More cell owners using phones to get health information online

Calling the doctor is not the only medical-related use for a cell phone.

With the proliferation of smart phones, mobile devices now are being used to gather, track and manage medical and health information, particularly by young adults, according to a survey by the Pew Internet Project.

The survey showed that 17 percent of all cell owners have used their phone to look up health or medical information on the Internet, with 29 percent of cell owners ages 18 to 29 doing such searches.

Also, 9 percent of all cell owners have software applications — or “apps” — on their phones that help them track or manage their health.

The heaviest use of health or medicine-related apps was by young adults: about 15 percent of those age 18 to 29 have such apps, compared with 8 percent of cell users ages 30 to 49.

Health and medicine-related apps vary widely from workout and food trackers to personal health record-keepers. The Cleveland Clinic, for example, has a free app that provides a daily health tip or a $1.99 app that offers ways to de-stress through meditation.

Both are available in the iTunes store.

Dan Young, owner of DXY Solutions, a mobile-application-building company in Cleveland, said he expects more and more people will be accessing health information online.

Health care providers should recognize the trend and make sure their Web content is designed to work with mobile platforms, Young said.

As for phone apps, security is extremely important, Young said. Phones “cache” or store data so that future requests for that data are answered faster.

That could spell trouble for someone who loses a cell phone that contains medical-records apps or other sensitive information.

Young said health-care providers — and cell phone users — should make sure such information can be erased remotely or be password-protected.

“It’s prudent that people think about those issues,” he said.

The Pew survey also showed that:

57 percent of American adults have a wireless connection and use a laptop or cell phone to access the Internet.

Black consumers were more likely than other groups to use mobile health apps.

Urban cell phone owners were more likely than those who live in suburban or rural areas to have such an app on their phone.

Most adults’ searches for health information, however, remains anchored in the offline world, the survey report said.

“Most people turn to a health professional, friend or family member when they have a health question,” the survey report said. “The Internet plays a growing but still supplemental role — and mobile connectivity has not changed that.”

The survey was conducted among 3,001 adults in August and September. The Pew Internet Project is a nonprofit, nonpartisan research center based in Washington, D.C.

Remainder of MDG Medical Inc. moving to Cleveland from Israel

By Kaye Spector

Plain Dealer Business Writer

 

One of the first Israeli medical companies to locate part of its business to Northeast Ohio will move the remainder of its operation to Aurora by early 2012.

MDG Medical Inc., a developer of automated pharmacy technology equipment and software, will move its research and development group from Lod, Israel, to its Aurora headquarters by March. The company’s electromechanical assembly also will relocate from Israel to the same site by early 2012.

With the move, MDG expects to make between 20 and 30 new hires in the next 18 months: programmers, engineers and manufacturing managers, as well as assembly workers. Some jobs will be filled by MDG Israeli employees who will relocate here.

President and Chief Executive Mark Saffran said Wednesday that the move will reduce expenses and simplify business processes.

MDG has 150 customers in five countries, but 95 percent of them are in the United States, Saffran said.

“It was my feeling that we want to get research and development and assembly closer to the core of our customer base,” he said.

MDG Medical was founded in Tel Aviv in 2001 and moved its headquarters to Beachwood a year later, keeping its research and development staff in Israel.

BioEnterprise Corp., a Cleveland organization that helps the region’s bioscience industry, offered business development services, such as selecting a U.S. management team and finding sources of capital, to help lure MDG Medical to Northeast Ohio.

In January, MDG’s headquarters moved to the Aurora site, which will expand by 18,000 square feet to accommodate the Israel operations.

MDG makes drug-dispensing technologies that can streamline the administration of drugs and reduce medication errors. The company serves rural and community hospitals across the nation and has partners servicing correctional facilities and nursing homes.

Saffran said the company hopes to receive grants from the state and approach local hospitals to be test sites for new technology.

“The whole goal here is to reduce costs, improve quality and hire more people,” Saffran said.

AT&T, Verizon may have to alert customers near useage limits under FCC proposal

By Kaye Spector

Plain Dealer Reporter

 

After a monthlong business trip to Asia a few years ago, Les Wagenheim of Pepper Pike had an ugly surprise waiting for him when he returned home: a $2,500 bill for his BlackBerry.

This was despite signing up and paying for a plan that was supposed to keep his mobile phone bills lower while he was traveling.

What happened? Somehow, neither of the two AT&T employees he had contact with while signing up for the overseas plan told him to switch his phone’s roaming feature off.

“I took comfort in the fact that I was covered. Lo and behold, I was not,” he said.

“They cheerfully took my money but they didn’t say, ‘Hey be careful, don’t operate the phone in this mode.’ ”

Wagenheim, who eventually got his bill reduced to $500, would have been warned by AT&T that he was facing higher service charges if a measure under consideration by federal regulators had been in effect.

The Federal Communications Commission wants to stop cell phone “bill shock” by requiring wireless companies to alert subscribers before they run out of minutes, hit data usage or text messaging caps or start racking up international roaming charges.

The FCC will propose rules today and may take a final vote in coming months. Subscribers may get voice or text alerts when they use too many minutes in a month or place calls using more expensive networks outside the United States, the agency said in a summary distributed by e-mail.

The FCC has reports of unauthorized “mystery fees” popping up on bills, Chairman Julius Genachowski said Wednesday in a speech in Washington, D.C.

“It’s hard to keep track of everything you’re being charged and too easy to find yourself paying more than you had planned on,” Genachowski said.

A survey by the FCC showed 30 million Americans, or one in six mobile-phone users, had experienced bill shock, Genachowski said.

Carriers led by Verizon Wireless, under FCC investigation for overcharging 15 million customers for data, have said mandatory messages aren’t necessary because carriers give customers ways to track use of data, voice and text features.

AT&T’s iPhone app, for example, gives subscribers such information, which is also available on the company’s web site.

Providers are concerned about “prescriptive and costly rules,” Christopher Guttman-McCabe, a vice president for CTIA- the Wireless Association, a Washington-based trade group, said in an e-mail.

“The industry continues to develop tools to keep customers informed about their level of usage,” he said.

The FCC’s proposal would require clear disclosure of the tools to track minutes of use, in part because “too many consumers don’t know about them,” according to the summary.

Wagenheim, owner of Bedford Heights-based Pearlessence home fragrances, called the FCC proposal “brilliant.“

“Obviously, a lot of people have been burned, so it’s good that we’re headed in this direction,” he said. “Now that somebody’s on to protecting the consumer, we’ll all benefit from this.”

Bill shock typically happens only once, said computer consultant Spike Radway. After that, the customer is highly motivated to learn the details of how to use their phone.

“For parents or someone getting their first smart phone, I think it’s a good idea that they are doing the legislation,” said Radway, owner of Team Spike Consulting LLC. “I think it’s going to prevent people getting big bills one time for something they didn’t think about.”

Bloomberg News and the Associated Press contributed to this article.

Willoughby shop opposes FDA plan to require safety tests of e-cigarettes

By Kaye Spector

Plain Dealer Reporter

 

When electronic cigarettes hit the United States about three years ago, Sebastian Cangemi was among the first wave of entrepreneurs who entered the business.

 

He set up a 17,000-square-foot shop in an industrial park in Willoughby and began selling e-cigarettes to retail outlets and individuals nationwide. Electronic cigarettes, or e-cigarettes, are designed to mimic cigarettes and transmit nicotine to the user in a vapor. But now, after the Food and Drug Administration recently announced its intent to regulate electronic cigarettes – which it views as unapproved drugs and drug delivery devices – Cangemi fears he may have to shutter his business.

 

The FDA wants e-cigarette companies to obtain drug marketing approval from the agency. That means Cangemi would have to conduct extensive clinical safety testing and apply for formal FDA approval – a process he says he cannot afford.

 

For now, he's being careful about how he talks about his products because of warning letters the FDA recently sent to five electronic-cigarette companies. The letters said the companies' products were being marketed illegally as stop-smoking aids or were produced using poor manufacturing practices.

 

“You have to be very, very direct in your claims that they are not medically based,” Cangemi said. “You can't say they are healthier. You can't call it a smoking cessation device. We are marketing ours as an alternative to tobacco.”

 

Cangemi also says his manufacturing processes are up to snuff. So he hopes he can continue to make and sell Liberty Stix brand e-cigs.

 

“We have a premium product,” Cangemi said. “Our manufacturing process eliminates all the variables.”

 

The FDA is not looking at an outright ban on e-cigarettes, Michael Levy, director of the FDA's Division of New Drugs and Labeling Compliance, said at a recent media briefing. But the agency will continue to evaluate the marketers of e-cigarettes on a case-by-case basis.

 

The FDA already has had some discussions with firms that are interested in obtaining drug approval for e-cigarettes, Levy said.

 

The FDA has had health and safety concerns about e-cigarettes, which hit the U.S. market in 2007, for some time.

 

In July 2009, the agency released an analysis of 18 electronic cigarettes and components from two leading brands. Half the samples contained carcinogens, and one contained diethylene glycol, a toxic chemical used in antifreeze. The FDA also said cartridges labeled as having no nicotine had low levels of the chemical. The tests also suggested that quality control processes were inconsistent or nonexistent.

 

Cangemi said his product does not contain diethylene glycol or carcinogens such as those found in the tested samples. Liberty Stix's “juice” – the liquid that contains the nicotine, as well as distilled water, propylene glycol and flavorings – is made in the United States, he said.

 

Most of the e-cigarette components and liquid sold in the United States come from China. The FDA has been examining and detaining shipments of e-cigarettes at the border.

 

EXPLAINING E-CIGS

• What are they?

Electronic cigarettes, or e-cigarettes, are products designed to mimic cigarettes and deliver nicotine to the user in the form of a vapor, which the user inhales.

• Where are they sold?

E-cigs, which have been on the market since 2007, are sold in stores and mall kiosks and on the Internet. Estimated U.S. sales were $100 million in 2008 and are growing rapidly, the Electronic Cigarette Association says.

• What's the FDA's beef?

While the industry touts electronic cigarettes as a healthier alternative to tobacco, the Food and Drug Administration is increasingly asserting jurisdiction over the products, saying they are a drug delivery system. People who use, or "vape" - as opposed to "smoke" - e-cigarettes are assuming unknown risks, the FDA says. In some cases, companies are selling other substances to be inhaled via e-cigs, such as liquid forms of an erectile dysfunction drug or a weight-loss drug - substances that the FDA has not approved.

The agency has been challenged regarding jurisdiction over e-cigarettes in a case pending in federal court springing from the detained shipments. Oral arguments were heard in the case late last month.

Family culture helps agency do better work

David Rosenberg, 55, is president of Rosenberg Advertising, a Lakewood company he founded in 1981 with one employee – himself – and one client. Today, the full-service marketing and advertising firm employs 14 and has served more than 200 clients. Since 1997 Rosenberg's company has dwelled in an unusual office space: a renovated three-story, century-old home in Lakewood. These are excerpts from a recent chat between Rosenberg and Plain Dealer reporter Kaye Spector.

The Question: How would you describe your company's culture?

The Answer: It starts with having the atmosphere here, which is part of the house itself.

I moved here from the Warehouse District and was looking for something that I liked but was also our brand. Our brand is the fact that we do have this family culture, which we think helps us to do better work.

We have a magnolia tree outside. In our brand now we show the tree. We think the tree is very symbolic: fresh ideas, honest roots.

The honest roots comes in with how our culture is. We believe we are the roll-up-your-sleeves-and-work-hard mentality.

The Question: Making hiring decisions is particularly important in a small business. How do you choose new hires?

The Answer: First I try to identify what we need, the skill that we need. We want to make sure we hire somebody who has the skill to do the job.

But then, once that is given, that’s where the culture part comes in. We’re looking for the right person. We are looking for someone we feel we could see as a good team member and who has the same can-do attitude.

This is not a business where only I know the clients. Our clients know the people who work on their accounts. So we visualize, ‘Does this person represent us well, do they have the right type of spirit?’ ”

The Question: What’s the most important thing you’ve learned about management?

The Answer: Some people say the advertising business is an idea business or a communication business. I definitely realize we are a people business.

But even before that, you have to have the right mix. We basically start with a blank piece of paper every day and it’s the people who fill it in. If you get the people part right, you’re going a long way to establishing a successful business.

The Question: You allow your employees to work from home a day or two a week. What made you decide to do that?

The Answer: When I started the business, everybody had to start work at 8:30 and leave at 5:30 and take an hour lunch. And if they came in at 8:35, then I was not happy.

I realize now flexibility is huge in people’s lives. And so we came up with a schedule that would provide us with enough face-to-face time together so that we can do what we do.

We figured out the technology, which wasn’t that hard to do. The phones roll over to a cell phone at home. With e-mail and technology we still can communicate very well.

There’s enough face time where I feel we have not lost anything in terms of what we need to do to be productive, proactive and good at our jobs. And I realized our work gets done. It gets done just as well.

The Question: : What did you gain from such a schedule?

The Answer: I think people were dedicated before, but I definitely feel that they are happier. I think their stress level went down a tad.

My job is to provide them the right environment so they can do their best work.

The Question: How do you foster creativity?

The Answer: We all get along here and I think people are open to talking and disagreeing, just communicating with each other. That is what we do, but it spawns creativity.

Creativity is basically allowing any idea to come out, and then collectively you figure out what can we work with, what can we not work with. The open communication goes a long way into being open to come up with good work.

If I want to get a meeting moving and sometimes the ideas aren’t good, I catch myself saying, “That’s not a good idea,” and I know better. That is so counterproductive.

Sometimes a bad idea spawns a good idea, which spawns a great idea.

If at the core, people get along and can talk with each other, that’s not fancy but that’s how we do good work and get creative ideas.

Right from the crib, children hear advertising promoting unhealthy food and drinks

By Kaye Spector

Plain Dealer Reporter

 

Do our kids really have a chance? From the minute they wake up until the moment they go to bed, they are bombarded by messages pushing unhealthy foods and drinks.

It's a fully integrated, cross-platform, cross-promotional media assault.

Even though a number of major food manufacturers made changes in 2006, consider the many ways they get to children:

Commercials for sugar-laden cereal still monopolize early-morning cartoons.

Billboards and radio ads blare specials for double-decker burgers and extra-large fries.

School parent-teacher groups push sales of Market Day products, such as 10-inch, deep-dish apple pies and breaded mozzarella sticks.

Post cereal boxes direct kids to the Internet to play games aligned with their sugar-sweetened brands.

The checkout lines at grocery stores, pharmacies, big-box discount stores and even Home Depot are lined with sugary treats, many at kid's-eye level.

Science has yet to prove indisputably that food marketing is a direct cause of the climbing childhood obesity rate. But with one in every three U.S. youngsters ages 2 to 19 overweight or obese, food marketing to children is coming under increasing scrutiny.

Healthy-food advocates and many parents argue that the abundance of media messages for unhealthy foods is making it ever more difficult for impressionable young minds to resist the temptations — and for parents to say no.

At the same time, the advertising world insists it has the right to sell products and that parents must take responsibility and oversee their children’s media consumption and food choices.

Virtually all of the more than $1.6 billion that advertisers spend annually on youth-directed marketing is for processed, manufactured foods, such as baked goods, candy, frozen desserts and breakfast cereals.

Only a very small percentage — less than 1 percent — is for healthful foods, such as fresh fruits and vegetables. So says a report by the Federal Trade Commission to Congress in 2008 on spending by 44 leading food and beverage companies.

All this brand marketing has an impact, healthy-eating advocates say.

A recent study by research scientist Jennifer Harris and others in Yale University’s psychology department examined the effect of cumulative brand exposures on children ages 3 to 5. Children were asked to taste two sets of identical foods: one in a popular fast-food restaurant packaging and another in generic packaging.

After tasting each set, the children were asked whether the food tasted the same or if one tasted better. In four of five comparisons, the children were significantly more likely to prefer the taste of a food or drink they thought was from the fast-food restaurant.

“There’s really grave concerns about this stuff,” says Kelly Brownell, director of Yale University’s Rudd Center for Food Policy and Obesity. “The number of ways that marketing is done has exploded. . . . Marketing is undermining parental authority and making it very hard for parents to raise healthy children.”

But parents can exert some influence on the food-marketing messages their children see day in and day out. It can be as simple as talking to their kids about the ads they see. Around the age of 7 or 8, children can begin to understand that ads are trying to persuade them to action, according to the American Psychological Association.

“Parents can try to teach children as much as possible and help them realize when they are being marketed to,” Brownell says. “They can tell their children there are companies attempting to manipulate them.”

The power of the Internet

In recent years, food-advertising dollars have increasingly begun to move from traditional media to digital media, says Jim D’Orazio, a marketing instructor at Cleveland State University.

“Social media, online games and contests and mobile applications are all seeing major investment” from advertisers, he says.

Online is where some nutrition and child advocates are beginning to focus their attention, too, saying there are some important differences between food marketing in traditional media and that through digital media.

Most important, they say, is that on television, commercial messages are clearly separate from programming. But in digital media, the advertising, editorial content and content often are intertwined.

On General Mills’ website millsberry.com, for example, children can create a personalized character who operates in a virtual, Webkinz-like world: gobbling Fruit Gushers in a Pac-Man-like game. The player earns Millsbucks, which he can redeem at a virtual candy store that features more virtual, branded food products.

These advergames — the most frequently used strategy to encourage ongoing and return website visits — typically engage players for an average of nearly 30 minutes at a time, all the while inundating the player with images of products such as Trix or Lucky Charms cereal.

Long periods of time spent playing an advergame translates into sustained exposure to a brand name, and creates pleasant memories and associations, which builds brand loyalty, says Kathryn Montgomery, a communications professor at American University who has studied Internet food marketing.

“It’s different from an ad impression,” Montgomery says. “The way we think about it is different, the depth of involvement, emotional levels, things that are along multidimensional lines.”

Such intermingling of advertising and youth entertainment content is not allowed on television under federal law, which also limits ads directed at children to about 10 minutes per hour.

While the point of an Internet advergame appears to be fun, the marketing is in the game and “you’re not even aware of the message,” says Robin Kelly, an assistant professor of marketing at Cuyahoga Community College and former marketing executive. “But your subconscious absorbs it.”

While television advertising has been studied for a few decades, much remains unknown about the effects of digital food marketing and its unique characteristics.

“These are qualitatively different kinds of exposure and we need to understand them,” Montgomery says.

The tussle over advertising

Does that mean food marketing is to blame for obesity rates doubling for children and tripling for teens over the last 20 years?

There’s no clear consensus.

Even a well-known study on the point in 2006 by the Institute of Medicine is claimed by opposite sides on the issue.

Child and health advocates point to the study’s conclusion that television is associated with increased rates of obesity among children and youths; and that there’s strong evidence television advertising influences what children ages 2 to 11 choose to consume — and what they pester their parents to buy them to eat.

At the same time, the food and advertising industries point to the institute’s statement in the same study that “a causal link between marketing and increasing childhood obesity rates has yet to be firmly established.”

Among the institute’s recommendations in 2006 was that food and entertainment companies improve the balance of foods marketed to children within two years; otherwise, Congress should step in.

After the report came out, the Council of Better Business Bureaus established the Children’s Food and Beverage Advertising Initiative, or CFBAI. Its goal was to change the ratio of food and beverage advertising messages directed to children younger than 12 to encourage healthier eating and habits.

Since then, 16 major U.S. food companies have pledged to devote at least half of their child-targeted advertising to those goals. The group, which includes Burger King, Campbell Soup, Dannon, General Mills, Hershey, McDonald’s, Nestle, Post Foods, Coca-Cola and PepsiCo, represents 80 percent of television food, beverage and restaurant advertising directed to children younger than 12.

The companies agreed to five tenets:

Food advertising would promote “healthier dietary choices” or “better-for-you” products.

Products in online games must be “better-for-you” goods or must give healthy lifestyle messages.

They would use fewer licensed characters in ads that don’t promote healthy dietary choices or lifestyles.

They would stop seeking product placement in children’s entertainment.

They would stop advertising in elementary schools.

Four companies — Cadbury, Coca-Cola, Hershey and Mars — pledged to not aim any advertising to children younger than 12.

“Advertisers have made significant efforts to police themselves, and while many think they are moving too slowly, we know that children [ages 2 to 11] are seeing fewer food ads,” D’Orazio says.

But the initiative has been the object of some debate. The FTC’s 2008 report noted that the CFBAI companies’ nutritional standards, as well as their definitions of advertising directed at children, vary. Also, each company developed its own standards for “better-for-you” foods or a “healthy dietary choice.” In addition, the FTC criticized the program for applying these standards only to some forms of advertising.

The agency recommended, among other things, that the CFBAI develop consistent and high-quality nutritional standards and extend them to all advertising and promotional techniques, including product packaging and point-of-sale advertising.

In the face of mounting public pressure — and in response to heightened consumer interest in healthy eating — food manufacturers also have tinkered with their products and their messages. Some efforts include:

Healthier alternative products and reformulation of existing ones. Kraft Foods reworked Oscar Mayer Lunchables to reduce the amount of calories, fat and sodium.

Calorie-limited snacks, like 100-calorie packs of cookies, crackers and popcorn sold by Procter & Gamble, General Mills and Nabisco. Also, some restaurants, such as T.G.I. Friday’s, have pledged to abandon supersize portions.

Logos or other marketing strategies to highlight lower-calorie and healthier products within a product line. Kraft Foods created the “Sensible Solutions” seal and PepsiCo introduced a “Smart Spot” seal to identify products that have reduced calories, fat, saturated fat, sodium or sugar.

Nutrition education programs or websites, phone lines and magazines to educate customers about good nutrition. General Mills created a program that awards grants to organizations to support the development of youth nutrition and fitness programs.

Concern about the success of the food industry’s efforts to self-regulate led Congress in 2009 to form the Interagency Working Group on Food Marketed to Children. The group, which included the FTC, Food and Drug Administration, the Agriculture Department and the Centers for Disease Control and Prevention, was to develop recommendations for uniform standards for foods marketed to children younger than age 17 and the media where the foods are marketed.

The group released tentative voluntary standards in December to mixed reaction: applause from healthy-eating advocates and boos from the food and advertising industries. Dan Jaffe, executive vice president of the Association of National Advertisers, says, if enacted, the proposal would “virtually end all food advertising as it’s currently carried out to kids under 18.”

The group was expected to publish proposed standards in the Federal Register for public comment in July, but the New York Times reported in July that it could be months before the report is ready because of industry opposition and deep divisions among regulators.

First Amendment issues raised

In May, the White House Task Force on Childhood Obesity weighed in on food marketing to children. Its report recommended that self-regulatory groups, such as the CFBAI companies, adopt uniform nutritional and marketing standards across multiple platforms — including in-store advertising — and that there be “broad compliance” by all companies that market food and beverages to children.

The task force also recommended that media companies limit licensing of their characters to food and beverages that are healthy. A July study by the Rudd Center showed that children significantly preferred the taste of foods that had popular cartoon characters like Shrek, Scooby-Doo or Dora the Explorer on the packaging.

Lastly, the task force said that if the industry didn’t regulate itself, the government should step in.

“The prospect of regulation or legislation has often served as a catalyst for driving meaningful reform in other industries and may do so in the context of food marketing as well,” the report says.

The advertising industry disagreed with the research the report used and raised freedom-of-speech issues.

“Any effort by the FCC to restrict food marketing or impose a commercial ratings and blocking system would raise very serious First Amendment concerns,” Jaffe wrote in his blog shortly after the report’s release in May. “It would also seriously undermine the economic foundation that advertising provides for television programming, particularly children’s television.”

Kelly, the Tri-C marketing professor, says healthy-eating advocates and educators should beat food marketers at their own game by adopting their methods.

“We are going to have to fight the under-the-radar messages with other under-the-radar messages. We will have to find cachet individuals like Hannah Montana eating good stuff and talking about how wonderful they are,” she says.

“Clearly, habit by emulation is very strong.”

Cleveland Indians court digerati with Tribe Social Deck

By Kaye Spector

Plain Dealer Reporter

 

In the Cleveland Indians lackluster 2010 season the team can count one success: They drew a record crowd of social media lovers.

 

How? Through the Tribe Social Deck, a cordoned-off area in left field near the bleachers that serves as an invitation-only press box for the wired.

There's Wi-Fi, a flat-screen television with cable and electrical outlets for laptops. There's also visits from the communications staff and media packets with information about the players, statistics and game notes.

Sometime's there's surprises, too, such as upgrades to seats in the visitors dugouts or a suite when the weather's unpleasant.

It's the place where Tweeters, bloggers, Facebookers and others of the Internet ilk can watch the game live and connect with other members of the digital community.

Their comments have ranged from describing game play to shoutouts to friends. Many on Twitter post links to photos taken at the game.

Despite the Tribe's ho-hum action on the field this year, a spot on the Social Deck made a night at the ballpark one of the hottest tickets in town among the digerati.

The Indians' front office did not advertise the Social Deck when it was launched on Opening Day in April. Instead, over several games, the organization invited 18 influential people in the local social-media community, who talked, tweeted and blogged about their experience to their friends.

By May, the Indians had a website (indians.com/connect) where anyone could apply for a spot on the Social Deck by answering, in the Twitter-esque 140 characters (as on Twitter), questions about their interests and why they wanted to go.

At the end of the home season Wednesday, more than 500 people had applied this year to sit on the Social Deck. Five people were invited to each game, and each could bring a guest.

"It's sort of self-selecting, the way we went about the application," said Rob Campbell, executive development fellow-social media for the Indians. "We go to where they play."

The Indians worked with Arizona-based Digital Royalty to come up with the idea of a special section of seats catering to the social-media community. It's believed to be Major League Baseball's first, and the Indians have fielded calls from other teams inquiring about the Social Deck.

Sports marketing analyst Bob Dorfman, of Baker Street Advertising in San Francisco, said the Social Deck is an example of sports franchises trying to reach out to bloggers and Internet types.

"There's been a conflict in the press box over whether they should allow bloggers there," he said. "This is a great way to include those people, make them feel part of the team and get positive information disseminated. Everyone is doing it in some
way." 

While other teams have credentialed Internet-only writers, the Social Deck allows the Indians to include a broader spectrum of social media users, not just bloggers who want to cover the game, Dorfman said. 

Dominic Litten, leader of interactive marketing at Point to Point Inc., an advertising firm in Beachwood and founder of the Cleveland Social Media Club, was among those invited to Opening Day. 
Litten said that before accepting the invitation, he checked with the Indians and received assurances that he had complete freedom to say what he wanted about the game. Other online commenters will occasionally moan over a bad play. But most are polite. 
 Litten said the deck is a smart move for an organization trying to connect with an online audience that can be negative when the home team is losing. 

"Kudos to them for identifying them," Litten said. "It's something that's exclusive. And as soon as you make something exclusive, everybody wants it." 

Cleveland resident Paige Boyer, who went to the deck once as a guest and once as an invitee, said she continues to see the people she met at the ballpark. 

"It's a way to build your professional and social network, said Boyer, a communications and media relations coordinator with Hospice of the Western Reserve. "It takes that social media experience and adds human interaction, which makes social media even better."

 

Continental's free meals reach the end of the line

Say goodbye to free tiny pretzels and cold cereal Oct. 12 when Continental Airlines begins charging economy-class passengers for food on most domestic flights.

Continental, the biggest carrier in Cleveland, was the last airline to provide meals without a separate charge for all its travelers. United Airlines, which will merge with Continental on Friday, started charging for snack boxes in 2005.

Continental's move to a pay menu for some travelers means “Continental is now offering uniform product with other competitors,” said William Swelbar, a researcher at MIT International Center for Air Transportation.

“Meals were among the first thing to be cut back when the industry was looking to reduce costs,” he said. “Everyone followed suit. This has been a process by the airlines over the years.”

Monday's announcement gives more details and a date for the move, which was first announced in March.

Continental will still have free food in coach on international flights, as well as on domestic flights longer than 6½ hours.

First-class and BusinessFirst passengers will be unaffected.

All travelers will still receive nonalcoholic beverages at no charge.

Menu prices will range from $1.50 for a package of Pringles Original to Potato Crisps to $8.25 for a grilled chicken spinach salad.

The purchase menu also will include hot and cold dishes, such as an Asian-style noodle salad, an Angus cheeseburger, and a Jimmy Dean sausage, egg and cheese sandwich.

Snacks and desserts will include a gourmet cheese and fresh fruit plate, several types of snack boxes, a la carte brand-name snacks and chocolate-covered Eli's Cheesecake on a stick.

The new menu was developed with feedback from customers, who said they wanted more food choices on flights, Sandra Pineau-Boddison, Continental vice president of food services, said in a news release.

The airlines researched trends in the restaurant industry and tested a broad range of menu items, Pineau-Boddison said.

In announcing the move in March, the airline said it was eliminating some free meals because travelers no longer choose an airline based on the no-charge breakfasts, sandwiches, hot meals and desserts.

Continental expects to save $35 million a year from the move and see more revenue from the food-for-purchase program.

Air travelers have seen a steady unbundling of services they used to get for free, from checked bags to pillows and blankets on board.

Part of the reason is that airfares have not kept up with the rate of inflation and the price of oil, Swelbar said.

“It's really those cost inputs that have crowded out the superfluous offering of food,” Swelbar said. “Unfortunately, those little things are what gets cut.”

Parents jam phone lines, websites in wake of powdered Similac recall

By Kaye Spector

Plain Dealer Reporter

 

While worried parents and caregivers jammed phone lines and websites, retailers across the region pulled powdered Similac from their shelves Thursday following a request from the maker of the best-selling infant formula.

Illinois-based Abbott Laboratories recalled nearly 5 million containers of powdered Similac on Wednesday after finding beetles or beetle larvae during an internal quality review of formula made in a Sturgis, Mich., factory.

Abbott was unable to immediately release lot numbers of the affected products because the recall involved several thousand lots, some of which differ by one letter or number, spokeswoman Raquel Powers said. The lot numbers were released by midafternoon Thursday. Go to cleveland.com/business for a list.

Earlier, the company listed a toll-free number and a Web address at which customers could find out if they had the recalled formula. But many callers at midmorning heard a recording directing them to a company web address, which was inaccessible because of heavy Internet traffic.

“It was very upsetting and a frustrating experience,” said Jessica Johnson, of Manchester, Ohio. Johnson, who has a 13-month-old daughter, said she was “frantic” when she heard about the recall this morning.

Johnson said her cousin, who has a 2-month-old, spent three unsuccessful hours on the Internet trying to find out if her infant formula had been recalled. The company spent Thursday beefing up the capacity of its phone lines and website, Powers said. Access had improved somewhat by late afternoon.

Meanwhile, clients of the Ohio Women, Infants & Children program jammed the phone lines at the program's Cleveland office.

Clients were trying to find out what to do because Similac is an authorized food under the WIC program.

WIC participants who had already bought formula were told to contact Abbott Laboratories to make arrangements for exchanges.

Those with coupons for the powder could come to the WIC office and exchange them for coupons for liquid infant formula, which is not part of the recall.

"I feel for my participants," said Barbara Riley, general manager of public health for WIC's Cleveland office. "They bought the formula and they can't replace any of it."

Callers also jammed the call center at Rainbow Babies & Children's Hospital, a telephone triage center that represents physicians after hours.

Call volume was up 15 percent from the same time a week earlier, said medical director Dr. Andrew Hertz. Many of the nurses who staff the center said they took calls about the recall asking for advice or whether they should switch formulas.

Consuming small parts of insects or their larvae is not a significant health threat to children, Hertz said.

Even Abbott Laboratories' information saying infants could experience gastrointestinal discomfort or may refuse to eat as a result of small insect parts irritating the G.I. tract probably is a "worst-case scenario," Hertz said.

"I'm not even sure there would be gas," Hertz said.

Abbott Laboratories said that although more than 99.8 percent of the product from the Sturgis factory tested negative, the recall was issued as a precaution.

Retailers such as Heinen's, Giant Eagle and Dave's Supermarkets removed Similac products Thursday morning after receiving an e-mailed request from the formula maker.

"We have also implemented register sales block for the items, ensuring that none are inadvertently purchased," Giant Eagle spokesman Erik Yorke said in an e-mail. The stores also called customers who purchased the recalled items with their Giant Eagle Advantage card.

New powdered Similac is expected to be shipped in about a week, Powers said.

Welcome to Northeast Ohio, aka the Medical Capital

By Kaye Spector

Plain Dealer Reporter

 

Northeast Ohio has a serious identity problem when it comes to health care: Only 10 percent of people outside the area associate the region with the medical industry, a recent nationwide survey found.

The response will be unveiled today at the City Club of Cleveland.

It’s called the Medical Capital, an effort by health-care communication professionals to shape the national perception of the region as a powerhouse in the health-care industry. Ultimately, the goal is to bring money, entrepreneurs and established organizations to Northeast Ohio.

The effort doesn’t depend on billboards or pamphlets or bumper stickers.

Instead, it’s an attempt to catalog information about the region’s health-care institutions, innovations and people and spread it outside the region via a fact sheet, a blog (themedicalcapital.com), a LinkedIn page and a Twitter feed (@medicalcapital).

More than 80 percent of people locally already associate the area with health care, the Cleveland Plus marketing alliance found in its survey. But people find it difficult to describe why the region is a powerhouse.

Through the Medical Capital project, organizers hope public officials, businesspeople, public relations practitioners and others will become more knowledgeable and pass that information to people outside the area.

“We all tell our stories really well individually, but in the aggregate, it’s much more powerful,” said Erinne Dyer, director of corporate communications at the Cleveland Clinic and one of the group’s organizers. “I don’t think that story has ever been told.”

The project spans manufacturing, education and economic development groups, in addition to hospitals and health-care providers. More than 120 professionals have been involved since 2008 to develop the program.

The group found that the region is home to:

More than 600 medical-related organizations, including 60 hospitals.

Twenty-seven colleges and universities, housing more than 20 medical education programs.

Twelve of the top 18 medical device manufacturers in the nation.

Nearly 500 U.S. patents issued in the past four years.

More than 480,000 health-care, bioscience and support workers, including 9,000 physicians.

More than $835 million in venture funding for 90 companies since 2003.

“We don’t want to launch a brand,” said Cleveland Plus spokesman Rick Batyko. “This isn’t a campaign. The Medical Capital is a phrase we use to tidily sum up all the assets we have here in Northeast Ohio. We hope all communicators will infuse this into what they are already doing.”

The health-care professionals, who volunteered their time to the effort, plan to meet again in November.

“It’s more of a civic pride movement,” said Christina DeAngelis, communications director at Case Western Reserve University. “In order to do that, everyone needs to sing the same song.”

The City Club event is sold out, but you can watch a webcast at noon today on the City Club website: cityclub.org.

Woman who got face transplant at Cleveland Clinic has normal life again, doctor says

By Kaye Spector

Plain Dealer Health and Medical Writer

 

Connie Culp, the recipient of the first-ever U.S. face transplant, now can do many of the things we all take for granted: smile, squint, purse her lips and feel her grandson’s kiss on her cheek.

Culp, 47, had her last surgery — to remove excess skin at the jawline — at the Cleveland Clinic in mid-July and has returned home to Unionport in Jefferson County.

She also has returned to a normal life, says her physician, Dr. Maria Siemionow. After the latest surgery, she can go out in public without people staring at her and saying hurtful things.

“She is happy, as happy as she can be,” Siemionow said. “She is very surprised that no one is paying attention to her when she goes out.”

Culp lost the middle of her face in the fall of 2004 when her husband shot her before turning the gun on himself. He survived the shooting and is in prison.

Culp underwent the groundbreaking transplant in December 2008 after nearly 30 procedures failed to help. She couldn’t eat solid food, drink from a cup, smell or taste.

The only way she could breathe was through a hole cut into her throat.

Siemionow led a Clinic team that transplanted 80 percent of the face and underlying anatomy from a cadaver. Culp made her first appearance in public in May 2009.

Since then, much function has returned to Culp’s face, Siemionow said, because her nerves have grown back.

“Her face was flat like a mask without a lot of expression after surgery,” Siemionow said. “She now has a vivid face with full expression.”

Creating a better hospital gown: Von Furstenberg helps Cleveland Clinic with the design

By Kaye Spector

Plain Dealer Health and Medical Writer

 

Although medicine has changed greatly in the last 80 years, the hospital gown has not.

It’s pretty much the same embarrassing garment worn and reviled by your grandmother’s generation, short-sleeved and thigh-high, its gaping back held together with twill-tape ties.

The Cleveland Clinic has been working on a new, improved version of the patient gown for about three years. An initial prototype was deemed unattractive. But now, some patients at the Clinic and its regional hospitals are trying out a newly revamped patient gown — designed with input from fashion designer Diane von Furstenberg and her team.

Clinic CEO Toby Cosgrove met Furstenberg at a medical conference in Sun Valley, Idaho. He invited her to work with the Clinic’s gown redesign team, and she agreed. Soon after, Clinic executive liaison Jeanne Ryan flew to New York City to meet with the winner of the Council of Fashion Designers of America lifetime achievement award. Ryan was assigned a designer and a fabric expert.

Ryan says she told the team that the gown had to be comfortable and dignified, provide easy access for caregivers and work for ambulatory and nonambulatory patients.

They came up with a gown with elements recognizable to von Furstenberg fans familiar with her signature wrap dress: a wrap design with a bold, graphic print.

Von Furstenberg herself designed the print, which incorporates the Clinic logo.

“I’m not surprised to see the print and that it somehow spells the name of the Clinic,” says Connie Korosec, chairwoman of fashion merchandising and design at Ursuline College. “She did these iconic prints in the 1970s.”

Korosec also gave the gown high marks for its functionality.

“I like it because it wraps to the front or to the back,” she says.

The toughest part of the project turned out to be choosing the fabric.

Ryan was surprised to learn that most patients report being too warm in the hospital. She had expected the opposite.

So Ryan and the designers searched for a material that was lightweight enough to be cool but heavy-duty enough to withstand heavy, frequent laundering and things such as monitors and drains being pinned to it. They also looked for colors that would not fade.

“There was a lot to consider,” Ryan says. “I’ve been a nurse for nearly 30 years, but I did not have a complete understanding of how involved it was going to be. I’m used to other kinds of more technical stuff, but that’s OK. It’s an interesting, ongoing project.”

After the gown was first piloted on the colorectal floor at the Clinic’s main campus, a problem with the snaps was discovered: They didn’t fasten securely. The team corrected the problem and recently started a second trial now under way on general medical-surgical floors at Fairview and Euclid hospitals and in the vascular ICU on the Clinic main campus.

“Cleveland Clinic was very keen in us working with them on hospital gowns. We worked with their head nurses and combined need and design,” the designer posted on Twitter in August. “We are very proud of our hospital gowns for the Cleveland Clinic. We worked hard at it and we hope it will make patients happier! DVF”

Initial feedback has been good. Some men have said they find the print a bit feminine, so the team is considering changing the color scheme. And the fabric has shrunk in the wash, so the gowns might be made longer to compensate.

Von Furstenberg is not the first to re-envision patient gowns. Maine Medical Center in Portland, which serves a large Muslim community, redesigned its patient gown in 2004 after learning that many Muslim women, whose religion and culture require them to be covered, were canceling doctor visits because they were embarrassed to wear the gown.

Cynthia Rowley created a gown for Hackensack University Medical Center in 1999 that featured a mock turtleneck with three-quarter sleeves and drawstring pants with matching robes for men; V-necked and scoop-necked gowns for women; and three-quarter length pants for children.

Dim and Den Sum food truck now a fixture at the Cleveland Clinic farmers market

By Kaye Spector

Plain Dealer Health and Medical Writer

Setting up his Dim and Den Sum food truck at the Cleveland Clinic’s farmers market was a no-brainer for chef Chris Hodgson.

After all, he uses only fresh ingredients, grown or raised locally, just like what’s sold at the farmers market. Hodgson also likes the idea of serving — and selling — well-prepared food to the people from whom he bought the ingredients.

And then there’s the sheer number of potential customers: nearly 22,000 Clinic employees at the main campus, where the farmers market will continue for the next four Wednesdays this year.

That’s a lot more fish tacos and blue burgers than Dim and Den Sum sells at some of its other haunts, like late at night outside the Flying Monkey in Tremont or the Happy Dog in the Detroit Shoreway neighborhood.

The Clinic invited Hodgson, his three helpers and his revamped FedEx truck to its main-campus farmers market to induce people other than hospital employees to patronize the weekly event.

The market was created as a way to offer nutritious food to Clinic employees, patients and visitors as well as residents of the surrounding Fairfax neighborhood, where it’s difficult to find fresh food.

But a few things had to happen before the truck could participate. Hodgson had to retool his high-end menu to comply with Clinic guidelines for food sold on its premises: No trans fat, no added sugar, no high fructose corn syrup, no fried foods.

That meant Dim and Den Sum couldn’t serve its signature dish: handmade tater tots, served with fancy sauces. “We had a huge following, just for tater tots,” Hodgson says.

Hodgson and his crew took the potato treats off the menu. Each week they instead create three Clinic-friendly side dishes. On Wednesday, there was couscous with almonds, cilantro, red onion and cranberries; a Greek-yogurt parfait with almonds, granola and Ohio honey; and corn salad with smoked carrots and basil.

Because Dim and Den Sum is a movable feast, the business has to get the word out often and quickly about where it’s going to set up shop and what’s going to be sold, both of which change from day to day and, sometimes, on short notice.

Its fans keep track of Dim and Den’s movements and menu by “liking” the business on Facebook, checking on dimanddensum.com or following @DimAndDenSum on Twitter.

A tweet brought Caitlin Hooi, 28, to the farmers market on Wednesday. She made a detour from her home in North Ridgeville to her business in the Detroit-Shoreway neighborhood to lunch at the food truck.

Hooi, who had never been to the Clinic farmers market, was disappointed she couldn’t buy any tater tots. “It makes me very sad. They’re amazing,” she said, laughing while waiting for her gourmet burger topped with blue cheese, sweet slaw and lettuce.

Hodgson is hoping to compete in the Food Network’s “The Great Food Truck Race.” As of Wednesday, fans who voted for Dim and Den Sum on the Food Network’s website (foodnetwork.com/the-great-food-truck-race) have put the business in third place.

The main-campus market, operated by the North Union Farmers Market, is open Wednesdays from 10:30 a.m. to 2:30 p.m. through Oct. 6.

Fear, frustration fuel the spread of myths about cancer causes

By Kaye Spector

Plain Dealer Health and Medical Writer

 

Stop smoking. If you're overweight, drop some pounds. And exercise several times a week. Those are the things you can do to decrease your risk of developing cancer.

What's not going to do it: avoiding cell phones, underwire bras and hair dye.

Many myths persist about what causes cancer, and in recent years, their circulation has gone into overdrive because of the Internet and e-mail.

Doctors say the myths reflect the fear of cancer and frustration over not knowing its causes, coupled with a desire that the disease come from something controllable.

“A diagnosis of cancer is very scary and we often don't have a good explanation of why it occurred. So it's very natural to look for explanations that seem to make sense,” says Dr. Neal Meropol, hematology and oncology division chief of University Hospitals Case Medical Center.

Dr. Stanton Gerson, director of UH's Ireland Cancer Center, says that many myths, even though erroneous, gain credence because they have some elements of truth.

Take the one that cell phones cause brain cancer. Brain tumors tend to occur more frequently among upper socioeconomic groups and highly educated people.

Those two groups also have high cell-phone use, which may fuel the myth about the phones causing cancer.

But scientific studies have not shown a clear cause-and-effect relationship between the two.

A close examination of research results reveals that cell- phone use “really isn't associated with brain tumors,” Gerson says.

Another common cancer myth with seeds of truth is that heredity plays a large role in whether someone will develop cancer: “My mom had it, so I'm going to get it.” While it's true that some cancers are influenced by heredity, it's a small number – only about 5 percent to 10 percent.

“In most instances, it is environmental factors and behavioral factors that perhaps play the greatest role in cancer development,” Meropol says. “People are able to prevent cancer by following a healthy lifestyle and avoiding exposure to toxic substances such as tobacco.”

Doctors also need to be culturally sensitive and have a greater awareness of people's fears. Folk beliefs are not uncommon, especially among minority populations, the poor and the less-educated, the American Cancer Society says.

Gerson says doctors need to reorient conversations with their patients who ask about myths to talk about behavior that can make a difference. “Often the individual is not taking care of themselves,” he says. “Obesity, lack of exercise, those are the things that the public should be working on.”

The myth that Meropol is most eager to talk about is that cancer is a death sentence.

Cancer rates have actually declined over the past decade, and that reflects better screening as well as better treatment and healthier lifestyles, Meropol says. As researchers learn more and more about the interaction of behavior, exposure and genetic makeup, more effective treatments will be developed and more lives will be saved.

“Cancer survivors are increasing in number,” he says. “There are millions of cancer survivors who have been cured and are living normal lives.”

If you are seeking information about the causes of cancer, be cautious about health-related information you see on the Internet, advises the American Cancer Society.

Play the skeptic by evaluating the source of the information: Check to see who owns the site, make sure the sources are reliable, such as a medical research institution or hospital. Finally, ask your doctor about what you've read.

 

There are far too many myths about cancer causes to address them all. Here are a few popular ones, gleaned from the American Cancer Society, the National Cancer Institute and interviews with local oncologists.

Antiperspirants/deodorants — This myth works on the theory that antiperspirants prevent the body from eliminating dangerous toxins. But no conclusive research links the use of underarm antiperspirants or deodorants with breast cancer, the National Cancer Institute says. Additionally, breast cancer rates haven’t changed significantly since the 1930s, before most people used deodorants and antiperspirants regularly. (Now, more than 90 percent of adults regularly use deodorants.)

Artificial sweeteners — Nonsugar sweeteners got a bad name in 1981, after the U.S. National Toxicology Program’s “Report on Carcinogens” listed saccharin as a substance reasonably believed to be a human carcinogen. Experiments on rats had shown an increased risk of bladder cancer. But saccharin came off the list in 2000 after more research showed the tumors were caused by a mechanism not relevant to humans. Now, there’s no clear evidence that any artificial sweeteners available commercially in the United States are associated with cancer risk in humans, the NCI says. Studies have been conducted on the safety of several, including saccharin, aspartame, acesulfame potassium, sucralose, neotame and cyclamate.

Cell phones — A number of completed and ongoing studies have looked for a link between using a cell phone and brain tumors, says Dr. Neal Meropol, hematology and oncology chief at University Hospitals Case Medical Center. “So far they have failed to identify any increased risk, based on the type of cell phone or frequency of use,” he says. A large international study published this year found that, overall, cell-phone users have no increased risk for two of the most common types of brain tumor — glioma and meningioma. For the small proportion of study participants who reported spending the most total time on cell-phone calls, there was some increased risk of glioma, but the researchers considered this finding inconclusive, the NCI says.

Cancer cells spread when exposed to air — In a study in five urban clinics about 10 years ago, 38 percent of patients believed that cancer spreads when exposed to air during surgery. Of those, 24 percent said they would reject lung cancer surgery based on that belief. Nineteen percent said they would reject surgery even if their doctor told them the belief had no scientific basis. Meropol has encountered patients who believe this. “There really isn’t a basis for this belief,” he says.

Fluoridated water — Fluoride is added, at a rate of one part fluoride per million parts water, to public water-supply systems to prevent tooth decay. Many studies, in humans and animals, have shown no association between fluoridated water and risk for cancer, the NCI says.

Hair dye — Early hair-dye formulations contained chemicals found to cause cancer in animals, and manufacturers changed their products to eliminate some of these chemicals in the mid-to-late 1970s. Some studies have indicated that people who began using hair dyes before 1980 have an increased risk of developing non-Hodgkin’s lymphoma, but the evidence for increased risks of other cancers from hair dye use is limited and inconsistent, according to the NCI.

Mammogram radiation — The amount of radiation used in a mammogram, a low-dose X-ray picture of the breast, is very low, and the risk of any harm is extremely small, the NCI says. Patients should, however, make sure they are imaged at an American College of Radiology-accredited facility using up-to-date equipment.

Somebody else with cancer — Cancer is not a communicable disease, meaning it can’t be transmitted from person to person by close contact, Merepol says. But someone can give you human papillomavirus, a sexually transmitted disease that can cause cervical cancer or oral cancer. Also, hepatitis B and C, viruses transmitted through sexual intercourse or use of infected intravenous needles, can increase the risk of liver cancer.

Underwire bras — This theory was first floated in a 1995 book called “Dressed to Kill.” Authors Sydney Ross Singer and Soma Grismaijer claimed that women who wore tight bras all day, every day, had a much higher risk of developing breast cancer. Their theory was that underwire bras constrict the lymph system, trapping toxins. The magazine Scientific American reported that the authors failed to exclude variables such as known risk factors for breast cancer including age, family history, high-fat diet and obesity.

A weakened immune system — The “strength” of someone’s immune system does not affect the chance of developing cancer, Meropol says. However, a patient with an unusual condition such as HIV or someone who is taking immunosuppression drugs for an organ transplant are predisposed to certain cancers. “But these types of immunodeficiency conditions are very, very unusual,” says Meropol. “For people who frequently get bronchitis or the common cold, this isn’t the type of immunity problem that would lead to cancer.”
.

Raw veggies can pack a punch, but cooking can unlock some key benefits

By Kaye Spector

Plain Dealer Health and Medical Writer

 

Congratulations: You've incorporated more fresh fruits and vegetables into your diet. Now the goal is to get the maximum nutritional benefit from them.

Does it matter how you prepare them? And does it make enough difference to change your food-preparation habits?

The answer is yes, preparation does matter.

Raw fruits and vegetables are good choices if you're trying to lose weight, says Nancy Farmer-Dziak, director of clinical nutrition at MetroHealth Medical Center.

In their natural state, these foods are filled with fiber, which can help you feel fuller longer and help you eat less.

“The fiber content is a plus,” says Valerie Myers, a registered dietitian for Kaiser Permanente. “Cooking is going to process the fiber out of there.”

Raw-food advocates believe uncooked food is better for more than losing weight. They say that cooking fruits and vegetables kills the vitamins and minerals and denatures enzymes that aid in digestion. Devotees of the uncooked report more energy, a healthy glow, clearer skin and better endurance.

But a growing body of scientific research supports the view that cooked vegetables are better — depending on the preparation.

Cooked carrots, spinach, mushrooms, asparagus, cabbage, peppers and many other vegetables supply more cancer-fighting antioxidants than they do when raw, according to Rui Hai Liu, an associate professor of food science at Cornell University, in a report last year in Scientific American magazine.

Research also has shown that while some raw food may contain more nutrients, our bodies cannot absorb them.

Cooking releases nutrients locked away inside the food’s cell walls, says Kristin Kirkpatrick, a registered dietitian for the Cleveland Clinic’s Lifestyle 180 program.

“I think there’s been this misconception for a very long time that you have to have vegetables in a raw state,” she says. “But we find that cooking vegetables has a benefit over their raw counterparts.”

Take lycopene, an antioxidant thought to reduce the risk of certain cancers, especially prostate cancer, and guard against heart disease.

Lycopene is found in tomatoes and other red-tinged foods such as red bell pepper. But the nutrient is only released through cooking, which breaks down the cell walls of the plant.

Raw foodies could be missing out on this important nutrient. A British study of a group of strict raw-food eaters showed they had normal levels of vitamin A and relatively high levels of beta carotene, but low levels of lycopene in their blood.

Another example is lutein, an antioxidant found in corn and dark-green leafy vegetables such as spinach and kale. Lutein protects the eyes against age-related macular degeneration, the leading cause of blindness. Cooking helps to release the lutein in corn, Farmer-Dziak says.

Accompanying ingredients also can amp up the nutritional impact. Kirkpatrick recommends sauteing zucchini in a little olive oil — a healthier, “bad”-cholesterol-lowering type of fat — or adding a small amount to cooked tomatoes.

A study at Ohio State University showed that adding a little fat while cooking tomatoes helps the body to absorb lycopene. It also helps the body soak up fat-soluble vitamins, Kirkpatrick says.

Similarly, another OSU study found that when salsa or salad was served with fat-rich avocados or full-fat salad dressing, the diner absorbed as much as four times more lycopene, seven times more lutein and 18 times the beta carotene than those who ate their vegetables plain or with low-fat dressing.

There are tradeoffs. Vitamin C often is lost in cooked produce like tomatoes. Fresh spinach loses 64 percent of its vitamin C when cooked. But vitamin C is available from other sources, such as orange juice. Lutein or lycopene — nutrients released through cooking spinach and tomatoes — is not as readily available elsewhere, so consider cooking those veggies.

Another way to maximize the potential of fruit and vegetables is to buy as freshly picked as possible. Produce loses nutrients from the moment it is harvested.

“I always teach that fresh is best,” Myers says.

Produce that is shipped long distances often is picked before it’s fully ripe. That can lessen the nutrition power, because nutrients develop while the produce matures.

Frozen fruits and vegetables are good alternatives. “If you get the right type, they are picked when they are at their best,” Myers says.

Just make sure your frozen produce has the USDA Fancy shield, which guarantees the best size, shape and color, Myers says. “They tend to have more nutrients than lower grades,” she says.

If you’re making the switch to raw fruits and vegetables from canned or processed, proceed slowly, Myers says. Many people report some digestive problems as their body becomes accustomed to the natural fiber.

If all this is too confusing to remember, an easy rule of thumb is to avoid fried vegetables or recipes that are laden with fats or sugars, Kirkpatrick says. And eat a variety of fruits and vegetables prepared in a variety of ways.

Cleveland Clinic targets added sugar in effort to make its food, drinks healthier

First it was smoking. Then it was trans fat. Now, the Cleveland Clinic is taking aim at sugar-sweetened beverages and food.

 

By Aug. 9, the Clinic and its system affiliates will no longer sell food or drinks that have added sugar or sugar variants whose names end in “-ose.”

 

The Clinic has been slowly removing sugar-sweetened foods and beverages from its facilities. Since 2007, at least 70 percent of food and drinks sold in Clinic vending machines and in its cafeterias had to be no-sugar-added. Retailers such as Au Bon Pain and Starbucks in the main-campus food court even voluntarily modified their bakery menus to comply.

 

That mandate will grow to 100 percent in the coming weeks. The main campus began to eliminate sugar-sweetened beverages about two weeks ago.

 

Drinks with artificial sweeteners still will be available. Clinic leadership is still sorting out whether to ban sugar-added food served to patients.

 

The edict came from Chief Executive Toby Cosgrove, who banned smoking on Clinic property systemwide in 2005 and abolished artery-clogging artificial trans fats systemwide in 2007.

 

More recently, the Clinic directed its food vendor to supply it with antibiotic-free meat and locally sourced produce.

 

Pop and other sweetened beverages, like bottled iced teas, energy drinks and canned lemonade, are the No. 1 source of added sugars in the U.S. diet, the American Heart Association says. Many health experts say the drinks promote diabetes and other diseases and blame them, at least in part, for the soaring U.S. obesity rate.

 

A 12-ounce can of pop, which has no nutritional value, can contain up to 10 teaspoons of sugar and 150 calories.

 

“It’s an important initiative,” said Bill Barum, the Clinic’s senior director of hospitality. “There’s been a longstanding discussion in the health care community around what a poison sugared beverages are.”

 

Barum acknowledged the new policy isn’t going to be popular with some employees, but he said hospital leaders feel strongly about not having a role in providing unhealthy food and drink to its visitors.

 

“It’s a tough thing to tell adults you can’t have any more Coke,” Barum said. “People are going to complain and get upset, but when they realize the type of impact on their health, then it really starts to hit home. We have to put a line in the sand and it’s up to the Clinic to start those kinds of things.”

 

Employees and visitors can, however, still bring their own sugary drinks and food to the Clinic or its regional hospitals.

 

Or, on the main campus, they can stop in at the food court and buy a Coke at McDonald’s.

 

Clinic joins pledge to buy meat raised without antibiotics

By Kaye Spector

Plain Dealer Health and Medical Writer

 

Antibiotics are among the greatest discoveries in medicine. But the Cleveland Clinic doesn’t serve them on a plate to its patients, employees or visitors.

The Clinic is among nearly 300 hospitals that have signed a pledge with the international environmental coalition Health Care Without Harm to buy only meat raised without antibiotics.

All the meat dished up to Clinic patients throughout the system and sold in its cafeterias is to be antibiotic-free, under specifications given to the Clinic’s food service provider, AVI Food Systems, said Bill Barum, the hospital’s senior director of hospitality.

“It was to align ourselves with all the appropriate actions that have been going on in the line of food supply: responsible supply, responsible growing — basically everything to do with sustainability and environmental strategy,” he said. “It played very well into our mission statement. We have to walk the talk.”

The antibiotic-free promise is part of an eight-point pledge that includes purchasing locally raised food and minimizing or reusing food waste.

Health Care Without Harm and the Pew Campaign on Human Health and Industrial Farming publicized signers of the pledge on Tuesday to take aim at the practice of giving antibiotics to healthy animals being raised for meat. The U.S. House Energy and Commerce Subcommittee on Health will hold a hearing today on the use of antibiotics in animal agriculture.

The two groups say the practice promotes development of drug-resistant bacteria, which can then infect humans who work with the animals or eat their meat. Some of these drug-resistant bacteria can be fatal, causing death within 48 hours.
Up to 70 percent of antibiotics sold in the United States are routinely fed to healthy poultry or livestock to promote growth and weight gain, the Pew campaign said.

“This is an extremely dangerous practice,” said Dr. Lance Price, director of the Translational Genomics Research Institute’s Center for Metagenomics and Human Health in Flagstaff, Ariz. “It hastens the day when our antibiotics fail.”

The amount of antibiotic use in food animals is unknown because use of antibiotics in food animal production is unregulated. But scientists have traced some resistant bacteria found in humans back to poultry and dairy cattle.

“Hospitals play a vital role. Their purchasing power can change markets,” said Jamie Harvie, of Health Care Without Harm.
Late last month, the Food and Drug Administration released a draft of voluntary guidelines in which the agency acknowledged that antibiotic use for growth promotion is inappropriate.

The two groups support legislation pending in Congress to reform reporting and monitoring requirements for drug manufacturers and food producers and to curtail the use of antibiotics on industrial farms for healthy animals.

 

Expansion of University Hospitals program brings health care home to Slavic Village

 

By Kaye Spector

Plain Dealer Health and Medical Writer

 

After a hemorrhagic stroke last fall that paralyzed one side of her body, 72-year-old Trudy Greene came home to a hospital bed set up in the former dining room of her Slavic Village house.

The widow's adult sons moved in to take care of her around the clock: Lee, who works evenings, is there with her in the morning and afternoons; his younger brother Daniel works days and is there with her in the evenings.

Although she was home, Trudy Greene still needed lots of medical attention. But trips to the doctor's office were arduous. For a while, she had a breathing tube in her throat and she needed to bring an oxygen tank with her. The sons called a private ambulance or carried her themselves down the steps leading out of the house and into a car.

But a recent expansion of University Hospitals Case Medical Center's House Calls program to Cleveland's Slavic Village neighborhood means that Greene no longer has to leave home to see her doctor. Instead, the physician comes to her. And, when needed, a nurse, nurse practitioner or social worker can visit as well.

 

A $1 million gift from the Third Federal Foundation supported the program's growth and its ability to create partnerships with organizations, including Meals on Wheels, the Golden Age Center and churches.

The $55 million foundation, created through the 2007 minority public stock offering of Slavic Village-based Third Federal Savings & Loan, supports charitable organizations in the communities in which it operates.

The foundation is a major supporter of the Cleveland School District, Cleveland Central Catholic High School, the Boys & Girls Clubs of Cleveland, University Settlement and Habitat for Humanity and has made numerous grants focused on education and community redevelopment efforts to smaller institutions.

Third Federal spokeswoman Jennifer Rosa said via e-mail that the foundation chose the University Hospitals program because of its good track record in other neighborhoods.

“By investing in this program, we can give back to an elderly population that has given so much to Cleveland and Northeast Ohio,” she said.

Patients in the program are frail and fragile, said Dr. Peter DeGolia, House Calls' medical director. They represent the 15 percent of Medicare recipients who spend 85 percent of Medicare dollars in the last two years of life, he said.

“We work closely with patients and caregivers to help people remain where most people want to be – in their home,” DeGolia said.

Trudy Greene has lived in the Cullen Drive house, its living room adorned with childhood photos of her two sons, since 1996. Her husband died in 1997.

“This has been great for us,” son Lee Greene said as he watched Dr. Karen Parker examine his mother on a recent sunny morning. “She wanted to come home. I felt like we could do it.”

Parker chatted brightly with her patient about how much she was eating, asked about her pain medications and gave her some advice on how to deal with a dry mouth, before taking her vitals.

Bottles of hydrogen peroxide and moisturizing lotions sat behind glass doors on shelves that formerly housed china and tchotchkes. An oxygen tank stood in the corner.

“Seeing the physical environment really shows you where the barriers are,” Parker said. “The information you get on a house visit is astonishingly better.”

The house call visits also last longer than the typical 15-minute office visit. During her morning at the Greene home, Parker had time to troubleshoot problems Lee said he had obtaining a particular pain prescription for his mother and helped him make plans to get his mother a leg brace.

“They take care of me,” Lee Greene said, nodding toward Parker. “I don't know what I would do without them.”

Study: Wash reusable grocery bags to avoid bacteria

 

By Kaye Spector

Plain Dealer Health and Medical Writer

 

Those reusable fabric shopping bags may be kind to the environment, but they may not be good for your family's health – if you don't wash them.

A new study, in which researchers randomly tested 84 reusable grocery bags carried by shoppers in Tucson, Los Angeles and San Francisco, found that more than half of the bags were contaminated with food-borne bacteria.

Twelve percent was E. coli, a bacterium that can cause food poisoning. While abdominal cramps and diarrhea are most common, serious – sometimes life-threatening – complications can develop, especially among young people and older adults.

Ninety-seven percent of the shoppers in the study said they do not wash their bags, nearly all of which were made of woven polypropylene.

“If you're going to use these bags, you need to take care of them,” the study's co-author, Charles Gerba, said Thursday. “The last thing you want to do is grow salmonella in your sack.”

The main concern, said Gerba, a microbiologist and professor at the University of Arizona, is cross contamination: a package of meat leaks juice in a bag. The bag is unpacked, then placed back in the hot car trunk until next week's shopping trip, when the bag is filled with vegetables.

By then a horde of bacteria may line the inside of the bag and transfer to the vegetables or your hands and spread elsewhere.

“It's a gamble,” Gerba said.

While unwashed bags might not result in headline-grabbing outbreaks, Gerba said, “Our data says it may be a common risk that might be overlooked.”

Despite the study’s findings, the Cuyahoga County Health Department has not traced any food-borne illness to reusable bags, said environmental health services director John McLeod.

But as more and more shoppers are adopting reusable bags — either for environmental concerns or to stem the tide of household plastic bags — washing the totes is a good habit to adopt, said Matt Carroll, Cleveland Public Health Department director.

“If you can keep E. coli out of your house by washing the bags, then obviously you should wash the bags,” Carroll said.

A thorough washing will kill nearly all bacteria that can accumulate in the bags, said Gerba.

“There’s a lot of different factors that go into bacteria growth: moisture, heat and having the bacteria itself,” McLeod said. “We want to make sure we break that cycle.”

Jeff Heinen, of Heinen’s Fine Foods, says that although they remain a minority, more and more of his customers are taking home groceries in reusable bags.

The local chain has been selling the bags for 10 years. At first they were made of cloth; now they are made of the woven polypropylene. The bags can be hand- or machine-washed in cold or warm water on gentle cycle and hung to drip dry. Do not put the bags in the dryer.

“It’s no different than your refrigerator,” Heinen says. “You want to clean it occasionally.”

Author Gail Sheehy offers advice on the role we rarely see coming

By Kaye Spector

Plain Dealer Health and Medical Writer

 

More than 65 million people – nearly 29 percent of the U.S. population – care for a chronically ill, disabled or aged family member or friend, says the National Family Caregivers Association. In Ohio, there are 1.14 million caregivers.

Typically, this person is a married, employed, 49-year-old woman who spends an average of 20 hours a week caring for her widowed, 69-year-old mother, who does not live with her.

Author Gail Sheehy, whose best-selling “Passages” books have chronicled the life stages of the baby boomer generation, has now turned her literary attention to the role of caregivers.

Her latest title, “Passages to Caregiving: Turning Chaos into Confidence,” describes eight crucial stages, or passages, of giving care to a loved one with a life-threatening illness.

In the book, Sheehy draws on her experiences as a caregiver for her husband, magazine editor Clay Felker, who died in 2008 after battling cancer for years.

We interviewed Sheehy by phone, shortly before her May appearance in Cleveland, sponsored by Hospice of the Western Reserve, to promote her book.

Q: Why did you write this book?

A: I've written five books about passages in life. And I often talk about the wonderful second adulthood that we enter after 50. What I didn't see coming was The Call [from a doctor reporting the diagnosis of a serious illness].

It usually plunges the family member into denial, fear, confusion as you confront doctors who have many different recommendations, many different diagnoses, certainly different treatment approaches.

You don't know the medical lingo, you don't know the insurance situation of your loved one, and you're already trying to balance probably your own work.

This becomes a second job for most of us for which we are not prepared, not trained and not expecting.

Q: How can we prepare for it?

A: My best advice is if you have a sibling, talk to them, have the conversation before the crisis. Send out an e-mail and or a nice card and say, you know, “Mom or Dad is getting older and at some point they are going to need some of our help. How about we all e-mail, 'This is what I'm good at.' ”

The point is to get the conversation started. Because although we'd like to think our siblings are going to be our greatest support, our studies show they are likely to be the greatest stress. If you're the person living closest to the parent who's going to need help and you take on the whole role of primary caregiver, you can be pretty sure your sibling who lives farthest away is going to call you and say, “You don't know what you're doing.” Because they're not on the spot and they probably feel guilty.

Q: Your book talks about creating a circle of care.

A: Nobody can do this alone. The first step is to call your local area agency on aging. There's one in every state and most cities and many counties. They often have a care manager who can begin to assess the situation and tell you what the community resources are.

The second thing is when you are talking to multiple doctors and you're so confused by all their different approaches, try to pick the one you most trust and ask him three questions because you want to see if he will be your medical quarterback:

Will you help me sort through the treatment options?

Will you help me assemble a care team?

And will you address pain and other side effects of treatment?

And if the doctor says yes, you've got your medical quarterback who will help you call the plays. It will make the ride so much smoother.

If you can't find a doctor who's willing to be a partner with you and collaborate with you, you may want to find a geriatric-care manager. That's a fairly new player in the health care arena.

These are nurses or social workers trained in geriatrics who can come to your home or your loved one's home, do an assessment, walk you through the medical lingo and the territory you're in and help you choose a doctor or a hospital. Then, more important, afterward, when your loved one is home from the hospital or goes to rehab, helps you to understand that whole territory, which is so complex and has its own set of rules.

Hiring a geriatric-care manager is not covered by Medicare. It may possibly be covered by your company. But if you have to pay for it, it may be from $85 an hour to even $250 an hour, which is huge, and most people resist paying for a geriatric-care manager. But I'll tell you, a two- or three-hour consult with a geriatric-care manager may tell you more than you need to know about the next year or two of your life than any three hours that you spend with anybody else.

Unless it's an elder attorney. That's the other key person who can help you to understand what your insurance does and doesn't offer, whether your loved one qualifies for Medicaid and what you can get covered under Medicare. That's the professional team.

Then you go to work on assembling the support team. This is something caregivers have to understand: You have to ask for help. You have to realize that you deserve to ask for help. Because you need to keep on working on your own life.

So I say, let your friends know. Also people you work with, people at your church or temple, and maybe even at the local community college if they have a health services major, they may be able to provide volunteers to look in on a parent or a spouse when you can't be there.

Q: Is there a place where caregivers should draw the line?

A: Oh, definitely. One of the biggest dangers is a phase I call Playing God. If you've become really devoted, you've learned the lay of the land, you know the lingo, you've become really good at it. You begin to think that it's you who's responsible for keeping your loved one safe or alive day to day.

That's OK as long as things are going well, and you're winning. It's very satisfying to the ego. But when things go wrong, which is inevitable, some treatment will backfire or the old illness will roar back. Then if you're God, it's your fault, and if you think it's your fault, a crash of guilt will come down on you.

So you have to at some point accept that there is a God, if you believe in one, but you aren't it. No one can control the aging process or the trajectory of illness. And you need to be able to take care of yourself. At the very least you have to get out for at least an hour every day and do something pleasurable just for yourself. And nothing to do with caregiving – no fair calling in for a prescription.

You have to break the cycle of hypervigilance, because that stress hormone cycle, if it's not interrupted, will eventually become completely depleted. And if you fall into caregiver burnout, that's a disease. That's really difficult to come back from. So you need to take precaution before that happens. There's nothing to feel guilty about, because if you get sick there's nobody to take care of your loved one or yourself.

Q: How is caregiving different now, and what are the implications?

A: In our parents' time, not so many women were working. It was just assumed, it was part of socialization, that women would just be available for whoever in the family got sick first or complained the loudest.

We have not acknowledged that there is this enormous free labor pool out there called mostly women middle-aged family caregivers who wrestle with, “How do I do right by Mom or Dad or my spouse who suddenly has a life-threatening illness without sacrificing the resources I will need to keep myself solvent and socially stimulated and healthy into my old age?”

You are expected to take over when somebody comes home from the hospital for a crew of about 24 people who have specialized jobs over the course of 24 hours in a hospital. Suddenly it's all on you.

It's an enormous shock and undertaking. So you have to find ways to enlist the doctor or the charge nurse to help you – before you leave the hospital – learn as much as you can and afterward to get more help at home.

It becomes a negotiation. And what I find is that you actually have to go to the doctor all the time because they know the magic words to use to get things done.

Q: Are boomers demanding a different model?

A: It hasn't been made a major national issue, and I hope this book will start that conversation.

Q: Your book says there are positive aspects to being a caregiver to someone with a life-threatening disease.

A: This is a chance to become more intimate with a parent, even if you've been distant or estranged. You discover each other all over again as different people. You have to make that delicate transition to being more of the nurturer and authority for your parent instead of expecting them to do that for you.

In the case of my husband, we found that facing a life-threatening illness prodded us to make a dramatic change in our lives.

When he got lymphoma, the doctor said, “Because your lymphoma is very mild and inactive, I'm not even going to give you any drug, because they wouldn't necessarily improve your life span. Why don't you two go out and do something wonderful that you wouldn't have dared before and do it together?”

We worked on how to do that for the next year until my husband was able to get to what he really loved about his work without any particular title or setting – which was identifying and shaping young talent.

At the same time, his colleagues, whom he had worked for and whose careers he helped to foster, were searching the different colleges and universities to see who would be interested in having him start a magazine program of actually making magazines and not just sitting in some dusty [department] chair, and University of California at Berkeley jumped at the chance. And we tore up our lives in New York and moved to California to start that new life.

That lymphoma never came back.

A lot about illness isn't just about medicine.

Q: So being a caregiver can be a profound experience.

A: Actually, the caregiver passage is going to be one of the most memorable ones in your life. It will shape how you think about yourself: Am I a good person? Did I do all I that I could? Did I shift some of that responsibility to my sibling or somebody else?

Did I let go at the right time? That's probably the most delicate decision of all.

But that's one that can only be made if you're on the spot with your loved one and talking about where they are, where they're going and what their goals are. To keep following their lead.

If you do that and are able to guide them to a place that none of us know in a gentle and loving way, you're going to walk away guilt-free and feeling spiritually nourished.

Opera singer, a double lung transplant recipient, takes the stage at Cleveland Clinic conference

By Kaye Spector

Plain Dealer Health and Medical Writer

Charity Sunshine Tillemann-Dick went to her first opera, “Hansel and Gretel,” at age 4. She knew then what she wanted to do and what she wanted to be.

She now sings soaring soprano coloratura, delivering difficult passages of high, rapid notes. She mastered the technique after years of rigorous training.

She hasn't let go of her dream, even though she battled pulmonary arterial hypertension for years before undergoing open-heart surgery and a double lung transplant.

Wednesday she takes the stage at the Cleveland Clinic's Patient Experience Summit. She will dedicate her rendition of Gershwin's “Someone to Watch Over Me” to the doctors, nurses and hospital staff who saw her through it all.

The Denver resident began “building a relationship” with the Cleveland Clinic doctors shortly after she was diagnosed in 2004 at age 21.

Tillemann-Dick and her doctors in Colorado and at Johns Hopkins Hospital in Baltimore, Md., tried to treat her condition. But the possibility of a transplant always loomed. She knew she would likely have it done at the Clinic.

“My doctors told me it was the best place to go,” she said.

With pulmonary arterial hypertension, the blood vessels that supply the lungs constrict and the walls thicken, so the blood vessels can’t carry as much blood. The heart has to work harder to force the blood through and pressure builds up. There’s less blood circulating through the lungs picking up oxygen. Patients become tired, dizzy and short of breath.

Pulmonary hypertension was a “daunting prospect” for the coloratura soprano.

“The most important thing is air flow,” she said. “It’s tremendously demanding work.”

Tillemann-Dick didn’t tell many people about her condition so she could keep on singing. She wore a pump the size of a cassette tape strapped to her leg or torso.

“When I sang, it was the only time I did not feel challenged by my physical disability. I had this freakish lung capacity,” she said. “But the truth was I was very sick.”

By 2009, she was having difficulty singing. She had canceled 100 engagements in the course of a year and decided she could not continue.

“I realized I couldn’t maintain my good name as an artist,” she said.

She had the transplant at the Clinic in September and returned home at Christmastime, determined to sing again.

She took tentative steps toward music by humming. After a few weeks, she tried to sing some gentle songs: jazz, folk music. More time passed. She moved on to more demanding music: theater standards. A few weeks later, she was singing her opera repertoire. In March, she began taking lessons again with her regular voice teacher.

“Coming back to Cleveland to sing is really a dream come true, considering I’m not even a year out,” she said in a phone interview during a taxicab ride to the Intercontinental Hotel on Monday morning.

“It’s a miracle and I’m so glad to share that.”