Current Events in January 2011

You hear all kinds of advice from government agencies when bad weather strikes. We're warned not to shovel too much snow, not to eat food that may have spoiled while the power was off and so on and so forth.

All of this is true, of course, but the winter storms that have blasted the East Coast the last few weeks have revealed some additional pointers. Here are a few that we, in our constant search for consumer enlightenment, have established through painful trial and error.

• Don't count on your cell phone. When the lights went out in suburban Washington, D.C., this week, most of us immediately dived smartly for our smartphones, swamping the networks. A call from down the block sounded worse than the first words from the moon. It didn't matter all that much since our battery soon failed anyway. Our HTC Incredible is normally hard-pressed to run for an entire day on its battery. It lasted about eight hours after the lights went out.

• Don't count on your Kindle. We went cold turkey Wednesday morning when, for whatever reason, the Wall Street Journal didn't arrive on our Kindle. We had sacrificed a few hours of reading Tuesday night to keep the battery fresh for the morning, but our efforts were in vain, and our Tuesday night was very boring.

• Don't rent an expensive Pay Per View movie on a stormy winter evening. When the power goes out and stays out, your purchase flies off into the void.

• Watch where you park. We were careful not to park any of our fleet where it might be obliterated by passing snow plows, rare though such things are in our neck of the woods. What we didn't think of was the big tree that used to lean over our driveway. It doesn't lean anymore. Weighted down with snow, it fell onto our month-old Volkswagen.

• Those paper fire logs? Yeah, they look nice but they don't generate much heat. We had to wade out into the snow to retrieve some actual firewood from our long-neglected woodpile. It's hard to get wet hard wood burning but when you do, it will warm up a room nicely. (Cautionary note from our legal department: Only try this if you have a fireplace. Be sure to open the damper.)

• Be careful with candles. They are incredibly dangerous. Left to their own devices, other family members will put them in bookcases, next to piles of laundry and in the exact location where the cat is likely to leap.

• Don't assume the dogs are OK. Huddled beneath piles of blankets deep in the night, we noticed the dogs – who are not welcome under the covers -- were shivering. We got them their own blanket, which seemed to resolve the issue.

• Keep at least one faucet open slightly to keep water moving in your pipes. Frozen pipes are no fun.

• Drain your garden hoses before winter settles in. Gazing out the kitchen window at the Winter Hinterland, we discovered what seemed to be sleet but was in fact our garden hose exploding and shooting ice all over our deck, which subsequently became quite slippery.

• Don't go to a lot of trouble digging out your electric snow-blower. It won't work very well without electricity.

• Kick the coffee habit now!  Or make a thermos full of coffee at the first sign of bad weather.  Ever tried to make coffee on a gas grill in the middle of a blizzard?

• Don't buy a house on a hill.

The U.S. Department of Agriculture is issuing recommendations to help minimize the potential for foodborne illnesses in the wake of continuing winter weather patterns that dump multiple inches of snow and bring strong chilling winds that can leave wide swaths of communities without power for extended periods.

"Food safety becomes even more of a critical public health issue when winter storms that bring heavy snow, ice, bitter cold and strong winds are part of the forecast," said USDA Food Safety and Inspection Service Administrator Al Almanza. "I want to make sure those who could be impacted by winter storms have the information they need so they can ensure the safety of the food and water they may consume, even in the event of power outages."

Steps to follow to prepare for a possible weather emergency:

• Keep an appliance thermometer in the refrigerator and freezer. An appliance thermometer will indicate the temperature inside the refrigerator and freezer in case of a power outage and help determine the safety of the food.

• Make sure the freezer is at 0°F or below and the refrigerator is at 40°F or below.

• Freeze containers of water for ice to help keep food cold in the freezer, refrigerator or coolers after the power is out.

• Freeze refrigerated items such as leftovers, milk and fresh meat and poultry that you may not need immediately — this helps keep them at a safe temperature longer.

• Plan ahead and know where dry ice and block ice can be purchased.

• Have coolers on hand to keep refrigerator food cold if the power will be out for more than 4 hours. Purchase or make ice cubes and store in the freezer for use in the refrigerator or in a cooler. Freeze gel packs ahead of time for use in coolers.

• Group food together in the freezer — this helps the food stay cold longer.

• Store food on shelves that will be safely out of the way of contaminated water in case of flooding.

Steps to follow after the weather emergency:

• Keep the refrigerator and freezer doors closed as much as possible to maintain the cold temperature.

• The refrigerator will keep food safely cold for about 4 hours if it is unopened. A full freezer will hold the temperature for approximately 48 hours (24 hours if it is half full) and the door remains closed.

• Discard refrigerated perishable food such as meat, poultry, fish, soft cheeses, milk, eggs, leftovers and deli items after 4 hours without power.

• Food may be safely refrozen if it still contains ice crystals or is at 40° F or below when checked with a food thermometer.

• Never taste a food to determine its safety!

• Obtain dry or block ice to keep your refrigerator and freezer as cold as possible if the power is going to be out for a prolonged period of time. Fifty pounds of dry ice should hold an 18-cubic-foot full freezer for 2 days.

• If the power has been out for several days, check the temperature of the freezer with an appliance thermometer. If the appliance thermometer reads 40° F or below, the food is safe to refreeze.

• If a thermometer has not been kept in the freezer, check each package of food to determine its safety. If the food still contains ice crystals, the food is safe.

• Discard any food that is not in a waterproof container if there is any chance that it has come into contact with flood water. Discard wooden cutting boards, plastic utensils, baby bottle nipples and pacifiers.

• Thoroughly wash all metal pans, ceramic dishes and utensils that came in contact with flood water with hot soapy water and sanitize by boiling them in clean water or by immersing them for 15 minutes in a solution of 1 tablespoon of unscented, liquid chlorine bleach per gallon of drinking water.

• Undamaged, commercially prepared foods in all-metal cans and retort pouches (for example, flexible, shelf-stable juice or seafood pouches) can be saved.

• Use bottled water that has not been exposed to flood waters. If bottled water is not available, tap water can be boiled for safety. For more information on drinking water safely during weather emergencies, access the FSIS publication "Keeping Food Safe During an Emergency" at: www.fsis.usda.gov/Fact_Sheets/Keeping_Food_Safe_During_an_Emergency/index.asp

• When in Doubt, Throw it Out!

On Tuesday, the Food and Drug Administration (FDA) announced a possible link between a rare form of cancer known as Anaplastic Large Cell Lymphoma (ALCL) and breast implants.

FDA scientists reached that conclusion after examining scientific literature that focused on cases of ALCL in 34 women with breast implants -- as well as information from agency reports, international regulatory agencies, scientific experts, and breast implant manufacturers.

This week’s announcement by the FDA left some people wondering, “What took them so long?”

Public Citizen, a consumer advocacy watchdog group, said they brought this issue to the FDA over 22 years ago.

According to Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, he alerted the FDA back in 1988 after receiving information from an anonymous source regarding studies done by Dow Corning, makers of silicone breast implants in the 1980s and 1990s, that found silicone gel to be highly carcinogenic in animals, causing sarcomas.

"The petition contains quotes from memos written by FDA employees who were very concerned about these findings and wanted the public to be informed about this problem. This was the original basis for our asking the FDA to ban silicone gel breast implants,” said Wolfe.

Wolfe said even though the FDA’s announcement is limited to lymphomas, not sarcomas, sarcomas are still a possible threat, too.  A study published in the journal Human Pathology in November 2009 found sarcomas in five women with breast implants.

"Animal evidence of carcinogenicity, especially with the highly malignant tumors found in these studies, should be taken more seriously than the leadership in the FDA has done over the past two decades," said Wolfe.

In response to the possible cancer risk associated with breast implants, the American Society of Plastic Surgeons (ASPS) announced Wednesday they’re collaborating with the FDA to establish a national registry for breast implants.

The ASPS and the FDA agree this extremely rare form of lymphoma is not breast cancer. Of the estimated 10 million implants worldwide, only 34 cases of ALCL have been identified since 1989.

While lymphomas can appear anywhere in the body, this condition appears in the scar tissue that forms around the breast implants. At this time both the FDA and ASPS remain confident that breast implants are safe and effective.

“ASPS shares the FDA’s commitment to patient safety, but we also want to make certain this information does not raise false alarms with our patients,” Phillip Haeck, MD, ASPS President, said.

“We’ve been down this path before. For nearly 20 years American women were denied access to their choice of breast implants because of false claims and unfounded science. We are determined this shouldn’t happen again.”

ASPS recommends that women with breast implants should continue their normal routine in medical care and follow-up, specifically regular self examination and mammography when appropriate.

Women with breast implants should watch for changes in their breasts such as pain and swelling and contact their plastic surgeon if they have questions.

Foreclosure activity increased last year in 149 of the nation's 206 metropolitan areas with a population of 200,000 or more -- suggesting the foreclosure problem has yet to peak.

But the year-end report from RealtyTrac, a foreclosure marketing firm, also showed the metro areas with the 10 highest  foreclosure rates all posted decreasing foreclosure activity since2009. Six  of the top 10 also posted decreasing foreclosure activity from 2008. Analysts say that suggests stability may be returning to the hardest-hit markets.

"Foreclosure floodwaters receded somewhat in 2010 in the nation's hardest-hit housing markets," said James J. Saccacio, chief  executive officer of RealtyTrac. "Even so, foreclosure levels remained five to 10 times higher than historic norms in most of those hard-hit markets, where deep faultlines of risk remain and could potentially trigger more waves of  foreclosure activity in 2011 and beyond. Meanwhile foreclosures became more  widespread in 2010 as high unemployment drove activity up in 72 percent of the  nation's metro areas, many of which were relatively insulated from the initial  foreclosure tsunami."

The usual suspects

California, Florida, Nevada and Arizona cities accounted for 19 of the top 20  metro foreclosure rates, with Boise City-Nampa, Idaho the lone exception at No.  20. Boise also was one of only three metros in the top 20 where foreclosure  activity increased from 2009, along with the Florida metro areas of Deltona-Daytona Beach-Ormond Beach at No. 13 and Tampa-St.  Petersburg-Clearwater at No. 17.

Top 10 metro foreclosure rates

Las Vegas-Paradise continued to post the nation's highest metro foreclosure rate, with one in  every 9 housing units (10.88 percent) receiving a foreclosure filing in 2010 -- nearly five times the national average. A total of 88,198 Las Vegas-area  properties received a foreclosure filing in 2010, a decrease of 7 percent from  2009 but still up 31 percent from 2008.

Despite decreasing foreclosure activity from both  2009 and 2008, Cape Coral-Fort Myers, Fla., documented the nation's second highest metro  foreclosure rate -- with one in every 12 housing units (8.40 percent) receiving a  foreclosure filing in 2010. A total of 30,660 properties in the metro area  received a foreclosure filing in 2010, down 28 percent from 2009 and down 25  percent from 2008.

Modesto, Calif., also reported a decrease in  foreclosure activity from 2009 and 2008, but the metro area still posted the  nation's third highest metro foreclosure rate with one in every 14 housing  units (7.34 percent) receiving a foreclosure filing in 2010.

Along with Cape Coral-Fort Myers and Modesto, four other metro areas with foreclosure rates in the top 10 also reported two-year  decreases in foreclosure activity: No. 6 Riverside-San Bernardino-Ontario,  Calif., where foreclosure activity was down nearly 20 percent from 2009 and  nearly 10 percent from 2008; No. 7 Stockton, Calif., where foreclosure activity  was down nearly 19 percent from 2009 and nearly 25 percent from 2008; No. 8  Merced, Calif., where foreclosure activity was down nearly 31 percent from 2009  and 30 percent from 2008; and No. 10 Vallejo-Fairfield, Calif., where foreclosure  activity was down 12 percent from 2009 and 3 percent from 2008.

Other metro areas with foreclosure rates in the top 10 were Phoenix-Mesa-Scottsdale at No. 4 (7.27 percent); Miami-Fort Lauderdale-Pompano Beach at No. 5 (7.08  percent); and Orlando-Kissimmee at No. 9 (6.86 percent).

Foreclosure activity trends were evenly split in  the nation's 20 largest metro areas, with 10 of those metro areas showing  decreasing foreclosure activity from 2009, and 10 showing increasing  foreclosure activity from 2009.

The United States has filed a complaint against Boston Scientific Corp. and related Guidant entities under the False Claims Act for conduct relating to certain of its cardiac devices, according to the Justice Department (DOJ).

The government accuses Guidant of selling cardiac devices -- the Ventak Prizm 2 and the Renewal 1 and 2 -- even though the company knew the devices were defective. Despite Guidant’s fixing the defect in these lines of devices, the company continued to sell their remaining stock of defective devices anyway.

The devices at issue are implantable cardioverter defibrillators, which are designed to deliver therapy to prevent sudden cardiac death. They are surgically implanted into patients’ chests. When they detect an irregular heartbeat, the devices send an electrical pulse to the heart to "shock" it back to normal rhythm.

Problems hidden

The government’s complaint alleges that Guidant hid the problems with their defibrillators from patients, doctors and the Food and Drug Administration (FDA). In February 2010, Guidant pleaded guilty to misleading the FDA about the problems in the devices. A district court in Minnesota accepted the company’s plea on Jan. 12, 2011. Guidant was acquired by Boston Scientific in 2006.

"Patients with serious heart conditions who depend on these devices should not have to second-guess whether they are safe and effective," said Tony West, Assistant Attorney General for the Justice Department’s Civil Division. "When a medical device manufacturer conceals problems with its products, as is alleged here, not only is taxpayer money wasted, but lives are put at risk."

"When companies like Guidant request and receive federal dollars for products they know to be defective, the United States is committed to aggressively seeking the recovery of those payments," said John R. Marti, First Assistant U.S. Attorney for the District of Minnesota. "That is especially true when the defective products endanger human lives. In today’s environment, it is essential that Medicare and other public health care programs be made whole to ensure their continued vitality for future generations."

The United States alleges that Guidant knew as early as April 2002 that an implantable cardiac device it manufactured and sold, known as the Prizm 2, contained a potentially life-threatening defect. The government’s complaint also maintains Guidant knew as early as November 2003 that another implantable device it manufactured and sold -- the Renewal 1 and 2 -- contained a similar, potentially life-threatening defect.

Yet, the United States alleges that, even after Guidant took corrective action to fix the defects, the company continued to sell its stock of the old, defective versions of the devices. Moreover, as information about the cause and nature of the defect grew within the top ranks of the company, the United States contends that Guidant took steps to hide the problem from patients, doctors and the FDA.

Failure to disclose

According to the government’s complaint, instead of disclosing the problem, Guidant issued a misleading communication to doctors that misinformed them about the nature of the defect.

The United States alleges that Guidant did not fully disclose the problem in the devices to doctors and the FDA until May 2005, after first being contacted by a reporter. The company subsequently recalled the devices shortly after a front-page article about the defects appeared in The New York Times.

The United States joined a lawsuit filed under the qui tam or whistleblower provisions of the False Claims Act by James Allen, who allegedly received one of the defective devices. Under the act’s qui tam provisions, a private citizen, known as a "relator," can sue on behalf of the United States and share in any recovery. The case is United States ex rel. Allen v. Guidant LLC et al., No. 11-CV-22 (D. Minn.).

Nursing homes in the poorest ZIP codes in the country are twice as likely to close as the richest ones, giving residents -- particularly minorities -- fewer choices for long term care.

Overall, the United States lost five percent, or 96,902, of its total nursing home beds between 1999 and 2008, as patients with means sought assisted living or other forms of home and community-based care instead.

Nursing homes were also 1.38 times more likely to close in the most predominantly black ZIP codes than in ZIP codes with the lowest representation of blacks, and 1.37 times as likely to close in the most predominantly Hispanic ZIP codes than in the least Hispanic areas.

The research is reported in the journal Archives of Internal Medicine.

Long-term issue

“This is an issue that is not going to go away, precisely because of the aging of the population and the increasing bifurcation of society into rich and poor,” says Vince Mor, professor of community health at Brown University.

Researchers, led by Zhanlian Feng, assistant professor of community health, say in the future people in poor urban neighborhoods will have to travel significantly farther to a nursing home. In ZIP codes where at least one nursing home closed during the decade, the shortest distance to another home increased to 3.81 miles from 2.73 miles.

“The further the patient is from their neighborhood, the more difficult it is for their family members and their neighbors to come visit them,” Mor says.

Vulnerability

In the study period, most nursing homes, whether freestanding or on hospital campuses, in rich neighborhoods and poor ones, have become more economically vulnerable. Homes that depend on Medicare and Medicaid for most or all of their revenue -- for instance those serving poor patients -- have suffered the most pressure.

When money becomes tight, especially at a somewhat inefficiently run home, quality of care declines, sometimes to the point where officials must consider shutting it down.

“This leads to a moral dilemma,” Mor says. “If the local nursing home is closed because their quality is so poor, that’s good, but the cost of that closure is disproportionately borne by a community. How much do you invest in a failing facility and how do you make that investment without rewarding a bad actor who runs a lousy place?”

Alternatives

If finding new money for nursing homes is not the entire answer for preserving access for the poor to long-term care, another option is to shift more money toward alternatives like assisted living, home-based care and community-based care, Mor says.

The new health care law and a system of waivers within Medicaid encourage states to do just that, but they are not targeted specifically to helping the urban poor or minorities, and they are optional programs. By contrast, reimbursements for nursing home care are legally required.

“Given the current budget environment, it is really uncertain how sustainable these alternatives will be,” says Feng. “Nursing homes are generally perceived as a last resort,” he says, but for millions of Americans desirable options in that undesired choice continue to decline.

The study was funded in part by the National Institute on Aging.

It's happened to most of us: you order something with an olive in it -- maybe a salad or a sandwich -- and bite into it, discovering suddenly that the fruit is not of the pitless variety. This may lead to a grimace or, on a bad day, maybe a curse -- but a lawsuit?

That's apparently the end game for Ohio Congressman Dennis Kucinich, who says in court papers that a wrap he ordered from a Capitol Hill cafeteria was “unwholesome and unfit for human consumption, in that it was represented to contain pitted olives, yet unknown to plaintiff contained an unpitted olive.”

Kucinich's suit, filed Wednesday in Washington, D.C., Superior Court, says that the wrap caused him “serious and permanent dental and oral injuries requiring multiple surgery and oral procedures.” The congressman also claims that he has suffered “significant pain, suffering and loss of enjoyment.”

Years-old incident

Despite the significant media coverage that Kucnich's suit has engendered, the incident happened nearly three years ago -- his suit says that he purchased the wrap “on or about April 17, 2008.”

The suit targets Restaurant Associates, which manages the cafeteria in the Longworth House Office Building, one of the four buildings used by members of the House of Representatives, as well as its parent company Compass Group.

Kucinich, whose campaign Website labels him “America's most courageous congressman,” hasn't been publicly exhibiting any of the “pain [and] suffering” he says he has experienced. According to an ABC report, Kucinich gave a speech on the floor of the house shortly after the alleged incident occurred. He also made no public mention of the injurious sandwich until five days after the mishap.

Negligence and warranty claims alleged

Kucinich's lawsuit alleges counts in negligence and breach of implied warranty. As to the negligence count, his complaint says the defendants “breached [their duty of care] by serving plaintiff food that ... contained dangerous substances, namely an olive pit, that a consumer would not reasonably expect to find in the final product served.” Regarding the breach of implied warranty claim, Kucinich says that the defendants reneged on their implied promise that “food sold by them for consumption was was fit for the ordinary purposes for which such goods are used.”

The suit, which demands damages in the amount of $150,000, was filed by Andrew R. Young, a prominent Cleveland-area attorney whose website lists him as a Super Lawyer.

Most parents may not realize that about the time the first little teeth start sprouting up through their infants’ gums is the best time to start seeing a dentist.

Think it’s too early? Temple University pediatric dentist Mark Helpin says taking your toddler to see the dentist puts him or her on the path to overall good health.

Early start

“A child should be first seen by a dentist by 12 months of age or within six months of the time that the first tooth emerges into the mouth,” said Helpin, who is acting chair of pediatric dentistry in Temple’s Maurice H. Kornberg School of Dentistry.

Helpin said at such at early age, the dentist’s focus will be more on prevention than treatment, including oral hygiene instructions such as how to clean the whole mouth, diet, fluoride, non-nutritional habits such as thumb sucking and injury prevention.

“We’re trying to follow the medical model of care for children by preventing disease from occurring before it begins,” he said. “What we want is to establish a ‘dental home’ for the child, as well as their parents, where they can go to get comprehensive and continuous oral health care.”

Thorough exam

According to Helpin, during the initial visit, the dentist should thoroughly exam the child’s teeth and gums, the roof and floor of the mouth and the shape of the developing jaws.

He or she should also discuss proper diet and nutrition and show the parent or guardian how to brush at home. The dentist may also clean the child’s teeth -- even if it’s only one or two to start.

Helpin said that although some might think preventive care is less important for baby teeth since they eventually fall out, keeping a young child’s teeth and mouth clean is imperative in order to control cavity-causing bacteria.

“Cavities are an infectious disease and are the most common, chronic disease during childhood,” he said. “It is five times more prevalent in children than asthma. And it is entirely preventable if we begin a program of oral health care early on.”

Need for treatment 

Left untreated, Helpin says cavities can cause an infection that can make a child ill. Cavities can also affect the development of permanent teeth if left untreated.

“The permanent tooth is sitting under the primary tooth and if it is exposed to this infection, it can become malformed,” he said. “In addition, the baby teeth guide the permanent teeth to where they should go in the mouth.”

Good development in permanent teeth is important for aesthetics, chewing and biting and speech development.

Helpin said if a primary tooth needs to be extracted due to infection caused by an untreated cavity, the permanent tooth may need assistance from a dentist in finding its proper location in the mouth.

“It’s best to keep babies, infants, toddlers and children healthy, and that includes good oral health that starts with an early visit to the dentist,” he said.

Discussion about kids with food allergies tends to focus on the elementary school set.  Parents and teachers are encouraged to play a very active role in making sure the classroom is a safe haven for little ones.

But what about when those young kids with food allergies enter high school?

Despite being older and wiser, new research reveals teens with severe food allergies feel less safe and less confident school personnel will keep them safe once they leave the sixth grade.

The study consulted directly with 20 kids -- ten children ages 8 through 12 and ten teenagers -- from various public schools in Ontario, Canada.

All the participants have potentially life-threatening food allergies which require them to carry an injectable form of adrenaline to treat episodes should they come in contact with a food allergen.

Both age groups said they felt isolated, excluded, or were more likely to be teased as a result of various environmental or social barriers. Most kids said they regularly miss out on school activities, camps, or time with friends.

“I feel left out because I can’t have everything, like my friends and the other people in my family,” one 16-year-old said.

Close friends provide key support to allergic kids but the teenage study participants said the thing that kept them from feeling totally safe in school was uninformed or misinformed teachers and school personnel.

And while those can be found at any grade level, elementary schools were considered safer because of the stronger presence of parents and consistent routines involving supervised lunch rooms, trained staff, and better communication strategies.

Less supervision

High schools were perceived as less safe because of the lack of homerooms, unsupervised lunch areas where food fights sometimes take place, and more uninformed staff.

Young children relied more on parents and teachers to cope, whereas teens often anxiously fended for themselves by avoiding risky foods, educating others, navigating confusing food labels and quickly escaping from unsafe places.

Some felt disempowered and overburdened and even developed symptoms like constant hand washing or waiting to eat until an adult was present who was available to drive them to the hospital.

Lead authors Nancy Fenton and Susan Elliott said the study “provided insight into more effective ways of informing educational and interventional efforts in responding to risk in schools.”

The study is considered exploratory by the authors, who caution against broader conclusions because of its limited sample size, but said the findings also suggest teens can benefit from discussing their perceptions of the safety of their school environment in improving their ability to cope.

The research also provides information for parents and allergic children to help inform school policies around risk management and coping.

Food allergy affects up to 6 percent of young children and results in an estimated 150-200 fatalities each year in the U.S. and 15-20 deaths in Canada.

Accidental exposures are common and occur in homes, camps and restaurants in addition to schools.

The study, “Illustrating Risk: Anaphylaxis Through the Eyes of the Food-Allergic Child,” was conducted by Canadian researchers and appears in the January issue of the journal “Risk Analysis” published by the Society for Risk Analysis.

The authors include Nancy Fenton of McMaster University, Susan J. Elliott of the University of Waterloo, Lisa Cicutto of the University of Toronto, Ann E. Clarke of McGill University, Laurie Harada of Anaphylaxis Canada, and Elizabeth McPhee of the Community Services Agency in Hamilton, Ontario.

The research was funded by AllerGen-NCE, Inc., with the support of Anaphylaxis Canada.

Nearly 300,000 Americans collapse from cardiac arrest each year. Quick response by medical personnel and bystanders using automated external defibrillators (AEDs) save some of them, but the U.S. Food and Drug Administration says there are too many instances of faulty and malfunctioning defibrillators.

An FDA advisory panel has been studying the issue, amid reports that there have been more than 28,000 reports of defibrillators failing and at least 68 recalls issued involving hundreds of thousands of the devices over the last five years.

Some of the malfunctions have caused or contributed to patient deaths, the FDA said, and a report found that the number of problems has been increasing over the last few years.

Even as malfunctions and recalls increase, the medical devices industry has been pressing for less strict regulation, a suggestion the FDA has so far rejected.

“While the FDA continues to advocate use of these important life-saving devices and is not recommending any change to current clinical practices, we believe the devices can be improved in ways that improve patient safety,” the agency said in a statement.

Testifying before the advisory panel, Dr. Michael Carome, deputy director of Public Citizen's Health Research Group, said 17 of the recalls were serious enough to be Class I recalls, involving situations in which there is a reasonable probability that using the product will cause serious injury or death.

Collectively, these 17 Class I recalls alone involve well over 100,000 AEDs and have resulted in deaths or life-threatening situations for many patients, Carome said.

“In the interest of protecting public health and promoting innovation, it is imperative that FDA reject industry wishes” and maintain strict regulation of the design and manufacture of the devices, Carome said, adding that applications for new designs “must include data from robust clinical trials that reasonably assure that AEDs are safe and effective.”

In a related development, a Read more finds that cardiac arrests that can be treated by electric stimulation, also known as shockable arrests, were found at a higher frequency in public settings than in the home. Read more

An auto service contract company that used illegal telemarketing calls to trick seniors and other car owners into signing up is now barred from operating in North Carolina, Attorney General Roy Cooper said Tuesday.

Automotive Protection of New Jersey is the third company prohibited from selling or pitching auto service contracts in North Carolina in as many months. In November, North Carolina Attorney General Roy Cooper won an agreement with the individuals who ran U.S. Fidelis, formerly the nation's number one seller of car service contracts. In December, Credexx and its owner were banned from doing business in the state.

Under scrutiny

"Each week, we hear from people who aren't getting their money's worth from auto service contracts," Cooper said. "We're watching this industry closely to protect North Carolina drivers."

Superior Court Judge Abraham Penn Jones on Tuesday granted Cooper's request for a default judgment against Automotive Protection and its manager Christopher Doyle. The judgment resolves Cooper's suit filed against the company in February of 2009.

Under the judgment, the defendants are prohibited from telemarketing in North Carolina and from selling or administering auto service contracts in the state. Any consumer who purchased a contract from Automotive Protection now has the option to cancel it. Automotive Protection and Doyle have also been ordered to pay $4.5 million in civil penalties, which would go to North Carolina public schools.

Not true warranties

Auto service contracts are different from true warranties, which are included in the price of vehicles and offered through the manufacturer. Service contracts are sold separately, usually by third party sellers, for an extra charge.  Consumers often pay more than $1,000 for an auto service contract.

Over the years, ConsumerAffairs.com has received hundreds of complaints about various companies selling these service contracts. The most common complaint is the coverage is very limited. Often, the consumer’s needed repair isn’t covered.

These policies are heavily marketed through direct mail and telemarketing, with an implied message that a consumer faces financial exposure if they do not purchase one of these contracts.

Cooper says a total of 25 consumers filed complaints about Automotive Protection calls and sales practices, and the Attorney General's Office was able to work with the third-party finance company to cancel some contracts and save consumers money.

Targeting seniors

An investigation by Cooper's Consumer Protection Division uncovered that Automotive Protection targeted consumers aged 65 or older and frequently called people who had signed up for the Do Not Call Registry to stop telemarketing calls. The company's telemarketers tricked consumers by pretending to represent car manufacturers and claiming to sell auto service contracts that offered bumper-to-bumper protection.

Consumers were told they could cancel anytime, but those who purchased a contract had a difficult time getting the company to honor their wish to cancel. Cooper says Automotive Protection gave out the wrong contact information to make it hard for consumers to reach the company, refused to answer the phone or return consumers' messages, and claimed they didn't receive the cancellation notices. In some cases, even when consumers cancelled properly, the defendants charged their bank accounts or credit cards anyway.

"Think twice before you respond to a pitch for an auto service contract," Cooper urged consumers. "Do your own research to see if you really want or need extra warranty coverage. Don't just take the sellers' word for it."

Keep the following tips in mind to avoid trouble with auto service contracts:

• Don't fall for urgent calls or letters warning you that your car warranty is about to expire. Be sure to review your current warranty to see if it's still active and don't give in to pressure from salespeople.

• Read both the manufacturer's warranty and the service contract carefully. If they cover many of the same parts for the same period of time, you probably don't need the service contract. 

• Read the entire contract before you sign or pay any money. Make sure that any spoken promises are put in writing. If the service contract doesn't say that an item is covered, assume that it isn't.

• Most extended service contracts have a deductible, meaning you'll pay a fee for each repair. Be sure to read the contract to determine if you're required to pay upfront for the repair and then wait to be reimbursed.

• Make sure you are dealing with a reputable seller and are ready to purchase before you give them your bank account or credit card information over the telephone.

Ian’s is voluntarily recalling specific lot numbers of two products due to a risk of contamination with Listeria monocytogenes.

Listeria monocytogenes is an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people and others with weakened immune systems.

Although healthy persons may suffer only short-term symptoms such as high fever, severe headaches, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths in pregnant women.

The following two products with the specific use-by dates and UPC codes listed are being recalled because they may have been distributed to retailers nationwide and sold in the frozen foods section of the supermarket:

• 8-ounce boxes of Ian’s Wheat Free, Gluten Free Mac and No Cheese with a use-by date of 26Aug2011 and UPC code 7-49512-43670-8 (372 packages affected)

• 8-ounce boxes of Ian’s Wheat Free, Gluten Free French Bread Pizza with a use-by date of 28Aug2011 and UPC code 7-49512-91572-2 (120 packages impacted)

A total of 492 individual boxes are potentially affected.

Consumers who purchased the above products with the specific use-by dates and UPC codes listed are asked to return the products to the place of purchase to receive a full refund.

Products that do not contain the specific use-by dates and UPC codes listed are not affected by the recall, and can be used by consumers.

Before young couples decide to get married, they may discuss lots of things: children, politics, dreams and aspirations. But chances are they haven't talked about money.

In fact, one out of five respondents in a recent survey revealed that they avoided the subject altogether before walking down the aisle. The Zogby survey commissioned by zendough.com, part of the TransUnion credit bureau, found that nearly one in five respondents either didn't think of discussing finances before getting married or thought about having "the talk" -- but avoided the conversation.

Only one-fourth -- 24.2 percent -- talked about finances and took the important step to create a budget before tying the knot. One-third said they did not know their spouse's credit score, even though one spouse's poor credit score could affect a couple's access to credit in the future.

Approaching the discussion

"Discussing finances with your significant other can be scary and awkward, but being open and honest about your individual financial situation can help you avoid issues or stress down the road," said Heather Schneider, education director for zendough.com.

The experts at zendough.com offer the following pre-marital discussion tips:

• Be honest with your future spouse and discuss your financial goals and dreams.

• Make a list of creative ways to manage wedding expenses. For example, using potted flowers and making the invitations yourself can help shrink your costs without reducing your style.

• Discuss whether to establish joint checking and savings accounts.

• Develop a money management plan that meets both your needs.

• Allocate part of your monthly budget to saving for a down payment on a home or other large purchase. For example, if you'll jointly earn $100,000 per year, saving 5-10 percent of that could help cover a portion of a down payment on a home.

• Regularly review your credit and debt information to help each of you better understand your collective financial situation.

Before starting a family, couples should make a list of the essentials and the "nice to haves" for the baby and focus on the essentials. For instance, it's important to evaluate your medical insurance policy to see what expenses will be covered during pregnancy and infancy.

Be practical

You probably don't really need that top-of-the-line, high-priced stroller or crib with all the bells and whistles. Consider purchasing a highly recommended, reputable and safe stroller or crib that still fits within your budget and you'll have money left over for diapers and formula.

While it may seem early, couples can open a tax-advantaged or other college fund for their newborn by setting aside a specific amount each month. This can help alleviate stress when it's time to send kids off to school.

And while you're in the plan-ahead mode, research the cost of childcare and discuss which options are right for your family. Do your best to be sure your financial house is in order before baby arrives. You can get started on this by working together to reduce debts and making sure both of you have credit that's in good standing.

But first, you have to have that conversation about money.

Hospital quality watchdog The Leapfrog Group issued a Call to Action in response to its new findings that thousands of babies are electively scheduled for delivery too early, resulting in a higher likelihood of death, being admitted to a neonatal intensive care unit (NICU), and various life-long health problems.

Despite the importance of this issue to women and babies, Leapfrog said is the first national organization to make this information public by hospital.

No set standards

The findings from 773 hospitals in Leapfrog's 2010 annual hospital survey reveal significant variation among hospitals in their rates of early elective cesarean section and elective inductions, with some hospitals having ten times the rate of others.

Leapfrog CEO Leah Binder said hospitals, health plans, providers, and communities need to do more to protect women and babies from this harmful practice. "And women need to protect themselves by refusing to schedule their deliveries before 39 weeks without a sound medical reason, and by knowing the facts about the hospitals they plan to deliver in," she added.

Binder noted that currently only hospitals that report to Leapfrog's annual hospital survey are making their rates of early elective deliveries public.  "Every hospital should publicly report on their rate and actively prevent the practice, and every woman planning to give birth should demand the information."  

Caution urged

Experts, including those from the American College of Obstetricians and Gynecologists (ACOG), Childbirth Connection and the March of Dimes, caution that the amount of time a baby needs to develop fully -- which includes having a fully developed brain and other organs --is at least 39 completed weeks.

Sometimes there is a medical reason to schedule a newborn delivery before the 39th week -- for example, if the mother has high blood pressure at the end of pregnancy or broken membranes before labor begins.

However, Leapfrog finds many newborns are being "electively" scheduled for delivery before the 39th week, meaning without a medical reason, at alarming rates.

According to the group, hospital rates of early elective deliveries range from less than five percent to more than 40 percent.

The 773 hospitals from around the country that voluntarily provided Leapfrog with information on this measure reported over 57,000 early elective deliveries by cesarean section or induction during the reporting period.

Variations

The variation in hospital rates has long been talked about in the health care community, but Leapfrog's release of 2010 data is the first real evidence that the practice of scheduling newborn deliveries before 39 weeks without a medical reason is common and varied among hospitals even in the same state or community.

For example, in the city of Los Angeles, hospitals reported rates as low as 4 percent and as high as 29 percent. In Boston, Leapfrog saw similar variation with some hospitals reporting near 0 and others as high as 27 percent.

In light of these findings, Leapfrog, Childbirth Connection, and the March of Dimes are working together to provide information about the importance of every week of pregnancy with women, purchasers, and others.

Awareness campaign

Leapfrog also announced a Call to Action to other leaders in the health care community to prevent elective deliveries before 39 weeks.  

So far, health insurance companies Aetna, CIGNA, UnitedHealthcare, and WellPoint have all responded to the call and are collaborating on an awareness campaign that includes three key messages:

• The last weeks of pregnancy are important
• There are risks for mothers and babies if births are scheduled before 39 weeks for nonmedical reasons
• Expectant mothers should investigate the rates of elective deliveries for hospitals in their community  

Leapfrog's membership of employers and regional business coalitions plans to help raise awareness by providing Leapfrog data along with resources from Childbirth Connection and the March of Dimes with their employee populations.

Leapfrog also plans to host two national Webinars for health care professionals, focusing on the new 39-week toolkit developed by the March of Dimes and its partners.  

Critical period

Alan R. Fleischman, MD, senior vice president and medical director of the March of Dimes said the last few weeks of pregnancy are critical to a baby's health because important organs, including the brain and lungs, are not completely developed until then.

"We thank Leapfrog for making this data available. A baby's birth should not be scheduled before 39 weeks of pregnancy, unless their health care provider says it's medically necessary. The 39-week toolkit can help ensure that inductions and c-sections are done at the right time and for the right reasons," said Fleischman.

Maureen Corry, executive director for Childbirth Connection, a national advocacy organization that works to improve the quality of maternity care, salutes Leapfrog for making hospital rates of elective delivery accessible so women can make an informed decision about where to give birth.

"Now we need to make the data available for all hospitals and individual physicians and midwives. We are pleased to join Leapfrog's Call to Action by providing women with evidence-based resources on benefits, harms, and appropriate use of labor induction, including tips and tools for avoiding an unnecessary induction,” said Corry.

Setting goals

In 2010, Leapfrog's target for hospitals was a cesarean section and/or induction rate of less than 12 percent of the total number of non-medically indicated deliveries occurring between the 37th and 39th week of gestation.  

In 2011, Leapfrog will lower the target to five percent. This change was made in part because 50 percent of reporting hospitals were able to meet Leapfrog's 12 percent target in 2010 and 29 percent of reporting hospitals exceeded Leapfrog's target by reporting rates of five percent or less.

Additionally, Leapfrog has identified several hospitals and health systems, such as Hospital Corporation of America, which have promoted and supported implementation of policies to deter doctors from scheduling cesarean sections and elective inductions for nonmedical reasons.

The group said this example suggests all hospitals can help implement policies that improve adherence to evidence-based care.

We all feel pain at some point. And while we can often pinpoint the source of our discomfort, the answer may not always be so obvious.

If you’re suffering from pain and you aren’t sure why, consider some everyday items and activities. From our choice of shoes to what we do on the weekends, sometimes our simple daily decisions may be the culprit. Charles Friedman, D.O. pain specialist at Pain Relief Centers in Pinellas Park, knows of some surprising pain triggers and ways to avoid them.  

Wardrobe malfunction

When we wake up in the morning, it’s not very likely we’re thinking about how painful our shoes or accessories are going to be when we’re getting ready for the day ahead. However, it’s possible that paying attention to what we put on our body or carry around with us could prevent problems a few hours later.

Take our shoes for example. “It’s well-known that high heels can cause pain,” says Friedman, “but few people realize that flip-flops may just be worse. They offer almost no arch support, which can lead to pain not only in all areas of the foot, but the ankles and knees as well.” Friedman suggests reserving the flip-flops for the beach or pool and wearing shoes with better arch support for everyday use.

While they’re meant for our convenience, our everyday accessories can often lead to inconvenient pain. Sure, that wallet may prevent you from misplacing your credit card, but it can also hurt your back. “Placing your wallet in your back pocket, especially while sitting, can place unnecessary pressure on the sciatic nerve, causing pain in both the back and legs,” says Friedman. “The easiest way to prevent this is by removing your wallet before getting in your car or taking a seat.”

A day at the office

While many of us may say it in a joking manner, sometimes our jobs can literally be “a pain.” For example, if your desk chair is positioned poorly, it may cause you to slouch, straining your back and neck. A computer monitor placed anywhere but eye level pulls on the muscles in the neck, creating neck pain. The best way to alleviate this workstation discomfort is by making a few minor adjustments.

“Adjust your chair so you can sit upright while placing your feet comfortably on the floor, and place your computer screen at eye level,” says Friedman. “Rearranging your office space can make a big difference if you often suffer from pain in your back or neck.”

The computer keyboard is another workplace culprit. Without proper positioning, it cannot only cause everyday finger and wrist pain, it can lead to a more serious problem. “Repetitive motion, such as typing on a keyboard, can cause a nerve problem called carpal tunnel,” says Friedman. “To avoid this, adjust your keyboard by tilting it to keep your wrists and arms in alignment.”  

Weekend plans

You’ve worked all week and now it’s time for some relaxation. But even your leisure time can cause pain if you don’t do it properly. If you slouch or lounge on the sofa with your neck turned toward the television, your back and neck may not be as relaxed as the rest of you. Try to maintain proper posture even during your R&R.

For many people, the weekends are less about lounging and more about enjoying those things you can’t while in the office eight hours a day. If you like to engage in more physical activities on the weekends, be careful if you’ve been sedentary in the office all week.

“If your muscles aren’t prepared for the level of activity, they are more likely to suffer strains,” says Friedman. “Make sure to stretch your muscles and start with a lighter activity to warm-up. Also, by exercising regularly, your muscles will be better prepared for more strenuous activity on the weekends.”

So before you slip on those flip-flops or start entering data on that keyboard, remember that they may cause more discomfort than you would like. But with a few minor adjustments, these surprising pain triggers won’t have to be a pain in your life.

When it comes to economic development in American cities, that line from the movie Field of Dreams -- “If you build it, they will come” -- may not work.

Conventional wisdom holds that job growth attracts people to urban areas. But according to a study in the Journal of Urban Affairs, sociologist Zachary Neal found the opposite to be true. Bringing the people in first -- specifically, airline passengers traveling on business -- leads to a fairly significant increase in jobs, he says.

“The findings indicate that people come first, then the jobs,” says Neal, assistant professor at Michigan State University. “It’s just the opposite of an ‘If you build it, they will come’ sort of an approach.”

However, this job growth tactic may not work for all cities.

People places

According to the study, municipalities with the greatest potential to convert business passengers into new jobs were largely “sunbelt” cities such as Phoenix, Miami, Dallas, Houston, and Riverside, Calif. Those with the least potential were mostly East Coast or Midwestern cities such as Boston, Pittsburgh, and Detroit.

For the study, Neal examined the number of business air-travel passengers in major U.S. cities during a 15-year period (1993-2008). Business passengers destined for a city and not just passing through are a key to job growth, he says.

Attracting business travelers to the host city for meetings and other business activities by offering an easily accessible airport and other amenities such as hotels and conference centers is one of the best ways to create new jobs, Neal says.

Climate for growth

These business travelers bring with them new ideas and potential investment, which creates a positive climate for innovation and job growth. In the study, Neal analyzed all permanent nonfarm jobs.

He says the finding does not contradict more direct job-creation strategies, including the construction of office and retail spaces, which can often lead to new jobs in the area. However, such approaches are unlikely to attract business travelers and others to the area.

The study helps clarify the relationship between the two main ways cities can grow: by attracting new people and by attracting new jobs. Attracting new people to a city leads to job growth, but job growth does not attract new people, he says.

Neal adds that business airline traffic is far more important for a city’s economic vitality than population size -- a finding he established in an earlier study and reaffirmed with the current research.

“One might expect to see a bump up in jobs first, and then a year or two later an increase in business passenger traffic,” Neal says. “But we saw just the opposite. There was a bump up in business traffic and then about a year later a bump up in jobs. The business passengers were coming before the jobs did, rather than after.”

A federal judge in Santa Ana, Calif., has refused to dismiss about a dozen cases charging that Toyota failed to inform consumers about a defect in the antilock braking systems of certain Prius and Lexus models.

U.S. District Judge Cormac Carney ruled that the plaintiffs had established enough evidence to proceed under California's Unfair Competition Law and Consumers Legal Remedies Act as well as the implied warranty laws of various states.

The case was filed last February after Toyota recalled 150,000 Priuses and Lexus HS-250h models from the 2010 model year because of a defect in their antilock braking systems.

The suits claim that Toyota refused to repair the alleged defect. Furthermore, they say, Toyota knew about the alleged defect as early as 2004.

The claims were brought on behalf of consumers who bought or leased a 2004 to 2009 Prius, 2006 to 2010 Highland Hybrid, 2006 through 2008 Lexus RX 400h, or 2010 Lexus RX 450h. The suits allege that the antilock braking systems do not engage properly, causing drivers to take longer to stop.

The results included accidents that cost plaintiffs "several thousand dollars worth of damage to their cars and other's cars," according to Carney's order.

At the time of the Feb. 9, 2010, recall, ConsumerAffairs.com reported that, although the recall was limited to 2010 models, owners of Priuses from other model years had reported similar problems.

“From day one I have noticed the brakes do not work properly,” Lisa of South Salt lake, Utah, said. “At first I thought it was just a terrible car for rain or snow but it was having problems in the slightest rain shower.

“Now that I'm aware of the brakes slipping I've noticed it's every day, the roads will be perfectly dry, I have brand new tires, the brake pads just barely checked at the dealer, but if I hit a bump I have no brakes,” she said.

Toyota said it would update software in the vehicles' anti-lock brake system. The ABS, in normal operation, engages and disengages rapidly as the control system senses and reacts to tire slippage.

The brake problem recall came on top of the highly-publicized “sudden acceleration” recall that prompted Toyota to not only recall eight popular models of its cars, but to temporarily suspend their sale in the U.S.

Responding to Judge Carney's ruling, Toyota spokesman Brian Lyons said: "We are confident Plaintiffs will be unable to introduce evidence that actually proves the allegations in their complaint that the Court relied on in denying Toyota's motion."
Sudden acceleration

Another case in the Santa Ana court involves more than 200 claims associated with unintended acceleration. On Nov. 19, U.S. District Judge James Selna refused to dismiss economic damages claims brought by consumers against Toyota and, on Dec. 8, refused to dismiss claims that the alleged defect caused injuries or death.