Walter Reed Army Medical Center closing its doors

History has marched through the halls of Walter Reed Army Medical Center, where presidents, princes, kings and generals mingled in their hospital gowns, according to a story in the New York Times.

Lyndon B. Johnson visited an ill, pajama-clad Richard M. Nixon during the 1960 campaign. President Harry S. Truman went to his first church service here after taking office. President Dwight D. Eisenhower signed the bill that established the Interstate highway system in 1956, while a patient here, according to John Pierce, a retired Army colonel and an expert on the history of the hospital. Eisenhower later spent the last 11 months of his life in the presidential suite, as his health declined, his wife, Mamie, living in a small room nearby.

So Walter Reed’s closing — scheduled for the end of August when the keys to its stately brick buildings will be given to the State Department and the District of Columbia — drew an emotional response from many gathered Wednesday to commemorate the occasion. Flags were folded and put away. Songs were sung. A sword was handed down, to symbolize the transition.

“These doors may close, the address may change, but the name, the legacy and, most important, the work and healing will endure,” said John M. McHugh, secretary of the Army, in a speech at the ceremony.

It was the end of an era for Walter Reed Army Medical Center, the principal hospital for soldiers wounded in Iraq and Afghanistan, which next month will be moved to the National Naval Medical Center in Bethesda, Md., and to a new facility in Fort Belvoir, Va.

The hospital’s patients will be moved in ambulances one by one, and outpatients, currently about 430, many of whom live in housing in the Walter Reed complex, will be moved in cars and moving vans over two weekends in August.

Maj. Gen. Carla G. Hawley-Bowland, commander of the Army’s Northern Regional Medical Command, to which Walter Reed belongs, said the move was intended to reduce the number of facilities — three in the Washington area, including Walter Reed — in order to better fit the military’s needs. Treatment has improved significantly in the past two decades and today requires less inpatient care, and more outpatient capacity, something the new medical centers will have, the general said.

The center’s reputation took a hit in 2007, when The Washington Post published a series of articles exposing poor living conditions and excessive bureaucracy for soldiers at the hospital. In response, officials established a unit designed to assist troops in every stage of the recovery process.

Its medical care is among the best in the country, particularly in the area of prosthesis, which have improved significantly since the Persian Gulf war in 1991. General Hawley-Bowland said soldiers now had prosthetic arms that allow them to do push-ups and hold rifles, innovations that did not exist for patients in the past.

McDonald’s cutting back on Happy Meal French fries

A Happy Meal in San Francisco, which banned the inclusion of toys in children’s meals unless nutritional requirements were met, according to a story in the New York Times.

The company announced Tuesday that it would more than halve the amount of French fries and add fruit to its popular children’s meal in an effort to reduce the overall calorie count by 20 percent.

But McDonald’s appeasement only went so far. A toy will still come with each Happy Meal despite criticism that the trinkets, often with tie-ins to movies like “Toy Story,” foster a powerful connection between children and the often calorie-laden meals.

While Happy Meals account for less than 10 percent of all McDonald’s sales, the signature box and its contents — first introduced in 1979 — have become a favorite target in recent years. Lawmakers and consumers have rallied around breaking that childhood link between toys and fast food, with the efforts increasing as Michelle Obama and national public health officials point to the estimated 17 percent rate of obesity among the nation’s youths.

San Francisco, for example, has banned the inclusion of toys in children’s meals unless certain nutritional requirements are met. A New York City councilman is proposing a similar law.

Other restaurant chains have gone further than McDonald’s in acceding to calls for improving the fare on children’s menus and eliminating marketing appeals. In June, Jack in the Box announced the end of toys in its children’s meals, and this month, Burger King, IHOP and more than a dozen other restaurant chains backed an effort led by the National Restaurant Association to serve and promote healthier options for youngsters.

“McDonald’s is not giving the whole loaf, but it is giving a half or two thirds of a loaf,” said Michael F. Jacobson, executive director of the Center for Science in the Public Interest, which is representing a woman in California who is suing McDonald’s for including toys in its Happy Meals. “This is an important step in the right direction.”

McDonald’s made it clear that it was changing the composition of Happy Meals in response to parental and consumer pressure. It also pledged to reduce the sodium content in all of its foods by 15 percent, with the exceptions of soda and desserts. It set a deadline of 2015 for limiting salt, and said it would spend the rest of this decade cutting back on sugars, saturated fats and calories and making adjustments to portion sizes.

The new Happy Meals will be introduced in September and rolled out across the company’s 14,000 restaurants by April 2012. They will all include apple slices, but in a smaller amount of three to five slices than the current eight to 10 offered as an alternative. (The Apple Dippers also will be renamed after the company phases out the caramel dipping sauce, according to Tuesday’s announcement).

“It’s a trade-off between everybody getting a small portion and 10 percent of kids getting a larger portion, which is better than nothing and maybe will accustom kids to eating fresh fruits and vegetables when they go out to eat,” Mr. Jacobson said.

Parents will have the option of requesting more fruit or, possibly at a later date, vegetables instead of fries. McDonald’s will also offer a fat-free chocolate milk option, along with the option of low-fat milk or the traditional soda. The price is not expected to change.

Today’s Happy Meal with chicken nuggets has 520 calories and 26 grams of fat, and the reconstituted version, with 1 percent milk, will total 410 calories and 19 grams of fat, according to the company.

The company said it had experimented with eliminating French fries altogether from the boxes, but that generated a lot of customer complaints. Danya Proud, a spokeswoman for the company, said that McDonald’s tests also found that parents wanted soda among the drinks available, too.

“That’s what we’ve really felt all along, that ultimately, it’s a parent decision to make about their child’s well-being,” she said.

McDonald’s has long offered parents the option of asking for fruit rather than fries, although a study by Yale University’s Rudd Center for Food Policy and Obesity found that only 11 percent took advantage of that option.

While some critics of fast-food and public health officials praised the moves (Mrs. Obama called them “positive steps”), others complained that McDonald’s did not go far enough. Marion Nestle, a professor of nutrition at New York University and an outspoken critic of the food industry, called the changes a “sham,” in part because McDonald’s is not doing more to limit soda with the Happy Meal.

“They’re going to get huge publicity for this — an ounce less of French fries,” Dr. Nestle said. “I’m not impressed.”

Is playground equipment too safe?

When seesaws and tall slides and other perils were disappearing from New York’s playgrounds, Henry Stern drew a line in the sandbox, according to a story in the New York Times. As the city’s parks commissioner in the 1990s, he issued an edict concerning the 10-foot-high jungle gym near his childhood home in northern Manhattan.

“I grew up on the monkey bars in Fort Tryon Park, and I never forgot how good it felt to get to the top of them,” Stern said. “I didn’t want to see that playground bowdlerized. I said that as long as I was parks commissioner, those monkey bars were going to stay.”

His philosophy seemed reactionary at the time, but today it’s shared by some researchers who question the value of safety-first playgrounds. Even if children do suffer fewer physical injuries — and the evidence for that is debatable — the critics say that these playgrounds may stunt emotional development, leaving children with anxieties and fears that are ultimately worse than a broken bone.

“Children need to encounter risks and overcome fears on the playground,” said Ellen Sandseter, a professor of psychology at Queen Maud University in Norway.  “I think monkey bars and tall slides are great. As playgrounds become more and more boring, these are some of the few features that still can give children thrilling experiences with heights and high speed.”

After observing children on playgrounds in Norway, England and Australia, Sandseter identified six categories of risky play: exploring heights, experiencing high speed, handling dangerous tools, being near dangerous elements (like water or fire), rough-and-tumble play (like wrestling), and wandering alone away from adult supervision. The most common is climbing heights.

“Climbing equipment needs to be high enough, or else it will be too boring in the long run,” Sandseter said. “Children approach thrills and risks in a progressive manner, and very few children would try to climb to the highest point for the first time they climb. The best thing is to let children encounter these challenges from an early age, and they will then progressively learn to master them through their play over the years.”

Sometimes, of course, their mastery fails, and falls are the common form of playground injury. But these rarely cause permanent damage, either physically or emotionally. While some psychologists — and many parents — have worried that a child who suffered a bad fall would develop a fear of heights, studies have shown the opposite pattern: A child who’s hurt in a fall before the age of 9 is less likely as a teenager to have a fear of heights.

By gradually exposing themselves to more and more dangers on the playground, children are using the same habituation techniques developed by therapists to help adults conquer phobias, according to Sandseter and a fellow psychologist, Leif Kennair, of the Norwegian University for Science and Technology.

“Risky play mirrors effective cognitive behavioral therapy of anxiety,” they write in the journal Evolutionary Psychology, concluding that this “anti-phobic effect” helps explain the evolution of children’s fondness for thrill-seeking. While a youthful zest for exploring heights might not seem adaptive — why would natural selection favor children who risk death before they have a chance to reproduce? — the dangers seemed to be outweighed by the benefits of conquering fear and developing a sense of mastery.

“Paradoxically,” the psychologists wrote, “we posit that our fear of children being harmed by mostly harmless injuries may result in more fearful children and increased levels of psychopathology.”

The old tall jungle gyms and slides disappeared from most American playgrounds across the country in recent decades because of parental concerns, federal guidelines, new safety standards set by manufacturers and — the most frequently cited factor — fear of lawsuits.

Shorter equipment with enclosed platforms was introduced, and the old pavement was replaced with rubber, wood chips or other materials designed for softer landings. These innovations undoubtedly prevented some injuries, but some experts question their overall value.

“There is no clear evidence that playground safety measures have lowered the average risk on playgrounds,” said David Ball, a professor of risk management at Middlesex University in London. He noted that the risk of some injuries, like long fractures of the arm, actually increased after the introduction of softer surfaces on playgrounds in Britain and Australia.

“This sounds counterintuitive, but it shouldn’t, because it is a common phenomenon,” Ball said. “If children and parents believe they are in an environment which is safer than it actually is, they will take more risks. An argument against softer surfacing is that children think it is safe, but because they don’t understand its properties, they overrate its performance.”

Reducing the height of playground equipment may help toddlers, but it can produce unintended consequences among bigger children.

“Older children are discouraged from taking healthy exercise on playgrounds because they have been designed with the safety of the very young in mind,” Ball said. “Therefore, they may play in more dangerous places, or not at all.”

Fear of litigation led New York City officials to remove seesaws, merry-go-rounds and the ropes that young Tarzans used to swing from one platform to another. Letting children swing on tires became taboo because of fears that the heavy swings could bang into a child.

“What happens in America is defined by tort lawyers, and unfortunately that limits some of the adventure playgrounds,” said Adrian Benepe, the current parks commissioner. But while he misses the Tarzan ropes, he’s glad that the litigation rate has declined, and he’s not nostalgic for asphalt pavement.

“I think safety surfaces are a godsend,” he said. “I suspect that parents who have to deal with concussions and broken arms wouldn’t agree that playgrounds have become too safe.”

The ultra-safe enclosed platforms of the 1980s and 1990s may have been an overreaction, Benepe said, but lately there have been more creative alternatives.

“The good news is that manufacturers have brought out new versions of the old toys,” he said. “Because of height limitations, no one’s building the old monkey bars anymore, but kids can go up smaller climbing walls and rope nets and artificial rocks.”

Still, sometimes there’s nothing quite like being 10 feet off the ground, as a new generation was discovering the other afternoon at Fort Tryon Park. A soft rubber surface carpeted the pavement, but the jungle gym of Stern’s youth was still there. It was the prime destination for many children, including those who’d never seen one before, like Nayelis Serrano, a 10-year-old from the South Bronx who was visiting her cousin.

When she got halfway up, at the third level of bars, she paused, as if that was high enough. Then, after a consultation with her mother, she continued to the top, the fifth level, and descended to recount her triumph.

“I was scared at first,” she explained. “But my mother said if you don’t try, you’ll never know if you could do it. So I took a chance and kept going. At the top I felt very proud.” As she headed back for another climb, her mother, Orkidia Rojas, looked on from a bench and considered the pros and cons of this unfamiliar equipment.

“It’s fun,” she said. “I’d like to see it in our playground. Why not? It’s kind of dangerous, I know, but if you just think about danger you’re never going to get ahead in life.”

16-pound baby breaks Texas record

This one’s big, even for Texas.

The birth of a 16-pound, 1-ounce baby boy in Longview, Tex., on Friday may be the largest bundle of joy the state has ever seen. The baby boy, JaMichael Brown, measured 2 feet long and had a 17-inch chest, according to a story in the Chicago Tribune.

Doctors expected the baby to weigh 12 or 13 pounds, and even induced labor a week early. JaMichael is still at the hospital, according to reports, and isn’t yet breathing by himself. Staff at the hospital are monitoring his blood sugar levels.

The boy isn’t the largest on the books — the Guinness record goes to a 23-pound, 12-ounce birth in Canada in 1879 — but such a large weight is rare. Only about 1 in 1,000 newborns weighs in above 11 pounds.

For such large babies, the vaginal birthing process can damage the baby’s shoulders, and weighing more than about 9 pounds puts them at risk for breathing problems. And big babies might become children at risk for obesity and diabetes, according to an American Diabetes Assn. article.

JaMichael was delivered via Cesarean section. The baby’s obstetrician, Dr. John Kirk, told ABC News:

“He’s really only had some minor problems,” said Kirk. “We have made them aware of the possible complications down the road, but hopefully, they’ll continue to be under medical care and we’ll keep an eye on them.”

Report: Lexington least-active city in U.S.

Summer is the season for kicking back and doing nothing, which means it’s always summer in Lexington, according to Men’s Health magazine.

In fact, folks there didn’t need to lift a finger to be named America’s Most Sedentary City, since movement of any kind means you’re not a committed couch potato.

Now, Men’s Health doesn’t doubt the Lexington work ethic — it’s the workout ethic that’s in question.

Men’s Health looked at where and how often people exercise (Experian Marketing Services); the percentage of households that watch more than 15 hours of cable a week and buy more than 11 video games a year (Mediamark Research); and the rate of deaths from deep-vein thrombosis, a condition linked to a lot of sitting (CDC).

And since some people define “exercise” loosely, Men’s Health gave credit for any physical activity in the past month (CDC).

Lexington ranks the lowest on the list of 100. Indianapolis is 99, Nashville 93, Louisville 81, Cincinnati 76, St. Louis 63, New York 33, Chicago 31.

The most-active city is Seattle. Ranking 2 to 10 are San Francisco, Oakland, Washington, D.C., Salt Lake City, Reno, Portland (Maine), Atlanta, Denver and Minneapolis.

 

Government won’t use ‘mystery shoppers’ to investigate physicians

The U.S. Department of Health and Human Services has decided against using “mystery shoppers” to investigate whether primary care physicians are accepting or rejecting new patients depending on the type of insurance they have.

“After reviewing feedback received during the public comment period, we have determined that now is not the time to move forward with this research project,” an HHS official said in a statement.

Instead, according to the statement, the government would focus on improving access to primary care in other ways, including an emphasis on training new practitioners and encouraging providers to practice in underserved areas. The Obama administration is also working on a plan to offer better payments to providers.

The original government proposal describing the program said staff from the Office of the Assistant Secretary for Planning and Evaluation would call 4,185 primary care physicians in nine states and pose as prospectdive new patients, saying they had either private or public insurance. The purpose would be to determine if the doctors’ willingness to accept new patients depended on the type of insurance.

 ABC News asked a number of primary care physicians and health policy experts for their thoughts on the government’s “mystery shopper” initiative. Many of the responses were negative and accused the government of spying and being deceptive.

The American Medical Association was strongly against the government’s proposal.

“We know there is a physician shortage in this country that will only grow worse as more people enter Medicare and coverage is expanded to those currently uninsured,” said Dr. Cecil Wilson, the AMA’s immediate past president.

“The government should be working to address this shortage so all patients can have access to the health care they need, rather than using mystery shoppers to tell us what we already know.”

“Patients don’t want the federal government sneaking around, trying to manipulate their doctors,” said Richard Saltman, professor of health policy and management at Emory University’s Rollins School of Public Health in Atlanta.

“It is almost laughable to think that our federal government would spend good money during these difficult times to see if we (primary care physicians) are putting up obstacles to deter Medicaid patients from making appointments in our practices,” said Dr. J. Jacques Carter, assistant professor of medicine at Harvard Medical School in Boston.

He said that repeated surveys indicated there is a growing shortage of primary care physicians for a number of reasons, including retirement and frustration over a seemingly endless amount of paperwork.

He acknowledged that some physicians do try to turn away Medicaid patients, which he called “deplorable,” but said doctors get paid so little from Medicaid that it rarely covers the cost of providing medical services.

“All over the country, doctors are dropping out of poorly reimbursing plans,” said Dr. Peter Lavine, an orthopedic surgeon and past president of the Medical Society of the District of Columbia.

Patients with Medicare can generally get appointments, experts say, because Medicare pays physicians more than Medicaid does.

 

Potato industry fights back after anti-chip study

Potato marketers resent a recent Harvard weight-loss study that encourages Americans to bag the spuds, but pistachio growers are nuts about the study’s findings, according to a story in USA Today.

The study, released last Thursday by the Harvard School of Public Health, linked eating potatoes with gaining weight. Yogurt and nuts, on the other hand, were associated with losing weight.

Western Pistachio, a pistachio growers association, has already started work on a new marketing campaign touting the findings. But the study is a cause for alarm to potato growers, as it faults even boiled and baked potatoes for people’s expanding waistlines — not just chips and fries.

But Katherine Tallmadge, author of Diet Simple, says taters shouldn’t bear all the blame.

“Usually when people are eating mashed potatoes, they’re eating big steaks right beside them,” she said. “And then not exercising.”

What’s more, Idaho Potato Commission President Frank Muir says one of the scientists who did the study —Walter Willett— had an anti-potato bias six years ago when he published a food pyramid on his website.

“He’s got potatoes right at the top with soft drinks,” Muir said.

But Willett says his previous studies had nothing to do with weight gain. And he notes the new study mirrors his earlier work showing potato starch is broken down very quickly into glucose.

“We do have a history of pointing out relationships with potatoes and diabetes risks — which in some sense is more dangerous,” he said.

One crisis PR expert said the Harvard researchers have wrongfully demonized potatoes.

“It’s just irresponsible on Harvard’s part,” says Gene Grabowski, senior vice president of Levick Strategic Communications, who was eating a bag of potato chips when reached at his office. “Whenever a study like this one comes out, it creates a real problem for an industry.

“The vegetable has done nothing wrong,” he said.

Still, some food marketers are responding:

Potatoes — The Idaho Potato Commission will launch a television marketing campaign with fitness guru Denise Austin beginning in September, that delivers “a real straightforward message: Potatoes are good for your heart,” Muir said.

“The American Heart Association has endorsed Idaho potatoes as a heart-healthy food.”

Austin could not be reached for comment, but Muir said she orders potatoes every time they dine together.

Yogurt — National Yogurt Association Executive Director Elise Cortina said the group was “delighted” to see the study. But she said it won’t change yogurt brands’ marketing plans, as the benefits of yogurt are already well known.

Nuts — While growers of almonds and other nuts are also excited about the study’s findings, the pistachio growers group is using it in a new marketing campaign involving partnerships with the USA Water Polo Team and Miss California.

“We’ve enlisted icons of both fitness and beauty to help educate people about the great nutritional findings about pistachios,” said Judy Hirigoyen, director of marketing for Western Pistachio.

“You don’t hear so much about pistachios,” she said. “Well that’s about to stop — they’re coming out of their shell.”