Kellogg to Phase Out Some Food Ads to Children

Froot Loops’ days on Saturday morning television may be numbered.

The Kellogg Company said yesterday that it would phase out advertising its products to children under age 12 unless the foods meet specific nutrition guidelines for calories, sugar, fat and sodium.

Kellogg also announced that it would stop using licensed characters or branded toys to promote foods unless the products meet the nutrition guidelines.

The voluntary changes, which will be put in place over the next year and a half, will apply to about half of the products that Kellogg currently markets to children worldwide, including Froot Loops and Apple Jacks cereals and Pop-Tarts.

Frosted Flakes, for example and Rice Krispies with Real Strawberries will still make the nutritional cut, though regular Rice Krispies will not (too much salt).

The president and chief executive of Kellogg, David Mackay, said that the products that did not meet the guidelines would either be reformulated so that they did, or no longer be advertised to children.

“It is a big change,” Mr. Mackay said. “Where we can make the changes without negatively impacting the taste of the product, we will.”

If the product cannot be reformulated, Mr. Mackey said, the company will either market it to an older audience or stop advertising it.

The policy changes come 16 months after Kellogg and Viacom, the parent company of Nickelodeon, were threatened with a lawsuit over their advertising to children by two advocacy groups, the Center for Science in the Public Interest and the Campaign for a Commercial-Free Childhood, and two Massachusetts parents.

Because of the changes by Kellogg, the groups said that they would not proceed with the lawsuit against the company. Viacom had not negotiated with the groups and was not part of today’s announcement; the groups said that they had not determined if they would proceed with legal action against the broadcaster.

“Kellogg’s position has really evolved over those months from pretty much ‘no way’ to acceptance of some nutrient criteria,” said Michael F. Jacobson, executive director of the Center for Science in the Public Interest. He said he hoped the Kellogg announcement would lead its competitors to adopt even tougher standards for food advertising to children.

Susan Linn, the co-founder of the Campaign for a Commercial-Free Childhood, said that Kellogg’s decision to stop using licensed characters on sugary food was particularly significant. “Until now the industry has absolutely dug in their heels,” Ms. Linn said.

In the last several years, health officials have repeatedly warned that the steady stream of food ads aimed at children is contributing to the number of overweight or obese children, which has soared over the last several decades.

Some countries have banned advertising of nutritionally questionable food to children altogether, and some members of Congress have suggested that federal regulation may be needed in the United States, too. The food industry has promised to bolster its own self-regulation.

Last November, for instance, 10 of the largest food and beverage companies, including McDonald’s, General Mills and Kellogg, vowed that at least half of their advertising directed at children under 12 would promote healthier foods or encourage active lifestyles.

The companies also agreed not to advertise in elementary schools and to reduce the use of licensed characters to promote food. Those companies are expected to complete individual plans for how they will address the guidelines in the next 60 days or so.

But like Kellogg, a few companies have already unveiled tougher standards for advertising to children. Last October, for instance, Walt Disney said that it would allow its characters to be used in food advertising only if the products complied with nutritional standards.

And in 2005, Kraft Foods announced that it would stop advertising products to children under 12 that did not meet specific nutrition guidelines.

Under Kellogg’s new guidelines, food advertised on television, radio, Web sites and in print that have an audience that is 50 percent or more of children under 12 will have to meet the new nutrition standards. Kellogg already had a policy of not aiming advertising at children younger than 6, so the new guidelines apply to children 6 through 11.

Kellogg officials said that about 27 percent of its advertising budget in the United States aims at that age group. They declined to give the dollar value of that budget.

Under the new standards, one serving of food must have no more than 200 calories, no trans fat, no more than 2 grams of saturated fat, no more than 230 milligrams of sodium (except for Eggo frozen waffles) and no more than 12 grams of sugar.

Cocoa Krispies cereal would not qualify because one serving has 14 grams of sugar. But Kellogg could still advertise Frosted Flakes to children because it has 11 grams of sugar. Shrek cereal does not meet the criteria because it has 15 grams of sugar a serving and uses a licensed character.

In a related initiative, Kellogg said it would introduce Nutrition at a Glance labels on the top right corner of cereal boxes this year.

Already introduced in Europe and Australia, the new labels will take information from the Nutrition Facts panel on the side of the boxes, which are mandated by the federal government, and highlight important parts on the front of the box.

The new labels will show consumers the percentage of calories, total fat and sodium in a single serving, based on a 2,000-calorie daily diet, and will also display grams of sugar and nutrients like fiber and calcium.

In Health Care, Cost Isn’t Proof of High Quality

Stark evidence that high medical payments do not necessarily buy high-quality patient care is presented in a hospital study set for release today.

In a Pennsylvania government survey of the state’s 60 hospitals that perform heart bypass surgery, the best-paid hospital received nearly $100,000, on average, for the operation while the least-paid got less than $20,000. At both, patients had comparable lengths of stay and death rates.

And among the 20 hospitals serving metropolitan Philadelphia, two of the highest paid actually had higher-than-expected death rates, the survey found.

Hospitals say there are numerous reasons for some of the high payments, including the fact that a single very expensive case can push up the averages.

Still, the Pennsylvania findings support a growing national consensus that as consumers, insurers and employers pay more for care, they are not necessarily getting better care. Expensive medicine may, in fact, be poor medicine.

“For most consumers, the fact that there is no connection between quality and cost is one of the dirty secrets of medicine,” said Peter V. Lee, the chief executive of the Pacific Business Group on Health, a California group of employers that provide health care coverage for workers.

Some Pennsylvania employers said the state’s findings, based on data from 2005, might put more pressure on insurance carriers and hospitals to start demonstrating the value of care. “It now provides us a tool to have a serious dialogue with our carriers,” said Mark Dever, a benefits consultant for Duquesne Light, a regional utility in Pittsburgh.

“We have to question,” he said. “There’s a big difference in price — why?”

The report by the Pennsylvania Health Care Cost Containment Council, a state agency, provides a rare public glimpse of detailed information about hospital payments and patient outcomes. And the seemingly random nature of the payments is striking.

Although federal Medicare payments are largely fixed, they varied somewhat among the Pennsylvania hospitals surveyed. The far greater disparity involved commercial insurers, which must negotiate their rates hospital by hospital.

And the survey found that good care can go unrewarded. One Philadelphia area hospital, Main Line Health’s Lankenau center, which performs a large number of bypass surgeries and has a high success rate, according to the survey, was paid an average of $33,549 by private insurers. That was less than half the nearly $80,000 in average payments received by the other hospitals, with poorer track records.

“It doesn’t make sense,” said Marc P. Volavka, the executive director of the Pennsylvania Health Care Cost Containment Council. “Certain payers are paying an awful lot for poor quality.”

He points to some of the experiments to change how hospitals are paid, like Geisinger Health System in central Pennsylvania, which is trying to demonstrate its commitment to high-quality care by offering a 30-day warranty on its cardiac surgery.

“The current reimbursement paradigm is fundamentally broken,” said Dr. Ronald Paulus, an executive with Geisinger, who says there is no current financial incentive for a hospital to provide the kind of care that leads to better outcomes and lower payments.

Pennsylvania is the first state to make such information, normally closely guarded by the hospitals and the insurers, available to everyone — including patients who may never see their hospital bills or be aware of how their hospitals compare with others in the state.

The council collected the payment data from the insurers and calculated averages of the payments to each hospital. So each hospital’s average includes small numbers of extraordinarily high-cost cases, where patients may have developed complications and had lengthy hospital stays.

As a result, a hospital with a relatively low number of surgeries but a high number of costly cases, could wind up with a high average payment. In the Philadelphia area, for example, Lower Bucks Hospital says its average of nearly $100,000 paid by commercial insurers for a bypass patient was skewed by a single very expensive case. Without that case, its average would be closer to $40,000, the hospital said.

But fully explaining the discrepancies in payments and quality of care is difficult.

In Philadelphia, heart patients have a choice among several academic medical centers. Two, Albert Einstein and Hahnemann University, were paid nearly $80,000, on average, for treating a bypass patient. The hospitals at the University of Pennsylvania and Thomas Jefferson University, whose patients did as well or better, were paid much less.

Both Albert Einstein and Hahnemann disputed the survey’s findings, saying payments they receive are lower than the state is reporting.

Hahnemann says its calculations show the average to be significantly lower — $23, 420 — rather than the $78,312 reported in the survey.

The council conceded that the pool of Hahnemann patients it used for its calculations was different from the patients the hospital might count. The council defended its conclusions, saying it used the same methodology for all the hospitals surveyed.

As for the quality measures, Hahnemann says its higher-than-expected mortality rates might reflect the hospital’s own poor record-keeping, which it says did not give the state an accurate picture of how sick some of its patients were before their surgeries. As eye-opening as the Pennsylvania report may be to the public, insurers have already been aware that their payment practices do not necessarily encourage hospitals to provide better care. Medicare, for example, pays essentially a flat fee, which varies depending on location and type of hospital, for the same surgery, regardless of outcome. Complications tend to simply mean additional payments. And many insurers follow the government’s lead.

And so hospitals are rewarded for providing more care, not better care.

“The Medicare program pays for services,” said Leslie Norwalk, the acting administrator for the federal program, who says hospitals are reimbursed even if the care they are providing is a result of a mistake or avoidable hospital infection.

Independence Blue Cross, which is Philadelphia’s largest private insurer, says the difficulty lies in finding the right measures to use to pay for quality care.

“Philosophically, you’re not going to get an argument from us,” said Dr. Richard Snyder, a senior executive at Independence. “We believe we should pay more for high quality than poor quality.”

He says hospitals that are poor performers do risk being excluded from its network, as happened in one case with a hospital — which he would not identify — that was not allowed to deliver cardiac care to the plan’s members for a year until the hospital improved its performance.

Fears over child epilepsy drugs

Urgent safety studies are needed for newer anti-epilepsy drugs that are being increasingly prescribed for children, say UK researchers.

The British Journal of Clinical Pharmacology report says prescriptions have risen five-fold in 13 years.

Yet the drugs' long-term safety has not been established, say the researchers.
Many medicines are not fully tested on children before licensing, meaning consultants have no official guidance on doses to refer to when prescribing.

Instead they often have to estimate a safe and effective dose based on the age and the size of the child.

Lead author Professor Ian Wong, from the Centre for Paediatric Pharmacy Research in London, studied antiepileptic drugs given to nearly 8,000 children over a 13-year period.
The centre is a collaborative project run by the School of Pharmacy at the University of London, the UCL Institute of Child Health and Great Ormond Street Hospital.
Professor Wong and his colleagues found three drugs in particular - lamotrigine, topiramate and levetiracetam - had seen a "massive" rise in prescribing.
Professor Wong said this was concerning.
"The uptake of these drugs has been rapid, yet their long-term safety has not been established and further research must now be seen as a priority."

Side-effects
He said that while newer drugs were less likely to react with other prescribed drugs, it was possible that restrictions in their use might have to be introduced as any side-effects in children became more apparent.
He said multi-organ failure, renal failure, blood disorders and skin reactions had been reported in patients using lamotrigine.

Dr Jeffrey Aronson, a reader in clinical pharmacology at Oxford University, said many drugs were not tested on children because of the difficulties that including children in clinical trials posed.
"This means that clinicians often have to rely on their experience and scale down adult drugs for paediatric use, which is widely regarded as most unsatisfactory," he said.
Dr Colin Ferrie, a consultant paediatric neurologist at Leeds General Infirmary, said that not only were new trials important, but pharmaceutical companies should be encouraged to carry out "clinically relevant" trials prior to the original granting of a licence.
"Obviously it's an area of concern, and when you are prescribing a drug 'off licence' to a child, it's important to let the family know exactly the implications of this.
"However, it is often possible to find data, either from journal abstracts or the drug company, which can help you calculate a safe and effective dose of a drug."

New Drug Fails to Improve Odds for Heart Failure Patients

TUESDAY, May 1 (HealthDay News) -- A new drug is no more effective at improving the survival rates of people with decompensated heart failure than a widely used medication is, a new international study has found.

Decompensated heart failure is one form of the general condition in which the heart progressively loses the ability to pump blood. It is characterized by a set of symptoms including shortness of breath and intolerance to exercise.

There were hopes that the new drug, levosimendan, would improve survival, because it uses a unique mechanism that makes heart muscle cells more sensitive to the calcium that causes them to contract. However, the study of 1,347 persons with acute decompensated heart failure, done at 75 centers in nine countries between March 2003 and December 2004, found essentially the same death rate for participants who got levosimendan as those who received an established medication, dobutamine, said a report in the May 2 issue of the Journal of the American Medical Association.

The trial leaves cardiologists without a totally satisfactory treatment for decompensated heart failure, said Dr. Robert Hobbs, a Cleveland cardiologist specializing in treatment of the condition. Some 5 million Americans have one form or another of heart failure, and about 1 million of them are hospitalized for it each year.

"The original therapy, which is still basic, is diuretics," Hobbs explained. "They make the body lose water, so people feel better. In the 1980s, ACE inhibitors came along to make people feel better and live longer, and they were added for long-term benefit. The third group of drugs to be used were beta blockers."

Dobutamine is a positive inotropic agent that has been found to improve symptoms, but it has also been associated with an increased risk of death and cardiovascular problems. In the latest trial, participants with decompensated heart failure received levosimendan or dobutamine intravenously.

"The common practice has been to give dobutamine in the belief that the heart is like a battery that has lost its charge," Hobbs said. "By giving dobutamine, you would recharge it. That didn't actually happen [in previous studies]. It appeared to be associated with complications, longer hospital stays and more mortality."

In another previous study, careful analysis indicated that levosimendan was associated with a lower risk of death than dobutamine. "It did have the different mechanism of action, and it was felt that might translate into improved safety," Hobbs said. But it proved to be no better in the new trial.

In the 180 days after drug infusion, the death rate was 26 percent among patients who got levosimendan and 28 percent in those getting dobutamine. There was no statistical difference between other endpoints, such as incidence of breathing difficulties and days spent out of the hospital.

Participants who got levosimendan were less likely to experience cardiac failure but more likely to experience the abnormal heartbeat called atrial fibrillation, low blood levels of potassium, and headache.

"The bottom line on all of this is that it is hard to show benefit for what we do for acute decompensated heart failure," Hobbs said.

More information

All aspects of heart failure are explored by the American Heart Association .

Egyptian girl dies of bird flu

CAIRO (AFP) - A 10-year-old Egyptian girl has died of bird flu, the health ministry announced on Saturday, bringing to 15 the number of Egyptians who have succumbed to the deadly H5N1 strain of the virus.

The girl, from the southern province of Qena, was found to be "very critical" and hospitalised "too late," health ministry spokesman Abdel Rahman Shahin told AFP.

Although the girl had been ill for more than 10 days, she had only been treated with Tamiflu for the past two days, he added.

John Jabbour, a World Health Official in Cairo, had earlier in the week told AFP the girl had been in contact with poultry.

The highly pathogenic virus has killed 15 people out of the 35 cases reported to date in Egypt. The disease was first diagnosed in the country in February 2006.

Egypt's geographical location on major bird migration routes and the widespread practice of keeping domestic fowl near living quarters have led to it being the hardest-hit country outside of Asia.

Women and children have borne the brunt of the virus due to their role in taking care of domestic fowl.

The government says it is conducting a vigorous campaign to combat the spread of the virus through vaccinations and raising awareness, but cases continue to appear.

Yoga tested as back pain therapy

The potential for yoga to be used to treat low back pain is being investigated by researchers.

Millions of UK people suffer from chronic low back pain, and existing treatments have only a limited effect.

A team of academics, yoga teachers and practitioners have joined forces to find out if a 12-week course of yoga can make a difference.

The Arthritis Research Campaign-backed project will assess moves from the two most popular types of yoga.

These are lyengar yoga and hatha yoga, favoured by the British Wheel of Yoga.

More than 260 people between the ages of 18 and 65 who have had back pain in the past 18 months will be recruited for the trial.

Recent, small studies in the US have shown that yoga can be helpful for back pain sufferers.

But David Torgerson, director of the University of York Clinical trials Unit, and Jennifer Klaber Moffett, deputy director of the Institute of Rehabilitation at the University of Hull, believe a bigger study is needed to unequivocally establish the benefits.

'Considerable impact'

Professor Torgerson said: "Yoga offers a combination of physical exercise with mental focus that may make it a suitable therapy for the treatment of low back pain.

"If the trial shows yoga to be effective then this low-cost treatment will have a considerable impact in the quality of life of patients with back pain."

Yoga develops flexibility and muscular endurance by allowing the muscles to be stretched and strengthened.

Patients will be recruited from GP surgeries from September and the 12-week classes, to be held in north and central London, York, Manchester and Cornwall, will begin in November.

The classes will be run by 10 experienced yoga teachers who have all received specialist training.

No difficult poses

Half the participants will take part in yoga classes, and the other half will receive the usual care.

They will be assessed at the end of the classes, then six months and a year later to see if there are any longer-term benefits.

The yoga classes will be carefully structured for people who are complete novices and will not involve any difficult poses.

They will be graduated over the 12-week period, starting off gently and becoming more demanding, with a combination of stretches, bends, lying sitting, standing and relaxing poses.

Patients will also be encouraged to practise daily at home.

Anna Semlyen, a yoga teacher who is helping to run the classes, said: "Regular yoga increases the benefits, and we would hope that at the end of the 12 weeks people would carry on."

House Votes to Expand Stem Cell Research

WASHINGTON, June 7 — The House gave final Congressional approval on Thursday to legislation aimed at easing restrictions on federal financing of embryonic stem cell research, but Democratic leaders in both chambers conceded they were short of the votes needed to override a veto threatened by President Bush.

On a vote of 247 to 176, the House overwhelmingly passed the bill, with more than three dozen Republicans joining a Democratic-led effort to authorize federal support for research using stem cells from spare embryos that fertility clinics would otherwise discard. The Senate approved the legislation in April.

“Science is a gift of God to all of us and science has taken us to a place that is biblical in its power to cure,” said Speaker Nancy Pelosi, Democrat of California, arguing for the bill’s passage. “And that is the embryonic stem cell research.”

But minutes after the vote, Mr. Bush renewed his pledge to veto the proposal, which he called “a recycled old bill.” It would reprise the first veto of his presidency, which occurred last year when he rejected a similar bill passed by the Republican-controlled Congress.

“Recent scientific developments have reinforced my conviction that stem cell science can progress in ethical ways,” Mr. Bush said in a statement from Germany, where he was attending the Group of 8 meeting. “Researchers have been investigating innovative techniques that could allow doctors and scientists to produce stem cells just as versatile as those derived from human embryos, but without harming life.”

The House bill received support from 210 Democrats and 37 Republicans, 35 votes short of what would be needed to override a presidential veto; 16 Democrats joined 160 Republicans in opposing the legislation.

Several Republicans voting against the bill seized upon scientific findings reported Wednesday, in which biologists said they could use cells from ordinary, adult cells of the body, instead of stem cells. Critics of the bill also said taxpayer dollars should not be used for research on cells derived from discarded human embryos, particularly in the wake of such advances.

“How many more advancements in noncontroversial, ethical, adult stem cell research will it take before Congress decides to catch up with science?” said Representative Joseph R. Pitts, Republican of Pennsylvania, holding up a front-page newspaper account of the scientific discovery. “These have all of the potential and none of the controversy.”

Such techniques, if proven successful, could sidestep heated debates about the research. The technique described on Wednesday works only in mice and is unsuitable for humans. Scientists hope it will prove adaptable to human cells, but cannot say when that may happen.

“None of this work lessens the imperative to loosen federal and state restrictions that currently slow progress in this area,” said Dr. Sean J. Morrison, director of the Center for Stem Cell Biology at the University of Michigan.

While lawmakers who support more federal financing of embryonic stem cell research also hailed the research development, they said such advances should not stop Congress from expanding research that could lead to treatments for a litany of diseases, including Alzheimer’s and juvenile diabetes.

“We welcome these advances as we welcome all advances in ethical life-saving research,” said Representative Diana L. DeGette, a Colorado Democrat and a sponsor of the bill. “However, this new scientific research should not be used as an excuse to say that it is a substitute for embryonic stem cell research.”

Many scientists agree, saying they need to generate new lines of embryonic cells from discarded human blastocysts, or very early embryos. They also want to develop embryonic stem cells by nuclear transfer, the replacement of an egg nucleus with one from an adult cell. A major benefit of nuclear transfer would be to walk a patient’s cell back to an embryonic state so disease processes could be better understood.

“I would find it immoral to delay the research to see if egg nuclear transfer or this method gets to our goals first,” said Dr. Irving L. Weissman, a Stanford University researcher, referring to the new technique.

Democrats urged the president to change his mind and sign the legislation. Their campaign to override the expected veto began only hours after the bill was passed, with Ms. Pelosi and Senator Harry Reid of Nevada, the majority leader, staging a ceremony to send the legislation to Mr. Bush. They invited a few dozen children and adults — many of them in wheelchairs — who say they could benefit from stem cell research.

Any effort to override a veto would begin in the Senate, where the bill passed April 11 on a 63-45 vote. Even counting the three Senate Democrats who were not present for the vote, passage was one vote shy of the two-thirds majority needed to override a veto.

“I would hope that people around the president will have him understand how important this is,” Mr. Reid said. “We’re depending on the president to do the right thing.”

Representative John A. Boehner of Ohio, the Republican leader, said Democrats were trying to turn the debate into a political opportunity because they knew the president intended to veto it. After winning the majority in both houses last fall, Democrats made expanding federally financed stem cell research a priority in the new Congress.

“This is politics. This is not about expanding research,” Mr. Boehner said. “They understand clearly that the president has vetoed this bill in the past and will veto it again.”

Since 2001, when Mr. Bush issued an order prohibiting the use of federal money for research on new stem cells derived from embryos, medical research and domestic politics have been intertwined. His order limited federal financing to the handful of lines of embryonic stem cells already in existence, but researchers complained that most of those cells were damaged or inadequate.

The new legislation essentially would overturn Mr. Bush’s order. Polls suggest a wide majority of Americans support embryonic stem cell research, but many social conservatives in Congress find the use of discarded embryos unacceptable. “I believe that life begins at conception and destroying embryonic human life for the purpose of research is morally wrong,” said Representative Mike Pence, Republican of Indiana.

Others vigorously disagreed.

“Being pro-life is about more than caring for the unborn,” said Representative Christopher Murphy, Democrat of Connecticut. “It’s about caring for the living as well.”