities need to consider further strategies to create an environment that discourages binge drinking."

Drinking too much, including binge drinking, causes more than 79,000 deaths in the United States each year. Binge drinkers also put themselves and others at risk of car crashes, violence, the risk of HIV transmission and sexually transmitted diseases, and unplanned pregnancy.

Over time, drinking too much can lead to liver disease, certain cancers, heart disease, stroke, and other chronic diseases. Binge drinking can also cause harm to a developing fetus, such as fetal alcohol spectrum disorders, if a woman drinks while pregnant.

Binge drinking varies widely from state to state, with estimates of binge drinking for adults ranging from 6.8 percent in Tennessee to 23.9 percent in Wisconsin. It is most common in the Midwest, North Central Plains, lower New England, Delaware, Alaska, Nevada, and the District of Columbia.

Tips for parents

Richard Gallagher, Ph.D., Director of the Parenting Institute and the Thriving Teens Project at the New York University Child Study Center offers these tips for parents concerned about their children's drinking:

· Clearly state what actions you expect your teen to take when confronted with substance use. Teens who know what their parents expect from them are much less likely to use substances, including alcohol.

· Talk about the alcohol use that your children observe. Parents need to make it clear how they want their children to handle substances, such as alcohol and tobacco. Children need to have controlled exposure to learn the rules of acceptable use.

· Help your teen find leisure activities and places for leisure activities that are substance-free. Then, keep track of where, with whom, and what your teen is doing after school and during other free times.

· Limit the access your children have to substances. Teens use substances that are available. They report that they sneak alcohol from home stocks, take cigarettes from relatives, and obtain marijuana from people that they know well.

· Inform teens about the honest dangers that are associated with alcohol use and abuse. Although teens are not highly influenced by such information, some discussion of negative consequences has some impact on the decisions they make. Especially emphasize how alcohol clouds one's judgment and makes one more likely to be harmed in other ways.

Because the number of people refinancing existing mortgages dropped 2.5 percent, the overall Weekly Mortgage Applications Survey was down for the week.

"The increase in purchase activity was led by a 17.2 percent increase in FHA applications, while conventional purchase applications also increased by 3.6 percent," said Jay Brinkmann, MBA's Chief Economist.

"This is the second straight weekly increase in purchase applications and the highest Purchase Index level since the expiration of the homebuyer tax credit program. One possible driver of last week's big increase in FHA applications was a desire by borrowers to get applications in before new FHA requirements took effect October 4th, which included somewhat higher credit score and down payment requirements."

The refinance share of mortgage activity decreased to 78.9 percent of total applications from 80.7 percent the previous week. The adjustable-rate mortgage (ARM) share of activity increased to 6.1 percent from 6.0 percent of total applications from the previous week.

Falling rates

Meanwhile, record low interest rates continue to get lower. The average contract interest rate for 30-year fixed-rate mortgages decreased to 4.25 percent from 4.38 percent, with points decreasing to 1.00 from 1.01 (including the origination fee) for 80 percent loan-to-value (LTV) ratio loans.

The 30-year contract rate is the lowest recorded in the survey, with the previous low being the rate observed last week. The effective rate also decreased from last week.

According to the National League of Cities' (NLC) annual report on cities' fiscal conditions, cities are now less able to meet their fiscal needs in 2011 and beyond. Financial officers are reporting the largest spending cuts and loss of revenue in the 25-year history of the survey.

In the research brief, "City Fiscal Conditions in 2010," 87 percent of city finance officers report their cities are worse off financially than in 2009. City revenues -- as generated in property, sales, and income taxes -- will decline -3.2 percent in inflation-adjusted dollars according to finance officers.

Severe cuts

To compensate, city officials are cutting back spending, with expenditures declining by -2.3 percent. These are the largest cutbacks in spending in the history of the survey and the fourth year in a row that revenue declined.

Financial pressures are forcing cities to fire workers (79 percent), delay or cancel capital infrastructure projects (69 percent), and modify health benefits (34 percent). There were also significant increases in the number of officers reporting across-the-board services cuts (25 percent) and public safety cuts (25 percent). Public safety is usually reduced only as a last resort option.

"This historic recession has forced city officials to make difficult decisions that impact the social and economic fabric of their communities," said Ronald O. Loveridge, mayor of Riverside, CA and president of NLC. He continued, "This recession is making city officials fundamentally rethink and repurpose the provision of services in their communities. Some are innovating and finding creative solutions but, regrettably, without the necessary resources, cities will continue to have a difficult time assisting their residents through these trying economic times."

Revenue crunch

The continuing weakness in the housing market, along with poor retail sales, has reduced the available revenue by significant margins. The responses from the finance officers clearly illustrate that the effects of the economic crash are intensifying in cities.

Because most tax revenue is collected at specific points during the year, and since it takes time for housing assessments to catch up to current values, cities will still be feeling the full effect of the downturn in 2011. The national economy's slow recovery to date also means the recession's effects will potentially linger in cities for several more years.

Spotty recovery

"These stark numbers continue the trend we've been seeing for the past several years: lower revenue and reduced services at a time when there is an increased demand for services," said co-author Christopher Hoene, director of the Center for Research and Innovation for the National League of Cities. He continued, "Unfortunately, because of the loss in revenue, cities will face even more difficult circumstances in the months, if not years, to come."

Cities have been forced to confront low consumer spending, unemployment, and cuts in state aid that have severely affected the types of services and the manner in which they are offered by cities. In response, many cities are revisiting the range of services provided and looking for new service-delivery models in order to balance budgets and minimize the impacts of cuts on residents.

"While certain segments of the economy may be under recovery, cities as a whole are not yet experiencing growth," said co-author Michael A. Pagano, dean of the College of Urban Planning and Public Affairs at the University of Illinois at Chicago. He continued, "As a consequence, cities are facing very serious financial hurdles right now in providing basic public services."

A new Cochrane review finds that about half of those with migraine headaches reported pain relief within two hours after taking over-the-counter ibuprofen, such as Advil or Motrin.

"We knew that many migraineurs rely on over-the-counter medication to treat attacks and surveys show that while some find them helpful, many are dissatisfied," said review co-author Sheena Derry of the Pain Research and Nuffield Department of Anaesthetics at the University of Oxford.

Migraine headache is intense throbbing pain on one side of the head, and an attack can last anywhere between four and 72 hours. Symptoms such as nausea, vomiting, aura and increased sensitivity to light and sound often accompany migraines.

The systematic review was published by The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

In the Top 20

According to the Migraine Research Foundation, migraine ranks in the top 20 of the world's most disabling medical illnesses with more than 10 percent of the population, including children, suffering from the condition.

Migraine also causes less productivity at work and school. Fewer than 10 percent of sufferers are able to work or function normally during their migraine attacks, and American employers lose more than $13 billion each year as a result of 113 million lost work days, according to the Migraine Research Foundation.

To relieve their headache pain, almost half (49 percent) of migraine sufferers use over-the-counter medication only, 20 percent use prescription medication and 29 percent use both, according to the Cochrane review.

Derry said she and her fellow reviewers conducted the Cochrane review to help provide a more definitive answer on whether ibuprofen is effective for migraine pain. They also wondered whether also taking an antiemetic to relieve nausea was better than taking an ibuprofen alone.

"We knew that there were a number of published trials using ibuprofen for acute treatment of attacks," she said. "Individual trials, however, can be misleading for a number of reasons, and generally it is recognized that using systematic review and meta-analysis is likely to provide a more accurate estimate of the effects of any intervention."

The study

The reviewers evaluated nine studies with 4,373 adult participants who had a diagnosis of migraine headache. The average age of the participants was 30 to 40 years and all had a history of migraine for at least 12 months before entering the studies.

In total, 414 people with migraines underwent treatment with 200 milligrams of ibuprofen, 1,615 received a dose of 400 milligrams, 208 received a 600-milligram dose and 1,127 received a placebo.

Twenty-six percent of patients taking the 400-milligram dose were pain free within two hours, compared with 20 percent who took the smaller dose and 11 percent who received a placebo. In the same period, 57 percent who took 400 milligrams of ibuprofen had their pain reduced from moderate or severe to "no worse than mild," compared with 25 percent taking a placebo.

"For those who experience these outcomes, ibuprofen is a useful, inexpensive and readily available treatment," Derry said. "Those who don't experience good outcomes will need to look at alternative treatments."

Claiming it was only following the terms of previously negotiated pay packages, General Motors, which is still 61%-owned by the government, revealed this week that it has paid out stock shares worth millions of dollars to 15 current and former top executives as third quarter bonuses.

In filings with the Securities and Exchange Commission (SEC), GM revealed that former CEO Edward Whitacre received more than 16,300 shares worth over $883,000 on September 30 while current CEO Daniel Akerson received nearly 8,200 shares worth over $441,000.

Keep in mind that Akerson has only been CEO for a little over one month. Not bad for a company that filed for Chapter 11 bankruptcy a little over a year ago and then received $50 billion from the federal government in exchange for shares in the company.

Thirteen other GM executives also received bonuses, including Tom Stephens, vice chairman for product development, who received more than 15,600 shares worth over $840,000, while Chief Financial Officer Chris Liddell got nearly 16,000 shares worth over $862,000. Stephen Girsky, another vice chairman received nearly 13,900 shares worth $750,000.

Another 10 executives received smaller stock grants, but the total quarterly payout was worth something over $4 million.

Are Investors Ready to Buy GM Stock Again?

So far, GM, which has come to be known by some as "Government Motors" has repaid $6.7 billion of that $50 billion, and plans to repay the remaining $43.3 billion over the next few years, beginning possibly as early as next month when it hopes to bring out an initial public offering or IPO.

One would guess they're hoping investors who were burned when the company filed for bankruptcy last year have short-term memory issues. Either that, or new investors will bet on GM continuing the historical trend that, according to the Wall Street Journal's Deal Journal blog, "companies that emerge from bankruptcy can significantly outperform the stock market."

Meanwhile, according to The New York Times and Bloomberg, GM plans to sell fewer shares in the planned IPO than it initially expected, which means American taxpayers, in other words, us, will continue to own a sizable portion of General Motors for a couple more years.

Another question that begs to be asked is that if we, the American taxpayer own 61% of GM, shouldn't we get a discount to buy shares in our own company? Other firms do that. They'll even let employees, for example, purchase shares at a 15% discount.

Then there's the question over how much the General Motors IPO will be priced. At least one valuation company hired by GM put the price at around $58 a share which is less than half of what an official for the Troubled Asset Relief Program or TARP estimated an average share needs to be worth for the treasury to get back its remaining investment. All in all, a November IPO of General Motors stock may not be an easy sell, especially in this economy.

Bonuses Not First Time GM Spent Taxpayer Money

Getting back to the 3rd quarter bonuses, this isn't the first time General Motors has handed out our money without asking. According to an editorial in The Wall Street Journal, GM has also been spending our money on lobbying and political campaigns.

For example, the Journal reports GM has given Midwestern Democratic incumbents $90,500 in campaign donations so far in the current election cycle. As for lobbying, The Hill newspaper in D.C. reports that GM has spent $7 million in the past four quarters.

Maybe they'll revise that old ad line of "See the USA in a Chevrolet," with "Payback the USA, buy a Chevrolet."

"The FDA approval process is designed to help protect the public, and when a manufacturer puts potential profits and sales ahead of the approval process, they risk paying a bigger price," United States Attorney Sally Quillian Yates said. "At the time of the offenses, Allergan knew that there was insufficient clinical evidence for the wide range of claims the company was promoting and pushing with doctors. We hope other companies are paying close attention to what can happen if they don't follow the rules and rush towards making profits."

Botox is a prescription biological product containing botulinum toxin type A, a purified neurotoxin. Under the Food, Drug and Cosmetic Act ("FDCA"), a company must specify each intended use of a biologic product in an application submitted to the FDA. After the FDA approves the product as safe and effective for a specified use, any promotion by the manufacturer for any other uses - known as "off-label" uses - renders that product misbranded.

According to United States Attorney Yates and the information presented in court: Allergan pleaded guilty for promoting Botox between 2000 to 2005 for headache, pain, spasticity, and juvenile cerebral palsy - none of which were FDA approved uses during that period. The FDA approved BOTOX for limited therapeutic uses in that period: strabismus (crossed eyes) and blepharospasm (involuntary eyelid muscle contraction), cervical dystonia (involuntary neck muscle contraction) and primary axillary hyperhidrosis (excessive underarm sweating).

According to the evidence, Allergan made it a top corporate priority to maximize sales of Botox for so-called "off-label" uses, such as headache, pain, and spasticity. Allergan's off-label marketing tactics included calling on doctors who typically treat patients with off-label conditions.

In 2003, Allergan doubled the size of its teams that assisted doctors in obtaining reimbursement for such off-label Botox injections. Allergan held workshops to teach doctors and their office staffs how to bill for off-label uses, conducted detailed audits of doctors' billing records to demonstrate how they could make money by injecting Botox, and operated the Botox Reimbursement Hotline which provided a wide array of free on-demand services to doctors for off-label uses.

Allergan also lobbied government healthcare programs to expand coverage for off-label uses, directed physician workshops and dinners focused on off-label uses, paid doctors to attend "Advisory Boards" promoting off-label uses, and created a purportedly independent neurotoxin education organization to stimulate increased use of Botox for off-label indications.

Although all of the approved uses for Botox in 2000-2005 were relatively rare, Allergan exploited its on-label cervical dystonia ("CD") indication to grow off-label headache ("HA") and pain sales. In 2003, Allergan developed the "CD/HA Initiative" as a "rescue strategy" in the event of negative results from its headache clinical trials to ensure continued expansion into the headache market. As part of this initiative, Allergan marketed Botox for headache and pain by claiming that cervical dystonia was "underdiagnosed" and that doctors could diagnose cervical dystonia based on headache and pain symptoms, even when the doctor "doesn't see any cervical dystonia."

The company has signed a plea agreement admitting its guilt to a criminal misdemeanor for misbranding Botox in violation of the FDCA. Under the plea agreement, Allergan will pay a criminal fine of $350 million and forfeit assets of $25 million. Allergan's guilty plea and sentence was accepted yesterday by U.S. District Court Judge Orinda D. Evans in Atlanta.

The criminal plea and sentence is part of a global resolution of criminal and civil allegations. Allergan has also signed a civil settlement agreement in which the company agrees to pay an additional $225 million to the federal government and the states to resolve claims that its unlawful marketing practices caused false claims to be submitted to government health care programs such as Medicare, Medicaid, TRICARE, and to the Federal Employees Health Benefit Program, the Department of Veterans' Affairs, and the Department of Labor's Office of Workers' Compensation Programs.

Allergan markets Botox for its approved cosmetic use under the trade name Botox Cosmetic. Botox Cosmetic has its own FDA-approved label and drug code. The guilty plea and sentence announced today does not address Botox Cosmetic.

How do you respond? Your first instinct might be to provide mouth-to-mouth resuscitation, but that that might not be necessary. A new study published in the Journal of the American Medical Association (JAMA) says Chest compression-only bystander CPR may be as effective as conventional CPR with rescue breathing for out-of-hospital cardiac arrest.

Out-of-hospital cardiac arrest is a major public health problem, affecting approximately 300 000 people in the U.S. each year. Although survival rates vary considerably, overall survival is generally less than 10 percent among those in whom resuscitation is attempted.

Having a bystander respond with CPR significantly increases a victim's chances of survival, but unfortunately, bystanders respond in fewer than 30 percent of cases.

Few responders

Why so few people responding? Researches guessed that the expectation that mouth-to-mouth breathing assistance was needed proved to be intimidating. Bystanders were either reluctant to make such intimate contact with a stranger, or felt they lacked the knowledge of how to do it correctly.

When researchers analyzed more than 4,000 cases of out-of-hospital cardiac arrest, they found that victims who received compression-only resuscitation did just as well as those who received traditional mouth-to-mouth assistance. In fact, their survival odds were a little better.

Among patients with out-of-hospital cardiac arrest, layperson compression-only CPR was associated with increased survival compared with conventional CPR, leading to a recommendation for bystanders to administer chest-only CPR when confronted with such an emergency.

Policy change might lead more people to respond

"In this study, we evaluated whether intentional, widespread public endorsement of compression-only CPR for adult sudden cardiac arrest would be associated with an increased likelihood that lay rescuers would perform CPR and an increased likelihood of survival to hospital discharge compared with no bystander CPR and conventional CPR," the authors concluded.

The Red Cross has, for some time, encouraged untrained laypersons to respond in emergency situations with compression-only CPR.

"We recognize that upon witnessing the sudden collapse of an adult, calling 9-1-1, and providing Compression-Only CPR until an AED is available is an acceptable alternative for those who are unwilling, unable, or not trained to perform full CPR," the Red Cross said.

The video below, produced in conjunction with the Red Cross, shows how to administer compression-only CPR.

Lately, some scammers supposedly operating out of Tanzania have been using the 1980s technology of fax communications to put a new face on that tried and true story of the deposed prince needing to transfer large sums of money out of the country.

Known as a "419 scam," named for section 419 of the Nigerian penal code, this scheme is normally implemented with an email. Though the butt of numerous jokes, it has nonetheless been enormously effective as victims want to believe that a total stranger in distress is willing to cut them in on millions of dollars.

Mississippi Attorney General Jim Hood says his office has begun receiving reports of the 419 scam hitting fax machines in the state. It consists of a message stating that the sender has a large sum of money and needs help transferring it out of a foreign country. As a reward for the consumer's help, the sender promises to pay the consumer a share of the funds.

Evolution

The scam is always evolving. A sample of the most recent fax regarding Tanzania begins:

"MAY I USE THIS OPPORTUNITY TO INTRODUCE MYSELF TO YOU MY NAME IS CHARLES TAYLOR (JNR) I AM THE SON OF FORMER PRESIDENT OF LIBERIA. A COUNTRY IN WEST AFRICA, MY FATHER WHO IS CURRENTLY BEING HELD AGAINST HIS WILL BY THE UNITED NATIONS FOR ALLEGED OFFENCES OF WAR CRIMES. HE IS CURRENTLY FACING COURT TRIAL IN THE HAGUE IN NETHERLANDS. MY FATHER IS A GOOD MAN WHO TRIED TO DO SO MUCH FOR OUR PEOPLE LIBERIANS. I AM CONTACTING YOU WITH THE BELIEVE THAT WE WILL DEVELOP A CORDIAL BUSINESS RELATIONSHIP..."

The fax goes on to say that Mr. Taylor's father has a large sum of money - in this case $177 million in bank security vaults in the name of a friend, who has just recently died. The father has supposedly directed the son to use this money for investment purposes in our country. The fax promises funds in exchange for assistance in transferring the funds out of Tanzania. Details are to be conveyed once contact information is received.

"Don't assist these criminals in the transfer of funds, regardless of what is promised, or you will become the victim," said Hood.

Tips

Hood also offers the following tips to help consumers avoid becoming victims of these and other common scams:

• Never reply to a fax, email, pop-up, telephone or text message that asks for personal or financial information. Legitimate companies will not ask for this information in that format.

• Always contact the organization asking for your personal information using a telephone number you know to be correct to inquire why the information is needed. Never call or text the number left in the message, and never follow an Internet link to a site.

• Never fax or email personal or financial information. Review credit card and bank statements as soon as you receive them to determine whether there are any unauthorized charges.

• Keep your anti-virus software up to date. In addition, use a firewall, which helps to make you invisible on the Internet and blocks communication from unauthorized sources.

• Be cautious about opening attachments or downloading files from emails you receive, regardless of the sender.

The idea is to determine whether a lower blood pressure range in older adults will reduce cardiovascular and kidney diseases, age-related cognitive decline, and dementia.

"No large-scale clinical trial has examined the impact of aggressively lowering systolic blood pressure among older adults," said Susan B. Shurin, M.D., acting director of the NIH's National Heart, Lung, and Blood Institute (NHLBI).

Specific areas of study

"The SPRINT study and the senior expansion address four of the 10 common causes of death and disability in adults over 75 years: heart disease, stroke, kidney failure, and dementia," Shurin pointed out. "The addition of these participants promises to provide useful scientific and public health information on a large and growing segment of the population."

Current clinical guidelines recommend maintaining a systolic blood pressure -- the top number in a blood pressure reading -- of less than 140 millimeters of mercury (mm Hg) for healthy adults of all ages and 130 mm Hg for adults with kidney disease or diabetes. Two previous trials found that reducing systolic blood pressure in older participants reduced stroke, heart failure, and overall cardiovascular events by more than 30 percent.

SPRINT will evaluate the safety and potential benefits or risks of maintaining systolic blood pressure at either less than 140 mm Hg (standard group) or less than 120 mm Hg (treatment group) -- a lower target than currently recommended or studied in previous trials.

Researchers will treat study participants with commonly available medications to achieve their target blood pressure. Those in the treatment group will take an average of three to four medications. Those in the standard group will take an average of two medications.

Participants will be seen in clinics every month at the beginning of the study and less frequently as they reach their blood pressure targets. The study will include standard tests for determining the health of the heart, kidneys, and brain.

The National Institute of Neurological Disorders and Stroke (NINDS) and the National Institute on Aging (NIA) support SPRINT Memory and Cognition IN Decreased Hypertension (SPRINT-MIND), a substudy of SPRINT that focuses on the impact of lowering systolic blood pressure on cognitive decline and development of dementia.

All-encompassing

The study will also include brain imaging to measure treatment effects on brain structure. Participants in SPRINT-Senior, as the study expansion is known, will also be included in SPRINT-MIND.

SPRINT-Senior will be conducted through the existing SPRINT clinical center networks:

• Case Western Reserve University School of Medicine, Cleveland (Principal Investigator: Jackson T. Wright, M.D., Ph.D.)

• Department of Veterans Affairs, VA Medical Center, Memphis (Principal Investigator: William C. Cushman, M.D.)

• University of Alabama at Birmingham (Principal Investigator: Suzanne Oparil, M.D.)

• University of Utah, Salt Lake City (Principal Investigator: Alfred K. Cheung, M.D.)

• Wake Forest University Baptist Medical Center, Winston-Salem, N.C. (Principal Investigator: David C. Goff, Jr., M.D., Ph.D.

The coordinating center for the study is Wake Forest Baptist (Principal Investigator: David Reboussin, Ph.D.).

Announced in 2009, SPRINT is a nine-year study to be conducted in over 70 clinical sites across the United States. Including the 1,750 new SPRINT-Senior participants, approximately 9,250 people age 55 years or older are expected to be enrolled.

Participants will have systolic blood pressure of 130 mm Hg or higher as well as a history of cardiovascular disease; be at high risk for heart disease by having at least one additional risk factor, such as a history of smoking or a high blood cholesterol level; or have chronic kidney disease. Over 40 percent of the SPRINT participants are expected to have chronic kidney disease.

SPRINT and SPRINT-Senior are examples of comparative effectiveness research, which compares different interventions or strategies to prevent, diagnose, treat, and monitor health conditions in clinical settings. SPRINT enrollment will begin this fall.

The first two years of SPRINT-Senior will cost $12.7 million, and is being funded by the economic stimulus. NIH is providing $30.1 million for the remaining six years of the project.

Results of the five-year study are published in Chronobiology International, an international journal on how biological rhythms affect the systems of living things. The authors say the findings will change the way high blood pressure medication is administered and have a profound impact on the type of treatment that hypertension patients receive.

In two articles, Chronobiology International covers and interprets the newly completed MAPEC study, which shows that the simple shift to taking medication at night instead of in the morning significantly increases efficacy in keeping blood pressure within a healthy range. In addition, taking medication at night offers extra protection against heart attacks, strokes and other types of cardiovascular diseases.

The results are impressive. The group of patients who took at least one of their medications at night experienced just one-third of the number of cardiovascular disease (CVD) episodes experienced by the group of patients who took all their medications in the morning.

Huge difference

"This study proves that the time of day when patients take their high blood pressure medications can make a huge difference due to the effect of the body's circadian rhythms on the actions of medications and because of the importance of preserving the normal day-night pattern of blood pressure in hypertension," explains the lead investigator of the MAPEC Study Professor Ramón C. Hermida, PhD, Director of Bioengineering and Chronobiology Labs at the University of Vigo in Spain. "Conventional treatment typically advises taking blood pressure medications in the morning. The MAPEC study shows that conventional treatment is not the most effective way to help patients with high blood pressure."

Taking at least one blood pressure medication at bedtime - as opposed to taking all medications in the morning - was found, based on around-the-clock ambulatory blood pressure monitoring, to best normalize the sleep-time blood pressure. This is known to be the most sensitive predictor of a patient's 5-year risk of CVD mortality. In addition, the MAPEC study shows that taking medication at night is the best way to control daytime BP levels.

The study also highlighted the importance of knowing a patient's sleep-time blood pressure readings. While most hypertension patients can attest to the fact that their BP reading is normally taken during a daytime clinic, not knowing what a patient's blood pressure is doing over the entire 24-hour period - and crucially, what the sleep-time readings register - is like playing Russian roulette.

"Historically, medical professionals have operated on the assumption that sleep-time blood pressure levels will drop by 10-20 percent from daytime levels. However, for many patients - called non-dippers - this doesn't happen and sleep-time therefore becomes a high risk period," says Dr. Francesco Portaluppi of the Hypertension Center at the University Hospital of Ferrara in Italy and lead author of the perspectives article on the MAPEC study.

70 million people

More than 70 million people in the U.S. have hypertension. Millions suffer heart attacks and strokes every year. Imagine if those CVD episodes could be cut by almost two thirds. Professor Hermida and his team are convinced there is no time to lose.

"This study was the first to conclusively find that the time of day when medications are ingested not only affects efficacy but also CVD risk and these findings must fundamentally change the way patients are treated worldwide," said Portaluppi.

Experts who analyzed the study results conclude that a number of steps should be taken urgently in order to best utilize the findings and save lives.

First, 24-hour ambulatory blood pressure monitoring should be the proper means of differentiating the needs of BP patients and the only means of categorizing patients as non-dippers in the 24-hour pattern. It is also the best means of confirming that treatment goals of BP control are met, which include ensuring that sleep-time BP levels are in the correct range.

Second, elevated sleep-time blood pressure should be made an important new therapeutic clinical target for medications. Based on this and borne out by the results of the study, prescribing that hypertension medications be taken at night offers an inexpensive and highly efficacious means of controlling blood pressure without the need to increase either the dose or number of medications.

"Our body clocks are extremely powerful biological tools and this study offers insight and hard facts on how we can harness that power to help millions of people stay healthier and safer by ensuring that their blood pressure medications are taken as effectively as possible," said Dr. Michael Smolensky, Editor of Chronobiology International.

Stella Gurr, of British Columbia, lost her son, Michael Benedetti Gurr, in September 2008, when the Ford E-Series van in which he was riding ran off the Trans-Canada Highway, rolling several times.

The suit is being handled by Tony Merchant, the high-profile Canadian attorney who has filed, among others, a lawsuit taking issue with Facebook's privacy policies and one alleging that denture cream manufacturers failed to warn consumers that overuse of the products could lead to zinc poisoning.

Merchant is planning to seek a refund for every Canadian who owns one of the vans, and is pursuing compensation for anyone with a relative who was killed or injured in an E-Series crash. Merchant eventually plans to expand the lawsuit to all ten Canadian provinces.

Lobbying for stricter regulation

Since her son's death, Gurr has been urging the Canadian government to ban the use of 15-seat vans to transport children on field trips and other outings. Quebec, Nova Scotia, and New Brunswick have already instituted such bans, and U.S. law prohibits the vans from being used for children of high school age and younger. No such ban exists for college students, however.

Joining Gurr in her lobbying effort is Isabelle Hains of New Brunswick, who lost her son in a similar accident in January 2008. Daniel Hains was one of seven high school basketball players killed on the way back from an away game when their Ford E-Series van collided head-on with a transport truck on an icy highway.

Last week, Gurr and Hains met with Canadian Transportation Minister Chuck Strahl, who has been studying measures to more strictly regulate the vans.

"It's my duty as a mother to send a message loud and clear to the [department] to ban 15-passenger vans," Hains told reporters last week. "The time for studying and debating passed a long time ago."

Long history of problems

And indeed, the vans' safety problems have been well-established for years. In April 2001, the National Highway Traffic Safety Administration (NHTSA) issued a consumer advisory stating that the vans are especially prone to roll over when fully loaded, and that only trained drivers should be behind the wheel in those situations. According to NHTSA's analysis, when the vans are filled to capacity, their center of gravity shifts rearward and upward, which increases the chance that the driver will lose control, especially in emergency situations.

The Safety Forum, a U.S. watchdog group, calls the vans "high-riding death traps" that are "among the most lethal vehicles on the road today." According to the group, 15-passenger vans are involved in rollover accidents more often than any other type of vehicle, with over half of the victims either killed or seriously injured as a result. And while other cars involved in a single-vehicle accident have only a 33 percent chance of rolling over, the vans' rollover rate is above 50 percent.

Between 1992 and 2002 alone, over 1,100 people were killed in single-vehicle accidents involving the vans, according to NHTSA.

Yet despite the vans' atrocious safety record, they remain on the road, with predictable results. On Sunday, four members of a Georgia church group were killed when their Dodge Ram Wagon blew a tire and rolled over, ejecting several of its occupants.

The scheme allegedly debited the bank accounts of hundreds of thousands of cash-strapped consumers in violation of federal law.

The FTC complaint contends that Swish Marketing Inc. and its three officers -- Mark Benning, Matthew Patterson, and Jason Strober -- operated Websites advertising short-term, or "payday," loan-matching services. The Websites included an online loan application form that tricked consumers into unknowingly ordering a debit card when they applied for a loan online.

Consumers duped

On numerous sites, clicking the button for submitting loan applications led to four product offers unrelated to the loan, each with tiny "Yes" and "No" buttons. "No" was pre-clicked for three of them; "Yes" was pre-clicked for a debit card, with fine-print disclosures asserting the consumer's consent to have their bank account debited. Consumers who simply clicked a prominent "Finish matching me with a payday loan provider!" button were charged for the debit card. Other websites touted the card as a "bonus" and disclosed the fee only in fine print below the submit button. As a result, consumers allegedly were improperly charged up to $54.95 each.

In August 2009, the FTC charged these marketers and VirtualWorks LLC -- the debit card company that helped them design the online offers -- with deceptive business practices. The debit card company paid Swish Marketing up to $15 for each transaction. The debit card company defendants have settled the charges against them.

Additional charges

In April 2010, the FTC filed an amended complaint against the payday loan marketers, adding an allegation that the defendants sold consumers' bank account information to the debit card company without the consumers' consent.

The amended complaint further states that Benning, Patterson, and Strober were made aware of consumer complaints about the unauthorized debits, as indicated in their e-mail and instant messages. For example, Patterson explained that consumers were going "ballistic" about the debit because the offer was defaulted to yes "...and customers don't see it." More than six months after first learning of the complaints, Benning allegedly described the practice of defaulting to "Yes" as "fraud and identity theft."

The settlement order with Strober, the Vice President of Product Development and/or Engineering of Swish Marketing, bars him from misrepresenting material facts about a product or service, such as the cost or the method for charging consumers. He also is permanently prohibited from misrepresenting that a product or service is free or a "bonus" without disclosing all material terms and conditions, and from charging consumers without first disclosing what billing information will be used, the amount to be paid, how and on whose account the payment will be assessed, and all material terms and conditions.

The order further requires that transactions be affirmatively authorized by consumers, and that Strober, in marketing financial products or services, monitor his affiliates to ensure compliance with the order. He also is required to provide specific cooperation to the FTC in its ongoing litigation. In addition, the order requires him to pay $850,000.

The BMW 5 Series four-door, rear-wheel-drive sedan received a 4 for Overall Frontal Crash Rating and 5's for Overall Side Crash Rating and Rollover Rating for an Overall Vehicle Score of 5.

A late model-year release of the Hyundai Sonata received identical scores. An earlier Sonata release received an overall rating of 4, as did 27 other makes and models. Two models of Toyota Camry received ratings of 3 and one vehicle -- a Nissan Versa - got a 2-star rating.

"More stars equal safer cars," said Transportation Secretary Ray LaHood. "With our upgraded Five-Star Safety Ratings System, we're raising the bar on safety. Through new tests, better crash data, and higher standards, we are making the safety ratings tougher and more meaningful for consumers."

The Insurance Institute for Highway Safety (IIHS) welcomes the revised standards, saying the government "has taken a step in the right direction to beef up its testing program."

Changing the grades

Vehicle safety ratings range from one to five stars, with one star being the lowest and five stars the highest. Because so many vehicles had reached the highest rating under the old rating criteria, and because the new standards are much more rigorous, not all previously rated 5-star vehicles will remain at five stars.

The new 5-Star Safety Ratings System evaluates the safety of passenger cars, SUVs, vans and pickup trucks in three broad areas -- frontal crash, side crash, and rollover resistance. For model year 2011, NHTSA will rate 24 passenger cars, 20 sport utility vehicles, two vans and nine pickups under the new ratings system.

"We want consumers to embrace these new safety technologies as a way to make vehicles safer," said NHTSA Administrator David Strickland. "We believe electronic stability control, lane departure warning, and forward collision warning offer significant safety benefits and consumers should consider them when buying a new car."

Ratings and consumers

One of the most significant changes to the ratings program for consumers is the addition of an Overall Vehicle Score for each vehicle tested. That score combines the results of a frontal crash test, side crash tests and rollover resistance tests and compares those results to the average risk of injury and potential for vehicle rollover of other vehicles.

NHTSA recommends consumers consider vehicles with crash avoidance technologies that meet the 5-Star Safety Ratings minimum performance tests, such as forward collision warning (FCW), lane departure warning (LDW), and electronic stability control (ESC). All of the 2011 model year vehicles currently rated have ESC as standard, except for the Nissan Versa, in which it is optional.

More information, including the full list of newly-rated vehicles is available at Safercar.gov, the official Website for the Federal government's 5-Star Safety Ratings Program. There, consumers can also find comprehensive information about safe driving, vehicle defects, safety recalls, and passenger safety.

News of the latest legal action comes just a day after Toyota issued a statement saying it has examined more than 4,000 vehicles and found no evidence that its electronic throttle control is to blame for the cases of unintended acceleration repoprted by consumers. The company's findings are supported by government tests that have also uncovered no evidence of problems in Toyota's electronics.

But the Allstate suit claims that Toyota waited too long to respond to complaints about unintended acceleration and failed to install a brake override system that automatically releases the accelerator when the brake pedal is pressed.

Allstate charges Toyota "essentially hid the problem" instead of recalling the cars. "This has resulted in numerous claims of instances of property damage and injuries, including in some instances fatalities," the suit says. A Toyota spokesman said the suit's allegations "have no basis."

Toyota already faces several class-action complaints and numerous individual personal injury claims, and it's likely that other insurance companies will follow Allstate in seeking compensation from the Japanese automaker.

In a conference call with reporters yesterday, a Toyota executive said the company "has not found a single case in which electronics would lead to sudden unintended acceleration." Steve St. Angelo said Toyota has reviewed 4,200 complaints so far.

Drivers, for years, have reported instances in which their car accelerated on its own and failed to stop, even when they applied brakes. In some cases, these reports of sudden acceleration resulted in crashes.

But for the better part of a year government safety investigators have probed the thousands of reports of sudden acceleration in some Toyota vehicles. In a preliminary report to Congress in August, they said they have uncovered no evidence of problems in the vehicles' electronics.

Toyota has insisted from the start that, whatever the reason for these anomalies, they weren't caused by hiccups in the vehicles' sophisticated electronics. The National Highway Traffic Safety Administration (NHTSA), in its preliminary report, said it had reviewed 58 of the more than 3,000 submitted cases, and found no evidence of an electronics flaw.

Toyota yesterday said that complaints of sudden-acceleration incidents have dropped 80 percent since April.

The company also said it has added a "brake-override control" to 84 percent of the Toyota, Lexus and Scion vehicles now on sale in the U.S. and said it intends to be the first manufacturer to affer the safety technology in all of its models. The software is intended to ensure that, even if the accelerator sticks, pressing the brake will cause the accelerator to release.

"Toyota has made significant progress in recent months to help ensure that our customers can have complete confidence in the quality, safety and reliability of their vehicles, and our latest initiatives build on those accomplishments," said St. Angelo, Toyota's chief quality control officer for North America. "Toyota's continuous efforts to strengthen vehicle quality and safety, and to respond swiftly and thoroughly to our customers' concerns, are driven by our core values and will always be a fundamental part of our company. Our goal is to set new, even higher standards for quality assurance and customer responsiveness in both the factory and the market by continuing to put our customers first in everything that we do."

Since September 2009, Toyota has recalled about nine million vehicles to either replace floor mats or alter the design of accelerator pedals. The NHTSA report said investigators found only one case in which a floor mat trapped a gas pedal, pressing it to the floor, and no case in which the gas pedal became stuck.

However, Consumer Reports says credit cards remain one of the lowest-rated services it has ever analyzed with only 45 percent of respondents saying they are completely or very satisfied with their cards.

Still in the red

The survey, conducted in July by the magazine's National Research Center, also shows consumers are carrying less credit card debt, with median balances of $3,793 -- $1,100 lower than in 2009.

In addition some 23 percent of respondents said they were motivated to pay off their credit cards faster by the Minimum Payment Warning on their bills mandated by the new law. The warning shows cardholders how long it would take to retire their debt and the total amount of interest they must pay if they made only the minimum payment each month.

Of the people who carried a balance, 23 percent owed more than $10,000 compared with 30 percent last year. Still, 18 percent said they wouldn't be able to handle their expenses for six months without credit cards; 19 percent said it would take longer than two years to pay off their balances; and 20 percent didn't know when they'd be able to.

Despite some positive changes, there is still plenty of peril out there. Among other reforms, the card act bars issuers from raising rates in the first year or on existing balances unless your payment is 60 days late. Banks can still impose annual fees, slash cardholder's borrowing limit, cancel their account without notice, and raise their minimum payment. In CR's survey, 47 percent of respondents complained about such experiences.

Best Credit Cards

The best card for consumers depends on whether they pay their balances in full each month, and, if so, what types of rewards they're looking for. Consumer Reports money experts surveyed the marketplace and found that none of these nationally available cards limit the amount of points, miles, or cash-back consumers can earn. None charge an annual fee in the first year. Cards are listed in alphabetical order.

· CASH-BACK CARDS (Higher APRs make these rewards cards most suitable for people who pay off balances in full each month): Amazon.com Rewards Visa, American Express Blue Cash, American Express Costco TrueEarnings, Capital One No Hassle Cash Rewards, Chase Freedom, Fidelity Rewards American Express, PenFed Visa Platinum Cashback Rewards.

· TRAVEL CARDS (These cards offer the best deals for frequent travelers.): Capital One Venture Rewards, PenFed Premium Travel Rewards American Express.

· LOW-INTEREST/FEES CARDS (For consumers who carry a balance or want to transfer a balance): Iberiabank Visa Classic, PenFed Promise Visa and Simmons First Visa Platinum.

Worst Credit Cards

Some of the worst cards with the highest-fees are aimed at people with a poor or limited credit history. The two cards below are particularly fee-laden and may be the worst options available:

· First Premier Bank Mastercard: This card now advertises a $25 to $95 processing charge (which fluctuates by the minute, depending on when you click on the card's website). What's worse is that when magazine drilled deeper into the fine print, it found a $75 annual fee and an APR of 23.9 percent to 59.9 percent on purchases and cash advances (again, depending on when you visit the site).

So cardholders could face a minimum of $100 or a maximum of $170 in fees in the first year for a card with only a $300 initial credit limit. Other fees include an $11 charge for expediting bill payment over the phone and a credit-limit increase fee equal to 50 percent of the increase. So for every $100 that First Premier increases the cardholder's credit limit it charges him $50. Also, look out for copycats of this card. First Premier Bank markets very similar cards under the names Centennial and Aventium.

· Platinum Zero Secured Visa from Applied Bank: The Platinum Zero's marketing trades off its name -- zero percent APR on purchases, zero application fee, zero annual fee. But Consumer Reports found the zero fees end about halfway through the terms and conditions with a $9.95 monthly "maintenance" fee that equates to $119.40 annually.

If cardholders are late paying their bill, they will get hit with a fee of up to $35. And though the card claims to charge zero percent APR on purchases, the agreement states, "There is no grace period for the account. Interest charges accrue on purchases, cash advances and our charges beginning on the date the transaction occurs or on the first day of the billing cycle in which the transaction is received by us or, at our option, the date the transaction is posted to your account."

Consumer Reports Credit Card Use survey is based on an online nationally representative sample of American adults, conducted by the CR National Research Center. A total of 1,212 interviews were completed among adults aged 18+. Interviewing took place between July 3 and July 22, 2010. The margin of error is +/- 3.5 points at a 95 percent confidence level.

But not all that support is welcome. When alcoholic beverage companies take up the cause, it raises eyebrows.

Mike's Hard Lemonade now comes in a pink variety to promote the cause. And Chambord, which markets pink vodka and liqueurs, urges people to "pink their drink," saying that "by adding a splash of Chambord to any cocktail, you're supporting breast cancer awareness year-round."

But some breast cancer survivors aren't happy, saying it's hypocritical to raise money for research while selling a product that contributes to the disease.

Both the American Cancer Society and the National Cancer Institute say even moderate drinking increases breast cancer risk.

"Anybody trying to sell alcohol to promote breast cancer awareness should be ashamed of themselves," said Barbara Brenner, executive director of Breast Cancer Action, an advocacy group.

Chambord's website notes that its Pink Your Drink campaign has raised more than $50,000 in donations for the Breast Cancer Network of Strength and other patient groups.

Mike's Hard Lemonade has given $500,000 over the past two years to the Breast Cancer Research Foundation, company president Phil O'Neil says. The company was inspired by the loss of an employee named Jacqueline who died after a long battle with breast cancer.

"The donations we make to breast cancer research are not tied to sales; they are our way of honoring Jacqueline," O'Neil said in a statement.

But in many cases, cause-related marketing is not about charity, said Dwight Burlingame, associate executive director of the Center on Philanthropy at Indiana University.

"These businesses are promoting their product," he said.

At least one breast cancer charity is walking away from alcohol-related gifts.

"We have a partnership with alcohol, and I don't understand it, either," said Cindy Geoghegan, the new interim CEO at Breast Cancer Network for Strength. "Those kinds of relationships will not continue."

And though the Breast Cancer Research Foundation said it appreciates donations from Mike's Hard Lemonade, spokeswoman Anna DeLuca says, the group "in no way, shape or form endorses the consumption of alcohol."

"This donation does not constitute a partnership," DeLuca said.

Many Lincoln dealers were, until last spring, Lincoln-Mercury dealers. But now that Ford has killed off Mercury, dealers find themselves, shall we say, lacking in high-demand merchandise. Ford CEO Alan Mulally hopes to change that, but to save the Lincoln dealers he plans to destroy about 500 of them.

It always sounds strange when car manufacturers say that to grow, they need to reduce the number of dealers. Various justifications are offered. In Lincoln's case, the rap on many existing dealers is that they run a down-market operation that stacks up poorly against the competition -- namely, Lexus, BMW, Audi and Mercedes-Benz.

At a closed-door meeting with Lincoln dealers yesterday, Mulally reportedly showed videos of customers of Lexus, BMW and so forth talking about why they like their cars and how they are treated at the dealership. Some of the customers also had a few things to say about Lincoln, some of them not so complimentary.

The problem seems to be two-fold: a. Many Lincoln dealerships are in less-than-choice locations and don't present an image as upscale as their European and Japanese competitors; and b. Many consumers associate Lincoln with the aging Town Car, popular with limousine services but basically a dolled-up Ford Crown Victoria.

Well, not to worry. Mulally made it clear that the Town Car is on its way to the history books -- along with those 500 or so dealers. Although no details were offered, Ford said its design teams are hard at work on new sedans, SUVs and maybe even a pickup truck.

Meanwhile, dealers were told that if they want to remain on board, they need to make a serious financial commitment, including upgrading their showrooms and service departments to the level that luxury car purchasers have come to expect. Walking into a European or upscale Japanese dealership these days is more like visiting a spa than a car showroom. You never see anyone walking around with a greasy rag sticking out of his pocket, not even in the service department.

Lincoln today has about 1,200 dealers, about 500 of them in the 130 largest urban areas. Those urban areas account for about 85 percent of all luxury vehicle sales in the United States, so you have to wonder what those other 700 dealers are doing with their time.

One place Lincoln might start to rehabilitate its image is to do something about its vehicles' propensity to spit out spark plugs -- a failing that runs in the Ford family.

"The spark plug spit out in my used 1998 Lincoln Navigator with a big 5.4-liter V-8 engine causing over 4,000 dollars of damage," said Kevin of Chicago.

Eliminating Ford/Lincoln's bothersome penchant to burst into flames would also go a long way with motorists like Diane of Murrieta, Calif.

"At or around 2am on April 11th, my husband awoke to a loud noise in our garage. He opened the door to the garage to see that our 2001 Navigator was on fire in our driveway. The fire department arson expert told us about this problem with Fords and Lincolns. Before that morning, we had never heard of such a thing. We've owned the car since early 2003, and have never been notified by Ford or Lincoln of a recall, or any problems with the car," Diane said.

Salvaging Lincoln may be Ford's last chance to keep a toehold in the luxury market. It has already sold off Jaguar, Land Rover, Aston Martin and Volvo, saying it needed to concentrate its resources on its mass-market Ford brand.