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Study sees heart risk in Meridia diet pill

A clinical trial of Meridia, a controversial diet pill, in nearly 10,000 overweight or obese older patients over many years found that the drug increased the risks of heart attacks and strokes while doing little to slim their waists.

The study was paid for by Abbott Laboratories, Meridia's maker, and published in The New England Journal of Medicine. And the authors of the study, three of whom are Abbott employees, concluded that the trial results did little more than show that patients with heart problems should not be prescribed Meridia - a restriction already included in Meridia's label.

But in an unusual rebuke, The Journal's top editors wrote an editorial concluding that the study actually showed that Meridia, also known as sibutramine, should be removed from the market.

"It wasn't that we disagreed with the interpretation of the authors," said Dr. Gregory D. Curfman, the journal's executive editor. "It's just that we thought they didn't quite go far enough."

After seeing preliminary results of the trial in January, the European Medicines Agency ordered Abbott to remove Meridia from the European market. The Food and Drug Administration took a less forceful step and instead requested that Abbott state on the drug's label that Meridia should not be used in patients with a history of cardiovascular disease.

The agency will ask a committee of experts Sept. 15 whether further steps are needed.

Dr. David J. Graham, a drug-safety official at the FDA, said the agency's decision to allow continued marketing of Meridia was mistaken and resulted because officials who approved the drug remain in charge of assessing its safety.

Homemade hazardous to health?

ATLANTA - Could your kitchen at home pass a restaurant inspection?

New research suggests that at least one in seven home kitchens would flunk the kind of health inspection commonly administered to restaurants.

The small study from California's Los Angeles County found that only 61 percent of home kitchens would get an A or B if put through the rigors of a restaurant inspection. At least 14 percent would fail - not even getting a C.

"I would say if they got below a C, I'm not sure I would like them to invite me to dinner," said Dr. Jonathan Fielding, director of the Los Angeles County Department of Public Health. In comparison, nearly all Los Angeles County restaurants - 98 percent - get A or B scores each year.

The study, released Thursday, is believed to be one of the first to offer a sizable assessment of food safety in private homes. But the researchers admit the way it was done is hardly perfect.

The results are based not on actual inspections, but on an Internet quiz taken by about 13,000 adults .

So it's hard to use it to compare the conditions in home kitchens to those in restaurants, which involve trained inspectors giving objective assessments of dirt, pests, and food storage and handling practices.

What's more, experts don't believe the study is representative of all households, because people who are more interested and conscientious about food safety are more likely to take the quiz. A more comprehensive look would probably find that an even smaller percentage of home kitchens would do well in a restaurant inspection.

ONLINE: Food safety quiz: http://bit.ly/aMyIdw

Science Q&A

Q: I found a snake in the Bronx, pale brown with a couple of dark stripes on the back. What is it? What is it doing there?

A: It's a brown snake, also known as DeKay's snake, named for pioneering New York naturalist James E. DeKay (1792-1851), said Harry Greene, a herpetologist and professor of ecology and evolutionary biology at the College of Agriculture and Life Sciences at Cornell.

"It's a diminutive relative of garter snakes and water snakes - live-bearing, not egg-laying," he said. "It feeds entirely on earthworms and slugs. Most importantly, it is completely nonvenomous and inoffensive."

More precisely, it is a Northern brown snake, Storeria dekayi, said Jack Conrad, co-curator the "Lizards and Snakes: Alive!" exhibition at the American Museum of Natural History, which closes on Monday.

"They're not uncommon in the area," he said, "and the Bronx is a good place to find them."

Its temperament, he said, is somewhere between that of an Eastern ribbon snake (inoffensive, usually almost friendly) and a Northern water snake (very grumpy) - that is, a little more unpredictable in mood.

The pattern on the back is actually a broad light stripe bordered by two rows of black spots.

Brown snakes provide a valuable food supply for predators, including crows, hawks and blue jays.

Health & Science briefs

Top medical journal's editor leaving post

One of the country's leading medical journals is looking for a new editor.

Dr. Catherine DeAngelis has announced she is leaving the Journal of the American Medical Association and returning to Johns Hopkins in Maryland.

Dr. DeAngelis, 70, was Hopkins' vice dean for academic affairs before joining JAMA as its first female editor-in-chief in 2000. She has worked to strengthen the ethics of medical journal publishing, aiming to make doctor-industry ties more transparent.

She plans to develop a Center for Professionalism in Medicine and related professions at Johns Hopkins Medical School.

Stents more risky for black patients

Blacks who receive drug-coated stents have nearly triple the risk of having a blood clot compared with other racial groups, researchers said this week.

Stents are used to open blocked coronary arteries. Drug-coated stents release medication that can prevent the artery from becoming blocked again. Blood clots are a known risk of the procedure, although the probability of a clot is relatively low.

A study of more than 7,000 patients found the rate of a life-threatening blood clot is much higher in blacks. One month after the stent insertion, the clotting risk was 1.71 percent in blacks compared with .59 percent in other racial groups. Three years after surgery, blacks had a clotting rate of 3.67 percent compared with 1.25 percent in other groups.

Key Tasmanian devil Cedric euthanized

A Tasmanian devil named Cedric, once thought to be immune to a contagious facial cancer threatening the iconic creatures with extinction, has been euthanized after succumbing to the disease, researchers said.

The death of the devil - previously heralded as a possible key to saving the species - is another blow for scientists struggling to stop the rapid spread of the cancer, which is transmitted when the furry black marsupials bite each other.

The Tasmanian devil population has plummeted by 70 percent since devil facial tumor disease was discovered in 1996.

Panel: India should protect elephants

India should protect its elephant population by securing its wildlife reserves, curbing poaching and restricting development in the corridors they use to travel between forested areas, a panel recommended.

Poaching for ivory and increased conflicts between people and elephants because of their dwindling habitat are key problems faced by India's wild elephant population, estimated at around 26,000.

The Elephant Task Force recommended setting up a national elephant conservation authority, better management of elephant reserves and protecting 88 corridors that the animals use across the country from mining, irrigation and other industrial projects.

ODD leads to unrest for family

Q: My son has oppositional defiant disorder (ODD), and he seems to scheme to upset the peace in our home. Once there is a blowup, he gets a little half smile on his face. What is a parent to do to fix this?

A: All children and teens have moments when they can be difficult, moody and argumentative. This is perfectly normal. However, when tantrums, arguing and angry or disruptive behaviors (especially toward the parent/guardian and other authority figures) become regular occurrences, ODD may be the reason.

Symptoms are hard to distinguish from normal behaviors of strong-willed or emotional people. In fact, the symptoms of ODD are the same as behaviors expected during certain stages of a child's development. When these behaviors become persistent, are disruptive to the family, home or school, and have lasted at least six months, ODD must be considered.

Negativity, defiance, hostility toward authority figures and disobedience are common with ODD and lead to temper tantrums, academic problems, anger, resentment, argumentative, spiteful or vindictive behavior with adults and aggressiveness toward peers. There may be deliberate annoyance of others, blaming others for mistakes, difficulty maintaining friendships, easy annoyance, acting irritably and refusal to comply with requests. ODD often accompanies other problems, such as depression, anxiety and attention deficit/hyperactivity disorder.

There is no clear cause, but it is thought that is it likely the result of a combination of inherited and environmental factors.

Diagnosis is not made through blood or other physical testing. A child must meet certain criteria set by the American Psychiatric Association.

Treatment of ODD typically involves several types of psychotherapy and training for the child and parents. Medication to treat any associated conditions, such as ADHD, may also be used. Individual and family therapy can help the child manage anger and express feelings, and help the family understand how the child is feeling and provide a safe, neutral environment to discuss concerns, and learn how to cope and work together. Parent-child interaction therapy teaches parents how to interact with their children to bring out their best behavior without stressing the parent and straining the already tenuous relationship. This may include social-skills training, which teaches the child how to interact with others in a positive manner; parent training; and cognitive problem-solving training.

The best approach is for your entire family to seek out some or all of the treatment options. In this way, everyone can come to understand what is happening and how best to handle problems.

PETER GOTT, M.D., is a retired general internist. Send questions to Dr. Gott, c/o United Media, 200 Madison Ave., 4th Floor, New York, NY 10016. His website is www.askdrgottmd.com.

New TB test quick, accurate

Scientists are reporting a major advance in diagnosing tuberculosis: A new test can reveal in less than two hours, with very high accuracy, whether someone has the disease and if it's resistant to the main drug for treating it.

The test could revolutionize TB care and replace the 125-year-old process used now, which is slow and misses more than half of all cases, experts say. A better test would be a powerful tool to curb TB in poor countries, where most people spread the lung disease before they are diagnosed and treated, and many don't return for follow-up doctor visits to get test results.

In the United States, it could be a big help in inner city clinics, where diagnosing a drug-resistant strain on someone's first visit enables proper treatment right away.

"You can tell the patient before they leave the office if they have TB and if it's drug-resistant. It's transformational," said Dr. Peter Small, head of TB programs at the Bill & Melinda Gates Foundation, which helped fund the work, along with the U.S. government.

The World Health Organization will meet with experts over the next few days to review results and plan steps forward, says a statement from one of its TB experts, Dr. Mario Raviglione.

"These results suggest that it has the potential to revolutionize TB care, and WHO will treat it as a top priority," the statement says.

A study of the test was published online Wednesday by the New England Journal of Medicine.

TB kills about 1.8 million people a year and increasingly is caused by bacteria that are resistant to one or more drugs. The best test - growing the bacteria in a lab dish from a mucus sample - takes a week or more, so the most common approach is to look for bacteria in a sample under a microscope. That misses many cases, tells nothing about drug resistance, and doesn't usually give an answer before a patient leaves the clinic.

"It's antiquated," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. "If you have 50 patients in a clinic and one person looking at a microscope it could take hours and hours."

The government set out to develop a better test with a host of partners: Cepheid, a California-based diagnostics company; the University of Medicine and Dentistry in New Jersey, and the Foundation for Innovative New Diagnostics, a Swiss-based nonprofit group supported by the Gates Foundation.

The test they devised is simple enough to be done with minimal training.

The whole process takes less than two hours.

A TASTE FOR THE EXOTIC

POMONA, Calif. - Persimmon grower Jim Bathgate handed out tiny yellow peaches to others at the California Rare Fruit Growers' annual "Festival of Fruit" and watched with anticipation as they bit into the sweet and juicy flesh.

The fruit grew on a peach tree that sprouted accidentally in Mr. Bathgate's persimmon grove, and he eagerly collected the sticky pits to plant more.

Mr. Bathgate was one of hundreds of rare fruit aficionados gathered to share seeds, cuttings and knowledge. The organization founded in 1968 encourages gardeners and hobby farmers to plant unusual fruit instead of commonplace fare, such as apples and oranges. Members search the globe for new varieties or seek to develop tastier, heartier strains suitable for backyard growing.

While the organization focuses on fruit that is not widely commercially grown, members have a chance at immortality, and perhaps profit, with discoveries that become named varieties.

The peach was Mr. Bathgate's shot at fame in the small but passionate world of exotic fruit growers.

Along with sampling new varieties of plums, apricots, peaches and other stone fruit, the growers could tour a pomegranate plantation or learn to propagate jujubes during the four-day conference held each year in August.

Edgar Valdivia, 70, escorted visitors through his shady San Fernando Valley backyard to show off spiky, pink dragon fruit, which is also known as a pitaya or pitahaya.

Although native to Central America, dragon fruit is more popular in Southeast Asia, where growers have bred varieties of the climbing cactus that are self-fertile, or don't require pollination by insects. But Asian varieties are often dull and bland, Mr. Valdivia said.

Few rare fruits have commercial potential. Consumers are unlikely to see Mr. Bathgate's peach in grocery stores because it doesn't develop the kind of ripe blush most shoppers look for and it's too small and delicate to be stored and shipped long distances.

But rare fruit lovers hold out hope that one of their homegrown varieties might deserve a name, become popular with backyard growers and get registered on the Department of Agriculture's list of varieties.

Study: MS effects seasonal

LOS ANGELES - Multiple sclerosis, a disease in which a person's own immune system attacks the brain and spinal cord, is a lifelong problem - but its effects can be highly seasonal, researchers say.

Between March and August, patients suffering from multiple sclerosis were two to three times more likely to develop brain les-ions than during the rest of the year, according to the paper published in the Tues-day issue of the journal Neurology.

The scientists looked for new T2 lesions in 939 MRI exams of 44 patients, taken between 1991 and 1993. The study found that the disease's intensity also rose in the summer months, and appeared to be linked to solar radiation (which includes sunlight), as well as temperature.

The research was unique and unlikely to be repeated, Anne Cross, a neurologist at Washington University School of Medicine in St. Louis, wrote in an editorial on the study.

Because certain drugs currently taken by multiple sclerosis patients weren't readily available in the early 1990s, this data would not be complicated by the presence of those now-common medications.

Scientists trying to set up studies examining multiple sclerosis will now have to consider seasonal variability, Dr. Cross wrote in the report.

Case in point: Say researchers conduct a study on a drug that could potentially help multiple sclerosis patients. If that study lasts just six months, from summer into winter, any positive effects may simply be due to cooling weather and less sunlight, not to the drug's effectiveness.

PCOS can be linked to obesity

Q: My 38-year-old granddaughter is convinced that because she has polycystic ovarian syndrome, or PCOS, she cannot lose weight. She is grossly overweight, and I am concerned about her future. She sees an endocrinologist about once a year, and takes thyroid medication and niacin for cholesterol. Can she be helped? Thank you for your consideration of this serious problem.

A: PCOS is a hormonal disorder that commonly begins when a female begins menstruation; however, it can develop later in life.

Obesity presents in nearly half of all patients with PCOS and is often the initial complaint. Abnormalities in the menstrual cycle, infertility, pre or type II diabetes and the presence of polycystic ovaries diagnosed through ultrasound are but a few of the other symptoms. It should be noted, however, that having polycystic ovaries is not a firm indication of PCOS.

There is no specific testing for diagnosis. Rather, it is one of exclusion, meaning that a physician will rule out a number of related possibilities prior to deciding on PCOS. The disorder makes other conditions, such as type II diabetes, hypertension and sleep apnea, more likely to occur.

Only you and your granddaughter can determine the sequence of events. When was she diagnosed? Could the PCOS be a result of her obesity? Is that issue under control? I cannot tie in high-cholesterol levels with her excess weight; however, thyroid disorders are often linked with obesity, elevated cholesterol and menstruation abnormalities.

There is help and hope that focuses primarily on her major symptoms. She should exercise and become involved with a regular weight-control program.

Diet modification appears essential. There is some initial evidence of success on a low-carbohydrate diet without discrimination between carbs on either end of the glycemic index.

No flour, no sugar

Q: I'm 100 pounds overweight and have tried every diet known. I know it's never too late to start a healthier lifestyle.

A: You have several options. The first is to order my "A Strategy for Losing Weight: Introduction to the No Flour, No Sugar Diet." Simply send a self-addressed, stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.ask drgottmd.com. My books, "Dr. Gott's No Flour, No Sugar Diet" and "No Flour, No Sugar Cookbook," can be ordered by following the links on my website. You're on the right track, and it is never too late to take steps to improve your health.

PETER GOTT, M.D., is a retired general internist and the author of "Dr. Gott's No Flour, No Sugar Cookbook." Send questions to Dr. Gott, c/o United Media, 200 Madison Ave., 4th Floor, New York, NY 10016. His website is www.askdrgottmd.com.

For many women, c-sections first choice

A new study suggests several reasons for the nation's rising cesarean section rate, including the increased use of drugs to induce labor, the tendency to give up on labor too soon and deliver babies surgically instead of waiting for nature to take its course, and the failure to allow women with previous cesareans to try to give birth vaginally.

Thirty two percent of all births in the United States - nearly 1 in 3 - now occur by cesarean section. The operations have been increasing steadily since 1996, setting records year after year, and have become the most common surgery in American hospitals. About 1.4 million cesareans were performed in 2007, the latest year for which figures are available. The increases have caused debate and concern.

The concern arises because cesareans pose a risk of surgical complications, and research has found that they are more likely than normal births to cause problems that can put the mother back in the hospital and the infant in intensive care. Risks to the mother also increase with each subsequent cesarean, because it raises the odds that the uterus will rupture in the next pregnancy, which can seriously harm both the mother and the baby.

Cesareans also increase the risk of dangerous abnormalities in the placenta during later pregnancies, which can cause hemorrhaging and lead to a hysterectomy. Repeated cesareans can make it risky or even impossible to have a large family. In addition, costs for a cesarean are nearly twice those for a vaginal delivery.

Most women who have had one or even two cesareans can at least try to give birth vaginally, and studies have found that 60 to 80 percent succeed. But vaginal births after cesarean sections have become increasingly uncommon.

Worries about the ever-increasing cesarean rate led the National Institutes of Health to form a Consortium on Safe Labor, which performed a detailed analysis of electronic records from 228,668 births at 19 hospitals in the United States from 2002 to 2008. The study is the first to analyze how often cesareans were performed before women went into labor (more than half the time) and how often after labor had begun.

Nutrition, exercise answers

Q: Is pumpernickel bread better than white bread?

A: That depends. Is it real pumpernickel bread? Traditional pumpernickel bread, with its German roots, is made from ground-up rye and is dark in appearance. And the fact that traditional pumpernickel is made with a whole grain (rye) is exactly why people believe it is healthier than white bread.

However, the bread you're eating likely is not real German pumpernickel. What most people eat is made from white flour and a coloring and/or sweetener such as molasses or caramel. It's also pretty similar in calories to other breads. Your best bet is to look for 100 percent whole-wheat bread without added sugar.

Q: If I sweat more when I work out, does that mean I'm losing more weight?

A: Unfortunately, sweating doesn't mean that you're burning calories. Sweating is the way your body cools itself. People sweat because their body temperature increases. Often when you work out, your body temperature goes up, and that's why sweating is associated with exercise. But that's where the relationship ends. It's a real mistake to monitor your level of exercise based on how much you're sweating.

The talk test is a simple way to measure exercise intensity. According to the Centers for Disease Control and Prevention: "As a rule of thumb, if you're doing moderate-intensity activity you can talk, but not sing, during the activity. If you're doing vigorous-intensity activity, you will not be able to say more than a few words without pausing for a breath."

Q: Are lobsters healthy or not? I've heard that they're not good for you.

A: First of all, "good" is always relative in terms of health. However, in general lobsters are a pretty healthy choice. A 6-ounce serving of meat (about a 1¼-pound to a 1½-pound lobster) has 167 calories, 34.9 grams protein, 2.2 grams carbs and 1 gram fat. There is virtually no saturated fat, and lobster is loaded with vitamin B12, selenium and copper. Selenium helps regulate thyroid function and boosts the immune system. Vitamin B12 is necessary for red blood cell formation and neurological function, as well as DNA synthesis.

In terms of dietary cholesterol, 6 ounces of lobster has 120 milligrams. The American Heart Association recommends an intake of 300 milligrams or less of dietary cholesterol a day.

Q: Do I need to use heavy weights to build muscle?

A: Not necessarily. A recent study conducted at McMaster University in Canada showed that a similar degree of muscle building can be achieved by using lighter weights as compared to the traditional theory that you need heavy weights.

CHARLES STUART PLATKIN, Ph.D., M.P.H., is a nutrition and public health advocate and founder of DietDetective.com. His column appears every Wednesday.

Benefit seen for high-risk women in ovary removal

CHICAGO - Surgery to remove healthy ovaries gives a triple benefit to high-risk women: It lowers their threat of breast and ovarian cancer, and boosts their chances of living longer, new research suggests.

The study is the largest to date to find advantages for preventive surgery for women who carry BRCA gene mutations. Women with the faulty genes have a dramatically higher cancer risk than other women - five times greater for breast cancer and at least 10 times greater for ovarian cancer.

The study, appearing in Wednesday's Journal of the American Medical Association, found benefits for women with two different BRCA gene variants whether they had previously had breast cancer or not.

The results offer more tailored evidence for women considering ovary removal, a surgery that ends fertility, fast-forwards them into early menopause and may contribute to osteoporosis or heart problems later in life.

"It's really critical to have the best information when making such a profound decision," said senior author Timothy Rebbeck of the University of Pennsylvania School of Medicine.

The researchers followed nearly 2,500 women with BRCA mutations in Austria, England, the Netherlands and the United States. All the women were cancer-free at the start. They were watched for an average of four years. Most of the women were younger than 50 at the start of the study.

They got counseling to help them choose between surgery or increased screening to watch for cancers early.

Ten percent of the women chose mastectomy and 40 percent chose to have their ovaries removed; some had both. More than half the women had neither surgery.

The study also found preventive mastectomy lowered the risk of breast cancer.

Hatchlings help boost Komodo population

LOS ANGELES - Twenty-two Komodo dragons have hatched at the Los Angeles Zoo in August, giving a modest boost to the world's endangered population.

The zoo's adult female Komodo, Lima, laid the eggs on Jan. 22. The first one popped through its shell on Aug. 8 and hatchlings kept coming for two weeks.

Komodos are the world's largest lizards and are popular attractions at zoos from the United States to Europe. All 2,500 Komodos left in the wild can be found at the 700-square-mile Komodo National Park in Indonesia.

Komodos are cannibalistic and usually eat their young and eggs of their own species, so zoo officials say staying alive is tricky for a hatchling.

This is the first time the Los Angeles Zoo has succeeded at a breeding attempt.

It joins fewer than 10 other zoos in North America that have made it work.

Keep eye on intake of sugar

Q: My fasting glucose has been averaging between 116 and 118 for the past 3½ years. Now, all of a sudden, I've had a couple readings in the 135 to 145 range. What can I do without going on medication?

A: There are a number of reasons why you might have a few random high readings. Perhaps you ate out and consumed something the evening before your testing that had a higher-than-normal amount of sugar included. Or you've experienced trauma, had a minor illness, consumed alcohol, or have been placed on a medication that affects your readings.

I would certainly keep a close eye on it but would not jump the gun to consider medication at this stage. Watch your sugar intake. Eat healthful meals, avoid sugar, reduce your carbohydrate intake, and exercise appropriately.

What's 'quality time'?

Q:   In one of your replies to a reader who, at 39 years of age, was having severe hip pain, you said he had a lot of time left and that it should be quality time.

First, I don't believe you can determine how much time someone has left to live. Secondly, at what age does an individual's right to quality time expire?

As a senior with a family history of longevity, the issue of quality time greatly concerns me.

A: Well, you're certainly right that I can't determine how much time someone has left to live. My inference was that at 39, and under ideal circumstances, a person likely has 45 or more years of life left. In fact, average life expectancy in the United States is nearly 78 years. I've personally seen all too often that a young person with so much to look forward to has the rug pulled out from under him or her. And I've also seen people who don't contribute to society, defy what we perceive to be a good lifestyle, smoke, drink too much, drive too fast, are obese, eat all the wrong foods and live to a ripe old age.

In large part, quality time is what we make of every day of our lives, and hopefully, it involves good or relatively good health, not a life fraught with pain and the unhappiness of one serious medical condition after another.

Human beings should not have a predetermined age at which quality time expires. That would open a can of worms, and we would likely behave in inappropriate ways, knowing we had little time left.

An exemplary lifestyle can often be snuffed out like a lit candle at an early age. We simply have no control over that. I cannot play God, nor can anyone else and determine an age at which quality is no longer important and we become mere shadows of our former selves. That's why it is so important to make every day count. Take care of your health to fight off the unknown.

PETER GOTT, M.D., is a retired general internist and the author of "Dr. Gott's No Flour, No Sugar Cookbook." Send questions to Dr. Gott, c/o United Media, 200 Madison Ave., 4th Floor, New York, NY 10016. His website is www.askdrgottmd.com.

Season of the shot

WASHINGTON - It's flu-shot season already, and for the first time health authorities are urging nearly everyone to get vaccinated. There is even a new high-dose version for people 65 or older.

What a difference a year makes: Crowds lined up for hours for scarce shots during last fall's swine flu pandemic, when infections peaked well before enough vaccine could be produced. This year, a record vaccine supply is expected - an all-in-one inoculation that now promises protection against that swine flu strain plus two other kinds of influenza.

Shipments began so early that drugstores are offering vaccinations amid their back-to-school sales.

But without last year's scare factor, the question is how many people will heed the new policy for near-universal vaccination. No more stopping to check if you're on a high-risk list: A yearly dose is recommended for virtually everyone except babies younger than 6 months - the shot isn't approved for tots that young - and people with severe allergies to the eggs used to brew it.

"Influenza is serious, and anyone, including healthy people, can get the flu and spread the flu," said Dr. Anne Schuchat of the Centers for Disease Control and Prevention. "Flu vaccines are the best way to protect yourself and those around you."

Here are some questions and answers about flu:

Q: I got vaccinated against both seasonal and that so-called H1N1 flu last year, so why do I need vaccine this year?

A: It protects against a different strain of the H3N2 influenza family that has cropped up, as well as last year's swine flu, part of the H1N1 family, and a Type B strain. Every year, a different flu vaccine is brewed to match the constantly changing flu strains that circle the globe.

Q: Why is there a new high-dose version for seniors?

A: Your immune system weakens with age, so it doesn't respond as actively to a flu shot. Sanofi Pasteur's Fluzone High-Dose quadruples the standard dose for people 65 and older. This winter, scientists will track if that translates into less illness.

Until that proof's in, the CDC says it's OK to choose either option.

Q: Will I need just one shot?

A: Most people will, but any children under 9 getting their first-ever flu vaccine will need two, a month apart, to prime their immune systems.

Q: Will there be enough vaccine?

A: Manufacturers project 170 million doses. Obviously that won't cover the entire population, but the CDC knows its near-universal vaccination policy won't spark a stampede for shots. Before last year, flu vaccine was recommended for 85 percent of Americans but only about a third got vaccinated. Last year, nearly all 114 million doses of seasonal vaccine were used, but as the swine flu outbreak slowed, just 90 million doses of the special vaccine were used out of nearly 162 million eventually produced.

Q: Who is at high risk from flu?

A: Young children, anyone 50 or older, anyone with chronic medical conditions such as asthma or heart disease, pregnant women. Also, health workers and caregivers of infants can infect the vulnerable unless vaccinated.

Q: When should vaccination start?

A: Chain pharmacies already have started vaccinating. It takes about two weeks to kick in, and flu starts circulating around November.

Q: How do I know it's safe?

A: Unprecedented safety monitoring last year turned up no rare side effects from the special swine flu-only vaccine sold in the United States.

Questions loom over sleep aid given to vets

WASHINGTON - Andrew White returned from a nine-month tour in Iraq beset with signs of post-traumatic stress disorder: insomnia, nightmares, constant restlessness. Doctors tried to ease his symptoms using three psychiatric drugs, including a potent anti-psychotic: Seroquel.

Thousands of soldiers suffering from PTSD have received the same medication over the last nine years, helping to make Seroquel one of the Veterans Affairs Department's top drug expenditures and the nation's No. 5 best-selling drug.

Several soldiers and veterans have died while taking the pills, raising concerns among some military families that the government is not being upfront about the drug's risks. They want Congress to investigate.

In Cpl. White's case, the nightmares persisted. So doctors recommended progressively larger doses of Seroquel. At one point, the 23-year-old Marine was prescribed more than 1,600 milligrams per day - more than double the maximum dose recommended for schizophrenia patients.

A short time later, Cpl. White died in his sleep.

"He was told if he had trouble sleeping he could take another (Seroquel) pill," said his father, Stan White, a retired high school principal.

A VA investigation concluded that Cpl. White died from a rare drug interaction. He was also taking an antidepressant and an anti-anxiety pill, as well as a painkiller for which he did not have a prescription. Inspectors concluded he received the "standard of care" for his condition.

It's unclear how many soldiers have died while taking Seroquel, or if the drug definitely contributed to the deaths.

A stockier, deadlier velociraptor found

WASHINGTON - Around 70 million years ago a stocky dragon stalked what is now Romania.

A new type of dinosaur similar to the frightening velociraptor - but with two sharp claws on each foot instead of just one - has been discovered by Romanian and American researchers.

Balaur bondoc, which means "stocky dragon," was discovered in Romania by geologist Matyas Vremir of the Transylvanian Museum Society. The find is reported in today's edition of Proceedings of the National Academy of Science.

"Balaur might be one of the largest predators in this ecosystem," explained co-author Zoltan Csiki of the University of Bucharest, who noted that higher sea level at the time made the region an island archipelago.

Mr. Csiki said that while Balaur is extremely unusual, it is closely related to animals like velociraptor and the feathered dinosaurs in China.

The researchers said the fossils show an animal 6 to 7 feet long with a stockier build than similarly sized velociraptors that lived elsewhere on the globe. There are numerous similarities between the two predators, though.

"While we would expect that there were carnivorous animals in these faunas, finding one as unusual as Balaur is thrilling," said co-author Mark Norell of the American Museum of Natural History in New York.

Matthew T. Carrano, curator of dinosauria at the Smithsonian's National Museum of Natural History in Washington, said the discovery is "one of those bizarre things that keeps reminding us not to expect that we've found everything there is to find."

The new Balaur fossil is a partial skeleton that includes leg, hip, backbone, arms, hand, rib and tail bones.

It had a big toe with a large claw that can be hyperextended, presumably used to slash prey, as well as a large claw on the second toe.

ONLINE: www.pnas.org

Review finds climate panel needs fixing

WASHINGTON - Scientists reviewing the acclaimed but beleaguered international climate change panel called Monday for major changes in the way it's run, but stopped short of calling for the ouster of its leader.

The independent review of the U.N. climate change panel puts new pressure on panel Chairman Rajendra Pachauri, who has been criticized for possible conflicts of interest but shows no sign of stepping down.

"It's hard to see how the United Nations can both follow the advice of this committee and keep Rajendra Pachauri on board as head," said Roger Pielke Jr., a frequent critic of the Intergovernmental Panel on Climate Change. The professor at the University of Colorado praised the review findings as a way of saving the climate panel with "tough love."

Representatives of the world's science academies outlined a series of "significant reforms" in management structure needed by the IPCC, a body that won a Nobel Prize with former Vice President Al Gore in 2007.

Last year, a batch of errors embarrassed the authors of the climate report. Among the most prominent were misleading statements about glaciers in the Himalayas. The IPCC incorrectly said they were melting faster than others and that they would disappear by 2035 - hundreds of years earlier than other information suggests.

"Those errors did dent the credibility of the process, no question about it," said former Princeton University president Harold Shapiro, who led the review.

Dr. Pach-auri, an academic from India who also is a professor at Yale, said many of the specific recommendations outlined are ones that he already has started. Critics, including those in the U.S. Senate, have called upon him to resign, but on Monday he gave no indication he would.

"This has nothing to do with personalities," Dr. Pachauri told The Associated Press. "I think we're jumping the gun if we're talking about taking any action before the IPCC takes a look at the report."

Dr. Shapiro said if fundamental changes are made, the IPCC - created in 1989 by the United Nations and World Meteorological Organization - can regain its credibility. The IPCC involves scientists mostly volunteering, with only 10 staffers. Even Dr. Pachauri is a part-time volunteer.

ONLINE: InterAcademy Council: http://interacademycouncil.net

Health & Science briefs

NASA wants help choosing tunes

Now's your chance to help pick the wake-up music for astronauts.

NASA is holding a first-of-its-kind contest to select some songs that will rouse the crews of the final two shuttle flights. Normally, astronauts' family and friends choose the tunes.

The space agency's Top 40 list is posted online. The two top vote-getters will serve as wake-up calls during Discovery's November flight. The choices include Frank Sinatra's "Fly Me to the Moon" and Tom Petty's "Free Fallin," as well as some U2 and Elton John.

NASA also is seeking original space-themed songs. Two winners will wake up Endeavour's crew in February.

To vote on a song or nominate your own, visit https://songcontest.nasa.gov.

Russia building new launch center

Russia will launch its manned space missions from a new center in the Far East in 2018, Prime Minister Vladimir Putin said, as the country seeks greater independence for its space program.

Mr. Putin made the comments Saturday as he inaugurated the start of construction for the new cosmodrome at the former missile defense base of Vostochny, outside the town of Uglegorsk, a few hundred miles from China.

Russia now uses the Soviet-built Baikonur launch facility in Kazakhstan for all of its manned space missions and other commercial launches.

Vostochny is to host all launches of manned spacecraft starting in 2018. Launches of unmanned craft are expected to start in 2015.

New chameleon named for Tarzan

Scientists have named a newly discovered chameleon in Madagascar after the jungle hero Tarzan in a bid to draw attention to and protect the region's biodiversity.

The Technical University of Braunschweig in Germany said the animal, which is about 5 inches long, had been named Calumma tarzan as a "flagship species" to draw attention to the biodiversity of central-eastern Madagascar and encourage the creation of areas free of logging.

"The Tarzan chameleon is going to use his celebrity name to promote protection for this last patch of forest," said Philip-Sebastian Gehring, the lead author of an article describing the animal.

Japan loses key intel satellite

Of four Japanese intelligence-gathering satellites in orbit to observe North Korea, the lone radar orbiter impervious to darkness and cloudy weather has broken down.

Officials said they detected a glitch in the satellite's radar system and began remote operations to restart it, but the outlook for recovery was "extremely grim."

The satellite, Radar Satellite No. 2, was launched in February 2007. Officials attributed the malfunction to battery trouble. The satellite was designed to function for five years and should have operated until 2012.

Protection from noise important

Q: For years, I worked in a heavy-equipment industry that manufactured farm equipment. Though working in an engineering position, I was often exposed to loud noises in the shops for long periods. In later years, OSHA required hearing protection. Earlier job training did not warn us of the dangers of loud noise.

I now suffer from a constant ringing in my ears. At 65, I'm in good health and take no medications other than Allegra D for nasal congestion. My blood pressure is good, and I just had a recent checkup.

Is there some medication that I can take that might reduce or eliminate the noise I hear all the time? I mentioned the problem to my doctor and just got a blank look.

A: There are a number of conditions that can cause tinnitus (ringing in the ears). For example, more than 200 medications, kidney malfunction, tumors, wax buildup, ear infection, dental issues including temporomandibular joint syndrome, migraine headaches, trauma, inner-ear injuries, hypertension and exposure to loud noises can be to blame. It's likely that work exposure is the culprit, but you should request referral to an otolaryngologist (ear-nose-and-throat specialist), who can perform testing to determine whether an underlying, treatable cause is to blame.

Your primary-care physician can certainly remove a wax impaction and can treat infection with antibiotics; however, because you have a positive history, I believe a specialist might get to the bottom of the issue. Until you determine the problem, it is difficult to determine whether drug therapy, hearing aids, counseling or another form of therapy will be most beneficial.

Sense of taste lost

Q: I am a senior citizen. My problem is that I've lost my taste buds. Nothing I drink or eat has any taste. What can I do to get my sense of taste back?

A: Some loss of taste (and smell) is common with aging. Other than that, there are several possibilities, including poor dental hygiene, Alzheimer's and Parkinson's diseases, a smoking habit, allergies, sinus problems and medications.

Make an appointment with your primary-care physician. If he or she determines the problem is age-related, there may not be a way to reverse it. If, however, your physician has you on a specific medication with even a minor side effect of loss of taste, a simple switch to another drug might be all that is necessary. If you smoke, quitting will make a big difference. If you need dental work, that option might provide the relief you are seeking. Work with your doctor to get to the root of the problem. Only then can you take steps to correct the problem.

PETER GOTT, M.D., is a retired general internist and the author of "Dr. Gott's No Flour, No Sugar Cookbook." Send questions to Dr. Gott, c/o United Media, 200 Madison Ave., 4th Floor, New York, NY 10016. His website is www.askdrgottmd.com.

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