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Health & Fitness (233)

BEIJING (AP) -- A new study links heavy air pollution from coal burning to shorter lives in northern China. Researchers estimate that the half-billion people alive there in the 1990s will live an average of 5 1/2 years less than their southern counterparts because they breathed dirtier air.

China itself made the comparison possible: for decades, a now-discontinued government policy provided free coal for heating, but only in the colder north. Researchers found significant differences in both particle pollution of the air and life expectancy in the two regions, and said the results could be used to extrapolate the effects of such pollution on lifespans elsewhere in the world.

The study by researchers from China, Israel and the United States was published Tuesday in the Proceedings of the National Academy of Sciences.

While previous studies have found that pollution affects human health, "the deeper and ultimately more important question is the impact on life expectancy," said one of the authors, Michael Greenstone, a professor of environmental economics at Massachusetts Institute of Technology.

"This study provides a unique setting to answer the life expectancy question because the (heating) policy dramatically alters pollution concentrations for people who appear to be of otherwise identical health," Greenstone said in an email. "Further, due to the low rates of migration in China in this period, we can know people's exposure over long time periods," he said.

The policy gave free coal for fuel boilers to heat homes and offices to cities north of the Huai River, which divides China into north and south. It was in effect for much of the 1950-1980 period of central planning, and, though discontinued after 1980, it has left a legacy in the north of heavy coal burning, which releases particulate pollutants into the air that can harm human health. Researchers found no other government policies that treated China's north differently from the south.

The researchers collected data for 90 cities, from 1981 to 2000, on the annual daily average concentration of total suspended particulates. In China, those are considered to be particles that are 100 micrometers or less in diameter, emitted from sources including power stations, construction sites and vehicles.

The researchers estimated the impact on life expectancies using mortality data from 1991-2000. They found that in the north, the concentration of particulates was 184 micrograms per cubic meter - or 55 percent - higher than in the south, and life expectancies were 5.5 years lower on average across all age ranges.

The researchers said the difference in life expectancies was almost entirely due to an increased incidence of deaths classified as cardiorespiratory - those from causes that have previously been linked to air quality, including heart disease, stroke, lung cancer and respiratory illnesses.

Total suspended particulates include fine particulate matter called PM2.5 - particles with diameters of no more than 2.5 micrometers. PM2.5 is of especially great health concern because it can penetrate deep into the lungs, but the researchers lacked the data to analyze those tiny particles separately.

The authors said their research can be used to estimate the effect of total suspended particulates on other countries and time periods. Their analysis suggests that every additional 100 micrograms of particulate matter per cubic meter in the atmosphere lowers life expectancy at birth by about three years.

The study also noted that there was a large difference in particulate matter between the north and south, but not in other forms of air pollution such as sulfur dioxide and nitrous oxide.

Francesca Dominici, a professor of biostatistics at Harvard School of Public Health who has researched the health effects of fine particulate matter in the U.S., said the study was "fascinating."

China's different treatment of north and south allowed researchers to get pollution data that would be impossible in a scientific setting.

Dominici said the quasi-experimental approach was a good approximation of a randomized experiment, "especially in this situation where a randomized experiment is not possible."

She said she wasn't surprised by the findings, given China's high levels of pollution.

"In the U.S. I think it's pretty much been accepted that even small changes in PM2.5, much, much, much smaller than what they are observing in China, are affecting life expectancy," said Dominici, who was not involved in the study.

---

AP researcher Yu Bing contributed to this report.

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Tuesday, 09 July 2013 07:06
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DUBLIN (AP) -- Ireland appeared on course to legalize abortion in limited circumstances as lawmakers voted Tuesday to support a bill that would permit a pregnancy to be terminated when deemed necessary to save a woman's life.

Catholic leaders warned that the proposed law, which faces potential amendments this week and a final vote next week, was a "Trojan horse" designed to permit widespread abortion access in Ireland. But Prime Minister Enda Kenny insisted Ireland's constitutional ban on abortion would remain unaffected, and his government's Protection of Life During Pregnancy Bill won overwhelming backing in a 138-24 vote.

Ireland's 1986 constitutional ban on abortion commits the government to defend the life of the unborn and the mother equally. Ireland's abortion law has been muddled since 1992, when the Supreme Court ruled that this "ban" actually meant that terminations should be legal if doctors deem one essential to safeguard the life of the woman - including, most controversially, from her own suicide threats.

Six previous governments refused to pass a law in support of the Supreme Court judgment, citing its suicide-threat rule as open to abuse. This left Irish hospitals hesitant to provide any abortions except for the most clear-cut emergencies and spurred many pregnant women in medical or psychological crises to seek abortions in neighboring England, where the practice has been legal since 1967.

Kenny's government had been under pressure to pass a law on life-saving abortions ever since the European Court of Human Rights ruled in 2011 that Ireland's inaction forced women to face unnecessary medical dangers.

But the catalyst for change was Savita Halappanavar, a 31-year-old Indian dentist who died last year in a western Ireland hospital one week after being admitted in severe pain at the start of a miscarriage. Doctors cited Ireland's ill-defined and Catholic-influenced laws when denying her pleas for an abortion, even though her uterus had ruptured and exposed her to increased risk of blood poisoning.

By the time doctors authorized an abortion, Halappanavar had already been hospitalized for four days and the 17-week-old fetus was stillborn. She fell into a state of toxic shock, then into a coma, and died from massive organ failures three days later. Two fact-finding investigations since have found that an abortion one or two days before the fetus' death would have increased Halappanavar's chance of survival, but said the hospital was guilty of many other failures in her care.

In years past, a government that took on Catholic orthodoxy in Ireland would have feared damaging splits and electoral annihilation. But Tuesday's vote illustrates changed social mores and widespread disenchantment with Catholic leaders following two decades of revelations of the Irish church's role in protecting pedophile priests from public exposure and prosecution.

The most recent opinion poll found that 89 percent want abortions to be granted in cases where a woman's life is endangered by continued pregnancy. Some 83 percent also want abortion legalized in cases where the fetus could not survive at birth, 81 percent for cases of pregnancy caused by rape or incest, and 78 percent where a woman's health - not simply her life - was undermined by pregnancy. The government bill excludes those three scenarios. The June 13 poll in the Irish Times had an error margin of three percentage points.

Four anti-abortion lawmakers from Kenny's socially conservative Fine Gael party did vote against the bill, fewer than expected given the strong Catholic traditionalist wing in his party. They particularly opposed the bill's section authorizing abortions in cases where a panel of three doctors, including two psychiatrists, unanimously rules that a woman is likely to try to kill herself if denied one.

But Kenny, who since rising to power in 2011 has repeatedly clashed with Catholic Church attitudes, emphasized beforehand that he would tolerate no dissent and pointedly described himself as a prime minister "who happens to be Catholic" but has a public duty to separate church and state.

The four rebels were expected to be expelled from Fine Gael's voting group in parliament and, much more damagingly, be barred from seeking re-election as Fine Gael candidates. The move would not affect Kenny's commanding parliamentary majority.

Ireland's other traditional center-ground party, the opposition Fianna Fail, did not attempt to impose such discipline because it risked tearing apart the party. Thirteen Fianna Fail lawmakers voted against the bill, while only six supported it.

Kenny won strong support from the left-wing side of the house, both from his Labour Party coalition partners and opposition lawmakers including the Irish nationalist Sinn Fein. Only one of Sinn Fein's 14 lawmakers voted against the bill and he, too, faces expulsion from his voting bloc.

Hours before the vote, Cardinal Sean Brady, leader of Ireland's 4 million Catholics - two thirds of the island's population - appealed to Fine Gael lawmakers to rebel against Kenny. Previously some Catholic bishops have hinted that Kenny and other Catholic lawmakers who vote for the bill should be barred from receiving Communion at Mass, a traditional method of public shaming.

"In practice, the right to life of the unborn child will no longer be treated as equal. The wording of this bill is so vague that ever wider access to abortion can be easily facilitated," Brady said in a statement. "This bill represents a legislative and political Trojan horse which heralds a much more liberal and aggressive abortion regime in Ireland."

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Wednesday, 03 July 2013 09:08
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WASHINGTON (AP) -- It took 50 years for American attitudes about marijuana to zigzag from the paranoia of "Reefer Madness" to the excesses of Woodstock back to the hard line of "Just Say No."

The next 25 years took the nation from Bill Clinton, who famously "didn't inhale," to Barack Obama, who most emphatically did.

And now, in just a few short years, public opinion has moved so dramatically toward general acceptance that even those who champion legalization are surprised at how quickly attitudes are changing and states are moving to approve the drug - for medical use and just for fun.

It is a moment in America that is rife with contradictions:

-People are looking more kindly on marijuana even as science reveals more about the drug's potential dangers, particularly for young people.

-States are giving the green light to the drug in direct defiance of a federal prohibition on its use.

-Exploration of the potential medical benefit is limited by high federal hurdles to research.

Washington policymakers seem reluctant to deal with any of it.

Richard Bonnie, a University of Virginia law professor who worked for a national commission that recommended decriminalizing marijuana in 1972, sees the public taking a big leap from prohibition to a more laissez-faire approach without full deliberation.

"It's a remarkable story historically," he says. "But as a matter of public policy, it's a little worrisome. It's intriguing, it's interesting, it's good that liberalization is occurring, but it is a little worrisome."

More than a little worrisome to those in the anti-drug movement.

"We're on this hundred-mile-an-hour freight train to legalizing a third addictive substance," says Kevin Sabet, a former drug policy adviser in the Obama administration, lumping marijuana with tobacco and alcohol.

Legalization strategist Ethan Nadelmann, executive director of the Drug Policy Alliance, likes the direction the marijuana smoke is wafting. But he knows his side has considerable work yet to do.

"I'm constantly reminding my allies that marijuana is not going to legalize itself," he says.

--- By the numbers: Eighteen states and the District of Columbia have legalized the use of marijuana for medical purposes since California voters made the first move in 1996. Voters in Colorado and Washington state took the next step last year and approved pot for recreational use. Alaska is likely to vote on the same question in 2014, and a few other states are expected to put recreational use on the ballot in 2016.

Nearly half of adults have tried marijuana, 12 percent of them in the past year, according to a survey by the Pew Research Center. More teenagers now say they smoke marijuana than ordinary cigarettes.

Fifty-two percent of adults favor legalizing marijuana, up 11 percentage points just since 2010, according to Pew. Sixty percent think Washington shouldn't enforce federal laws against marijuana in states that have approved its use. Seventy-two percent think government efforts to enforce marijuana laws cost more than they're worth.

"By Election Day 2016, we expect to see at least seven states where marijuana is legal and being regulated like alcohol," says Mason Tvert, a spokesman for the Marijuana Policy Project, a national legalization group.

---

Where California led the charge on medical marijuana, the next chapter in this story is being written in Colorado and Washington state.

Policymakers there are struggling with all sorts of sticky issues revolving around one central question: How do you legally regulate the production, distribution, sale and use of marijuana for recreational purposes when federal law bans all of the above?

How do you tax it? What quality control standards do you set? How do you protect children while giving grown-ups the go-ahead to light up? What about driving under the influence? Can growers take business tax deductions? Who can grow pot, and how much? Where can you use it? Can cities opt out? Can workers be fired for smoking marijuana when they're off duty? What about taking pot out of state? The list goes on.

The overarching question has big national implications. How do you do all of this without inviting the wrath of the federal government, which has been largely silent so far on how it will respond to a gaping conflict between U.S. and state law?

The Justice Department began reviewing the matter after last November's election and repeatedly has promised to respond soon. But seven months later, states still are on their own, left to parse every passing comment from the department and President Obama.

In December, Obama said in an interview that "it does not make sense, from a prioritization point of view, for us to focus on recreational drug users in a state that has already said that under state law that's legal."

In April, Attorney General Eric Holder said to Congress, "We are certainly going to enforce federal law. ... When it comes to these marijuana initiatives, I think among the kinds of things we will have to consider is the impact on children." He also mentioned violence related to drug trafficking and organized crime.

In May, Obama told reporters: "I honestly do not believe that legalizing drugs is the answer. But I do believe that a comprehensive approach - not just law enforcement, but prevention and education and treatment - that's what we have to do."

Rep. Jared Polis, a Colorado Democrat who favors legalization, predicts Washington will take a hands-off approach, based on Obama's comments about setting law enforcement priorities.

"We would like to see that in writing," Polis says. "But we believe, given the verbal assurances of the president, that we are moving forward in Colorado and Washington in implementing the will of the voters."

The federal government has taken a similar approach toward users in states that have approved marijuana for medical use. It doesn't go after pot-smoking cancer patients or grandmas with glaucoma. But it also has warned that people who are in the business of growing, selling and distributing marijuana on a large scale are subject to potential prosecution for violations of the Controlled Substances Act - even in states that have legalized medical use.

Federal agents in recent years have raided storefront dispensaries in California and Washington, seizing cash and pot. In April, the Justice Department targeted 63 dispensaries in Santa Ana, Calif., and filed three asset forfeiture lawsuits against properties housing seven pot shops. Prosecutors also sent letters to property owners and operators of 56 other marijuana dispensaries warning that they could face similar lawsuits.

University of Denver law professor Sam Kamin says if the administration doesn't act soon to sort out the federal-state conflict, it may be too late to do much.

"At some point, it becomes so prevalent and so many citizens will be engaged in it that it's hard to recriminalize something that's become commonplace," he says.

--- There's a political calculus for the president, or any other politician, in all of this.

Younger people, who tend to vote more Democratic, are more supportive of legalizing marijuana, as are people in the West, where the libertarian streak runs strong. In Colorado, for example, last November more people voted for legalized pot (55 percent) than voted for Obama (51 percent), which could help explain why the president was silent on marijuana before the election.

"We're going to get a cultural divide here pretty quickly," says Greg Strimple, a Republican pollster based in Boise, Idaho, who predicts Obama will duck the issue as long as possible.

Despite increasing public acceptance of marijuana, and growing interest in its potential therapeutic uses, politicians know there are complications that could come with commercializing an addictive substance, some of them already evident in medical marijuana states. Opponents of pot are particularly worried that legalization will result in increased adolescent use as young people's estimations of the drug's dangers decline.

"There's no real win on this from a political perspective," says Sabet. "Do you want to be the president that stops a popular cause, especially a cause that's popular within your own party? Or do you want to be the president that enables youth drug use that will have ramifications down the road?"

Marijuana legalization advocates offer politicians a rosier scenario, in which legitimate pot businesses eager to keep their operating licenses make sure not to sell to minors.

"Having a regulated system is the only way to ensure that we're not ceding control of this popular substance to the criminal market and to black marketeers," says Aaron Smith, executive director of the National Cannabis Industry Association, a trade group for legal pot businesses in the U.S.

See Change Research, which analyzes the marijuana business, has estimated the national market for medical marijuana alone at $1.7 billion for 2011 and has projected it could reach $8.9 billion in five years. Overall, marijuana users spend tens of billions of dollars a year on pot, experts believe.

Ultimately, marijuana advocates say, it's Congress that needs to budge, aligning federal laws with those of states moving to legalization. But that doesn't appear likely anytime soon.

The administration appears uncertain how to proceed.

"The executive branch is in a pickle," Rep. Ed Perlmutter, D-Colo., said at a recent news conference outside the Capitol with pot growers visiting town to lobby for changes. "Twenty-one states have a different view of the use of marijuana than the laws on the books for the federal government."

---

While the federal government hunkers down, Colorado and Washington state are moving forward on their own.

Colorado's governor in May signed a set of bills to regulate legal use of the drug, and the state's November ballot will ask voters to approve special sales and excise taxes on pot. In Washington state, the Liquor Control Board is drawing up rules covering everything from how plants will be grown to how many stores will be allowed. It expects to issue licenses for growers and processors in December, and impose 25 percent taxes three times over - when pot is grown, processed and sold to consumers.

"What we're beginning to see is the unraveling of the criminal approach to marijuana policy," says Tim Lynch, director of the libertarian Cato Institute's Project on Criminal Justice. But, Lynch adds, "the next few years are going to be messy. There are going to be policy battles" as states work to bring a black market industry into the sunshine, and Washington wrestles with how to respond.

Already, a federal judge has struck down a Colorado requirement that pot magazines such as High Times be kept behind store counters, like pornography.

Marijuana advocates in Washington state, where officials have projected the legal pot market could bring the state a half-billion a year in revenue, are complaining that state regulators are still banning sales of hash or hash oil, a marijuana extract.

Pot growers in medical marijuana states are chafing at federal laws that deny them access to the banking system, tax deductions and other opportunities that other businesses take for granted. Many dispensaries are forced to operate on a cash-only basis, which can be an invitation to organized crime.

It's already legal for adults in Colorado and Washington to light up at will, as long as they do so in private.

That creates all kinds of new challenges for law enforcement.

Pat Slack, a commander with the Snohomish County Regional Drug Taskforce in Washington state, said local police are receiving calls about smokers flouting regulations against lighting up in public. In at least one instance, Slack said, that included a complaint about a smoker whose haze was wafting over a backyard fence and into the middle of a child's birthday party. But with many other problems confronting local officers, scofflaws are largely being ignored.

"There's not much we can do to help," Slack says. "A lot of people have to get accustomed to what the change is."

In Colorado, Tom Gorman, director of the federal Rocky Mountain High Intensity Drug Taskforce, takes a tougher stance on his state's decision to legalize pot.

"This is against the law, I don't care what Colorado says," Gorman said. "It puts us in a position, where you book a guy or gal and they have marijuana, do you give it back? Do you destroy it? What in effect I am doing by giving it back is I am committing a felony. If the court orders me to return it, the court is giving me an illegal order."

More than 30 pot growers and distributors, going all-out to present a buttoned-down image in suits and sensible pumps rather than ponytails and weed T-shirts, spent two days on Capitol Hill in June lobbying for equal treatment under tax and banking laws and seeking an end to federal property seizures.

"It's truly unfortunate that the Justice Department can't find a way to respect the will of the people," says Sean Luse of the 13-year-old Berkeley Patients Group in California, a multimillion-dollar pot collective whose landlord is facing the threat of property forfeiture.

---

As Colorado and Washington state press on, California's experience with medical marijuana offers a window into potential pitfalls that can come with wider availability of pot.

Dispensaries for medical marijuana have proliferated in the state. Regulation has been lax, leading some overwhelmed communities to complain about too-easy access from illegal storefront pot shops and related problems such as loitering and unsavory characters. That prompted cities around the state to say enough already and ban dispensaries. Pot advocates sued.

In May, the California Supreme Court ruled unanimously that cities and counties can ban medical marijuana dispensaries. A few weeks later, Los Angeles voters approved a ballot measure that limits the number of pot shops in the city to 135, down from an estimated high of about 1,000. By contrast, whitepages.com lists 112 Starbucks in the city.

This isn't full-scale buyer's remorse, but more a course correction before the inevitable next push to full-on legalization in the state.

Baker Montgomery, a member of the Eagle Rock neighborhood council in Los Angeles, where pot shops were prevalent, said May's vote to limit the number of shops was all about ridding the city of illicit dispensaries.

"They're just not following what small amounts of rules there are on the books," Montgomery said.

In 2010, California voters opted against legalizing marijuana for recreational use, drawing the line at medical use.

But Jeffrey Dunn, a Southern California attorney who represented cities in the Supreme Court case, says that in reality the state's dispensaries have been operating so loosely that already "it's really all-access."

At the Venice Beach Care Center, one of the dispensaries that will be allowed to stay open in Los Angeles, founding director Brennan Thicke believes there still is widespread support for medical marijuana in California. But he says the state isn't ready for more just yet.

"We have to get (medical) right first," Thicke said.

Dunn doubts that's possible.

"What we've learned is, it is very difficult if not impossible to regulate these facilities," he said.

---

Other states, Colorado among them, have had their own bumps in the road with medical marijuana.

A Denver-area hospital, for example, saw children getting sick after eating treats and other foods made with marijuana in the two years after a 2009 federal policy change led to a surge in medical marijuana use, according to a study in JAMA Pediatrics in May. In the preceding four years, the hospital had no such cases.

The Colorado Education Department reported a sharp rise in drug-related suspensions and expulsions after medical marijuana took off. An audit of the state's medical marijuana system found the state had failed to adequately track the growth and distribution of pot or to fully check out the backgrounds of pot dealers.

"What we're doing is not working," says Dr. Christian Thurstone, a psychiatrist whose Denver youth substance abuse treatment center has seen referrals for marijuana double since September. In addition, he sees young people becoming increasingly reluctant to be treated, arguing that it can't be bad for them if it's legal.

Yet Daniel Rees, a researcher at the University of Colorado Denver, analyzed data from 16 states that have approved medical marijuana and found no evidence that legalization had increased pot use among high school students.

In looking at young people, Rees concludes: "Should we be worried that marijuana use nationally is going up? Yes. Is legalization of medical marijuana the culprit? No."

---

Growing support for legalization doesn't mean everybody wants to light up: Barely one in 10 Americans used pot in the past year.

Those who do want to see marijuana legalized range from libertarians who oppose much government intervention to people who want to see an activist government aggressively regulate marijuana production and sales.

Safer-than-alcohol was "the message that won the day" with voters in Colorado, says Tvert.

For others, money talks: Why let drug cartels rake in untaxed profits when a cut of that money could go into government coffers?

There are other threads in the growing acceptance of pot.

People think it's not as dangerous as once believed; some reflect back on what they see as their own harmless experience in their youth. They worry about high school kids getting an arrest record that will haunt them for life. They see racial inequity in the way marijuana laws are enforced. They're weary of the "war on drugs," and want law enforcement to focus on other areas.

"I don't plan to use marijuana, but it just seemed we waste a lot of time and energy trying to enforce something when there are other things we should be focused on," says Sherri Georges, who works at a Colorado Springs, Colo., saddle shop. "I think that alcohol is a way bigger problem than marijuana, especially for kids."

Opponents have retorts at the ready.

They point to a 2012 study finding that regular use of marijuana during teen years can lead to a long-term drop in IQ, and a different study indicating marijuana use can induce and exacerbate psychotic illness in susceptible people. They question the idea that regulating pot will bring in big money, saying revenue estimates are grossly exaggerated.

They counter the claim that prisons are bulging with people convicted of simple possession by citing federal statistics showing only a small percentage of federal and state inmates are behind bars for that alone. Slack said the vast majority of people jailed for marijuana possession were originally charged with dealing drugs and accepted plea bargains for possession. The average possession charge for those in jail is 115 pounds, Slack says, which he calls enough for "personal use for a small city."

Over and over, marijuana opponents warn that baby boomers who are drawing on their own innocuous experiences with pot are overlooking the much higher potency of the marijuana now in circulation.

In 2009, concentrations of THC, the psychoactive ingredient in pot, averaged close to 10 percent in marijuana, compared with about 4 percent in the 1980s, according to the National Institute on Drug Abuse. An estimated 9 percent of people who try marijuana eventually become addicted, and the numbers are higher for those who start using pot when they are young. That's less than the addiction rates for nicotine or alcohol, but still significant.

"If marijuana legalization was about my old buddies at Berkeley smoking in People's Park once a week I don't think many of us would care that much," says Sabet, who helped to found Smart Approaches to Marijuana, a group that opposes legalization. "But it's not about that. It's really about creating a new industry that's going to target kids and target minorities and our vulnerable populations just like our legal industries do today."

---

So how bad, or good, is pot?

There are studies that set off medical alarm bells but also studies that support the safer-than-alcohol crowd and suggest promising therapeutic uses.

J. Michael Bostwick, a psychiatrist at the Mayo Clinic, set out to sort through more than 100 sometimes conflicting studies after his teenage son became addicted to pot. In a 22-page article for Mayo Clinic Proceedings in 2012, he laid out the contradictions in U.S. policy and declared that "little about cannabis is straightforward."

"Anybody can find data to support almost any position," Bostwick says now.

For all of the talk that smoking pot is no big deal, Bostwick says, he determined that "it was a very big deal. There were addiction issues. There were psychosis issues. But there was also this very large body of literature suggesting that it could potentially have very valuable pharmaceutical applications but the research was stymied" by federal barriers.

Marijuana is a Schedule I drug under 1970 law, meaning the government deems it to have "no currently accepted medical use" and a "high potential for abuse." The only federally authorized source of marijuana for research is grown at the University of Mississippi, and the government tightly regulates its use. The National Institute on Drug Abuse says plenty of work with cannabis is ongoing, but Bostwick says federal restrictions have caused a "near-cessation of scientific research."

The American Medical Association opposes legalizing pot, calling it a "dangerous drug" and a public health concern. But it also is urging the government to review marijuana's status as a Schedule 1 drug in the interest of promoting more research.

"The evidence is pretty clear that in 1970 the decision to make the drug illegal, or put it on Schedule I, was a political decision," says Bostwick. "And it seems pretty obvious in 2013 that states, making their decisions the way they are, are making political decisions. Science is not present in either situation to the degree that it needs to be."

The National Institute on Drug Abuse's director, Dr. Nora Volkow, says that for all the potential dangers of marijuana, "cannabinoids are just amazing compounds, and understanding how to use them properly could be actually very beneficial therapeutically." But she worries that legalizing pot will result in increased use of marijuana by young people, and impair their brain development.

"You cannot mess around with the cognitive capacity of your young people because you are going to rely on them," she says. "Think about it: Do you want a nation where your young people are stoned?"

---

As state after state moves toward a more liberal approach to marijuana, the turnaround is drawing comparisons to shifting attitudes on gay marriage, for which polls find rapidly growing acceptance, especially among younger voters. That could point toward durable majority support as this population ages. Gay marriage is now legal in 12 states and Washington, D.C.

On marijuana, "we're having a hard time almost believing how fast public opinion is changing in our direction," says Nadelmann of the Drug Policy Alliance.

But William Galston and E.J. Dionne, who co-wrote a paper on the new politics of marijuana for the Brookings Institution, believe marijuana legalization hasn't achieved a deep enough level of support to suggest a tipping point, with attitudes toward legalization marked by ambivalence and uncertainty.

"Compared with attitudes toward same-sex marriage, support for marijuana legalization is much less driven by moral conviction and much more by the belief that it is not a moral issue at all," they wrote.

No one expects Congress to change federal law anytime soon.

Partisans on both sides think people in other states will keep a close eye on the precedent-setting experiment underway in Colorado and Washington as they decide whether to give the green light to marijuana elsewhere.

"It will happen very suddenly," predicts the Cato Institute's Lynch. "In 10-15 years, it will be hard to find a politician who will say they were ever against legalization."

Sabet worries that things will move so fast that the negative effects of legalization won't yet be fully apparent when other states start giving the go-ahead to pot. He's hoping for a different outcome.

"I actually think that this is going to wake a lot of people up who might have looked the other way during the medical marijuana debate," he says. "In many ways, it actually might be the catalyst to turn things around."

Past predictions on pot have been wildly off-base, in both directions.

The 1972 commission that recommended decriminalizing marijuana speculated pot might be nothing more than a fad.

Then there's "Reefer Madness," the 1936 propaganda movie that pot fans rediscovered and turned into a cult classic in the 1970s. It labeled pot "The Real Public Enemy Number One!"

The movie spins a tale of dire consequences "leading finally to acts of shocking violence ... ending often in incurable insanity."

--- Associated Press writers Kristen Wyatt in Denver, Gene Johnson in Seattle, Lauran Neergaard in Washington and AP researcher Monika Mathur in Washington contributed to this report.

--- Follow Nancy Benac on Twitter: HTTP://WWW.TWITTER.COM/NBENAC and Alicia Caldwell at HTTP://WWW.TWITTER.COM/ACALDWELLAP © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Tuesday, 02 July 2013 10:44
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LAS VEGAS (AP) -- A prominent former Las Vegas doctor and endoscopy clinic owner was convicted Monday of all 27 criminal charges against him - including second-degree murder - in a 2007 hepatitis C outbreak that officials called one of the largest ever in the U.S.

A former employee at Dipak Desai's Endoscopy Clinic of Southern Nevada, nurse-anesthetist Ronald Lakeman, was found guilty of 16 of 27 charges against him but was spared a murder conviction stemming from the death of 77-year-old Rodolfo Meana in April 2012.

Defense attorneys for both men said they'll appeal.

Desai, a former Nevada state medical board member, surrendered his medical license, declared bankruptcy and turned over his business affairs to family members and lawyers in recent years. He stared straight ahead as the jury's verdicts were read.

His lawyers maintained that he was unfit for trial because of the effects of several strokes in recent years.

Desai's wife, Kusam, sobbed quietly and one of their adult daughters cried out as Desai and Lakeman were handcuffed and led from the courtroom to jail to await sentencing Sept. 5.

"We love you, Daddy," she said to Desai. "God is with you. Always with you."

Desai didn't appear to respond.

Desai, 63, and Lakeman, 66, face the possibility of life in prison for their multiple felony convictions.

Jurors heard more than 70 witnesses during seven weeks of testimony about a case that shocked the community when the outbreak became public in February 2008. Health officials issued advisories that led 63,000 clinic patients to get tested for potentially fatal blood-borne diseases, including hepatitis and HIV.

Investigators blamed unsafe injection practices and traced the infections of nine people to Desai clinics, although local and federal health investigators said they thought the hepatitis C infections of another 105 patients might have been related to similar practices. In those cases, however, they said they couldn't rule out other sources of infection.

The charges in Clark County District Court resulted from the infection of seven patients and bills paid by their insurers.

Prosecutors alleged that Desai and Lakeman recklessly and negligently put patients at risk with the reuse of syringes and vials of the general anesthetic propofol during procedures at a clinic where speed was emphasized over patient safety.

Health investigators testified that they believed vials became contaminated with hepatitis C virus from two different "source" patients on two dates in 2007, and that tainted anesthetic was injected into subsequent patients on those dates.

In addition to the murder charge, Desai was found guilty of seven counts of criminal neglect of patients resulting in substantial bodily harm, seven counts of reckless disregard of persons resulting in substantial bodily harm, nine counts of insurance fraud, two counts of obtaining money under false pretenses and one felony theft charge.

Lakeman was found guilty of 16 charges including insurance fraud, criminal neglect, reckless disregard, obtaining money under false pretenses and theft. He was acquitted of 11 counts.

"I'm elated that he didn't get convicted on the murder charge," Lakeman's lawyer, Frederick Santacroce, said outside court. "I'm disappointed that he was convicted of the other charges."

Desai attorneys Richard Wright and Margaret Stanish, and prosecutors Michael Staudaher and Pamela Weckerly, declined immediate comment.

The jury of seven women and five men deliberated Friday and most of the day Monday before reaching their verdict.

Another former Desai clinic nurse anesthetist, Keith Mathahs, 77, pleaded guilty in December to five felonies, including criminal neglect of patients resulting in death, insurance fraud and racketeering. He testified against Desai and Lakeman and could get probation or up to six years in state prison when he is sentenced.

The state criminal case is separate from a case pending against Desai and a former clinic business manager, Tonya Rushing, in U.S. District Court in Las Vegas.

Desai and Rushing have pleaded not guilty to conspiracy and health care fraud charges alleging they schemed to inflate anesthesia times and overbill health insurance companies. Trial is scheduled to begin Aug. 20.

The hepatitis outbreak also spawned dozens of civil lawsuits, including several that yielded jury findings holding drug manufacturers and the state's largest health management organization liable for hundreds of millions of dollars in damages to plaintiffs.

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Tuesday, 02 July 2013 10:42
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RICHMOND HEIGHTS, Mo. (AP) -- Hospitals have fretted for years over how to make sure doctors, nurses and staff keep their hands clean, but with only limited success. Now, some are turning to technology - beepers, buzzers, lights and tracking systems that remind workers to sanitize, and chart those who don't.

Health experts say poor hand cleanliness is a factor in hospital-borne infections that kill tens of thousands of Americans each year. The U.S. Centers for Disease Control and Prevention in Atlanta estimates that one of every 20 patients in U.S. hospitals gets a hospital-acquired infection each year.

"We've known for over 150 years that good hand hygiene prevents patients from getting infections," said Dr. John Jernigan, an epidemiologist for the CDC. "However, it's been a very chronic and difficult problem to get adherence levels up as high as we'd like them to be."

Hospitals have tried varying ways to promote better hygiene. Signs are posted in restrooms. Some even employ monitors who keep tabs and single out offenders.

Still, experts believe hospital workers wash up, at best, about 50 percent of the time. One St. Louis-area hospital believes it can approach 100 percent adherence.

Since last year, SSM St. Mary's Health Center in the St. Louis suburb of Richmond Heights, Mo., has been the test site for a system developed by Biovigil Inc., of Ann Arbor, Mich. A flashing light on a badge turns green when hands are clean, red if they're not. It also tracks each hand-cleaning opportunity - the successes and the failures.

The failures have been few at the two units of St. Mary's where the system is being tested, the hospital said. One unit had 97 percent hand hygiene success, said Dr. Morey Gardner, the hospital's director of infection disease and prevention. The other had 99 percent success.

"The holy grail of infection prevention is in our grasp," Gardner said.

The Biovigil system is among many being tried at hospitals. A method developed by Arrowsight, based in Mt. Kisco, N.Y., uses video monitoring. It is being used in intensive care units at North Shore University Hospital in Manhasset, N.Y., and the University of California San Francisco Medical Center.

Akron, Ohio-based GOJO Industries, maker of Purell hand sanitizer, has developed an electronic compliance monitoring system using wireless technology to track when soap and hand sanitizer dispensers are used. The SmartLink system gives the hospital data on high- and low-compliance areas. The company said it has installed the system at several hospitals around the country, but didn't say how many.

HyGreen Inc.'s Hand Hygiene Reminder System was developed by two University of Florida doctors. The Gainesville, Fla., company now features two systems used in seven hospitals, including Veterans Administration hospitals in Chicago, Wilmington, Del., and Wilkes-Barre, Pa.

One is similar to Biovigil's green badge method. In HyGreen's, a wall-mounted hand wash sensor detects alcohol on the hands. The badge includes an active reminding system. Unclean hands create a warning buzz. If the buzz sounds three times, the worker is noted for noncompliance.

HyGreen spokeswoman Elena Fraser said that because some hospitals are moving away from alcohol-based sanitizers, HyGreen offers a second system. A touch of the sanitizer dispenser clears the worker to interact with a patient. If the worker shows up at the patient bed without hand-cleaning, the series of warning buzzes begins.

Fraser said hospital infections have dropped 66 percent at units of Miami Children's Hospital where the badge system has been implemented.

Nurses using the Biovigil system at St. Mary's near St. Louis wear a badge with changeable colored lights. A doorway sensor identifies when the nurse enters a patient's room, and the badge color changes to yellow.

The nurse washes his or her hands and places them close to the badge. A sensor in the badge detects chemical vapors from the alcohol-based solution. If hands are clean, the badge illuminates a bright green hand symbol.

If the nurse fails to sanitize, the badge stays yellow and chirps every 10 seconds for 40 seconds, then flashes red. Once the flashing red starts, the nurse has another 30 seconds to wash up, otherwise the badge turns solid red, denoting non-compliance. Either way, each instance is tracked by a computer. The hospital can track each individual's compliance.

Registered Nurse Theresa Gratton has helped lead the effort toward hand cleanliness at St. Mary's. She heard about the Biovigil system in early 2012 and convinced the hospital to give it a try.

Gratton said patients are aware of the risk of infection and frequently inquire about whether caregivers have washed their hands. She said the badge relieves their anxiety.

Bill Rogers, a 65-year-old retiree recuperating at St. Mary's from back surgery and a heart scare, agreed.

"The first thing I noticed up here was the badges," Rogers said. "It is comforting for me to know their hands are clean as soon as the badge beeps and it goes from yellow to green."

St. Mary's is expanding the Biovigil system later this year to other units of the hospital and to employees other than nurses, though details are still being worked out, Gardner said. Eventually, the system may be expanded to SSM's seven other St. Louis-area hospitals, he said.

Biovigil's chief client officer, Brent Nibarger, said customers won't buy the system but will pay a subscription fee of about $12 a month per badge.

The CDC's Jernigan said the high-tech systems can only help.

"For a health care worker, keeping their hands clean is the single most important thing they can do to protect their patients," Jernigan said.

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Friday, 28 June 2013 11:06
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BALTIMORE (AP) -- In the 15 years between a shotgun blast that ravaged the bottom half of Richard Norris' face and the face transplant that ended a hermit-like life for him, the man from rural southwest Virginia faced cruelty from strangers, fought addiction and contemplated suicide.

But even if he could go back in time, he's not sure he would erase the accident that left him severely disfigured.

"Those 10 years of hell I lived through, it has given me such a wealth of knowledge," Norris recently told The Associated Press, one of only two news outlets granted interviews since his transplant last year. "It's unreal. It has put some of the best people in my life."

Now, at 38, he's starting a new life: taking online classes in pursuit of a degree in information systems and contemplating a foundation to help defray future transplant patients' everyday expenses during treatment.

He also has been working with a photojournalist who just completed a book about his journey, titled "The Two Faces of Richard."

He hopes his story sends a message of hope to people in similar situations and encourages empathy in others.

"I've heard all kinds of remarks," he said. "A lot of them were really horrible."

After the 1997 accident at his home, Norris had no teeth, no nose and only part of his tongue. He was still able to taste but could not smell. When he went out in public, usually at night, he hid behind a hat and mask.

Norris had dozens of surgeries to repair his face, but eventually reached the limits of what conventional surgery could do for him, said Dr. Eduardo Rodriguez, who performed some of those operations and later led the surgical team that performed Norris' face transplant.

Some parts of the anatomy, such as eyelids and lips, are just too complex to recreate, he noted.

"You can create a semblance of something, but I can guarantee you it's not normal by any means."

Just weeks after Norris was told by another doctor that there was little else that could be done for him, Rodriguez presented him with another option: a transplant.

The doctor, who is head of plastic surgery at the University of Maryland Medical Center's R Adams Cowley Shock Trauma Center, had been following advancements in the face transplant field for years. An Office of Naval Research grant for the purpose of helping wounded warriors made it possible for him and his team to attempt their first face transplant, an operation that previously had been performed by only two other centers in the United States.

The world's first partial face transplant was performed in France in 2005 on a woman who was mauled by her dog. Of the 27 other transplants that have followed, four recipients have died, and the survivors face a lifetime of immunosuppressant drugs, which can take a toll on their health.

Unlike most organ transplant recipients, who need their surgeries to live, face transplant patients are risking death to eliminate a non-life-threatening condition, noted Dr. Mark Ehrenreich, the psychiatric consultant to Norris' transplant team.

Rodriguez says patients are well aware of the situation.

"If you talk to these patients, they will tell you it is worth the risk," he said.

The team carefully lays out all of the dangers for patients: Norris' mother, Sandra, remembers Rodriguez saying there was a 50-50 chance her son would survive the surgery.

"We looked at Richard and we told him we loved him the way he was and it didn't matter to us, but it was his life," she said. "That was what he wanted to do and we supported him."

Norris said he is humbled by the gift he received from the family of 21-year-old Joshua Aversano, who died after being struck by a minivan while crossing the street. The Maryland family, which agreed to donate his organs, declined to be interviewed by the AP.

In a statement, the family said, "We are grateful Joshua's legacy continues through the lives of the individuals he was able to save with gifts of organ and tissue donation."

Norris said he speaks to the family regularly and keeps them updated on his life and health.

Norris' 36-hour transplant operation is still considered the most extensive ever conducted because it included transplantation of the teeth, upper and lower jaw, a portion of the tongue and all of the tissue from the scalp to the base of the neck, Rodriguez said.

"The real main limitation ... is that patients are dependent on medication for life," he said. The immunosuppressant medications carry risks for the patients, who don't know how long the transplant will last. Rodriguez said if all goes well, a transplanted face could last 20 to 30 years.

For Norris, who makes daily visual checks, the risk of rejection is never far from his mind.

"Every day I wake up with that fear: Is this the day? The day I'm going to go into a state of rejection that is going to be so bad that the doctors can't change it?"

But he said he can't let himself worry about it too much, and he knows that he's in good hands.

Norris has come far in the past 15 months, learning how to eat and talk again and adjusting each time his face gains more feeling. He continues with therapy, travels to Baltimore from his home in Hillsville, Va., regularly to see doctors, and still takes pain and immunosuppressant medications. He says his faith in God has carried him through it all; that he has maintained a sense of humor and remained the same person inside.

And he agrees with doctors, who dismiss a commonly held belief that face transplant patients are likely to experience an identity crisis.

"When I look in the mirror, I see Richard Norris," he said remembering the immediate connection he felt with his new face.

The bigger issue for Norris is being able to appear in public again. Facial disfigurement tends not to engender sympathy, leaving patients feeling shunned, Ehrenreich noted.

"Unfortunately, with severe facial disfigurement, people recoil and make comments they would never make to someone in a wheelchair," he said. The transplant marks "such a significant improvement, that they're welcome to be in public."

Since his surgery, Norris says the gawking has disappeared.

"When I was disfigured, just walking the sidewalk, I was surprised that more people didn't walk into telephone poles or break their necks to stare at me," he said.

"Now ... there's no one paying attention. Unless they know me personally, they don't know I am a face transplant patient. That right there is the goal we had."

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Friday, 28 June 2013 10:51
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WASHINGTON (AP) -- Huge list prices charged by hospitals are drawing increased attention, but a federal law meant to limit what the most financially vulnerable patients can be billed doesn't seem to be making much difference.

A provision in President Barack Obama's health care overhaul says most hospitals must charge uninsured patients no more than what people with health insurance are billed.

The goal is to protect patients from medical bankruptcy, a problem that will not go away next year when Obama's law expands coverage for millions.

Because the Affordable Care Act doesn't cover everyone, many people will remain uninsured. Also, some who could sign up are expected to procrastinate even though the law requires virtually everyone to have health insurance.

Consumer groups that lobbied for a "fair pricing" provision are disappointed. A university researcher who's studied the issue says the government doesn't seem to be doing much enforcement, and at least one state, Colorado, enacted a stricter rule since the federal statute passed.

Critics say the law has several problems:

-It applies only to nonprofit institutions, which means about 40 percent of all community hospitals are exempted. By comparison, the Colorado law also covers for-profit hospitals.

-It lacks a clear formula for hospitals to determine which uninsured patients qualify for financial aid, and how deep a discount is reasonable. A California law spells out such a formula for that state's hospitals.

-More than three years after Obama signed his law, the Internal Revenue Service has not issued final rules explaining how hospitals should comply with the federal billing limits. Delay doesn't signal a high priority.

"We still hear the same stories about patients who are being sent to (debt) collection," said Jessica Curtis, director of the hospital accountability project at Community Catalyst, a Boston-based advocacy group that led the push for billing limitations. "It's the same behavior that we were seeing before the passage of the Affordable Care Act."

The Obama administration responds that fair pricing is the law of the land, and that hospitals are expected to comply even if the IRS has not finalized the rules. The agency has begun compliance reviews, a spokeswoman said.

The health law "helps to protect patients from hidden and high prices and unreasonable collection actions," said Treasury Department spokeswoman Sabrina Siddiqui.

The American Hospital Association says it urges members to limit charges to the uninsured in line with the federal law. But neither the administration nor the industry has statistics on how many hospitals are doing so.

Health and Human Services Secretary Kathleen Sebelius recently took on hospital pricing policies when she released federal data that document wide disparities in what different hospitals charge for the same procedures.

Most patients never face those list prices because private insurers negotiate lower rates and government programs such as Medicare get to set what they will pay. The burden of paying list price falls on the uninsured and people with skimpy policies. It's unclear that the federal requirements are helping at all.

Justin Farman, a nursing student from Watertown, in upstate New York, was diagnosed with a blood cancer last fall, when he was uninsured.

Going without health insurance is a calculated risk taken by many young people starting out their careers. Farman, 26, said the $120 his employer charged monthly for premiums was too much for his budget. Besides, he was in good shape and an avid weightlifter. But months of deep tiredness and unexplained weight loss led him to consult doctors, and he was eventually diagnosed with lymphoma.

Treatment at Upstate University Hospital in Syracuse was successful, but Farman faced more than $54,000 in medical bills, between the hospital and doctors.

"After I went into remission, the bills started to roll in," said Farman. The hospital did not tell him that financial assistance might be available, Farman said.

He had to fend off collection agencies. "That's not too fun," he added.

A spokesman for Upstate said the federal fair pricing law does not appear to apply to the hospital because it is publicly owned and not incorporated as a nonprofit under federal law. Spokesman Darryl Geddes said he could not discuss individual cases, but the hospital does not decline care to anyone based on the individual's ability to pay. Upstate maintains a financial assistance program that complies with state law, he added.

Part way through his treatment, Farman was able to get on Medicaid. With the help of a community agency, he also applied for assistance under New York law to help pay for his medical care during the period he was uninsured. On Friday, he received a letter saying his application had been approved and his debts would be greatly reduced.

Such discounts should be taken up front, advocates say.

Congress needs to take a second look at the federal law, says University of Southern California health policy professor Glenn Melnick.

As written, the law leaves it up to hospitals to determine which uninsured people qualify for discounted bills, and that could create a whole new set of disparities.

"One hospital could say it applies to people at 100 percent of the poverty line, and another could say 200 percent," Melnick explained. He called the enforcement provisions were "very weak."

A California law could serve as a model, he said. It defines the patients who qualify for assistance as those who are uninsured or making at or below 350 percent of the federal poverty line - $40,215 for an individual and $82,425 for a family of four. Those patients cannot be charged more than the hospital would receive from Medicare.

"This issue will not go away," said Melnick. "Even when the (Affordable Care Act) is fully implemented, there will be millions and millions of people without insurance."

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Wednesday, 26 June 2013 09:41
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