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Sourse:Seafood Salad Recipe

Grilling: Wilted Spinach and Portobello Salad

Posted by Joshua Bousel, February 26, 2010 at 7:30 PM

[Photograph: Joshua Bousel]

I told myself that after a no-holds-bared eating fest that happened over the holidays in Houston (seems to happen every time I visit that city), that I would slowly simmer down my gut-busting diet. With the cold weather and the steady stream of party foods that followed, my plan never came to fruition. Nearly two months later, it's high time I finally act, and over the weekend I decided that a salad was in store—grilled, of course.

I'm not much of a recipe follower when it comes to throwing together some leafy greens and a vinaigrette, but this particular one caught my eye because it required the grilling of spinach. Finally, an interesting way to use my underloved accessory, the grilling basket. Not only was the dressed spinach taken to the flames, but also the sage-rubbed portobellos and walnuts. This was a grilled salad through and through.

This meal fit into the season as much as a salad could. The mushrooms gave it a heartiness, the walnuts a nice toasty crunch, and the warm, wilted spinach was like a hint of the freshness that will soon come. Now the trick is to keep up some healthier eats while enduring the final throes of winter.

Grilled Wilted Spinach & Portobello Salad

Adapted from Grilling & Roasting by Chuck Williams
- serves 4 -

Ingredients

1 lb fresh portobellos, scrubbed clean and stems removed
1/4 cup safflower oil
1 teaspoon chopped fresh sage
1/2 teaspoon freshly ground black pepper
1/4 cup walnuts
10 oz spinach, stems removed
2 tablespoons walnut oil
1 tablespoon fresh lemon juice
2 teaspoons red wine vinegar

Procedure

1. Light one chimney full of charcoal. While the charcoal is lighting, brush the mushrooms with the safflower oil and sprinkle with the sage and pepper, set aside.

2. Whisk together the walnut oil, lemon juice, and red wine vinegar in a small bowl and set aside.

3. When all the charcoal is lit and covered with gray ash, pour out and spread the coals evenly over the charcoal grate. Place a cast iron skillet on the grill. When heated up, place the walnuts in the skillet and cook until lightly browned and fragrant, 3 to 5 minutes, stirring nuts frequently. Remove the skillet from the grill and coarsely chop the walnuts.

4. Place the mushrooms on the grill, gill side down, and cook until lightly browned, about 3 minutes. Flip and continue to cook until browned and just tender, about 3 to 4 minutes longer. Remove from the grill and slice into 1/4 inch strips.

5. Place the spinach leaves in a grill basket, and sprinkle with 1/2 of the the vinaigrette. Place the basket on the grill and cook until the leave are slightly wilted, about 3 minutes on each side.

6. To assemble the salad, place 1/4 of the spinach leaves on each plate, add a few strips of the mushrooms, sprinkle with the walnuts, and dress with remaining vinaigrette to taste.

About the author: Joshua Bousel blogs about grilling on his blog, The Meatwave, and appears weekly here on Serious Eats during grilling season.

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As we told you earlier this month, sister pub Consumer Reports tested 208 bagged salads and found 39% had excessive bacteria, including fecal contamination. That means there's poop in the greens. And now there's something you can do about it.

Consumer Reports tested for total coliforms and other bacteria including enterococcus. According to industry experts, 10,000 or more colony forming units per gram (CFU/g) is excessive. The tests of 16 different brands had 39% exceeded that level for total coliforms, and 23% for enterococcus.

Hate spinach? Bacteria doesn't. Many of the unacceptable packages contained spinach and were within 1-5 days of their use-by date. Bag vs clamshell, organic vs non, baby greens or no baby greens, made no difference. And packages that were 5-8 days until their use-by date fared better.

Even if the package says super-duper-washed, you should still wash them by hand. Or, better yet, just buy your salad elements separately, wash them, and chop them.

The big problem is the FDA hasn't set limits for how much poop or other bacteria can be in bagged salad. Tell 'em to get crackin' by signing this petition.

Bagged salad: How clean? [Consumer Reports]
PREVIOUSLY: Who Keeps Pooping In My Bags Of Salad?!

Everyone gets sick once in a while. It's waited. Therefore people have sick time at job. That's why there are physician and insurance companies. However here are a lot of basic stuff to be sure you be in principal good health. You should wash your hands. In general, not enough people do this. Especially after using the lavatory. Studies have been shown and a shockingly low percentage of men and women wash their hands after using the lavatory or before meals.

I always say: Consume liquid. Water cures all ills. Deprivation of water is the guilty of many common ill health such as dry skin and addition bloating. 8 cups of liquid is the minimum so be sure you're consuming at least that much. Think that fruits and vegetable juices count towards your daily dose of hydrating drink. Sport. Physical activity does not have to mean hours on the treadmill sweating away to emaciation. Sport can be as easy as walking across the parking lot to the grocery store or doing housework. That's true! Airless get off calories! The more active in general you are the more do sport youare getting. Think getting a pedometer. Pedometer's have shown that men and women who wear pedometer's are more effective than those who do not.

According to Health-emark.com, Oprah's healthy weight loss diet can be summarized as low fat, no alcohol and drinking more water. Not many of us have Oprah's resources and yet the program she adopted is one that most of us could afford to follow. If expensive products or fad foods were necessary or more productive, I suspect she would have gone with them.

Oprah's trainer Bob Greene also advocates eliminating soda: “If you substitute one sugary beverage every day with water, that's 38 pounds of calories a year that was just eliminated,” says Bob in an interview with ET's Kevin Fraser.

Healthy weight loss.

The key for Oprah as with anyone battling obesity is to make a healthy change. You may have seen sweat suits advertised for quick weight loss from sweating out water. Does this seem healthy or a lasting proposition to you?

Water is vital to the healthy functioning of the body. Even if you do end up drinking excess water, it passes through. Excess food has to be processed and stored before eventually being burned off which is takes a lot of energy.

Tips on incorporating water for healthy weight loss.

1. Bob Greene suggests 64 to 80 ounces of water a day in his Summer Fitness Plan. Drinking more water in hot weather is suggested.

2. Drink two glasses of water a half hour before each meal. The body's signal for thirst and hunger pains is very similar and sometimes a person has the condition of dehydration but eats a snack or meal instead of taking in water. By separating thirst from hunger, you are better able to stop eating when full.

3. Drink two glasses of water two and half hours after each meal.

4. Substitute water for alcohol and soda. And coffee, tea, milk, juices etc. do not count towards your water intake goal. Water means plain water!

Salt and potassium.

The body needs a proper ratio of salt to water. According to the author of “Your Body's Many Cries for Water” Dr. Batmanghelidj, it is vital to the process of healthy weight loss.

He contends that potassium comes in adequate quantities as long as you include plenty of fruits and vegetables in your diet. In fact, he recommends that you don't add any potassium supplements.

But salt doesn't come in natural foods and must be supplemented. He recommends a half teaspoon of salt a day for every 10 glasses of water. Athletes know the importance of incorporating salt and staying hydrated with water.

Of course, too much salt is unhealthy so spread out the intake throughout the day.

Healthy weight loss and exercise.

Just substituting water for alcohol and soda and drinking more of it like Oprah and Bob Greene is a great step in the direction of healthy weight loss. If you are able to add sensible exercise, you can reach your healthy weight loss goals that much more effectively. Bob Greene advises a walking program as a great first step!

Sources:

Oprah's Weight Loss Plan
Bob Greene's Summer Fitness Plan
ET's Bob Greene Interview

Sydney, Jan 16 (IANS) Forget the food fads and ‘Take 10′ small steps to weight loss success – that’s the message from dietitians to the thousands who will make weight loss their goal this year.
“Fad and quick-fix weight loss programs often promise easy, no-effort weight loss. The reality is these programs can set people up to fail and damage their self-esteem in the process,” said Claire Hewat, CEO of Dieticians Association of Australia (DAA).

Clare Collins, associate professor of dietics, said: “A range of approaches can help you lose weight in the short term, but making small, permanent changes that fit with your lifestyle will give you the best chance of keeping weight off in the long term.”

Collins’ ‘Take 10′ tips for achieving or maintaining a healthy weight are:

1. Eat breakfast

2. Include vegetables or salad with lunch and dinner

3. Choose fruit as a snack

4. Replace full-fat food and drinks with reduced-fat alternatives

5. Choose wholegrain foods instead of more refined foods

6. Eat smaller serving sizes by using smaller plates and cups

7. Eat slowly and stop when you are satisfied, not stuffed full

8. Eat when you genuinely feel hungry, rather than for emotional or other reasons

9. Swap sweetened drinks such as cordial, soft drink and juice with water

10. Eat your evening meals at a dinner table with the TV turned off.

The DAA commissioned research was conducted by Newspoll market research nationally among 1,201 respondents aged 18 years and over. Interviews were conducted by telephone Nov 14-16, 2008, says a DAA release.

It found that 45.5 percent people had actively tried to lose weight during the 12 months prior to the survey, with 21.8 per cent of these people following a diet from a book or magazine and 16.4 per cent seeking advice from a dietitian.

First we obsess over stars’ “baby bumps,” then we shame the new moms into squeezing back into skinny jeans as quickly as possible. Katie Gentile on the double standard that hurts women.

Sarah Michelle Gellar is back in her “skinny jeans” just four weeks after giving birth to her daughter, reports Us Weekly. Ditto Ellen Pompeo, I read in People. Twice, Heidi Klum walked the Victoria Secret runway just six weeks after having a baby. Natalia Vodianova topped them all, taking to the catwalk a mere two weeks after giving birth.

In 2010, God help the celebrity who fails to shed the baby weight immediately, as she may end up on the wrong side of one of those ubiquitous “best and worst post-baby bodies” pictorials. It is chilling to watch the culture become more and more obsessed with babies, while the evidence of how these babies are created is removed from public view. The supermarket tabloids obsessively scope out “baby bumps,” cooing each time a C- or even D-lister conceives. But the second the bumps become bouncing bundles of joy, the pressure is on for the new mom to squeeze back into her skinny jeans. The post-baby body must banish the bump, or risk ridicule.

It’s as if we should actually believe the baby dropped from the stork, from the sky, from anywhere but that toned, buff body.

It used to be that People magazine confined news about pregnancy and babies to its “Milestones” section. Now baby obsession has changed the very structure of the magazine, giving us features such as “Mommy and Me Fashion,” “Celebrity Family Albums,” and the ever-popular rush to publish the first photos of celebrity spawn. Similarly, celebrity gossip magazines and blogs now devote entire sections to bump patrols, moms and babies (only occasionally dads), and a parade of post-baby body photos. In this “new” culture that seems to mix domestic ideals of the 1950s with the expanded opportunities of the 21st century, baby bumps—expanding breasts and bellies—are celebrated, photographed, tracked, and made an endless source of speculation. But we ignore the less attractive, yet all-too-real aspects of pregnancy: There are no swollen ankles, plump thighs, or puffy faces allowed on the red carpet.

Of course, intense scrutiny of women’s bodies is not new, and celebrity antics have long made for profitable media fodder, but the obsession with postpartum weight control is something new. These days, we rarely see a picture of a pregnant celebrity without the requisite estimation of weight gain, called “baby weight,” as if it is somehow separate from the mother’s body. The best way to get rid of it is breast-feeding, the tabloids tell us, claiming that lactation magically and effortlessly melts away pounds.

Yet as The New York Times recently noted, research is conflicting as to whether breast-feeding actually promotes weight loss. Breast-feeding may burn calories, but it also stimulates appetite, leading many women to eat more. The Mayo Clinic advises normal-weight, healthy women to exercise moderately and eat about 300 more calories per day while pregnant, gaining between 25 and 35 pounds over the course of the nine months. And Mayo advises women to lose only 1 postpartum pound per week in order to maintain solid nutrition. La Leche League advises that women not diet for the first 2 months after delivery to help their bodies recover and establish good milk flow.

Contrast this information with Us Weekly celebrating Ashlee Simpson-Wentz for sticking to her 1,500-calorie-a-day post-pregnancy diet, People discussing Liv Tyler’s postpartum fasting and colonics, or Ok magazine’s “Baby Weight Secrets,” which advise women to stick to fat- and carb-free diets and spend hours exercising daily.

It would be easy to see this obsession with post-baby weight control as just part and parcel of the usual misogynistic obsession with women’s weight. Female celebrities are under constant pressure to stay thin. But look at it another way: When women shed the baby weight, they are not merely getting back their pre-baby body, they are obliterating all the evidence of ever having had a baby in the first place. This means the one thing that only women’s bodies can do is expected to be immediately erased. The post-baby body is wrung of its recent life-giving feat. Sagging milk-filled breasts must appear perky; the once-swollen abdomen is made concave. It’s as if we should actually believe the baby dropped from the stork, from the sky, from anywhere but that toned, buff body.

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My grandmother used to tease me all the time that I would end up getting all of the things that she copes with everyday. I never thought she was right, but unfortunately I have been diagnosed with diverticulitis. What is diverticulitis you ask? Well this is what it boils down to…It means that pouches have formed in the wall of your colon. Part of your large intestine can become inflamed or infected. Let me tell you, this is not fun in any way.

When I first started having pain in my stomach, mostly on my left side I thought something horrible had happened. I started thinking my appendix etc…Well I went to the hospital and they could not figure out what was going on with me. They gave me pain meds and nothing seemed to work much. They found out that I also had several kidney stones (which I had no clue I even had lol). So they chalked it up to that and sent me home with some meds for pain and that was that. Well needless to say the pain didn't go away. It would not go away no matter what I did. I could not lie down or sit or stand without being in pain. At times the pain got pretty bad too. So I went back to the ER about 7 times before they finally diagnosed me with diverticulitis.

I had no clue what it was, I just knew that my grandmother had it also. So I asked about it and they told me. So they put me on some pain meds again and sent me home with a prescription for cipro and levaquin. They also gave me some muscle relaxers.

Now diverticulitis is caused by bacteria becoming trapped in pouches that form along the wall of the large intestine. The bacteria grow and cause inflammation and pressure that may lead to a small perforation or tear in the wall of the intestine. The symptoms can include pain in the abdomen, right or left side is possible and it doesn't seem to get any better no matter which way you move or lie or stand. Fever and chills, a lot of gas and I do mean a lot lol, diarrhea or constipation, nausea (which I definitely had!), loss of appetite which I also had.

I am only 37 and fortunately for all of you diverticulitis doesn't occur often in people under the age of 80. I am one of the unlucky 10 percent under 40 that has the condition. Now the only thing that helps diverticulitis is a high fiber diet. The doctors told me to give up nuts and seeds and corn etc…They actually say that there is no real link saying that these foods really do make the diverticulitis worse. I know from personal experience though that everytime I eat sesame seeds or corn (which is my favorite vegetable) my diverticulitis starts acting up again. You can tell by the changes in your bowel movements. They will become runnier and turn a different color then usual. You will also get very gassy, it is real easy to tell when it's coming on now that I have been diagnosed.

If you are diagnosed and start treatment right away you will usually see the symptoms subside in about 2 to 3 days. Usually there isn't a need for surgery or anything unless something else develops or your symptoms worsen even after dietary changes. There can for instance be complications with diverticulitis. You can develop an abscess a perforation (tear) or bowel obstruction can happen. If that happens you would need that part of your intestine removed. You could have elective surgery if you develop 2 or more attacks.

My suggestion to get through having diverticulitis is definitely watch which foods start to bother you more and like I said, once you are diagnosed and go through the first attack you will know when it is going to start to act up. I noticed that anything having corn in it and sesame seeds bother me more then anything else. Other people have different things bother them. So keep tabs on what foods make it act up more then others and drink a lot more water then you usually do. I was never a water drinker until now. I do not want to deal with that pain again. So it's easier to stay away from the foods that bother me and drink more water then anything else. I do not want to have surgery unless I absolutely have to. So for those of you that have been unlucky enough like me to be diagnosed with diverticulitis, good luck to all of you. Just take care of yourself and listen to your body and you should be ok living with diverticulitis.

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Here's good news for your wallet.  If the high cost of medication in the United States is breaking your budget, you can fight heart disease with affordable prescription drugs from Canada 

Heart disease is the leading cause of death for both women and men in the United States according to the Centers for Disease Control and Prevention. Research has shown that lowering your high blood cholesterol and high blood pressure can reduce the risk of you dying of heart disease or needing heart bypass surgery.  Millions of Americans also have diabetes which increases the chance of developing high blood pressure (hypertension), which could lead to a heart attack. Cardiovascular disease is the leading cause of diabetes-related death

More good news is that some risk factors leading to heart disease, such as smoking, poor diet and lack of exercise are controllable.   Obviously there are other risk factors such as age, gender, ethnicity, and family history that can not be controlled. 

However, luckily there are medications that your doctor can prescribe for you to help lower high blood pressure and high cholesterol which otherwise could lead to heart disease.  There are also medications to treat heart disease symptoms, such as arrhythmias (abnormal heart rhythms) and angina (chest pain that occurs when the heart muscle is not getting enough blood.)

There are eight types of medications that doctors prescribe to treat high blood pressure:

(brand names are in parenthesis)

1.  Angiotensin converting enzyme inhibitors (ACE): captopril (Capoten), benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil, Zestril) fosinopril (Monopril), ramipril (Altace), perindopril (Aceon), quinapril (Accupril),moexipril (Univasc), and trandolapril (Mavik)

2.  Angiotensin receptor blockers (ARBs): candesartan (Atacand), eprosartan (Tevetan), irbesartan (Avapro), telmisartan (Mycardis), valsartan (Diovan), and losartan (Cozaar)

3.  Alpha-blockers: terazosin (Hytrin) and doxazosin (Cardura).

4.  Beta-blockers: acebutolol (Sectral), atenolol (Tenormin), bisoprolol (Zebeta), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol (Corgard), and timolol (Blocadren

5.  Diuretics: hydrochlorothiazide (Hydrodiuril), furosemide (Lasix) and torsemide (Demadex), a combination of triamterene and hydrochlorothiazide (Dyazide), and metolazone (Zaroxolyn).

6.  Calcium channel blockers (CCBs): amlodipine (Norvasc), sustained release nifedipine (Procardia XL, Adalat CC), felodipine (Plendil), and nisoldipine (Sular)

7.  Central alpha agonist: Clonidine (Catapres)

8.  Muscle relaxant: Minoxidil – a peripheral vascular smooth muscle vasodilator.  This medication is usually reserved for patients with high blood pressure who do not respond to other treatment. 

High Cholesterol is treated with prescription drugs called statins: (Lipitor),  (Pravachol), (Zocor), (Lescol), (Crestor), and (Altocor) lower LDL [high-density lipoproteins -so called bad cholesterol] and raise HDL [high-density lipoproteins-good cholesterol].

Abnormal heart rhythms, called arrhythmias, are treated with one of two of the medications used to treat high blood pressure. 

- Beta-blockers: acebutolol (Sectral), atenolol (Tenormin), bisoprolol   (Zebeta), metoprolol (Lopressor, Lopressor LA, Toprol XL), nadolol (Corgard), and timolol (Blocadren)

- Calcium channel blockers (CCBs): amlodipine (Norvasc), sustained release nifedipine (Procardia XL, Adalat CC), felodipine (Plendil), and nisoldipine (Sular).

Another prescription drug called digoxin is also used to treat arrhythmias.  Digoxin is also known as (Digitek), (Lanoxin),(Lanoxicaps), (Digitaline), and (Novo-Digoxin.)

The most common medication that is prescribed to control symptoms of angina is nitrate medication, such as nitroglycerin tablets.

LESSEN YOUR RISK OF DYING OF HEART DISEASE

After your doctor prescribes your medication to prevent heart disease or treat the symptoms of heart disease, the rest is up to you. To lessen the risk that you will die of heart disease: 

1.  Take your prescribed medication correctly.  According to the U. S. Food and Drug Administration (FDA) 30 to 50 percent of patients fail to follow instructions for taking a medication.

2.  Many patients –14 to 21 percent – never fill their original prescription.  That frequently is because of the high cost of many medications in the United States.  Senior citizens on a limited income in the U.S. sometimes have to choose between eating or buying prescription medication that they need.   

3.  The high cost of prescription drugs also accounts for about two-thirds of chronically ill adults in the United States cutting back on their medications. 

One solution to the problem of the high cost of prescription drugs in the U.S. is to buy your medication from much less expensive Canadian pharmacies. It is easy to buy prescription drugs online at the discount prices offered by pharmacies in Canada.  

Surveys released when the state of Minnesota launched its groundbreaking Canadian prescription drug program revealed a remarkable 62 percent savings on commonly prescribed prescription medications.  For some medications the savings can be as great as 80 percent when you buy prescription drugs from a Canadian pharmacy. .

So it makes sense to buy from licensed Canadian pharmacies to get affordable, safe and effective medications.  The Canadian Ministry of Health oversees the sale of prescription drugs in the country.  Health Canada is the federal regulatory agency. 

Other information you can find at Online Pharmacy in Austin.

When caring for a loved one who suffers from Alzheimer's disease, the complications associated with mental and emotional health can be overwhelming for many families. From depression to extreme episodes of exhilaration and happiness, many Alzheimer's patients are simply unable to control their emotions as they once did.

A behavior that is quite common among Alzheimer's patients is commonly referred to as agitation outbursts. Symptomatically, agitation encompasses a complication wherein the Alzheimer's patient will scream, shout, pace back and forth, and curse for unknown reasons. Often, it is the agitation outburst episodes of the Alzheimer's patient that result in the most frustration for friends and loved ones.

While commonly believed to be associated to the side effect of medication administered to the Alzheimer's patient, agitation outbursts can result from any event that is deemed frightening or stressful to the Alzheimer's patient. Such agitating events might include moving to a new home, changing of caregivers or just a simple change to the dynamics and arrangement of the home in which the Alzheimer's patient lives.

When agitation in the Alzheimer's patient is related to an event or change in lifestyle, usually the episodes of outburst will dwindle with time. However, when the complication is persistent and related to a side effect of medication, it is important to speak with a health care professional to determine what, if any, treatment can be provided to alleviate the complication and frequency of agitation outbursts in the home.

When in the middle of an outburst, families and caregivers can learn simple techniques to alleviate agitation in the Alzheimer's patient. For example, re-directing their attention to another object, offering re-assurance, and using calming and positive reinforcement speech are all ways in which the agitation outbursts can be diminished.

While some medications can be used to manage agitation, your healthcare professional will need to take great care in prescribing additional medications so as to avoid other side effects or contraindications. Most commonly, however, the physician may want to use drugs such as Zyprexa, Seroquel or Risperdal to quell or subside the frequency of agitation outbursts in your loved one.

Creating a relaxing and stress free environment is the best way in which to reduce the agitation outbursts in the Alzheimer's patient. Avoiding the movement of furniture, loud sounds and changes in lighting are all measures you can take to create that environment that is so desperately needed by the Alzheimer's patient and, ultimately, create an environment where agitation and outbursts are less frequent.

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The Federal Drug Administration on Friday issued a warning to doctors that adolescents taking the drug olanzapine have an "increased potential" — in comparison with adults taking the new-generation antipsychotic drug — for weight gain and metabolic disturbances that could result in diabetes or elevated blood cholesterol levels.

"Clinicians should consider the potential long-term risks when prescribing to adolescents," the FDA said in a statement released Friday night. "In many cases, this may lead to prescribe other drugs first," the statement went on.

The agency has not approved the marketing of olanzapine — sold under the commercial name Zyprexa by the drug maker Eli Lilly — for use in children under 13 who are diagnosed with schizophrenia or bipolar disorder. But the medication, one of a class of psychiatric medications called the "atypical antipsychotics," is widely prescribed for young patients, despite growing evidence that call its safety profile into question for this population.

The warning comes in the wake of the October publication in the Journal of the American Medical Assn., in which a study showed that children and adolescents taking their first-ever course of Zyprexa gained, on average, more than 17 pounds over a 12-week period, as well as dramatic increases in triglycerides and cholesterol levels — all factors that put them at higher risk of developing cardiovascular disease. While two other antipsychotic drugs — Seroquel and Risperdal — were implicated in significant weight gain and metabolic changes, Zyprexa was found to carry the highest risks of all three.  

The FDA said that in cases where physicians opt to prescribe olanzapine, the drug should be part of a "comprehensive treatment program," which could include psychological, educational and social counseling as well as medication therapy.

–Melissa Healy

Johnson & Johnson (JNJ) shares are rebounding today, up nearly 1.5% to $65.51. The drugmaker is trying to recover from a rough week, when the Justice Department charged it with paying kickbacks to a pharmacy company to boost sales of its drugs to nursing-home patients, and the Food and Drug Administration accused it of being too slow with its product recall during a Tylenol scare.

Late last year, J&J, based in New Brunswick, N.J., expanded its recall of its top-selling Tylenol line, which sold at least $1 billion in the U.S. last year. The incident echoes an unsolved 1982 crime in which seven Chicago-area Tylenol consumers died after using tampered Tylenol laced with cyanide. Johnson & Johnson's quick, decisive response to the incident earned plaudits and sparked reforms in packaging over-the-counter drugs. The current recalls began in September, expanded in late December, and then expanded again last week to include more batches and other brands.

Voluntary Recall

The issue at hand is an unusual moldy, musty, or mildewy odor in the drugs caused by small amounts of a chemical associated with the treatment of wooden pallets. Users who reported the smell complained of nausea, stomach pain, vomiting, and diarrhea.

Despite a voluntary recall, J&J's McNeil Consumer Healthcare Products got a stern warning from the FDA for manufacturing-standards violations and for failing to report and investigate the problem quickly. Timothy Calkins, a marketing professor at Northwestern University's Kellogg School of Management, told The New York Times that the FDA's criticisms “were devastating, because they make the company seem to be complacent and sloppy.”

To make matters worse, the Justice Department has filed a civil False Claims Act complaint against Johnson & Johnson for paying millions of dollars in kickbacks to Omnicare, the nation's largest pharmacy to specialize in dispensing drugs to nursing homes.

The allegation isn't a huge surprise: In Novevember, Omnicare entered into a $98 million settlement for taking kickbacks from J&J. Omnicare's pharmacists, according to the complaint, reviewed charts of nursing-home patients with dementia and then recommended that the physicians add antipsychotic drug Risperdal if the patient showed signs of agitation or inappropriate behavior. Physicians, who were not involved in the scheme, agreed with the pharmacists' recommendations about 80% of the time, although Risperdal isn't approved to treat this form of psychosis.

“Kickbacks in the nursing home pharmacy context are particularly nefarious, because they can result in excessive prescribing of strong drugs to patients who have little or no control over the medical care they are receiving,” said U.S. Attorney Carmen Ortiz.

Risperdal sales brought J&J $1.73 billion in the first nine months of 2009: nearly 4% of the company's $45.3 billion in revenue.

Chemical Restraints

Risperdal doesn't reverse or relieve dementia, and in fact carries a “black box” warning of increased chances of death among elderly patients with dementia-related psychosis. Still, it has been widely prescribed in nursing homes, in a practice criticized as “chemical restraints”: altering patients' behavior for the convenience of the staff. The practice still continued by 2006, as a study published Monday in the Archives of Internal Medicine shows, although at a lower rate. Because most elderly patients are covered by Medicaid, the lawsuit suggests, J&J and Omnicare J&J and Omnicare had to have been creative in accounting for the kickbacks and listed them as education funding, grants, and data on the drug. J&J did not respond to inquiries.

J&J is on the hook not only with the FDA and the DOJ but with public opinion. The company's actions after the Tylenol scare of 1982 fully restored its corporate and brand images, but this recall and the FDA letter (not to mention the kickbacks allegations) has harmed its stature.

J&J reports financial results on Jan. 26. Whether the recall affects its business is unclear. The company doesn't expect the recall to be material, but the lasting effects on the company's image might be significant.
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Are the severe and numerous risks worth the benefits?

Isotretinoin is a prescription drug intended for severe nodular acne. Results are often short-lived and acne returns within a week or two after the end of therapy. Acne symptoms caused by environmental allergens such as ingredients in body care and cleaning products and chloracne caused by dioxins cannot be controlled with isotretinoin therapy. For detailed information about the causes of acne, please read, “What Causes Acne?” Although isotretinoin therapy can control the production of sebum associated with acne during treatment, when treatment ends the environmental antagonists remain, and the acne returns.

Isotretinoin is a prescription drug intended for severe nodular acne. However, according to many reports, such as Use of isotretinoin (Accutane) in the United States: Rapid increase from 1992 through 2000, this drug is being heavily prescribed for moderate acne. In some cases, this drug is also being prescribed for mild acne that has not responded to other methods of controls. Sold under the brand names of Accutane, Amnesteem, Claravis, or Sotret, there are well over 2 million prescriptions written for isotretinoin. In addition, black market internet sales cannot be calculated.

There are incredible risks associated with isotretinoin. Severe birth defects, including clef palette and severe brain damage, are the most well known side effect. Liver function tests are required during therapy to monitor damage to the liver during the course of treatment. Other side effects are known that can have a life-long impact requiring medical care for the lifetime of the patient such as the following list of Accutane's Harmful Side Effects from YourLawyer.com. I was skeptical that all these horrible conditions are potential side effects from this single drug. However, the Roche documentation on Accutane supports every single one of these conditions as a potential side effect from this drug. There is actually one side effect missing from this list; hearing loss. Imagine never being able to hear your mother tell you she loves you again.

Here's the list of potential adverse reactions to Isotretinoin (Accutane, Amnesteem, Claravis, or Sotret):

Inflammatory Bowel Disease which includes: Crohn's Disease, Ulcerative Colitis, Proctitis, Enterocolitis, Ileocolitis, Ileitis, Rectal Bleeding, Sigmoiditis, Colitis

Musculoskeletal Disease which includes: Premature epiphyseal closure, Desiccation of the spine & dessicated discs

Vision Damage: Optic neuritis, Cataracts, Conjunctivitis, Corneal opacities, Keratitis, Papilledema, Blindness

Liver Damage: Cirrhosis, Hepatotoxicity, Hepatitis

Central Nervous System: Pseudotumor Cerebri (false brain tumor, can lead to blindness), Seizures, Stroke, Paralysis

Pancreas: Pancreatitis Hemorrhagic Pancreatitis, Hypertriglyceridemia

Immune System Disorder: Lupusm Rheumatoid Arthritis, Multiple Sclerosis, Connective Tissue Disorders, Wegener's Granulomatosis, Agranulocytosis, Diabetes, Hodgkin's Disease, Inflammatory Bowel Diseases, Lymphadenopathy, Neutropenia

Kidney Disease: Glomerulonephritis, Hyperuricemia (Gout), Proteinuria, Rhabdomyolysis, Kidney Stones, Urogenital conditions, Hypercalcaemia

Cardiovascular Injuries: Arteriosclerosis, Calcification of coronary arteries, Calcification of mesenteric arteries, Calcification of poulmonary arteries, Fibrosis of the myocardium, Inflammation of the myocardium, Palpitations – Tachycardia, Vascular thrombotic disease, Vasculitis, Ventricular tachycardia, By Pass surgery

Skin Dieases: Acne fulminans, Alopecia, Bruising, Cheilitis, Dry mouth, Dry nose, Dry skin, Epistaxis, Eruptive xanthomas, Flushing, Fragility of skin, Hair abnormalities, Hirsutism, Hyperpigmentation, Hypopigmentation, Infections, Nail dystrophy, Paronychia, Peeling of palms and soles, Photoallergic/photosensitizing reactions, Pruritus, Pyogenic granuloma, Rash – including facial erythema, seborrhea, and eczema), Sunburn susceptibility increased, Sweating, Urticaria, Vasculitis – including Wegener's granulomatosis, Abnormal wound healing – delayed healing or exuberant granulation tissue with crusting

Psychiatric Diseases: Suicide and Suicidal Thoughts, Depresssion, Aggression, Psychosis

Birth Defects: New evidence is showing that birth defects may be paternal as well as maternal. In addition, the risks associated with birth defects by isotretinoin may be for the life of the patient rather than just during the course of treatment.

Internal Birth Defects: CNS abnormalities (including cerebral abnormalities, cerebellar malformation, hydrocephalus, microcephaly, cranial nerve deficit), cardiovascular abnormalities, thymus gland abnormality, parathyroid hormone deficiency

External Birth Defects: Skull abornormality, ear abnormalities (including anotia, mircopinna, small or absent external auditory canals, eye abnormalities (including microphthalmia), facial dysmorphia, and cleft palate[9, 10]

Social and environmental costs associated with isotretinoin are incalculable at this time.

Summary

Isotretinoin is the highest risk, including death, suicide, potential life-time risk of bearing deformed offspring and, should those offspring reproduce, the potential for their offspring to suffer abnormalities is not known at this time. The increased social costs for potential long-term adverse reactions is incalculable at this time. The increased risks for long-term, and potentially generational, costs of health maintenance of deformed offspring is incalculable at this time. The environmental fate of isotretinoin is unknown at this time. It is not known if isotretinoin can be removed from the waste stream prior to environmental release at this time. It is not known if there is the potential for isotretinoin to survive the disinfection process of public water supplies and be returned to public drinking water at this time.

To learn other treatment options for your acne, such as antibiotic treatment, chemicals such as glycolic acid, salicylic acid and benzoyl peroxide treatments and holistic treatment please visit: http://www.sunflowernaturals.com.

Resources:

1. Use of isotretinoin (Accutane) in the United States: Rapid increase from 1992 through 2000, http://www.accutaneaction.com/Press/AAD2002UseofIsotretinoin.pdf

2. Accutane's Harmful Side Effects,http://www.accutanelawyernetwork.com/index.html3. Roche, Accutante, Isotretinoin capsules, http://www.rocheusa.com/products/accutane/pi.pdf

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