Professional Documents
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B 001 001 025
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Anatomy of
A Hospital
Drama
can save your heart. can save your bones. can save your vision, i
Shouldn't you be doing all you can to help preserve your sight?
Recent studies show proper nutrition is vital for eye health and that Lutein is
important to help prevent age-related eye diseases — the leading cause of blindness*
Lutein is found in dark green leafy vegetables but most Americans don't get nearly
the amount recommended for long-term eye health. Even the number one
multivitamin contains neither the Lutein you need nor the Omega-3 that
That's why Bausch & Lomb developed Ocuvite® Adult and Ocuvite® Adult 50+
vitamin and mineral supplements. They contain Lutein, Omega-3 and other powerful
antioxidants eye doctors believe are essential to eye health. So if you want to be sure
your eyes are getting the nutrition they need, start taking Ocuvite today.
Bausch &Lomb
1
*Seddon, J.M.; Ajani, U.A.; Sperduto, R.D.; et al. "Dietary Carotenoids, Vitamins A, C, and E, and Advanced Age-Related
Macular Degeneration." JAMA and
(1994): 272:1413-1420. Delcourt, Carriere, Delage, Barberger-Gateau, Schalch, the POLA
Study Group. "Plasma Lutein and Zeaxanthin and Other Carotenoids as Modifiable Risk Factors for Age-Related
Maculopathy and Cataract: The POLA Study." Investigative Ophthalmology 8 Visual Science, June 2006, Vol. 47, No. 6.
© 2007 Bausch & Lomb Incorporated.
®/TM denote trademarks of Bausch & Lomb Incorporated.
Advertisement
Look Forward
to Healthy Eyes
You rely on your sight to enjoy life’s activities-from reading a book
to playing cards with friends. As you age, however, be aware of
changes your eyesight and know that the nutritional demands
in
These statements have not been reviewed by the Food and Drug
Administration. This product is not intended to diagnose,
treat,
cure or prevent any disease, tm/® denote trademarks of
Bausch
& Lomb incorporated. ©2007 Bausch & Lomb incorporated.
eader’s
Digest
A IN YOUR POCKET*
FEATURES
2 * ON THE COVER
110 Breathing Room 126 Battlefield Advances
LISA COLLIER COOL
MIYAZAKI/REDUX
MICHAEL J. WEISS
Little Kate’sspine was squeezing her Remarkable innovations in treating
lungs, threatening to kill her. A new injured soldiers will ultimately
J
KEVIN
device gives her a fighting chance. benefit us all.
BY
116 Brain Powered 136 Stopping a Stroke
DAN FERBER, PHD LISA COLLIER COOL
PHOTOGRAPHED
A wave of recent advances shows When the mother of two passed out,
how the mind affects health in a revolutionary surgery was her best
ways we never imagined. hope. But the clock was ticking.
215 RDLIVING
The see-more way to sightsee, affordable
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VYTORIN
You probably know that cholesterol comes from food. But what you might not know is that
cholesterol has a lot to do with family history. VYTORIN treats both sources of cholesterol.
Only VYTORIN helps block the absorption of cholesterol that comes from food and reduces
the cholesterol that your body makes naturally. A healthy diet is important, but when it's not
enough, adding VYTORIN can help.
In clinical trials, VYTORIN lowered bad cholesterol more than Lipitor alone. VYTORIN
contains two cholesterol medicines: Zetia (ezetimibe) and Zocor (simvastatin) in a single tablet.
Continue to follow a healthy diet, and ask your doctor about adding VYTORIN.
't/
VYTORIN and ZETIA are registered trademarks of MSP Singapore Company, LLC.
Other brands listed are the trademarks of their respective owners and are not trademarks of MSP Singapore Company, LLC.
from 2 sources:
Family
Important information: VYTORIN is a prescription tablet and isn't right for everyone,
including women who are nursing or pregnant or who may become pregnant, and anyone with
liver problems.
Unexplained muscle pain or weakness could be a sign of a rare but serious side effect and
should be reported to your doctor right away. VYTORIN may interact with other medicines or
certain foods, increasing your risk of getting this serious side effect. So, tell your doctor about
any other medications you are taking.
VYTORIN
lezetimibe/simvastatin)
Treat the 2 sources of cholesterol.
VYTORIN® (ezetimibe/simvastatin)Tablets
Patient Information about VYTORIN (Vl-tor-in)
Generic name: ezetimibe/simvastatin tablets
Read this information carefully before you weakness.This is because on rare occasions,
start taking VYTORIN. Review this information muscle problems can be serious, including
each time you refill your prescription for muscle breakdown resulting in kidney damage.
VYTORIN as there may be new information.
This information does not take the place of The risk of muscle breakdown is greater at
talking with your doctor about your medical higher doses of VYTORIN.
condition or your treatment. If you have any
questions about VYTORIN, ask your doctor. The risk of muscle breakdown is greater in
Only your doctor can determine if VYTORIN patients with kidney problems.
is right for you.
section at the end of this information sheet. are taking coumarin anticoagulants (drugs
that prevent blood clots, such as warfarin).
• Ifyou have active liver disease or
repeated blood tests indicating possible Tellyour doctor about any prescription and
liver problems. nonprescription medicines you are taking
or plan to take, including natural or herbal
• If you are pregnant, or think you may remedies.
be pregnant, or planning to become
pregnant or breast-feeding. Tellyour doctor about all your medical
conditions including allergies.
VYTORIN is not recommended for use in
children under 10 years of age. Tell your doctor if you:
• Take VYTORIN once a day, in the evening, General Information about VYTORIN
with or without food.
Medicines are sometimes prescribed for
• Try to take VYTORIN as prescribed. If you conditions that are not mentioned in patient
miss a dose, do not take an extra dose. information leaflets. Do not use VYTORIN for
Just resume your usual schedule. a condition for which it was not prescribed.
Do not give VYTORIN to other people, even if
• Continue to follow a cholesterol- they have the same condition you have. It
lowering diet while taking VYTORIN. Ask may harm them.
your doctor if you need diet information.
vaccines. A pill
^ g
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FDIC
Editor-in-Chief Jacqueline Leo Group Publisher Denise Favorule
Executive Editor MarciaRockwood Publisher Benjamin D. Madden
Hannu Laakso
Design Director Associate Publisher, Group Marketing Lauren Jay
West Coast Editor Meg Grant Advertising Sales New York Ed Proshuto, John McKittrick,
Health Director Julie Bain Leslie Bergen, Tricia Branch, Laurie Evans, Sylvia Pakeman,
Director of Reporting and Research Deirdre M. Casper Katie Phelan, Andy Spinelli Chicago Scott Ashmore, Brian
Managing Editor Lawrence McIntyre Brigman, Heather Goeld, Lisa Morton, Lisa Schluchter
Detroit Todd Rankin San Francisco Mike Ostfeld,
Features Editors Donna G. Banks, Gary A. Sledge Noreen Tomita
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Ed Shanahan Marketing Jill Fischer (Director), Patty Bogie
Senior Editors Patricia Curtis ( RD Living), Business Office Jeremy Carlucci, Gisele Myer
Andy Simmons (Humor)
Vice President, Consumer Marketing Cara L. Schlanger
Senior Writer Kenneth Miller Retail Sales David Algire
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Reporters Carol Kaufmann (National Affairs), Public Relations Ellen Morgenstern
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in Braille, on cassette, in large print, and in a digital version Senior Counsellor Melvin R. Laird
L -
i • «•
.* y
i«r~_
ThermaCare.
’Use as Erected. Have heat. Will travel.
aRis
People with COPD breathe better with SPIRIVA.
SPIRIVA does not replace fast-acting inhalers for sudden symptoms. Do not
swallow the SPIRIVA capsule. The most common side effect of SPIRIVA is dry
mouth. Others include constipation and problems passing urine. Tell your doctor
about your medicines, including eye drops, and illnesses like glaucoma and urinary
or prostate problems. These may worsen with SPIRIVA. If you have vision
changes, eye pain, your breathing suddenly worsens, you get hives, or your throat
Please see brief summary of full Prescribing Information on the following pages.
INDICATIONS AND USAGE and 0.5 times the Recommended Human Daily Dose (RHDD) on a mg/nr basis,
SPIRIVA HandiHaler (tiotropium bromide inhalation powder) is indicated for the respectively. These dose multiples may be over-estimated due to difficulties in
long-term, once-daily. maintenance treatment of bronchospasm associated with measuring deposited doses in animal inhalation studies
chronic obstructive pulmonary disease (COPD), including chronic bronchitis and Tiotropium bromide demonstrated no evidence of mutagenicity or clastogenicity in
As an anticholinergic drug, SPIRIVA (tiotropium bromide inhalation powder) may in the number of live pups at birth and the mean pup weights, and a delay in pup
potentially worsen symptoms and signs associated with narrow-angle glaucoma, sexual maturation were observed at inhalation tiotropium doses of >0.078 mg/kg
prostatic hyperplasia or bladder-neck obstruction and should be used with caution (approximately 35 times the RHDD on a mg/m' basis). In rabbits, an increase in
in patients with any of these conditions. post-implantation loss was observed at an inhalation dose of 0.4 mg/kg/day
As a predominantly renally excreted drug, patients with moderate to severe renal (approximately 360 times the RHDD on a mg/m basis). Such effects were not
impairment (creatinine clearance of <50 mL/min) treated with SPIRIVA should be observed at inhalation doses of 0.009 and up to 0.088 mg/kg/day in rats and
monitored closely (see CLINICAL PHARMACOLOGY, Pharmacokinetics, Special rabbits, respectively. These doses correspond to approximately 4 and 80 times the
Populations, Renally-impaired PatientSj. RHDD on a mg/m basis, respectively. These dose multiples may be over-estimated
Information for Patients due to difficulties in measuring deposited doses in animal inhalation studies
It is important for patients to understand how to correctly administer SPIRIVA There are no adequate and well-controlled studies in pregnant women. SPIRIVA
capsules using the HandiHaler inhalation device (see Patient’s Instructions for should be used during pregnancy only if the potential benefit justifies the potential
Use). SPIRIVA capsules should only be administered via the HandiHaler device and risk to the fetus.
the HandiHaler device should not be used for administering other medications. Use in Labor and Delivery
Capsules should always be stored in sealed blisters and only removed immediately The safety and effectiveness of SPIRIVA has not been studied during labor and
before use. The blister strip should be carefully opened to expose only one capsule delivery.
at a time. Open the blister foil as far as the STOP line to remove only one capsule Nursing Mothers
at a time. The drug should be used immediately after the packaging over an data from nursing women exposed
Clinical to tiotropium are not available Based
individual capsule is opened, or else its effectiveness may be reduced. Capsules
on lactating rodent studies, tiotropium is excreted into breast milk. It is not known
that are inadvertently exposed to air (i.e., not intended for immediate use) should whether tiotropium is excreted in human milk, but because many drugs are
be discarded. excreted in human milk and given these findings in rats, caution should be
Eye pain or discomfort, blurred vision, visual halos or colored images in association exercised if SPIRIVA is administered to a nursing woman.
with red eyes from conjunctival congestion and corneal edema may be signs of Pediatric Use
acute narrow-angle glaucoma. Should any of these signs and symptoms develop,
SPIRIVA HandiHaler is approved for use in the maintenance treatment of
consult a physician immediately. Miotic eye drops alone are not considered to be
bronchospasm associated with chronic obstructive pulmonary disease, including
effective treatment.
chronic bronchitis and emphysema. This disease does not normally occur in
Care must be taken not to allow the powder to enter into the eyes as this may children The safety and effectiveness of SPIRIVA in pediatric patients have not
cause blurring of vision and pupil dilation.
been established
SPIRIVA HandiHaler is a once-daily maintenance bronchodilator and should not be Geriatric Use
used for immediate relief of breathing problems, i.e., as a rescue medication.
Of the total number of patients who received SPIRIVA in the 1 -year clinical trials.
Drug Interactions 426 were <65 years, 375 were 65-74 years and 105 were >75 years of age
SPIRIVA has been used concomitantly with other drugs commonly used in COPD Within each age subgroup, there were no differences between the proportion of
without increases in adverse drug reactions. These include sympathomimetic patients with adverse events in the SPIRIVA and the comparator groups for most
bronchodilators, methylxanthines, and oral and inhaled steroids. However, the co- events. Dry mouth increased with age in the SPIRIVA group (differences from
administration of SPIRIVA with other anticholinergic-containing drugs (eg., placebo were 9.0%, 17.1%, and 16.2% in the aforementioned age subgroups) A
ipratropium) has not been studied and is therefore not recommended. higher frequency of constipation and urinary tract infections with increasing age
Orug/Laboratory Test Interactions was observed in the SPIRIVA group The
in the placebo-controlled studies
The most commonly reported adverse drug reaction was dry mouth. Dry mouth was usually mild and often resolved during continued treatment. Other reactions reported
in individual patients and consistent with possible anticholinergic effects included constipation, increased heart rate, blurred vision, glaucoma, urinary difficulty, and
urinary retention
Four multicenter, 1-year, controlled studies evaluated SPIRIVA in patients with COPD. Table 1 shows all adverse events that occurred with a frequency of >3% in the
SPIRIVA group in the 1-year placebo-controlled trials where the rates in the SPIRIVA group exceeded placebo by £1%. The frequency of corresponding events in the
ipratropium-controlled trials is included for comparison.
Table 1: Adverse Experience Incidence (% Patients) in One-Year-COPD Clinical Trials
Dry Mouth 16 3 12 6
Dyspepsia 6 5 1 1
Vomiting 4 2 1 2
Musculoskeletal System
Myalgia 4 3 4 3
Resistance Mechanism Disorders
Infection 4 3 1 3
Moniliasis 4 2 3 2
Respiratory System (upper)
Epistaxis 4 2 1 1
Pharyngitis 9 7 7 3
Rhinitis 6 5 3 2
Sinusitis 11 9 3 2
Upper Respiratory Tract Infection 41 37 43 35
Skin and Appendage Disorders
Rash 4 2 2 2
Urinary System
Unnary Tract Infection 7 5 4 2
I Arthritis, coughing, and influenza-like symptoms occurred at a rate of >3% in the SPIRIVA treatment group, but were <1% in excess of the placebo group.
Other events that occurred in the SPIRIVA group at a frequency of -3%
trials where the rates exceeded that in the placebo group include: Body
1 in the placebo-controlled
as a Whole: allergic reaction, leg pain: Central and Peripheral Nervous System: dysphonia, paresthesia: Gastrointestinal System Disorders: gastrointestinal disorder not
otherwise specified (NOS), gastroesophageal reflux, stomatitis (including ulcerative stomatitis); Metabolic and Nutribonal Disorders: hypercholesterolemia,
hyperglycemia;
I Musculoskeletal System Disorders: skeletal pain: Cardiac Events: angina pectoris (including aggravated angina pectoris); Psychiatric Disorder: depression;
Infections:
herpes zoster: Respiratory System Disorder (Upper): laryngitis; Vision Disorder: cataract. In addition, among the adverse events observed the clinical
in trials with an
incidence of <1 % were atrial fibrillation, supraventricular tachycardia, angioedema, and urinary retention.
I
In the 1 -year trials, the incidence of dry mouth, constipation, and urinary tract infection increased with age (see PRECAUTIONS, Geriatric Use)
Two multicenter, 6-month, controlled studies evaluated SPIRIVA in patients with COPD. The adverse events and the incidence rates were similar to those seen in the
1 -year controlled trials.
The following adverse reactions have been identified during worldwide post-approval use of SPIRIVA: dizziness, epistaxis, hoarseness, palpitations, pruritus, tachycardia,
throat irritation, and urticaria.
carton containing 6 SPIRIVA capsules (1 blister card) and 1 HandiHaler inhalation device (NDC 0597-0075-06)
carton containing 30 SPIRIVA capsules (5 blister cards) and 1 HandiHaler inhalation device (NDC 0597-0075-37)
only
SV-BS (10/05)
SP277540A Copyright ©2006, Boehringer Ingelheim Pharmaceuticals, Inc. All rights reserved. (12/06)
® Boehringer
Ingelheim
YOU SAID IT
LETTERS ON THE JANUARY ISSUE
A Case of Abuse
was appalled by the mili-
tary doctors who didn’t
I correctly diagnose osteo-
genesis imperfecta, also
known as brittle bone dis-
ease, in Liliana Velasquez
(“A Parent’s Worst Night-
mare”). In 1956, long before
tests were available, my oldest
child fractured his leg when he
was six months old. Fortunately, Services workers were to appear on
the doctor immediately recognized my doorstep, I would immediately
signs of OI. order them from the property and
I was never accused of child refuse to participate or allow my
abuse, like Liliana’s father, even children to participate in any
though my son fractured his legs interview or examination in the
nine more times before he turned absence of a direct court order.
five. HELEN MEULINK, Grand Rapids. Michigan And I would immediately hire the
best attorneys I could find to go on
Tale”).
Victory
My
daughter was very sick with
asthma and unable to run and play
with the neighborhood kids. One
day, her school took a field trip to
Victory Gallop. That evening, she
couldn’t wait to tell me about riding
a horsenamed Jay-Ray. My daughter
has been taking lessons there for
over a year. She was once very shy
and afraid she’d fall off the horse.
Now she’s a confident little girl who
can ride without a lead, l. h., via Internet
Signs of Trouble
our article on male depres-
NUTnutrition.com
move
allow
mance of a terminated employee. Planters NUT-ritlon Energy Mix. The sweet and savory
We said we would be happy to combination of almonds, honey roasted sesame sticks,
The Preacher
ILLYGRAHAM’S ADVICE is
simple yet profoundly
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all people
New Caltrate.
The key to strong bones:
Wyeth
© 2006 Wyeth Consumer Healthcare
'These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.
caltrate.com
Are you getting relief for your stabbing,
burning, shooting pain?
nerves that cause this pain. So you can start to think about other things
besides your pain. LYRICA is one of several treatments for you and your
doctor to consider. Call today to find out if LYRICA can help.
Prescription LYRICA is not for everyone. Some of the most common side
LYRICA are dizziness and sleepiness. Others are dry mouth, swelling
effects of
ofhands and feet, blurry vision, weight gain, and trouble concentrating. You
may have a higher chance of swelling or gaining weight if you are also taking
certain diabetes medicines. And, if you drink alcohol or take medicines that
make you sleepy, you may feel more sleepy when you start LYRICA. You
should not drive a car or work with machines until you know how LYIUCA
affects you. Tell your doctor about any changes in your eyesight, muscle pain
along with a fever or tired feeling, or skin sores due to diabetes. Also tell your
doctor if you are planning to father a child. If you have had a drug or alcohol
problem, you may be more likely to misuse LYRICA. You should talk with your
doctor before you stop taking LYRICA or any other prescription medication.
j®. , .
Uninsured? Need help paying for medicine? Pfizer has programs that can
^lp, no matter Your a 8 e or income. You may even qualify for free Pfizer
xMwers
medicines. Call 1-866-706-2400. Or visit www.pfizerhelpfulanswers.com
Ple&se see important product infomneition on sdjecent pege. © 2007 razerinc-MiighE reserved. PB280598F
IMPORTANT FACTS Lyri'ca (LEER-i-kah)
LYRICA may cause problems with your eyesight, including blurry vision. Call your doctor
if you have any changes in your eyesight.
ABOUT LYRICA
LYRICA is a prescription medicine used to treat:
• Nerve pain from diabetes
• Nerve pain that continues after the rash from shingles heals
This pain can be sharp or burning. It can feel like tingling, shooting, or numbness. Some
people taking LYRICA had less pain by the end of the first week. LYRICA may not work
for everyone.
• Have abused drugs or alcohol. LYRICA may cause some people to feel “high.”
• Are either a man or woman planning to have children or a woman who is breast-feeding,
pregnant, or may become pregnant. It is not known if LYRICA may decrease male fertility,
cause birth defects, or pass into breast milk.
Tell your doctor about all your medicines. Include over-the-counter medicines, vitamins, and
herbal products. Tell your doctor if you take:
• Rosiglitazone (Avandia®)* or pioglitazone (Actos®)** for diabetes
• Narcotic pain medicines such as oxycodone, tranquilizers, or medicines for anxiety such
as lorazepam
• Any medicines that make you sleepy
PARKE-DAVIS,
New York, NY
Division of Pfizer Inc.
10017 Rx only
© 2007 Pfizer Inc.
All rights reserved. Printed in USA.
PBIF Rev. 1 ,
May 2006
* Avandia is a registered trademark of GlaxoSmithKline.
**Actos is a registered trademark ofTakeda Chemicals Industries, Ltd., and is used under license
by Takeda Pharmaceuticals of America, Inc., and Eli Lilly and Co.
02007 CSC Brands IP
rntngw,
n! Good! /7> 0
LiOhbeAyole/
CampbellsKitchen.com POSSiBiLiTieS
W ithin the past year, several
states
its
have raised speed lim-
along some stretches of
highway. In Texas, those
can legally drive 80
who want to
mph on parts of SPEED
two Now, other states
interstates.
including Louisiana and Kentucky
are considering similar moves.
What’s the rush? Yes, there is evi-
LIMIT
dence that adjusting speed limits to
reflect the true rate at which mo-
torists travel actually boosts safety.
But conflicting data in Iowa and Indi-
ana shows an uptick in interstate fa-
talities
limits.
since those states increased
At the very
legislators across the
least,
country may
it
Falling Hook,
Online and Sinker
ro fishing is a big-time sport: Total
in a prize catch
without baiting a hook. Thanks to the
growing popularity of fantasy fishing,
thousands flock to the FLW Outdoors
and ESPN websites during tournament season
and, like those who play fantasy baseball and
football, pick top performers by analyzing key
statistical data. An angler’s “catch average” on
a certain lake, for instance, can be a telling stat
Prizes for picking a winner — $5,000 per tour-
ney (FLW); gadgets and fancy fishing gear
(ESPN)— make the number-crunching
worthwhile. Better still, there’s nothing to clean.
Getting Dressed
For the Night Shift
So what if we’re not getting enough shut-
eye these days? At least we’re dressing
like we’ll be ready if the opportunity to
FAT
CHOLESTEROL
CALORIES
PROTEIN
RD I
MARCH 2007
Lincoln Bicentennial
Commission has begun
approving some events, COURTESY
YEA NAY
Starbucks and KFC For joining the Fairfax County, Virginia, library officials
ranks of chain eateries shedding trans For using computer software to aggres-
k. fats from the menu. Even sively weed out books not checked out
/ if we're in a rush, our for two years or more. Budget cuts may
SHf arteries shouldn’t have make shelf space precious, but this
to pay the price. move speaks volumes. .
, ,
prudes, but it’s a good step. A school justice in a federal voting-rights suit.
dance isn't the place for this stuff. We hope the station gets lots of static.
32
(THE MOST IMPORTANT, DECISIONS START
lifixi xi r- i j/\ ^x t a & -*- p%-iA mi > VHI
WITH THE MOST IMPORTANTiPEOPLE.
i i
1
There's strong. And then there's Army Strong. You taught them right from wrong.
You told them they could do anything. Now they want the discipline, leadership
training and college benefits that come from being In the U.S. Army.
If your son or daughter wants to talk about joining, listen. You just might be proud
of what they have to say. Find out more at goarmy.com/for_parents.
M
We Don't Want You to Miss
C
Bridge to
Terabithia
faithful
is
big-screen
a
Watch conserva-
tive kid
J.
Michael
Fox baffle his
adaptation of Kath- liberal parents on
erine Paterson’s the first season of
RD's picks for great
1978 Newbery ’80s fave Family
ways to spend your Medal-winning On 2/20
MU
Ties. sale
ANN/CORBIS
I
HOME touched only
briefly
Johnny Cash's
on
BETTM
CASH)
On sale 3/6
Contributor: LINDSAY MILLER
34
Qoiffi• n
Jve teeo
9 Poking?
Here*
® of ever, w
fh ;
Milpc>u/et
1 always HentbJck.
So here I am...
Worrying about
iYiy h&Q \th
THE UNEXPECTED
From her EVERYDAY
home computer,
Shannen Rossmiller
helps take down
terrorists.
Cybersleuth
Mom
BY LYNN ROSELLIN1
W
tember 11,
as it coincidence?
Fate? Shannen Ross-
miller isn’t sure. But
on the evening of Sep-
2001, after a wrenching
day absorbing horrific images of
death and destruction from the East
Pennsylvania. But before long, her
tears turned to anger.
these terrorists?
Who were
And why
our government protect us? Ross-
miller was
couldn’t
miller remained in bed, her husband about serial killers. With a degree
drove to Great Falls, 45 miles away. in criminal justice and paralegal
He brought his wife books on A1 studies, she speaks French, Spanish
Qaeda, Islam and jihad, as well as and German, and had signed up for
a biography of the Prophet Muham- an online course in Arabic.
mad. When she was able to sit up, One night, she dared herself to
Rossmiller logged on to alneda.com, post a message on a Saudi Arabian
then one of A1 Qaeda’s main Inter- Internet forum known for its violent
anti-American content.
An idea took form: Why Within a few months, Ross-
miller had begun to establish
couldn't she infiltrate contacts among the muja-
40
Act fast.
At the first sign of flu, see your doctor and ask about antiviral medications that
can help you feel better faster and that can help keep the rest of your family from
getting the flu. Learn more at fluFACTS.com.
fluFACTS.com
“Slain Pastor’s Wife Says Little in Court” ap, submitted by karen robbins
42
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WE TESTED FORMULA 410 ONCE,
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BY SACHA ZIMMERMAN, GUEST COLUMNIST
ico;
Florida;
South Dakota,
Donaldson
his earnings as a
broadcast journalist with $88,308
for a livestock ranch in New Mex-
and Rockefeller, a financier and
philanthropist, got $553,782 for two
to rich guys like these in the form farms in New York.
of farm subsidies. That’s right, our Appalled that your tax money is
government is paying big bucks to going to people who hardly need a
wealthy individuals who happen handout? Well, it’s worse than you
BEACH
and soybeans. Among those soaking just another way to let Congress
up the subsidies are well-to-do bring home the bacon.” Among
operators of large industrial farms. those legislators whose districts are
Meanwhile, the small, struggling living high off the hog are Rep. Jerry
farmer who may actually need Moran of Kansas, Rep. Earl Pomeroy
assistance is getting squeezed out of North Dakota and Rep. Tom
of business by the big boys lined Osborne of Nebraska.
up at the public trough. Those locales are no big surprise,
Talk about an abuse of tax money. since they’re home to many agri-
The good news is that this year, businesses. But take a look at the
Congress is scheduled to craft a farm subsidy website of the Envi-
new farm bill— a fresh chance to fix ronmental Working Group, and
the mess. The bad news is that farm you’ll see some baffling zip codes,
subsidies have a long history and a like 90210. That’s Beverly Hills,
lot of political muscle behind them. which has 136 subsidized farmers
It all began during the Great listed! For my own urban neighbor-
Depression, when FDR got Congress hood in Washington, D.C., the site
to pass laws designed to help cash- identifies 62 farmers getting federal
strapped farmers. The government money. And 80 on the Lower East
introduced price supports for vari- Side of Manhattan.
ous crops, and in periods when the Let’s be generous and assume
crop yield outpaced market demand, these folks are genuinely operating
the feds agreed to buy the excess farms somewhere. Do they really
supply. These and other subsidies need to be on the dole?
continued to grow until, in the With pork being served so freely,
47
WEIGH the FACTS
not previously taken methotrexate. Almost 2 out of 3 people taking HUMIRA and
methotrexate had no further joint damage after one year (compared to 37% taking
HUMIRA can reduce the pain, inflammation and fatigue of moderate
methotrexate alone.)
to severeRA that make simple tasks impossible. HUMIRA is usually injected in the
convenience of your own home. So don’t wait to talk to your rheumatologist.
HUMIRA
adalimumab
Visit HUMIRA.com or call 1.800.205.7029.
Individual results may vary. “Diagnosed with moderate to severe RA for less than 3 years.
Important Safety Information About HUMIRA* (adalimumab). HUMIRA is
approved for reducing the signs and symptoms, inducing major clinical
response,
slowing the progression of joint damage, and improving physical function in
adult
patients with moderate to severe rheumatoid arthritis. HUMIRA is approved
for
reducing the signs and symptoms of active arthritis in patients with psoriatic arthritis.
HUMIRA can be used alone or with methotrexate or other DMARDs (disease modifying
anti-rheumatic drugs). HUMIRA is also approved for reducing signs and symptoms in
patients with active ankylosing spondylitis.
you have ever been treated for heart failure. Do not start taking HUMIRA if you are
allergic to the drug or anything in it. Once you start taking HUMIRA, tell your doctor
right away or seek emergency care immediately if you have an allergic reaction (a
bad rash, swollen face or trouble breathing). Tell your doctor right away if you have
signs of a blood disorder (persistent fever, bruising, bleeding or paleness). There have
been rare cases of severe allergic reactions after taking HUMIRA. Lymphoma, rare
cases of nervous system disorders, and blood disorders have occurred in patients
taking TNF blockers, including HUMIRA. Tell your doctor about all medicines you
are taking or considering. The combination of
HUMIRA and Kineret (anakinra) is not
recommended. Check with your doctor before you receive any vaccines or before you
have major surgery. Tell your doctor if you are pregnant, become pregnant or plan
to become pregnant. The most common side effects of HUMIRA are injection site
reactions (redness, rash, swelling, itching or bruising), upper respiratory and sinus
infections, headache, and nausea.
©2006 Abbott Laboratories Abbott Park, IL 60064 06H-64R-Q493-1 August 2006 Printed in U.S.A.
CONSUMER BRIEF SUMMARY prefilled syringe contains dry natural rubber. Tell your doctor if you
CONSULT PACKAGE INSERT FOR FULL PRESCRIBING INFORMATION have any allergies to rubber or latex.
HUMIRA?
HUMIRA® Tell
•
your doctor
Any
if you have or have had any of the following:
kind of infection including an infection that is in only one
(adalimumab)
place in your body (such as an open cut or sore), or an infection
Patient Information that is in your whole body (such as the flu). Having an infection
Read this leaflet carefully before you start taking HUMIRA could put you at risk for serious side effects from HUMIRA.
(hu-mare-ah). You should also read this leaflet each time you get If you are unsure, please ask your doctor.
your prescription refilled, in case something has changed. The • If you are a carrier of or suspect that you may be infected with
information in this leaflet does not take the place of talking with your the hepatitis B virus.
doctor before you start taking this medicine and at check ups. Talk to • A history of infections that keep coming back or other
your doctor if you have any questions about your treatment with conditions that might increase your risk of infections.
HUMIRA. • Ifyou have ever had tuberculosis (TB), or if you have been in
should know about close contact with someone who has had tuberculosis. If you
What is the most important information I
infections. Before starting HUMIRA your doctor should test you for TB and perform a skin test.
you experience any If you are not sure or have any questions about any of this
Tell your doctor or seek medical treatment if
information, ask your doctor.
signs or symptoms that may indicate you have developed an infection
such as persistent cough, weight loss, fever, chills, congestion or Need Know About Side Effects
What Important Information Do I to
flu-like symptoms. with HUMIRA?
Also see “What important information do I need to know about Any medicine can have side effects. Like all medicines that affect
side effects with HUMIRA?” for information regarding other your immune system, HUMIRA can cause serious side effects. The
serious side effects. possible serious side effects include:
Serious Infections
What Is HUMIRA?
HUMIRA is a medicine that is used in people with moderate to There have been rare cases where patients taking HUMIRA or other
(RA), with psoriatic (PsA), or TNF-blocking agents have developed serious infections, including
severe rheumatoid arthritis arthritis
tuberculosis (TB) and infections caused by bacteria or fungi. Some
with a type of arthritis called ankylosing spondylitis (ank-e-low-sing
patients have died when the bacteria that cause infections have
spond-e-lie-tis) (AS). RA is an inflammatory disease of the joints.
may be given other important information I should know about HUMIRA?” for
inflammatory disease of the spine. People
HUMIRA. additional information regarding infections.
medicines for their disease before they are given
Hepatitis B
How Does HUMIRA Work? HUMIRA may result in
Treatment with TNF-blocking agents such as
HUMIRA is a medicine called a TNF blocker, that is a type of protein a reactivation of the hepatitis B virus in people who carry this virus
that blocks the action of a substance your body makes called
in a dormant state. In some cases patients have died as a result of
TNF-alpha. TNF-alpha (tumor necrosis factor alpha) is made by your
hepatitis B virus being reactivated. If you know or suspect you may
body’s immune system. People with RA, PsA, or AS have too much
be a carrier of hepatitis B virus, be sure to tell your doctor about this
of it in their bodies. The extra TNF-alpha in your body can attack
as this may impact the decision to start treatment with HUMIRA.
normal healthy body tissues and cause inflammation especially in the
tissues in your bones, cartilage, and joints. HUMIRA helps reduce
Nervous System Diseases
There have been rare cases of disorders that affect the nervous system
the signs and symptoms of RA (such as pain and swollen joints), may
help prevent further damage to your bones and joints, and may help of people taking HUMIRA or other TNF blockers. Signs that you
perform daily addition, could be experiencing a problem affecting your nervous system
improve your ability to activities. In
include: numbness or tingling, problems with your vision, weakness
HUMIRA helps reduce the signs and symptoms of PsA (such as pain
and swollen joints). HUMIRA helps reduce the signs and symptoms in your legs and dizziness.
HUMIRA can make you more prone to getting infections or make RA that have had the disease for a long time may have a higher than
average risk of getting a kind of cancer that affects the lymph system,
any infection you have worse.
called lymphoma. If you take HUMIRA or other TNF blockers, your
Who Should Not Take HUMIRA? risk may increase.
You should not take HUMIRA if you have an allergy to HUMIRA or
Lupus-like Symptoms
to any of its ingredients (including sodium phosphate, sodium citrate,
Some patients have developed lupus-like symptoms that got better
citric acid, mannitol, and polysorbate 80). The needle cover on the
after their treatment was stopped. If you have chest pains that do not been shown how to inject HUMIRA before you do yourself. You it
go away, shortness of breath, joint pain or a rash on your cheeks or can call your doctor or the HUMIRA Patient Resource Center at
arms that is sensitive to the sun, call your doctor right away. Your 1-800-4HUMIRA (448-6472) if you have any questions about giving
doctor may decide to stop your treatment. Someone you know can also help you with
yourself an injection.
your injection. Remember to take this medicine just as your doctor
Blood Problems
has told you and do not miss any doses.
In some patients the body may fail to produce enough of the blood
cells that help your body fight infections or help you to stop bleeding. What Should I Do If I Miss a Dose of HUMIRA?
If you develop a fever that doesn't go away, bruise or bleed very If you forget to take HUMIRA when you are supposed to, inject the
easily or look very pale, call your doctor right away. Your doctor may next dose right away. Then, take your next dose when your next
decide to stop treatment. scheduled dose is due. This will put you back on schedule.
Heart Problems
Is One Time Better Than Another for Taking HUMIRA?
You should tell your doctor if you have ever been treated for heart
Always follow your doctor's instructions about when and how often
failure. If you have, your doctor may choose not to start you on
to take HUMIRA. To help you remember when to take HUMIRA,
HUMIRA, or may want to monitor you more closely. If you develop
you can mark your calendar ahead of time with the stickers provided
new or worsening problems like shortness of breath or swelling of
in the back of the patient information booklet. For other information
your ankles or feet, you should call your doctor right away.
and ideas you can enroll in a patient support program by calling the
Allergic Reactions HUMIRA Patient Resource Center at -800-4HUMIRA (448-6472). 1
In rare cases, patients taking HUMIRA have had severe allergic reactions
leading to difficulty breathing and low blood pressure, or shock. Allergic
How Do I Dispose of Syringes and Needles?
reactions can happen after your first dose or may not happen until after
You should always check with your healthcare provider for
instructions on how to properly dispose of used needles and syringes.
you have taken HUMIRA many times. If you develop a severe rash,
Yes, you can take other medicines provided your doctor has contains a glass syringe.
prescribed them, or has told you it is ok to take them while you are Keep HUMIRA, injection supplies, and all other medicines out of the
taking HUMIRA. It is important that you tell your doctor about any reach of children.
other medicines you are taking for other conditions (for example,
Ref: 03-55 16-R9
high blood pressure medicine) before you start taking HUMIRA.
Revised: July, 2006
You should also tell your doctor about any over-the-counter drugs,
herbal medicines and vitamin and mineral supplements you are
taking.
You should not take HUMIRA with other TNF blockers. If you have
questions, ask your doctor.
2
If you want to quit smoking,
today’s your day.
3. endeavor n
A: earnest attempt.
.
5 * 15. verdant adj.—
A: truthful. B: lush with
vegetation. C: inac-
B: heavy burden. tive. D: easily angered.
C: affection.
16. sardonic adj.—
D: approval.
A: optimistic. B: restful.
4. amenable adj.— C: scornfully mocking.
A: withdrawn. B: agree- 8. eminent adj.— D: stylish.
able. C: exceptional. A: recently retired.
D: hopeless. B: greatest. C: deeply Birthday Boy
5.perplex v.— A: to emotional. D: likely.
March 12 marks 85 years
suspend. B: change 9. innumerable adj.— since Kerouac's birth. Fill
without permission. A: essentially harmless. in these blanks for the titles
C: confuse. D: speak B: untimely. C: count- of some of his other books.
out forcefully. less. D: unusually Answers on the next page.
6. recrimination n.— curious.
T— D-a— B-s
A: advice. B: legal 10. cajole v — A: to D-t-r -ax
protection. C: collec- confront. B: persuade. B-- S-r
tion of money or goods. C: deflect blame. Lo-s-e T-a-ler
D: countercharge. * D: calculate. Ma-i- C-ssi-
ILLUSTRATED BY DAVID SHELDON 53
RD I
MARCH 2007
ANSWERS
1.inhibition— [C]
Something that re- 7.grimace — [D] 12. dichotomy— [A] Divi-
sion into two parts. The
strains or suppresses. pollster was amazed by
Luckily, her inhibitions
Contorted facial the clear dichotomy be-
prevented her from expression. Her tween men and women
doing anything too voters in the small town.
foolish. father’sgrimace 13. firmament— [A] The
vault or expanse of the sky
2. forlorn— [B] Miser- told her she
able, as in condition or heavens.Even after
or appearance. The was in these years, he was
all still
54
Lunesta Lu llab y.
. ta
^zopidone)G
_
Peaceful, gentle sleep. Isn’t that what you long for? That's what uwoawTwns
Lunesta® is all about: helping most people fall asleep quickly, and stay asleep all
through the night. It’s not only non-narcotic, it’s approved for long-term use. So you can
feel comfortable taking it night after night. Talk to your doctor first before using
sleep aids for extended periods. Ready for sweet slumber? Just leave the rest to Lunesta.
Find out how to improve your sleep habits at www.lunesta.com. Or call 1-800-Lunesta.
IMPORTANT SAFETY INFORMATION: Lunesta works quickly, and should be taken right before bed.
Be sure you have at least eight hours to devote to sleep before becoming active. Until you know how you’ll
react to prescription Lunesta, you should not drive or operate machinery. Do not use alcohol while taking
Lunesta. Most sleep medicines carry some risk of dependency. Side effects may include unpleasant taste,
headache, drowsiness and dizziness. See important patient information on the next page. ©2006 Sepracor inc.
without a prescription. Some medicines can cause
drowsiness and are best avoided while taking LUNESTA.
• Always take the exact dose of LUNESTA prescribed by
your doctor. Never change your dose without talking to
your doctor first.
"'pszopiclone)€
1,2 AND 3 MG TABLETS Special Concerns
There are some special problems that may occur while taking
Please read this summary of information about LUNESTA sleep medicines.
before you talk to your doctor or start using LUNESTA. It is
• Lightheadedness Dependence
• Difficulty with coordination
Sleep medicines can cause dependence in some people,
Sleep medicines can make you sleepy during the day. How especially when these medicines are used regularly for longer
drowsy you feel depends upon how your body reacts to the than a few weeks or at high doses. Dependence is the need to
medicine, which sleep medicine you are taking, and how large continue taking a medicine because stopping it is unpleasant.
a dose your doctor has prescribed. Daytime drowsiness is
When people develop dependence, stopping the medicine
best avoided by taking the lowest dose possible that will still
suddenly may cause unpleasant symptoms (see Withdrawal
help you sleep at night. Your doctor will work with you to find
below). They may find they have to keep taking the medicine
the dose of LUNESTA that is best for you. Some people taking
either at the prescribed dose or at increasing doses just to
LUNESTA have reported next-day sleepiness.
avoid withdrawal symptoms.
To manage these side effects while you are taking this medicine:
All people taking sleep medicines have some risk of becoming
• When you first start taking LUNESTA or any other dependent on the medicine. However, people who have been
sleep medicine, until you know whether the medicine dependent on alcohol or other drugs in the past may have a
will still have some effect on you the next day, use higher chance of becoming addicted to sleep medicines. This
extreme care while doing anything that requires possibility must be considered before using these medicines
complete alertness, such as driving a car, operating for more than a few weeks. If you have been addicted to
machinery, or piloting an aircraft. alcohol or drugs in the past, it is important to tell your doctor
• Do not drink alcohol when you are taking LUNESTA or before starting LUNESTA or any sleep medicine.
any sleep medicine. Alcohol can increase the side
Withdrawal
effects of LUNESTA or any other sleep medicine.
• Do not take any other medicines without asking your Withdrawal symptoms may occur when sleep medicines are
doctor first. This includes medicines you can buy stopped suddenly after being used daily for a long time. In
some cases, these symptoms can occur even if the medicine has Safe Use Of Sleep Medicines
been used for only a week or two. In mild cases, withdrawal
To ensure the safe and effective use of LUNESTA or any other
symptoms may include unpleasant feelings. In more severe sleep medicine, you should observe the following cautions:
cases, abdominal and muscle cramps, vomiting, sweating,
shakiness, and, seizures may occur. These more
rarely, 1. LUNESTA is a prescription medicine and should be
withdrawal symptoms have not been observed in the doctor's instructions about how to take, when to take,
relatively limited controlled trials experience with LUNESTA, and how long to take LUNESTA.
there is, nevertheless, the risk of such events in association
2. Never use LUNESTA or any other sleep medicine for
with the use of any sleep medicine. longer than directed by your doctor.
3. If you notice any unusual and/or disturbing thoughts
Another problem that may occur when sleep medicines are
or behavior during treatment with LUNESTA or any
stopped is known as “rebound insomnia." This means that a
other sleep medicine, contact your doctor.
person may have more trouble sleeping the first few nights
4. Tell your doctor about any medicines you may be
after the medicine is stopped than before starting the medicine.
taking, including medicines you may buy without a
If you should experience rebound insomnia, do not get
prescription and herbal preparations. You should also
discouraged. This problem usually goes away on its own after
tell your doctor if you drink alcohol. DO NOT use alcohol
1 or 2 nights.
while takingLUNESTA or any other sleep medicine.
If you have been taking LUNESTA or any other sleep medicine 5. Do not take LUNESTA unless you are able to get 8 or
for more than 1 or 2 weeks, do not stop taking it on your own. more hours of sleep before you must be active again.
Always follow your doctor’s directions. 6. Do not increase the prescribed dose of LUNESTA or
Changes In Behavior And Thinking any other sleep medicine unless instructed by your
doctor.
Some people using sleep medicines have experienced
7. When you first start taking LUNESTA or any other
unusual changes in their thinking and/or behavior. These
sleep medicine, until you know whether the medicine
effects are not common. However, they have included:
will still have some effect on you the next day, use
• More outgoing or aggressive behavior than normal extreme care while doing anything that requires
•
complete alertness, such as driving a car, operating
Confusion
machinery, or piloting an aircraft.
• Strange behavior
8. Be aware that you may have more sleeping problems
• Agitation the first night or two after stopping any sleep medicine.
•
9. Be sure to tell your doctor if you are pregnant, if
Hallucinations
you are planning to become pregnant, if you become
• Worsening of depression pregnant, or if you are breastfeeding a baby while
• Suicidal thoughts taking LUNESTA.
10. As with all prescription medicines, never share
How often these effects occur depends on several factors,
LUNESTA or any other sleep medicine with anyone
such as a person's general health, the use of other medicines,
else. Always store LUNESTA or any other sleep medicine
and which sleep medicine is being used. Clinical experience
in the original container and out of reach of children.
with LUNESTA suggests that it is rarely associated with these
11. Be sure to tell your doctor if you suffer from depression.
behavior changes.
12. LUNESTA works very quickly. You should only take
It is also important to realize it is rarely clear whether these LUNESTA immediately before going to bed.
behavior changes are caused by the medicine, are caused by 13. For LUNESTA to work best, you should not take it with
an illness, or have occurred on their own. In fact, sleep problems or immediately after a high-fat, heavy meal.
that do not improve may be due to illnesses that were present 14. Some people, such as older adults (i.e., ages 65 and
before the medicine was used. If you or your family notice over) and people with liver disease, should start with
any changes in your behavior, or if you have any unusual or the lower dose (1 mg) of LUNESTA. Your doctor may
disturbing thoughts, call your doctor immediately. choose to start therapy at 2 mg. In general, adults
recommended
feeding a baby.
ail
that
LUNESTA on an
other prescription sleep medicines,
you not take LUNESTA
infant are
if
not known;
Fits in your pocket. Dissolves in seconds. So you can relax and refocus.
T a sound sleeper,
quently up 4 a.m. This
at
around the time that my
husband, Ed, having woken up
at 3, will generally crawl back into
I am fre-
is
when I’m awake. Eyelid position,
basically, is the difference.
going: “He was the voice of the
Wolverines.”
was partly awake
Ed kept
I at this point,
bed. Ed goes downstairs to watch and for some reason, the sentence
TV so that his tossing and turning struck me as the funniest thing I’d
doesn’t wake me up. This is very heard in a very long time. Different
considerate, except that when he rules apply between the hours of
returns, he likes to chat about what 2 and 4 a.m., I find. Things that
he’s been watching. The other would ordinarily not even qualify as
night, Ed had been watching an mildly amusing will often, at 3 a.m.,
infomercial for something called strike the ear as high comedy.
the Steam Shark. I have a distinct Worries are similarly warped.
memory of surfacing from the I recently spent the hour from
In the morning, we went out to be. I make noises while I sleep, and
look at the plants. If anything, they Ed has had many hours to devote to
looked a little lonesome there at 17 cataloging them. Common varietals
inches apart, just as the label had include the Click, the Tommy gun
recommended. I am now known far and the Darth Vader.
and wide as the Nervous Gardener. Light is also a problem for my
Anyway, once the laughter sets in, husband. There can be no light in
we’re both up. The topic of wolver- the bedroom, not even the light
ines led to savage animals in gen- from the digital clock, which is
eral, and from there to a game called hidden away on the bottom shelf
African Veldt. We frequently make of Ed’s nightstand, broadcasting
up mindless games to wile away the the time to toddlers and gnomes.
time until the sandman agrees to The room across the hall must also
take over the proceedings again. be dark. We can’t just close our bed-
“First person to run out of ani- room door to block the light from
mals is the loser,” I said. Ed pointed that room, because this will make
out that since I had been to Africa, the bedroom too stuffy for Ed to
thegame was rigged in my favor. He sleep. That room must also have its
made me name three animals for curtains drawn. If he could, Ed
every one of his. would draw the curtains on the
“Fine. Leopard, zebra, elephant.” windows of our neighbors across
“Lion,” said Ed with great the driveway, and on down the
confidence. street, all the way to the horizon.
60
Get up to 6 months of
osteoarthritis (OA)
* Is FDA-approved.
SOME COMFORTING %
«
Does not require knee replacement surgery.
FREE "In Step With SYNVISC" Knee Pain Relief Packet. 'Treatment with SYNVISC may not eliminate the
Or visit www.SYNVISC.com for more information need for other OA medications.
Synvisc*
HYLAN G-F 20
doctor immediately
• You should not be given Synvisc
if you develop any of these signs of an
if
PATIENT INFORMATION
Be sure to read the following important information carefully. This information does THINGS YOU SHOULD KNOW ABOUT SYNVISC:
you do not understand this information
• Synvisc is only for injection into the knee, performed by a doctor or other
not take the place of your doctor's advice. If
in very high amounts in joints. The body’s own hyaluronan acts like a lubricant a child.
• The safety and effectiveness of Synvisc have not been tested in children.
and a shock absorber in the joint and is needed for the joint to work properly.
Osteoarthritis (pronounced os-TE-o-ar-THRI-tis) (OA) is a type of arthritis that
involves the wearing down of cartilage (the protective covering on the ends of
POSSIBLE SIDE EFFECTS:
• The side effects (also called reactions) sometimes seen when Synvisc is injected
your bones). In OA, there may not be enough hyaluronan, and there may be a
comes syringes into the knee as a first or repeat set of injections were pain, swelling, heat,
decrease in the quality of the hyaluronan in the joint. Synvisc in
redness, and/or fluid build-up around the knee. These reactions were generally
containing 2 mL (half a teaspoon) of product. Synvisc is injected directly into
mild and did not last long, but sometimes fluid accumulation was considerable
your knee.
and painful; cases where the swelling is extensive and painful should be
WHAT IS SYNVISC USED FOR? discussed with your doctor. The reactions seemed to occur more often when
Synvisc is used to relieve knee pain due to OA. It is used for patients who do Synvisc was injected into the knee as a repeat set
not get enough relief from simple painkillers, such as acetaminophen, or from of injections than when Synvisc was injected as a first set of injections.
exercise and physical therapy. • These reactions were generally treated by giving pain relievers by mouth such
as acetaminophen or by giving NSAIDs by mouth or injections of steroids, or
WHAT ARE THE BENEFITS OF SYNVISC? by removing fluid from the knee joint. Patients have rarely undergone
Two medical studies involving a total of 132 patients were done in Germany. The
arthroscopy (a surgical inspection of the knee joint) and other medical
patients in these studies were at least 40 years old and had knee pain due to OA. procedures.
The were placed in one of two groups. One group was given an injection
patients
• Rare cases of knee joint infection have been reported after Synvisc injections.
of Synvisc into one or both knees once a week for three weeks. The second group
was given an injection of salt water once a week for three weeks. As part of the • Rashes, hives and itching have been seen in patients after Synvisc treatment
study, knee joint pain was measured for 26 weeks. Also, patients and doctors Before you are given Synvisc, tell your doctor if something like this has ever
were asked to judge the success of the treatment for 26 weeks. Patients with OA happened to you after receiving an injection of Synvisc or other hyaluronan
knee pain, who did not get pain relief with other medicines, got pain relief with products.
Synvisc. The patients given Synvisc had more pain relief than the patients given
week
• Other less common side effects have been: muscle pain/cramps, flushing
salt water. Some patients started to feel pain relief after the first of Synvisc
and/or swelling of your face, fast heartbeat, nausea (or feeling sick to your
treatment. The most pain relief and the greatest amount of treatment success
stomach), dizziness, fever, chills, headache, difficulty breathing, swelling in your
was seen 8 to 12 weeks after Synvisc treatment started.
arms and/or legs, prickly feeling of your skin, and in rare cases a low number of
A medical study done in the United States involved 90 patients. The patients were platelets in the blood (platelets are a type of blood cell that are needed to help
at least 40 years old and had knee pain due to OA. Patients were placed into one clot your blood when you are cut or injured).
of two groups. One group was given Synvisc once a week for three weeks. The
• Ifany of the above symptoms or signs appear after you are given Synvisc, or if
second group had a needle inserted into the knee to have any fluid removed (this
you have any other problems, you should call your doctor.
procedure is called arthrocentesis [pronounced AR-thro-sen-TE-sis]) once a week
for three weeks. Patients improved after Synvisc treatment, but not more than
HOW IS SYNVISC GIVEN?
patients who had arthrocentesis. This study was different from the German
Your doctor will give you your injection of Synvisc (2mL) into your knee once a
studies because the last time the two groups were compared was only two weeks
week, for a total of three injections.
after the last Synvisc injection. The study was also different inother ways,
including length of time that patients had to stop taking medicines before they
MANUFACTURED AND DISTRIBUTED BY:
could start treatment. The length of time patients had to stop taking medicines
Genzyme Biosurgery a division of
was two weeks in the German studies and four weeks in the U.S. study.
Genzyme Corporation
1 1 25 Pleasant View Terrace
WHAT OTHER TREATMENTS ARE AVAILABLE FOR OA? Ridgefield, New Jersey 07657
If you have OA, there are other things you can do besides getting Synvisc.
These include:
HOW DO I GET MORE INFORMATION ABOUT SYNVISC?
Non-drug treatments If you have any questions or would like to find out more about Synvisc, you may
• avoiding activities that cause knee pain call Genzyme Biosurgery at 1-888-3-SYNVISC (1-888-379-6847).
• exercise
SYNVISC and GENZYME are registered trademarks of
• physical therapy
• removal of excess fluid from your knee
Genzyme Corporation.
Synvisc* is covered by U.S. patents.
Drug therapy
• pain relievers such as acetaminophen and narcotics 70230602 Revised November 15, 2004
• drugs that reduce inflammation (signs of inflammation are swelling,
SYNVISC is eligible for reimbursement by most insurance plans. Many require that your physician provide
SYNVISC. If your physician does not provideSYNVISC and he or she writes a prescription for SYNVISC, some
insurance plans, including Medicare, may not cover the cost. Therefore, it is recommended that you ask your
physician if his or her office provides SYNVISC. Procedures vary from policy to policy, so please check with your
physician and/or your insurer. If you have additional questions about insurance coverage, please contact the
SYNVISC Reimbursement Hotline at 1-800-982-8292. This toll-free number can be accessed between
8:30 a.m. and 6:00 p.m., Eastern Time, Monday through Friday.
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ASSOCIATION
f
ARIETY, BALANCE and bles and omega-3s
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FOTOSTOCK/SUPERSTOCK
CAROLYN O'NEIL, RD, Atlanta, Georgia, Coauthor of STEVEN C, HALBERT, MO, Clinical Assistant Professor,
The Dish: On Eating Healthy and Being Fabulous! Jefferson Medical College, Philadelphia, Pennsylvania
LES
BOTTOM LINE
A balanced immune system not only protects against the
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FOOD.FOR
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We often
enjoy a bowl
day?” March is National our work. of whole-
Nutrition Month, so it’s In gen- grain cereal
a good time to talk. our
eral, with soy milk
Let’s dish! meals are based and fresh fruit
In general, we follow on fruits, vegetables, (usually a banana or
our own advice. Anne whole grains, legumes berries), some whole-
BUTLER
AGE
opment of children, have anti-
including better aca- inflamma-
demic performance
(EGG)
tory benefits.
and fewer behav- On weekends,
ioral problems, we’ll sometimes
so we always sit treat ourselves to a
71
RD I
MARCH 2007
and cauliflower in the often mask the intrinsic However, what matters FOLIO/
and preserves most If you want a little the overall meal, not in
of the flavor zing or zip to pump up specific items, so even
(TURMERIC)
since then. My LDL ranges from 70 happy. When I wake up each day with
to 80 mg/dl, and my blood pressure Anne and Lucas, I feel like the luckiest
is 110/70. But the main reason for guy in the world.
72
POOR CIRCULATION IN THE LEGS
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He Had a Hunch...
that ordinary people would want their
own computer one day. Revolutionary!
W
cost as
on
much
hen Steve Wozniak was
in high school in the
mid-1960s, he dreamed
of owning a computer.
His father told him that computers
as the down payment
“Then I’ll live in an
a house.
grade, encouraged by his father,
an aerospace engineer.
when NASA and the race to the
moon regularly made front-page
It
who said, “Let’s build a PC board sold his van, and Wozniak sold his
that makes the assembly easy. We’ll prized HP calculator. Together, they
build it$20 and sell it for $40.”
for managed to scrounge up a few hun-
(This solution enabled members to dred dollars. They named the com-
save time by soldering the elec- pany Apple Computer and called
tronic parts directly onto the PC Wozniak’s creation the Apple I.
board, a kind of motherboard, and Jobs went out looking for cus-
avoid handling the wires.) tomers and located a computer
It was the start of an extraordin- store in the area that wanted 100
arily productive partnership. At the completely built computers. It
time, Wozniak was working as an offered to pay $500 each. “We had a
engineer at Hewlett-Packard. “I $50,000 order,” Wozniak marvels.
wanted HP to build the computer, so “That was twice my annual salary.”
76
Where will you take them?
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OUR SOFTEST EVER.
engineer, but at Apple. The rest, of that other people could not design.
course, is history. The large com- Also the social ramifications of
puter companies that were manufac- doing good. We were talking about
turing mainframes scoffed at the taking thelittle guy to a new place
Now 56, Wozniak looks back on your own time. It’s worth the sacrifice.
PRIORITIES, PRIORITIES
“Are Men Smarter? Researcher Says Yes,”
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Splashing water on that theory was a link just
beneath it to another health article
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Men delay medical care when the game’s on.”
AMY BAIK
80
•nark of Takeda Pharmaceutical Company Limited and used wider license by Takeca Pharmaceuticals North America. Inc.
ORozerem
when yon can’t sleep , you can’t dream. But now there’s Rozerem, a sleep aid like no
other. Rozerem is approved For adults having trouble falling asleep. In fact, it’s the first and only
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R
Patients should be advised to avoid engaging in hazardous activities (such as
the active metabolite M-ll, respectively, at the maximum recommended human dose
operating a motor vehicle or heavy machinery) after taking ROZEREM.
based on an area-under-the-curve [AUC] comparison). The no-effect level
Patients should be advised that they should not take ROZEREM with or immedi- tic tumors in female mice was 1 00 mg/kg/day (827-times and 1 2-times the
ately after a high fat meal. therapeutic exposure to ramelteon and M-ll, respectively, at the MRHD based on AUC).
Patients should be advised to consult their health care provider if they experience In a two-year carcinogenicity study conducted in the Sprague-Dawley rat, male and
worsening of insomnia or any new behavioral signs or symptoms of concern. female rats were administered ramelteon at doses of 0, 15, 60, 250 or 1000 mg/kg/day
Patients should consult their health care provider if they experience one of the fol- by oral gavage. Male rats exhibited a dose-related increase in the incidence of hepatic
lowing: cessation of menses or galactorrhea in females, decreased libido, or adenoma and benign Leydig cell tumors of the testis at dose levels > 250 mg/kg/day
problems with fertility. and hepatic carcinoma at the 1000 mg/kg/day dose level. Female rats exhibited a dose-
related increase in the incidence of hepatic adenoma at dose levels > 60 mg/kg/day
Laboratory Tests
and hepatic carcinoma at the 1000 mg/kg/day dose level. The no-effect level
No standard monitoring is required.
for hepatic tumors and benign Leydig cell tumors in male rats was 60 mg/kg/day
For patients presenting with unexplained amenorrhea, galactorrhea, decreased (1,429-times and 12-times the therapeutic exposure to ramelteon and M-ll,
libido, or problems with fertility, assessment of prolactin levels and testosterone respectively, at the MRHD based on AUC). The no-effect level for hepatic tumors in
levels should be considered as appropriate. female rats was 15 mg/kg/day (472-times and 16-times the therapeutic exposure to
Drug Interactions ramelteon and M-ll, respectively, at the MRHD based on AUC).
ROZEREM has a highly variable inter-subject pharmacokinetic profile (approxi- The development of hepatic tumors in rodents following chronic treatment with
mately 100% coefficient of variation in Cmax and AUC). As noted above, CYP1A2 non-genotoxic compounds may be secondary to microsomal enzyme induction,
is the major isozyme involved in the metabolism of ROZEREM; the CYP2C sub- a mechanism for tumor generation not thought to occur in humans. Leydig cell
family and CYP3A4 isozymes are also involved to a minor degree. tumor development following treatment with non-genotoxic compounds in
Effects of Other Drugs on ROZEREM Metabolism rodents has been linked to reductions in circulating testosterone levels with com-
Fluvoxamine (strong CYP1A2 fluvoxamine 100 mg twice daily
inhibitor): When pensatory increases in luteinizing release, which is a known proliferative
hormone
was administered for 3 days prior to single-dose co-administration of ROZEREM stimulus to Leydig cells in the rat testis. Rat Leydig cells are more sensitive to the
16 mg and fluvoxamine, the AUCo-.nt for ramelteon increased approximately stimulatory effects of luteinizing hormone than human Leydig cells. In mechanis-
190-fold, and the C max increased approximately 70-fold, compared to ROZEREM tic studies conducted in the rat, daily ramelteon administration at 250 and
administered alone. ROZEREM should not be used in combination with fluvox- 1000 mg/kg/day for 4 weeks was associated with a reduction in plasma testos-
amine (see WARNINGS). Other less potent CYP1A2 inhibitors have not been terone levels. In the same study, luteinizing hormone levels were elevated over a
adequately studied. ROZEREM should be administered with caution to patients 24 hour period after the last ramelteon treatment; however, the durability of this
taking less strong CYP1A2 inhibitors. luteinizing hormone finding and its support for the proposed mechanistic expla-
nation was not clearly established.
Rifampin (strong CYP enzyme inducer): Administration of rifampin 600 mg once
daily for 1 1 days resulted in a mean decrease of approximately 80% (40% to Although the rodent tumors observed following ramelteon treatment occurred at
90%) in total exposure to ramelteon and metabolite M-ll, (both AUC 0-.ni and Cmax) plasma levels of ramelteon and M-ll in excess of mean clinical plasma concentra-
after a single 32 mg dose of ROZEREM. Efficacy may be reduced when ROZEREM tions at the MRHD, the relevance of both rodent hepatic tumors and benign rat
is used in combination with strong CYP enzyme inducers such as rifampin. Leydig cell tumors to humans is not known.
Mutagenesis Pediatric Use
Ramelteon was not genotoxic in the following: in vitro bacterial reverse mutation Safety and effectiveness of ROZEREM in pediatric patients have not been estab-
(Ames) assay; in vitro mammalian cell gene mutation assay using the mouse lished. Further study is needed prior to determining that this product may be used
lymphoma TK +/‘ cell line; in vivo/in vitro unscheduled DNA synthesis assay in rat safely in pre-pubescent and pubescent patients.
hepatocytes; and in in vivo micronucleus assays conducted in mouse and rat.
Geriatric Use
Ramelteon was positive in the chromosomal aberration assay in Chinese hamster
lung cells in the presence of S9 metabolic activation.
A 654 subjects in double-blind, placebo-controlled, efficacy trials who
total of
received ROZEREM were at least 65 years of age; of these, 199 were 75 years of
Separate studies indicated that the concentration of the M-ll metabolite formed by age or older. No overall differences in safety or efficacy were observed between
the rat liverS9 fraction used in the in vitro genetic toxicology studies described elderly and younger adult subjects.
above, exceeded the concentration of ramelteon; therefore, the genotoxic poten-
tialof the M-ll metabolite was also assessed in these studies.
ADVERSE REACTIONS
Overview
Impairment of Fertility The data described in this section reflect exposure to ROZEREM in 4251 subjects,
Ramelteon was administered to male and female Sprague-Dawley rats in an initial fertil- including 346 exposed for 6 months or longer, and 473 subjects for one year.
and early embryonic development study at dose levels of 6, 60, or 600 mg/kg/day.
ity
No effects on male or female mating or fertility were observed with a ramelteon Adverse Reactions Resulting in Discontinuation of Treatment
Five percent of the 3594 individual subjects exposed to ROZEREM in clinical
dose up to 600 mg/kg/day (786-times higher than the MRHD on a mg/m 2 basis).
studies discontinued treatment owing to an adverse event, compared with 2% of
Irregular estrus cycles, reduction in the number of implants, and reduction in the
number of live embryos were noted with dosing females at > 60 mg/kg/day (79- the 1370 subjects receiving placebo. The most frequent adverse events leading to
discontinuation in subjects receiving ROZEREM were somnolence (0.8%), dizziness
times higher than the MRHD on a mg/m 2 basis). A reduction in the number of
corpora lutea occurred at the 600 mg/kg/day dose level. Administration of (0.5%), nausea (0.3%), fatigue (0.3%), headache (0.3%), and insomnia (0.3%).
ramelteon up to 600 mg/kg/day to male rats for 7 weeks had no effect on sperm ROZEREM Most Commonly Observed Adverse Events in Phase 1-3 trials
qualityand when the treated male rats were mated with untreated female rats there The incidence of adverse events during the Phase 1 through 3 trials (% placebo,
was no effect on implants or embryos. In a repeat of this study using oral adminis- n=1370; % ramelteon [8 mg], n=1 250) were; headache NOS (7%, 7%), somno-
tration of ramelteon at 20,60 or 200 mg/kg/day for the same study duration, lence (3%, 5%), fatigue (2%, 4%), dizziness (3%, 5%), nausea (2%, 3%),
females demonstrated irregular estrus cycles with doses > 60 mg/kg/day, but insomnia exacerbated (2%, 3%), upper respiratory tract infection NOS (2%, 3%),
no effects were seen on implantation or embryo viability. The no-effect dose for diarrhea NOS (2%, 2%), myalgia (1%, 2%), depression (1%, 2%), dysgeusia (1%,
fertility endpoints was 20 mg/kg/day in females (26-times the MRHD on a mg/m 2 2%), arthralgia (1%, 2%), influenza (0, 1%), blood cortisol decreased (0, 1%).
basis) and 600 mg/kg/day in males (786-times higher than the MRHD on a mg/m 2
Because clinical trials are conducted under widely varying conditions, adverse
basis) when considering all studies.
reaction rates observed in the clinical trials of a drug cannot be directly com-
Pregnancy: Pregnancy Category C pared to rates in clinical trials of other drugs, and may not reflect the rates
Ramelteon has been shown to be a developmental teratogen in the rat when observed in practice. The adverse reaction information from clinical trials does,
given in doses 197 times higher than the maximum recommended human dose however, provide a basis for identifying the adverse events that appear to be
[MRHD] on a mg/m 2 basis. There are no adequate and well-controlled studies in related to drug use and for approximating rates.
pregnant women. Ramelteon should be used during pregnancy only if the poten-
tial benefit justifies the potential risk to the fetus.
DRUG ABUSE AND DEPENDENCE
ROZEREM is not a controlled substance.
The effects of ramelteon on embryo-fetal development were assessed in both the
rat and rabbit. Pregnant rats were administered ramelteon by oral gavage at doses
Human Data: See the CLINICAL TRIALS section, Studies Pertinent to Safety
of 0,10, 40, 150, or 600 mg/kg/day during gestation days 6-17, which is the period
Concerns for Sleep-Promoting Agents, in the Complete Prescribing Information.
of organogenesis in this species. Evidence of maternal toxicity and fetal terato- Animal Data Ramelteon did not produce any signals from animal behavioral studies
.
genicity was observed at doses greater than or equal to 150 mg/kg/day. indicating that the drug produces rewarding effects. Monkeys did not self-administer
Maternal toxicity was chiefly characterized by decreased body weight and, at ramelteon and the drug did not induce a conditioned place preference in rats. There
600 mg/kg/day, ataxia and decreased spontaneous movement. At maternally toxic was no generalization between ramelteon and midazolam. Ramelteon did not affect
doses (150 mg/kg/day or greater), the fetuses demonstrated visceral malforma- rotorod performance, an indicator of disruption of motor function, and it did not
tions consisting of diaphragmatic hernia and minor anatomical variations of the potentiate the ability of diazepam to interfere with rotorod performance.
skeleton (irregularly shaped scapula). At 600 mg/kg/day, reductions in fetal body
Discontinuation of ramelteonin animals or in humans after chronic adminis-
weights and malformations including cysts on the external genitalia were addition-
produce withdrawal signs. Ramelteon does not appear to
tration did not
ally observed. The no-effect level for teratogenicity in this study was 40 mg/kg/day
produce physical dependence.
(1,892-times and 45-times higher than the therapeutic exposure to ramelteon and
the active metabolite M-ll, respectively, at the MRHD based on an area-under-the- OVERDOSAGE
curve [AUC] comparison). Pregnant rabbits were administered ramelteon by oral Signs and Symptoms
gavage at doses of 0,12, 60, or 300 mg/kg/day during gestation days 6-18, which is No cases of ROZEREM overdose have been reported during clinical development.
the period of organogenesis in this species. Although maternal toxicity was appar- ROZEREM was administered in single doses up to 160 mg in an abuse liability
ent with a ramelteon dose of 300 mg/kg/day, no evidence of fetal effects or trial. No safety or tolerability concerns were seen.
teratogenicity was associated with any dose level. The no-effect level for terato-
genicity was, therefore, 300 mg/kg/day (11 ,862-times and 99-times higher than the Recommended Treatment
therapeutic exposure to ramelteon and M-ll, respectively, at the MRHD based on AUC). General symptomatic and supportive measures should be used, along with immediate
gastric lavage where appropriate. Intravenous fluids should be administered as needed.
The effects of ramelteon on pre- and post-natal development were in the rat
As in all cases of drug overdose, respiration, pulse, blood pressure, and other appropriate
studied by administration of ramelteon to the pregnant rat by oral gavage at
vital signs should be monitored, and general supportive measures employed.
doses of 0, 30, 100, or 300 mg/kg/day from day 6 of gestation through parturi-
tion to postnatal (lactation) day 21, at which time offspring were weaned. Hemodialysis does not effectively reduce exposure to ROZEREM. Therefore, the
Maternal toxicity was noted at doses of 100 mg/kg/day or greater and consisted use of dialysis in the treatment of overdosage is not appropriate.
of reduced body weight gain and increased adrenal gland weight. Reduced body Poison Control Center
weight during the post-weaning period was also noticed in the offspring of the As with the management of all overdosage, the possibility of multiple drug inges-
groups given 100 mg/kg/day and higher. Offspring in the 300 mg/kg/day group tion should be considered. The physician may contact a poison control center for
demonstrated physical and developmental delays including delayed eruption of the current information on the management of overdosage.
lower incisors, a delayed acquisition of the righting reflex, and an alteration of
emotional response. These delays are often observed in the presence of reduced Rx only
offspring body weight but may still developmental delay. An appar-
be indicative of Manufactured by:
ent decrease in the viability of offspring in the 300 mg/kg/day group was likely due Takeda Pharmaceutical Company Limited, 540-8645 Osaka, JAPAN
to altered maternal behavior and function observed at this dose level. Offspring of
Manufactured in:
the 300 mg/kg/day group also showed evidence of diaphragmatic hernia, a finding
Takeda Ireland Ltd.
observed in the embryo-fetal development study previously described. There were
Kilruddery, County Wicklow,
no effects on the reproductive capacity of offspring and the resulting progeny
Republic of Ireland
were not different from those of vehicle-treated offspring. The no-effect level for
pre- and postnatal development in this study was 30 mg/kg/day (39-times higher Marketed by:
than the MRHD on a mg/m 2 basis). Takeda Pharmaceuticals America, Inc.,
475 Half Day Road,
Labor and Delivery
The potential effects of ROZEREM on the duration of labor and/or delivery, for Lincolnshire, IL 60069
either the mother or the fetus, have not been studied. ROZEREM has no estab- ROZEREM™ is a trademark of Takeda Pharmaceutical Company Limited and used
lished use in labor and delivery. under license by Takeda Pharmaceuticals America, Inc.
Ramelteon is secreted into the milk of lactating rats. It is not known whether this 05-1118 Revised: Nov., 2005
drug is excreted in human milk. No clinical studies in nursing mothers have been
performed. The use of ROZEREM in nursing mothers is not recommended.
W
and offers
out the complex.
ho says companies only care about the
bottom line? Ours is socially conscious
employees fun outdoor activities through-
Businesses
when word
thrive
gets out
about them. The trick
is choosing the right
Both of these admirable elements were driven words.
home one day when a voice over the loudspeaker • The flyer for a foot
boomed “Everyone who signed up to donate blood, and ankle clinic invites
please report to the rifle range!” lisa carnes people with fractures,
heel spurs, arthritis and
hammertoes to visit.
Best of all: “Walk-
Ins Welcome.”
REED COOPER
• Big B, in
Murfreesboro, Ten-
nessee, has been
dry-cleaning peo-
ple’s laundry for
so long, its newspa-
per ad brags, “Cele-
brating 50 years
cleaning on the
same spot.”
"I’m disappointed. If anyone should have JOAN H. HARRIS
seen the red flags, it’s you.” • A sleep studies clinic
needs volunteers. To
Even though it was one-man job, so I could qualify, explains an ad in
warm outside, the heat not figure out why two The Sunday Oklahoman ,
secretary to get some- read “Head nurse is hot.” asleep for at least three
one to fix it. This was a CAROLYN HOUSE months.” don ramsey
She quickly diag- “Chopsticks are pro- sponse. “But then we’d
nosed the problem. vided on request,” the have to hire three more
"Your computer is suf- waiter told him. people to clean up the
fering from irritable My friend had a better mess.” becquet.com
vowel syndrome."
ANGIE BULAKITES
When i put on my new chef uniform — a pair
of very baggy, loud-striped pants— I was mildly
Don, my husband, horrified. But my wife was philosophical.
“It’s okay, honey,” she said in her soothing way.
rarely brings his job
home. But having “You’re just a victim of circus
worked at the phone pants.” BRIAN W. KIMBELL
company for years, he
M
can’t always avoid it.He
once asked me to make any senior The injury to our
an appointment for him executives find piglet wasn’t serious,
with the optometrist. talking with management but it did require
“What should I say consultants invaluable. stitches. So I sent my
is wrong?” I asked. My friend, a no-nonsense teenage daughter back
He said, “Tell them my businessman who works into thefarmhouse to
local is fine, but I’m hav- for a large firm, is not get needle and thread
ing trouble with my long one of them. and bring it to me, while
distance.” janice gray Halfway through their I looked after the squeal-
• meeting, and noting my ing animal.
friend’s terse answers, Ten minutes later, she
Since my purchases the consultant asked, still hadn’t returned.
came to $19.06, 1 handed “How do you cope with “What are you doing?”
the cashier a twenty. managerial stress?” I called out.
“Do you have six “I don’t,” came the She yelled back,
cents?” she asked. gruff reply. “I cause it.” “Looking for the pink
“Sorry,” I said after CLIVE ATTWATERS thread.” june haley
fishing around my pock-
ets, “I have no cents.” Your favorite new joke or one-liner
if* |
“Finally,” she mut-
tered, “a man who can
Go to rd.com/joke or see page 146 for details.
admit it.” kelly smith
85
HUMOR IN UNIFORM
A S IF BEING sent
off to war-torn
Somalia in the ’90s
weren’t nerve-racking
enough, there were also
the bugs.
“Sergeant,” I called
out during our orienta-
tion briefing, “is there a
problem with scorpions
here?”
“No need to worry
about scorpions. Cap-
tain,” he assured me. Halfway through wife then asked me.
“There are enough dinner one night, our “Yes,” I answered.
snakes around to eat friend Jim told us of his “I was on West Point’s
most of them.” days playing football in shooting team.”
CAPT. M. A. NIXON college as a defensive “That’s great,” she
lineman. said, appropriately
“Did you play sports impressed. “Offense or
Short and baby-faced, in college, Mike?” his defense?” mike maloney
my buddy Wiggins had
trouble being taken seri-
ously in the Army. A When we agreed to for his favorite pot, no
mustache, he assumed, help our sergeant move one moved.
would fix that. He was to a new apartment, we “I’ll give a bottle of
wrong. didn’t know the elevator Scotch to whoever finds
“Wiggins!” bellowed wasn’t working. So after it,” he shouted. Within
our drill instructor after hours of carrying heavy minutes, a private found
spotting the growth boxes and furniture up the pot.
during inspection. 11 floors, we were wiped “Good,” said the sarge.
“What’s so out. And when the ser- “Now look for the
geant asked us to search Scotch.” WOO-KI SOWN
special about
your nose that
it’s got to be ^ |
Your favorite new joke or one-liner
underlined?” might be worth $$$.
Go to rd.com/joke or see page 146 for details.
K. TROTT
A* CLOU
Pharmaceuticals
Squibb/Sanoft
Clots are the number one cause ol heart attack and stroke, but you can help reduce your risk.
This is important information it you’ve been hospitalized with PLAVIX, in combination with aspirin, helps provide greater
heart-related chest pain or a certain type of heart attack. protection against a future heart attack or stroke than aspirin alone.
That’s because these conditions, known as Acute Coronary PLAVIX, taken with aspirin, plays its own role in helping reduce
I Syndrome-or ACS -are usually caused your risk of heart attack and stroke.
when blood platelets stick together and That’s because, unlike your cholesterol HRORl
form clots that block blood flow to your and pressure medications.
blood "-A'fX
1 heart. And if you’ve already had a clot, prescription PLAVIX works to help keep
I
1
you're at an increased risk for a future
heart attack or stroke.
blood platelets from sticking together
and forming clots. HK9H
IMPORTANT INFORMATION: If you have a stomach ulcer or other condition that causes bleeding, you shouldn’t use PLAVIX.
When taking PLAVIX alone or with some medicines including aspirin, the risk of bleeding may increase. To minimize this risk,
talk to your doctor before taking aspirin or other medicines with PLAVIX. Additional rare but serious side effects could occur.
See important product information on the following pages. BECAUSE YOU'RE NO MATCH FOR A DANGEROUS CLOT.
INDICATIONS AND USAGE bleeding time induced by PLAVIX. PLAVIX potentiated the effect of aspirin on
PLAVIX (clopidogrel bisulfate) is indicated for the reduction of atherothrom- collagen-induced platelet aggregation. PLAVIX and aspirin have been admin-
botic events as follows: istered together for up to one year.
• Recent Ml, Recent Stroke or Established Peripheral Arterial Disease Heparin: In a study in healthy volunteers, PLAVIX did not necessitate modifi-
For patients with a history of recent myocardial infarction (Ml), recent stroke, cation of the heparin dose or alter the effect of heparin on coagulation.
or established peripheral arterial disease, PLAVIX has been shown to reduce Coadministration of heparin had no effect on inhibition of platelet aggrega-
the rate of a combined endpoint of new ischemic stroke (fatal or not), new tion induced by PLAVIX.
Ml (fatal or not), and other vascular death. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): In healthy volunteers receiving
• Acute Coronary Syndrome naproxen, concomitant administration of PLAVIX was associated with
-For patients with non-ST-segment elevation acute coronary syndrome increased occult gastrointestinal blood loss. NSAIDs and PLAVIX should be
(unstable angina/ non-Q-wave Ml) including patients who are to be managed coadministered with caution.
medically and those who are to be managed with percutaneous coronary Warfarin: Because of the increased risk of bleeding, the concomitant admin-
intervention (with or without stent) or CABG, PLAVIX has been shown to istration of warfarin with PLAVIX should be undertaken with caution. (See
decrease the rate of a combined endpoint of cardiovascular death, Ml, or PRECAUTIONS- General.)
stroke as well as the rate of a combined endpoint of cardiovascular death, Other Concomitant Therapy: No clinically significant pharmacodynamic
Ml, stroke, or refractory ischemia interactions were observed when PLAVIX was coadministered with atenolol,
-For patients with ST-segment elevation acute myocardial infarction, PLAVIX nifedipine, or both atenolol and nifedipine. The pharmacodynamic activity
has been shown to reduce the rate of death from any cause and the rate of of PLAVIX was also not significantly influenced by the coadministration of
a combined endpoint of death, re-infarction or stroke. This benefit is not phenobarbital, cimetidine or estrogen.
known to pertain to patients who receive primary angioplasty. The pharmacokinetics of digoxin or theophylline were not modified by the
coadministration of PLAVIX (clopidogrel bisulfate).
CONTRAINDICATIONS
At high concentrations in vitro, clopidogrel inhibits P450 (2C9). Accordingly,
The use of PLAVIX is contraindicated in the following conditions:
• Hypersensitivity to the drug substance or any component of the product.
PLAVIX may interfere with the metabolism of phenytoin, tamoxifen, tolbu-
tamide, warfarin, torsemide, fluvastatin, and many non-steroidal anti-
• Active pathological bleeding such as peptic ulcer or intracranial hemorrhage.
inflammatory agents, but there are no data with which to predict the
WARNINGS
magnitude of these interactions. Caution should be used when any of these
Thrombotic thrombocytopenic purpura (TTP):
drugs is coadministered with PLAVIX.
TTP has been reported rarely following use of PLAVIX, sometimes after a
In addition to the above specific interaction studies, patients entered
short exposure (<2 weeks). TTP is a serious condition that can be fatal and
into clinical trials with PLAVIX received a variety of concomitant medications
requires urgent treatment including plasmapheresis (plasma exchange). It is
including diuretics, beta-blocking agents, angiotensin converting enzyme
characterized by thrombocytopenia, microangiopathic hemolytic anemia
inhibitors, calcium antagonists, cholesterol lowering agents, coronary
(schistocytes [fragmented RBCs] seen on peripheral smear), neurological
vasodilators, antidiabetic agents (including insulin), thrombolytics,
findings, renal dysfunction, and fever. (See ADVERSE REACTIONS.)
heparins (unfractionated and LMWH) GPIIb/llla antagonists, antiepileptic
PRECAUTIONS agents and hormone replacement therapy without evidence of clinically
General significant adverse interactions.
PLAVIX prolongs the bleeding time and therefore should be used with caution There are no data on the concomitant use of oral anticoagulants, non-study
in patients who may be at risk of increased bleeding from trauma, surgery, or oral anti-platelet drugs and chronic NSAIDs with clopidogrel.
other pathological conditions (particularly gastrointestinal and intraocular). If a
Drug/Laboratory Test Interactions
patient is to undergo elective surgery and an antiplatelet effect is not desired,
None known.
PLAVIX should be discontinued 5 days prior to surgery.
Carcinogenesis, Mutagenesis, Impairment of Fertility
Due to the risk of bleeding and undesirable hematological effects, blood cell
There was no evidence of tumorigenicity when clopidogrel was administered
count determination and/or other appropriate testing should be promptly
for 78 weeks to mice and 104 weeks to rats at dosages up to 77 mg/kg per day.
considered, whenever such suspected clinical symptoms arise during the
which afforded plasma exposures >25 times that in humans at the recom-
course of treatment (see ADVERSE REACTIONS)
mended daily dose of 75 mg.
In patients with recent TIA or stroke who are at high risk for recurrent
Clopidogrel was not genotoxic in four in vitro tests (Ames test, DNA-repair test
ischemic events, the combination of aspirin and PLAVIX has not been shown
in rat hepatocytes, gene mutation assay in Chinese hamster fibroblasts, and
to be more effective than PLAVIX alone, but the combination has been shown
metaphase chromosome analysis of human lymphocytes) and in one in vivo
to increase major bleeding.
test (micronucleus test by oral route in mice).
Gl Bleeding: In CAPRIE, PLAVIX was associated with a rate of gastrointestinal
Clopidogrel was found to have no effect on fertility of male and female rats
bleeding of 2.0%, vs. 2.7% on aspirin. In CURE, the incidence of major gastro-
at oral doses up to 400 mg/kg per day (52 times the recommended human
intestinal bleeding was 1.3% vs 0.7% (PLAVIX + aspirin vs. placebo + aspirin,
dose on a mg/m 2 basis).
respectively). PLAVIX should be used with caution in patients who have lesions
with a propensity to bleed (such as ulcers). Drugs that might induce such lesions
Pregnancy
severe hepatic disease, who may have bleeding diatheses. PLAVIX should be mended daily human dose on a mg/m? basis), revealed no evidence of
impaired fertility or fetotoxicity due to clopidogrel. There are, however, no
used with caution in this population.
Use in Renally-impaired Patients: Experience is limited in patients with severe
adequate and well-controlled studies in pregnant women. Because animal
renal impairment. PLAVIX should be used with caution in this population.
reproduction studies are not always predictive of a human response, PLAVIX
should be used during pregnancy only if clearly needed.
Information for Patients
Patients should be told it may take them longer than usual to stop bleeding, Nursing Mothers
Studies in rats have shown that clopidogrel and/or its metabolites are excreted
that they may bruise and/or bleed more easily when they take PLAVIX or
PLAVIX combined with aspirin, and that they should report any unusual
in the milk. It is not known whether this drug is excreted in human milk.
that they are taking PLAVIX and/or any other product known to affect bleed- for serious adverse reactions in nursing infants, a decision should be made
scheduled and before any new drug is taken. whether to discontinue nursing or to discontinue the drug, taking into
ing before any surgery is
Major bleeding event rates for PLAVIX + aspirin by age were: <65 years Gastrointestinal system disorders
= 2.5%, £65 to <75 years = 4.1%, £75 years 5.9% Any event 27.1(3.2) 29.8 (4.0)
§ Major bleeding event rate for placebo + aspirin was dose-dependent on Abdominal pain 5.6 (0.7) 7.1 (1.0)
aspirin: <100 mg=2.0%; 100-200 mg= 2.3%; >200 mg=4.0% Dyspepsia 5.2 (0.6) 6.1 (0.7)
Major bleeding event rates for placebo + aspirin by age were: <65 years
Diarrhea 4.5 (0.4) 3.4 (0.3)
= 2.1%, £65 to <75 years = 3.1%, £75 years 3.6%
Nausea 3.4 (0.5) 3.8 (0.4)
K Led to interruption of study medication.
Metabolic & nutritional disorders
Ninety-two percent (92%) of the patients in the CURE study received
Hypercholesterolemia 4.0 (0) 4.4 (<0.1)
heparin/LMWH, and the rate of bleeding in these patients was similar to the
Musculoskeletal system disorders
overall results.
Arthralgia 6.3 (0.1) 6.2 (0.1)
There was no excess in major bleeds within seven days after coronary bypass
graft surgery in patients who stopped therapy more than five days prior to Back Pain 5.8 (0.1) 5.3 (<0.1)
surgery (event rate 4.4% PLAVIX + aspirin; 5.3% placebo + aspirin). In patients Platelet, bleeding, & clotting disorders
who remained on therapy within five days of bypass graft surgery, the event rate Purpura/Bruise 5.3(0.3) 37(0.1)
was 9.6% for PLAVIX + aspirin, and 6.3% for placebo + aspirin. Epistaxis 2.9 (0.2) 2.5(0.1)
Table 7: Adverse Events Occurring in £2.5% PLAVIX*
of PLAVIX Patients in CAPRIE (continued) clopidogrel bisulfate tablets
% Incidence (% Discontinuation)
-cases of bleeding with fatal outcome (especially intracranial, gastrointestinal
Body System PLAVIX Aspirin and retroperitoneal hemorrhage)
Event [n=9599] [n=9586] -thrombotic thrombocytopenic purpura (TTP) - some cases with fatal
Psychiatric disorders outcome- (see WARNINGS).
Depression 3.6 (0.1) 3.9 (0.2) -agranulocytosis, aplastic anemia/pancytopenia
increased. Metabolic and nutritional disorders: Gout, hyperuricemia, non- Acute Coronary Syndrome
protein nitrogen (NPN) increased. Musculoskeletal system d/sorders: Arthritis, For patients with non-ST-segment elevation acute coronary syndrome
Arthrosis. Platelet, bleeding & clotting disorders: Gl hemorrhage, hematoma, (unstable angina/non-Q-wave Ml), PLAVIX should be initiated with a single
platelets decreased. Psychiatric disorders: Anxiety, Insomnia. Red blood cell 300 mg loading dose and then continued at 75 mg once daily. Aspirin (75 mg-
disorders: Anemia. Respiratory system disorders: Pneumonia, Sinusitis. Skin 325 mg once daily) should be initiated and continued in combination with
and appendage disorders: Eczema, Skin ulceration. Urinary system disorders: PLAVIX. In CURE, most patients with Acute Coronary Syndrome also received
Cystitis. Vision disorders: Cataract, Conjunctivitis. heparin acutely (see CLINICAL STUDIES).
Other potentially serious adverse events which may be of clinical interest but For patients with ST-segment elevation acute myocardial infarction, the rec-
were rarely reported (<1%) in patients who received PLAVIX in the controlled ommended dose of PLAVIX is 75 mg once daily, administered in combination
clinical trials are listed below regardless of relationship to PLAVIX. In general, with aspirin, with or without thrombolytics. PLAVIX may be initiated with or
the incidence of these events was similar to that in patients receiving aspirin without a loading dose (300 mg was used in CLARITY; see CLINICAL STUDIES)
(in the other clinical trials) PLAVIX can be administered with or without food.
Body as a whole: Allergic reaction, necrosis ischemic. Cardiovascular disorders: No dosage adjustment is necessary for elderly patients or patients with renal
Edema generalized. Gastrointestinal system disorders: Peptic, gastric or disease. (See Clinical Pharmacology: Special Populations.)
duodenal ulcer, gastritis, gastric ulcer perforated, gastritis hemorrhagic, Distributed by:
upper Gl ulcer hemorrhagic. Liver and Biliary system disorders: Bilirubinemia, Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership
hepatitis infectious, liver fatty. Platelet, bleeding and clotting disorders: New York, NY 10016
hemarthrosis, hematuria, hemoptysis, hemorrhage intracranial, hemorrhage
retroperitoneal, hemorrhage of operative wound, ocular hemorrhage,
pulmonary hemorrhage, purpura allergic, thrombocytopenia. Red blood cell
sanofi-synthelabo f§§* Bristol-Myers Squibb Company
female: Menorrhagia. Respiratory system disorders: Hemothorax. Skin and PLAVIX® is a registered trademark of Sanofi-Synthelabo.
appendage disorders: Bullous eruption, rash erythematous, rash maculo-
Brief Summary of Prescribing Information Revised August 2006
papular, urticaria. Urinary system disorders: Abnormal renal function, acute
PLA-AUG06-B-Af
renal failure. White cell and reticuloendothelial system disorders:
Agranulocytosis, granulocytopenia, leukemia, leukopenia, neutropenia.
Postmarketing Experience
The following events have been reported spontaneously from worldwide
postmarketing experience:
• Body as a whole:
-hypersensitivity reactions, anaphylactoid reactions, serum sickness
• Central and Peripheral Nervous System disorders:
-confusion, hallucinations, taste disorders
• Hepato-biliary disorders:
-abnormal liver function test, hepatitis (non-infectious), acute liver failure
W
basketball.
originated with
Mitchell,
hen
old,
i
I
was seven years
knew one
for certain:
baseball and stunk at
My passion for baseball
who was
I
my baby-sitter, Mary
a rabid fan and
thing
loved
Little League. The Inwood section
of Manhattan, where
was few miles north of
just a
I
lived near both Yankee Stadium and that basketball was a choice I could
the Polo Grounds. My mom also no longer completely ignore.
liked baseball and often listened Eventually, I ventured onto the
to the play-by-play Brooklyn court and tried a few shots.
Dodger broadcasts by Red I failed miserably. My
Barber. As a little kid in father then took me
1951, watched Joe
1 to the public park.
DiMaggio play his last “This is how you
season and Willie Mays protect the
play his first. I quickly ball,” he said.
learned to appreciate He proceeded
the hysteria that was to elbow me
New York baseball then. in the face.
OUTLINE
My love of the game After that
grew at the same rate as
my body, and when I was
finally old enough, I joined
SCHIFFMAN/CORBIS
The physical beating took place learned not to joke around with the
in 1956, when I was nine. My parents other students and not to volunteer
had sent me to an all-black boarding answers in class. A happy face
school, Holy Providence in Corn- seemed to antagonize the bullies,
so, yeah, I had stopped
A happy face seemed to smiling. I’d had to find
refuge on my own.
antagonize these kids, I found it on the court.
Despite my lack of ability
so I stopped smiling or interest, being on the
team kept me away from
I had to find refuge.
the knuckle-dragging crew.
wells Heights, near Philadelphia. As a nine-year-old kid imprisoned
The school had about 30 boys and in a grown man’s body, I was all
100 girls, but the benefits of such wobbly legs and gangly arms. I must
a lopsided gender ratio were com- have looked like a puppet being
pletely lost on a shy nine-year-old. controlled by a drunk puppeteer.
Besides, my problem was with If my teammates passed the ball to
the boys. Though I was already a me, I soon made them regret it.
towering five feet eight inches, I But no matter how badly I played
was mild mannered and cheerful. the game, at least while I was on
I also excelled in my classes. With the court, no one was punching
my parents’ encouragement, I was me in the face.
reading several grade levels above In one game, I was trapped by the
the other fourth-graders and earning other team and, having lost the drib-
straight A’s. Naturally, I was hated. ble, was desperate to get rid of the
This hatred was expressed by the ball. Unable to find an open team-
"ON THE SHOULDERS OF GIANTS." COPYRIGHT © 2007 BY KAREEM ABDUL-JABBAR. IS PUBLISHED AT $26
BY SIMON & SCHUSTER. 1230 AVENUE OF THE AMERICAS, NEW YORK, NEW YORK 10020
i
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Only BONIVA
treats osteoporosis
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cannot sit or stand for at least 60 minutes, have severe kidney disease, or are allergic to BONIVA.
Stop taking BONIVA and tell your healthcare provider if you experience difficult or painful swallowing,
chest pain, or severe or continuing heartburn, as these may be signs of serious upper digestive problems.
Follow the once-monthly BONIVA 150 mg dosing instructions carefully to lower the chance of these
events occurring. Side effects are generally mild or moderate and may include diarrhea, pain in the
arms or legs, or upset stomach. If you develop severe bone, joint, and/or muscle pain, contact your
healthcare provider. Your healthcare provider may also recommend a calcium and vitamin D supplement.
Do not take BONIVA if you: chosen day (see “How should take BONIVA?”).
I
• cannot sit or stand up for at least 1 hour (60 minutes) • If your next scheduled BONIVA day is more than
• have kidneys that work very poorly 7 days away, take one BONIVA 150-mg tablet in the
• are allergic to ibandronate sodium or any of the other morning following the day that you remember (see
ingredients of BONIVA (see the end of this Patient
“How should take BONIVA?”). Then return to
I
Information for a list of all the ingredients in BONIVA) taking one BONIVA 150-mg tablet every month in
Tell your health care provider before using BONIVA: the morning of your chosen day, according to your
• if you are pregnant or planning to become pregnant. It original schedule.
is not known if BONIVA can harm your unborn baby. • Do not take two 1 50-mg tablets within the same week.
• if you are breast-feeding. is not known BONIVA
It if
If your next scheduled BONIVA day is only 1 to 7 days
passes into your milk and can harm your baby.
if it
away, wait until your next scheduled BONIVA day to
• have swallowing problems or other problems with your take your tablet. Then return to taking one BONIVA
esophagus (the tube that connects your mouth and 1 50-mg tablet every month in the morning of your
stomach) chosen day, according to your original schedule.
• if you have kidney problems
and supplements. Some medicines, especially certain the morning at least 1 hour (60 minutes) before you eat,
vitamins, supplements, and antacids can stop BONIVA drink anything other than plain water, or take any other
from getting to your bones. This can happen if you take oral medicine (see “How should I take BONIVA?”).
other medicines too close to the time that you take What to do if miss a daily dose:
I
POSSiB/Li77eS
ASK LASKAS
YOU'VE GOT QUESTIONS, SHE'S GOT ANSWERS
Q
he’s
very appreciative. He’s hard-working
and finishes assignments
become very secretive and protective.
on time, but
big enough dose, bring your rejuve- two years. My wife left and
nated self to your hubby. Tell him my father died. Now I’m about to
how you define fun. Sit down with marry a wonderful woman, but I’ve
him and prepare your next vacation, begun to notice changes in my 15-
year-old daughter. First, she began
making a “have fun” to-do list that
to have panic attacks. And lately,
is equal parts his and hers.
itseems she eats barely anything.
Her hands and feet are as cold as
My parents are competitive
Q and put pressure on me and my
brother. All their friends have kids
ice. And she’s started to wear her
13-year-old sister's clothes. What’s
wrong? WORRIED SICK
going to elite colleges, so they’re
pushing us to achieve the same. I Dear Worried,
love my parents, but sometimes they Good for you for so astutely
expect too much. I’ve tried talking noticing the warning signs of an
to them, but they say I’m goofing off. eating disorder. You need to get
Any advice? trophy daughter your daughter to her pediatrician
Questions about parents, partners or atonce for a full physical. Tell the
office politics?E-mail Jeanne Marie Laskas doc of your suspicions. You could
at [email protected]. Sending gives us be saving your daughter’s life.
permission to edit and publish.
100
The fcfc QUOTABLE QUOTES
ball doesn't
know how
old I am. It’s only when the tide
MARTINA
NAVRATILOVA
in Shape Your
(Rodale)
Self goes out that you learn who’s
been swimming naked.
WARREN BUFFETT on Charlie Rose (PBS)
FLATTERY IS LIKE ri
CHEWING GUM. Having children is like living
ENJOY IT, BUT V f in a frat house —
nobody sleeps,
KASCHT
DON'T SWALLOW everything’s broken and there’s
IT. HANK KETCHAM a lot of throwing up. ray romano
JOHN
on Everybody Loves Raymond (CBS)
BY
A synonym is a word you
use when you can’t spell the People will accept your ideas
ILLUSTRATED
first word you thought of. much more readily if you tell
WHO
SAID IT?
You have to remember
one thing about
the will of the people:
It wasn't that long ago that
we were swept away by
I’m not a businessman. the macarena. jon stewart
c) Jay-Z FOR ANSWER, SEE BELOW We pay $100 for the wit and wisdom of
$ famous contemporary people. See page 146.
Z-Aef (o
101
/V JL MERCK / Schering-Plough Pharmaceuticals
Merck/Schering-Plough To find out if you qualify, Copyright © MercK/Schering- Plough Pharmaceuticals. 2006
Patient
Assistance
call 1-800-347-7503. All rights reserved. 20652648(2)(800)-ZET
ZETIA has not been shown to prevent heart disease or heart attacks.
people who are allergic to any of its ingredients. If you have ever had liver problems, are
nursing or pregnant or may become pregnant, a doctor will decide if ZETIA alone is right
for you.
Unexplained muscle pain or weakness could be a sign of a rare but serious side effect
and should be reported to your doctor right away. Common side effects included stomach
pain and feeling tired.
(ezetimibe) Tablets
ZETIA' (ezetimibe)Tablets
Patient Information about ZETIA (zet-e-a)
Generic name: ezetimibe (e-zet-e-mlb)
Read this information carefully before you start taking ZETIA and each time you get more ZETIA.
There may be new information. This information does not take the place of talking with your doctor
about your medical condition or your treatment. If you have any questions about ZETIA, ask your
doctor. Only your doctor can determine if ZETIA is right for you.
What is ZETIA?
ZETIA is a medicine used to lower levels of total cholesterol and LDL(bad) cholesterol in the blood.
It is used for patients who cannot control their cholesterol levels by diet alone. It can be used by
itself or with other medicines to treat high cholesterol. You should stay on a cholesterol-lowering
diet while taking this medicine.
ZETIA works to reduce the amount of cholesterol your body absorbs. ZETIA does not help you lose weight.
For more information about cholesterol, see the "What should I know about high cholesterol?"
section that follows.
Tell your doctor about all your medical conditions including allergies.
Tell your doctor if you:
• ever had liver may not be right for you.
problems. ZETIA
• are pregnant or plan to become pregnant. Your doctor will decide if ZETIA is right for you.
• are breast-feeding. We do not know if ZETIA can pass to your baby through your milk. Your doctor
willdecide if ZETIA is right foryou.
• experience unexplained muscle pain, tenderness, or weakness.
See your doctor regularly to check your cholesterol level and to check for side effects. Your doctor
may do blood tests to check your liver before you start taking ZETIA with a statin and during treatment.
In clinical studies patients reported few side effects while taking ZETIA. These included stomach
pain and feeling tired.
Very rarely, patients have experienced severe muscle problems while taking ZETIA® (ezetimibe),
usually when ZETIA was added to a statin drug. If you experience unexplained muscle pain,
tenderness, or weakness while taking ZETIA, contact your doctor immediately. You need to do
this promptly, because on rare occasions, these muscle problems can be serious, with muscle
breakdown resulting in kidney damage.
Additionally, the following side effects have been reported in general use: allergic reactions (which
may require treatment right away) including swelling of the face, lips, tongue, and/or throat that may
cause difficulty inbreathing or swallowing, rash, and hives; joint pain; muscle aches; alterations
in some laboratory blood tests; liver problems; inflammation of the pancreas; nausea; gallstones;
inflammation of the gallbladder.
your doctor if you are having these or any other medical problems while on ZETIA. For a
Tell
complete list of side effects, ask your doctor or pharmacist.
Cholesterol is a type of fat found in your blood. Yourtotal cholesterol is made up of LDL and HDL
cholesterol.
LDL cholesterol is called "bad" cholesterol because it can build up in the wall of your arteries and
form plaque. Overtime, plaque build-up can cause a narrowing of the arteries. This narrowing can
slow or block blood flow to your heart, brain, and other organs. High LDL cholesterol is a major
cause of heart disease and stroke.
HDL cholesterol is called "good" cholesterol because it keeps the bad cholesterol from building up
in the arteries.
This summarizes the most important information about ZETIA. If you would like more information,
talk withyour doctor. You can ask your pharmacist or doctor for information about ZETIA that is
written for health professionals.
Inactive ingredients:
By:
Schering Corporation
Kenilworth, NJ 07033, USA
or
Merck & Co., Inc.
Whitehouse Station, NJ 08889, USA
REV 08 29480800T
COPYRIGHT ©Merck/Schering-Plough Pharmaceuticals, 2001, 2002.
All rights reserved.
Printed in USA. 20652648(2)(800)-ZET
BREAK
THROUGH!
Amazing
discoveries, devices,
tests and cures
»» STOP AN EPIDEMIC!
oon there may be blood cleaner comes
S a way to fight a
pandemic before
has time to spread. The
it
in two sizes and is used
with portable pumps
or dialysis machines.
Hemopurifier, designed The smaller version is
by Aethlon Medical, a the size of a large pen. James A. Joyce, points
small biotech company Itcan be attached to out that it took about
in California, is a blood- an artery in the arm by 90 days before the
filtering device that emergency medical SARS virus was identi-
removes viruses and personnel, using only fied. With the Hemo- DESIGN
toxins before infection needles, tubing and purifier, you won’t lose
attacks organs, using tape. After filtering of valuable time — and
a method similar to the blood is complete lives —while scientists HEADCASE
ment can begin without to identify the germ they’re dealing with.
first identifying the or toxin from blood M 1-2 YEARS ILLUSTRATED
UFESCIENCES
new material that could » 4-5 YEARS
one day be used in LISA FIELDS
growing and repairing
human bones.
BETTER
EDWARDS
CHURCHMAN/PHOTONICA/GETTY
promises to improve
the quality of bone im-
plants in surgery. Earlier
A technique lets ra-
diologists distin-
guish between malignant
detection is their best
hope. “If our results can
be reproduced in a large
research on spider silk and benign breast le- multicenter trial,” says
for people with knee the 80 cases studied. reduce the number
(TOP) injuries. M 5* YEARS An estimated 213,000 of breast biopsies
NEENA SAMUEL women are diagnosed required.” M l YEAR
with breast cancer in the FRAN LOSTYS
107
I
BREAK
THROUGH!
II SMALL
I» MEDICATION MATCH GAME POX CURE
cientists seeking new treatments for dis- But wasn't that disease
stamped out
officially
Human Genome Project data, and the results should be out there. And if they
help researchers discover new applications for ended up in terrorists'
existing medications. So far, about 160 drugs and hands, the results could
compounds are cataloged, and a few new uses for be devastating, infecting
existing drugs have been suggested. Eventually, all thousands, possibly mil-
FDA-approved drugs should be included. I) NOW lions. of people. Up to
S Americans (about
a third of them
kids) suffer from
In studies, most
patients who
the therapy breathed
received
as dangerous as small-
pox. » 1-3 YEARS
CYNTHIA DERMODY
(BELOW)
INC.,
MB. A
ble tube,
the mouth
is inserted into
or nose and
larger trial
under way. »» 3-5
is
YEARS
V'. (LEFT)
(TOP)
and disaster scenarios while, the Navy is urg- needed. > 1-3 YEARS
because unlike real ing more studies of LAURA MCCLURE
Little Kate's twisted spine
was squeezing herjunes,
threatening to kill her.
Now, with a new expindab|e
titanium rib, she hak
w '
WM
defect that affects muscles and joints. on the TV with her toes, rolled
to turn
Over the next few months, Kate’s from room to room, then zipped
fingers loosened up, thanks to physi- around on her bottom with such en-
cal therapy. But the scoliosis made it thusiasm that her parents nicknamed
hard for her to eat, since her contorted her Scooter. When she finally learned
bones squeezed her stomach. “We had to crawl, at 18 months, she looked like
to fight for every calorie because she a tiny bulldozer because her forehead
vomited very easily,” says Lynn, a glided on the floor.
Kewaunee, Wisconsin, stay-at-home
mom who also has a six-year-old n 2005, dr. noonan suggested a
daughter, Alexandra. “Every day was surgical treatment that had been
horribly stressful. We fed Kate eight approved by the FDA the year be-
times a day through a tube, and most fore: implanting an artificial rib
gurt.” The little girl grew painfully nine-inch-long device has hooks on ei-
thin and gasped at the slightest exer- ther end, the doctor explained: “It’s at-
tion, such as reaching for a toy. tached to a rib at the top of the curve
Kate’s situation was dire. The and the spine at the bottom, then acts
Rueckerts searched for a specialist like a jack to stretch the bones to the
who could help and found Kenneth correct position.” There were several
Noonan, MD, a pediatric orthopedic risks, including bone fractures, infec-
surgeon at University of Wisconsin tions and the possibility of spinal cord
Children’s Hospital. When he exam- or nerve damage. And Dr. Noonan had
ined Kate in 2004, her spine curved never done the operation before.
90 degrees. “Such extreme scoliosis “We were scared and nervous, but
in an infant is potentially fatal, be- we trusted Dr. Noonan,” says Lynn.
cause there was very little room in her She and Jack, a nuclear plant opera-
chest for her lungs to develop. As she tor, researched the rib, which has been
got older, they’d stay very small, which used more than 300 cases nation-
in
could cause restrictive lung disease. wide. They learned that in cases like
Without effective treatment, she was Kate’s, the VEPTR is a huge advance
likely to die by age 15 to 20.” over previous scoliosis surgeries,
For a few months, Dr. Noonan tried which can cause spinal fusion. That’s
body casts, a spine-straightening treat- okay for a teenager who has finished
ment that’s been used for over 40 growing but not for a toddler like Kate.
years. But Kate didn’t improve, Lynn To prepare for the procedure, the
says. “Her head leaned on her shoul- doctor flew to Texas to train with the
der, and she couldn’t look up.” Kate device’s inventor, Robert Campbell,
found ways to compensate for her dis- MD, and also asked another surgeon
ability, however. She figured out how who was highly experienced in the
112
AFTER
technique to assist with Kate’s August the rib expanded by making a small
2005 operation. incision, loosening a screw and rotat-
Lynn and Jack braced themselves ing the VEPTR like a car jack. It will
for a five- to six-hour wait as Dr. Noo- be adjusted every four to six months as
nan worried whether Kate’s bones she grows and, most likely, will be re-
were tough enough to accept the de- moved when she’s older.
vice easily. “We were almost scared to A friendly girl who loves to play
hope too much,” says Lynn. So when with My Little Ponies, make up songs
the doctor came back sooner than ex- with her sister and scribble in color-
pected, they panicked, thinking some- ing books, Kate recently took her first
thing was wrong. But the procedure steps. Lynn cheered the accomplish-
had gone smoothly. The Rueckerts vis- ment and rejoices to hear her daugh-
ited Kate in the ICU. “We were amazed. ter, whose appetite is much better, say,
pill,
bined with radioactive
SHINGLES Anyone three impressive jobs: iodine and injected into
who’s had chickenpox The beta blocker Coreg the body, the venom HEADCASE
114
» NANO-KNITTERS
FOR NERVES
esearchers at assemble
R a
MIT have found
way to restore
vision in brain-damaged
into a
mesh-
like struc-
rodents. The innovative ture that’s
procedure uses nano- similar to
technology to spur the body’s
growth in damaged connective
nerve cells. Scientists tissue. This Nanoscaffolding allows damaged
say the technique could “scaffolding” allows nerve cells to regrow.
someday be used to nerve cells to grow and
restore speech, hearing, reconnect, restoring lost
vision and movement communication between both young and adult ro-
in people affected by the brain and the body. dents. “The brain started
and spinal cord injuries. Rutledge Ellis-Behnke says. “We have never
How does it work? tested the solution in seen that before.” Six
A clear liquid of amino hamsters with severed months later, 75% of the
acids is injected into optic tracts. Within 24 animals had regained
the injured part of the hours, the injured nerve functional vision.
brain. The amino acids cells began to regrow in 1*5+ YEARS LAURA MCCLURE
W
University
hat if there were a
off the diseases that
at the
may have found
pill you could take
come with
to ward
aging? Researchers
National Institute on Aging and Harvard
the answer: resveratrol, a
substance found naturally in red wine. Even though scien-
tists fed mice a high-fat diet, a daily dose of resveratrol pro
tected them from diabetes, and they lived longer than mice
who didn’t get any. It’s still unclear exactly how resveratrol
works, but it seems to mimic the life-lengthening benefits
of calorie restriction. No matter how much red wine you
drink, it would be tough to get enough resveratrol (not
115
BREAK
THROUGH!
years ago, she’d lose track of orders “I’m more clear and I feel better about
BRAIN
in the flower shop she ran with her myself,” Anna says. “It’s been a real
husband, James Hickerson, 75. She’d blessing,” says her husband.
FOR
forget the day of the week and got lost Researchers reported encouraging
so often, she quit driving. Ralph Phase II trial results on Alzhemed in
INSTITUTE
therapies have been used in six early brain damage. Such brain-cell-saving
three for Parkinson’s, two for
trials: drugs are desperately needed to pro-
lethal pediatric brain disorders and tect stroke patients from brain dam-
one for Alzheimer’s. If they continue age, but over the past decade, none have
to prove safe and show positive re- passed muster in clinical trials. Arma-
sults, we’ll be able to treat some of the Gen Technologies, which Dr. Pard-
most devastating brain disorders. ridge founded to commercialize the
technology, plans a human safety trial
» BRIDGINGTHE on the new stroke drug in late 2007.
BLOOD-BRAIN BARRIER The smuggling strategy could work
Scientists have begun to overcome with any brain drug, Dr. Pardridge
one of the biggest obstacles to treat- says, and ArmaGen is developing
ing brain disease: getting drugs into drugs for Alzheimer’s, Parkinson’s and
the brain. Ninety-eight percent of can- a class of hereditary brain diseases
didate drug compounds do not pass that cause birth defects, mental retar-
from the bloodstream into the brain, dation and other severe problems.
even though they move easily into
other organs, says William Pardridge, W HOW YOUR
MD, a professor of medicine at Uni- MIND HEALS YOU
As
versity of California, Los Angeles. In one of brain biology’s most amaz-
a result,good drugs for brain disor- ing advances, scientists have found
ders are few and far between. that our brain may actually help our
Would-be drugs fail because the immune system fight disease. It took
walls of the brain’s blood vessels act 20 years of careful experiments for
likeborder-crossing guards after a Kevin Tracey, MD, to see it that way.
code-red terror alert: They allow only It also took a very special patient
pasta, tripped over her and spilled a testines — stops severe sepsis. It does
ten-quart pot of boiling water onto so by using neurochemicals to signal
the baby Tracey cared for the
girl. Dr. immune cells, which prevents them
girl, who had suffered second- and from releasing alarm molecules that
third-degree burns over 75 percent of spur inflammation and cause damage.
her body. A week after she was admit- In a 2006 study, he discovered a brain
ted, Janice developed severe sepsis, a circuit that could stimulate the
vagus
condition in which the immune sys- nerve to switch off inflammation.
tem massively overreacts to a bacter- Taken together, the studies demon-
ial infection, indiscriminately training strated a hard-wired connection be-
its cannons on the body’s own tissues. tween the brain and immune system
For the next two and half weeks, Jan- that Dr. Tracey calls the “inflamma-
ice lay clinging to life in her hospital tory reflex.” Normally, when inflam-
bed, as Dr. Tracey and his colleagues mation spreads, the brain tells the
triedone heroic measure after another immune system to turn it down. In
to revive her. She recovered enough patients like Janice with severe sepsis,
to celebrate her first birthday in the that reflex fails.
burn unit with her parents, her grand- Drugs that activate the reflex could
mother and the medical staff, and was one day reduce chronic low-grade
expected to be discharged soon. Then, inflammation— the kind that causes
the next day, her heart stopped sud- Crohn’s disease and rheumatoid
denly and she died. “She’s the only pa- arthritis, and contributes to heart dis-
tient I ever had nightmares about,” Dr. ease. Meditation might help, too, says
Tracey says. “She shouldn’t have died.” Dr. Tracey. People can learn to slow
No one knew then what caused se- their heartbeat by modifying vagus
vere sepsis, so, inspired by Janice, Dr. nerve activity, which suggests they
Tracey set out to learn. Two decades might be able to control their own
later, his work is paying off. In a se- brains to calm inflammation and fight
ries of studies since 2000, he’s shown disease.“It’s the most exciting thing
can spur lab-grown cancer cells to re- the human brain to help people heal
lease two compounds that help them themselves.
move through the body and then For example, using special fMRI
metastasize, according to a study in scanners and software that allowed
the November issue of Cancer Re- patients to see their own brain activ-
search by virologist Ronald Glaser, ity, scientists at Stanford University
PhD, of Ohio State University Medical and Omneuron, a biotech company,
Center. A third compound that’s re- trained participants to reduce chronic
leased helps supply growing tumors it and learning
pain by just visualizing
with nutrients. So reducing stress may to control it. Some were able to de-
DRIVEN TO DISTRACTION
At a family reunion, my cousin recalled the day his wife gave birth.
As he excitedly described the trip to the hospital, someone asked,
“What would you have done if the expectant mother had developed
complications during the car ride?”
“What do you think?” replied my cousin. “I would’ve slid over and
taken the wheel.”
tion,
nausea and constipa-
so some patients get
levels, which help indicate the presence of cancer. grief along with relief. But
They found that drinking eight ounces of the tangy scientists have changed IMAGES
juice daily significantly slowed rising PSA levels in the way narcotic drugs
235,000
patients previously treated for the disease. Addi- behave by activating only
tional clinical trials are planned to confirm the the receptors that relieve
/NONSTOCK/JUPITER
SURGERY
Using medical robots for
'
G joice: Hospital
waiting rooms
could soon be killing
put the coating on
hospital furniture,
drapes — the potential
on
is
T
NEBRASKA-LINCOLN,
it
years with melanoma, just about everyone is.
texture and activates
But May, and it is his cancer
41, is quite alive,
transducers on the sur-
OF
that has died, thanks to an experimental gene ther-
geon’s glove to give the
apy. Steven A. Rosenberg, MD, chief of surgery at
sensation of touch. This
the National Cancer Institute in Bethesda, Maryland,
UNIVERSITY
125
Remarkable innovations in treating
injured soldiers will ultimately
benefit us all BY MICHAEL J. WEISS
Staff Sgt. Jacque
Keeslar stretches
after physical
therapy at Walter
Reed. His left leg
is the C-Leg.
tated his right leg below the knee and vember, he competed in the New York
his left one at the kneecap. “I don’t re- City Marathon, riding a hand-cranked
member when I realized my legs were recumbent bicycle to reach the finish
gone,” says Keeslar today. “All I could line of the 26-mile course in a little
think about was starting the recovery over three hours. This year, he hopes
process so could walk again.”
I to return to active duty as an instruc-
A mere four months after the at- Knox, Kentucky, and looks
tor at Fort
tack, Keeslar is getting his wish. At forward to spending weekends riding
Walter Reed Army Medical Center in his Harley-Davidson motorcycle. “As
Washington, D.C., he strides around soon as I put on the C-Leg, I was walk-
the physical therapy center with barely ing again,” Keeslar says. “It’s an awe-
Beneath baggy
a hitch in his gait. some piece of equipment.”
sweatpants and jogging shoes, he Though Keeslar’s recovery seems
AN EXPLOSION RIPPEDTHROUGHTHE
vehicle. “OH, MY GOD, I'M HIT!" the
BLASTSHREDDED BOTH OF KEESLAR'S LEGS.
128
BATTLEFIELD ADVANCES
received in combat to be fatal. Less Dr. Armonda estimates that the sur-
than ten percent of soldiers survived vival rate of neuro-rescued brain-
severe head injuries, and fewer than trauma victims has risen to more than
five percent went on to lead inde- 50 percent and more than a third
pendent, functioning lives. But when have returned to independent living
coalition forces landed in Iraq in working, driving a car and even at-
2003, a group of eight U.S. neurosur- tending college.
geons and neurologists decided to try Meanwhile, neuro-rescue tech-
a new front-line approach to TBIs niques are slowly being adopted in
called damage control neurosurgery, hospitals in the States, where 1.4 mil-
or neuro rescue. lion Americans suffer TBIs every year.
Stationed at the 28th Combat Sup- After ABC News anchor Bob Woodruff
port Hospital near Fallujah, they de- sustained a brain injury in Iraq, he re-
veloped a technique that involved ceived the pioneering treatment under
delicately removing part of a patient’s Dr. Armonda’s care last winter.
skull to allow the brain to swell instead
of put pressure on the brainstem, II ULTIMATE BANDAGE
which could cause irreversible coma. Since the dawn of warfare, a major
After closing the scalp, doctors en- on the battlefield has
killer of soldiers
sure the brain receives plenty of blood been severe bleeding. Even today in
by using micro-balloons and medica- Iraq and Afghanistan, many of those
129
Made of
an organic
substance
from shrimp
shells called
chitosan, the
bandage
becomes
sticky when in
contact with
blood, and
seals bleeding
wounds. The
positively
charged chi-
tosan bonds
with the nega-
tively charged
red blood cells
to form a clot.
who die in combat bleed to death in blood. Then it adheres to the sur-
the minutes before they can be evac- rounding tissue and seals off the blood
uated to an aid station. But that tragic like no other conventional bandage.”
may soon decline with the devel-
toll Created by scientists at the Oregon
opment of an innovative dressing Medical Laser Center under a grant
called the HemCon Bandage. Made from the U.S. Army Medical Research
with chitosan (pronounced KY-tuh- and Materiel Command, the HemCon
san), it uses an organic substance from (for “hemorrhage control”) Bandage
shrimp shells to help blood cells form works because the positively charged
clots. A four-inch-square dressing can chitosan material bonds with nega-
staunch a heavily gushing wound in tively charged blood cells to form an
30 seconds and has been shown to stop artificial clot. When researchers first
military reports credit the bandage ments and civilian hospitals in the
with already saving more than 100 United Kingdom. Pilot programs are
lives. In mid-2006, the manufacturer, being set up in France and Canada.
Portland-based HemCon Medical First responders in the United States
Technologies Inc., began marketing are also using it to record medical in-
Tactical (and pronounced “bee mist”), lion service members and veterans.
the software allows medics to gener- When these advances are combined,
ate an electronic health record about medical workers will have access to
a soldier for later retrieval by front- the complete health records of even
line doctors or a stateside hospital. In unconscious soldiers. This will allow
addition, it acts like a medical text- them to determine whether a person
book, so medics can look up diagnos- has been exposed to a chemical agent,
tic and treatment information in a and it will also prevent deadly drug
combat zone. Already, BMIST software interactions. Over the past five years,
has been licensed to military depart- AHLTA has identified and resolved
131
Medics input symptoms, and BMIST
comes up with a treatment plan.
integrating BMIST with a sensor that origins of pain, they developed an ex-
will automatically alert a doctor when — actually, a synthetic
perimental drug PROTECTION
medics in the near future will be able called nerve growth factor. The pow-
to wave a handheld BMIST device over erful antibody keeps the brain from FOR
a wounded soldier, save the patient’s receiving pain messages sent by nerve
AFFAIRS
vital signs on an EIC, and take com- endings surrounding an injury. And
fort in knowing that the medical chart the drug is long-lasting; a single dose
HEALTH
will follow the patient for the rest can block pain for several weeks. Best
of his life. of all, it has no addictive side effects.
DEFENSE
For over a century, doctors have to a hospital days later,” says Brett
treated seriously wounded soldiers Giroir, MD, deputy director of DARPA ’s COURTESY
with morphine, all the while knowing Defense Sciences Office in Arlington,
the narcotic’s downsides. It impairs Virginia. RN624 was developed at Palo
breathing, reduces decision-making Alto-based Rinat Neuroscience Cor-
abilities and, if taken over time, can poration, which was bought by Pfizer
be addictive. But three years ago, last year. Pfizer is conducting clinical
researchers funded by the Defense trials on the drug and hopes to market
132
BATTLEFIELD ADVANCES
it. According to Dr. Giroir, “This could nology to people, says Dr. Ling, and
revolutionize the way we treat pain.” scientists are conducting the first
human trials with paraplegics and pa-
» PROSTHETICS WITH tients who have Parkinson’s disease.
THOUGHT CONTROL DARPA’s timetable calls for complet-
While some of the military’s medi- ing a working prosthetic arm and hand
cal initiatives are years away from by the end of the year that will look,
fruition, they have astonishing promise. feel and perform like natural limbs.
At DARPA, it’s hoped that an ambitious Two years later, it hopes to apply for
four-year, $48 million Revolutionizing FDA approval for a working, neurally
Prosthetics Program will result in the controlled model.
human arms and
creation of artificial Having served as a military physi-
hands controlled by brain waves. Al- cian in Afghanistan and Iraq, Dr. Ling
ready, researchers have found success knows the urgency in bringing these
with primates. At the University of —
advances to life “for the good of the
Pittsburgh, scientists taught a monkey troops,” he says. But he also knows
to feed itself using thought-generated that medical breakthroughs born of
impulses picked up by the electrodes war aid all humanity: Blood banks,
of a prosthetic arm. “The monkey was penicillin and reconstructive surgery
able to move the robot arm out, grab all emerged from past conflicts. “Per-
OUR BAD
These newspaper editors stand corrected.
133
BREAK
»» THROUGH!
ONE FLU SHOT FITS ALL
universal vaccine could protect you from
A
called
all major strains of flu, even the dreaded avian
T
in
proven cancer
a ment and is being used
the blood of chocolate
fighter) have given to treat macular degen-
lovers than in those
millions of macular de- eration, and Lucentis
who passed on the
generation patients hope was approved as a treat- sweets. Cocoa beans
of improving their vi- ment for the disease
contain chemicals called DESIGN
killing the cancer while Doctors often place a balloon in the blocked artery,
sparing healthy tissue. opening it up to restore blood flow and limit the
Researchers at UCLA damage. Adding stem cells taken from your own
used HIV to attack bone marrow may be even more effective, say re-
melanoma in mice. Al- searchers in London. When injected into the artery,
though humans won’t be the cells go directly to the spot where the heart was
tested with this protocol damaged. In mice studies, the cells turn into heart
for years, at the Mayo muscle and restore much of the heart function.
Clinic, trials are under One day we might be able to completely restore
way using the measles the heart after an attack, says researcher Anthony
virus to fight ovarian and Mathur, PhD. “This is the first time we’ve used our
Zu brain cancers. II 5* YEARS own cells to repair damaged organs.” II 3-5 YEARS
LISA FIELDS PATRICIA CURTIS
U artificial
the market
designed for everybody.
knee on
was
Flex Knee, from Zim-
mer, Inc. “Women are
not just little men. They
going to be customizing
parts to patients rather
than saying everybody
But women’s knees are are different, and they drives a Ford.” Next up:
narrower and more walk differently,” says artificial hips for
delicate than men’s, and Robert Booth, MD, chief women. II NOW
the implant commonly of orthopedic surgery at CYNTHIA DERMODY
caused parts to over- Pennsylvania Hospital,
hang, causing rubbing who has installed about
and pain and mak-
ing it difficult for
patients to get
out of chairs or
climb stairs.
Last year, the
FDA approved
the first implant
for women, the
Z Z S '
for their growing family, and her par- open. She was raced to a local hospi-
ents would be visiting later in the day. tal, then airlifted to a trauma center in
“I’m going to take a shower,” she told Morristown, New Jersey. “I knew they
Michael, who was still dozing. “I’ve wouldn’t do that unless her condition
do before Mom and Dad get
stuff to was very serious,” says Michael, who
—
here and we need groceries too.” followed in his car. “I was crying as I
Seconds later, Michael heard a thud. drove. How could she have hurt herself
He didn’t know it, but a desperate race so badly slipping in the bathroom? I
against time had just begun. He leapt panicked to the point that I thought
out of bed to see what was wrong. In about losing my wife, and our girls
the bathroom, he found his wife of five growing up without their mother.”
years slumped against the tub. “I was
dialed
He carried her to their bed,
911. During the
that Traci couldn’t
“That scared
call,
Blood clot
The Merci Retriever is then
deployed through the
Microcatheter until it comes
out the other end and curls
into a “corkscrew."
Merci Retriever
The Merci Retriever is
again? Was she going to die? Strokes clock, but his best guess was that she
kill more than 157,000 Americans was stricken at around 6 a.m., or pos-
a year, about 60 percent of them sibly a little later.
women. Survivors can be left with The specialist checked his watch. It
paralysis, impaired vision, chronic was 8:45 a.m. There were just minutes
pain, difficulty speaking, or cognitive left to administer tPA (tissue plasmino-
or emotional problems. gen activator), a clot-busting drug
The neurologist explained that it that’s only approved for use within
might be possible to reverse the three hours of a stroke. But the doc-
stroke. But it all depended on whether tor worried that the clot in Traci’s
Traci could be treated in time. The brain was too big to dissolve with tPA.
longer her brain went without blood If it didn’t work, she’d be left pro-
flow, the greater the damage. Before foundly disabled, if she survived at all.
device called the Merci Retriever (FDA right decision,” he says. “I would have
approved August 2004) is designed
in agreed to anything if it gave Traci a
to pluck clots out of blocked vessels better chance at getting back to nor-
like corks from wine bottles. It’s more mal. She didn’t seem to be suffering,
beneficial than tPA for large blockages but when the doctor asked her to stick
and works for up to eight hours after out her tongue, she couldn’t even do
a stroke, says Ronald Benitez, MD, that.” Michael sped to Overlook Hos-
Overlook’s director of endovascular pital so fast thathe actually beat the
neurosurgery. “Expanding the treat- ambulance there. When Traci arrived,
ment window means many more pa- about 10 a.m., he kissed her and
tients will be spared death or disability, promised that the surgeons would help
sincemost people don’t get to the hos- her. “I must have said ‘I love you’ a
time for tPA.” (See “Stroke
pital in hundred times before they pulled me
Warning Signs,” page 142.) away. I was bawling my head off.”
The Merci treatment has serious Four and a half hours after the stroke
risks, including punctured blood ves- began, Traci was put under general
140
But Dr. Benitez’s first
cited, relieved and hopeful,” says a flashlight into her left eye. “I was dev-
Michael. Even though Traci seemed astated that I couldn’t see on that side,”
dazed, and had limited use of her right says Traci, who was struggling to un-
arm, he was convinced that over time, derstand what had happened to her. “I
she’d recover 100 percent. didn’t get the whole stroke thing, or
The next day, however, there was a why something was wrong with my left
setback. When a doctor checked her eye, when the other problems were on
vision, she didn’t react when he shone the right side of my body.” The doctor
thought that a fragment of the
clot might have blocked flow
» STROKE to a vessel in that eye during
must get tPA within three hours, or the Merci she burst into tears, then put
Retriever procedure within eight hours. For Alexis in her lap while they
more information, visit the manufacturer’s squeezed and molded the Play-
website, concentric-medical.com. or the Doh together.
National Stroke Association at stroke.org. After a week, Traci was
142
STOPPING A STROKE
Please note that this rule of thumb does not apply in the other direc-
tion. A guy in Illinois was picked up on charges of attempting to mug
a Chicago police officer. Mugger’s gun was phony; cop’s wasn’t. Name
of perp: Eugene Smart, Jr.
143
LAUGHTER, THE BEST MEDICINE
FORTUNE-TELLERS are SO
easy to buy clothes for
they’re all mediums.
Submitted by FRED MECKLEY
Funnier
Did you hear
about the little
green man who
went to
A
jail?
woman rubbed thousands of years. I'm
a lamp and out not that good,” he said. Yeah, he was
popped “Do I
a genie. “What do you have?”
else a lepre-con.
get three wishes?” she “Well, I’d love a good
asked. man. One who’s consid-
“Nope, I’m a one-wish erate, loves kids, likes to Funniest
genie. What will it be?” cook and doesn’t watch Why can’t
“See this map? want sports day.”
I all
you borrow
these countries to stop “Okay,” the genie said
fighting so we can have with a sigh. “Let me see
money from
world peace.” that map again.” a leprechaun?
“They’ve been at war Submitted by D. RICHARDS
Because they’re
always a little
man turns to leave. “But you left three glasses room, an indication that
untouched.” reading is definitely
“I know," the man says. “My doctor says okay
it’s becoming a lost art.
to have the odd drink.” submitted by jee wan yau Submitted by GARTH GAMBLIN
How does
Snoop Dogg MaIy mother could make anybody feel guilty. She
used to get letters of apology from people she didn’t
cook his eggs? even know. joan rivers
Ta sizzle.
Submitted by YANG XI
it
w hat starting
salary are
you looking for?” the
head of human resources
vnce upon a time, a
beautifulyoung antelope
was going to the party of
the year. Excited, she
put on a new outfit,
the whole nine yards.
Suddenly, she was
stampeded by a herd
of buffalo, making her
the first self-dressed
asks the newly gradu- makeup, great shoes, stamped antelope.
ated engineer at the
end of a job interview.
Going for it, the guy
says, “Well, sir, I was
thinking about $125,000,
depending on the bene-
fits package.”
“Okay," the HR direc-
tor says. “How about five
weeks’ vacation, 14 paid
holidays, full medical
and dental, 100% com-
pany match for your
401(k) and a Porsche for
your company car?”
The engineer gasps
and says, “Wow! Are you
kidding?”
“Yeah,” he replies.
“But you started it.”
Q: How many suburban- What did our farmer say about roasting a pig to cel-
ites does it take to screw ebrate his anniversary? January's winning punch line
A: One, but it has to be Ohio: "Maybe, but cows are better at taking a joke."
146
Overboard
Confessions of
a (way too)
protective parent
"THE MR. & MRS. HAPPY HANDBOOK." COPYRIGHT %> 2006 BY STEVE DOOCY, IS PUBLISHED AT $23.95
BY WILLIAM MORROW. AN IMPRINT OF HARPERCOLLINS PUBLISHERS. 10 E. 53RD ST.. NEW YORK, NEW YORK 10022
DAD OVERBOARD
and cut off the air supply. They said how they are over-
hot dogs were also exactly the diam-
eter of a kid’s throat and great caution “The Kryptonite 51
’
^edi'tcj'rI
must be used when consuming them. Stroller, that’s a nice CHOICE
Both these foods were fine to eat, we touch,” says my wife.
were told, as long as they were cut up.
From that day forward, whenever we
CEP To buy a copy of The Mr. & Mrs.
Happy Handbook, go to rd.com/doocy.
the next day was, she answered, “The first day of spring training.”
EDNA HILTS
149
Can the
Jlflaverick
Go
Mainstream?
BY CARL M. CANNON
John mccain leaned forward, his voice low and firm. “In 1994, we
became the majority in both houses of Congress in order to change
government. Instead, government changed us. We began to value
power over principle.”
It’s a theme Senator McCain pressed strongly in a recent interview
with Reader’s Digest and will no doubt sound often in the months
ahead: The Republicans were hammered in the 2006 midterm elections
because “we lost our way,” corrupted by special-interest money.
His voice rose as he warmed to a prime target of his wrath
pork barrel spending. “We had begun to believe that it’s our
money!” he said. “Honest to God, we believe it’s our money,
not theirs [taxpayers’].”
This is the John McCain etched deeply in our minds,
the principled straight shooter with the courage to take on
anyone, even a fellow Republican, if he or she somehow
betrayed the public trust. It’s a reputation that has made
him a front-runner for the GOP nomination for President in
2008. But being a maverick is also his biggest hurdle. Conser-
vative activists are not at all sure that McCain is one of them, and in
150
THE CONTENDERS 2008
John McCain
PLATON/ART DEPT /CPI
RD MARCH 2007
trying to woo these kingmakers, the Yet less than a decade later, there
Senator could alienate moderates who he was campaigning in Phoenix and
are drawn to his aura of independence winning over voters with his upbeat
and integrity. manner and infectious humor. A nag-
Whatever else, there is nothing ging issue dogged his campaign,
predictable about his coming candi- though: Why was McCain running
dacy. But then, his rise in national pol- in this district at all? He’d lived in
itics was never predictable— much Phoenix less than a year and had
less inevitable. almost no connection with Arizona.
He put the matter to rest during a can-
wenty-five years ago, John didates’ debate when a rival leveled
McCain was a retired U.S. the carpetbagger charge yet again.
away in the grim prison that POWs the longest in my life was Hanoi.”
dubbed the Hanoi Hilton. For five and The audience sat for a few seconds
a half years, he was tortured and in stunned silence, then erupted in
starved. Several times, the North Viet- deafening applause. McCain won the
namese attempted to use him for election, served two terms in the
propaganda purposes by offering House, and then ran for the Senate
to release the admiral’s son ahead from Arizona in 1986, winning by
of other Americans who’d been increasingly absurd margins every six
imprisoned longer. McCain kept re- years.
fusing to accept his own freedom, This ability to make the best of a
which engendered more beatings and bad situation is John MfcCain’s hall-
more torture. mark as a public figure. From the mo-
By the time he returnedto America ment he set foot again on American
man, his hair had turned white
a free soil in 1973, he made it a point not to
and he was suffering from severe quarrel with the antiwar protesters
wounds that persist to this day. An- of the Vietnam era, even the draft
other casualty of war was the collapse dodgers. In 1994, McCain and future
of his marriage to Carol Shepp, mother Democratic Presidential nominee John
of McCain’s first daughter, Sydney. Kerry were invited to the Oval Office
152
CAN THE MAVERICK GO MAINSTREAM?
by President Clinton to discuss the laws but had shown “poor judgment.”
political fallout of normalizing rela- Then there’s the matter of McCain’s
tions with Vietnam. “McCain spoke famous temper. Many is the time he
for less than a minute,” recalled Mc- has sent notes to staffers, and even
Cain’s chief of staff, Mark Salter. “He fellow Senators, apologizing for one
basically said, ‘It doesn’t matter who outburst or another. During the 2000
was for the war, who was against the some Repub-
Presidential primaries,
war. Let’s move on.’ Clinton just licansworking for Bush tried to
looked at McCain and said, ‘You’re an undermine McCain’s candidacy by
”
amazing man.’ disseminating talking points about his
To be sure, he has not led a pristine short fuse. The Bush people were im-
public life. Three months after Mc- plying that McCain lacked a proper
153
RD MARCH 2007
JOHN MCCAIN'S
abuses of power and REPORT CARD melanoma (which has
misuse of the trust of been treated success-
BRAINPOWER 2.8
the American people. fully, according to his
When I see $233 million TEMPERAMENT 2.2 doctors). Even without
an island
for a bridge to COURAGE 3.9 that grave health threat,
in Alaska with 50 peo- political observers note,
VISION 2.2
ple on it. I’m angry. by 2008 he will be 72
COMMUNICATION
When I see Vladimir
3.2
years old — too old, in
Putin consolidating the CHARISMA 3.3 the view of some, to
old Russian Empire, I INTEGRITY 2.9 seek the Presidency.
get angry. When I see EXPERIENCE 3.3
Asked how he’d an-
Hugo Chavez call the swer voters who ques-
President of the United
JUDGMENT 2.6
tion whether he has the
States all kinds of GPA 2.9 stamina to handle the
names, I get angry. So White House job, Mc-
ti'X-l'ViW Grade Senator
the question is, Do you McCain at rd.com/election.
Cain replies, “I think I
act just out of control, would say that I’m older
or do you maintain your capacity for than dirt. That I have more scars than
anger, which makes you even more Frankenstein. That I’ve learned a few
motivated to carry out the responsibil- things along the way. Anyone who ac-
ities of your oath of office?” companied me in the two months be-
Oh yes, there’s that other potential fore the last election, or while I was
impediment — concerns about his hiking in the Grand Canyon, can at-
health and age. During thesummer of test to the fact that I’m capable of keep-
2000, McCain was diagnosed with ing a very rigorous schedule.”
VISION Promotes large goals for America and policies to fulfill them
COMMUNICATION Can articulate and ''sell" a vision for the country to everyday people
CHARISMA Has a dynamism and charm that encourages others to follow
INTEGRITY Honest and trustworthy, engendering respect even among political foes
EXPERIENCE Savvy about the workings of government so goals can become accomplishments
JUDGMENT Has a track record of sound decisions based on facts, not hopes or emotions
RD PANEL OF EXPERTS Richard Brookhiser, biographer and historian; Mickey Edwards, former
Republican Congressman, Oklahoma; Les Francis, deputy chief of staff. Carter White House; Thomas
Mann, senior fellow, Brookings Institution; Norman Ornstein, resident scholar, American Enterprise
Institute; John J. Pitney, political scientist, Claremont College; Shirley Anne Warshaw, political
scientist, Gettysburg College; Michael Cromartie, vice president, Ethics and Public Policy Center.
CAN THE MAVERICK GO MAINSTREAM?
ltimately, his candidacy will Cain has come out in favor of making
likely rise or fall on his pol- the Bush tax cuts permanent, even
U
needs.
icy stands.
sure to
And
disappoint
he's almost
constituency he desperately
Enamored independents and
moderate Democrats will discover that
some
though in his previous incarnation
as a deficit hawk, McCain didn’t sup-
port them. “A profile in courage can
become a profile in unrestrained am-
Kenneth Duberstein, Rea-
bition,” said
McCain is fully honest when he says, gan’sWhite House chief of staff, in an
“My 24-year voting record is a consis- interview with Time magazine. “He
tent, conservative voting record. So- has to remember who his friends are
cially, fiscally and militarily, I am a and not spend his integrity on one-
conservative.” He is certainly pro mil- night stands with those who will never
itary and antiabortion, and a foe of ex- fully trust him.”
cessive federal spending. On one issue, and it’s a big one, Mc-
But these stands won’t necessarily Cain has remained constant: Iraq. And
win over the party’s base. They aren’t that may prove the greatest barrier
forgetting that McCain went against between McCain and the Presidency.
President Bush on his tax cuts, and The Senator believes the invasion was
that he championed campaign
federal the right thing to do, has consistently
finance reform alongside liberal Wis- called for more — not fewer — troops
consin Senator Russ Feingold. And and thinks victory is still possible.
evangelicals will be reminded that in Former Senator John Edwards, who is
2000, McCain characterized Jerry Fal- pursuing the 2008 Democratic nomi-
well and Pat Robertson as “agents of nation, has taken to calling the policy
intolerance” and “corrupting influ- of sending more American soldiers to
ences” in American politics. It’s true Iraq the McCain Doctrine.
that last year, Falwell reached out to This is intended to stigmatize Mc-
McCain, who responded by giving the Cain with voters, which it may do. If
2006 commencement address at the that happens, McCain says simply, it’s
155
Take a peek inside TV's top
medical dramas and see how
real those cases are
BY MARY A. FISCHER
to a nurse, who passes it along to a the popular FX series about two racy
lab tech. Suddenly, chaos erupts as Miami cosmetic surgeons.
everyone exposed becomes woozy To show the actors how to realisti-
and collapses. cally perform their doctorly duties, to
The episode being filmed comes make sure the props — from blood
from a real-life case in Southern syringes to suture-removal kits— are COLLECTION;
COLLECTION
herbal remedy, and the combination Klein puts in long hours on Anatomy’s EVERETT
emits toxic fumes from her body, caus- set whenever medical procedures are
ing her attending doctors to pass out. being filmed. COURTESY
But it wasn’t enough for the produc- “Linda takes the time to show us TV/COURTESY
wanted to make sure all the medical Anatomy’s title character, Dr. Mere- UNIVERSAL
details on the set added up. To do that, dith Grey (and, as fans will know, the ST.
they called in Linda Klein, who, after love interest of Dr. Derek “McDreamy”
M.D.)
working for more than ten years as a Shepherd). “She makes sure every-
M*A*S*H,
surgical tech and nurse, recently be- thing is done perfectly.” WELBY,
came a producer and medical consult- As medical dramas have evolved KILDARE.
ant for Grey’s Anatomy and Nip/Tuck, from fiction to near fact, professionals (MARCUS
(DR
158
DOCS IN THE BOX
Jg
O—
like Klein have become the backbone got blood on their hands and never
<r
of such hit shows as House and ER. made mistakes. The sanitized image
Zo
They teach actors how to hold a of medicine and its practitioners was
St scalpel, insert (fake) intubation tubes, a reflection of the script-approval
52 perform CPR, choreograph operations, process: Until the mid-1970s, produc-
make incisions into lifelike (pros- ers routinely submitted scripts to the
Ss thetic) chests and brains, and speak American Medical Association for
“i and think like doctors — all with the review.
jj goal of giving TV viewers the pre- By the early ’70s, Marcus Welby,
jg scription they’ve come to crave: a M.D. and Medical Center began deal-
heavy dose of realism. ing with controversial social issues—
O £:
iz rape, homosexuality, sexually trans-
Cable s Nip/Tuck
features glam
Miami plastic —
surgeons and gritty
OR scenes.
RD MARCH 2007
N
has there been such a your engagement or your Golden
quirky, angst-ridden but lov- Globe nomination?
able prime-time character Pompeo: They were both very, very
as Meredith Grey. In por- surprising, and I wasn’t expecting
traying the female lead of Grey’s either, honestly.
Anatomy, Ellen Pompeo has gener-
ated a lion’s share of the show’s water- RD: How does your fiance react to
was
cooler and online chatter, and she your romantic scenes with Patrick
nominated Golden Globe. The
for a Dempsey?
actress has come a long way since an Pompeo: Chris is the most secure man
agent approached her in the mid-
first I know, which is why I’m going to
1990s in a New York restaurant, where marry him. But I don’t like to throw
she was working as a bartender. A na- these scenes in his face. I certainly
tive of Boston, she made her film debut wouldn’t like to see him kissing an-
in Moonlight Mile opposite Jake other woman on-screen. He’s not an
Gyllenhaal, but found her true calling actor, so he doesn’t understand just
playing a surgical intern on the small how unsexy it really is with 40 crew
flaws and exhaustion, the crowded Los Angeles. “In the beginning,” he
waiting room, the explicit surgeries, recalls, “we said ‘That’s too bloody to
successful and botched,” says Dr. Fred show,’ or ‘We can’t use technical medi-
Einesman, ER’s medical advisor. “The cal jargon.’ But now, viewers expect it
show became a phenomenon in the to be real.”
medical community at the time be- “In Hollywood, what sells is sex
cause it was so accurate.” and violence,” says Professor Turow.
Einesman would know. He worked So when ER has to get people’s atten-
for more than 15 years as an ER doc- tion in sweeps week, they have an in-
tor at Cedars-Sinai Medical Center in credible helicopter crash or a bus
them in the oven and make him check means to be a doctor and what they
on them all the time. have to deal with. With all the pressure
they’re under, and the many other
RD: What do you like most about the things they have going on at any one
character of Meredith Grey? moment, Iunderstand now why they
Pompeo: The fact that she’s flawed can’t be as compassionate as I might
but is determined to become a sur- like them to be.
geon even though she doubts
herself sometimes. There’s a re- RD: Tell us what you have
markable amount of sexism on learned about the medical
TV. When male characters are profession.
flawed, they’re interesting, deep Pompeo: I certainly have
and complex. But when female more respect for doctors
characters are flawed, they’re just than before. I didn’t realize
a mess. It’s good to put the fatigue and pressure
flawed but interesting female that most of them are
characters out there because working under all
it promotes equality. the time. It’s one
of the few profes-
RD: Has playing the role sions where if you
of Meredith Grey given make a mistake, it
you certain expectations can mean some-
about doctors and hospi- body’s life.
tals that you didn’t have tiiiwuiiB Listen
before? to more of the
Pompeo: No. I have Ellen Pompeo
interview— and
fewer expectations now
view a slide show of
because I understand
d on-the-set photos— at
more about what it rd.com/pompeo.
RD MARCH 2007
Today, there are few taboo subjects. didn’t have the luxury of reacting
AIDS, abortion, even the death penalty emotionally.”
have been addressed on recent Einesman has shared that lesson in
episodes of House. When a death row reality when advising actors about
inmate becomes seriously ill, Dr. how to make their interactions with
Gregory House, the chronically cranky, patients look real. “I tell them, ‘You
pain-pill-addicted medical genius don’t have time to emote here; you
played by Golden Globe winner Hugh have to get the job done. There are 35
Laurie, rises to the diagnostic chal- people in the waiting room, and you
lenge. Is it a tumor, a blood disease? have to see one patient every 15
No, turns out the inmate ingested toxic minutes.’
”
actually
ample, gives the thick, drying blood gone to an HMO knows differently.”
you’d see congealed on an old knife A persistent criticism of these
wound or a battered corpse. series from the medical community
Actual cervical-spine x-rays and is the survival rate of both CPR
MRIs from anonymous patients’ files and coma patients, which medical
are used on ER, and the medical equip- research says is much less success-
ment on these shows heart moni- — ful in real life. Another criticism:
tors, respirators, EKGs is also — Nobody ever talks about money or
authentic, as are the machines’ nu- insurance.
merical readings to reflect the cases “Now and then on ER, you’ll get the
being portrayed. sense of a beleaguered hospital with
Still, for all their realism, these dra- people waiting for care,” Turow says.
mas remain, at heart, fiction. “They “But you don't see anyone at the recep-
setup unrealistic expectations about tion booth being asked for their in-
doctors and hospitals,” points out And there’s no real social
surance card.
Professor Turow. “Who wouldn’t want context —
American society owning
a Dr. McDreamy listening intently to up what it means to have the baby-
to
their problems? But when you go to boom generation marching toward its
a hospital, it can be a scary place. final years.”
Doctors and nurses are overloaded, Still, there’s no arguing with one
and in these days of managed care, aspect of medical dramas. The suc-
you’re lucky if you see the same cessful formula of presenting doctors
doctor twice.” who care but have flaws and make
“The idea that there’s one brilliant mistakes leads to a scary truth. Says
doctor, like Gregory House, who Turow, “It’s a crapshoot on these
would become that invested in a real- shows as to whether a patient will
life patient’s case is very appealing,” come out okay — which is just like in
says David Foster. “Anyone who’s the real world.”
163
V
amazing
animals
BY MAUREEN M ACKE V.'.
The Bodyguard
She’s 150 pounds of pork and
attitude, and good thing too. When
seven-year-old Jordan Jones was playing
outside his Las Vegas homeOctober
in
164
m llldLb MU Diruurdlll Sunshine’s radiant colors
are a good match for this six-year-old macaw's bold personality.
When a burglar broke into J. W. Erb’s apartment in Williamsport,
Pennsylvania, one January day in 2006, the bird was sitting on top
of his cage— "a favorite perch,” Erb says— awaiting his owner's return
from work as a hairdresser. Spotting the stranger, who began ran-
sacking the place, Sunshine flew at him, pecking madly. An awful
scuffle ensued. "And my bird won," says Erb. The burglar fled, $100
richer— but beaten up. When Erb got home, he found his beloved
pet curled up in a corner, traumatized, with blood and feathers every-
where. Erb called police, who nabbed their suspect shortly after; he'd
been brought in on another charge. Beak bite-marks gave him away.
Pet Pals When
an electrical fire roared
through the Gardner fam-
NEWS
ily home in Palo Cedro,
California, in December
2006, firefighters rushed
in but fortunately found
no one two-
CANTILLON/BUFFALO
inside. Still,
PHOTOGRAPHED
Casey kept running from
room to room, searching.”
When the dog found
(RIGHT)
Cindy, the family’s plump
and elderly cat, he used
his nose to nudge the
who
SHARKEY:
scared-to-death feline out of the house. Gardner, with wife Chyla celebrated the
M.
birth of their fourth child this past Christmas, feels blessed. "It was heart-wrenching
to lose our home. But Casey's a hero. Thanks to him, we still have Cindy."
(LEFT)
—
——
,
THE HOARDING SYNDROME
room and then the dining area, where they always did. But the visit in May
piles of papers, books and other ob- 2006 was different. By then, Howard
jects (including boxes and boxes of had separated from her husband and
past-their-prime Girl Scout Cookies) was raising Kelsie, 16, Zachary, 15, Clay,
were stacked on nearly every surface. 10, and Ben, 8, on her own for almost
This was not the life Sue Howard a year and a half. The clutter was get-
had imagined in 1988, when she mar- ting worse —
and potentially danger-
ried and joined her husband in satisfy- ous. The caseworker told Howard to
ing but low-paying church work. Her move the children to their father’s
family had grown at a much faster rate
apartment.
than their modest income. The finan-
cial strugglebecame overwhelming.
About nine years ago, Howard, now
COMPULSION
42, began to feel trapped by poverty. Saving stuff, in moderation, is usu-
“I thought, What can I do? I’ll do what ally considered normal. But this oth-
my grandma did.” From that moment, erwise healthy impulse can go too
Howard refused to discard anything far and develop into what some ex-
she considered potentially useful. perts consider a clinical obsessive-
In 2001, when her husband went to compulsive disorder. Compulsive
graduate school,Howard began selling hoarding can’t be chalked up to ec-
books online. She took pride in snap- centricity or a character flaw. It’s more
ping up bargains for her four children serious and harder to control than that.
and her business at thrift stores, “This not laziness, criminal negli-
is
garage sales and Wal-Mart. But those gence or failure to attend to the re-
bargains gradually took over the sponsibilities of life,” explains Sanjaya
household, adding to the tension of Saxena, MD, director of the Obsessive-
an already troubled marriage. The Compulsive Disorders Program at the
scuffed kitchen floor was sometimes University of California, San Diego.
and appliances, including the
sticky, “It is, in fact,
a neuropsychiatric dis-
dishwasher and refrigerator, were order that will not get better unless
often on the fritz. Howard was too em- the person is treated.”
barrassed to allow a stranger in to do And can lead to tragic conse-
it
repairs and too overwhelmed to clean quences. One
of the most famous cases
up a home filled with clutter. Every involved the wealthy and reclusive Col-
time the doorbell rang, her stomach lyer brothers. In 1947, their bodies were
knotted in fear. discovered in a crumbling New York
Between 2002 and 2005, casework- City mansion packed with more than
ers visited Howard’s home at least five 100 tons of junk. Last year, a resident
times in response to anonymous calls. of Shelton, Washington, was smoth-
They gave Howard and her husband ered when a massive pile of clothes
time to clean up the property, which toppled on her. And a few fatal fires
170
WHEN CLUTTER GOES OUT OF CONTROL
have even made headlines. Hoarders old newspapers may see an archive of
tend to fill their homes with flamma- valuable, potentially life-changing
ble materialand often block hallways information. From that perspective,
and exits in the process, which can discarding a newspaper is wasteful,
make escaping a fire impossible. foolish,perhaps even a personal fail-
Hoarding can affect people of all ure. And so this clinical disorder
ages and backgrounds. As many as transforms the everyday act of throw-
three million to six million Americans ing away an object into a deeply
may be afflicted at some level, and wrenching, personal violation.
Saxena warns that hoarding often re- Organization is also a nightmare.
quires extensive treatment. But many Steketee and Frost say that compul-
deny that they have too much stuff or sive hoarders usually have trouble
171
RD MARCH 2007
risk of injuring themselves in a fall. say they don’t always have a choice.
Extreme hoarding endangers not “The constant refrain we hear from
only the residents but also neighbors professionals is ‘If they aren’t a dan-
and firefighters, who face greater risk ger to others, then they have a right
of injury and death when battling to live how they want,’ ” says Donna
clutter-fed flames. It can become a Austin,who founded the Children
financial threat to communities as of Hoarders online support group
well. Making a hoarder’s home safe (childrenofhoarders.com). “When
and habitable can be staggeringly an aging parent runs the daily risk of
expensive, and hoarders can’t always slipping on glossy magazines on the
pick up that tab. One year, the health floor and breaking a hip, or lives in an
department of town spent
a small extreme fire hazard, it’s not so easy to
approximately 75 percent of the com- stand by and do nothing.”
munity’s entire budget on cleaning It’s not so easy to help either. By
out a hoarder’s home, according to the time Eugenia Lester’s children
Frost. A mere 18 months later, “the stepped in, the 60-year-old former
home was back the way it was before." businesswoman was sleeping in the
yard of her Southern California home.
Piles of stuff blocked every door of
SUFFERS the pale stucco residence, which could
Family members often feel angry be entered only through a window.
and resentful about a hoarder’s seem- Unhappy neighbors had circulated a
ingly inexplicable behavior. They also petition to force Lester out of the area,
feel trapped. Forcible cleanups are and she was in and out of court for
risky, but so is honoring a hoarder’s failing to clean up the property, ac-
wishes to be left alone. Relatives often cording to her daughter Cynthia, a 28-
try to sortthrough a hoard secretly or year-old filmmaker in New York. Even
without permission. That’s “a very bad as rats rooted through refuse in the
idea,” according to Fugen Neziroglu, uninhabitable home, Lester was un-
PhD, co-author of Overcoming Com- able or unwilling to acknowledge the
pulsive Hoarding and clinical director physical and legal dangers she faced.
of the Bio-Behavioral Institute of Son Brian, 25, says cleaning out his
Great Neck, New York. mother’s home was like working at a
Neziroglu encourages family mem- landfill. “Everything inside was rotted
bers to take a different approach and mildewed,” he says. “It looked like
and confront hoarders about the the city dump. There was stuff piled
problem with the help of an experi- up about four feet high— trash, pic-
enced therapist. Experts like her tures, clothes, newspapers.” House-
caution that disposing of a person’s hold leaks meant the bottom layer was
belongings without permission can wet; the entire house stank.
lead to trauma or worse. But relatives Cynthia’s upcoming documentary,
172
While Sue Howard’s hoarding is more much better in a board-and-care fa-
under control in her house, her garage think our family and my
cility. “I
(above) still harbors some clutter. mother are in a much better space,”
Cynthia says. “We are closer and
My Mother’s Garden, records the long, happier.” But Cynthia is still trying to
painful process of separating Lester arrange appropriate treatment for her
from most of her possessions during mother’s disorder.
the summer and fall of 2005. It took Steketee says hoarders and their
Lester’s children about eight weeks families pay a toll for interventions.
and some $20,000 simply to empty the “Whichever family members carry the
place. Lester’s disorder made her any- stick are going to pay for that in terms
thing but grateful when she returned of the relationship,” she says. The
home after the cleanup. “I hate you Lester family was no exception.
people; you robbed me,” she shouted, Cynthia says her mother may never
then started weeping. A few weeks forgive her for the forced cleanup.
later, Lester was so depressed and sui- Clearing a clutter-ridden home is
cidal that she needed emergency care. so stressful that family members are
More than a year after the painful often tempted to simply trash every-
intervention, Lester seems to be doing thing, which adds to the hoarder’s dis-
LJ
RD MARCH 2007
A girl I liked said she wouldn’t date people born the same month as
she was.”— Greg, 22
“A woman told me she’d be too tired the night I asked her out, but she
told me this two days ahead of time.”— Kevin, 41
“A girl said that her car broke down and then gave me
a big, long story
about what was wrong. Only problem? I have a car and could’ve
driven her. Plus, I’m a mechanic.”— Wally, 20
She told me that she had to go buy the doughnuts for her singles
STDs group. Point taken.’’-Greg, 32 happenmag.com
174
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Visit www.AmbienCR.com or call 1-800-662-9864.
- DHtiMine
S2SMG e 12 5-MG EX D RELEASE TABLETS
With AMBIEN CR. getting to sleep fast and staying asleep helps you wake up and get ready for the day." AMBIEN CR is a treatment option you and your healthcare provider can
consider along with lifestyle changes and can be taken for as long as your healthcare provider recommends. Ask your healthcare provider about the latest AMBIEN, AMBIEN CR —
and don't forget to mention the CR.
When you first start taking AMBIEN, use caution in the morning when engaging in activities It is a treatment option you and your healthcare provider can consider along with lifestyle
requiring complete alertness untilyou know how you will react to this medication. Inmost changes and can be taken for as long as your healthcare provider recommends. Untilyou
instances, memory problems can be avoided you take AMBIEN only when you are able to
if know how AMBIEN CR will affect you, you shouldn't drive or operate machinery. Be sure
get a fu* night’s sleep (7 to 8 hours) before you need to be active again. As with any sleep you're able to devote 7 to 8 hours to sleep before being active again. Side effects may include
medication, do not use alcohol while you are taking AMBIEN. next-day drowsiness, dizziness and headache. It's non-narcotic; however, like most sleep
healthcare provider. Like most sleep medicines, it has some risk of dependency.
There is a low occurrence of side effects associated with the short-term use of AMBIEN.
The most commonly observed side effects in controlled clinical trials were drowsiness (2%), C?
dizziness (1%). and diarrhea (1%).
sanofi aventls
Not actual pdl size Please see important patient information on adjoining page
02005-2006 sanofi-aventis U.S. LLC. All rights reserved. US ACR.06.12 021 December 2006 Printed in USA
INFORMATION FOR PATIENTS
Ambien CR™ @
(zolpidem tartrate extended-release) tablets
/4MBENCR
INFORMATION FOR PATIENTS TAKING happened for severalhours after taking the medi- Ifyou have been taking Ambien CR or any other
AMBIEN CR cine. This is usually not a problem since most peo- sleep medicine for more than 1 or 2 weeks, do not
Vour doctor has prescribed Ambien CR to help you ple fall asleep after taking the medicine. stop taking it on your own. Always follow your doc-
sleep. The following information is intended to Memory loss can be a problem, however, when tor's directions.
guide you in the safe use of this medicine. is not sleep medicines are taken while traveling, such as Changes
It
in behavior and thinking: Some people
meant to take the place of your doctor's instruc- during an airplane flight and the person wakes up using sleep medicines have experienced unusual
tions. If you have any questions about Ambien CR before the effect of the medicine is gone. This has changes in their thinking and/or behavior. These
tablets be sure to ask your doctor or pharmacist. been called “traveler’s amnesia." effects are not common. However, they have
Ambien CR is used to treat different types of sleep Be sureto talk to your doctor if you think you are included.
problems, such as: having memory problems. Although memory • more outgoing or aggressive behavior than
• trouble falling asleep problems are not very common while taking normal
• waking up often during the night Ambien CR, most instances, they can be
in • confusion
Some people may have more than one of these avoided if you take Ambien CR only when you • strange behavior
problems. are able to get a full night's sleep (7 to 8 hours) • agitation
Ambien CR belongs to a group of medicines before you need to be active again. • hallucinations
known as the "sedative/hypnotics", or simply, Tolerance: When sleep medicines are used every
• worsening of depression
•
sleep medicines. There are many different sleep night for more than afew weeks, they may lose suicidal thoughts
medicines available to help people sleep better their effectiveness to help you sleep. This is known How often these effects occur depends on several
Sleep problems are usually temporary, requiring as "tolerance". Sleep medicines should, in most factors, such as a person's general health, the use
treatment for only a short time, usually 1 or 2 days cases, be used only for short periods of time, such of other medicines, and which sleep medicine is
up to 1 or 2 weeks. Some people have chronic as 1 or 2 days and generally no longer than 1 or 2 being used.
sleep problems that may require more prolonged weeks. If your sleep problems continue, consult
It is also important to realize that it is rarely clear
use of sleep medicine. However, you should not your doctor, who will determine whether other
whether these behavior changes are caused by the
use these medicines for long periods without talk- measures are needed to overcome your sleep
medicine, an illness, or occur on their own. In fact,
ing with your doctor about the risks and benefits problems.
sleep problems that do not improve may be due
of prolonged use.
Dependence: Sleep medicines can cause depend- to illnesses that were present before the medicine
SIDE EFFECTS ence, especially when these medicines are used was used. If you or your family notice any changes
regularly for longer than a few weeks or at high your behavior, or you have any unusual or
Most common side effects: in if
• headache
doses. Some people develop a need to continue disturbing thoughts, call your doctor immediately.
• somnolence
taking their medicines. This is known as depend-
(sleepiness) Pregnancy: Sleep medicines may cause sedation
ence or "addiction."
• dizziness of the unborn baby when used during the last
You may
When people develop dependence, they may have weeks of pregnancy.
find that these medicines make you
difficulty stopping the sleep medicine. the med-
sleepy during the day. How drowsy you feel If
Be sure to tell your doctor if you are pregnant, if
icine is suddenly stopped, the body is not able to
depends upon how your body reacts to the medi- you are planningto become pregnant, or if you
which sleep medicine you are taking, and
function normally and unpleasant symptoms may
cine, become pregnant while taking Ambien CR.
how large a dose your doctor has prescribed.
occur (see Withdrawal). They may find that they
special type of memory loss or "amnesia." When not get discouraged. This problem usually goes
this occurs, a person may not remember what has away on its own after 1 or 2 nights.
6. Do not increase the prescribed dose of 8. Be aware that you may have more sleeping INFORMATION FOR PATIENTS
Ambien CR or any other sleep medicine problems the first night after stopping
unless instructed by your doctor. Ambien CR or any other sleep medicine.
Ambien CR™ (jy
7. When you first start taking Ambien CR or 9. Be sure to tell your doctor if you are preg- (zolpidem tartrate extended-release) tablets
11.
any other sleep medicine, until you know nant. if you are planning to become preg-
whether the medicine will still have some nant, or if you become pregnant while taking
Ambien CR or any other Ambien CR works very quickly. You should
carryover effect in you the next day, use sleep medicine.
prescription medicines, never
only takeAmbien CR right before going to
extreme care while doing anything that 10. As with all
requires complete alertness, such as driving share Ambien CR or any other sleep medi-
bed and are ready to go to sleep.
a car, operating machinery, or piloting an cine withanyone else. Always store Ambien
aircraft. CR or any other sleep medicine in the origi- sanofi-aventis U.S. LLC
nal container that you received it in and Bridgewater, NJ 08807
store it out of reach of children.
Country of Origin: France
Copyright, sanofi-aventis U.S. LLC 2006 Printed in USA AMBCR-FEB06-IFP-Ae Revised February 2006
INFORMATION FOR PATIENTS TAKING the next day, use extreme care while doing any- used regularly for longer than a few weeks or at
AMBIEN thing that requires complete alertness, such as high doses. Some people develop a need to con-
driving a car, operating machinery, or piloting an tinue taking their medicines. This is known as
Your doctor has prescribed Ambien to help you aircraft. dependence or “addiction."
sleep. The following information is intended to • NEVER drink alcohol while you are being treat- When people develop dependence, they may
guide you in the safe use of this medicine. It is not
ed with Ambien or any sleep medicine. Alcohol have difficulty stopping the sleep medicine. If the
meant to take the place of your doctor's instruc- can increase the side effects of Ambien or any medicine is suddenly stopped, the body is not
tions. If you have any questions about Ambien other sleep medicine. able to function normally and unpleasant symp-
tablets be sure to ask your doctor or pharmacist. toms may They may
• Do not take any other medicines without asking (see Withdrawal) occur. find
Ambien is used to treat different types of sleep your doctor first. This includes medicines you can they have to keep taking the medicine either at
problems, such as: buy without a prescription. Some medicines can the prescribed dose or at increasing doses just to
• trouble falling asleep cause drowsiness and are best avoided while tak- avoid withdrawal symptoms.
• waking up too early in the morning ing Ambien. All people taking sleep medicines have some risk
• waking up often during the night • Always take the exact dose of Ambien pre- of becoming dependent on the medicine.
Some people may have more than one of these scribed by your doctor. Never change your dose However, people who have been dependent on
problems. without talking to your doctor first. alcohol or other drugs in the past may have a
Ambien belongs to a group of medicines known higher chance of becoming addicted to sleep
SPECIAL CONCERNS
as the “sedative/hypnotics, ' or simply, sleep med- medicines. This possibility must be considered
icines. There are many different sleep medicines There are some special problems that may occur before using these medicines for more than a few
available to help people sleep better. Sleep prob- while taking sleep medicines. weeks.
lems are usually temporary, requiring treatment If you have been addicted to alcohol or drugs in
Memory problems: Sleep medicines may cause a
for only a short time, usually 1 or 2 days up to 1 the past, it is important to tell your doctor before
special type of memory loss or 'amnesia." When
or 2 weeks. Some people have chronic sleep prob- starting Ambien or any sleep medicine.
this occurs, a person may not remember what has
lems that may require more prolonged use of happened for several hours after taking the med- Withdrawal: Withdrawal symptoms may occur
sleep medicine. However, you should not use when sleep medicines are stopped suddenly after
icine. This is usually not a problem since most
these medicines for long periods without talking being used daily for a long time. In some cases,
people fall asleep after taking the medicine.
with your doctor about the risks and benefits of these symptoms can occur even the medicine
Memory loss can be a problem, however, when if
sleepy during the day. How drowsy you feel the medicine is stopped than before starting the
Tolerance: When sleep medicines are used every
depends upon how your body reacts to the med- medicine. If you should experience rebound
night for more than a few weeks, they may lose
icine, which sleep medicine you are taking, and insomnia, do not get discouraged. This problem
their effectiveness to help you sleep. This is
how large a dose your doctor has prescribed. usually goes away on its own after 1 or 2 nights.
known as “tolerance." Sleep medicines should, in
Daytime drowsiness is best avoided by taking the If you have been taking Ambien or any other
most cases, be used only for short periods of time,
lowest dose possible that will still help you sleep sleep medicine for more than 1 or 2 weeks, do not
such as 1 or 2 days and generally no longer than
at night.Your doctor will work with you to find stop taking it on your own. Always follow your
1 or 2 weeks. If your sleep problems continue,
the dose of Ambien that is best for you. doctor’s directions.
consult your doctor, who will determine whether
To manage these side effects while you are taking Changes in behavior and thinking: Some peo-
other measures are needed to overcome your
this medicine: ple using sleep medicines have experienced
sleep problems.
• When you Ambien or any other
first start taking unusual changes in their thinking and/or behav-
sleep medicine until you know whether the med- Dependence: Sleep medicines can cause
ior. These effects are not common. However, they
icine will still have some carryover effect in you dependence, especially when these medicines are
have included:
• more outgoing or aggressive behavior than SAFE USE OF SLEEPING MEDICINES
normal
INFORMATION FOR PATIENTS
• loss of personal identity To ensure the safe and effective use of Ambien or
Ambien® 6
• confusion any other sleep medicine, you should observe the
• strange behavior following cautions: (zolpidem tartrate)
• agitation 1 . Ambien is a prescription medicine and should
• hallucinations be used ONLY as directed by your doctor. the medicine will still have some carryover
• worsening of depression Follow your doctor's instructions about how effect inyou the next day, use extreme care
• suicidal thoughts to take, when to take, and how long to take while doing anything that requires complete
How often these effects occur depends on several Ambien. alertness, such as driving a car, operating
factors,such as a person’s general health, the use 2. Never use Ambien or any other sleep medi- machinery, or piloting an aircraft.
of other medicines, and which sleep medicine is cine for longer than directed by your doctor. 8. Be aware that you may have more sleeping
being used. Clinical experience with Ambien sug- 3. If you notice any unusual and/or disturbing
problems the first night or two after stopping
gests that it is uncommonly associated with these thoughts or behavior during treatment with Ambien or any other sleep medicine.
behavior changes Ambien or any other sleep medicine, contact 9. Be sure to tell your doctor if you are pregnant,
It is also important to realize that your doctor. you are planning
it is rarely clear if to become pregnant, or if
whether these behavior changes are caused by 4. Tellyour doctor about any medicines you may you become pregnant while taking Ambien.
the medicine, an illness, or occur on their own. In be taking, including medicines you may buy 10. As with all prescription medicines, never
fact, sleep problems that do not improve may be without a prescription. You should, also tell share Ambien or any other sleep medicine
due to illnesses that were present before the your doctor if you drink alcohol. DO NOT use with anyone else. Always store Ambien or any
medicine was used. If you or your family notice alcohol while taking Ambien or any other other sleep medicine in the original container
any changes in your behavior, or if you have any sleep medicine. out of reach of children.
unusual or disturbing thoughts, call your doctor 5. Do not take Ambien unless you are able to get 11. Ambien works very quickly. You should only
immediately. a full night's sleep before you must be active takeAmbien right before going to bed and are
Pregnancy: Sleep medicines may cause sedation again. For example, Ambien should not be ready to go to sleep.
taken on an overnight airplane flight of less
of the unborn baby when used during the last
than 7 to 8 hours since -traveler’s amnesia-
weeks of pregnancy. Ambien' 6
Be sure to tell your doctor if you are pregnant, if
may occur. (zolpidem tartrate)
you are planning to become pregnant, or if you
6. Do not increase the prescribed dose of
Ambien or any other sleep medicine unless Printed in USA
become pregnant while taking Ambien.
instructed by your doctor.
7. When you first start taking Ambien or any Copyright, sanofi-aventis U.S. LLC 2006
other sleep medicine until you know whether
I have one hundred and sixteen soy I have one hundred and eighty-four
GRAVE MATTERS
If someone misspeaks, it’s usually fixable— after all,
dorox.com
When the man of her dreams
descended into madness, she
became his victim
BY ELLEN SHERMAN
Kathryn keats awoke in a panic, convinced she’d
heard the curtains in front of her bedroom’s French
doors swaying. In the dim glow from a bathroom night-
light, she made out a ghostly shadow on the wall and
The figure lunged toward her. But 32-year-old musical director, a com-
instead of the assault of a murderous pelling presence with long black hair
stalker, Keats, 43, felt her seven-year- and piercing green eyes. “I thought
old son wrapping his arms around her. he was not only beautiful,” Munger
Frightened by a bad dream, he’d come recalls, “but also the most mysterious
to his parents’ room for comfort. “All and talented person I had ever met.”
I could think was, If I’d had a gun, I That day, the two began a musical
would have shot him,” Keats says collaboration that would continue
today. “No one could understand how for years.
scared I was.” Munger joined the show’s Philadel-
No one could understand because phia company, and soon she and Ford
not even her closest friends knew that were living together. Raised in Phila-
Keats’s true name was Ellen Christ- delphia, Ford had served in Vietnam
ian Munger, and that for 21 years, and, upon his return in the early 1970s,
she’d been in hiding from a man who had immersed himself in the world of
had worked with her, loved her and musical theater, composing and writ-
ultimately become bent on destroy- ing shows that gained little notice until
ing her. a producer brought him in to direct
Let My People Come. When Ford and
Munger weren’t working on the pro-
M
unger grew up in Evans-
ville, Indiana, the young- duction, which played to packed
and “the
est of three houses in both New York and Phila-
star” of the family. By her delphia, they successfully teamed up
late teens, she was an ac- on other musical compositions and
complished singer and musician who performed at cabarets.
had performed at the Grand Ole Opry. But in the couple’s second year
In 1978, at age 18, she moved to New together, Munger noticed a troubling
York to pursue a career in theater and shift in Ford’s personality. He was
was soon called to audition for the distracted and moody and increas-
successful off-Broadway show Let My ingly seemed mutter to himself.
to
People Come. Back in their apartment one rainy
At the audition, she watched a man night after the show, Ford hurled
play the piano with impressive virtu- Munger against a wall, shouting that
osity. He was Ken Ford, the show’s he didn’t like the way other male cast
When she tried to flee, he held up a her. Eventually Munger stopped fight-
bottle he’d broken in the sink. He used ing back. “I was numb,” she says.
the glass to cut himself, then spread Ford, who disconnected the phone
blood on Munger’s arm. “See what I lines, allowed her to eat only tomato
can do to you?” he shouted. soup, which he would crush cigarette
That night, Munger stayed with butts into. “He’d blindfold me and
friends. But she went back to Ford the throw a glass at the side of my head to
next day— as she would, again and see if I trusted him,” Munger recalls.
she says, “but like most victims of He repeatedly raped and beat her. “In
abuse, I thought I could be the one to my mind,” says Munger today, “I was
save him.” a dead person.”
In the spring of 1983, Munger and Finally, one afternoon in the spring
Ford left the tour and moved to Oak- of 1984, Ann Carlin, who had assumed
land, California, where Munger’s sis- that her sister was on an extended
ter, Ann Carlin, had settled with her tour out of town, drove to Munger’s
family. Munger hoped that, without apartment and rang the bell. When
the pressures of the show, Ford would Ford opened the door a crack, Carlin
stabilize. Instead, his delusions wors- caught a glimpse of her sister, covered
186
POSSESSED BY LOVE
in blood. She ran to a nearby pay who didn’thave a career that would
phone and called the police. When the put her in the public eye. Worse than
officers arrived, it took five of them to giving up her name, Ellen Munger
haul Ford off in a straitjacket. would have to abandon her music. “It
Munger was taken to a safe house meant losing the one thing on earth I
run by the Alameda Victim/Witness had lived for,” she says today. “I was
Assistance program, and Ford was devastated.”
committed to Oakland’s Highland But she also realized there was no
Hospital for 72 hours. Afterward other way and that she didn’t have
he was flown back to Philadelphia, much time. Her father moved to Oak-
where his parents were waiting. Soon land to be nearby and hired a body-
Munger moved to her sister’s home guard for her. With the help of the
to recuperate. Victim/Witness Assistance program,
But her nightmare was not over. she legally changed her name to
One afternoon just two weeks after Kathryn Keats. She started training
Ford flew East, the phone in Carlin’s as a paralegal, and by the time Ford
kitchen rang. It was Ford, who told was released, Ellen Munger was gone.
Carlin that Zen gods had instructed All that remained was the fear. As
him to return to Oakland, dismember long as Ken Ford walked free, Keats
and kill Munger, hang her entrails believed her life was in danger.
from a tree and then kill himself.
M
Munger contacted police, who took onths turned into years,
up watch outside Carlin’s home. Two and Kathryn Keats began
weeks later, the officers apprehended to emerge from her co-
Ford as he approached the house; he coon. She spoke to no
was dressed all in white, wearing a one from her past aside
white wig. Charged with being a dan- from family members and a few
ger to himself and others, Ford was trusted childhood friends. She got a
found guilty and committed to Napa job in film financing and slowly made
State Hospital for six months. new friends, always keeping her back-
To Munger, all that meant was Ford ground vague. In 1988, she met a man
would be free in just 180 days to make who interested her— Richard Conti, a
good, once again, on his promise to printing executive.
kill her. In desperation, she met with “She was so dynamic and yet very
Alameda County Assistant District stable,” says Conti. But there was
Attorney Leo Dorado, who suggested something unsettled about her. “She’d
a plan. Ellen Munger, he told her, wake up scared to death, shaking, and
would have to disappear for her own couldn’t tell me why,” he says. “All I
safety. The singer who’d dreamed of could do was just be there for her.”
seeing her name in lights would have After a year, Keats told him the truth
to become someone else — someone about her past. She and Conti mar-
187
ried in 1993 and had two sons, Andrew, Keats, husband Richard Conti and sons
now 11, and Lorenzo, 9. Lorenzo (left) and Andrew enjoy an
Early in her new life, Keats con- outing with their family pooch. Scarlet.
tacted Barbara Crawford, a Philadel-
phia psychologist who had befriended thriving at work, raising her family
Ford years earlier. While she didn’t and getting involved in her commu-
provide her new name or location, nity. “But inside,” she says, “I was still
Keats learned from Crawford that a hostage.” One afternoon, she glanced
Ford was living on the streets of out her front window and saw some-
Philadelphia. Crawford told her she one sitting in a parked car with tinted
had once invited Ford into her resi- windows. Minutes turned into Flours,
dence and that he set fire to her piano. and the driver remained, waiting and
She also said Ford had told her that watching. “I broke out in a cold sweat,”
he remained obsessed with killing Keats says. “I thought, Why would
his former lover. anyone sit outside my house for so
To outsiders, Keats appeared to be long? I was sure Ken had found us.”
188 PHOTOGRAPHED BY TIM TADDER
POSSESSED BY LOVE
She frantically called police, but be- room, tears rolling down her cheeks.
door opened
fore they arrived, the car “I cried because I knew I would
and a woman emerged. It was a neigh- finally sing and write again,” Keats
bor’s baby-sitter, doing some home- says. “And I cried out of relief, be-
work before going to work. cause I was finally free. My hell was
morning, she called one of the pro- her husband and two sons, who often
ducers of Let My People Come and join her at the piano. Though she
learned that Ford, who’d still been liv- hasn’t shared all the details with them,
ing on the streets of Philadelphia, her boys now know that their mother
had died more than a year earlier of had to change her identity for her
lung cancer. safety. And they know that, after so
She sat down at her piano, put her long, EllenMunger and Kathryn Keats
hands on the keys and, for the first have finally become one.
time in years, composed a song. She ii'IMnW To hear a clip from Kathryn's CD
sang it out loud to the empty living After the Silence, visit rd.com/kathryn.
189
5 BIGGEST
HOME REPAIR
RIP-OFFS BY TOM PHILBIN
V V BASEMENT
BOONDOGGLE
THE RIP-OFF If your basement is
THE REALITY chronically wet, unscrupulous con-
Most of the time, tractors might tell you they need to
V roof leaks occur because dig out your entire foundation and wa-
| |
the sealing around vent terproof it, for anywhere from $5,000
pipes has failed, the metal flash- to $15,000. More often, though, the so-
ing on the chimney has deteriorated lution is simple and costs very little.
or the connections between roof sec- THE REALITY Many basement leaks
tions have eroded. Replacing the seal- are caused by overflow from clogged
ing or flashing, simply and cheaply, gutters,misrouted downspouts, un-
will often solve the problem. sloped land around the house or even
Normally, an asphalt shingle roof improperly aimed lawn sprinklers.
lasts 15 to 20 years. You need to re- “Think of your masonry foundation
place the roof if you see curling or as a rigid sponge,” explains water-
missing shingles or a large amount of proofing expert Richard Barako. If the
granular material from the shingles water volume is above normal, water
collecting in gutters. will wick through the cinder blocks.
Don’t get talked into having the bad So before calling in profes-
roof torn off, at a potential 50 per- sional help, try to reduce
cent increase in costs, unless the moisture along the
your building code demands it. foundation by cleaning
Many towns will allow a sec- gutters, rerouting down-
ond or even third asphalt roof spouts, repositioning sprin-
to be installed if the home’s packing fresh soil six
klers, or
framing can support the inches high against the founda-
extra weight. tion and sloping it back to level
And beware a roofer within about three feet.
who says you need an en- Damp walls may be caused by
tirely new deck, the wood high humidity. To test, attach a
base beneath the shingles. piece of aluminum foil to the foun-
That will cost thousands dation wall; moisture shows up
if
of dollars more. In fact, on the patch in a day or two,
a completely new deck is it’s just condensation. Start
needed only one in 1,000 shopping for a dehumidifier.
192
5 BIGGEST HOME REPAIR RIP-OFFS
If water is still seeping in, repair any find woodor woodlike products,
cracks with hydraulic cement, avail- and water. To get into your house,
able at home and apply a qual-
stores, they’ll often build moist, earthen tun-
ity waterproof paint such as Latex nels across foundations to your
Base Drylok Masonry Waterproofer. home’s lower frames, a clear sign of
As a last resort, consider hiring a pro- infestation.
fessional engineer, whose impartial Wood that’s been damaged by ter-
advice would be worth the expense. mites is hollowed out along the grain,
Home inspectors are less expensive, with bits of dried mud or soil lining
but be sure they’re certified by the the feeding galleries. Be wary of ex-
American Society of Home Inspectors. terminators showing you termites on
wood piles or fences unconnected to
(NOBUGS.COM)
ENVIRONMENTAL
tucky,60 percent of JUST AN ANT? home during the
people thought ter- spring are another
mites could take sign of infestation.
BAYER
a house down in These may be fly-
COURTESY
Nothing could be Termites have a full
was successful, termites could still be $100 to $150. Hire only certified chim-
back within a year. ney sweeps who’ve been taught and
tested by the Chimney Safety Insti-
tute of America. Also, watch the tech-
CHIMNEY SWEEP nician as he makes his inspection.
SWINDLE Lately, sweeps are using video cam-
THE RIP-OFF In a classic bait and eras fed down the flue, so ask to see
switch scam, a chimney sweep calls the video and have the technician ex-
from a “boiler room” or comes to your plain it as you watch. If he balks, he’s
door telling you he’s just fixed a neigh- scamming you.
bor’s chimney and is offering an in- Chimneys for oil and gas burners
spection for the low price of $39.95. are far less a concern. An oil-heat sys-
Once inside the chimney, he may tem that’s serviced every year before
194
5 BIGGEST HOME REPAIR RIP-OFFS
chimney sweep, call your local fire The CDC (www.cdc.gov) and En-
department; some conduct inspec- vironmental Protection Agency (www
tions for free. .epa.gov) have plenty of good infor-
mation on their sites for free. —
MOLD MAYHEM HIRING A CONTRACTOR
THE RIP-OFF Mold is making a
No matter what repair you need,
comeback— not in your home, neces-
getting the right contractor is key.
sarily, but with con artists, especially
since Hurricane Katrina. Playing up @=3> Talk not only to friends, neighbors
fears about disease from mold, par- and associates, but also to materials
THE REALITY What you need to ©> Ask for proof of liability and work-
know about mold is simple: Healthy ers' compensation insurance, and, if
people usually have nothing to worry required, a home improvement license.
about. “If you’re immunosuppressed Be sure to call references.
don’t need a remediation company for <t@> Most important, pay as you go,
small areas. Just clean nonporous sur- never letting the contractor get
faces with soap and water, followed by ahead on the money.
a solution of one cup bleach mixed
with one gallon water. To control fu- Could you be a victim of home repair
ture growth, eliminate excess moisture scams? Take our quiz at rd.com/scams.
195
Everybody Loved
BY PHIL
FROM "YOU'RE LUCKY YOU'RE FUNNY"
ROSENTHAL
BOOK BONUS
How a
bunch of
wacky
relatives
became
America’s
funniest
family
INTERNATIONAL
TALBERT/ICON
A
this being television,
wouldn’t do
fore Everybody Loves
for years,
much about
first
The real challenge came an episode called “The Ball.” The climactic
in
scene called for Ray to discover why his father forged Mickey Mantle’s sig-
nature on a baseball for him when he was a kid. It turned out that his father,
Frank— played by the great actor Peter Boyle— waited outside the stadium
for days, and Mantle wouldn’t see him.
Frank didn’t want to disappoint Raymond, so he practiced Mantle’s
signature and gave his son the ball. When Ray finally hears his father explain
it all these years later, he’s so touched that the script calls for him to cross
to his dad, who’s sitting at the kitchen table, and kiss him on the head.
“No way would that ever happen,” said Ray, stopping rehearsal.
I didn’t understand. But Ray insisted he would never, ever kiss his father.
“Okay, but could you see that a son could kiss his dad?” I asked.
“It would never happen.” And he started getting upset in front of every-
one at the rehearsal.
I took him aside and told him he certainly didn’t have to do the kiss.
Never mind. Forget about it. “But,” I said to Ray, “come shoot night, if you
get to that moment and you feel it ... do it.”
So it’s a few nights later, and we’re shooting the show. And here comes
that scene. It’s going well, and we get to that moment. And Ray crosses to
his father and— kisses him on the head. With feeling. What a guy.
I’m telling you, yes, it’s just a television sitcom. But there was not a dry
eye in the house. It was because it came from a guy you’d never expect
would do something like that.
"YOU'RE LUCKY YOU'RE FUNNY," BY PHIL ROSENTHAL, COPYRIGHT © 2006 BY BUONA SERA PRODUCTIONS. INC., IS
PUBLISHED AT $25.95 BY VIKING, A MEMBER OF PENGUIN GROUP (USA) INC., 375 HUDSON ST., NEW YORK, NEW YORK 10014
The show was the brainchild of two main players, Ray Romano and Phil
Rosenthal. “We spent a huge chunk of our lives together,” says Rosenthal.
mm
moments — moments of discovery for all of us and the realization that maybe
we were onto something special. But first let me tell you how we got there.
cr
ing David Letterman. And here comes a comedian. We always root for the
J comedian, because we enjoy the comedy and know the pressure the come-
dian must be under. To even get a shot on Letterman’s show is a once-in-
a-lifetime opportunity, like Johnny Carson’s show before him.
It’s this comedian’s first time on Letterman. And he’s funny. He’s doing well.
He talks about his twin baby boys and how he hasn’t written any new
material since they were born, except ... “Well, here’s the one new joke I’ve
written,” he says. “Tell me if you like this.” He pulls out a ring of keys and
shakes it out in front of him. “Here you go. Look! Look!”
We crack up.
“I’m glad you liked that,” he says to the audience. “Otherwise I’d have to
come down and rub my nose in your bellies.”
vising producer, which means writer, which means I have an increasing say
in what we’ll order for lunch. This alone is reason to work in television
Chinese, deli, Greek, sushi, Indian, anything you want, from anyplace in
town. It’s a fantastic perk. So fantastic, I gained 30 pounds in five years.
But I was 35 by then and wondering if maybe there wasn’t something bet-
ter for me. Monica and I had a baby boy named Ben. Sweetest boy in the world.
And we played with our boy, and lived in a house in Los Feliz with a pine
tree, and I kept writing for Coach, and I was wondering, What else is there?
Then a videotape shows up at the house. And it’s this comedian’s appear-
ance on Letterman, the same guy we saw that night.
It turns out that he’d been a stand-up comic for 11 years before his shot
on Letterman, and from that one six-minute appearance, Letterman said,
“There should be a show for this guy.” So they started sending the tape
around looking for writers who might want to create a show for Ray Romano.
That’s how it works sometimes. As a writer for television, you get tapes
of actors and comedians, and your writing samples are sent to actors and
comedians who are looking for writers. If you have a meeting, and it works
out, maybe you get paid to write a pilot script. So sure. I’ll take a meeting.
Ray’s act is reliable. He comes across as a down-to-earth guy, and he talks
about his kids, like Bill Cosby did. Cosby was always one of my favorites.
Ray and I meet at Art’s Deli on Ventura Boulevard, “where every sand-
wich is a work of Art.” (I didn’t write that. It’s on their calendar.) And we
hit it off. He was born in Queens, New York. I was born in Queens. He has
a crazy Italian family. I have a crazy Jewish family— not such a big differ-
ence. In both, all problems are solved with food, and the mother never
leaves you alone. For every story he had about his family, I had one too.
What I liked about Ray was that he was nervous about Hollywood and
nervous about people in general. And I was pretty much the same way. I just
couldn’t let him know that one detail yet. (I was supposed to instill trust.)
200
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I think Ray met with a dozen other guys, and I was not his first choice,
but I got lucky. The other guy was from a hot new show called Friends, but
he was busy. So I got the call. And they wanted toknow if I could go to
New York and meet with David Letterman.
So I go to New York, to the Ed Sullivan Theater, and go upstairs. Mr.
Letterman was done taping for the evening, and they sent me to his office.
At the doorway, there’s Letterman, post-show— in sweat clothes, sneakers,
baseball hat, cigar. Hello, very nice. Oh, by the way, heavy-metal music is
playing loudly on his stereo. And they don’t shut it off for the meeting.
Mr. Letterman says, “Have a seat.”
And he gestures for me to sit behind his desk.
I say, “Not behind the desk.”
He says, “Absolutely, behind the desk.” So I sit there, and he and two of
his producers sit across me in chairs. Like it’s my office and my meet-
from
ing. So the first thing them to get out of my office.
I do is tell
Really, what was nice was that they treated me as if I had the job already.
They were very cordial. They asked if I’d thought about what the premise
of the show would be. I really hadn’t yet, but I imagined that at the center
would be Ray’s persona. “He seems to be the show,” I said.
Pretty lame, no? But I guess that wasn’t such a terrible answer.
The one piece of advice that Letterman gave me— I’ll never forget it— was,
“Don’t embarrass us.” That was the job interview. I guess it went well
enough. I couldn’t hear half of it because of the heavy-metal music.
The show, we could sell it, would be a co-production of Letterman’s com-
if
pany (Worldwide Pants, Inc.) and HBO Independent Productions, two very
small production companies joining forces. The next step was for me to
pitch an idea for this thing at CBS. So now is the time when I have to really
figure out what this show with Ray Romano is going to be.
when you’re going to work with someone. We didn’t sing “Getting to Know
You.” We had lunch, and talked more about his life and where he’s from.
204
BEFORE EVERYBODY LOVED RAYMOND
Ray said, “Well, I live in Queens and I’ve got this family — twin boys and
an older daughter, and my parents live close by. They live with my older
brother who’s a police sergeant who eats his food like this: He touches it to
his chin before he eats it. And he’s kind of jealous of me even though he’s
older and he’s a cop. One day he saw my Cable Ace award for stand-up, and
”
he goes, ‘It never ends for Raymond. Ehhhhhverybody loves Raymond.’
And I said, “Well it doesn’t seem like there’s anything there we can use.”
...
No, I knew that was the show. What else should it be?
Since Ray hadn’t acted before, I wasn’t going to make him a gay astronaut
from Cleveland. He had to be comfortable. So I’dsurround him with his
own life. Plus, if this was going to be the first show I ever created, I would
write about what I was comfortable with, the kind of show I knew best and
loved, in the style of classics like The Honeymooners, All in the Family, The
205
RD BOOK BONUS I MARCH 2007
body noticed him and he could pocket some of the hard candy from Mr.
Moonves’s coffee table. But they did like Ray’s stand-up, and I told them that
his actual life was even better. And what I didn’t know about his life, or the
personalities of his family, I’d fill in with the details of my own life.
It also didn’t hurt that we came from David Letterman, whom CBS had a
and would let me write the script. And that the casting worked out, and
then we got on the air. And then survived a few episodes. And then a whole
season. And another. And then to have success beyond all that— being nom-
inated for 70 Emmys and winning 15 over the course of nine years. All the
planets have to line up, and God has to say, “Okay, you people with the TV
show on Channel 2 with the arguing, you get to live your dream.”
And that December afternoon in 1995, we sold the show.
I had a wonderful moment of happiness, followed immediately by an oy.
My mind flooded with the million things that could go wrong starting —
with the script I now had to write.
ANO
it, and it became terrible. The network guy rejected that one too and then
CALTABI
another one that had been picked over by the studio people. Finally, the
network guy said to me, “I’m beginning to think that maybe you can’t do this.”
TOM
Maybe I couldn’t. Maybe this was going to be like waiting two hours on
line for Space Mountain only to have your seven-year-old son say as they’re
strapping you both in, “I’m not doing this.” And the ride is over.
No. I decided to quickly let this guy know he could trust me. I thought
of a very simple story and called him back. “It’s Debra’s birthday and she
would rather celebrate it with just Ray and the kids this year, without his
family coming over.”
“That’s it,” said the network guy. “Go write it.”
Here was my biggest worry: What did I have that other sitcom writers did
not have? I had the very funny Ray and his family, but I didn’t really know
them. And then I realized what I had: my own experience. I had my wife. I
It was a story that I’d told at my brother Richard’s wedding when I was
making the toast as best man. And if it hadn’t gotten laughs from the guests
at the wedding, I might not have had the confidence to put it into the script.
I had suppressed this anecdote for several years. It drove me nuts then,
207
The much-debated “son kisses father” scene. Peter Boyle, who played his
role with great heart and feeling, passed away in December 2006 at age 71.
and thinking about it again rekindled the nuts, and that illustrated the in-
sanity in my family and would serve as a warning to Richard’s bride, Karen,
why she should perhaps reconsider marrying into this psycho ward.
as to
The fact that the toast would come at the wedding reception and that
my brother and his wife would already be married didn’t change the
urgency of my writing. “Karen,” I started. “There is still time to run.”
I When I first started to make a little money in Hollywood, I
explained:
bought my mom a gift of the Fruit of the Month Club.
And then came the phone call from Rockland County, New York: “Philip,
we got the pears,” my mother said.
“Oh, that’s good, Ma. You like them?”
“Yes, they’re very nice, but please ... it’s an entire box of pears. There
must be 12 or 14 pears here. There are so many pears. Please, Philip, don’t
ever send us any more food again, okay?”
I said, “Well, Ma, another box is coming next month.”
She said, “What, more pears?”
I said, “No, Ma, a different fruit every month.”
“Every month? My God, Max, he got us in some kind of cult! What am I
208
BEFORE EVERYBODY LOVED RAYMOND
“Lee and Stan buy their own fruit. Why did you do this to me?”
“Ma, what’s happening?”
“I can’t talk anymore, there’s too much fruit in the house!”
I went on to describe my father’s misery as well as this misfortune that
had befallen them. (“You think we’re invalids? We can’t get our own fruit?”)
The wedding guests laughed, including my parents. Richard and Karen
remain married to this day and even have two children.
The key was the specificity. If I had tried a vague example, I would’ve
missed everybody. Each of our lives deals in specifics, and we relate to that
specificity in other people’s lives. To this day, people tell me that they can’t
give a gift to their parents without it blowing up in their faces. And some
say they’ve even had that exact experience with their parents and the Fruit
of the Month Club. So I’m very happy that so many people are out of their
minds and we can all laugh, or cry, together.
In January 1996, when I was about to hand in the pilot script, I thought it
might be funny. But first I sent the draft to Jeremy Stevens, a pal of mine who
has a great eye and ear. He was one of the creators of The Electric Company
and worked on Saturday Night Live and other shows. He was also the sweet-
est guy I knew. Whatever he had to say, he’d at least say it nicely.
Jeremy didn’t disappoint. The first words I heard from him when I picked
up the phone were, “We’ll be on for ten years!”
209
RD BOOK BONUS I MARCH 2007
than Ray, so naturally we started looking for a shorter fellow to play Robert,
the older brother who would literally have to look up to Raymond. And
then into the casting office came this talking tree. His name was Brad Garrett,
and I thought, Well, here’s another way to go. When he opened his mouth,
and those basso profundo notes came out with brilliant timing, matchless
facial expression and expert delivery, I fell over laughing.
This was nothing like Ray’s life or mine. It was better. That was easy. We
found the brother.
The Father. We started hearing about how we shouldn’t get too ethnic
with the cast. For this show to play in Middle America, we couldn’t have too
many overtly swarthy Italian or Jewish types populating this family. Ray
and Brad are both, and respectively, swarthy, Italian and Jewish.
I asked, “It’s an Italian family. What are we supposed to cast?”
When he finally did, he was ticked off. Now, I only know this man from see-
ing him in Young Frankenstein and, worse, Joe, in which he played an angry,
bigoted factory worker. Joe shot punks like me for fun, and here he comes
into the room, angry at me. At that moment, he wasn’t a movie star to me,
he was a big, angry movie star. I gave him the part. I was afraid of him.
his wife, sons and anyone else in his range. We had our father.
The Mother. I saw more than 100 women for this role in New York and
Los Angeles. It was very tough for me to cast because I had someone very
specific in mind for this mother. My mother. And she was too ethnic.
Then into the room came Doris Roberts, a 45-year veteran of stage and
screen. She read the Fruit of the Month scene and was perfect. Though she
210
BEFORE EVERYBODY LOVED RAYMOND
doesn’t look anything like my mother, she totally got what was in my head
and in my life. She also has perfect timing, delivery and facial expression.
It seemed as if Doris was born to do this role. I was starting to feel lucky.
The Wife. This is the hardest person to cast in a sitcom. The wife can’t
just be the straight man or the nice lady who says, “Here’s your lunch,
honey.” She has to be all things to all people: funny, tough, sexy, sweet, vul-
nerable, confident, charming. I’m lucky because I found her in real life.
I didn’t marry know where she is. Wife joke. Half the
that girl ... but I
jokes on Everybody Loves Raymond were wife jokes. The other half were
husband jokes.
It was a long and involved process trying to cast Raymond’s wife. We saw
over 200 women for the role. Finally, Patty Heaton walked in, was perfect
and was cast. When it’s right, it’s right. Now we could go on to film a show.
“Well, my question is, if Ray says that to his parents, what happens in
next week’s episode if he’s told them not to come over anymore?”
I paused. “Well, just off the top of my head, they don’t listen to him.”
At the end of that week, we filmed the pilot. The cast was sharp, the
scenes seemed to work, the audience laughed. Most had never seen Raymond
before that night, and they liked him, if not loved him, immediately.
211
RD BOOK BONUS I MARCH 2007
A few Sundays later, I was out at a restaurant with my friends. The owner
came over and said, “There’s a call for you by the register. It’s Les Moonves.”
“Whooah,” said my friends as I got up to get the phone.
And Les said, “Order an ice cream sundae.”
What a nice way to hear good news.
I went back to my friends and said, “I guess I’m buying lunch.”
It's a Wrap
We liked the show, the critics liked the show, and the audience liked the
show. People were watching. People were talking.
We filmed 22 episodes that first season. Variety reported, “It looks like
Raymond has found a permanent spot on Monday nights.” I clipped that
little mention and kept it in my wallet. I stopped being nervous.
We had a great, festive wrap party. David Letterman filmed a special “Top
Ten” list for us, we showed our first gag reel, and really laughed together.
We were all proud of what we’d done and happy that we were some of the
lucky few who got to keep doing it.
During all the dancing and eating and drinking, Ray came
over and handed me a note. I later found a quiet corner of
theroom to read it.
The note said, “I never thought I’d thank anyone for CHOICE
making me kiss Peter Boyle.”
To buy a copy of You're Lucky You're Funny, go to rd.com/rosenthal.
PRESENT TENSE
Halfway through his sermon, our minister grew
we knew, was nigh.
quite serious. Profundity,
“Do you know what the three most discouraging
words in the English language are?” he asked.
A congregant did. He yelled out, “Some assembly
required.” william f. Christiansen
212
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ticipated in its development. Each day
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she described, little by little, the
main principles of this new weight- continuing to eat all
loss plan that didn’t resemble any- that I wanted, and
”
thing that 1 had tried before. everything that I liked.
Question: What can you tell us
about this secret?
Answer: You know, despite every-
thing, I was skeptical. When you’ve
I
MPORTANT NOTICE
HlUiwa "”bb-
Looking at is really
relieving that
it
cess
having lost tar e‘
'
after
tot f" P h0, °:
Francois Frank,
Now* rertify
i — Anirlififon
“I,
prints which
that normally make me gain pleasant, natural, and excellent for
graphs are original weight). your health. It permits you to lose 6
on dep
and which remain
me
to
concWetWih Question: How can we to 10 pounds each week for the first
permits me to
tave no learn more about this secret? few weeks and 4 to 6 pounds per
the same person, and week afterwards - even if you eat
Year 2001, on the 8th Answer: With the agree-
m the
ment of my nutritionist pasta, rice, cakes, buttery foods,
2:00 PM."
sugary foods, or even fatty meats.
...
that this weight-loss plan worked. in a special report that comes with Question: I've heard that this com-
I rapidly lost 35 pounds in only my complete weight-loss plan, about plete weight-loss plan contains 2 kinds
5 weeks. During the following 2 which I can be a bit more precise: of capsules. Is it thanks to the cap-
months, I lost another 3 1
pounds, for This has nothing to do with a diet
1 .
sules that you lose weight so quickly?
a total of 66 pounds. or exercise (I’m not very athletic). Answer: The capsules, in addition
Question: But you had lost some You can do it on your own, at home. to the weight-loss plan, accelerate the
weight with the other weight-loss You can even do it at restaurants or weight-loss effect. These capsules,
plans... while on vacation. which are 100% natural and are
Answer: That’s true, but there 2. Because I’m fond of good therefore totally safe, stimulate the
are 2 new and different aspects to food, the most important thing bum excess fat.
digestion and help to
this weight-loss plan: is thatI’m able to eat what I Their unique combination of specific
1 been almost 2 years since
. It’s
want and not deprive myself. ingredients is truly revolutionary and
I’ve lost the weight, and I With this complete weight-loss come with the weight-loss plan in
have not regained a single plan, you can eat everything, easy-to-swallow, flavorless capsules.
ounce. a
and as much as you want, All you have to do is take these
Woman of the Evening received the Maggie Drozd weight-loss plan. I then weighed 222
at a fashion show put pounds (I'm 5'5” tall). For as long as I can remember, I've always
on by France’s top been big. From the age of 12, 1 started gaining from year to year.
fashion designer. I had followed several diets, but each time that I lost between
20 to 30 pounds, I gained them back quickly. It was horrible: I
Maggie Drozd has was always hungry, I felt faint, I was always counting calories.
played in 2 award-winning I was very self conscious and I suffered a lot, psychologically.
films at the Cannes film Then, I discovered the Maggie Drozd weight-loss plan one
ference—I've lost 44 pounds. Since I've Now, I’ve already lost 59 pounds... I was so prove it. When I compare an older photo
lost my excess weight, I am working as glad to be able to lose weight without being with the most recent pictures of me, I have
a stewardess, I am very happy, and I feel hungry. I thank you, because I am very the impression that they're of two dif-
very pretty. happy." ferent people. I can't believe it myself...
and why I’ve never regained them is nowned health spa, was revealed to I had before my marriage. I really
because I continued to eat what I only a few people, of whom I am wanted to look like you in your photo
wanted, and as much as I wanted. lucky to be one. because I was in the same shape as
In only one year, my complete you before..." J.F.R. Germany
Question: How many pounds can
weight-loss plan has helped hundreds “...My weight was 183 pounds on
we lose in a week?
of thousands of people in Europe. It my 5 ’6" frame. This created within
Answer: The weight-loss rate
is widely distributed in at least me an obstacle to my happiness.
varies from person to person. With twelve countries in Europe, such as Thanks to your weight-loss plan, and
the weight-loss plan associated with Poland, Russia, Hungary, Germany, while continuing to eat as before af-
the capsules, you can lose up to 12 Italy, Switzerland, England, etc., and ter two months, I now weigh no more
pounds week. Myself, I
in the first 1
few new shows a little bit everywhere, eat as much as I wanted..." “...I have seen specialists. I have
on television, and in movie theaters. G.D. Luxembourg swallowed medicines and followed
Numerous producers have called me. “...To lose weight without counting diets that made me sick. A close
My husband looks at me as if I were j
calories, without a strict diet and friend told me about your weight- loss
a new woman. A few months ago, at i
without weighing foods, I thought plan and I tried it because I had
COPYRIGHT 0 2006 TOTAL AS OF WS5001 "WORTANT NOTICE: THE TEXT Of THIS AWEFTTCRIAJ. ARE EXTRACTS FROM THE UAGGIE DROZD METHOD AND ARE NOT NTEWffi AS A SUBSTITUTE FOR MEDICAL MSEUNG CONSULT A PHYSOAN BEFORE STARTWG THS OR ANY IKECHT^OSS PLAN ESPECMU.Y F
IAN FOR ANY SERIOUS HEALTH PROBLEM THIS WEIGHT-LOSS PUN SHOULD NOT BE TREATED FOR HGH BL000 PRESSURE OR DEPRESSION OR HMD HAVE A
RXL0WD BY Tt£ ELDERLY OR CHLDREN. BY PEOPLE
DIAGNOSE, CARE OR PREVENT ANY DISEASE TESTIMONIALS PUBLISHED ARE AAIONG THE BEST RECEIVED MOMDIWL RESULTS MAY VARY FH0M ONE WtXVIDUAL TO AMOTHBA AND CAN BE MOflE Ofl LESS TrtW HESULTE
N ELECTRONIC TRANSACTION OR A DRAFT N THE EVENT YOUR CHECK IS RETURNED UfAD. IT WY BE RE-SUBITTED ELECTR0HCAU.Y AND A SERVICE FEE AS AU0HH) BY STATE LAW WY 8E CHARGEE
ADVERTISEMENT
lose. In two months, I lost
nothing to natural capsules will only have cost Maggie Drozd has requested that
42 pounds and since then I haven’t you less than $1 per day! everyone who asks to try her weight-
regained anything..." M.D. Germany It’s important for me that anybody loss plan and who does not lose their
“.../ lost 29 pounds in 5 weeks and can try this new weight-loss plan. excess weight to be fully reimbursed.
/ don't gain back my extra weight That’s why, in cooperation with my That’s why, if you do not lose your
anymore. A new life is beginning for American distributor, Hollywood extra pounds, you have 12 months to
me..." M.A. Switzerland Health & Beauty, my complete weight- return your weight-loss plan and you
You can also see the photos sent to loss plan is offered at such a low will be immediately and completely re-
and the fourth 95 pounds), and I’ve wine, and ate everything: an ap- this new amazing weight-loss plan
got more to show you. petizer, an entree and a dessert. and Maggie Drozd.
Question: Yes, dear Maggie, that 's London, the 17th of October, 2001. The Maggie Drozd weight-loss
plan is not sold in any stores yet. You
very impressive, but how much does Only read this if you are
can only obtain it by returning the
this weight-loss plan cost? skeptical and no longer coupon below. So, don’t hesitate and
Answer: I know that those people believe in anything: act today. This might be your last
who, like me, have tried everything If you’ve already tried many diets chance to lose all your excess weight
would spend up to $1000, and even and many weight-loss plans, you may and to rediscover the figure that
more, to be absolutely certain that
be reluctant. you’ve been dreaming about, without
they’d lose the weight they want.
How can you be sure that you’ll final- risking a single cent.
Question: This weight-loss plan is ly lose the weight you want... for good?
very expensive, then. The answer is obvious: Maggie CAUTION
Answer: Absolutely not. If you do Drozd would not risk her reputation Don't take more capsules per day
not lose all your excess weight while as an international star by guaran- than what is indicated on the labels.
continuing to eat as much as you teeing her weight-loss plan if she was
If,by following the Maggie Drozd
weight-loss plan, you find that you
want whenever you want, this weight- not absolutely certain that you would
are losing more than 10 pounds
loss plan will not have cost you a lose your extra weight. If she guaran-
a week for the first 4 weeks, and
single cent.And if you lose all your tees that you’ll lose 6 to 10 pounds a
more than 6 pounds per week dur-
excess weight at a rate of 6 to 10 week for the first 4 weeks, and 4 to 6
ing the following weeks, stop taking
pounds a week for the remaining
pounds in the first four weeks, and 4
to 6 pounds a week for the following weeks until you reach your ideal weight
the capsules for at least 3 days —then
take only the capsules as indicated
weeks, the complete weight-loss plan and obtain long-lasting results, it’s every other day.
that comes with 2 different kinds of because such a thing is now possible.
Coupon to lose excess weight thanks to the Maggie Drozd complete weight-loss plan
This coupon has to be cut out and stood that: 5. The Maggie Drozd weight-loss
returned as soon as possible to: 1. I must lose 6 to 10 pounds per plan is not a strict diet. It does not
Hollywood Health & Beauty week for the first 4 weeks. require me to perform exhausting ex-
2. I must lose 4 to 6 pounds per ercises or to take medications.
9903 Santa Monica Blvd., #4444
week for the following weeks until I 6. have 12 months to see for
I
Maggie Drozd weight-loss plan without 4. I will receive 2 different kinds of turn my weight-loss plan (even the if
risking a single cent interests me. natural capsules of these amazing and bottles are empty) and you promise to
Send me the Maggie Drozd com- new combinations of ingredients that refund me the full amount paid imme-
plete weight-loss plan. It is well under- will help accelerate my weight loss. diately and without discussion.
I WANT TO LOSE UP TO 35 LBS: send me the 30-DAY STANDARD WEIGHT-LOSS PLAN (including a total
of 180 capsules) for only $29.95 + $5.05 for special handling and first-class shipping, TOTAL $35.
I WANT TO LOSE UP TO 55 LBS: send me the 60-DAY EXTENSIVE WEIGHT-LOSS PLAN (including a
total of 300 capsules) for only $49.95 + $7.05 for special handling and first-class shipping, TOTAL $57.
I WANT TO LOSE UP TO 75 LBS: send me the 90-DAY EXTRA-STRENGTH WEIGHT-LOSS PLAN (inclu-
ding a total of 480 capsules) for only $59.95 + $9.05 for special handling and first-class shipping, TOTAL $69.
I enclose my payment by check or money order to the order of: Hollywood Health & Beauty
I prefer to pay by credit card Visa Mastercard
Card number:
Exp. Date: /
Signature:
(IN CAPITALS)
Ms. Miss Mrs. Mr. FIRST NAME
LAST NAME
ADDRESS
CITYTOWN . STATE _ .
ZIP.
Phone orders, call toll-free: 1-800-460-7089. Have your credit card handy. MGZ050
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A sign in a small
Virginia town has to be
admired for its cynical
honesty: “Antique Tables
Made Daily.”
JASON BLEVINS,
Round Hill, Virginia
IVIy friend was flabbergasted. She’d read that in Dinosaurs are fascinat-
a recent survey, our home state of California was ing. My three-year-old
ranked 47 in a list of the nation’s smartest states. is obsessed with them.
“Can you believe that?” she fumed. “We’re 47 Recently we were riding
out of 52!” JUAN GONZALES. Chula Vista, California on a bus, and he asked
another passenger for
her name.
The minute I walked into the post office, the
“My name is Deena,”
postmaster noticed the beautiful diamond earrings
she said. “Can you say
my husband had just given me.
“Those must be real diamonds," she said.
Deena?”
“Yes, they are.” I was thrilled she’d noticed. “How “Deena,” said my
could you tell?”
son. “Can you say
“Because,” she said, “no one buys fake diamonds pachycephalosaurus?”
that small.” DEBORAH CAUOELL. Keller, Washington RGB SANCHEZ.
Broomfield, Colorado
with less fat and fewer Too many bounced One night, I told my
calories. He watches
checks meant no more four-year-old son the
out for chemicals and
Mr. Nice Guy for the story of Noah and the
additives. We were
manager of a local con- ark. I gave him the full
grocery shopping, and
venience store. A sign in treatment, complete
asked him to go get
I
attack?” KAREN JENSEN, to $20 when you provide two by two. At the end,
Branford, Connecticut six forms of identifica- I asked him if he had
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by Master Doll Artist
Linda Webb
Only I
payments o,
$29 "*
Imagine all the delicate realism of a real
infant that you can almost cradle in one
hand! That’s Tiny Miracle Emmy—the first
Heart transplants are the cure for this puzzle. Each pair
of clues leads to two five-letter answers. Change the
—
middle letter or “heart” of the first answer to an R to —
get the second. Example: Home/Equine = House/Horse.
Okay, scrub up and start your surgery!
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