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Barbara Strauch, 63, Science and Health Editor at The New York Times, Dies

Written By Unknown on Kamis, 16 April 2015 | 13.57

Photo Barbara Strauch in 2009. She directed health and science coverage for The New York Times for a decade. Credit Earl Wilson/The New York Times

Barbara Strauch, a reporter and editor who wrote two books about the brain and directed health and science coverage for The New York Times for a decade, died on Wednesday at her home in Rye, N.Y. She was 63.

The cause was breast cancer, her husband, Richard Breeden, said.

Before joining The Times, Ms. Strauch (pronounced STROWK) ran the Newsday team that won the 1992 Pulitzer Prize for spot news for its coverage of a midnight subway derailment in Manhattan that left five passengers dead and more than 200 injured.

Hired by The Times after New York Newsday ceased publication in 1995, Ms. Strauch worked on the national desk, edited business coverage of the New York metropolitan area and was media editor. She joined the paper's science department as an assistant editor in 2000.

Appointed health editor in 2004, Ms. Strauch supervised coverage of a rapidly changing health care industry, tracking advances in pharmaceutical research, the rising costs of health care, debates over health insurance coverage and the politics of medical care, as well as the changing roles of doctors and hospitals. She was named science editor in 2011, overseeing all health and science coverage in the daily news report, as well as in the weekly Science Times section. She held that post until this month.

As science editor, Ms. Strauch oversaw the introduction of the popular Well blog and a number of projects, including "Chasing the Higgs," about the race between two teams of researchers to discover the Higgs boson, sometimes called the "God particle." It was a Pulitzer finalist in 2014. Other projects examined patient care, treating children with mental illness and the struggles in cancer research.

"Barbara's stewardship of the science section was the capstone to an extraordinary career in journalism," Dean Baquet, the executive editor of The Times, said in a memo to the newsroom staff. "Her zest for a great story and her determination to infuse science journalism with sophistication, heart and rigor made our coverage the envy of our peers."

Ms. Strauch was the author of "The Primal Teen: What the New Discoveries About the Teenage Brain Tell Us About Our Kids," published in 2003, and "The Secret Life of the Grown-up Brain: The Surprising Talents of the Middle-Aged Mind" (2010), which concluded that certain cognitive functions peak fairly late, when people are in their 60s.

Responding to online questions from readers in 2009, she explained that teenagers are naturally attracted to risk, because from an evolutionary standpoint they need a biological incentive to leave familiar surroundings to mate and avoid inbreeding. Adults, she said, are better at assessing consequences.

Photo In 2010, Ms. Strauch published "The Secret Life of the Grown-up Brain: The Surprising Talents of the Middle-Aged Mind," which concluded that certain cognitive functions peak fairly late, when people are in their 60s. Credit Viking Adult

"We have teenagers staying out all night or skipping school and their parents tearing out their middle-aged hair," she wrote. "The good news is that, if we can get past the power-struggle part of all this, admit what we were like at that age, take the long view and call on the calmer middle-aged brain we have, we should also realize that a few bad and even risky moves by teenagers are natural and necessary, as long as they do not kill themselves. Easier said than done."

Barbara Ellen Strauch was born in Evanston, Ill., on May 10, 1951. Her father, Frederic Jr., was an electrical engineer. Her mother, the former Claire Christiansen, was a reporter for the newspaper The Daily Pilot in Orange County, Calif.

In addition to her husband, she is survived by two daughters, Hayley and Meryl Breeden, and a brother, Ron Strauch.

After graduating from the University of California, Berkeley, with a bachelor's degree in English, Ms. Strauch worked for newspapers in New England, Venezuela and Houston. She was a senior editor at New York Newsday.

Molly Gordy, a former Newsday reporter, recalled: "She sent me to interview a Salvadoran refugee family for an immigration series, and when I came back saying they were boring, she told me to pack a suitcase and move in with them and not leave until I was in love." She stayed five days, she said.

In the course of her career, Ms. Strauch dealt with subjects as diverse as space shuttle missions and police shootings, but she said in the 2009 online piece that "sorting out health news is one of the hardest I have run across, in part because of the hype and — more alarming — the financial ties and conflicts of interest of many researchers."

She lamented the decline in science coverage in other general-interest publications.

"Something quite serious has been lost," she wrote in 2013 on the website Edge.org., an online discussion group. "And, of course, this has ramifications not only for the general level of scientific understanding, but for funding decisions in Washington — and even access to medical care. And it's not good for those of us at The Times, either. Competition makes us all better."

"So what we have is a high interest and a lot of misinformation floating around," she warned. "And we have fewer and fewer places that provide real information to a general audience that is understandable, at least by those of us who do not yet have our doctorates in astrophysics. The disconnect is what we should all be worried about."

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California Parents Opposing State-Mandated Vaccinations of Children Delay Vote

Photo State Senators Richard Pan, left, Loni Hancock, center, and Ben Allen talked about a bill requiring California's schoolchildren to be vaccinated. Credit Rich Pedroncelli/Associated Press

SACRAMENTO — Several hundred Californians swarmed the State Capitol on Wednesday to oppose a bill that would eliminate their right not to vaccinate their children against contagious diseases like measles. They were able to help stall a committee vote on the legislation by a week.

The bill, introduced after a measles outbreak over the winter that originated at Disneyland, would require nearly all children to be vaccinated, eliminating the growing use of the so-called personal belief exemption that has contributed to the spread of preventable diseases. Parents who refused to immunize their children and did not have a medical exemption would be forced to teach their children at home.

The bill, which was passed by the State Senate's Health Committee, was up for a hearing on Wednesday before the Senate Education Committee. There, the small but vocal minority of parents who object to scientifically proven vaccinations showed up in force and helped stall the measure.

"I strongly oppose injection of questionable materials into the bodies of our children as a condition of education," said Steve Wall, an environmental engineer from Bay Point, who lined up with hundreds of others to denounce the bill before the Education Committee.

Continue reading the main story


A map of counties where cases have been reported so far this year, and a chart showing how the number of cases compares to previous years.

State Senator Richard Pan, a physician and a Democrat, has been threatened on Facebook over his sponsorship of the bill. He told the committee that the growing use of the personal belief exemption had been identified as aiding the spread of measles from the Disneyland outbreak. "We are clearly at a point where our community immunity is dropping too low," he said. To believe otherwise, he said, is a "luxury."

Jay Hansen, a member of the Sacramento City Unified School District, said the measure was based on science, not emotion. "We should stand up for the scientific method we all learned in school," he said.

But after nearly two hours of opposition testimony, doubts among committee members emerged, from both Republicans and majority Democrats. One concern was that the bill did not address what would happen to children who now have exemptions from vaccines on Jan. 1, when the law would take effect. At the end of the hearing, Senator Carol Liu, the committee chairwoman and a Democrat, told Mr. Pan that his bill lacked the votes for passage and gave him a week to fix the measure.

If the bill passes, California will become the largest state by far to bar exemptions from vaccines for any reason other than medical necessity. Only two other states, Mississippi and West Virginia, have such rules.

Testifying for the bill, Romana Garcia, 77, who has used a wheelchair since childhood because of polio, tearfully declared, "I beg you, please prevent infectious diseases that are preventable."

Also supporting Mr. Pan's bill were groups like the California Medical Association, the March of Dimes, the California State PTA and the California School Boards Association.

The hearing drew one of the largest crowds seen in the Capitol in years. Some people waited for hours to speak their name, city and their opposition to the measure. Among them was Jeany Bowen of San Diego, with her sons, Colin, 7, and Ethan, 12. She described herself as the "mother of two unvaccinated, healthy boys."

She said one of her sons suffered a reaction to a vaccine when he was young, but her physician insisted that it was a virus. "I never saw a doctor who said it was the vaccine," she said.

She said that she taught the boys at home, but that Ethan would like to go to a public high school. "But he won't be able to if this bill passes," she said.

From December to mid-April, 134 people in California were reported by the state to have contracted measles. Attention focused on the growing number of unvaccinated children whose parents used the personal belief exemption. The state reports that 2.5 percent of kindergarten pupils in 2014 were excused from some vaccines because of the exemption, but in some areas the percentage ran much higher; in Nevada County, in the Mother Lode of the Sierra Nevada, it was 22 percent, or 184 pupils.

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F.D.A. Approves Amgen Drug to Treat Heart Failure

The Food and Drug Administration on Wednesday approved a drug to treat chronic heart failure that may help keep patients out of the hospital.

The drug, which Amgen will sell under the name Corlanor, works by slowing the heart rate, which helps relieve stress on the organ. Amgen licensed the American rights to the drug, known generically as ivabradine, from the French company Servier, which has been selling it in Europe for about a decade.

Many Wall Street analysts and heart failure specialists are lukewarm about the drug, which has had mixed results in clinical trials. They are more excited about a heart failure drug from Novartis, called LCZ696, which could be approved by August.

Amgen's drug will be for "a niche of patients, potentially small, compared to a full cohort of patients who will be immediate candidates for LCZ696," Dr. Clyde W. Yancy, chief of the cardiology division at the Feinberg School of Medicine at Northwestern University, wrote in an email.

Still, the approval moves Amgen into the cardiology drug business, preparing it for the expected approval this summer of a much more important cardiovascular drug — a powerful cholesterol fighter called evolocumab.

More than five million Americans suffer from heart failure, in which the heart does not pump blood adequately, a condition that can result from a heart attack or other causes. Heart failure is a leading cause of hospitalizations.

People with heart failure now take various drugs, including beta blockers, which work partly by slowing down the heart beat. Corlanor is approved for patients whose resting heart rate is still above 70 beats a minute — considered high enough to strain the heart — despite taking the highest dose of beta blockers they can tolerate. Dr. Sean E. Harper, executive vice president for research and development at Amgen, said about one million Americans fit that description.

Amgen will charge $375 a month, or about $4,500 a year, for Corlanor, which could be a challenge because most other drugs used for heart failure are relatively low-cost generics. But Dr. Harper said the drug could save the health care system money by reducing hospitalizations.

"It's an unusual circumstance where the impact of the product is so tangibly calculable," he said.

He said Corlanor, a pill taken twice a day, represents the first new type of drug for heart failure that has been approved in about a decade. The drug works by inhibiting what is known as the "funny current" in the heart's natural pacemaker.

Amgen won approval based on a trial sponsored by Servier that involved more than 6,500 patients with moderate to severe heart failure and heart rates over 70 beats a minute. They were randomly assigned to take either ivabradine or a placebo, in addition to their existing medications.

After nearly two years, 16 percent of patients receiving ivabradine were hospitalized for worsening heart failure compared with 21 percent of those getting the placebo. That represented a reduction in risk of 26 percent by a measure known as the hazard ratio. The drug also reduced deaths from heart failure but not deaths from all cardiovascular causes, according to the results published in The Lancet in 2010.

Dr. Yancy said the results of the trial, which was conducted from 2006 to 2009 outside the United States, might not fully apply to American patients treated with the most modern methods.

There have been other studies, albeit in different patient populations, in which the drug did not work as well. The European Medicines Agency said last year that in certain patients with angina, which is chest pain from insufficient blood flow to the heart, the drug might actually increase the risk of heart attacks and deaths from cardiovascular causes. The drug can also cause heart rates to drop dangerously low in some patients.

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Doctors See Benefits and Risks in Medicare Changes

Photo Dr. Daniel Craviotto, left, an orthopedic surgeon, expressed concern about new legislation leading to a loss of doctors' autonomy. Credit Emily Berl for The New York Times

Dr. Robert Wergin, president of the American Academy of Family Physicians, made little effort to contain his glee Wednesday over the news that Congress had voted to end a reviled payment system for doctors, simultaneously averting a 21 percent physician pay cut and overhauling the way Medicare will pay doctors in the future.

"I just can't be more positive about it," said Dr. Wergin, who is a family doctor in rural southeast Nebraska. "The one word is yahoo."

Then he added: "Now, what next?"

President Obama has signaled that he will sign the bill, resolving an issue that frustrated lawmakers in both parties for more than a decade because it repeatedly required Congress to step in to avert cuts to doctor fees. Doctors and health policy experts have begun to take stock of the practical implications of the legislation, which seeks to move away from paying doctors solely on the volume of their services and toward reimbursing them based on the quality and value of the care they provide. Many said the legislation was short on details about how such quality will be measured, and others expressed apprehension about whether the system will be fair.

"It's very important legislation in that it aims to support better care and lower costs, but there are a whole lot of details that still need to be filled in," said Dr. Mark McClellan, a senior fellow at the Brookings Institution and a Medicare administrator in the George W. Bush administration.

Under the new legislation, Medicare will increase the amount it reimburses doctors by 0.5 percent for the next five years. Doctors will earn a 5 percent bonus if they participate in newer payment models that seek to better coordinate care. One example is the so-called medical home, in which a medical team coordinates a patient's care. They could also work in groups, called accountable care organizations, that receive a set fee to take care of a patient while still meeting quality standards.

"It's a very big boost to these models," said Paul B. Ginsburg, a health economist at the University of Southern California, although he and others noted that how these payment models will be defined is still not clear.

Mr. Ginsburg and others expressed more skepticism about another component of the legislation: one that, beginning in 2019, would pay doctors based on how they perform on quality and other measures. Ultimately, the Department of Health and Human Services will decide those standards.

Mr. Ginsburg said that doctors did not typically see enough patients to yield reliable data about how well they perform, or to adjust their scores for whether their patients are sicker than average.

Travis Singleton, senior vice president at Merritt Hawkins, a physician consulting firm, said doctors needed more direction and were understandably worried. "What if my patient isn't listening to me? Who is judging this quality?" he said. "I just don't think doctors are there yet. I don't think they're fighting the concept of trying to be more efficient, but I don't think anyone's given them a clear mousetrap or a picture of how they're going to do it."

Some standards are straightforward, such as measuring a patient's blood pressure or a diabetic's blood sugar. But Meredith Rosenthal, a health economist at Harvard University, said there was no clear agreement on how best to measure the quality of other kinds of doctors, like radiologists or a dermatologist in solo practice. "Once we're out of primary care, we're in kind of a neverland of measurement," she said, predicting that there would be significant work to develop new standards because of the legislation.

Some doctors said they feared the new measures would result in a loss of independence. "All of a sudden you have nonmedical entities and people outside of medicine deciding what is value," said Dr. Daniel Craviotto, an orthopedic surgeon in Santa Barbara, Calif., who has spoken out against what he describes as a loss of autonomy as insurers and Medicare have increasingly scrutinized doctors' practices. "It's become so burdensome for some of the silly things we have to do."

Dr. Wergin, of the family practice group, said he sympathized with concerns like those of Dr. Craviotto. "But what do we have now?" he asked, noting that doctors are often held to a variety of standards by different insurers. He said he hoped that the legislation would lead to more standardized quality measures. "Isn't quality quality, no matter which insurance you have?" he asked.

Doctors are also relieved that there is now more certainty over how they will be paid, with both Medicare and private insurers moving toward a system that rewards them for delivering higher-quality care. Doctors had complained of being paid under the old volume-based system even as they were trying to meet the demands of new models. "It allows docs to have a good sense of the next decade and plan for it," said Dr. Lisa Bielamowicz, an expert on physician strategy for The Advisory Board Company.

Even small physician practices are going to have to invest in making sure that they can better keep track of patients, she said, predicting that this would add to the pressure on doctors to join larger groups or work for hospital systems.

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Bits Blog: Report Questions Whether Health Apps Benefit Healthy People

Written By Unknown on Rabu, 15 April 2015 | 13.57

Photo Dr. Iltifat Husain is the editor-in-chief of iMedicalApps.com, a review site for medical professionals.Credit Wake Forest Baptist Health

Consumers looking to use their mobile devices to improve their health — or at least maintain their well-being — have tens of thousands of choices.

But if those consumers are already healthy, the apps won't necessarily do them any good, according to a new report in The BMJ, a British medical journal.

On Tuesday afternoon, for instance, the top 10 free health and fitness apps for iPhones included MyFitnessPal, a calorie counter and diet tracker; the FitBit activity tracker; Pacer, a pedometer and blood pressure tracker; and Period Tracker Lite, a menstrual-cycle tracker, according to data compiled by App Annie, an analytics firm.

For consumers with concerns of a more medical nature, apps in the Google Play store, among others, offer all kinds of advice, self-diagnosis and treatment. One is marketed as an HIV risk calculator, another is a self-described self-test for erectile dysfunction, and a third purports to offer home remedies for cold sores, colitis, conjunctivitis and constipation.

An article published in The BMJ on Tuesday evening, however, questions whether such consumer health apps provide any real health value to already-healthy consumers – and whether the apps could even cause harm by stoking unneeded anxiety among the worried well.

Doctors don't yet have definitive answers to these questions, partly because smartphone apps are so new and partly because government health authorities regulate consumer health apps at their own discretion, depending on the possible risks to users. As a result, many health and fitness apps lack rigorous clinical evidence to demonstrate they can actually improve health outcomes.

The medical journal article, titled "Can Healthy People Benefit From Health Apps?," lays out arguments for and against the apps by juxtaposing the opposing views of two doctors.

Arguing in favor, Dr. Iltifat Husain, the editor in chief of iMedicalApps.com, a review site for medical professionals, contended that some apps, by encouraging healthy behavior, could hold great potential to reduce the rate of illness and death.

"They can help people to correlate personal decisions with health outcomes," Dr. Husain wrote, "and they can help doctors to hold patients accountable for their behavior."

He recommended that doctors become more involved in educating the public on which health details to track and which apps to use. If doctors waited for scientific studies to prove the benefits of health apps, he added, they could lose their power to influence patients to "the industry dictating which tools people should use."

To provide a dissenting perspective, The BMJ enlisted Dr. Des Spence, a general practitioner in Glasgow. He argued that many health tracking apps encouraged healthy people to unnecessarily record their normal activities and vital signs — turning users into continuously self-monitoring "neurotics." He recommended people view these new technologies with skepticism.

"The truth is that these apps and devices are untested and unscientific, and they will open the door of uncertainty," Dr. Spence wrote. "Make no mistake: Diagnostic uncertainty ignites extreme anxiety in people."

Although both doctors agreed there was no evidence that health apps had caused harm, federal regulators in the United States have been cracking down on health apps that make deceptive claims — an issue with the potential to cause mistreatment or misdiagnosis of medical problems.

In 2011, the Federal Trade Commission accused the developers of two acne apps of falsely claiming they could treat acne by shining colored light onto users' skin.

This year, the agency accused two melanoma app marketers of deceptively claiming that their products could accurately analyze skin moles for the risk of melanoma, even in its early stages. Regulators said the marketers did not have sufficient evidence to support those medical claims.

"If an app claims to treat, diagnose or prevent a disease or a health condition, it needs to have serious evidence to back up those claims," Mary K. Engle, associate director of the F.T.C.'s division of advertising practices, said in a phone interview this year. "We hope marketers will take heed of that and do their homework before they get into the marketplace."

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Well: Christopher McDougall Wants You to Go Outside

Photo Credit Stuart Bradford

The author Christopher McDougall helped make barefoot running mainstream with his best-selling book "Born to Run," a tale about a tribe of endurance runners and an annual 50-mile footrace in the mountains of Mexico.

Now Mr. McDougall returns with another tale that he hopes will again upend the fitness world, this time by getting people out of the sterile gym environment to run, jump, throw and climb outdoors. In his new book, "Natural Born Heroes: How a Band of Misfits Mastered the Lost Secrets of Strength and Endurance," Mr. McDougall writes about the benefits of exercising outdoors on trails, creek beds and rocks, where footholds are uncertain and paths contain obstacles like rocks and fallen trees that need to be climbed or hurdled.

For this month's Well Book Club, I spoke with Mr. McDougall about the problem with indoor fitness routines, what kind of workout he has been doing lately and what it really takes to climb a rope. Here's an edited version of our conversation.

Where did the idea for this book come from?

It came out of "Born to Run," but by accident. I was researching indigenous and ancient runners, and I came across a reference to the Cretan runner. He was a foot messenger during World War II. I put it aside but I was intrigued. What was this guy's story? I circled back and found this whole other fascinating story about people doing these superhuman feats on foot, behind enemy lines, running 40 to 100 miles at a time on a starvation diet.

Achieving that level of fitness seems so unattainable. Is there a lesson here for a regular person?

The big reveal to me was that they're not superhuman at all. Where we have really gone off the rails in our modern concept of the hero is this Hollywood assumption that they are all like Hugh Jackman. In reality, the classic Greek ideal of a hero was a common person. It was a virtue, a responsibility, that every person should be able to develop these natural, very attainable skills to be reliable in a crisis, to be capable of helping someone else out.

What are the skills of a natural-born hero?

It's about developing your natural abilities so you have dexterity for throwing, climbing or crawling. Strength is about using that natural elastic recoil in our body to tap into these latent reservoirs of strength. They are there; we just don't use them.

One of the skills you write about is climbing. Can you tell me more about that?

Kids love to climb. They want to get off the ground all the time. After the age of 5 or 6, we stop practicing the ability to get our bodies off the ground. One of the things I never could do was climb a rope. Climbing a rope is not a muscular challenge; it's a dexterity challenge. I got a 30-foot rope, slung it over a branch in my yard and started studying climbing techniques. Within a day, I was climbing. You trap the rope between your feet. You don't pull yourself up by your arms; you step up with your legs.

Why do you think people have lost these natural abilities for throwing and climbing?

At age 5 or 6, we stick kids in a class and say: "Sit there. Don't move until 3 p.m. and then go home and do homework." We take these physical animals and turn them into sedentary animals. And one of the things I've really come to believe passionately while researching this book is that most recreational sports are created by men for men, and they use male attributes like body strength. But the real skills, the human skills, are the ones where the differences between men and women are the slimmest. Humans have great dexterity and adaptability. Some of the greatest rock climbers in the world are women.

So how should people change their exercise habits in the modern world?

Add things to your workout that you don't think you can do. Try to climb a rope. Walk on all fours. Get outside and do things you're not expecting.

Why is an outdoor workout better than a workout in a gym?

In a gym, you are stationary and artificially balanced. You're on a padded seat, strapped in and isolating one muscle. All of the uncertainty in the range of motion has been stripped away. In the real world when you move, you don't isolate one muscle. We have been trying the stationary machine model for 40 years, and it's failed. It's based on body building. Size was never the goal of the hunter gatherer. You never wanted to be big; you wanted to be mobile and agile.

So many people embraced barefoot running after your first book. What is the ultimate advice in this book?

I think it's that we should be fit to be useful. What's the point of your exercise? Why are you getting big or lifting stuff if it's not useful? Can I use this skill to pick up a child who needs help or use this to pull a rope? There is this group called the November Project. In Boston when they got hit by the blizzard, they got snow shovels and dug out subway stations. How cool is that? They probably got the best workout of their lives, and so many people were benefiting from it.

So what kind of training do you do now?

I've become infatuated by Parkour. People think it's daredeviltry on rooftops, but it's about learning how to shift our body weight and using parts of your body you tend to ignore. I also take my runs off of trails and into creek beds. That uncertain footing allows you to work on agility and nimbleness. An immediate benefit is that it focuses you on the present.

Are there physical challenges that intimidate you? Author Christopher McDougall is responding to your posts and comments.

Join the conversation

Want a free Parkour lesson and a chance to meet Christopher McDougall? If you are among the first 10 Well readers to participate in our discussion who can attend, you'll receive a free Parkour lesson for you and a friend and two tickets to the "Natural Born Heroes" stage show in Central Park.

Winners will gather at the Society for Ethical Culture on Wednesday, April 15, at 5:30 p.m. for their Parkour lesson with The Movement Creative, New York's premier Parkour academy, and attended by Dan Edwardes, co-founder of London's Parkour Generations, and Julie Angel, movement specialist. The "Natural Born Heroes" show begins immediately after at 7 p.m.

A version of this article appears in print on 04/14/2015, on page D6 of the NewYork edition with the headline: Workout for an Everyday Hero.

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Listeria in Sabra Hummus Prompts New Wave of Recalls

Photo Sabra Dipping Company recalled 30,000 cases of its classic hummus after tubs in Michigan tested positive for listeria. Credit Spencer Platt/Getty Images

Two food manufacturers have issued nationwide recalls of products because of the discovery of the potentially lethal bacterium listeria, which federal authorities have now linked to three deaths and five illnesses in Texas and Kansas.

On Wednesday, the Sabra Dipping Company recalled 30,000 cases of its classic hummus after one tub in Michigan tested positive for the food-borne bacteria. No illnesses related to the hummus have been reported so far, according to Jennifer Holton, a spokeswoman for the Michigan Department of Agriculture and Rural Development.

Separately, the Centers for Disease Control and Prevention has confirmed that three people in Texas fell ill after eating Blue Bell ice cream from 2011 to 2014. The agency had already connected the company with three listeria-related deaths and two additional cases.

The agency is investigating three more potential cases, according to Dr. Rob Tauxe, deputy director of the C.D.C.'s Division of Foodborne, Waterborne and Environmental Diseases, which would bring the total number of cases to 11.

The agency initially linked five patients at a hospital in Kansas who fell ill from January 2014 to January 2015 to Blue Bell Products. The C.D.C. determined that at least four had consumed milkshakes made with Blue Bell ice cream.

Listeria is among the most dangerous food-borne illnesses, particularly to people with compromised immune systems, although it is much more rare than other common diseases like salmonella poisoning. The C.D.C. estimates that about 380 people die of salmonella every year, which translates to less than 1 percent of about one million annual cases. About 260 people, or about 16 percent of about 1,600 cases, die of listeria every year.

Symptoms include headaches, fever and abdominal pain. Consumers who were exposed to Blue Bell or Sabra products and exhibit signs of illness should contact their doctors, Dr. Tauxe said. Consumers who have been exposed but do not exhibit symptoms probably have little reason to worry, he added.

Health officials say that consumers should wrap potentially contaminated products in plastic before throwing them away. Closed containers that have not spilled do not pose a significant risk of spreading listeria to other areas of the home.

Blue Bell has been expanding a recall of its products over listeria concerns since March, when the company recalled 10 frozen snack items manufactured at a plant in Brenham, Tex., where Blue Bell is based. The company said it was its first recall in 108 years.

"This is really surprising, very startling and distressing to the company," said Gene Grabowski, a Blue Bell spokesman.

Days later, the company recalled its chocolate, vanilla and strawberry three-ounce cups manufactured at a second plant in Broken Arrow, Okla. Those cups were available only to institutional buyers like schools and hospitals, Mr. Grabowski said, and not to the public.

Blue Bell expanded the recall a third time this month to include banana pudding, butter crunch, mint chocolate chip, cookies 'n cream, homemade vanilla, Dutch chocolate and "moo-llennium crunch" flavors of ice cream manufactured from Feb. 12 through March 27 at the Broken Arrow plant.

In a statement on its website, Blue Bell said that it suspended operations at the Broken Arrow plant on April 3, and that it was "working with retail outlets to remove all products" made there. The company hopes to resume operations at the plant in the next seven to 10 days, Mr. Grabowski said, once it has identified the source of the contamination and sterilized the facilities.

Blue Bell is offering a full refund for all products made at its Broken Arrow plant. Such products are stamped with a six-digit code and the letter "O," "P," "Q," "R," "S" or "T."

Ice cream, unlike hummus, can stay good in a freezer for years, posing a challenge to health officials.

"We are concerned that there may be contaminated ice cream still in people's freezers," Dr. Tauxe said. "It appears that products from the Oklahoma facility may have been contaminated for some time."

An outbreak of listeria traced to cantaloupe killed 33 people in 2011 and sickened more than 140 others. In March, a district court judge approved settlements for the families of 30 people who died.

The Sabra and Blue Bell recalls follow three other recent food recalls over listeria concerns. Amy's Kitchen, the maker of organic frozen meals, recalled about 74,000 cases of prepackaged products. Wegmans Food Markets issued a recall of more than 12,000 packages of organic spinach, while the Carmel Food Group recalled some of its Rising Moon Organics frozen ravioli.

Correction: April 14, 2015

An earlier version of this article misstated the number of tubs of Sabra hummus that tested positive for listeria in Michigan. It was one, not several.

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Senate Approves a Bill on Changes to Medicare

WASHINGTON — The Senate on Tuesday overwhelmingly approved sweeping changes in the way Medicare pays doctors, clearing the bill for President Obama and resolving an issue that has bedeviled Congress and the Medicare program for more than a decade.

The 92-to-8 vote in the Senate, following passage in the House last month by a vote of 392 to 37, was a major success for Republicans, who devised a solution to a complex policy problem that had frustrated lawmakers of both parties. Mr. Obama has endorsed the bill, saying it "could help slow health care cost growth."

The bill, drafted in the House in negotiations between Speaker John A. Boehner and Representative Nancy Pelosi, the Democratic leader, also extends the Children's Health Insurance Program for two years, through 2017.

Without action by Congress, doctors would have faced a 21 percent cut in Medicare fees on Wednesday or Thursday. Senate leaders cleared the way for final passage by allowing votes on several amendments sought by liberal Democrats and conservative Republicans.

Medicare spent $70 billion last year under the fee schedule used to pay doctors and some other health care professionals. That accounts for about 12 percent of all Medicare spending. Ninety-eight percent of people enrolled in the traditional fee-for-service Medicare program receive at least one physician service during the year.

The legislation moves Medicare in a direction espoused by Mr. Obama and many health policy experts, toward payment based on the quality and value of care, rather than just the volume of services. Organized medicine now accepts that change in principle, and the American Medical Association lobbied strongly for the bill, demanding that Congress "fix Medicare now."

Congress has passed 17 short-term bills since 2003 to block cuts in Medicare doctors' fees that were called for under the existing law. Such cuts would most likely prompt some doctors to accept fewer Medicare patients.

The Senate majority leader, Mitch McConnell, Republican of Kentucky, said the bill taken up Tuesday was "designed to ensure that seniors on Medicare don't lose access to their doctors."

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"It's a solution to a broken Medicare payment system that has vexed congressional leaders of both parties for years," he said. "It would mean an end to the annual exercise of Congress passing a temporary fix to the problem one year and then coming right up to the very same cliff the next year, without actually solving the underlying problem."

Senator Ron Wyden of Oregon, the senior Democrat on the Finance Committee, called the bill "a milestone for Medicare." But he and other Democrats said it would have been better to extend the children's insurance program for four years, rather than two.

Mr. Wyden said the current formula for paying doctors was "horrendously flawed" but had "dominated much of the discussion" in the last 18 years.

Before passing the bill, the Senate rejected a half-dozen proposed amendments on Tuesday night. Democrats, for example, wanted to provide more money for women's health care. Republicans wanted to repeal a provision of the Affordable Care Act that requires most Americans to have health insurance, and they tried to force Congress to pay for the Medicare bill so it would not increase budget deficits.

The current payment formula, set by Congress in 1997, links Medicare spending on doctors' services to growth of the overall economy. Medicare spending has regularly exceeded the targets. Under the law, the excess is supposed to be recouped in subsequent years through cuts in payment rates for doctors.

The bill would repeal that formula. Fiscal conservatives object because only one-third of the cost would be offset. The rest, $141 billion from 2015 to 2025, would add to federal budget deficits.

"This bill is not paid for," said Senator Jeff Sessions, Republican of Alabama.

New spending would total $211 billion over 10 years, the Congressional Budget Office estimated. Higher-income Medicare beneficiaries would pay additional premiums totaling nearly $35 billion, and Medicare would save a similar amount by trimming payments to hospitals, nursing homes and home health agencies.

Senator Mike Lee, Republican of Utah, said the bill "doubles down on Medicare's broken price control model" and "inflates the administration's power as regulator and compliance officer."

"The principal change proposed in this bill is to move from a Medicare payment system based on volume to one based on bureaucratic measures of quality and value," Mr. Lee said.

The votes against the bill came from Republicans: Mr. Sessions and Mr. Lee, along with Senators Ted Cruz of Texas, David Perdue of Georgia, Marco Rubio of Florida, Ben Sasse of Nebraska, Tim Scott of South Carolina and Richard C. Shelby of Alabama.

For a few hours on Tuesday, it seemed senators might also be close to an agreement to vote on Mr. Obama's nomination of Loretta E. Lynch to be attorney general, but the prospect evaporated.

Senator John Cornyn of Texas, the No. 2 Senate Republican, offered a plan to overcome an impasse over abortion restrictions in a sex-trafficking bill, but Democrats quickly rejected it. Republican leaders have held up a vote on Ms. Lynch until the Senate finishes work on the trafficking bill.

Democrats on Tuesday repeated their opposition to the abortion restrictions and denounced the delay of Ms. Lynch's nomination. "They can stall her for 157 days; she is going to be attorney general of the United States," said Senator Harry Reid of Nevada, the Democratic leader.

Commenting on the Medicare bill, federal officials welcomed its emphasis on the quality of care but said it would probably not provide a permanent solution.

Paul Spitalnic, the chief actuary of the Medicare program, said the bill could lead to "a payment reduction for most physicians" after 2025. "If not addressed by subsequent legislation," he said, "we expect that access to and quality of physicians' services would deteriorate over time for beneficiaries."

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Study Finds Broad Rise in Medication Use by Those Newly Joining Medicaid

Written By Unknown on Selasa, 14 April 2015 | 13.57

Photo In Miami, an ad for the Affordable Care Act. Expanded access to Medicaid led to a 25 percent rise in prescriptions in 2014. Credit Joe Raedle/Getty Images

People newly covered by Medicaid drove a significant increase in prescription drug use in 2014, even as those with private commercial coverage filled fewer prescriptions and, over all, patients did not visit the doctor as often, according to a new report by the IMS Institute for Healthcare Informatics, which tracks the health industry.

The report, released on Tuesday, offers a window into how consumers used their insurance in 2014, the first full year after millions of Americans gained coverage through the health care law, which expanded eligibility for Medicaid in many states and set up marketplaces where consumers could shop for insurance.

Patients with Medicaid in states that expanded access to the program filled 25.4 percent more prescriptions than in the previous year, before the expansion. In states that opted not to expand the program, the increase was much smaller at 2.8 percent.

Sabrina Corlette, a senior research fellow at the Center on Health Insurance Reforms at Georgetown University, described the difference as "stark," adding, "it suggests that in the Medicaid expansion states, people are accessing the health care system. They are seeing physicians and other prescribers and getting needed drugs."

The report also provided some new details on the overall growth of spending on prescription drugs, which, it said, rose substantially in 2014 — by 13.1 percent, to $373.9 billion. The increase is the highest since 2001 — mainly because of the arrival of expensive new drugs for conditions like hepatitis C, cancer and multiple sclerosis, at the same time that sales eroded less for brand-name drugs because of new competition with generic drugs. Spending on so-called specialty drugs — high-priced treatments that typically treat serious chronic diseases — accounted for one-third of drug spending in 2014, up from 23 percent five years ago.

Last year "was a remarkable year in terms of growth in spending on medicines," said Murray Aitken, executive director of the IMS Institute. But he added that while growth in specialty drug spending was expected to continue, the eye-popping increase in 2014 was unique and spending would most likely not rise as sharply in future years.

The report sheds some light on who enrolled in coverage through the new marketplaces. The IMS Institute found that 70 percent of people who used a marketplace plan to fill a prescription in 2014 had been covered by commercial insurance in 2013, either through an employer or through purchasing an individual plan. Nearly a quarter — 24 percent — paid cash in 2013, meaning they may have been uninsured. In all, the number of prescriptions paid in 2014 with cash declined by 5.5 percent compared to 2013.

Steven Jacobsohn, a retired financial analyst who lives in Manhattan, said his prescription drug coverage improved in 2014, when he switched from individual coverage through EmblemHealth to a less expensive marketplace plan sold by Health Republic. He said two common generic drugs to treat high cholesterol and blood pressure cost $10 a month under his old policy, but were free under the Health Republic plan. "It's a very good plan," said Mr. Jacobsohn, who is 57.

But even as some have seen their options improve, the report found that many are cutting back on prescription drug use and doctor visits. Many marketplace plans — and, increasingly, plans through employers — come with high deductibles and co-payments, forcing some patients to make tough choices.

Over all, patients made 3 percent fewer office visits and had 1.7 percent fewer hospital admissions. They filled slightly more prescriptions — 2.1 percent — but that was mainly driven by the large increases among Medicaid patients, the report found.

Researchers found that patients who took one type of diabetes drug were less likely to take the drug after their own costs reached $30, and even more so when their costs exceeded $125. Patients who had recently changed to a plan with a deductible took their drug for 25 fewer days, on average, compared to those with more comprehensive plans.

Gary Claxton, a vice president at the Kaiser Family Foundation, said it was difficult to generalize about consumers' coverage under high-deductible plans because they can vary widely in how they are set up. Still, he said, previous studies support the idea that "with more cost-sharing, you get less use."

Mr. Jacobsohn counts himself among patients who have let costs drive his health care decisions. Last year, he said, his doctor suggested that he switch from his generic atorvastatin prescription to Crestor, a more expensive brand-name drug, because his cholesterol was too high. When he learned that the Crestor prescription came with a $60 co-payment, Mr. Jacobsohn said he decided to wait six months to give the cheaper drug another chance to work. His cholesterol improved at the next visit and he never switched to Crestor.

"Not that I couldn't afford it," Mr. Jacobsohn said. "I just didn't know if I wanted to pay for it."

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Texas Medical Panel Votes to Limit Telemedicine Practices in State

Taking a stand against the rapidly expanding use of telemedicine, the Texas Medical Board voted Friday to sharply restrict the practice in the state, siding with organizations representing doctors over the objections of industry representatives who said the new rules would reduce access to medical care at a time of increasing demand.

The vote was the latest salvo in a four-year battle between the state board, which licenses and regulates doctors, and Teladoc, a national company based in Dallas that provides telephone or video consultations with doctors on its staff, typically for routine problems like urinary tract infections, sore throats and rashes.

It also comes as companies like Teladoc, helped by enthusiastic investors and rapid advances in technology, are seeking to expand around the country, promoting their services as a convenient, inexpensive alternative to the emergency room, retail clinics or doctors who do not work nights or weekends. Many states are loosening restrictions on telemedicine, and requiring insurers to pay for it, citing doctor shortages and pressure to increase convenient access to medical care, partly because of the Affordable Care Act.

Texas, however, is moving in the opposite direction. The Texas board already required doctors to establish a relationship with patients before giving a diagnosis or prescribing drugs.

But on Friday, it changed its rules to state that "questions and answers exchanged through email, electronic text, or chat or telephonic evaluation of or consultation with a patient" are inadequate to establish a doctor-patient relationship. The move significantly tightens rules that already preclude video consultations except under a narrow set of circumstances.

The Texas Medical Association and other groups representing doctors in the state strongly supported the new restrictions, citing concerns about patient safety. In a letter to the board, the association said it "supports the use of telemedicine that can provide safe, high-quality, timely care," but that safeguards must be in place "to protect patients and ensure telemedicine complements the efforts of local health care providers."

But Jason Gorevic, the chief executive of Teladoc, said in a statement that the new restrictions were "a huge step backward for Texas," eliminating "a safe, affordable and convenient health care option that many have depended on for more than a decade."

The new restrictions do not outright ban telemedicine, however. Doctors will still be able to treat patients by phone or video from another location under certain circumstances. For example, patients will have to be at a hospital or clinic, with a second health care provider there to "assist." The new restrictions do not apply to mental health visits, most likely because of a continuing shortage of psychiatrists.

Telemedicine companies either directly charge consumers a flat fee, typically around $40 per consultation, or contract with employers or insurers to provide the consultations as a covered benefit. But they emphasize that they cannot treat serious problems or medical emergencies, and that they are meant to complement, not replace, people's relationships with their doctors.

"This is going to quickly emerge as one way to relieve the demand pressures that are being put on the system," said Ceci Connolly, managing director of the PriceWaterhouseCoopers Health Research Institute. "We're just getting started."

Texas is among a handful of states that still require an in-person exam before a telemedicine consult can take place, according to the American Telemedicine Association, a trade group in Washington. Other states have vaguely worded policies that are not clear on whether an in-person visit is needed first.

In a recent interview, Mr. Gorevic said Teladoc's national network of 700 board-certified physicians receive special training in how to conduct telemedicine consultations and follow clinical guidelines that are "specific to telehealth." The company, which operates in every state except Arkansas and Idaho, has seen rapid growth in demand for its services, he said, with almost 300,000 consultations last year, double the number in 2013. It has more customers in Texas than in any other state.

The company says its doctors are available 24 hours a day, seven days a week. When a customer requests a consultation by calling or going to the company's website, Mr. Gorevic said, a doctor licensed in the person's state responds within 10 minutes on average. Its doctors do not prescribe narcotics, other controlled substances, or what it refers to as "lifestyle drugs," such as Viagra.

Teladoc's conflict with the medical board started in 2011, when the board threatened to discipline the company's doctors for prescribing drugs to patients they had not seen in person. Teladoc sued, accusing the board of changing its rules without going through the proper process. Late last year, a state appeals court sided with Teladoc, which led the medical board to issue an emergency rule in January. Teladoc won a temporary injunction while the board went through its formal rule-making process over the last few months.

The new restrictions are to take effect in June. Before voting on them, Frank Denton, an investment executive from the Houston area who was the only board member to oppose them, said telemedicine was the "least desirable" way to deliver health care but that "the public should have the right to use that option."

But another board member, Dr. George Willeford of Austin, expressed the opinion of the majority when he said he worried that telemedicine, unless properly regulated, could weaken doctor accountability to patients. "I'm terribly, terribly worried about the absence of responsibility and accountability," he said.

That view was echoed at a public hearing on Thursday by Dr. Steven Yount, a family practice doctor in Bastrop, near Austin, who said that hands-on diagnosis and treatment was essential.

"A patient encounter that from the very get-go removes many of the abilities of a physician to comprehensively look at any given patient is of a lower quality," Dr. Yount said.

But most of about a dozen people who spoke at the hearing, including several Teladoc officials, opposed the change. Bill Hammond, chief executive of the Texas Association of Business, said the restrictions would "drive a stake through the heart" of telemedicine in Texas at a time when thousands of small businesses are looking for innovative solutions to combat rising insurance costs and to provide health care to employees.

"This proposal is bad for business, bad for health care, bad for consumers," Mr. Hammond said.

Correction: April 14, 2015

An article on Saturday about a vote by the Texas Medical Board to limit the use of telemedicine referred incorrectly to Jason Gorevic's role with Teladoc, a national company that provides telephone or video consultations with doctors. While Mr. Gorevic is Teladoc's chief executive, he is not a founder of the company.

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