Think 'Tennis' for Yes, 'Home' for No

How doctors helped man in vegetative state
Guardian UK

Images from an fMRI machine showed that when the patient was asked a specific question and told to respond in a specific way, the same areas of his brain lit up as in a healthy person.

For seven years the man lay in a hospital bed, showing no signs of consciousness since sustaining a traumatic brain injury in a car accident. His doctors were ­convinced he was in a vegetative state. Until now.

To the astonishment of his ­medical team, the patient has been able to ­communicate with the outside world after scientists worked out, in effect, a way to read his thoughts.

They devised a technique to enable the man, now 29, to answer yes and no to ­simple questions through the use of a hi-tech scanner, monitoring his brain ­activity.

To answer yes, he was told to think of playing tennis, a motor activity. To answer no, he was told to think of wandering from room to room in his home, visualising everything he would expect to see there, creating activity in the part of the brain governing spatial awareness.

His doctors were amazed when the patient gave the correct answers to a series of questions about his family. The ­experiment will fuel the controversy of when a patient should have life support removed.

It also raises the prospect of some form of communication with those who have been shut off from life, perhaps for years.

"We were astonished when we saw the results of the patient's scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts," said Dr Adrian Owen, ­assistant director of the Medical Research Council's cognition and brain sciences unit at ­Cambridge University.

"Not only did these scans tell us that the patient was not in a vegetative state but, more importantly, for the first time in five years it provided the patient with a way of communicating his thoughts to the outside world."

Dr Steven Laureys, from the University of Liège in Belgium and co-author of the paper on the patient, said: "It's early days, but in the future we hope to develop this technique to allow some patients to express their feelings and thoughts, control their environment and increase their quality of life."

The patient has not been identified, but his family was said to have been happy with the outcome. "That's not unusual," said Owen. "The worst thing in this sort of situation is not knowing."

He said that as many as one in five patients in a vegetative state may have a fully functioning mind.

The British and Belgian teams studied 23 patients classified as in a vegetative state and found that four were able to generate thoughts of tennis or their homes and create mind patterns that could be read by an fMRI (functional magnetic resonance imaging) scanner – although only one was asked specific questions.

Owen said that misdiagnosis of vegetative state was fairly common: in about 40% of cases people are later found to be able to communicate in some way.

He said he believed that the patients who responded in the study were probably "perfectly consciously aware", although he knew others would disagree.

"To be able to do what we have asked, you have got to be able to understand instructions, you have to have a ­functioning memory to remember what tennis is and you have to have your attention intact. I can't think of what cognitive functions they haven't got and still be able to do this," he said.

When it was suggested that to be ­conscious but trapped in an inert body might be a worse fate than to know nothing, Owen said: "On the plus side we are making enormous advances. Things have changed so much in the last few years."

Owen was speaking from Austria, where he had travelled for a conference on the latest in brain-operated technology – ­computerised devices powered by thought – which is attracting interest, including from the games industry.

"Perhaps some of these patients could benefit from some of these activities," he said. In the meantime, doctors will at least be able to ask patients if they are ­experiencing pain.

The paper, published tonight in the New England Journal of Medicine, generated immediate excitement.

"These findings have broad ­implications, not just for concerns about the accurate assessment of vast numbers of patients in custodial care situations, but in the context of any clinical encounter where we currently rely on behavioural assessment alone to identify consciousness," said Dr Nicholas D Schiff, associate professor of neurology and neuroscience at Weill Cornell medical college in New York.

He called for urgent efforts to identify and help such patients.

"The most important question left unanswered by these findings is what mechanism accounts for the stunning dissociation of behaviour and integrative brain function. I think we can be sure that as the biological answers underlying this question become more clear this will have a profound impact across medicine."

Professor Chris Frith, of the Wellcome Trust's centre for neuroimaging at University College London, said Owen and his colleagues had opened the way to communicating with patients in a vegetative state.

"It is difficult to imagine a worse experience than to be a functioning mind trapped in a body over which you have absolutely no control," he said.

"Obviously, more technical ­development is required, but we now have the distinct possibility that, in the future, thanks to Owen and colleagues' work we will be able to detect cases of other patients who are conscious, and what's more, we will be able to communicate with them."

Patients in a vegetative state are defined as having "wakefulness without awareness". They are people who have survived an acute brain injury who are not in a coma – they may go through sleep cycles, for instance – but they do not respond to any stimuli.

Some stay this way permanently, but others start to show some awareness, although without being able to communicate. They may be able to move a finger when asked to do so, but not always, and they are not able to signal yes or no by their movements. These patients are now referred to as being in a minimally conscious state (MCS). It can be hard to know whether their movements are intentional or merely reflexive.

Recovery from a traumatic brain injury – such as a blow to the head in a car accident – is more frequent than that caused by disease, such as a stroke. But after a year in a vegetative state, most health professionals do not recommend further treatment, because official advice is that the chances of recovery are virtually zero. With the consent of the family, doctors may go to court for an order allowing them to sedate the patient and withdraw nutritional support, allowing them to die. This study may cause a rethink.

Questionable Future for State Health Plans

Many individuals are embracing the summer season with fear. A Washington state health insurance program for low-income adults is planning to close, ending insurance coverage for about 65,000 individuals.

The ill economy is forcing Washington state as well as many other states to shave their health insurance programs for low-income people, even as jobless motives are demanding help. Five of the six states that

utilize state funds to help adults who are not covered by Medicaid are considering cuts. These program cuts are barring new enrollment or raising fees.

The 250,000 individuals taking advantage of the state programs are adults who do not qualify for the federal-state Medicaid program. This is either because they have no children or have earnings exceeding the limits which state imposes on Medicaid eligibility. The number of adults represent a small fraction of those who get government health insurance coverage, even though the state programs are often their only option for health coverage.

Individuals are taking action to counter the state's insurance cuts. For example, in California, many are consulting insurance brokers for Medigap insurance quotes to fill the coverage gaps of Medicare. This type of plan is also known as supplemental insurance.

The U.S. Senate passed a health bill that does include funding for the state programs. That bill, along with a bill the House of Representatives passed, would also expand Medicaid and provide federal subsidies to help low-income and middle-income Americans acquire affordable insurance. The bill's fate is uncertain as Democrats regroup after a recent loss in a key Senate seat.

Even if the bill is approved, the relief for states, as well as the uninsured population, is years away. For this reason, experts are advising the uninsured to be prepared and obtain personal health insurance quotes from several insurance providers.

Potential Stimulus Protection

Stimulus money from the Federal government has sheltered many state Medicaid programs. However that funding is set to run out in December and could result in Medicaid eligibility cuts, on top of potential cuts in states' adult health programs.

A Washington senator added a provision to the Senate health bill to permit a state to find federal funds for Basic Health until 2014. The senators spokesman says the provision would apply to other states with basic health insurance plans.

A second Cantwell amendment would allow states to form basic health insurance plans after 2014. These plans would be available to individuals who earn over the limit for Medicaid but less than twice the poverty level.

Many insurance experts say such state insurance plans would not be needed if a healthcare overhaul passes. This is because most individuals who qualify would suit the new Medicaid enrollment guidelines or qualify for federal subsidies.

"There will be no reason for states to pay for this themselves," says an expert at the Urban Institute.

However, an overhaul is still up in the air. Until then, policy experts recommend shopping for individual health insurance with the best benefits.

Whatever the outcome of the debate at the capital, policy experts cross their fingers that lawmakers can seek the money to save Basic Health.

For more information on how to protect yourself with affordable, health insurance coverage, consult a policy expert to better understand your insurance options.

University of Michigan, Blue Cross Blue Shield of Michigan Collaborating to Cut Rehospitalizations

Ann Arbor

The University of Michigan and Blue Cross Blue Shield of Michigan are backing a statewide initiative meant to cut back on hospital readmissions that occur for up to 1 in 5 patients.

The campaign, called Project BOOST, is meant to help mitigate the risk of complications that could land high-risk patients back in the hospital after being discharged. Focusing on improving the discharge process at hospitals, it is a model that has been used around the country.

The goal of the program is to help reduce unexpected and preventable readmissions for the health and quality of life of patients, said Scott Flanders, U-M's director of the hospital medicine program and president of the society of hospital medicine. Often when a patient is discharged from the hospital, follow up tests and care with a primary care physician is recommended. In the pass-off, patients can fall through the cracks.

Reducing cost is also a major factor driving the project.

According to Blue Cross Blue Shield of Michigan data on a majority of its patients, about 1 in 10 patients discharged from the hospital are readmitted within the month.

Even when adjusting for readmissions unrelated to the original problem or planned readmissions, at least 6.4 percent of discharge patients return to the hospital with unexpected and potentially preventable problems. That represents an opportunity to imrpove quality and save up to about $75 million every year, said Tom Leyden, a manager in clinical programs with Blue Cross Blue Shield.

And according to national Medicare data, about 20 percent of senior patients discharged from the hospital unexpectedly return within the month, costing more than $17 billion nationally each year, according to a statement.

"It's substantial," Leyden said. "That's a lot of patients who come back in for healthcare professional services  who shouldn't really have to."
Reviewing the way hospitals discharge patients is important because not every patient is equal at discharge, Flanders said.

Some get new medications to take every day or get new regimens and may get confused about how to best take care of themselves. Steps like identifying who the highest risk patients are and targeting them for more intensive support after discharge could help reduce their chances of being readmitted, Flanders said.

Solutions for these patients include having a health professional take extra time to explain medication instructions and having a patient or caregiver verbally "teach back" what they were instructed to do. It can also includes follow-up phone calls and direct communication with a patient's primary care physician. The steps could be the difference that keeps a patient's medical issue from returning in a serious enough way to land him or her back in the hospital, Flanders said.

For example, he said, when a patient is hospitalized and treated for congestive heart failure, it means the heart is not pumping as well as it should, and fluid can build up and needs to be addressed by a doctor.

"But if patients go home and don't rigidly adhere to instructions on taking medications and salt intake, then the fluid can build up again," Flanders said. "If a patient is telling a primary care doctor they can't breath again, they can make changes … so (the patient doesn't) end up in the hospital again."

In the coming weeks, 15 hospitals will be chosen across the state to participate in the program. By May, programs will begin to be set up, and healthcare data migration training will be offered to staff. The University of Michigan is leading the effort with the Society of Hospital Medicine.

Pregnancy Bug Linked to Childhood Asthma in Premature Babies

Complications during pregnancy may predispose prematurely born children to asthma, a comprehensive study reports. Taking a closer look at the unique correlation are pediatric physicians and pediatric allergists.

The problem is a result of chorioamnionitis, which is inflammation of the fetal membranes and amniotic fluid from a bacterial infection. It may be linked to over half of all preterm births, scientists noted in the Archives of Pediatric and Adolescent Medicine. Infections are proponent for countless problems, so parents should stay well informed about pediatric infectious diseases and the proper methods to prevention.

The infection may have spawned through the mothers' bloodstream or through the uterus from the her genital tract, says the head scientist at Kaiser Permanente Southern California's Department of Research and Evaluation in Pasadena. Pinpointing the cause of the pediatric infectious disease is still ambiguous.

The author emphasizes that, in animals, chorioamnionitis has been proven to induce lung and brain damage in their offspring. Also, specialists have discovered lung scarring among the infected infants who died after pregnancies.

Scientists analyzed electronic health records for all singleton children born at Kaiser's Southern California hospitals from 1991 to 2007. Out of 397,852 children, 28,869 of were born preterm.

Among children born full-term, chorioamnionitis was not correlated to an increased risk of acquiring asthma symptoms by the age of 8. However, those born prematurely faced considerable risk of being diagnosed with the condition. Scientists were able to pinpoint variations in asthma risk among different races of the preterm babies:

* Blacks faced double the risk of childhood asthma

* Hispanics a 70% increase risk

* Whites a 66% increase risk

Consulting a pediatric doctor can help families target potential risk factors.

The researchers noticed these differences even after considering other potential risk factors, like the whether the mother smoked or had asthma herself. Also intrigued by the findings are pediatric immunologists, who frequently see preterm patients.

Scientists conducting the study speculate that chorioamnionitis was not linked to asthma risks in full-term children because their mothers might not have had the infection for as long as those born prematurely. However, the team emphasized a lack of information regarding how early in the pregnancies women were diagnosed.

Diagnosing the condition is tricky, the head scientist adds, because symptoms like fever in the mother, discomfort in the uterus, foul-smelling amniotic fluid are not absolute correlations. In addition, some women never display such symptoms. The team is now trying to discover a marker in the mother's blood that would signify her symptoms as a cause of chorioamnionitis.

Expert pediatricians are considering the study to be highly significant in the field for children's immunology and disease prevention.

New Superstore for Growing Medical Cannabis Opens in Oakland

Mercury News

The place has the feel of the nursery at a Home Depot, but the house plants, barbecues and sheds are replaced with hydroponic equipment, fans and nutrients for growing medical cannabis plants.

It's called iGrow, and the owner of the 15,000-square-foot superstore, Dhar Mann, describes it as a one-stop shop for medical marijuana patients who want to grow their own cannabis plants.

"What we are doing is taking the black market out of the (medical cannabis growing industry)," said Mann, the 25-year-old son of the owners of Friendly Cab, an Oakland-based company for more than three decades.

The shop was made possible, in part, by a City Council resolution that allows medical marijuana patients to have a maximum of 72 plants indoors, a 36-square-foot growing area, 20 plants outdoors and up to three pounds of dried marijuana.

"If you come in here with valid California identification and you have a medical recommendation or patient identification card, we will be open to talking to you about growing cannabis," said General Manager Justin Jorgensen.

And even if you don't, iGrow will have a doctor on site to write recommendations for those who qualify.

"He is going to ask for supporting (medical documentation), and if you don't have it you may or may not get approved," said Jorgensen.

The iGrow superstore, located at 70 Hegenberger Loop near the airport, isn't the first hydroponics store in the city, but Mann says it's the largest in the Bay Area. Like other stores, the shelves are stocked with various types of grow lights, fans, plant nutrients and additives, and growing containers.

Many City Council members are supportive of the store.

"It's going to create new job opportunities for residents," said Councilmember Larry Reid (Elmhurst-East Oakland), who represents the district where iGrow opened Thursday.

Reid said he is confident the store has enough security to keep out criminals looking to steal valuable equipment and products. And he said he is excited that the store could appeal to gardeners looking to improve their vegetable or flower gardens.

"It can be useful for those that want to just grow tomatoes or any other vegetable in their backyard," Reid said.

But the main focus of iGrow will be selling supplies for and giving classes about growing medical marijuana.

A portion of the warehouse will be sectioned off for the 25 online classes offered by the University of Cannabis, also recently launched and run by Mann. Courses cover everything from the "Global History of Hemp" to "Sharpening Your Green Thumb" to "The Brain, the Body & the Bud." Classes, which run from $40 to $60, can be taken at
iGrow or on your own computer, Mann said.

And then there's the Grow Squad, experienced indoor cultivators who will give three hours of complimentary in-person or over-the-phone advice to people interested in growing cannabis, Mann said.

"We want to educate you," Mann said. "And hopefully that education will cut down on some of the fires (in grow houses recently)."

Mann has been working on the $250,000 project, which included a new storefront and a complete overhaul of the long-vacant warehouse, since the fall.

Several hundred people attended Thursday's grand opening, which included speeches by Reid and Oakland Councilmember Rebecca Kaplan (at-large).



"The grow business is an economic opportunity for our city," Kaplan said. "We want to celebrate, we want to support and we want to uplift that to help pay for the parks, libraries and services that people need," referring to the fact that the business will generate tax revenue.

Dave Weddingdress, co-founder of the Harborside Health Center cannabis club in San Jose, also attended the event.

"We are happy to see these places open under reasonable regulations," he said.

Mann also had short videos from other elected officials, including Rep. John Garamendi, touting the project as a boon for urban agriculture and the city's economy.

"We're excited that iGrow was born in the epicenter of the cannabis movement," said Mann. "And we're even more thrilled to see the strong support that the city of Oakland and the community has shown us for the grand opening of our new business."

Obama Issues New Rules on Mental Health Coverage

ABC News

Many Americans will get broader coverage for mental illness and substance abuse treatment under rules issued Friday by the Obama administration.

Health plans offered by employers with more than 50 workers will be required to treat mental health benefits the same way they handle coverage for physical ailments. That means no separate annual deductibles for mental health treatment. And copayments for visiting a psychiatrist or social worker can't be more than the charge for going to the family doctor or a medical specialist.

"Health plans will be under an obligation to provide the same level of coverage for treatment of mental illness as they do for cancer, diabetes and heart disease," said Andrew Sperling of the National Alliance on Mental Illness.

The rules, which take effect July 1, provide a blueprint for employers to carry out a law passed by Congress in 2008 with broad bipartisan support.

Health plans will be under an obligation to provide the same level of coverage for treatment of mental illness as they do for cancer, diabetes and heart disease

The legislation aims to remove financial barriers to treatment for people with mental health problems. About 140 million Americans in more than 450,000 employer plans will benefit from improved coverage.

The law also prohibits health plans from setting limits on number of visits or hospital days for mental health problems that are different from any such limitations on treatment for medical problems. Sperling said the rules issued Friday clarify that other kinds of treatment limits in health plans, such as case reviews and lists of preferred drugs, may not be used to discriminate against people with mental illness.

The Congressional Budget Office concluded the law would raise costs only slightly, less than half of 1 percent, for employers.

California Hospitals Fined for Medical Errors

LA Times

 

State Department of Public Health officials require hospital officials to submit plans to correct the problems, which in some cases killed or seriously injured patients.

State officials have fined 13 California hospitals for medical errors that in some cases killed or seriously injured patients, according to a report made public Wednesday.

California Department of Public Health officials have required hospital officials -- who may appeal the fines -- to submit plans to correct the problems.

Three hospitals in Los Angeles County face penalties.

Los Angeles Community Hospital in Norwalk was fined $50,000 in connection with the death of a patient in May who was supposed to be restrained and supervised, but was instead left to repeatedly pull out his tracheotomy tube until he was found unresponsive in his bed. Hospital staff referred questions to spokeswoman Ellen Shin, who did not return calls.

California Hospital Medical Center was fined $50,000 after a medical resident in the emergency room misdiagnosed a woman in March with an ectopic pregnancy. The woman was not pregnant and the chemotherapy drugs she was treated with suppressed her immune system and caused mouth, throat and skin sores.

The hospital has since restricted residents' access to the drug and required pharmacy staff to closely monitor how the drug is dispensed.

"We responded to the incident appropriately, reported it promptly and took long-term corrective action in a timely manner," said Katreena Salgado, a hospital spokeswoman.

Marina del Rey Hospital was fined $25,000 after intensive care nurses failed to monitor a woman's oxygen levels in March 2007; the patient passed out and had to be placed on a ventilator.

In Orange County, three hospitals were each fined $50,000.

St. Jude Medical Center in Fullerton was fined in connection with the death of a patient treated in the emergency room for a heart attack in February. Investigators found nurses failed to notice that the man's heart monitor had disconnected. Chief Medical Officer Michael Marino released a statement Wednesday saying an internal investigation showed the volume on the patient's heart monitor alarm was not loud enough to alert staff. He said the hospital has since added engineering controls for the monitors, and checked the alarms and staff training. The hospital does not plan to appeal, a spokeswoman said.

Western Medical Center in Santa Ana faced its second fine in the last year after staff left a surgical sponge in a patient in March. She got sick and had to undergo a second operation.

At Hoag Memorial Hospital in Newport Beach, investigators found a patient on a metal gurney was sucked in by an MRI machine's magnetic force in January 2009, fracturing her leg and foot. It was the hospital's third penalty in the last two years. The hospital's chief executive, Dr. Richard Afable, said the staff was retrained and the hospital does not plan to appeal the fine.

In Riverside County, John F. Kennedy Memorial Hospital in Indio got four $25,000 fines for failing to monitor patients and medication in 2008.

The state has issued 134 fines since they were first required by law in January 2007, said Kathleen Billingsley, deputy director of the department's Center for Health Care Quality. In all, 90 hospitals have been fined and the state has collected $2.3 million. Twenty-two of the fines have been appealed, Billingsley said.

Surgical Procedure Urged for Atrial Fibrillation

LA Times

Study finds catheter ablation is highly effective when medication doesn't work. The irregular-heartbeat disorder, once considered benign, is now seen as a precursor to stroke that needs treatment.

People with atrial fibrillation, a common type of irregular heartbeat, should be referred for a surgical treatment called catheter ablation if an oral medication is not effective, said Wyandotte Cardiologists.

In a head-to-head comparison of the two forms of treatment, catheter ablation was so superior in resolving the disorder and helping patients to feel better that the study was halted early. The results will be published today in the Journal of the American Medical Assn.

Atrial fibrillation, which affects more than 2 million Americans, occurs when the heart's two small upper chambers quiver instead of beating effectively. It can cause blood to pool and clot, raising the risk of a stroke. The condition can go undetected indefinitely, though many people have symptoms such as palpitations, dizziness, chest pain, fatigue and shortness of breath. Once considered a nuisance, the condition is now recognized as a potential precursor to stroke that should be treated.

Atrial fibrillation is distinguished from ventrical fibrillation which can cause sudden cardiac arrest, often requiring emergency action with such devices as a Zoll defibrillator.

"It's really important that we have advances in treating atrial fibrillation because the risk climbs dramatically as you age," said Dr. Douglas Zipes, past president of the American College of Cardiology and a cardiologist at Indiana University School of Medicine. Zipes was not involved in the study. "I always say -- only partially tongue-in-cheek -- that if you live long enough, you'll have atrial fibrillation."

Woodhaven Heart Doctors suggest that the first choice for treating the condition is oral medications to reduce the heart rate. They work by slowing the conduction of the electrical impulses in the heart. Such medications, however, are ineffective in a large portion of people with the disorder.

For those who continue to feel unwell, catheter ablation should be recommended, said Dr. David Wilber, director of the Cardiovascular Institute at Loyola University Chicago Stritch School of Medicine and the lead author of the study.

"Atrial fibrillation has always been difficult to treat," Wilber said. "Certainly, the effectiveness of the drug therapies is about 50% at best. The likelihood of a second drug working is about 20%. So the role of this study is to point out that there isn't much point in going to a second drug."

During catheter ablation, doctors make a small incision in the patient's neck or groin and insert a thin, flexible tube to reach the heart. They then apply radiofrequency energy to cauterize -- or burn off -- small pieces of abnormal tissue triggering the irregular heartbeat.

The study was performed at 19 medical centers and included 167 atrial fibrillation patients who had failed to benefit from at least one drug. The patients, whose average age was 55, were randomly assigned to receive ablation or try a different medication than what they had already tried. Most took flecainide or propafenone.

One year later, 66% of the ablation patients were free of an irregular heartbeat or symptoms, compared with 16% of those treated with drugs.

Longer studies are needed to assess whether the treatment provides a long-term cure and if it reduces stroke and death, Wilber said.

Catheter ablation has been in use for several years but is still underutilized, said Dr. Shephal K. Doshi, director of electrophysiology and pacing at Saint John's Health Center in Santa Monica. Doshi was not involved in the study.

Wayne County Cardiologists remind that there are risks associated with the procedure. Rare complications include damage to the esophagus and stroke. Damage to veins is a more common complication but is treatable.

"It has to be used appropriately, but in the right hands it's a very powerful tool for the management of atrial fibrillation," Doshi said. "There is a 1% risk of having a stroke during the procedure. So that's not trivial. For a young patient, a patient who feels bad, it may be worth it."

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Smokers with Lung Cancer: Still Not Too Late to Quit

WebMD

 

Smokers with lung cancer who have asked "Why quit now, I'm already sick?" may find new motivation in this answer: Doing so could double their odds of survival over five years.

A report published online today in BMJ suggests that people who give up smoking after being diagnosed with early-stage lung cancer live longer than patients who continue the habit. 

The findings underscore the importance of the notion that it is never too late to quit smoking.

Lung cancer is the most common cause of cancer death, according to the American Lung Association. And smoking causes most cases of lung cancer.

Medical evidence has repeatedly shown that as soon as a person quits smoking the body begins to repair the damage done by tobacco-smoke-related chemicals, and it's been theorized that continued smoking can influence the behavior of lung tumors. But until now it was not clear if ending the smoking habit after being diagnosed with lung cancer had any impact on a patient's survival.

Researchers at the University of Birmingham in England reviewed the results of 10 studies that evaluated how smoking cessation after lung cancer diagnosis affected a patient's prognosis. The review included patients with both non-small-cell and small-cell forms of lung cancer.

Among their findings:

    * Patients with early-stage lung cancer who continued to smoke had a "substantially higher risk of death" than those who quit after their diagnosis. The increased death risk appeared to be due to the cancer spreading.
    * The five-year survival rate for the quitters was 64%-70% compared with 29%-33% for those who continued to smoke.
    * The continued smokers were also more likely to have their cancer return than those who quit.

The researchers say their findings suggest that smoking-cessation programs may benefit patients with early-stage lung cancer, but they add that more research is needed.

Salami Recalled Over Salmonella Concern

USA Today

Pepper, a spice historically used to preserve food, could be the cause of a 1.24 million-pound salami recall, some food safety experts say.

Daniele Inc., of Pascoag, R.I., recalled ready-to-eat pepper-coated salami, sausage and other cured meats Saturday, saying they may be contaminated with salmonella.

The outbreak began in July. So far it has sickened 184 people in 38 states, leading to at least 35 hospitalizations but no deaths, according to the federal Centers for Disease Control and Prevention.

To date, health officials have not found this salmonella strain in any Daniele products. But 11 people who recently ate "Daniele Italian Brand Gourmet Pack" were infected, said the company's Davide Dukcevich, in a statement on its website.

The one thing all the recalled products have in common is that they were rolled in pepper, or packaged with a product that was.

The answers won't be known until the factory investigation is finished. "I don't think that other possibilities have been ruled out yet," said William Keene, a senior epidemiologist with Oregon's Dept. of Public Health.

Uncooked pepper has been known to carry salmonella, said David Theno, formerly head of food safety at Jack in the Box and now a consultant. "Frankly, if you're using pepper and you're not doing some sort of sterilization process on it, you're rolling the dice."

Some suppliers sell irradiated pepper, but "there is no federal requirement that pepper be sterilized," Daniele spokesman Jason Maloni said Sunday. "However, we will begin only using irradiated pepper next week for all our products."

Last April, at least 42 people were sickened with salmonella linked to pepper.

Salmonella can cause diarrhea, fever and stomach cramps; in infants, elderly and those with weak immune systems, illness can be severe.