The New York Times, November 11, 2008, by Eric Nagourney — People who survive a heart attack are at much higher risk of sudden cardiac death in the next 30 days, researchers have found.

The findings, which appeared in the Nov. 5 Journal of the American Medical Association, suggest that doctors need to closely supervise patients in the month after a heart attack, and that patients also need to be alert to signs of trouble.

“The first month after a heart attack can be envisioned as a period of healing with heart tissue remodeling, which conceptually is associated with a propensity to experience sudden death,” one of the authors, Dr. Véronique L. Roger of the Mayo Clinic in Rochester, Minn., said in an e-mail message.

The researchers, led by Dr. A. Selcuk Adabag of the Veterans Affairs Medical Center in Minneapolis, followed the health of almost 3,000 people who had a heart attack from 1979 to 2005.

In the first 30 days, they found, the rate of sudden cardiac death was 1.2 percent, about four times the risk that would have been expected in the general population, once age and sex were taken into account.

But the rate improved greatly over the following 11 months, dropping to a level lower than that usually seen in the general population.

In fact, over all, the study found big improvements in the rate of sudden cardiac death for heart attack patients in the past three decades. The decline, the researchers said, was more than 40 percent. They attributed that to improved treatment for people who have just had a heart attack.


The New York Times, November 11, 2008 — Eighty-year-olds with clogged arteries or leaky heart valves used to be sent home with a pat on the arm from their doctors and pills to try to ease their symptoms. Now more are getting open-heart surgery, with remarkable survival rates rivaling those of much younger people, two new studies show.

Years ago, physicians “were told we were pushing the envelope” to operate on a 70-year-old, said Dr. Vincent J. Bufalino, a cardiologist at Loyola University Chicago. But today “we have elderly folks who are extremely viable, mentally quite sharp,” who want to decide for themselves whether to take the risk, said Dr. Bufalino, one of those who reviewed the studies for the American Heart Association.

Even 90-year-olds are having open-heart surgery, said Dr. Harlan M. Krumholz, a Yale cardiologist who has done other research on older heart patients. “Age itself shouldn’t be an automatic exclusion,” Dr. Krumholz said.

Not every older person can undergo such a challenging operation, but the results seen in the new studies show that doctors have become good at figuring out who can.

People 75 and older are the fastest-growing segment of the population, and 40 percent of them have heart disease. Treatment guidelines issued by the heart association and other groups do not have age cutoffs for open-heart surgery. It has been up to patients, doctors and insurers to decide whether to risk it.

In one of the two new studies, which were reported Sunday at the heart association’s conference in New Orleans, researchers led by Dr. Paul A. Kurlansky followed 1,062 octogenarians who had heart bypass surgery at Mount Sinai Medical Center in Miami Beach from 1989 through 2001.

Their average survival was roughly six years, almost the same as for similarly aged people who do not have heart disease. Ninety percent survived their surgery to leave the hospital. The rate of such survival improved sharply as the study went on, from 85 percent in the early years to 98 percent by its end. Patients also reported a quality of life similar to that of those their age who did not have bypass surgery.

The second study, by Donald S. Likosky, a researcher at Dartmouth, involved 8,796 elderly people in Maine, New Hampshire and Vermont with leaky aortic valves. The condition can kill within two or three years, and “surgery is their best option” for treatment, Dr. Likosky said.

Six years after valve surgery, sometimes accompanied by a bypass procedure as well, most were still alive. The median survival was seven years, about the same as in the general population of that age. In fact, those in the study who were 85 or older actually outlived their general-population counterparts.


The New York Times, November 12, 2008, by Miguel Helft — What if Google knew before anyone else that a fast-spreading flu outbreak was putting you at heightened risk of getting sick? And what if it could alert you, your doctor and your local public health officials before the muscle aches and chills kicked in?

That, in essence, is the promise of Google Flu Trends, a new Web tool that, the company’s philanthropic unit, unveiled on Tuesday, just as flu season was getting under way in the United States.

Google Flu Trends is based on the simple idea that people who are feeling sick will probably turn to the Web for information, typing things like “flu symptoms” or “muscle aches” into Google. The service tracks such queries and charts their ebb and flow, broken down by regions and states.

Early tests suggest that the service may be able to detect regional outbreaks of the flu a week to 10 days before they are reported by the Centers for Disease Control and Prevention. Some public health experts say that could help accelerate the response of doctors, hospitals and public health officials to a nasty flu season, reducing the spread of the disease and, potentially, saving lives.

It could also offer a dose of comfort to stricken individuals in knowing that a bug is going around.

“This could conceivably provide as early a warning of an outbreak as any system,” said Lyn Finelli, lead for surveillance at the influenza division of the C.D.C. Ms. Finelli noted that people often search the Internet for medical information before they call their doctor.

“The earlier the warning, the earlier prevention and control measures can be put in place, and this could prevent cases of influenza,” Ms. Finelli said. Between 5 and 20 percent of the nation’s population contracts the flu each year, Ms. Finelli said, leading to an average of roughly 36,000 deaths.

Google Flu Trends ( is the latest indication that the words typed into search engines like Google can be used to track the collective interests and concerns of millions of people, and even to forecast the future.

“This is an example where Google can use the incredible systems that we have to come up with an interesting, predictive result,” said Eric E. Schmidt, Google’s chief executive. “From a technological perspective, it is the beginning.”

For now the service covers only the United States, but Google is hoping to eventually use the same technique to help track influenza and other diseases worldwide.

The premise behind Google Flu Trends has been validated by an unrelated study indicating that the data collected by Yahoo, Google’s main rival in Internet search, can also help with early detection of the flu.

“In theory, we could use this stream of information to learn about other disease trends as well,” said Philip M. Polgreen, assistant professor of medicine and epidemiology at the University of Iowa and a co-author of the study based on Yahoo’s data.

Still, some public health officials note that many health departments already use other techniques, like gathering data from visits to emergency rooms, to keep daily tabs on disease trends in their own communities.

“We don’t have any evidence that this is more timely than our emergency room data,” said Farzad Mostashari, assistant commissioner of the New York City Department of Health and Mental Hygiene.

If Google provided health officials with details of the inner workings of the system so that it could be validated scientifically, the data could serve as an additional way to detect influenza that was free and might prove valuable, said Mr. Mostashari, who is also chairman of the International Society for Disease Surveillance.

A paper on the methodology behind Flu Trends is expected to be published in a future issue of the journal Nature.

Researchers have long said that the data sprinkled throughout the Web amounts to a form of “collective intelligence” that could be used to make predictions. Commercial Web sites mine this information to predict airfares or home prices.

But the data collected by search engines is particularly powerful, because the keywords and phrases that people type into search engines represent their most immediate intentions. People may search for “Kauai hotel” when they are planning a vacation and for “foreclosure” when they get in trouble with their mortgage. Those queries express the world’s collective desires and needs, its wants and likes.

Internal research at Yahoo suggests that increases in searches for certain terms can help forecast what technology products will be hits, for instance. Yahoo itself has begun using search traffic to help it decide what material to feature on its home page. It analyzes what its users are interested in and then programs its Web site accordingly.

Two years ago, Google began opening its search data trove through Google Trends, a tool that allows anyone to track the relative popularity of search terms. Google also offers more sophisticated search traffic tools that marketers can use to fine-tune advertising campaigns. And internally it has tested the use of search data to reach conclusions about economic, marketing and entertainment trends. It found both promises and limitations.

“This works remarkably well, but tends to miss ‘turning points,’ times when the data changes direction,” said Hal Varian, Google’s chief economist.

Prabhakar Raghavan, who is in charge of Yahoo Labs and the company’s search strategy, also said search data could be immensely valuable for forecasters and scientists, but concerns about privacy had generally stopped the company from sharing it with outside academics.

Google Flu Trends gets around privacy pitfalls by relying only on aggregated data that cannot be used to identify individual searchers. To develop the service, Google’s engineers devised a basket of keywords and phrases related to the flu, including thermometer, flu symptoms, muscle aches, chest congestion and many others. Google then dug into its database, extracted five years of data on those queries and mapped the data onto the C.D.C.’s reports of “influenzalike illness,” which the agency compiles based on data from labs, health care providers, death certificates and other sources. Google found an almost perfect correlation between its data and the C.D.C. reports.

“We know it matches very, very well in the way flu developed in the last year,” said Larry Brilliant, executive director of Ms. Finelli of the C.D.C. and Mr. Brilliant both cautioned that the data needed to be monitored to ensure that the correlation with flu activity remained valid.

Other people have tried to use information collected from Internet users for public health purposes. A Web site called, for instance, invites people to report about what ails them and superimposes the results on a map. But the site has received little traffic, so its usefulness is limited.

HealthMap, a project affiliated with Children’s Hospital Boston and Harvard Medical School, scours the Web for news articles, blog posts and electronic newsletters to create a map that tracks emerging infectious diseases around the world. It is backed by, which counts the detection and prevention of diseases as one of its main philanthropic objectives.

But Google Flu Trends appears to be the first public project that uses the powerful database of a search engine to track the emergence of a disease.

“This seems like a really clever way of using data that is created unintentionally by the users of Google to see patterns in the world that would otherwise be invisible,” said Thomas Malone, a professor at the M.I.T. Sloan School of Management. “I think we are just scratching the surface of what’s possible with collective intelligence.”

Even dogs that don’t shed can trigger an allergic reaction. (G. Paul Burnett/The New York Times, Phil Mansfield for The New York Times, Scott Mullin for The New York Times, Tony Cenicola/The New York Times)

The New York Times, November 2008, by Tara Parker-Pope — Few appointments in the new Obama administration are as eagerly awaited as the choice of first dog. Animal advocacy groups are lobbying for a rescue pet. Meanwhile, the American Kennel Club has seized on the fact that Malia Obama has allergies, suggesting that the first family choose among several so-called “hypoallergenic” breeds like the Bichon Frise or the poodle.

Now allergy specialists are weighing in as well, noting that there really is no such thing as a nonallergenic dog. People who are allergic to dogs are reacting to the pet dander, not the pet hair. Dogs like poodles, with coats that don’t shed, and hairless dogs will typically produce less dander than other types of dogs, but they still can produce enough dander to affect a highly allergic person.

Dr. Jonathan Field, director of the allergy and asthma clinic at New York University’s Langone Medical Center/Bellevue, said he gets questions all the time from parents who want dogs despite a child’s allergies. “Pet allergies are not due to hair, but are from pet dander — skin flakes — but also can be reactions to saliva or urine,” Dr. Field said. “Before investing in a dog, I suggest that parents have their child spend time with an animal — if possible — to see how they react.”


Dogs may play a larger role in health than realized. (Andrea Mohin/The New York Times)

The New York Times, by Tara Parker-Pope — Dogs have long had special standing in the medical world. Trained to see for the blind, hear for the deaf and move for the immobilized, dogs have become indispensable companions for people with disabilities.

But dogs appear to be far more than four-legged health care workers. Over the years, data on the larger role dogs play in health has trickled out from various corners of the world. One Japanese study found pet owners made 30 percent fewer visits to doctors. A Melbourne study of 6,000 people showed that owners of dogs and other pets had lower cholesterol, blood pressure and heart attack risk compared with people who didn’t have pets. Obviously, the better health of pet owners could be explained by a variety of factors, but many experts believe companion animals improve health at least in part by lowering stress.

Dogs, in particular, also have been shown to do remarkable things to improve the health of their owners. There are stories of dogs warning their owners of imminent health threats. In 2003, University of Florida researchers published a report in the journal Seizure noting that some dogs seem to have an innate ability to detect impending seizures. A 2000 report in the British Medical Journal examined case studies of dogs alerting people with diabetes of a coming hypoglycemic episode.

More recently, some studies have suggested dogs can be cancer detectors. In 2006, the medical journal Integrative Cancer Therapies reported how ordinary house dogs could identify breast and lung cancer patients by smelling their breath. A University of Maine study is testing whether dogs can sniff out ovarian cancer.

The role dogs play in medicine is celebrated in a new book, “Paws & Effect: The Healing Power of Dogs’’ (Alyson Books, 2007), which chronicles the numerous ways dogs contribute to our health. Author Sharon Sakson is a journalist and television producer, dog breeder and American Kennel Club dog-show judge. She admits to being biased about her subject matter, and she tends to write about the mundane details of dogs and their owners. Much of the evidence surrounding dogs and health is anecdotal, although Ms. Sakson includes many references to published research. The stories of service dogs are particularly impressive, as is the nascent research into dogs’ ability to detect cancer.

Ms. Sakson said she first began thinking about the link between dogs and health while reporting an earlier book on men and dogs. A few men she interviewed who had AIDS credited their dogs with playing a role in their improved health.

While Ms. Sakson says more studies are needed to show exactly what role dogs play in health, any dog owner already knows the benefits of their relationship with their pet.

“I went into it because I loved my dogs — they can do so much for our society,” said Ms. Sakson. “There’s no question they give us emotional support.”

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Wildlife official John Rueth carries a salmon being moved to a tank in Shasta Lake, California, last month.

Severe Restrictions On Salmon Fishing Needed

The New York Times, November 2008 — The stunning collapse of one of the West Coast’s biggest wild salmon runs has prompted even cash-strapped fishermen to call for an unprecedented shutdown of salmon fishing off the coasts of California and Oregon.

“There’s likely no fish, so what are you going to be fishing for?” asked Duncan MacLean, a fisherman from Half Moon Bay. “I have no problem sitting out to rebuild this resource if that’s what’s necessary.”

The Pacific Fishery Management Council meets in Seattle this week and will likely vote to impose the most severe restrictions ever on West Coast salmon fishing to protect California’s dwindling chinook stocks.

The Sacramento River chinook run is usually one of the most productive on the Pacific Coast, providing the bulk of the salmon caught by sport and commercial trollers off California and Oregon.

But only about 90,000 adult chinook returned to the Central Valley last fall — the second lowest number on record and well below the number needed to maintain a healthy fishery. That number is projected to fall to a record low of 58,000 this year. By contrast, 775,000 adults were counted in the Sacramento River and its tributaries as recently as 2002.

“This stock got off-the-charts bad very suddenly,” said Donald McIsaac, the council’s executive director. “It’s a very, very severe situation.”

The council, which regulates Pacific Coast fisheries, will choose between three management options: a total ban on salmon fishing off the coast of California and Oregon; extremely limited fishing in select areas; or catch-and-release fishing for scientific research.

The council also is expected to set strict limits on salmon fishing off the coast of Washington to protect that state’s declining chinook and coho stocks.

The council’s final decision is expected Thursday. The National Marine Fisheries Service will then decide whether to implement the regulations by May 1.

The Central Valley collapse is a blow to fishermen, tackle shops, charter boat operators and other businesses that depend on commercial and recreational salmon fishing.

For consumers, it will be hard to find any chinook, also known as king salmon, which are prized by anglers, seafood connoisseurs and upscale restaurants. There should still be abundant supplies of farm-raised salmon and wild sockeye from Alaska, but prices could be higher.

“It’s going to be devastating to the marketplace to have no California king salmon at all,” said David Goldenberg, CEO of the California Salmon Council. “For people who want high-quality salmon, they’re not going to have that choice.”

Biologists and others are trying to figure out what caused the salmon collapse so they can make sure California’s chinook populations rebound.

There are many potential factors, because wild salmon are born in streams and rivers, migrate to the ocean when they’re juveniles and spend two to four years there before returning to spawn in the areas where they were born. In between they have to navigate the often treacherous waters of the Sacramento-San Joaquin Delta and San Francisco Bay.

The council has asked state and federal scientists to research 46 possible causes, including water diversions, habitat destruction, dam operations, agricultural pollution, marine predators and ocean conditions.

Many scientists point to unusual weather patterns that disrupted the marine food chain along the Pacific Coast in 2005, when thousands of seabirds washed up dead or starving because they couldn’t find enough to eat.

Researchers believe those poor ocean conditions also devastated the juvenile salmon that would have returned to the Central Valley last year. Young chinook couldn’t find the tiny shrimp and fish they depend on to survive.

“The fish went to the ocean in 2005 and found nothing to eat when they got there. They either starved to death or got so weak from not eating enough that they got eaten by predators,” said Bill Peterson, an oceanographer with the National Marine Fisheries Service.

Peterson said ocean conditions have improved since then, which could help revive West Coast salmon populations.

Many fishermen and environmentalists believe the main problem lies in the Sacramento-San Joaquin Delta. They say too much water is being diverted to farms and water districts in the San Joaquin Valley and Southern California.

They want the state and federal government to limit pumping from the delta, which disorients migrating salmon and kills young fish that get sucked into the powerful pumps. They’re also calling for a reduction in agricultural runoff and the restoration of salmon habitat in the rivers.

“We did have some poor ocean conditions, but that doesn’t explain why the Central Valley stocks took such a severe hit,” said Zeke Grader, who heads the Pacific Coast Federation of Fishermen’s Associations.

But state water officials believe the ocean is the chief culprit. The water pumps continue to meet stringent operating standards, and while more water has been diverted in recent years, there’s also been more water available to export, said Jerry Johns, deputy director of the California Department of Water Resources.

“Ocean conditions are the most likely cause here,” Johns said. “The requirements that we have to abide by to protect these fish haven’t changed in the last several years.”