How does nature nurture the brain?

Living in a city is a well-known risk factor for developing a mental disorder, while living close to nature is largely beneficial for mental health and the brain. A central brain region involved in stress processing, the amygdala, has been shown to be less activated during stress in people who live in rural areas, compared to those who live in cities, hinting at the potential benefits of nature. “But so far the hen-and-egg problem could not be disentangled, namely whether nature actually caused the effects in the brain or whether the particular individuals chose to live in rural or urban regions,” says Sonja Sudimac, predoctoral fellow in the Lise Meitner Group for Environmental Neuroscience and lead author of the study.
To achieve causal evidence, the researchers from the Lise Meitner Group for Environmental Neuroscience examined brain activity in regions involved in stress processing in 63 healthy volunteers before and after a one-hour walk in Grunewald forest or a shopping street with traffic in Berlin using functional magnetic resonance imaging (fMRI). The results of the study revealed that activity in the amygdala decreased after the walk in nature, suggesting that nature elicits beneficial effects on brain regions related to stress.
“The results support the previously assumed positive relationship between nature and brain health, but this is the first study to prove the causal link. Interestingly, the brain activity after the urban walk in these regions remained stable and did not show increases, which argues against a commonly held view that urban exposure causes additional stress,” explains Simone Kühn, head of the Lise Meitner Group for Environmental Neuroscience.
The authors show that nature has a positive impact on brain regions involved in stress processing and that it can already be observed after a one-hour walk. This contributes to the understanding of how our physical living environment affects brain and mental health. Even a short exposure to nature decreases amygdala activity, suggesting that a walk in nature could serve as a preventive measure against developing mental health problems and buffering the potentially disadvantageous impact of the city on the brain.
The results go in line with a previous study (2017, Scientific Reports) which showed that city dwellers who lived close to the forest had a physiologically healthier amygdala structure and were therefore presumably better able to cope with stress. This new study again confirms the importance for urban design policies to create more accessible green areas in cities in order to enhance citizens’ mental health and well-being.
In order to investigate benedicial effects of nature in different populations and age groups, the researchers are currently working on a study examining how a one-hour walk in natural versus urban environments impacts stress in mothers and their babies.
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Study calls for change in guidance about eating fish during pregnancy

The findings, which drew together analyses on over 4,131 pregnant mothers from the Children of the 90s study in the UK, with similar detailed studies in the Seychelles, are published in NeuroToxicology.
Importantly, the researchers also found that it does not appear to matter which types of fish are eaten because the essential nutrients in the fish could be protective against the mercury content of the fish. The more important factor was whether the woman ate fish or not. This contrasts with current advice warning pregnant women not to eat certain types of fish that have relatively high levels of mercury.
Although there are several studies that have considered this question, this research has looked at two contrasting studies of populations with mercury levels measured during pregnancy where the children were followed up at frequent intervals during their childhood.
The first is a study focused on a population in the Seychelles, where almost all pregnant women are fish eaters. The second study considered analyses of data from the University of Bristol’s Children of the 90s study (also known as the Avon Longitudinal Study of Parents and Children (ALSPAC)), based in a relatively industrialised area in south-west England where fish are consumed far less frequently. No summary of the findings from this study has been published before.
Although it has been known for some time that the children of women who eat fish in pregnancy are likely to benefit in various ways in regard to their eyesight and intellectual abilities, official advice has included the warning not to eat certain types of fish that have relatively high levels of mercury. As a result, there is the possibility that some women will stop eating any fish ‘to be on the safe side’.
Dr Caroline Taylor, Senior Research Fellow and co-author of the study, said: “We found that the mother’s mercury level during pregnancy is likely to have no adverse effect on the development of the child provided that the mother eats fish. If she did not eat fish, then there was some evidence that her mercury level could have a harmful effect on the child. This could be because of the benefits from the mix of essential nutrients that fish provides, including long-chain fatty acids, iodine, vitamin D and selenium.”
Professor Jean Golding, co-author and Emeritus Professor of Paediatric and Perinatal Epidemiology at the University of Bristol, said: “It is important that advisories from health professionals revise their advice warning against eating certain species of fish. There is no evidence of harm from these fish, but there is evidence from different countries that such advice can cause confusion in pregnant women. The guidance for pregnancy should highlight ‘Eat at least two portions of fish a week, one of which should be oily’ — and omit all warnings that certain fish should not be eaten.”
The current study is funded via core support for ALSPAC by the UK Medical Research Council and the UK Wellcome Trust.
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Cooling away the pain: Researchers develop bioresorbable, implantable device to block pain signals from peripheral nerves

Opioid use is highly effective for pain management but is associated with high rates of addiction and deaths due to overdose. Now, an international team of researchers has developed a soft, bioresorbable, implantable device which can provide a cooling effect to peripheral nerves, leading to blocking of pain signals. The device demonstrated high precision and efficacy in rat models with spared nerve injuries and can serve as an effective substitute for opioids.
Owing to their high efficacy, opioids are used widely for the management of neuropathic pain, despite the increasing rates of opioid addiction and deaths due to overdose. To avoid these side effects, there is an urgent need for pain management approaches that can substitute opioid use.
It is well known that cold temperatures numb the sensation in our nerves. Evidence suggests that cooling peripheral nerves can in fact reduce the velocity and amplitude of neural signals that cause pain, leading to pain relief. What’s great about this approach is that if made possible, it will be completely reversible and non-addictive.
To this end, a team of researchers led by Professor Min-Ho Seo from Pusan National University developed a soft, bioresorbable, implantable device with the potential to cool peripheral nerves in a minimally invasive, focused manner. “Scientists already knew that low temperatures could numb the nerves in the body. But demonstrating this phenomenon with a small device at a clinical level was not an easy task,” said Prof. Seo while discussing the study, which was published in Science on June 30, 2022.
To develop the device, the team designed a microfluidics system formed with a bioresorbable material — poly(octanediol citrate) — with interconnects carrying a liquid coolant to a serpentine chamber. To top it off, a Magnesium temperature sensor for real-time temperature monitoring was incorporated at its distal end. The intensity and localization of the cooling effect was regulated by perfluoro pentane (PFP) and dry nitrogen gas (N2) — the two components of the liquid coolant, as well as the geometry of the serpentine chamber.
Next, the team tested the device by implanting it into the sciatic nerves of living rat models with neuropathic pain associated with spared nerve injury. After a three-week evaluation, the team found that the device successfully delivered cooling power to the peripheral nerves of the rats, which led to a reduction in their pain. Fortunately, the delivery of the cooling power occurred in a minimally invasive, stable, and precise manner. What’s more, this application was localized and reversible, and remained effective for almost 15 minutes during one session.
On being submerged in phosphate-buffered saline solution at 75°C, the device, which was made of bioresorbable materials, dissolved within 20 days and got eliminated in approximately 50 days. These findings imply that it has the potential to naturally degrade and get resorbed in the human body.
So, what are the future applications of this device? “The developed device can be used to treat pain after surgery. Since it is connected to an external source of fluid and power like a commercial intravenous (IV) device, it can easily be controlled by the patient. This way, our implantable device will be able to provide targeted and individualized relief without the drawbacks of the addictive pain medications,” said Prof. Seo in response.
With such progress underway, patients with neuropathic pain will finally be able to receive safe and sustainable treatment, without the risk of adverse effects associated with opioid use!
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Cellular 'waste product' rejuvenates cancer-fighting immune cells

A new study by UT Southwestern’s Simmons Cancer Center scientists suggests that lactate, a metabolic byproduct produced by cells during strenuous exercise, can rejuvenate immune cells that fight cancer. The finding, published in Nature Communications, could eventually be used to develop new strategies to augment the anti-tumor effect of cancer immunotherapies, the study authors said.
“The lactate that we usually think of as a waste product appears to have a previously unrecognized role in fighting cancer,” said Jinming Gao, Ph.D., Professor of Cell Biology, Otolaryngology — Head and Neck Surgery, and Pharmacology, and member of the Harold C. Simmons Comprehensive Cancer Center. Dr. Gao co-led the study with fellow Simmons Cancer Center members Baran Sumer, M.D., Professor of Otolaryngology — Head and Neck Surgery, and Bo Li, Ph.D., Assistant Professor of Immunology and in the Lyda Hill Department of Bioinformatics.
Lactate is commonly used in Ringer’s solution, administered intravenously to replace fluids after blood loss due to trauma, surgery, or severe burns or to treat a condition called metabolic acidosis. While lactic acid (lactate with an additional proton) has been associated with cancer growth and immune suppression, the effects of lactate on cancer and immunity have been unclear.
To investigate this question, Dr. Gao and his colleagues gave lactate injections to mice with colon cancer or melanoma; other tumor-bearing mice received glucose injections. While glucose had little effect, tumor growth was significantly reduced in mice treated with lactate. When the researchers tried the same experiment in mice genetically engineered to lack T cells, this anti-tumor benefit was blocked, suggesting that lactate appeared to be exerting its effects through this immune cell population.
Administering lactate alone didn’t completely eliminate the tumors. But when the researchers added a commonly used immune checkpoint inhibitor — a type of cancer immunotherapy that releases the brakes that prevent T cells from fighting malignancies — about half the mice became completely tumor-free. Lactate also significantly improved the effects of a cancer-fighting vaccine and improved the anti-cancer response of cultured T cells that were injected into tumor-bearing mice.
Further single-cell RNA sequencing analysis showed that more T cells infiltrated the tumors of the lactate-treated mice. Compared to animals that didn’t receive this treatment, T cells from the mice that received lactate expressed more genes associated with stem-like T cells and a smaller number of genes associated with exhaustion markers, making them more fit to effectively fight cancer.
Dr. Gao said the data suggest that lactate could be used to supplement existing immunotherapies, such as immune checkpoint inhibitors, cancer vaccines, and CAR-T cell therapy — a cancer treatment in which T cells engineered to fight specific tumor types are expanded in the laboratory and then injected into patients. It also suggests that exercise, which naturally raises lactate levels, may be protective against cancer or may augment the immune system to fight cancer as well. Dr. Gao and his colleagues plan to investigate these topics in future studies.
Dr. Gao holds the Elaine Dewey Sammons Distinguished Chair in Cancer Research, in Honor of Eugene P. Frenkel, M.D. Dr. Sumer holds the T.C. Lupton Family Professorship in Patient Care in Honor of Dr. John Dowling McConnell and Dr. David Andrew Pistenmaa. Dr. Fu holds the Mary Nell and Ralph B. Rogers Professorship in Immunology. Dr. Sumer is also a member of the Peter O’Donnell Jr. Brain Institute.
Other UTSW researchers who contributed to this study include Qiang Feng, Zhida Liu, Xuexin Yu, Tongyi Huang, Jiahui Chen, Jian Wang, Jonathan Wilhelm, Suxin Li, Jiwon Song, Wei Li, and Zhichen Sun.
This research was funded by the National Institutes of Health (R01CA216839 and U01CA218422) and the Mendelson-Young Endowment in Cancer Therapeutics.
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Researchers discover toxin that kills bacteria in unprecedented ways

Researchers at McMaster University have discovered a previously unknown bacteria-killing toxin that could pave the way for a new generation of antibiotics.
The study, led by John Whitney at the Michael G. DeGroote Institute for Infectious Disease Research, shows that the bacterial pathogen Pseudomonas aeruginosa, known to cause hospital-acquired infections such as pneumonia, secretes a toxin that has evolved to kill other species of bacteria.
For Whitney, the key aspect of his discovery is not just thatthis toxin kills bacteria, but howit does so.
“This research is significant, because it shows that the toxin targets essential RNA molecules of other bacteria, effectively rendering them non-functional,” said Whitney, associate professor for the Department of Biochemistry and Biomedical Sciences.
“Like humans, bacteria require properly functioning RNA in order to live.”
“It’s a total assault on the cell because of how many essential pathways depend on functional RNAs” said first study author Nathan Bullen, a graduate student in McMaster’s Department of Biochemistry and Biomedical Sciences.
“This toxin enters its target, hijacks an essential molecule needed for life, and then uses that molecule to disrupt normal processes.”
Whitney and Bullen, together with colleagues at Imperial College London and the University of Manitoba, have studied this toxin for nearly three years to understand exactly how it functions at a molecular level.
The breakthrough, published in Molecular Cell, was achieved by Bullen following rigorous experimentation on common targets of toxins, such as protein and DNA molecules, before eventually testing the toxin against RNA.
This discovery breaks well-established precedents set by protein-targeting toxins secreted by other bacteria, such as those that cause cholera and diphtheria.
Researchers say that this development holds great potential for future research that could eventually lead to new innovations that combat infection-causing bacteria.
Whitney says the newly-discovered vulnerability can be exploited for future antibiotic development.
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Materials provided by McMaster University. Original written by Blake Dillon. Note: Content may be edited for style and length.

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Artificial breathing system reveals alveoli function in lungs

Alveoli are the basic functional units of the human respiratory system, acting as tiny air sacs that exchange gases. Air inhaled through the mouth and nose flows into the lungs through the branched structure of the bronchial tubes, and the alveoli appear in the deep sections of this network.
To fully understand and treat respiratory diseases, it is important to determine the flow pattern of air and particulates through the alveoli. In Biomicrofluidics, by AIP Publishing, scientists from the Harbin Institute of Technology in China created a model alveolar system that mimics the breathing action of the human lung and allows visualization of flow patterns within the alveoli.
The investigators designed a chip that includes tubes arranged like the structure of a bifurcation point in the bronchial network. The upper layer of the chip is made of a flexible polymer molded into small tubes that mimic the alveolar structure. The lower layer is glass, which allows the authors to visualize fluid flow through the tubes.
To mimic respiration, the scientists devised a system in which gas was pressurized in a sinusoidal fashion and pumped around the flexible tubes. This creates a breathlike cycle of inhalation and exhalation. To study flow patterns in the system, the group added small red polystyrene spheres to the fluid flowing through tubes. These spheres allowed them to photograph movement of the fluid as it was pushed through the tubes by the artificial breathing apparatus.
Subsequent branches in the bronchial network are known as generations, and the team found different flow patterns for different generations. In the human lung, alveoli appear at the 15th generation and remain present for generations up to 23. The researchers found a change in flow pattern between the 19th-20th and the 21st-22nd generations.
“The alveolar flow pattern of the 19th generation is dominated by vortex flow,” author Yonggang Zhu said. “Alveolar flow patterns in the 20th generation are similar to those in the 19th, but somewhat compressed.”
The investigators observed a change in the next generation.
“The alveolar flow pattern in the 21st generation has both vortex flow and radial flow. The vortex region is much smaller than the radial flow region. By the time the flow reaches the 22nd generation, vortex flow disappears completely, and we observe only radial flow,” Zhu said.
The authors also found evidence of chaotic behavior near the vortex center. They said more research is needed to fully understand this, but they felt the current study provides a good baseline for deeper investigations.
With the model, researchers will be able to study changes in flow patterns in the alveoli due to diseases such as emphysema and COPD.
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Suicide Prevention Research in a Rapidly Changing World

Credit: iStock/PeopleImages

As I sit down to write this blog, the COVID-19 pandemic continues to have a widespread impact, and we’re all trying to figure out our “new normal.” For some, figuring out the new normal has been especially difficult, and that’s something for all of us to consider during September, which is National Suicide Prevention Awareness Month. It’s such an important time to share what we know about suicide prevention and consider how we can further this knowledge to those in need.

At NIH’s National Institute of Mental Health (NIMH), we’ve been asking ourselves: What have we learned about suicide risk and prevention during the pandemic? And how should our research evolve to reflect a rapidly changing world?

Addressing Disparities

Over the last few years, people have been concerned about the pandemic’s impact on suicide rates. So far, data suggest that the overall suicide rate in the U.S. has remained steady. But there is concerning evidence that the pandemic has disproportionately affected suicide risk in historically underserved communities.

For example, data suggest that people in minority racial and ethnic groups experienced greater increases in suicidal thoughts during the pandemic [1]. Additional data indicate that suicide rates may be rising among some young adult racial and ethnic minority groups [2].

Structural racism and other social and environmental factors are major drivers of mental health disparities, and NIMH continues to invest in research to understand how these social determinants of health influence suicide risk. This research includes investigations into the effects of long-term and daily discrimination.

To mitigate these effects, it is critical that we identify specific underlying mechanisms so that we can develop targeted interventions. To this end, NIMH is supporting research in underserved communities to identify suicide risk and the protective factors and effective strategies for reducing this risk (e.g., RFA-MH-22-140, RFA-MH-21-188, RFA-MH-21-187). There are important lessons to be learned that we can’t afford to miss.

Building Solid Foundations

The pandemic also underscored the urgent need to support youth mental health. Indeed, in December 2021, U.S. Surgeon General Dr. Vivek Murthy issued the Advisory on Protecting Youth Mental Health, calling attention to increasing rates of depression and suicidal behaviors among young people. Crucially, the advisory highlighted the need to “recognize that mental health is an essential part of overall health.”

At NIMH, we know that establishing a foundation for good mental health early on can support a person’s overall health and well-being over a lifetime. In light of this, we are investing in research to identify effective prevention efforts that can help set kids on positive mental health trajectories early in life.

Additionally, by re-analyzing research investments already made, we are looking to see whether these early prevention efforts have meaningful impacts on later suicide risk and mental health outcomes. These findings may help to improve a range of systems—such as schools, social services, and health care—to better support kids’ mental health needs.

Improving and Expanding Access

The pandemic has also shown us that telehealth can be an effective means of delivering and increasing access to mental health care. The NIMH has supported research examining telehealth as a tool for improving suicide prevention services, including the use of digital tools that can help extend provider reach and support individuals at risk for suicide.

At the same time, NIMH is investing in work to understand the most effective ways to help providers use evidence-based approaches to prevent suicide. This research helps inform federal partners and others about the best ways to support policies and practices that help prevent suicide deaths.

In July, the Substance Abuse and Mental Health Services Administration (SAMHSA) launched the 988 Suicide & Crisis Lifeline, a three-digit suicide prevention and mental health crisis number. This service builds on the existing National Suicide Prevention Lifeline, allowing anyone to call or text 988 to connect with trained counselors and mental health services. Research supported by NIMH helped build the case for such lifelines, and now we’re calling for research aimed at identifying the best ways to help people use this evolving crisis support system. 

Looking Ahead

With these and many other efforts, we are hopeful that people who are at risk for suicidal thoughts and behaviors will be able to access the evidence-based support and services they need. This National Suicide Prevention Awareness Month, I’d like to issue a call to action: Help raise awareness by sharing resources on how to recognize the warning signs for suicide and how to get help. By working together, we can prevent suicide and save lives.

References:

[1] Racial and ethnic disparities in the prevalence of stress and worry, mental health conditions, and increased substance use among adults during the COVID-19 pandemic – United States, April and May 2020. McKnight-Eily LR, Okoro CA, Strine TW, Verlenden J, Hollis ND, Njai R, Mitchell EW, Board A, Puddy R, Thomas C. MMWR Morb Mortal Wkly Rep. 2021 Feb 5;70(5):162-166.

[2] One Year In: COVID-19 and Mental Health. National Institute of Mental Health Director’s Message. April 9, 2021.

Links:

988 Suicide & Crisis Lifeline (Substance Abuse and Mental Health Services Administration, Rockville, MD)

Substance Abuse and Mental Health Services Administration Treatment Locator (SAMHSA)

Help for Mental Illnesses (National Institute of Mental Health/NIH)

Suicide Prevention (NIMH)

Digital Shareables on Suicide Prevention (NIMH)

Digital Shareables on Coping with COVID-19 (NIMH)

NIMH Director’s Messages about COVID-19 (NIMH)

NIMH Director’s Messages about Suicide (NIMH)

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Novel photon-counting CT improves myeloma bone disease detection

New CT technology paired with artificial intelligence (AI)-based noise reduction offers superior detection of bone disease associated with multiple myeloma at lower radiation doses than conventional CT, according to a new study published in Radiology, a journal of the Radiological Society of North America (RSNA).
The new technology, known as photon-counting detector CT, debuted in the clinic in 2021 after decades of development. By directly converting individual x-ray photons into an electric signal, photon-counting detector CT can decrease the detector pixel size and improve the image’s spatial resolution.
“Additionally, photon-counting CT has demonstrated much better dose efficiency than standard CT, which allows for acquisition of ultra-high-resolution images of large areas of the body,” said study lead author Francis Baffour, M.D., diagnostic radiologist at the Mayo Clinic in Rochester, Minnesota.
This potential for improved image quality in whole-body low-dose scans inspired Dr. Baffour and colleagues to study the technology in people with multiple myeloma, a disease that forms in a type of white blood cell found in the bone marrow called a plasma cell. Bone disease characterized by areas of bone destruction known as lytic lesions is found in approximately 80% of multiple myeloma patients.
The International Myeloma Working Group recommends low-dose, whole-body CT to evaluate associated bone disease. Much less is known about photon-counting detector CT is this setting.
Dr. Baffour and colleagues compared photon-counting detector CT with conventional low-dose, whole-body CT in 27 multiple myeloma patients, median age 68 years. The patients underwent whole-body scans with both types of CT and two radiologists compared the images.

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How Abbott Kept Sick Babies From Becoming a Scandal

Early on a Saturday morning in 2013, Mark Bennett, a federal judge, walked into his chambers in the courthouse in Sioux City, Iowa. He’d been out of town for a speaking engagement and was hoping to catch up on work. A surprise awaited him as he entered his office: Cardboard boxes were stacked everywhere. His immediate thought was that another judge might be moving in.Another judge was not moving in. Judge Bennett was presiding over a case in which Abbott Laboratories, the sprawling health care company that dominated the market for infant formula, was being sued on behalf of a girl, Jeanine Kunkel, who five years earlier had suffered severe brain damage after consuming the company’s powdered formula. Jeanine couldn’t speak, sit up or even swallow, and the tragedy had nearly destroyed her family.The boxes cluttering Judge Bennett’s chambers were filled in large part with evidence that Abbott’s lawyers wanted to be able to introduce at the upcoming trial.After more than two decades on the federal bench, Judge Bennett had a pretty good guess as to what was going on. The accusations in the lawsuit posed a threat to Abbott, which had staked its reputation on being family-friendly and devoted to health and safety. Judge Bennett figured that to protect an important client, the company’s outside lawyers, from the international law firm Jones Day, were trying to snow their opponents with tens of thousands of pages of paperwork. Even if the materials were only tangentially related to this particular case, the plaintiffs’ lawyers would need to spend countless hours poring over the documents to see what they contained.A couple of days later, at a meeting in his chambers, the judge laced into Abbott’s lawyers. Their conduct, he told me, was “the worst by a factor of 10” that he had seen in his 20 years as a judge.Judge Bennett, who retired in 2019 and now teaches at Drake University’s law school, may not have liked it, but the lawyers were effective. Over the ensuing months, Abbott prevailed in court, the poisoning of a newborn baby went largely unnoticed and the company continued making and selling its powdered formula just as it had done before.As a federal judge, Mark Bennett oversaw a case involving powdered-infant formula made by Abbott Laboratories.Rachel Mummey for The New York TimesNobody was prepared for what would happen nearly a decade later. In early 2022, after several infants fell ill and regulators found unsanitary conditions at an Abbott factory in Sturgis, Mich., the company voluntarily recalled its powdered formula and shut the plant. (No proof has emerged that the problems at the Sturgis factory caused the infant illnesses and deaths.)The closing caused a severe shortage of the formula that most American infants are fed. Desperate parents struggled to feed their children. Angry lawmakers convened hearings. Government agencies opened investigations. The Biden administration organized an airlift to import formula from overseas. The crisis focused attention on shortcomings with food safety and industry oversight.The scrutiny was new, but the phenomenon wasn’t. Over the years, newborns on rare occasions have fallen sick or died after being fed powdered formula. Until recently, however, the pattern largely lurked below the public and political radar. One big reason is that Abbott and its lawyers, at times deploying scorched earth legal tactics, have repeatedly beaten back attempts to hold the company liable.Several lawyers who have worked on baby-formula cases said they were not aware of a plaintiff ever beating Abbott or its competitors at trial. “These are tough, tough cases,” said William Marler, a Seattle lawyer who has sued companies for spreading food-borne illnesses.Much of this, of course, comes down to good lawyering. Jones Day — a 129-year-old law firm with roots in Cleveland and a powerful political practice in Washington — is a goliath in corporate litigation, having represented companies like R.J. Reynolds, Purdue Pharma, General Motors and Smith & Wesson.Often Jones Day dukes it out with other giant law firms that are also representing enormous companies. When the opposing sides shower each other in paperwork, discovery requests, venue changes and objections, it usually resembles a fair fight. But as the Abbott cases illustrate, when the resources and tactics of Big Law are brought to bear against poor families and their overwhelmed lawyers, the results tend to be lopsided.Jones Day lawyers told me the firm didn’t do anything unusual or untoward as it sought to fend off families like Jeanine’s. Kevyn Orr, the partner in charge of Jones Day’s U.S. offices, said the firm’s only goal “was to prove the truth that Abbott’s infant formula was not contaminated when it was opened.”Daniel Reidy, who until his retirement as a Jones Day partner represented Abbott, disputed elements of Judge Bennett’s critique, noting, for example, that the boxes in his chambers also contained the plaintiff’s evidence. Mr. Reidy said the judge was “deeply and irrevocably prejudiced against ‘big firms.’”There is little doubt, though, that Abbott’s victory streak was one of the forces that kept the connection between infant illness and the powdered formula from becoming a scandal sooner. “If there had been a large verdict, it would’ve gotten a lot of national publicity,” Judge Bennett said. When that didn’t happen, “what’s the focus for the public? Not much.”I learned about Jones Day’s work for Abbott as I conducted research for my forthcoming book, “Servants of the Damned: Giant Law Firms, Donald Trump, and the Corruption of Justice.” (This article is largely based on my reporting for the book.)In January, I asked an Abbott spokesman, Scott Stoffel, for comment. “Healthy infants and children are at the heart of what we do and ensuring the quality and safety of our products is a top priority,” he replied in an email on Jan. 25. “Our products undergo rigorous quality checks,” he went on, “to ensure that they meet both the nutritional and safety needs of infants and children.” In a follow-up email, Mr. Stoffel noted that the company was “very sympathetic to the families in these situations” but that juries had concluded Abbott was not to blame.Barely three weeks later, Abbott agreed to begin recalling its powdered formula.A formula shortage left parents scrambling to feed their babies.Bing Guan/ReutersU.S. soldiers loaded pallets with baby formula at Ramstein Air Base in Germany.Thomas Lohnes/Getty Images‘Time Is on Their Side’A few large companies control the $2.1 billion market for infant formula — none more so than Abbott, which before this year’s crisis accounted for nearly half of formula sales.Unlike breast milk and bottled formula, the powdered version is not sterile. (Its advantages include being less expensive than the ready-to-pour variety.) Academic and government studies have repeatedly found that powdered formula can be a breeding ground for a type of bacteria, Cronobacter sakazakii, that in babies can cause meningitis. Even when treated swiftly, the illness can lead to severe brain damage or death.A study in 2012, by a longtime official at the Centers for Disease Control and Prevention, found that it was “extremely unusual” for Cronobacter infections to occur in babies who were not fed powdered formula. In another paper, published in 2020, other C.D.C. officials studied scores of cases of infant meningitis since 1961 and found that in the vast majority — 79 percent — the baby had recently consumed powdered formula.But in any individual case, it can be hard to prove what caused an infection. The potentially deadly bacteria resides in dirt and water; studies have found it in kitchens. Because the bacteria can clump together in formula containers, it’s possible for a sample to test negative even if Cronobacter was in the powder that went into a baby’s bottle.Nick Stein, a lawyer with a small practice in Indiana, recalled the first time he encountered a case involving contaminated formula. A woman walked into his office with her toddler, limp in her arms, and explained that the child had suffered brain damage after being fed formula. Mr. Stein negotiated a settlement. More cases followed, and they, too, resulted in settlements that required Mr. Stein and his clients to keep quiet.In 2005, Mr. Stein received an email from Kimberly Sisk in rural Pisgah Forest, N.C. Her son, Slade, had suffered debilitating brain damage after consuming Abbott’s Similac powdered infant formula in 2004. Ms. Sisk, who lived in a mobile home and worked as a house cleaner, faced a lifetime of medical costs. In February 2007, Mr. Stein and a colleague, Stephen Meyer, sued Abbott in state court in North Carolina.The ensuing seven-year battle would become a case study for how firms like Jones Day use their mastery of the legal system to grind down — and in some cases attack — plaintiffs who have limited money and time on their hands.The first volley came in late 2007. Jones Day filed a motion seeking to remove Mr. Stein and Mr. Meyer from the case. The rationale was that, in an unrelated infant-formula case in Kentucky, Mr. Meyer had been in touch with an expert witness that Abbott had used in a different case. It turned out the expert had an ongoing relationship with Abbott. None of this had anything to do with Ms. Sisk’s case. But the trial judge concluded that the contact with the expert “constitutes the appearance of impropriety” and granted Abbott’s motion. An appeals court reversed the decision. Then, in 2010, the State Supreme Court upheld the initial ruling.More than three years had passed since Ms. Sisk’s lawsuit was filed, and the case hadn’t progressed. Now she had no lawyers. Mr. Stoffel, the Abbott spokesman, denied that the company was trying to delay the legal proceedings, but Ms. Sisk was skeptical. “Time is on their side,” she said. “It behooves them to stretch it out.”Mr. Stein, for his part, sounded a little awestruck by Jones Day’s hardball tactics. “It’s a different league than we all play in,” he told me. “It was brutal.”Ms. Sisk hired another lawyer, Stephen Rathke, a former local prosecutor in Minnesota. He refiled the suit in state court. Abbott then removed the case to federal court, which essentially restarted the legal process.A ‘Hush-Hush’ OfferAbbott’s strongest defense was that the powdered formula that Ms. Sisk had in her possession when Slade got sick had tested negative for Cronobacter. At the same time, a test of her kitchen sink had turned up traces of the bacteria.Ms. Sisk — who described herself as a neat freak who obsessively sanitized Slade’s bottles and used store-bought distilled water to mix with the powdered formula — said this was because she’d dumped her son’s unfinished milk down the drain. Jones Day argued that it was a sign that the Cronobacter that infected Slade came not from Abbott’s formula but from Ms. Sisk’s home. There is no way to know for sure who was right.The case dragged on. At one point in 2012, when Jones Day objected to a routine filing made by Mr. Rathke, a federal magistrate judge slammed the firm for making “nonsensical” claims that are “a waste of judicial resources.”The trial was scheduled to get underway in early 2014 — nearly a decade after Slade fell ill. In late 2013, Abbott offered to settle the case for $900,000, Ms. Sisk said. She and her lawyers regarded that as inadequate; by their math, she was staring at something like $3 million in expenses associated with Slade’s care. Plus, Ms. Sisk said, “they told me if I settled, I had to keep everything hush-hush.” That was a nonstarter. After Ms. Sisk turned down the settlement, Abbott cranked up the heat. Shortly before the trial began, two Jones Day lawyers, June Ghezzi and Paula Quist, informed the court that they planned to introduce as evidence a restraining order that had been imposed against a member of the Sisk family in 2012 — about eight years after Slade got meningitis. The restraining order stemmed from an assault that involved neither Ms. Sisk nor Slade. Jones Day argued it was relevant because it caused stress that may have contributed to a seizure Slade had.Mr. Rathke, Ms. Sisk’s lawyer, wrote in a court filing that this was “nothing more than an attempt to smear this family” and that “Abbott and its attorneys should be ashamed.” Jones Day ended up not mentioning the restraining order at trial.The firm didn’t need it to win. Jones Day managed to sow doubt about the source of the bacteria. After a weeklong trial, the jury concluded that Abbott was not liable.Immediately afterward, Jones Day sought a court order sealing some trial testimony and evidence on the grounds that they contained confidential information about Abbott’s testing and food safety protocols and “its sanitation, housekeeping and hygiene.” It wasn’t an unheard-of request, but when the judge granted it, details about Abbott’s factory in Sturgis, Mich. — the one that was shut down earlier this year — vanished from public view. (Late last month, Abbott announced that it would resume making Similac infant formula in Sturgis and that the product would begin shipping in about six weeks.)‘Not Going to Answer’As he worked on the Sisk lawsuit, Mr. Rathke was also battling Abbott in a similar case in Iowa. This one involved Jeanine Kunkel, and it would highlight how corporate litigators can flatten outmatched opponents — and potentially cross ethical lines in the process.Years earlier, when Jeanine and her twin brother were 12 days old, she’d been diagnosed with meningitis after being fed Abbott’s powdered formula, which her parents had received in a Similac-branded gift bag from St. Luke’s Regional Medical Center in Sioux City.Jeanine’s parents, Troy Kunkel and Megan Surber, told me that her twin did not drink the formula and did not fall ill.Jeanine Kunkel with her twin brother, James, at their home in Sioux City, Iowa.Rachel Mummey for The New York TimesJeanine receives pain medicine from her parents.Rachel Mummey for The New York TimesMr. Kunkel and Ms. Surber didn’t have much money. They lived in a small house, which Troy had spruced up with carpet and other materials he procured through his job as a construction worker. Their marriage was buckling under the pressure of caring for their brain-damaged child. Ms. Surber’s mother had seen a TV ad for Mr. Stein and urged her daughter to call him. Mr. Stein, who had lost his appetite for fighting Abbott and Jones Day, referred the Kunkels to Mr. Rathke. In 2011, Mr. Rathke sued Abbott, seeking $16 million in compensatory damages to cover a lifetime of caring for Jeanine.The case was assigned to Judge Bennett, who soon became troubled by what he saw from Jones Day. First there was the mountain of evidence in his chambers. Then he began flipping through the transcripts of depositions that Mr. Rathke and Ms. Ghezzi, the Jones Day partner, had taken of witnesses. “I was shocked by what I read,” the judge told me.Time after time, as Mr. Rathke questioned Abbott employees, Ms. Ghezzi had interrupted with objections that seemed intended to steer the witnesses’ testimony. That was potentially a violation of the federal rules of civil procedure, which require objections to be “stated concisely in a nonargumentative and nonsuggestive manner” and warn that “an excessive number of unnecessary objections may itself constitute sanctionable conduct.”In August 2012, for example, Mr. Rathke deposed two Abbott employees, a research scientist specializing in neonatal nutrition and a quality-assurance manager at Abbott’s Arizona factory. Over the course of about seven hours, Ms. Ghezzi lodged objections 115 times — an average of once every three or four minutes. And that didn’t count what Judge Bennett said in a subsequent court filing were hundreds of other interruptions by Ms. Ghezzi. The overall volume, he wrote, was “astounding.”To determine the safety of its powdered baby formula, Abbott draws small samples from large batches of the product at its factories. At one point, Mr. Rathke asked a witness whether she thought there was any correlation between what was found in those samples and the finished product that was shipped to customers. It was, as Judge Bennett later put it, a “completely reasonable” question.Ms. Ghezzi interjected: “Objection — vague and ambiguous.”“That would be speculation,” the witness echoed. Mr. Rathke rephrased. Ms. Ghezzi interrupted again: “Object to the form of the question. It’s a hypothetical; lacks facts.”“Yeah, those are hypotheticals,” the witness parroted. Mr. Rathke rephrased the question one more time.Ms. Ghezzi: “Same objection.”“Not going to answer,” the witness stated.“You’re not going to answer?” Mr. Rathke asked.“Yeah, I mean, it’s speculation. It would be guessing.”“You don’t have to guess,” Ms. Ghezzi chimed in.Over and over, this tag-team routine played out. During a break in one deposition, Mr. Rathke’s co-counsel, a Sioux City lawyer named Tim Bottaro, took Mr. Rathke aside. Ms. Ghezzi was dominating what was supposed to be the plaintiff’s deposition. “Why don’t you just let June do the deposition?” Mr. Bottaro recalled saying. “You’re getting steamrolled!” The depositions were important. Before the trial, Abbott sought a summary judgment ruling based in part on them. Portions would be read aloud to jurors during the trial. There was no telling what the witnesses might have said if Ms. Ghezzi hadn’t objected every few minutes, and Judge Bennett said he found it “inconceivable” that her interruptions had not influenced their testimony.At trial, Mr. Rathke and his expert witnesses argued that the sole logical explanation of how Jeanine got sick was that the bacteria was in the powdered formula. That was the only thing Jeanine had consumed, and it was a common carrier of Cronobacter.Jones Day’s strategy, as is the norm in product liability cases, was to raise doubts and cast blame elsewhere. An expert witness testified that Jeanine’s symptoms showed up so soon after she consumed the formula that she must have already been infected at the time of the feeding. The lawyers noted that the formula that the government tested didn’t contain Cronobacter. Maybe visitors had brought the bacteria into the house? Perhaps it was on the bottle that Megan had used or in the water that she had mixed with the powder. Really, it could have come from anywhere.The jury deliberated for seven hours before delivering its verdict: Abbott was not liable.Mr. Rathke called Jeanine’s parents. “I hate to tell you this, but we lost,” he said.The Abbott formula factory in Sturgis, Mich., was shut down for months after infants fell ill and regulators uncovered problems.Sarah Rice for The New York TimesChristopher Calamari, a senior executive at Abbott, testified before a House committee in May about formula safety.Kevin Wolf/Associated PressA Slew of LawsuitsJudge Bennett was not stunned by the verdict — he’d been impressed by the Jones Day team’s lawyering during the trial — but he told me it was the wrong outcome. “If it had been a bench trial, I would have ruled for the plaintiffs in all likelihood,” he said. (Mr. Stoffel, the Abbott spokesman, said that if the judge felt that way, he could have entered a verdict in the plaintiff’s favor or granted a new trial.)After its recall of formula this year, Abbott has been sued at least 30 times in federal courts around the country. Lawyers representing plaintiffs in those cases said the amount of evidence that has recently entered the public domain — including a lawsuit that the Justice Department filed against Abbott and a whistle-blower complaint submitted to the F.D.A. by a former employee — makes them optimistic that they will fare better against Abbott than their predecessors did.Abbott, though, already appears to be laying the groundwork for a robust defense, repeatedly stating that there is no proven link between its formula and the infants who recently fell sick or died. (Mr. Stoffel said Jones Day is not representing Abbott on any of the recently filed lawsuits.)For the Kunkel family, all of this has been an infuriating reminder of their legal ordeal — and how Abbott managed to avoid public attention to their child nearly dying after consuming powdered formula.“They didn’t want nobody to know” about the risks, Mr. Kunkel told me in August. “How many more families have been hurt since then?”

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High blood pressure awareness, control improved with better access to primary health care

Having easier access to primary care physicians may increase high blood pressure awareness and control regardless of where a person lives, according to new research published today in Circulation: Cardiovascular Quality and Outcomes, a peer-reviewed journal of the American Heart Association.
According to the American Heart Association, nearly half of all Americans have hypertension (high blood pressure), and many don’t even know they have it. High blood pressure is often called the “silent killer” because high blood pressure often has no obvious symptoms. The best ways to protect yourself are to be aware of the risks and make healthy life changes that matter.
In a new study, researchers note that health care professionals at community clinics and primary care practices may help expand awareness and detection of high blood pressure by providing affordable treatment and management. High blood pressure is a leading preventable risk factor for cardiovascular disease, and effective blood pressure control reduces the associated cardiovascular health risks.
“Access to primary care is the key to hypertension management, however, many Americans have limited access to primary care where they live. This is especially true of people in economically disadvantaged neighborhoods or people from diverse racial and ethnic groups, particularly among African American individuals,” said senior study author Brisa Aschebrook-Kilfoy, Ph.D., an associate professor of public health sciences at the University of Chicago in Illinois.
It is well known that better access to primary health care is linked to improved high blood pressure awareness and control. This study sought to clarify if people living in disadvantaged neighborhoods may benefit from better access to primary care health professionals.
In this study, neighborhood socioeconomic status was assessed using the Area Deprivation Index (ADI) created by the Health Resources & Services Administration (HRSA) over three decades ago. The ADI was chosen because it allows for rankings of neighborhoods by socioeconomic disadvantage in a region of interest (e.g., at the state or national level), and it is valuable to inform health delivery and policy, especially for the most disadvantaged neighborhood groups. ADI is composed of 17 indicators covering income, education, employment and housing quality. In this study, socioeconomically disadvantaged neighborhoods were defined as those in census tracts ranked in the 50th percentile and above.

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