5 Best Fitness Foods for Women

<div dir="ltr" style="text-align: left;" trbidi="on"><div style="text-align: justify;"><h1 style="text-align: center;"><span style="color: red;"><span style="font-size: x-large;"><span style="font-family: Trebuchet MS, sans-serif;">5 Best Fitness Foods for Women :</span></span></span></h1><span style="font-family: Trebuchet MS, sans-serif; font-size: large;"><br /></span><span style="font-family: Trebuchet MS, sans-serif; font-size: x-large;">Having a balanced diet is an integral part of having a healthy lifestyle.And although well-known rules like reducing your sugar and Reduce fat intake are effective, there are a number of particular foods that can take you that extra mile.Here are 5 Best Fitness Foods for Women, If you want to improve your thorough health, see these :</span></div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><img alt="5 Best Fitness Foods for Women" border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3qoYUaCQRnd2IdhvxWkDMAMBlLPmx0QyjCsFaNmUWYnRBThwnk2wjjsIInXm0gj_y8xgT-QVSlM99EYXNCZer703CVRH7pl4_FkrkYvl5rnp0ngCW0m8oIIHhlJe7ho5Tmi96faQLvrQ/s400/5+Best+Fitness+Foods+for+Women.jpg" title="5 Best Fitness Foods for Women" width="400" /></div><div style="text-align: center;"><br /></div><center><script async="" src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script><!-- LargeInPost_waysforweightloss_2 --><ins class="adsbygoogle" data-ad-client="ca-pub-5028478688240504" data-ad-slot="7474757677" style="display: inline-block; height: 600px; width: 300px;"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({}); </script></center><br /><h2 style="text-align: left;">Best Fitness Foods for Women :</h2><br /><div style="text-align: justify;"><span style="font-size: large;"><b><span style="color: red;">Eggs</span></b> : Contain an ingredient that can help to cut down calories consumed during each meal, and the yolk is a good source of iron, and it's loaded with lecithin, critical for brain health.</span></div><div class="separator" style="clear: both; text-align: center;"></div><br /><div class="separator" style="clear: both; text-align: center;"></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><br /></div><div style="text-align: justify;"><span style="font-size: large;"><b><span style="color: red;">Bananas</span></b> : high in potassium, You need it to replace sweat losses and help with fluid absorption. Bananas are also packed with energizing carbohydrates. Bananas perfect just before a workout, are a great source of energy, and they’re high in potassium to make up for what’s lost when you work up a sweat.</span></div><div><div style="text-align: justify;"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgv8peX-wsGVtt3_v0S7lMIlJYPHjzGOAXnyWnh7BBNrEjyumf0iijRDT75I8cVS-Q_k15mbcWaO8aDbgsJXfbKfJECq2IyQcn8wiBZGkf7_H2U_zv4KgoPEiZN1JNfabfy3r4llJL2JUY/s467/Bananas_Fitness+Foods+for+Women.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><br /></a></div><div style="text-align: center;"></div><div style="text-align: justify;"><br /></div></div><div style="text-align: justify;"><span style="font-size: large;"><b><span style="color: red;">Salmon</span></b> : Contain healthy omega-3 fatty acids, help lessen abdominal fat. having fairly high fat content, These unsaturated fats work hard in your body, protecting not just your brain, but your heart, your eyes, and your joints.</span></div><div><br /><div style="text-align: justify;"><span style="font-size: medium;"></span></div><div class="separator" style="clear: both; text-align: center;"></div><div style="text-align: center;"><span style="font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-size: medium;"></span></div><div style="text-align: justify;"><span style="font-size: large;"><b><span style="color: red;">Chicken Thighs</span></b> : Contains a lot of healthy ingredients that make it worth your while. Dark meat like that found in chicken thighs and drumsticks is high in zinc and iron to support energy, as well as B vitamins to support healthy brain functioning.  It's a good source of lean protein  gives you extra calories for your muscle building efforts.. that women need in their diets.. also dark meat tastes better than light.</span></div><br /><br /><div style="text-align: justify;"><span style="font-size: medium;"></span></div><div class="separator" style="clear: both; text-align: center;"></div><div style="text-align: center;"><span style="font-size: medium;"></span></div><div style="text-align: justify;"><span style="font-size: medium;"><br /></span></div><div style="text-align: justify;"><span style="font-size: large;"><b><span style="color: red;">Avocados</span></b> : Your body needs fat, but should be making the right choices.. Avocados contain healthy monounsaturated fats that actually boost your metabolism and help you burn fat! and help keep your body strong and pain free. They’re also really high in protein to support lean muscle.</span></div><span style="border: 0px; font-size: large; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"></span><br /><br /><span style="border: 0px; font-family: inherit; font-size: medium; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><br /></span> <br /><center><script async="" src="//pagead2.googlesyndication.com/pagead/js/adsbygoogle.js"></script><!-- Rectangle_waysforweightloss_300x250 --><ins class="adsbygoogle" data-ad-client="ca-pub-5028478688240504" data-ad-slot="8942340873" style="display: inline-block; height: 250px; width: 300px;"></ins><script>(adsbygoogle = window.adsbygoogle || []).push({}); </script></center><br /><span style="border: 0px; font-family: inherit; font-size: medium; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><br /></span></div></div>

fitness Foods WOMEN 5 Best Fitness Foods for Women

5 Best Fitness Foods for Women : Having a balanced diet is an integral part of having a healthy lifestyle.And although well-known rules like...

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Lost

Lost...  That's where I am.<br /><br />I'm back down in a really down and needy state.  Apologies for the mood swingy posts.  Aside from medicine to chill out panic attacks, I'm without benefit of anything to keep my brain and thoughts in order. <br /><br />So what <i>is</i> my deal?  Surely there's a trigger of some sort.  Well, this time I figured at least some of it out.<br /><br />There's my obvious need for tons of sex. Much more than most people.  It's been at least a week now.  It's not a huggy snuggly thing and it's not a need down there either - those needs can be met in other ways.  It's the stuff of excessively naughty details.  Can't explain it.  It just does good things to my head, settles me a little. That doesn't explain this though.  Leaving me a bit more on edge, probably so, but it's not all of it.<br /><br />I had the "ah hah" moment this morning.  It's talking to my husband.  We can talk about the right here and now, no problem.  The issue is all this personal talking BS.  We go for a while of just superficial conversations and I get more comfortable.  He softens, everything is good with the world, and then I feel comfortable enough to attempt a slightly less tangible discussion or letter or email.  I hit a brick wall, I'm dismissed, my feelings are dismissed, and I don't matter because he's not having a problem so all's good with the world.<br /><br />We've been talking in bed for a week or so (uh, another lighbulb moment - if I'd shut up there'd be sex probably).  Talking about silly stuff or something random.  Not much.<br /><br />We had an incredible day together yesterday.  Kids' cousin wanted to take them for a day - go for it sweetie!  We did a lot of work stuff, though it was all out and about so lots of time just being friends between stops.  We ate lunch and dinner out at new places.  It was wonderful.<br /><br />I decided it was time for a real talk.  It was dark so I couldn't see his expressions, it just felt safer to me. I wanted to know some things about myself that he doesn't like.  That there's lots of things about how I act that I'm not happy about, that I'm trying to be a better person and I'm having a hard time.  If he could kind of point me in the direction of the big things I could focus on those.  Maybe if I wasn't focusing on <i>everything</i> it would be easier for my efforts to become engrained as good habits.<br /><br />"Let me think about it for a minute... Nothing, I guess.  There's nothing about you that I have a problem with."  And yes, I know that would be the correct answer 99.9% of the time!<br /><br />Yeah right. I pointed out a few things about me that drive me crazy and I wanted to change.  He agreed completely and added to the list.  He told me to stop doing those things.  I'm trying, I explained.  I need your help.  I need your leadership. I need you to help me see how ridiculous I'm being when I'm being me.  A little hint to me that I'm being ridiculous so I can reel it in.  Or point it out after.  Or sometimes perhaps he could see it coming and stop it in its tracks.<br /><br />"Just make yourself do what you're supposed to. I'm not role playing"<br /><br />Nobody's asking you to.  Explained more that I want/need his help.  I need his support when I'm struggling. That I've technically been role playing by suppressing my needs and pretending they don't exist. That people in a relationship must be willing to change and adapt over time.  You can't have one person doing as they please, to please themselves, and tell the other person they can join you in your exact way or nothing.  People who love each other shouldn't have a "my way or the highway" thought process.  That my efforts to reach out to him are met with a big fat "Fuck off, Chickie.  I don't have time for your crazy."  No he's never said that and I made it clear I wasn't accusing him of that.  It just <i>feels</i> that way.<br /><br />"Well, I only deal with adults."<br /><br />I explained I am an adult.  There was lots of other talking and then it took a quick turn to the letter I'd written him.  Did you really read it, like to understand it?  Yes, he'd read it and admittedly brushed it off.  Then something like "If you want me to be in charge, I'll show you in charge."  He wanted to know what'll happen if he says we're doing something his way. I said I'd do it. <br /><br />And then veered off into DD territory from there, something I really didn't intend to do. It's something that I think will help us, something that will help me, and by helping me he'd help the whole family. Blah blah blabhbeddy blah.  Silence... Do you have anything you want to ask me?  Any questions about anything?<br /><br />"Nnnnnope," and rolled over and went to sleep.<br /><br />I cried myself to sleep.  Once again, as usual, any effort I make to move beyond roommates with benefits (really friggin' awesome benefits) was again shot down.  Be there for me, even if just an ear.  Is it really too much to ask?<br /><br />This morning was very cold.  The only words he spoke to me were asking if his new shirt looked good on him.  <br /><br />And so here I am in another "down" that'll work itself out over the next few days... just for me to screw it up again with a conversation.  i reach out and get knocked down.  I don't think I deserve this.  I'm not being a spoiled brat.  I simply want more to our marriage than being roommates, without one being so egotistical and self-serving.  But to that, he'd say that I knew what I signed up for.<br /><br />So after reading this through...  I'm seeing that despite that going exactly as I know it would, he <i>did </i>hear me out.  Maybe his silence this morning is more processing the reality of what I need.  Maybe he's retreating until the crazies go away.  Maybe he's got a headache or maybe he's trying to figure out if he forgot to do something yesterday.  Or maybe he's just afraid I'll say something about feelings and then he'll have to listed to all this crap again.  He doesn't hold grudges or anger or animosity of any sort... he's certainly not mad at me.  I hate being so darned sensitive.  I wish I didn't read into things that aren't readable.  And he's not a jerk even though he sounds that way.  He's a fun friendly guy and everybody likes him. 

Lost

Lost...  That's where I am. I'm back down in a really down and needy state.  Apologies for the mood swingy posts.  Aside from medici...

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Indoor Workouts From A Personal Trainer Moraga

<div style='font-style:italic;' class='uawbyline'>By Dee C. Williams</div><br /><br /> <div class='uawarticle'>Moraga is a suburban town that is situated in the state of California. It is near the San Francisco Bay and is known for its Mediterranean climate. During the winter, the town is all wet and cool. The weather is warm and dry during summer but morning fogs are scattered all around during early morning.<br /> <br /> It's for this reason why a lot of residents in Moraga cannot go on with their daily morning exercise outdoors during summer. But a personal trainer Moraga shared a number of indoor exercises which you can do during the early morning inside your home so you do not have to deal with the fogs outside.<br /> <br /> Squats<br /> <br /> To perform this exercise, you should begin by extending positioning your feet shoulder width apart. Make sure that you're very comfortable. Afterwards, slowly lower your buttocks without moving your feet and without bending your upper body. You should feel the tension in your lower body.<br /> <br /> Lower your buttocks up to the point wherein your thighs are parallel to the floor.<br /> <br /> Shoulder Press<br /> <br /> The personal trainer Moraga recommends the use of a dumbbell for the shoulder press exercise. Stand with your feet hip width apart from each other and make sure that you're holding one dumbbell for each hand. Afterwards, bend your knees slowly and plunge into a squat position while keeping your knees in line with your toes and heels. When going back to the standing position, push your arms upwards and move straight up towards the air.<br /> <br /> Incline Dumbbell Press<br /> <br /> The personal trainer Moraga recommends holding a 10 or 12 pound dumbbell when doing the incline dumbbell press. Hold the dumbbells on each hand and sit on an exercise ball while allowing it to roll below your back until such time that you are in a squatting position and the upper portion of your back is leaning on it. Hold on to the dumbbells beneath your shoulders and then slowly press straight up the dumbbell going towards the ceiling and then go back to the starting position.<br /> <br /> One Leg Dead lifts<br /> <br /> To perform this exercise, the personal trainer Moraga advises that you start on a standing position while your feet are hip width apart from each other. You should be holding two dumbbells on each sides and then slowly bend your body forward coming from your waistline while letting your hands lie freely on your sides. At the same time, slowly lift your leg up until such time that it is in the same height with your torso and in parallel with the floor. Go back to the standing position and continue doing the moves with the other leg.<br /> <br /> The personal trainer Moraga recommends that beginners must perform at least 8 to 12 reps of each of the exercises mentioned previously in order to be able to burn more calorie and fats. Those in the intermediate level who want to gain more muscle should be able to perform 12 to 15 repetitions of each exercise daily.<br /> <br /> </div><br /> <div class='uawresource'><br /> <div style='font-style:italic;' class='uawabout'><br /> About the Author:<br /> </div><br /> <div class='uawlinks'>Becoming in great condition with the help of <a href="http://www.theperfectworkout.com/personal-trainer-moraga/">Personal Trainer Moraga</a> not just improves your own physique but also your well being as well. The benefits that one can get from <a href="http://www.theperfectworkout.com/personal-trainer-palo-alto/">Personal Trainer Palo Alto</a> are limitless.</div><br /> </div><br />

Indoor Workouts From A Personal Trainer Moraga

By Dee C. Williams Moraga is a suburban town that is situated in the state of California. It is near the San Francisco Bay and is known ...

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Breaking the Seal on Drug Research - NYTimes.com

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><nyt_text style="color: rgb(51, 51, 51); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div id="articleBody"><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">PETER DOSHI walked across the campus of Johns Hopkins University in a rumpled polo shirt and stonewashed jeans, a backpack slung over one shoulder. An unremarkable presence on a campus filled with backpack-toters, he is 32, and not sure where he'll be working come August, when his postdoctoral fellowship ends. And yet, even without a medical degree, he is one of the most influential voices in medical research today.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Doshi's renown comes not from solving the puzzles of <a href="http://health.nytimes.com/health/guides/disease/cancer/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Cancer." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">cancer</a> or discovering the next blockbuster drug, but from pushing the world's biggest pharmaceutical companies to open their records to outsiders in an effort to better understand the benefits and potential harms of the drugs that billions of people take every day. Together with a band of far-flung researchers and activists, he is trying to unearth data from clinical trials — complex studies that last for years and often involve thousands of patients across many countries — and make it public.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The current system, the activists say, is one in which the meager details of clinical trials published in medical journals, often by authors with financial ties to the companies whose drugs they are writing about, is insufficient to the point of being misleading.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">There is an underdog feel to this fight, with postdocs and academics flinging stones at well-fortified corporations. But they are making headway. Last fall, after prodding by Dr. Doshi and others, the drug giant <a href="http://topics.nytimes.com/top/news/business/companies/glaxosmithkline_plc/index.html?inline=nyt-org" title="More information about GlaxoSmithKline PLC" class="meta-org" style="color: rgb(102, 102, 153); text-decoration: none; ">GlaxoSmithKline</a> announced that it would share detailed data from all global clinical trials conducted since 2007, a pledge it later expanded to all products dating to 2000. Though that data has not yet been produced, it would amount to more than 1,000 clinical trials involving more than 90 drugs, a remarkable first for a major drug maker.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The <a title="The agency s Web site." href="http://www.ema.europa.eu/ema/" style="color: rgb(102, 102, 153); text-decoration: none; ">European Medicines Agency</a>, which oversees drug approvals for the European Union, is considering a policy to make trial data public whenever a drug is approved. And on June 17, the medical world saw how valuable such transparency could be, as <a title="Times article." href="http://www.nytimes.com/2013/06/18/business/infuse-a-spinal-treatment-found-no-better-than-older-remedy.html?ref=barrymeier&_r=0" style="color: rgb(102, 102, 153); text-decoration: none; ">outside researchers published a review</a> of a spinal treatment from the device maker Medtronic. The review, which concluded that the treatment was no better than an older one, relied on detailed data the company provided to the researchers.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">For years, researchers have talked about the problem of publication bias, or selectively publishing results of trials. Concern about such bias gathered force in the 1990s and early 2000s, when researchers documented how, time and again, positive results were published while negative ones were not. Taken together, <a title="One such study." href="http://www.plosmedicine.org/article/info:doi%2F10.1371%2Fjournal.pmed.1000144" style="color: rgb(102, 102, 153); text-decoration: none; ">studies</a> <a title="Another study." href="http://www.bmj.com/content/344/bmj.d7292" style="color: rgb(102, 102, 153); text-decoration: none; ">have shown</a> that results of only about half of clinical trials make their way into medical journals.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Problems with data about high-profile drugs have led to scandals over the past decade, like one <a title="The contentions." href="http://www.nejm.org/doi/full/10.1056/NEJMe058314" style="color: rgb(102, 102, 153); text-decoration: none; ">involving contentions</a> that the number of heart attacks was underreported in research about the painkiller <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/vioxx_drug/index.html?inline=nyt-classifier" title="Recent and archival health news about Vioxx." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">Vioxx</a>. Another involved accusations of misleading <a title="Times article." href="http://www.nytimes.com/2012/07/03/business/glaxosmithkline-agrees-to-pay-3-billion-in-fraud-settlement.html?pagewanted=all" style="color: rgb(102, 102, 153); text-decoration: none; ">data about</a> links between the antidepressant <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/paxil_drug/index.html?inline=nyt-classifier" title="Recent and archival health news about Paxil." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">Paxil</a> and the risk of suicide among teenagers.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">To those who have followed this issue for years, the moves toward openness are unfolding with surprising speed.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"This problem has been very well documented for at least three decades now in medicine, with no substantive fix," said Dr. Ben Goldacre, <a title="Dr. Goldacre s Web site." href="http://www.badscience.net/" style="color: rgb(102, 102, 153); text-decoration: none; ">a British author</a> and an ally of Dr. Doshi. "Things have changed almost unimaginably fast over the past six months."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Much of that change is happening because of what Dr. Goldacre calls an "accident of history." In 2009, Dr. Doshi and his colleagues set out to answer a simple question about the anti-<a href="http://health.nytimes.com/health/guides/disease/the-flu/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about The flu." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">flu</a> drug<a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/tamiflu-drug/index.html?inline=nyt-classifier" title="Recent and archival health news about Tamiflu." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">Tamiflu</a>: Does it work? Resolving that question has been far harder than they ever envisioned, and, four years later, there is still no definitive answer. But the quest to determine Tamiflu's efficacy transformed Dr. Doshi and others into activists for transparency — and turned the tables on drug makers. Until recently, the idea that companies should routinely hand over detailed data about their clinical trials might have sounded far-fetched. Now, the onus is on the industry to explain why it shouldn't.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">IN summer 2009, Dr. Doshi received a call from Dr. Tom Jefferson, a British epidemiologist based in Rome. That year, the <a href="http://topics.nytimes.com/top/reference/timestopics/subjects/i/influenza/swine_influenza/index.html?inline=nyt-classifier" title="More articles about swine influenza." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">swine flu</a> pandemic was spreading worldwide, and Dr. Jefferson had been hired by the British and Australian governments to update an earlier review of Tamiflu, a drug produced by the Swiss company <a href="http://topics.nytimes.com/top/news/business/companies/roche-holding-ag/index.html?inline=nyt-org" title="More information about Roche Holding A.G" class="meta-org" style="color: rgb(102, 102, 153); text-decoration: none; ">Roche</a>, aimed at reducing the flu's severity and preventing more serious complications. He asked if Dr. Doshi wanted to help.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Determining Tamiflu's efficacy had significant economic as well as health consequences. Around the world, private companies and governments — including that of the United States — were stockpiling Tamiflu in case of influenza outbreaks, and their spending accounted for <a title="Roche annual report; see Page 27 (PDF)." href="http://www.roche.com/gb09e.pdf" style="color: rgb(102, 102, 153); text-decoration: none; ">almost 60 percent</a> of the drug's $3 billion in sales in 2009.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The review of Tamiflu was being conducted under the auspices of the <a title="The Web site." href="http://www.cochrane.org/" style="color: rgb(102, 102, 153); text-decoration: none; ">Cochrane Collaboration</a>, a well-regarded network of independent researchers, including Dr. Jefferson, who evaluate medical treatments' effectiveness by analyzing all available research.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">At the time, Dr. Doshi knew little about clinical trials or even much about the drug industry. But he knew Dr. Jefferson. Dr. Doshi, after receiving undergraduate and master's degrees in anthropology and East Asian studies from Brown and Harvard, had shifted focus and was pursuing a doctorate at M.I.T., studying the intersection of medicine and politics. He met Dr. Jefferson, <a href="http://www.bmj.com/content/333/7574/912" style="color: rgb(102, 102, 153); text-decoration: none; ">a prominent skeptic of the flu vaccine</a>, <a title="Abstract of research by Dr. Doshi." href="http://www.bmj.com/content/331/7529/1412" style="color: rgb(102, 102, 153); text-decoration: none; ">after researching</a> whether the Centers for Disease Control was exaggerating the deadliness of the disease.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"We were both lone wolves in the field of influenza," Dr. Doshi recalled.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Jefferson had conducted a Cochrane review of Tamiflu's effectiveness a few years earlier, concluding that the drug reduced the risk of complications from the flu. He assured Dr. Doshi and other researchers on his team that the update would be fairly simple.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">But just as their work was getting under way, a simple <a title="The objection of Dr. Hayashi. " href="http://www.bmj.com/highwire/filestream/440784/field_highwire_adjunct_files/1" style="color: rgb(102, 102, 153); text-decoration: none; ">comment</a> arrived on the Cochrane Web site that changed the course of the research and would ultimately fuel a worldwide effort to force drug companies to be more transparent.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The author of that comment, Dr. Keiji Hayashi, had no connection to the Cochrane group; he was a pediatrician in Japan who had prescribed Tamiflu to children in his practice, but had come to question its efficacy. He was curious about one of the main studies on which Dr. Jefferson had relied in his previous analysis. Called the <a title="The study." href="http://archinte.jamanetwork.com/article.aspx?articleid=215903" style="color: rgb(102, 102, 153); text-decoration: none; ">Kaiser study</a>, it pooled the results of 10 clinical trials. But Dr. Hayashi noticed that the results of only two of those trials had been fully published in medical journals. Given that details of eight trials were unknown, how could the researchers be certain of their conclusion that Tamiflu reduced risk of complications from flu?</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"We should appraise the eight trials rigidly," Dr. Hayashi wrote.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Reviews by the Cochrane group are known for being among the most thoroughly researched medical analyses available. But in trying to answer the pediatrician's question, Dr. Jefferson realized that there was a flaw: they relied too heavily on the assumption that the articles published in journals accurately represented the results of all clinical trials that had been conducted.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">As he tried to track down the authors of the Kaiser study and the two published trials, Dr. Jefferson said he hit dead ends: One author said he had moved offices and no longer had the files; another said he had never seen the primary trial data, instead relying on a summary analysis provided by Roche. All the authors suggested that he contact the company.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"We took it on faith — on trust," Dr. Jefferson, 59, said recently in a phone interview. Dr. Hayashi's question had tested that faith. Dr. Jefferson began typing each new discovery in a private journal he called Hayashi's Problem, which, he said, "charted my transformation from Dr. Jekyll to Mr. Hyde."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Doshi said that medicine "relies on hierarchies of trust." He added: "A patient is not going to be in a position to review the entire evidence base themselves. But they trust that there is a watchdog out there."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">As they dug into the Tamiflu research, Dr. Doshi said, he realized that such a watchdog didn't exist. Instead, he said, "we have partial watchdogs who see part of the full picture." It became his mission to see the full picture.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Having struck out with the authors of the disputed Kaiser paper and the two other published trials, Dr. Jefferson approached Roche itself, asking for the underlying data from the missing trials. But when he declined to sign a confidentiality agreement, Roche decided not to cooperate with the researchers.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Without more complete data about the clinical trials, the Cochrane group decided that it could not include the disputed study that summarized those results. In December 2009, the <a title="The team s research. " href="http://www.bmj.com/content/339/bmj.b5106" style="color: rgb(102, 102, 153); text-decoration: none; ">team reported</a>that Tamiflu could not be shown to reduce complications like <a href="http://health.nytimes.com/health/guides/disease/pneumonia/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Pneumonia." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">pneumonia</a> or hospitalizations.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The British Medical Journal, which printed the team's conclusions, also published its <a title="The article." href="http://www.bmj.com/content/339/bmj.b5387" style="color: rgb(102, 102, 153); text-decoration: none; ">own investigation</a>, showing that Roche had hired ghost writers to author some of the articles involving Tamiflu, and that those writers had said they were under pressure to highlight positive messages about the drug. Roche responded that hiring such writers was common industry practice at the time of the articles, and it rejected the idea that they had been pressured to write positively about the drug.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The articles in the British journal created a sensation, and the Cochrane Collaboration's efforts became a cause célèbre. "Everyone knows about publication bias," said <a title="Profile. " href="http://tdi.dartmouth.edu/faculty/steven-woloshin-md-ms/P120" style="color: rgb(102, 102, 153); text-decoration: none; ">Dr. Steven Woloshin</a>, a professor of medicine at the <a title="The institute s Web site." href="http://tdi.dartmouth.edu/" style="color: rgb(102, 102, 153); text-decoration: none; ">Dartmouth Institute for Health Policy and Clinical Practice</a> and an advocate of more widespread sharing of clinical trial data. "But they just had so much energy and they brought so much attention to it."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The group's efforts seemed to make a difference: After the articles in the British journal, Roche turned over partial copies of study reports, amounting to a little more than 3,000 pages. Then, in 2011, the European Medicines Agency turned over more than 22,000 pages of documents for 19 trial reports to Dr. Jefferson and his team.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The door had been opened. As they read through the records, the researchers discovered the importance of documents called clinical study reports, which are thousands of pages long and contain details as varied as descriptions of trial protocol and design and the ingredients of the placebo pills.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"We used to know that there was a published paper and there were data behind it," said <a title="Biographical information." href="http://www.bmj.com/about-bmj/editorial-staff/fiona-godlee" style="color: rgb(102, 102, 153); text-decoration: none; ">Dr. Fiona Godlee</a>, the editor of the British Medical Journal. "But people haven't talked about these things, like clinical study reports, that are now being talked about a great deal." Last fall, <a title="Times article on the journal s decision. " href="http://www.nytimes.com/2012/11/01/business/british-medical-journal-to-require-detailed-clinical-trial-data.html" style="color: rgb(102, 102, 153); text-decoration: none; ">the journal said</a> it would publish the results of clinical trials only if drug companies and researchers agreed to provide data upon request.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">In April, Roche said it would make available to the Cochrane researchers clinical study reports for all Roche-sponsored trials of Tamiflu. Dr. Jefferson, Dr. Doshi and their colleagues hope to complete another update to their review of the drug by year-end.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Some said it was a shame that it took this long for the company to relent. "All these years later, and we still don't know if Tamiflu is effective," said <a title="Faculty page." href="http://medicine.yale.edu/intmed/people/harlan_krumholz.profile" style="color: rgb(102, 102, 153); text-decoration: none; ">Dr. Harlan Krumholz</a>, the Yale cardiologist who oversaw the review of Medtronic's bone treatment. "It's perplexing to have a billion-dollar drug, and you're still not willing to share everything you've got to know whether this thing is effective and safe."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">THOUGH the Tamiflu question is not yet resolved, the Cochrane researchers have succeeded in a bigger way: by helping to change the conversation around companies' responsibility to reveal drug trial data.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Drug companies do not always credit the Cochrane Collaboration. In February, Roche followed Glaxo's lead and announced that it, too, would release detailed clinical data to outside researchers, upon request. But Daniel O'Day, chief operating officer of <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/drugspharmaceuticals/index.html?inline=nyt-classifier" title="Recent and archival health news about pharmaceuticals." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">pharmaceuticals</a> at Roche, denied that its pledge had been motivated by the Tamiflu experience. He said Roche has provided data to "thousands" of researchers.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Mr. O'Day said "there were probably errors on both sides" in how the Cochrane researchers and Roche communicated with each other, and said the relationship deteriorated after Dr. Jefferson refused to sign a confidentiality agreement. He said the company was trying to rebuild its relationship with the Cochrane researchers, but that it stood by the safety and efficacy of Tamiflu.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">In 2010, Roche commissioned researchers at the Harvard School of Public Health to conduct a <a title="The re-analysis." href="http://cid.oxfordjournals.org/content/53/3/277" style="color: rgb(102, 102, 153); text-decoration: none; ">re-analysis</a> of Tamiflu clinical data, which largely confirmed the positive conclusions of the Kaiser study.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Mr. O'Day asserted that the company's transparency pledge had arisen from "the call from society in general for greater transparency of the clinical trials that we have." But others say the Cochrane researchers are largely responsible for that call for transparency.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; "><a title="The Glaxo management team." href="http://www.gsk.com/about-us/corporate-executive-team.html" style="color: rgb(102, 102, 153); text-decoration: none; ">Andrew Witty</a>, Glaxo's C.E.O., said in an interview that his promise to provide detailed clinical data had grown out of a companywide effort, initiated soon after he became chief in 2008, that would "really ensure that we were more in step with where I thought, frankly, society and the world was moving."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Glaxo, moreover, was in need of an image rehabilitation. Last year, it pleaded guilty to criminal charges and agreed to pay $3 billion in fines after the United States Justice Department accused the company, based in London, of failing to report safety data about its <a href="http://health.nytimes.com/health/guides/disease/diabetes/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Diabetes." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">diabetes</a> drug <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/avandiadrug/index.htm?inline=nyt-classifier" title="Recent and archival health news about Avandia." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">Avandia</a>, and of publishing misleading information about Paxil, the antidepressant, in a medical journal. The settlement, which also included civil penalties over marketing of other drugs, was the largest ever involving a pharmaceutical company.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"We don't see any reason for this information to be held out of the public domain," Mr. Witty said, "provided that the people who are interrogating the information are legitimate researchers with a legitimate question to ask."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">In a twist, Roche now finds itself on the same side as the Cochrane researchers — and against many in its own industry — in a debate over what kind of data the European Medicines Agency should be making public. On Monday, the agency released a draft policy, expected to take effect next year, in which it would release clinical trial data whenever it approved a new drug. While Roche and Glaxo have supported the policy, the <a title="The organization s Web site." href="http://www.phrma.org/" style="color: rgb(102, 102, 153); text-decoration: none; ">Pharmaceutical Research and Manufacturers of America</a>, a major industry group, and other drug companies have opposed it.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">John J. Castellani, chief executive of PhRMA, said the industry had championed open-source efforts to develop better methods for <a title="One such project." href="http://ceo-lsc.org/projectdatasphere" style="color: rgb(102, 102, 153); text-decoration: none; ">testing cancer drugs</a>, for example. But proposals like those from the Cochrane team and the European agency go too far, he said.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"If you dump onto the sidewalk all the data and you include commercially protected information," he said, "then you're essentially giving to competitors what we invested billions of dollars in."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Others warned that such a policy could discourage drug companies from investing in Europe. "If you, on the other hand, say, 'You guys are bad actors, we want to cut your prices, we want to take your confidential data and share it with any one of your competitors,' you don't get the same feeling of encouragement," Christopher A. Viehbacher, C.E.O. of the French pharmaceutical company Sanofi,<a title="The article." href="http://www.reuters.com/article/2013/06/24/europe-drugs-transparency-idUSL5N0F022G20130624" style="color: rgb(102, 102, 153); text-decoration: none; ">told reporters</a> in Brussels on Monday, according to Reuters.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Industry officials and regulators in the United States say the public already has access to vast amounts of information about clinical trials. The basic results of all clinical trials must now be registered in a <a title="The Web site." href="http://www.clinicaltrials.gov/" style="color: rgb(102, 102, 153); text-decoration: none; ">federal clearinghouse</a>, for example, and the Food and Drug Administration publishes staff reviews and other documents when it approves a new drug. The F.D.A. has said that it is monitoring the developments in Europe but that federal laws in the United States restrict what types of information can be released, particularly data that could reveal personal or commercially confidential information.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Cochrane group members point to the Medtronic study as an example of the value of a neutral perspective.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">In 2011, Medtronic awarded a $2.5 million grant to Yale and asked it to oversee a detailed review of trial data for Infuse, a bioengineered material in spinal fusions to treat back pain. The company was facing claims that it had published misleading information about the treatment, and it turned over its data in an effort to address those criticisms. Two teams that examined the data came to similar conclusions: Infuse appeared to be no better than an older treatment, and may pose added risks.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">EARLIER this month, Dr. Doshi opened what he hopes will be a new chapter in his quest for greater understanding of clinical trials. He and several other researchers <a title="The article." href="http://www.bmj.com/content/346/bmj.f2865" style="color: rgb(102, 102, 153); text-decoration: none; ">published what amounted to an ultimatum</a> to drug companies: publish your data, or we'll do it for you.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Under the plan, researchers would publish articles summarizing trial results in cases where the underlying data has already been released. In isolated cases, such information has been made public through litigation and Freedom of Information Act requests.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"It's really neat to see a larger opportunity for a larger impact," he said. "Tamiflu just happened to be the lever that opened that door."</p><nyt_correction_bottom><div class="articleCorrection" style="font-style: italic; margin-bottom: 2.8em; "></div></nyt_correction_bottom><nyt_update_bottom></nyt_update_bottom></div></nyt_text><span style="color: rgb(51, 51, 51); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); display: inline !important; float: none; "></span></div><a href="http://www.nytimes.com/2013/06/30/business/breaking-the-seal-on-drug-research.html?">http://www.nytimes.com/2013/06/30/business/breaking-the-seal-on-drug-research.html?</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Breaking the Seal on Drug Research - NYTimes.com

PETER DOSHI walked across the campus of Johns Hopkins University in a rumpled polo shirt and stonewashed jeans, a backpack slung over one sh...

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Today's Teamster News 06.30.13

<a href="http://www.nytimes.com/2013/06/27/business/economy/mandated-us-budget-cuts-ripple-through-private-sector.html?_r=0">Mandatory Federal Cuts Hurt Private Sector, Too</a>  New York Times   ...Many in the facilities support field, a business category that includes janitorial, maintenance, trash disposal, guard and security, mail routing, reception and laundry services, say they are frustrated by the lack of public awareness about how defense budget cuts affect workers who are not performing stereotypical military functions...<br /><a href="http://tv.msnbc.com/2013/06/26/time-running-out-before-student-loan-rates-double/">Time is running out before student loan rates double</a>  MSNBC   ... even if a deal does pass, it’s still highly likely that future students will pay more in interest to the federal government as legislators continue to insist on budget austerity...<br /><a href="http://www.businessweek.com/articles/2013-06-27/the-supreme-court-corporate-americas-employees-of-the-month">The Supreme Court: Corporate America's Employees of the Month</a>  Bloomberg   ...the Supreme Court under Chief Justice John Roberts has narrowed the avenues available to employees and consumers seeking to take their grievances before a judge...<br /><a href="http://www.washingtonpost.com/blogs/federal-eye/wp/2013/06/24/supreme-court-to-hear-case-on-obamas-nlrb-appointments/">Supreme Court to hear case on Obama’s NLRB appointments</a>  Washington Post   ...The Supreme Court will decide next term whether President Obama exceeded his constitutional authority by making three appointments to the National Labor Relations Board while the Senate was on break last year...<br /><a href="http://inthesetimes.com/working/entry/15197/scotus_limits_civil_rights_protections_against_supervisor_abuse/">The Supervisor From Hell Gets a Pass From SCOTUS</a>  In These Times   ...The decision could sharply limit employer liability for supervisor harassment in many cases...<br /><a href="http://www.cepr.net/index.php/blogs/beat-the-press/the-social-security-and-medicare-cutters-are-very-unhappy?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+beat_the_press+%28Beat+the+Press%29">The Social Security and Medicare Cutters are Very Unhappy</a>  Center for Economic and Policy Research   ...No, things have not gone well for those wishing to ax Social Security and Medicare, but they are not about to give up. And with the money and access to the media they enjoy, why should they?...<br /><a href="http://blogs.wsj.com/economics/2013/06/29/number-of-the-week-u-s-oil-boom-affecting-global-prices/?mod=WSJ_hp_LEFTWhatsNewsCollection">Number of the Week: U.S. Oil Boom Affecting Global Prices</a>  Wall Street Journal   ...The U.S. oil boom is finally affecting global energy prices — but don’t expect cheap prices at the pump as a result...<br /><a href="http://www.reuters.com/article/2013/06/29/us-usa-eu-spying-idUSBRE95S0AQ20130629">U.S. bugged EU offices, computer networks: German magazine</a>  Reuters   ...The United States has bugged European Union offices and gained access to EU internal computer networks, according to secret documents cited in a German magazine on Saturday, the latest in a series of exposures of alleged U.S. spy programs...<br /><a href="http://www.reuters.com/article/2013/06/28/us-dealtalk-boozallen-carlyle-idUSBRE95R13R20130628">Snowden fallout comes at bad time for private equity </a> Reuters   ...The industry is under growing pressure because of a series of apparent security problems that allowed Snowden to leak details of secret U.S. surveillance programs and, according to government officials, badly compromise U.S. national security...<br /><a href="http://www.ipolitics.ca/2013/06/25/ed-fast-and-us-trade-rep-commit-to-conclude-the-tpp-in-2013/">Ed Fast and US trade rep commit to concluding TPP in 2013</a>  iPolitics   ...Trade Minister Ed Fast and his recently-confirmed American counterpart, Michael Froman, came out of their first tête-à-tête in Washington on Tuesday with an ambitious objective to conclude the Trans-Pacific Partnership before the end of the year...<br /><a href="http://www.reuters.com/article/2013/06/29/us-brazil-protests-rousseff-idUSBRE95S0EV20130629">Rousseff's popularity plummets in wake of Brazil protests</a>  Reuters   ...President Dilma Rousseff's approval rating sank by 27 percentage points in the last three weeks, a poll showed on Saturday in the strongest evidence yet that the recent wave of street protests sweeping Brazil poses a serious threat to her likely re-election bid next year...<br /><a href="http://blogs.sfweekly.com/thesnitch/2013/06/not_just_bart_but_whole_damn_c.php">Not Just BART, But Pretty Much the Whole Damn City of Oakland Is Going on Strike</a>  SFWeekly   ...Oakland city workers this morning announced the big news that they, along with BART employees, will walk off the job on Monday at 7 a.m., in protest of stalled labor negotiations...<br /><a href="http://www.politicususa.com/2013/06/29/alecs-latest-scam-sending-public-school-dollars-corporate-owned-private-schools.html">ALEC’s Latest Scam Is Sending Public School Dollars to Corporate Owned Private Schools</a>  PoliticusUSA   ...According to the data, contrary to what Republicans, ALEC, and corporate-education advocates contend, America’s public education system has made consistent and equitable progress over the past four decades...<br /><a href="http://southtownstar.suntimes.com/20966517-418/teamsters-funeral-directors-at-odds.html">Teamsters, funeral directors at odds </a> Southtown Star   ...Teamsters Local 727, which represents 59 funeral directors and drivers at 16 Chicago-area funeral homes owned by Service Corporation International, has lodged unfair labor practice charges against the company...<br /><a href="http://www.whas11.com/news/local/Indefinite-extension-reached-on-National-Master-Agreement-between-Teamsters-UPS-213611001.html">Indefinite extension reached on National Master Agreement between Teamsters, UPS</a>  WHAS11   ...The contract was set to expire at the end of July. It will now be extended through July of 2018...

Today's Teamster News 06.30.13

Mandatory Federal Cuts Hurt Private Sector, Too  New York Times   ...Many in the facilities support field, a business category that include...

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Red, White and Babe of the Week

<div dir="ltr" style="text-align: left;" trbidi="on"><div class="MsoNormal">The IWS Babes of the week are super sexy, talented and patriotic All-American babes! <o:p></o:p></div><div class="MsoNormal"><br /></div><div class="MsoNormal">1. Katy Perry <o:p></o:p></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjboorStZ5FaEOwFwZh4zt_ZZvk0KZx83gZjXae4i5cZv_QKjMgYMjtPE4DOFomFHADq6NRMZvVL8gJ8UP6xzJaEvuVe9bcHes1m0ZfjqFmwr0nAOhrLAOxbdwvdFsNK8FmIRDeR6aICeg/s600/Katy-Perry-Camel-Toe-Hot-Cleavage.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjboorStZ5FaEOwFwZh4zt_ZZvk0KZx83gZjXae4i5cZv_QKjMgYMjtPE4DOFomFHADq6NRMZvVL8gJ8UP6xzJaEvuVe9bcHes1m0ZfjqFmwr0nAOhrLAOxbdwvdFsNK8FmIRDeR6aICeg/s320/Katy-Perry-Camel-Toe-Hot-Cleavage.jpg" width="227" /></a></div><div class="MsoNormal"><o:p><br /></o:p></div><div class="MsoNormal">2. Rachel Bilson <o:p></o:p></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLpZWRyfqsIuAJzKJASu12FlkQovr6fm-UUgOXJ0qH7Rl3V4OB2RhiZtggZ8gLUfDl_M1-jSoLqsS-NT3XWZuICp_rMhiSMw9zhScLDCG78n7ckYblozdUEYnYuX5W6NMetT-eNO0byzo/s600/Rachel-Bilson-Bikni-Hot-Nude.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLpZWRyfqsIuAJzKJASu12FlkQovr6fm-UUgOXJ0qH7Rl3V4OB2RhiZtggZ8gLUfDl_M1-jSoLqsS-NT3XWZuICp_rMhiSMw9zhScLDCG78n7ckYblozdUEYnYuX5W6NMetT-eNO0byzo/s320/Rachel-Bilson-Bikni-Hot-Nude.jpg" width="211" /></a></div><div class="MsoNormal"><o:p><br /></o:p></div><div class="MsoNormal">3. Jamie Chung <o:p></o:p></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMTEqs7VL5OL6dm1DJMfwNcvVSfOyTdmbTBCX0rJCqoFgEePTGAPeOVUV_TLLKcplbrK09hh0mWvfpe313u9yJutwBnWpGrUIMttT5V0RqkjDtnRi2bAi1cZDXYO-rHDtSv9f8YFgdnT4/s777/Jamie-Chung-Abs-Bikini-Hot-Nude-Sexy.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMTEqs7VL5OL6dm1DJMfwNcvVSfOyTdmbTBCX0rJCqoFgEePTGAPeOVUV_TLLKcplbrK09hh0mWvfpe313u9yJutwBnWpGrUIMttT5V0RqkjDtnRi2bAi1cZDXYO-rHDtSv9f8YFgdnT4/s400/Jamie-Chung-Abs-Bikini-Hot-Nude-Sexy.jpg" width="156" /></a></div><div class="MsoNormal"><o:p><br /></o:p></div><div class="MsoNormal">4. Janet Jackson <o:p></o:p></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLSFTFZU38o6ddubZkmx9nU62pmXJAufmS2iBN54DWr5MjGHdCa4c_HCmLLXDfIzwmm-dO-H3EUw8yvkUgR7iM4Ixk5La8-fAJUhFxcOXb5slY9ehqiPatPUQFkIzNNA9bE8WGJAsRRI0/s767/Janet-Jackson-Bikini-Abs-Nude.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLSFTFZU38o6ddubZkmx9nU62pmXJAufmS2iBN54DWr5MjGHdCa4c_HCmLLXDfIzwmm-dO-H3EUw8yvkUgR7iM4Ixk5La8-fAJUhFxcOXb5slY9ehqiPatPUQFkIzNNA9bE8WGJAsRRI0/s320/Janet-Jackson-Bikini-Abs-Nude.JPG" width="224" /></a></div><div class="MsoNormal"><o:p><br /></o:p></div><div class="MsoNormal">And of course, America’s Sweetheart Kathy Griffin</div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjI3Go6ICEg10xNgVc5tPrdAoKRZzOTggt_Xr-Hn0DZ9TbyGQ42ubi1viLKSJEojSU-Zo8x3IY8QgjK6SsXemy3N9qWnzmGH7fbWArlNM363lPVZh0QQNegQOoTLZKAzBsTqFzbpK3Xg-4/s1500/Kathy-Griffin-Bikini-Hot-Nude.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjI3Go6ICEg10xNgVc5tPrdAoKRZzOTggt_Xr-Hn0DZ9TbyGQ42ubi1viLKSJEojSU-Zo8x3IY8QgjK6SsXemy3N9qWnzmGH7fbWArlNM363lPVZh0QQNegQOoTLZKAzBsTqFzbpK3Xg-4/s400/Kathy-Griffin-Bikini-Hot-Nude.jpg" width="250" /></a></div><br /><div class="MsoNormal"><o:p><br /></o:p></div><br /><div class="MsoNormal"><br /></div><div class="MsoNormal">Speaking of being a Great American be sure to catch “<a href="http://www.blogtalkradio.com/im-with-stupid/2013/06/30/drunk-on-history" target="_blank">Drunk on History</a>” at 12 Noon ET on I’m With Stupid! <o:p></o:p></div><div class="MsoNormal"><br /></div></div>

Red, White and Babe of the Week

The IWS Babes of the week are super sexy, talented and patriotic All-American babes! 1. Katy Perry 2. Rachel Bilson 3. Jamie Chung 4. Janet ...

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Saturday post weigh in....

Weekends are usually my worst time for food.  I EAT all the time.  So, with #belviq , my weekends are not being consumed by food, so now what?  Well, I will get in an exercise routine and start doing the things I love.<br /><br />Today, I ate my granola bar which satisfies me completely.  For lunch, I a salad with thinly sliced walnuts (45 calories per 1tbls.  They are really good, seasoned and if you have a Kroger, you may find them by the bagged lettuce.  Anyway, I had all kind of vegetables and about 1/8 a cup of cheese.  I was FULL. <br /><br />I'm in Houston, it was 105 today so I wanted something cool.  I found these cool real fruit small Popsicle and it was perfect. <br /><br />Tonight, as a reward to my hard work this week, while enjoying time at a friends house, I had a piece of large pizza.  Now, you have to understand, normally, I could finish at least 1/2 of the large pizza.  My thought was, have left over salad and pizza.  So, I ate the one piece of pizza and I could only eat 3 bites of salad.  That's it.  FULL.  It was really good.<br /><br />I calculated my calories to be about 1000 calories.  The pizza was the majority!! <br /><br />So, do I feel like I am missing out?  Absolutely not.  I am learning about doing proportions!<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5qczmfdiCSKQT__XiVeNAuIqJ0swrFRoG8_dtNQrlhWoKqDJlerVXCpP1eh4bMPMf8iO846CeCOI5esmn1B97ZuCaTJ47FcNzo3N9XzIO9olqtmRDOT78LUIVzYiI_B4tuGPtzTpC3ao/s960/salad.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5qczmfdiCSKQT__XiVeNAuIqJ0swrFRoG8_dtNQrlhWoKqDJlerVXCpP1eh4bMPMf8iO846CeCOI5esmn1B97ZuCaTJ47FcNzo3N9XzIO9olqtmRDOT78LUIVzYiI_B4tuGPtzTpC3ao/s320/salad.jpg" width="234" /></a></div><br /><br />I must let everyone know, Belviq is not a magic pill.  Well, it is in the fact that it tells your brain your not hungry.  I 100% believe that the success will come with diet and exercise.  I have many asking about it, etc.  If you do not intend to change your eating habits, you will fail.  (notice I did not say Belviq will fail).  You can't take the pill and eat pizza 3 times a day even if the proportions are cut down dramatically.  When you come off Belviq, you probably will resort to your old ways.  That's why I believe you MUST train yourself by eating healthy!!<br /><br />follow me on twitter @ewenker

Saturday post weigh in....

Weekends are usually my worst time for food.  I EAT all the time.  So, with #belviq , my weekends are not being consumed by food, so now wha...

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Post Pregnancy Weight Loss Challenges

<div style='font-style:italic;' class='uawbyline'>By Trishia Serinton</div><br /><br /> <div class='uawarticle'>Weight gain during pregnancy is a natural phenomenon. 'Baby weight' refers to the weight that has gained not only by the growing fetus and the enlarging womb but also the deposition of fat around the abdomen. Once the baby is delivered, the mother can have a tough time trying to lose the extra weight. If the mother had some extra weight before pregnancy, it can actually make the process even tougher.<br /> <br /> Below, we will be discussing some of the basic ways to get rid of unwanted weight after a mother has delivered her baby.<br /> <br /> 1. Keep hydrated<br /> <br /> Drink plenty of water after pregnancy to make sure that dehydration is not an issue. The extra liquid that you consume will also contribute to a fuller feeling in the stomach, which also helps some to avoid eating too much food. Don't over-do it though, drink only what your body craves.<br /> <br /> 2. Do not have overly strict diets<br /> <br /> This may sound as surprising advice but trying to lose weight by following a strict diet can reduce the amount of nutrients that you passed down to your baby through breast milk. Weight loss is thought to be more healthy when it is done in a steady and slower pace, instead of trying to drop a lot of weight in a short period of time. Consuming healthy foods such as plenty of fresh fruit and vegetables are excellent at keeping hunger at bay and making sure the weight comes off gradually.<br /> <br /> 3. Be sure to exercise regularly<br /> <br /> Plain old exercise is still quite effective. Excess calories can be burned in many ways, including cardiovascular exercises like aerobics which will maintain muscles and bone density. Exercises can include a brisk walk, jogging, swimming and cross-training. Endorphins are release during exercise, and this will do a lot to elevate one's mood. When the new mother uses exercise to lose weight, it has the added benefit of helping to reduce stress levels. It is essential that a doctor's advice on the sought before commencing any exercise program.<br /> <br /> 4. Continue breastfeeding<br /> <br /> The baby receives essential nutrients and fats from breastmilk that helps build antibodies for the newborn, and gives them the important nutrition they need. At this time, the full effects that breastfeeding has on weight loss can not be truly determined. Breastfeeding should be continued either way if possible, as it's very healthy for the baby.<br /> <br /> 5. Get plenty of rest<br /> <br /> Going through pregnancy can be taxing on the body, and looking after an infant can raise stress levels even further. Researchers have shown that losing weight from pregnancy is much easier if the mother is getting at least seven hours of sleep each night. <br /> <br /> Conclusion<br /> <br /> These methods that are time-tested and proven will help a new mother to shed the excess weight from a pregnancy in a healthy way.<br /> <br /> </div><br /> <div class='uawresource'><br /> <div style='font-style:italic;' class='uawabout'><br /> About the Author:<br /> </div><br /> <div class='uawlinks'>See <a href="http://iapam.com/vitamin-b12-for-weight-loss">Vitamin b12 for weight loss</a> info at the IAPAM. Find all you need to know about Medical Aesthetic Training at <a href="http://iapam.com/botoxtraining">www.iapam.com</a>.</div><br /> </div><br />

Post Pregnancy Weight Loss Challenges

By Trishia Serinton Weight gain during pregnancy is a natural phenomenon. 'Baby weight' refers to the weight that has gained not...

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The Smart Ways To Build And Manage Your Own Weight Loss Treatment Business

<div style='font-style:italic;' class='uawbyline'>By Susie Quan</div><br /><br /> <div class='uawarticle'>Owning your own weight loss treatment and consulting services business means you might not be making the same amount of money each week. When you have a slow week it can become a bit scary. That's why it is so important to have a plan in place regarding marketing your business. The following tips and suggestions will provide you with ideas on how you can run a successful business.<br /> <br /> The two kinds of things your weight loss treatment and consulting services business pays for are fixed and variable costs. Keep variable costs low, as fixed costs will always remain the same, if you want to be profitable. That is the way to maintain efficiency and make more money.<br /> <br /> Transactions are significant in every weight loss treatment and consulting services business ever. This aspect of your business should be a major focus when reviewing what has to be done or changed in your business. Try to constantly get as many sales as possible in order to maximize the amount of money coming in.<br /> <br /> You should never change the quality of your products or of your customer service. If customers come to expect a certain level from your weight loss treatment and consulting services business, they will be very upset if that level drops. Make sure that you stay consistent in quality so that customers will never have to be disappointed.<br /> <br /> No matter what kind of weight loss treatment and consulting services business you have, you can always find new ways to offer services to customers and make more money. Offering classes to customers that are related to your business model can be a great way to help customers, encourage them to buy more products, and make some money on the side.<br /> <br /> Most people prefer a story over a sales pitch. Writing case studies are a great way to give prospects and clients a concrete story about your products and/or services. Case studies go beyond simple testimonials by providing a real-life example of how you were able to satisfy a weight loss treatment and consulting services business need for one of your customers. Use case studies to highlight your successes in a way that will make prospects feel confident about becoming customers.<br /> <br /> Anyone in a weight loss treatment and consulting services business wants to see their hard work pay off. If you create an environment in which actions are favoured and rewarded, you will get positive results.<br /> <br /> You should keep enough money saved for your weight loss treatment and consulting services business. Not all of your customers will pay you on time, so make sure you have enough reserved to pay the bills.<br /> <br /> Technology grows every day, and the internet has become a very important part of our culture. If you want your weight loss treatment and consulting services business to be professional, you need to have a website. Hire a professional to design your website so that it will be attractive and convince people that they should come and visit your business.<br /> <br /> </div><br /> <div class='uawresource'><br /> <div style='font-style:italic;' class='uawabout'><br /> About the Author:<br /> </div><br /> <div class='uawlinks'>If you are looking for additional tips published by professionals, please open your favorite browser and search for <a href='http://www.surgicalweightlosscalifornia.com/gastric-banding/'>lap-band glendale ca</a>. You'll discover some interesting ideas related to <a href='http://www.surgicalweightlosscalifornia.com/'>lap-band california</a>.</div><br /> </div><br />

The Smart Ways To Build And Manage Your Own Weight Loss Treatment Business

By Susie Quan Owning your own weight loss treatment and consulting services business means you might not be making the same amount of mo...

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How A Diabetic Diet Can Help You Manage Your Blood Sugar

<div style='font-style:italic;' class='uawbyline'>By Ron Stucky</div><br /><br /> <div class='uawarticle'>Following a diabetic diet does not limit you to only eating certain foods. This diet, which refers to what you're eating, can be perfect for anyone.<br /> <br /> Diabetics use this diet to help them control their blood sugar levels. Because carbohydrates impact blood sugar levels the most, diabetics need to watch their overall carb consumption. Here are more important facts about the diabetic diet for your continued education.<br /> <br /> Diabetics are often advised to eat foods with a low glycemic rating. Foods that have a low rating on the glycemic index don't cause a huge spike in blood sugar levels. You want to avoid unstable blood sugar levels.<br /> <br /> Set a limit on the amount of carbohydrates you consume in a day. If you want to enjoy a slice of cake, you will need to cut out carbohydrates somewhere else. This is important to know about and is called carbohydrate substitution.<br /> <br /> Your doctor or dietician should be able to provide you with a well thought out diabetic diet plan. Your job is to adhere to this diet as closely as possible. It's important to be aware not only about exactly what you're eating, but the quantities too. If you have Type 2 diabetes, then you really have to avoid as much excess fat as possible. With this kind of diabetes, fat can affect how your body reacts to insulin, which can be harmful. Diabetics can also face increased risk of heart problems, which can be reduced by controlling your weight.<br /> <br /> People with diabetes, or those who need to reduce cholesterol are often put on the TLC diet. By following this diet, you can bring your cholesterol under control, which is especially important for diabetics. You can help the process along by doing other things in your everyday life as well. If losing weight is something that's recommended for you, you can't ignore the importance of getting regular exercise. The important thing is to decrease LDL, or bad cholesterol as much as possible. The kind of cholesterol that's beneficial is HDL cholesterol, so raising this is a good thing.<br /> <br /> If you have diabetes and want to reduce the impact it has on your life, it's critical to find the right diabetic diet. However, adhering to this diet plan and having good discipline is more important depending on certain factors. This kind of diet doesn't mean excluding all of the foods you like best. But remember to do so in careful moderation, and always ask your doctor about what you can eat that otherwise may not be recommended. Your main concern with diabetes is keeping your blood sugar levels healthy, so always keep this in mind.<br /> <br /> </div><br /> <div class='uawresource'><br /> <div style='font-style:italic;' class='uawabout'><br /> About the Author:<br /> </div><br /> <div class='uawlinks'>Ron Stucky is a expert blogger known for writing on a variety of subjects. His high-quality work can be seen at <a href="http://askmarcbarrett.com/mlm-reviews/nuskin-comp-plan-review-can-you-still-make-big-money-with-nu-skin">NuSkin</a> and on <a href="http://askmarcbarrett.com/mlm-reviews/wealth-masters-international-review">wealthmasters international review</a></div><br /> </div><br />

How A Diabetic Diet Can Help You Manage Your Blood Sugar

By Ron Stucky Following a diabetic diet does not limit you to only eating certain foods. This diet, which refers to what you're eati...

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Michael Specter: The Growing Battle Over How to Treat Lyme Disease : The New Yorker

Kaleigh Ahern was twelve years old when a tick bit her. She noticed it "perched" on her shoulder when she was taking a shower one morning. "I thought it was your average, everyday bug," Ahern told me recently. But, when she tried to brush it off, the tick wouldn't budge. "The legs wiggled but it was embedded in my skin. I freaked out and started screaming." Kaleigh's mother, Holly Ahern, came running and removed it. "I took the kid and the tick to the doctor," she said. "I told him, Here is my kid, here is the tick, and there is the place where it was attached to her." That was in 2002. The Aherns live near Saratoga Springs, New York, where Lyme disease has been endemic for years. The infection is transmitted by tick bites, so Ahern assumed that the doctor would prescribe a prophylactic dose of antibiotics. But he said that he wasn't going to treat it. "If a rash develops or she starts to have flulike symptoms, bring her back," he told her. At the time, Ahern, an associate professor of microbiology at SUNY Adirondack, didn't know much about tick-borne illnesses. She took Kaleigh home and watched for the signature symptom of Lyme disease: a rash that begins with a bright-red bull's-eye around the tick bite.<br /><br><br /><br>No rash developed, and Kaleigh was fine—strong enough to become an all-American swimmer both in high school and at Union College. There were times during high school when she felt mentally hazy and not quite right physically, which she attributed to allergies or a teen-age bout of mononucleosis. But at the end of her freshman year in college she found herself crippled by anxiety, depression, and insomnia. She was beset by searing headaches, her muscles often felt as though they were on fire, and her brain seemed wrapped in a dense fog. Kaleigh tested positive for Lyme disease. Like most physicians, her doctor followed the standard medical practice, endorsed by public-health officials throughout the United States, and prescribed a three-week course of antibiotics. "I was so happy to know what was wrong with me," Kaleigh said. "For a while, I didn't mind the pain."<br /><br><br /><br>The drugs didn't work, though. At her mother's insistence, the doctor extended the prescription three more weeks, but Kaleigh only got sicker. This brought the Aherns to a clinical impasse. The Centers for Disease Control and Prevention has established highly specific criteria for the diagnosis of Lyme disease: an acknowledged tick bite, the appearance of a bull's-eye rash, and, for those who don't live in a region where Lyme is common, laboratory evidence of infection. Most people who fit the profile respond well to antibiotics, even months or years after the initial infection. Many Lyme specialists, however, believe that short-term antibiotic therapy may suppress symptoms but rarely cures the disease. Kaleigh switched doctors and began a course of antibiotics that lasted eight more months.<br /><br><br /><br>There was no change. Furthermore, there is no evidence that prolonged antibiotic therapy helps patients with Lyme disease, so insurance companies almost never pay for it. "I realized that my parents were shovelling thousands of dollars into these antibiotics," she said. "After the oral approach failed, I was recommended to go onto I.V. treatment, but I had had enough." Kaleigh's condition had become so grave that she withdrew from school. "I would have episodes where I would just lie on the ground writhing. And my parents could do nothing but watch. I wish they had taken videos and put them online, so people would know."<br /><br><br /><br>Kaleigh turned to alternative treatments often recommended by Lyme patients with similar experiences. She took herbs—turmeric and ginger, which are thought by some to strengthen the immune system—and she gave up gluten, grains, refined foods, and sugar. The goal was to reduce inflammation caused by her body's production of insulin and to inhibit the growth of the bacterium that causes Lyme. She also began treatments with a Rife machine, an electromagnetic device invented in the nineteen-twenties which emits radio signals that, some researchers suggest, can destroy harmful bacteria. Although thousands of people are convinced that Rife therapy has helped them with Lyme and other diseases, little empirical evidence exists to demonstrate that it works. Nonetheless, Kaleigh began to feel better. She still has headaches and severe muscular pain at times, but she returned to Union a year ago and graduated this spring. She knows that her approach to Lyme disease is controversial and acknowledges that the improvements might be due to her dietary regimen or to Rife treatments or to a placebo effect. She doesn't mind; after enduring such pain, she has found that fine points don't matter.<br /><br><br /><br>Lyme disease is the most commonly reported tick-borne illness in the United States, and the incidence is growing rapidly. In 2009, the C.D.C. reported thirty-eight thousand cases, three times more than in 1991. Most researchers agree that the true number of infections is five to ten times higher. Although some of that increase is due to heightened awareness, transmission is rising in areas, like New England, where the disease is well established, and is spreading to regions as far south as Florida, through changes in climate and the movements of infected animals.<br /><br><br /><br>The disease is caused by the bacterium Borrelia burgdorferi. In the Northeast and the Midwest, B. burgdorferi is transmitted by the bite of a black-legged tick, Ixodes scapularis. (In the Western United States, a related tick, Ixodes pacificus, prevails, and in Europe the main vector is Ixodes ricinus.) Lyme was all but unknown until 1977, when Allen Steere, a rheumatologist at Yale, produced the first definitive account of the infection. The condition was initially thought to have been an outbreak of juvenile rheumatoid arthritis in and around Lyme, Connecticut. In 1982, Willy Burgdorfer, a medical entomologist at the National Institutes of Health's Rocky Mountain Laboratories, determined that the infection was caused by the previously unknown spirochete borrelia. As is common in scientific practice, the bacterium was named for him:Borrelia burgdorferi.<br /><br><br /><br>Those facts are undisputed. But nearly everything else about Lyme disease—the symptoms, the diagnosis, the prevalence, the behavior of the borrelia spirochete after it infects the body, and the correct approach to treatment—is contested bitterly and publicly. Even the definition of Lyme disease, and the terminology used to describe it, has fuelled years of acrimonious debate. The conventional medical assessment is straightforward: in most cases, the tick bite causes a skin rash, called erythema migrans, which is easily identified by its bull's-eye. If left untreated, the bacteria can spread to muscles, joints, the heart, and even the brain. Public-health officials say that a few weeks of antibiotic treatment will almost always wipe out the infection, and that relapses are rare. In this view, put forth in guidelines issued by the Infectious Diseases Society of America, Lyme is normally easy to treat and easy to cure.<br /><br><br /><br>For many people, though, the clinical situation is far more complicated. Some who have been infected with borrelia don't notice the rash. Others—up to a quarter of those with Lyme, including Kaleigh Ahern—never even get one. Most troubling, some patients who are treated continue to suffer from a variety of symptoms long after their therapy has ended. Nobody really knows why they fail to get better. Infectious-disease experts refer to the phenomenon, which can affect up to twenty per cent of patients, as Post-Treatment Lyme Disease Syndrome. Researchers have attempted to resolve the mystery in experiments with monkeys, mice, and dogs; human studies are also under way. As the number of infections grows, so does the number of people struggling to figure out what is wrong with them.<br /><br><br /><br>Many of these patients say that medical officials pay little attention to their persisting symptoms, and that Lyme disease is anything but easy to treat or to cure. They believe that the bacteria can hide in the body for years, potentially causing harm long after treatment ends. This condition, they say, is pernicious, difficult to diagnose, rarely cured, and widely ignored. Moreover, at least four pathogens, in addition to the Lyme bacterium, can be transmitted by the black-legged tick: Anaplasma phagocytophilium, which causes anaplasmosis; Babesia microti, which causes babesiosis; Borrelia miyamotoi, a recently discovered genetic relative of the Lyme spirochete; and Powassan virus. Some of these infections are more dangerous than Lyme, and more than one can infect a person at the same time. Simultaneous infection, scientists suggest, may well enhance the strength of the assault on the immune system, while making the disease itself harder to treat or recognize.<br /><br><br /><br>"I am not sure why we act as if we know the answers," Brian Fallon told me. Fallon, a psychiatrist who has studied the neurological impact of Lyme for years, is the director of the Lyme and Tick-Borne Diseases Research Center, at Columbia University. "The evidence that something more complex is going on is tantalizing and substantial."<br /><br><br /><br>Fallon is right, yet the medical issues have largely been eclipsed by the attention generated by another faction in the Lyme wars. These people—patients, advocates, politicians, and "Lyme literate" physicians, led by the International Lyme and Associated Diseases Society—refer to the illness as "chronic Lyme," and argue that the traditional approach to diagnosis and treatment, put forth by most American physicians, all but guarantees failure. The Lyme Action Network, one of many political groups that have formed to increase awareness and raise funds, recently released a pamphlet called "It Might Be Lyme." The group lists dozens of possible symptoms, including headache, joint pain, neck stiffness, chest pain, bladder dysfunction, hypersensitive skin, unexplained fevers, weight loss, sweats, chills, fatigue, blurry vision, heart murmurs, sleep disturbances (including too little or too much), difficulty with concentration, lightheadedness, and mood swings. Physicians associated with the network argue that a cure requires not weeks but months or years of strong antibiotics, and that relapses are common.<br /><br><br /><br>"There are two standards of care when it comes to Lyme," Holly Ahern said. "One in which patients are diagnosed and treated until they get better, and the other where people are treated for three weeks with antibiotics—and, if you don't get better, then there must be something else wrong with you, or perhaps you are making it up." Ahern is a scientist, and hers is a measured critique. But emotion and despair are often the driving forces behind Lyme activism. The documentary "Under Our Skin: The Untold Story of Lyme Disease" essentially accused organized medicine of ignoring the illness. Scores of highly read blogs—Lyme Policy Wonk, Touched by Lyme, Living the Lyme Life—regularly overflow with fury.<br /><br><br /><br>Nobody disagrees that more research into the long-term effects of Lyme is needed. But most doctors reject the term "chronic Lyme," in part because many people who say they have it are not infected with borrelia. Without biological proof—a positive blood test or the telltale skin rash—the symptoms are vague and varied and could apply to many conditions. Infectious-disease experts say that the lingering symptoms might be an autoimmune response to the original illness or residual damage to tissues caused by the infection. "There is no doubt that people can have symptoms after being treated for Lyme disease," Roy Gulick told me when I visited him recently in his office at the Weill Cornell Medical College, where he is a professor of medicine and the chief of infectious diseases. "They can hang on for weeks or months. But you have to be specific about whether it's plausibly related to Lyme.<br /><br><br /><br>"I am sympathetic to people who are suffering," he continued. "And I have no doubt that they are. But if you have not been infected with borrelia you can't have Lyme disease. We don't have all the answers. We never do. These people are true believers. But I'm an infectious-disease doctor. I understand pathogens that cause disease and I understand the manifestations of those infections. Believing or not believing is not part of the process."<br /><br><br /><br>I grew up in Connecticut, attended college in the Hudson Valley, and graduated in 1977, the year Lyme was first identified. I don't recall hearing about the disease. I do remember going to a professor's house for dinner one night that year and having him urge me to arrive before dusk, so that we might look for deer. We drove around for an hour without luck, and I wondered whether to believe him when he said he had seen one just the day before.<br /><br><br /><br>Today, deer are no longer exotic in the Hudson Valley, and the area has the highest rate of Lyme disease in the country. If you drive the back roads of Columbia County at dusk, deer are nearly impossible to avoid, and accidents are common. Ticks are constantly on residents' minds, and watching children run barefoot to the edge of the bucolic woods is no longer a carefree delight. Deer are not Ixodes's most important host, but they have come to symbolize the spread of Lyme, and represent an ecology that has changed dramatically in the past thirty-five years. "Once you have Lyme disease in the area, and once you start to carve up the forest into little bits, and especially when the fragmentation is done by suburban development, you get an increase in Lyme risk," Richard Ostfeld told me recently when I met with him at the Cary Institute of Ecosystem Studies, in Millbrook, New York. Ostfeld, a senior scientist there, has studied Ixodes for more than a decade. "The best host for the tick and pathogens is not deer but white-footed mice," he said. "And they do beautifully when you chop the forest into bits. They thrive. And competitors do not."<br /><br><br /><br>Ixodes scapularis is surprisingly sophisticated for an organism that, until it is engorged with blood, is less than half the size of a pea. "These ticks are nimble, durable, and adaptable," Ostfeld said. The black-legged tick passes through three distinct phases—larva, nymph, and adult—and females require a blood meal at each stage. They usually pick up the spirochete, which under the microscope looks like a spiral French fry, in their first meal, and pass the disease to the host—small mammals, birds, deer, and sometimes humans—during the second or the third. To insure that it becomes engorged, the tick can attach its barbed mouth to a host for up to a week. First, though, the tick releases a series of anti-inflammatory chemicals and antihistamines to numb the skin and make a bite difficult to notice. It then secretes a compound called cementum, a kind of glue that helps the tick adhere to its prey. With those tasks accomplished, the tick bores its mouthparts into its host. While it feeds, the tick can inject borrelia, and other pathogens, into the bloodstream.<br /><br><br /><br>Ostfeld is a thoughtful, soft-spoken man, not unduly excitable. But when he talks about the Lyme bacterium he sounds like a proud parent. "Borrelia is a remarkable creature," he told me. "It has all my respect." He went on to explain that the bacterium, after slipping through the tick's mouthparts, can change its form, cloaking itself in the surface proteins of the tick's saliva. Then, much like H.I.V., the bacterium hijacks the immune system. "It doesn't stay in the bloodstream for long," he said. "Instead, borrelia manages to insinuate itself into parts of the body that have fewer circulating antibodies, where it is harder for antibiotics to reach."<br /><br><br /><br>The relationship between the tick and borrelia can be compared to the deadly, symbiotic partnership of Plasmodium falciparum parasites and the anopheles mosquitoes that transmit malaria, which have evolved together for thousands of years. Genetically, the bacteria are so adaptable that it is possible to find different strains of borrelia in the same tick. "Some of these infections are really very worrying," Ostfeld said, as we sat, one sunny morning, in his green, airy office at the institute. "We can't even know yet how big a problem a bacterium like miyamotoi will become. But it is possible that Lyme will turn out to be among the least threatening of the pathogens carried by Ixodes."<br /><br><br /><br>Ostfeld, a field biologist, received his Ph.D. from the University of California at Berkeley, and studies the ecology of small mammals—skunks, possums, chipmunks, and white-footed mice—which are found in large numbers in the Hudson Valley. Soon after he arrived at the institute, in 1990, he noticed something striking about the thousands of mice he had trapped: their ears were often covered in ticks the size of poppy seeds. Those ticks, Ixodes nymphs and larvae, were feeding on the mice. "That was the beginning of my interest in Lyme disease," he said. His 2010 book, "Lyme Disease: The Ecology of a Complex System," describes the environmental relationship in detail. Before European colonists arrived in America, ninety per cent of New England and New York was covered in forest. Lyme was unknown. In the next century, forested areas were cut by half. "But it was a shitty life here," Ostfeld said. "Colonists had a rough go of it. The rocky soil was infertile and difficult for agriculture." In the eighteen-thirties, when the Erie Canal opened the Ohio Valley to agricultural development, the farms of the Northeast were abandoned. The forests returned, along with deer. Mice and other small mammals accompanied them.<br /><br><br /><br>Diagnostic failures cause much of the confusion associated with Lyme disease. It takes the tick at least thirty-six hours to transmit borrelia. If ticks are removed immediately, the threat of infection falls dramatically. But it takes weeks, and sometimes longer, for blood tests to detect antibodies; a test taken too soon will produce negative results. Even then, many people who become infected will test negative in error, while others who aren't infected will test positive.<br /><br><br /><br>"You get people all the time who have Lyme but who do not know it," Ostfeld said. "Their doctors don't know it." The basic blood tests look for antibodies but are not always sensitive enough to pick out the right ones. Another test for Lyme disease involves PCR, a technique that allows scientists to amplify the number of copies of a specific region of DNA. When done properly, that test can detect the Lyme spirochete directly. Yet it is prone to contamination, and it often produces positive results for people who are not infected. The situation is similar to one in India, where tens of millions of people test positive for tuberculosis. Few of them will actually get sick, but many are mistakenly treated with highly toxic drugs. A relatively new, but expensive, diagnostic machine can differentiate between latent and active t.b. infections. "We badly need that kind of diagnostic certainty with Lyme," Ostfeld told me. "And we do not have it."<br /><br><br /><br>Public-health officials stress that if doctors see a bull's-eye rash they should assume that the patient has Lyme and prescribe antibiotics. The advice is often ignored. Nor do many doctors or patients consider the potential impact of simultaneous infection with several pathogens. "This is not resolved science," Ostfeld said. "Clearly, not everyone claiming to have Lyme disease is sick, particularly those who have never tested positive for borrelia. But there are just too many questions we still have to answer about those who are infected: Does the bacterium persist after treatment? If so, is it capable of harm? What is the impact of co-infections, and what is really the best way to treat advanced stages of Lyme?<br /><br><br /><br>"The conventional view is that several studies have answered the most important questions about persistence and treatment," Ostfeld went on. "But look at heart disease. How many thousands of studies were conducted on the relationship between cholesterol and heart disease? Over how many decades? And we still go back and forth. When it comes to Lyme, we have a long way to go."<br /><br><br /><br>The controversy over Lyme disease is unlikely to diminish until scientists resolve at least two critical, but related, questions. Can the bacteria persist in the body, causing harm and illness months or even years after treatment has ended? And can prolonged antibiotic therapy destroy the remaining bacteria? Here, as with nearly every issue related to Lyme and its treatment, there is disagreement not only about the answers but also about the questions.<br /><br><br /><br>Determining whether Lyme spirochetes cause illness after treatment is difficult in part because the symptoms are so diverse. Moreover, it is nearly impossible, with current tests, to know whether the infection has been cured. Recent studies with mice and macaques provide interesting clues. In a study published last year in the online journal Plos One, a team of scientists led by Monica E. Embers, of the Tulane National Primate Research Center, and Stephen W. Barthold, the director of the Center of Comparative Medicine at the University of California at Davis, carried out two experiments on rhesus macaques to determine whether borrelia persists after antibiotic treatments.<br /><br><br /><br>First, twenty-four rhesus macaques were infected with the Lyme bacteria in the laboratory. After four to six months, half the macaques received aggressive antibiotic therapy, which, in theory, should have cured them, but the bacteria persisted in some of the animals. Then the scientists used a method called xenodiagnosis to determine if treatment worked in three other monkeys. They planted ticks that had been reared in the lab under sterile conditions on macaques that had received antibiotics, and let them feed for four days. When the ticks were removed and examined, the scientists found small numbers of intact, functioning spirochetes in two of them, which could have come only from the blood of the macaques. A team of scientists led by Adriana Marques, of the National Institute of Allergy and Infectious Diseases, and Linden Hu, of Tufts University School of Medicine, is conducting a similar study in humans. (The scientists have obtained permission from patients to permit ticks to feed on them.)<br /><br><br /><br>Other research, by Brian Fallon, the Columbia psychiatrist, found metabolic abnormalities in the brains of patients with confirmed cases of Lyme disease and chronic, post-treatment symptoms, when compared with the brains of healthy control subjects. That, too, suggests the bacterium continues to have an impact. None of these studies provide conclusive evidence, but together they strongly suggest that the infection can survive treatment in a primate. This finding raises the possibility that the bacteria could continue to cause illness long after a patient is supposedly cured. Similar research in mice, published last year in the Journal of Clinical Investigation by a team from Yale Medical School, found that while antibiotics stopped the infection, spirochete antigens persisted in areas adjacent to cartilage—a condition that could produce swelling.<br /><br><br /><br>None of these studies have swayed Gary Wormser, the chief of the division of infectious diseases at New York Medical College, and the lead author of the often criticized Infectious Diseases Society of America guidelines for Lyme. He says that, in the absence of new data, doctors should continue to treat Lyme with courses of oral antibiotics that generally take no more than thirty days.<br /><br><br /><br>"Right now, in the published literature, there is no evidence of persistence in humans, and if there were I would say, 'So what?' " he told me recently. "You would have to show me that the spirochetes continue to produce disease and you would have to show me that they would respond to antibiotics." Like most established scientists, Wormser maintains that one can rely only on the best current science-based evidence to practice medicine; otherwise, he may as well rely on voodoo. Furthermore, he stressed that it is dangerous to diagnose a disease based on symptoms alone. "There is a group of people with aches and pains and medically unexplained symptoms that are being treated for chronic Lyme." He said these patients often go "from doctor to doctor" without a satisfactory diagnosis. "They are suffering and unhappy, and finally they go to a doctor who says, 'I know what you have, it's chronic Lyme.' Then they get treated and treated and treated for chronic Lyme. And patients are happy because somebody has finally taken interest in them."<br /><br><br /><br>Wormser continued, "If you had Lyme and nobody disputes it and you don't feel back to normal, it's logical to ask, 'Does the antibiotic work?' Or maybe the organism is still there. Those questions have been explored, and we continue to explore them." Yet he added that the majority of people who are being treated as if they had post-Lyme symptoms have never had the disease. "Never had the test, the rash, swelling, not the slightest credible evidence of Lyme. If somebody walked into your office and said, 'I have renal failure, I need dialysis,' you would do a test. If it was negative, nobody in his right mind would give the patient dialysis."<br /><br><br /><br>Wormser's many critics regard his view of the disease as willfully limited. In response, he and others cite four double-blind, placebo-controlled trials funded by the N.I.H. over the past fifteen years. Each attempted to determine whether prolonged antibiotic treatment, given after the initial courses were completed, helps eliminate persistent symptoms of Lyme disease. The two largest studies reported no evidence of improvement; the results of the other two studies were equivocal. But none of the researchers concluded that the theoretical benefits outweighed the tangible risks of extended intravenous therapy, which included severe infections. In a separate case, a woman on intravenous antibiotics died after a blood clot.<br /><br><br /><br>Physicians who regularly see people with Lyme symptoms say that the conventional methods simply don't work. "I think a lot of these people who are set in their ways need to see more patients," Richard Horowitz told me when I called him at his office in Hyde Park, New York. Horowitz is one of the most prominent "Lyme literate" physicians: he is board certified in internal medicine and has practiced in the Hudson Valley for more than twenty-five years. Officials who endorse the Infectious Diseases Society of America's approach to Lyme disease consider Horowitz a pariah, but patients wait for months to see him, and several told me that he had essentially cured them of a disease that nobody else seemed able to treat.<br /><br><br /><br>Horowitz told me that he has seen more than twelve thousand patients, all of whom have a tick-borne ailment. Whenever possible, he avoids antibiotics. "Most of my patients do not present simply with Lyme," he told me. "They almost always have multiple co-infections. That means they have a suppressed immune system with complex symptomology. Thirty days of doxycycline"—the most common drug used to treat Lyme—"just isn't going to cure this. Each of these pathogens requires different regimens."<br /><br><br /><br>Horowitz offers a complex combination of dietary restrictions and supplements to help "detoxify" the body and starve the bacteria. He argues that organized medicine, by relying on a few double-blind trials, focusses only on borrelia and Lyme. "But we know the ticks can spread many pathogens. More than half of my patients present with babesiosis," he told me. (It causes symptoms similar to those of Lyme, though it more frequently begins with fevers and chills.) The incidence of babesiosis, which is caused by microscopic parasites that infect red blood cells, has been increasing dramatically in the Hudson Valley, according to research done by Wormser. "That infection has to be treated in an entirely different way from Lyme, and together they cause far more harm than either one does alone," Horowitz said. "I have never understood why that is a controversial assertion."<br /><br><br /><br>David Roth is not a scientist, but he believes that only science can end the Lyme wars. I met with him one gray, cloudy day on the forty-third floor of the Blackstone Investment Group building in Manhattan, where he is a managing director. Roth was dressed in pinstripes, a crisp white shirt, a yellow tie, and spit-shined brogues. He has an air of distinguished nonchalance, and his brown hair is tousled in the manner of a Kennedy. Three years ago, Roth became very sick, and while it has been difficult for him, and for his family, his illness may be the best thing that has happened for people infected with tick-borne ailments.<br /><br><br /><br>"I started working on this problem because I was shocked by the approach of the medical community," he told me. "I felt there was a real social injustice." Roth's story was similar to those of others I had heard. His illness began with flulike symptoms, enlarged lymph nodes, and insomnia. Doctors found no apparent cause. His symptoms worsened; full-body shakes, numbness in his feet and hands, pain in his tendons, and immense fatigue. "I went up and down this city seeing doctors," he said. "I had CAT scans and PET scans and M.R.I.s." Those tests also turned up nothing, but eventually—about four months after falling ill—he tested positive for both Lyme disease and babesiosis. He was treated with antibiotics as well as with malaria medication; they helped, but only for a while. "When I stopped, things got worse," he told me.<br /><br><br /><br>The more he looked into the treatment of Lyme, the angrier he became. "Here is what I don't understand," he said. "Somebody can get ill and not know what it is and the symptoms get worse and worse. Two years or more later, they can learn that they have Lyme. They take antibiotics for a month. And then, according to their doctors and insurance companies, they are done. Cured. Sometimes that is enough. But many people continue to be sick, and the government's position, in a world where there are ten times as many bacterial cells as human cells in our body, is that this particular bacteria has been removed forever and the problem must be due to something else."<br /><br><br /><br>Roth is forty-six, goes to the gym several times a week, and looks robust. ("One of the problems with Lyme is that people tend to look better than they are," he said.) He has received treatment—dietary supplements and dietary changes—from Horowitz, and his health has improved greatly. Like Kaleigh Ahern, he has difficult days, but they are less frequent. Recently, he was appointed to a federal advisory committee that is working on ways to improve Lyme diagnostics. He was one of the hosts of a gala, held by the Tick-Borne Disease Alliance, earlier this year, which raised eight hundred thousand dollars. "I try to act rationally and work with rational people," he went on. "Sometimes that is hard to do."<br /><br><br /><br>For Lyme activists to be taken seriously, they will have to be led more by people like Roth than by those who foster dark conspiracies. I was told by several Lyme activists that the government created the infection on Plum Island, that reporters at the Times have been "muzzled" and prevented from reporting honestly about Lyme, and that the N.I.H. has made a pact with pharmaceutical companies to ignore chronic Lyme. There is now a bill before the legislature in New York that would require insurance companies to reimburse long-term treatment with antibiotics—even though no study has proved their effectiveness, and treatment with I.V. antibiotics can cause serious, and sometimes fatal, complications.<br /><br><br /><br>Meanwhile, the scientists sometimes seem to respond more comfortably to data than to people. Researchers at the N.I.H. are pursing several lines of inquiry, including the possibility of bacterial persistence. The atmosphere resembles that of the early days of AIDS activism, when many of the individuals most at risk lost confidence in their doctors and sought their own medical answers. In the end, organizers of ACT UPand the Gay Men's Health Crisis became well known for their public protests, but they succeeded for another reason: they did their homework. Nobody was more knowledgeable about the course of H.I.V. infection than the best-informed activists.<br /><br><br /><br>Lyme-advocacy organizations need to rely on similarly well-informed people. Kaleigh Ahern is one of them. She recently presented a paper on the behavior of black-legged ticks at the annual meeting of the Federation of American Societies for Experimental Biology. "It was my thesis at Union," she explained. "I looked at the effects of soil pH on molting success. I wanted to know the ecological factors that make Lyme increase so steadily in this region." She has applied to graduate school, where she hopes to help develop more useful diagnostics for Lyme.<br /><br><br /><br>I asked if her parents were surprised that she has chosen to work with Lyme ticks. "They are horrified," she told me, laughing. "But, if I don't do it, who will? " ♦<br /><br><br /><br><a href="http://www.newyorker.com/reporting/2013/07/01/130701fa_fact_specter?printable=true">http://www.newyorker.com/reporting/2013/07/01/130701fa_fact_specter?printable=true</a>¤tPage=all

Michael Specter: The Growing Battle Over How to Treat Lyme Disease : The New Yorker

Kaleigh Ahern was twelve years old when a tick bit her. She noticed it "perched" on her shoulder when she was taking a shower one ...

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