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Archive for March, 2007

Pfizer to Advertise Diabetes Treatment

Friday, March 30th, 2007

Source: NJBIZ
Publication date: 2007-02-26
Arrival time: 2007-03-19

By Anonymous

NEW YORK

Physicians have largely spurned the drug

PFIZER INC., the world’s biggest drug maker, plans to use television commercials and magazine ads to pitch the first inhaled insulin treatment directly to diabetics after the product failed to catch on with doctors.

Approved by the U.S. Food and Drug Administration in January 2006, the drug, called Exubera, has been largely rejected by diabetes specialists, generating only about $5 million in sales last year, or one-tenth as much as some analysts forecast. Pfizer will start the advertisements later this year.

Analysts say the marketing strategy is designed to overcome the product’s higher cost and the inconvenience of the device used to administer the drug. The N.Y.-based drug maker, which has a large presence in New Jersey, is risking criticism by members of Congress and physician groups who say consumer advertising encourages excessive use of costly therapies.

Clinical trials have found the product can reduce lung function for some patients. Pfizer says the condition is reversible.

Copyright Journal Publications Inc. Feb 26, 2007

(c) 2007 NJBIZ. Provided by ProQuest Information and Learning. All rights Reserved.

Publication date: 2007-02-26
© 2007, YellowBrix, Inc.

13-Year-Old Wins Rotten Sneaker Contest

Friday, March 30th, 2007

Source: Associated Press/AP Online
Publication date: 2007-03-21

By JOHN CURRAN

MONTPELIER, Vt. - Thirteen-year-old Katharine Tuck’s sneakers are equal opportunity offenders. They smell as bad as they look. Now, the Utah seventh grader is $2,500 richer because of it: On Tuesday, she out-ranked six other children to win the 32nd annual National Odor-Eaters Rotten Sneaker Contest, stinking up the joint with a pair of well-worn 1 1/2-year-old Nikes so noxious they had the judges wincing.

“I’m so proud of the little stinker,” said her mother, Paula Tuck.

Ah, the foul smell of success.

The contest, which was founded in 1975 as a sporting good store promotion and is now sponsored by the manufacturer of anti-foot odor products, pits children from around the nation who have won state-level competitions for the generally cruddy condition of their footwear.

Kyle Underwood, 9, was in from Las Cruces, N.M., with his low-cut black Starters, the ones with the blown-out toe on the right foot. “These are bad,” sighed judge Andy Brewer. “Ooh, these are really bad.”

Michael Nduka, 9, of White Plains, N.Y., was there, too, with his ratty black-and-white low-cuts, which - like the others - were passed from judge to judge for inspection. Judge William Fraser, who is Montpelier’s city manager, held one up using the tip of a pen, like a crime scene investigator trying not to taint the evidence.

Eleven-year-old Alex Clark’s sneakers had tape over the holes in the toes, and the instep of one was blown out. When judge George Aldrich took a whiff, he coughed and then handed the sneaker back to Clark. “I saw you flinch,” Aldrich said to him.

“As a parent, you want to hide,” said Kathy Midgley, 48, of Berkeley Heights, N.J., who was there to watch her 8-year-old son compete.

Clad in Odor-Eaters baseball caps and Odor-Eaters T-shirts, each contestant had to jump in place once and then make one full turn in place before taking off his or her shoes and handing them to the judges. It was 24 degrees outside, but only one of them wore socks - since foot sweat is a boon not a bane in this game.

Odor-Eaters paid to fly eight contestants - each with a parent - to Vermont, but not all arrived on time. Devin Koivisto, 12, of Phoenix, didn’t make it due to travel complications.

Tuck almost didn’t, either: Her flight to Newark, N.J., was delayed, forcing she and her father to miss a connecting flight to Vermont. They drove the rest of the way, but their luggage still hadn’t arrived Tuesday.

But her mother had the foresight to warn Tuck not to ship her prized shoes in her checked baggage, lest it get lost en route.

Mercifully for airport security screeners, she didn’t wear them, either, opting to carry them in her purse.

For these sneakers, the smell was only the half of it. Ripped on the right toe, with red and yellow duct tape holding one together and frayed laces on both, they looked like something from a landfill.

She has used them to play soccer, basketball and other sports, hiked in them and waded into the Great Salt Lake, where they became infiltrated with brine shrimp.

“People ask me why I don’t get new ones and why I would enter a contest like this,” she said before the judging started.

Once it did, she called her mother on a cell phone and kept the line open so Mom could listen in. Once Fraser got a look - and a whiff - of Tuck’s Nikes, he took the phone from her. “Do you actually let her wear these in public?” he asked her mother.

After the judges’ decision was announced, Tuck shyly granted interviews. Was she proud? “Yeah, I guess.”

“She’s going to put this on her first job application,” said her father, Michael Tuck.

“I am?” she said.

Publication date: 2007-03-21
© 2007, YellowBrix, Inc.

Well-Fitting Shoes Protect Aging Feet

Friday, March 30th, 2007

Source: Malaysian Business
Publication date: 2007-02-16
Arrival time: 2007-03-21

By Compiled by Yap Eng Jin

IF style is the main objective when you select shoes, then your feet may suffer, especially as you age. Over time, your feet will become wider and longer, and the natural padding under your heel and forefoot thins. Years of use also flatten your arches and stiffen your feet and ankles. If you often wear shoes that are too short or too narrow, you may develop foot deformities such as bunions, calluses or corns, hammertoes or pinched nerves between your toes. Wearing better-fitting shoes reduces your chances of developing deformities or making them worse.

Tips for selecting shoes:

* Try on shoes later in the day. Feet can swell as the day wears on.

* Fit shoes to your largest foot. Your feet aren’t equally matched, so have both measured.

* Make sure there’s at least a half-inch for your longest toe at the end of each shoe when you’re standing. You should be able to wiggle all toes.

* Make sure your heel doesn’t ride up and down when you walk.

* Leave too-tight shoes behind. There’s no such thing as a break- in period.

* Look for shoes that are solidly constructed, conform to your feet and have cushioned soles that absorb the shock of hard surfaces.

* Try a lace-up style. A shoe that ties can be adjusted for better comfort and support.

* Look for a natural material, such as leather, on the upper portion of the shoes because it’s usually softer and provides more flexibility than a man-made material.

(c) 2007 Malaysian Business. Provided by ProQuest Information and Learning. All rights Reserved.

Publication date: 2007-02-16
© 2007, YellowBrix, Inc.

Cuban-Style Clinics May Be a Model for U.S.

Thursday, March 22nd, 2007

Source: The Miami Herald
Publication date: 2007-03-19

MIAMI _ At the new Leon Medical Center in Hialeah, Fla., a white-gloved and uniformed doorman welcomes seniors in front of bubbling waterfalls. Inside, along with marbled restrooms, seniors get free dental and vision care _ care that regular Medicare recipients must pay for themselves.

In Westchester, Fla., at a CAC Florida clinic, seniors are participating in free exercise classes, playing dominoes and competing in bingo tournaments, as well as getting free coffee and breakfast pastries.

In both places, everything is paid for by taxpayer dollars.

Most importantly, in these clinics and others like them, seniors get easy access to primary care physicians _ care intended to stop conditions from getting serious so that patients can avoid aggravating and expensive trips to the emergency room.

These clinics, which trace their roots to pre-Castro Cuba, could well be a vision of the future of healthcare in America. “This is a very good model,” says Steven Ullmann, a healthcare economist at the University of Miami.

Seniors tend to love the places. “I feel good here,” says Gerardo Gonzalez, 78, who went to the CAC clinic in Westchester one recent morning for a blood test and stayed to play dominoes. “I feel at home.”

So far the clinics, true to their Cuban origins, have focused primarily on Hispanic areas, but that’s changing. CAC plans to expand into Liberty City, Fla., within the next year, and Benjamin Leon Jr., CEO and founder of Leon Medical Centers, says he’s thinking of franchising his concept after getting inquiries from entrepreneurs in Arkansas, New Jersey and Puerto Rico.

Some experts argue that the clinics are good only because the Bush administration has put massive amounts of federal funding into the Medicare HMOs that these clinics depend on _ a push to shift a government program to for-profit corporations, on the theory that the private sector can do a better job managing money than can Washington bureaucrats.

“They’ve thrown a lot of money at this,” says Robert Berenson, a healthcare specialist with the Urban Institute. It used to be a Medicare HMO received 95 percent of what a senior in a given area would be expected to cost each year. Now, it’s 102 to 112 percent of expected traditional costs, says Berenson.

As Dartmouth researchers and others have shown, the average senior in Miami costs Medicare about twice as much per year as a senior in Minneapolis.

Because of that, the government reimburses HMOs in South Florida far more than most other places. An HMO in Miami-Dade gets $1,199 a month for each senior it signs up. In Minneapolis-St. Paul, an HMO gets $732 a month per member, according to a Medicare database provided by spokeswoman Sharon Fisher.

Over a year, that means a South Florida HMO gets up to an additional $5,600 to spend on each senior _ and that’s why it can lavish extra benefits on them.

Not surprisingly, seniors love those benefits. Put that together with a strong Hispanic tradition of using clinics and it means almost half of Miami-Dade seniors _ 48 percent _ are in HMOs. In Broward, it’s 43 percent. Both counties are more than double the national average of 19 percent.

This is such a lucrative field that national players are getting involved. Humana has purchased the CAC clinics, and Goldman Sachs, the New York investment group, recently purchased a controlling interest in MCCI Medical Group, a local firm with clinics throughout South Florida, according to Bruce March, a Greenberg Traurig attorney who helped broker the deal.

ContinuCare, with healthcare entrepreneur Phillip Frost as its main investor, has 15 primary-care clinics in Miami-Dade and Broward serving a broad range of patients. Chief Executive Richard Pfenniger Jr. says that facilities in Hispanic areas will offer the coffee and “social-related activities” that the competition offers.

Mike Fernandez, a Florida entrepreneur who helped develop the CAC model, says that the Cuban-style clinics will prosper even without boosted funding from Washington because they’re able to provide more value at lower cost. “Historically, these clinics have provided way beyond what anyone else was offering.”

Ullmann says the clinics prosper because of two keys: “First, they’re culturally sensitive, and second they have a focus on primary care.”

The clinics emphasize a “warm and friendly” atmosphere, says Fernandez, with service reps hovering to help patients negotiate the system. The CAC Westchester clinic even puts photos on the walls of patients’ recent birthday parties, and service is extensive. Many clinics are open 7 a.m. to 5 p.m. weekdays and Saturday mornings.

Still, the core is primary care. Elders tend to have a lot of aches and pains, and a good many of them are worriers. “They love to see their doctor,” says Ausberto Bianchi, the physician-in-charge at CAC’s Westchester center.

The clinics don’t try to limit those visits. “Why do that?” asks Leon. “If they can’t see their doctor, they’ll just go to the ER.”

Most clinics bring in specialists on certain days of the week, but the primary physician recommends a specialist only when he or she feels there’s a particular need.

Barbara Starfield, a Johns Hopkins professor, says a key reason why Europeans tend to live longer than Americans but spend only half the healthcare dollars is that in most European countries, about half the doctors are devoted to primary care, while only a third are in America. Primary physicians tend to do a better job treating basic ailments, her research found, at much lower cost.

The Dartmouth studies show specialists drive up costs. South Florida has 45 percent more specialists per 100,000 residents than does Minneapolis _ and about 20 percent more than the national average. Specialists tend to bounce patients between each other _ the gastroenterologist sends someone with backache to an orthopedist _ at much higher per hour charges than primary care doctors charge. And each specialist is likely to conduct his own tests. The average senior with traditional Medicare in Miami gets about twice as many lab tests a year as a senior in Minneapolis.

In the clinics, all test results are centralized with the primary doctor, and so there is virtually no repetition.

The clinics don’t directly discourage trips to emergency rooms, but they do work hard to make it easier for patients to get quick care at the clinic. Leon has a 24-hour hotline that seniors can call to ask whether a condition is serious enough to warrant an ER trip. CAC Westchester has a walk-in urgent care center with long hours.

Leon’s new facility in Hialeah even has a quasi-ER, where there are 10 beds separated by curtains. Benjamin Leon III insists this isn’t meant to replace the ER, but offers a place for ailing seniors to lay down as they wait to see their doctor.

Some are suspicious about the clinics’ motives, because they’re for-profit companies trying to maximize returns, which can be done by keeping costs low.

Ullmann doesn’t think that should deter patients. If one clinic doesn’t treat them well, they can switch to another _ just like most American consumers do in other matters. “You’re looking for value at a good cost. Why is that any different than picking a Dell or a Gateway?”

Ironically, a critic of the for-profit HMOs is a conservative, Michael F. Cannon, a scholar with the Cato Institute and author of “Healthy Competition.”

Cannon points out that with the HMO, the customer still can’t control his healthcare dollars and, like many liberals, he wonders whether the Medicare HMOs are “cherry-picking” their customers.

That’s against federal law, but there are subtle ways to do it, and Cannon wonders if CAC’s wellness programs _ offering daily exercise classes _ attract the most active and healthiest seniors, while the sickest tend to stay with traditional care, so they can see the specialists and get the customized treatment they feel they need.

“This is called screening,” he says.

In fact, CAC’s social and wellness programs are the one major difference between it and Leon.

CAC provides many daily social events, including English classes, and those who do the morning exercises are rewarded with a free lunch. CAC execs say exercise classes keep seniors fit _ and means they’re less likely to need expensive trips to ERs.

“But there’s also the mental health aspect,” says Hilda Lago, a CAC administrator. The senior sitting at home, often alone, has time to dwell on aches and pains, while going to a center to be with others can brighten a day.

“Every day I come here,” says Emma Rodriguez, 75, a regular at a CAC exercise class. “That’s better for me.”

Leon Jr. says his clinics offer no exercise or dominoes _ and never will. “We take the dollars and put them into healthcare.”

When Fernandez, a creator of the CAC dominoes-bingo style, heard that comment, he thought of the Leon clinics elaborate entrances and responded: “Well, healthcare _ and waterfalls.”

Leon says Congressmen from around the country have visited his centers, wondering if they can serve as a national model.

Ullmann doesn’t see why not. “If they put one in Chinatown in San Francisco, they’d have to be sensitive to different cultural needs, but the basic model” _ personal attention and strong primary care _ “would work just as well.”

___

(c) 2007, The Miami Herald.

Visit The Miami Herald Web edition on the World Wide Web at http://www.herald.com/

Distributed by McClatchy-Tribune Information Services.

_____

PHOTOS (from MCT Photo Service, 202-383-6099): MED-CLINICS

For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA. 1041803

Publication date: 2007-03-19
© 2007, YellowBrix, Inc.

River Parasite Eats at Africa’s Children

Thursday, March 22nd, 2007

Source: Chicago Tribune
Publication date: 2007-03-19

NASARAWA, Nigeria _ Flowing through the shantytowns and yam fields of this dust-choked region, the River Uke glimmers like a mirage, tiny white diamonds of sunlight dancing on its surface. As the temperature rises to 100 degrees, wiry boys run to the river and leap into its waters.

Ask the people of Nasarawa, and they say the river is the center of their lives. But the water hides a debilitating scourge: schistosomiasis, a disease spread by microscopic parasites that live in the river, burrow through skin and slowly infect organs, stunting children’s growth and sometimes causing death.

The solution, experts say, lies with just one dose, once a year, of about three white pills called praziquantel. Studies show that a single dose _ at a cost of 20 cents _ can reverse up to 90 percent of the damaging health effects of schistosomiasis within six months of treatment.

But while Nigeria profits handsomely from its oil industry and giant pharmaceutical corporations donate millions every year to treat more prominent diseases in developing countries, no one has stepped forward to help mass-produce and distribute praziquantel, which costs 7 cents per pill to manufacture.

“The pennies cannot be found,” said Frank Richards Jr., a doctor who heads a program to study the disease at the Atlanta-based Carter Center.

Schistosomiasis, also known as snail fever or bilharzia, has become yet another plague _ like intestinal worms, lymphatic filariasis and trachoma _ running rampant in Africa, despite an inexpensive and readily available medicine. It is estimated that 200 million people suffer from the malady worldwide, a majority without treatment.

“These are forgotten diseases and forgotten people,” Richards said.

The tropical disease is the second-most common in Africa behind malaria, and experts believe its numbers are rising. Development projects such as hydroelectric and irrigation dams provide the ideal environment, and increased construction has sparked outbreaks from sub-Saharan Africa to China.

Schistosomiasis rips through internal organs and leaves victims in misery. But because it usually isn’t fatal, the disease remains largely untreated as governments fight killers such as malaria, tuberculosis and AIDS, which experts call “the big three.”

The Carter Center, instrumental in battling the horrific Guinea worm and other neglected diseases across the globe, has launched a small but aggressive campaign against schistosomiasis. Armed with a grant of just $40,000 a year, a small band of doctors and workers has fanned out to distribute medicine to the remotest corners of Nigeria, a country with the highest numbers of “schisto” in the world.

Schistosomiasis plagues the poorest communities, places where people live without running water, latrines or basic sanitation. The parasite is carried and spread by snails that live in rivers and dams.

When mature, the parasite leaves the snail and enters the water, where it can penetrate the skin of people who are washing or swimming. Within several weeks, the parasite grows inside the blood vessels and produces thousands of eggs. The eggs travel to the bladder, lungs, liver and intestines, where they release an enzyme that eats through tissues.

The eggs eventually are discharged through urine or feces. When passed into water, the eggs hatch and infect the snails to restart the cycle.

In Nasarawa, a trash-strewn slum of densely packed concrete houses with rusting tin roofs, 63 percent of the children have blood in their urine, a sure sign that the worms’ eggs are digging into the bladder. Children are most likely to become infected because they typically spend the most time playing in contaminated water.

Parents take children to local clinics. But doctors often have no way to treat the disease.

“The drugs are not available,” said Dr. Emmanuel Miri, who runs health programs in Nigeria for the Carter Center. “You are faced with children urinating blood and there is nothing you can do.”

Most of the 7,000 residents in Nasarawa eke out an existence, tilling fields of cassava, corn and rice. Few people have access to latrines or running water. Fewer can afford praziquantel, which costs 20 cents per dose to produce but is sold in local pharmacies for about $2.

The lack of treatment means the town’s children are small and frail. Those who say they are 10 years old frequently look no more than 6.

Other ways to fight the disease have proven expensive or ineffective. A pesticide used to kill snails could be put in the water, but that chemical is more costly than praziquantel. A program to help the village build latrines might help, but experts don’t believe that would stop the spread of the disease because, as Richards said, “it’s hard to keep kids from peeing when they swim.”

Though many know the river is contaminated, it is nearly impossible to avoid contact with its waters. On a recent day, women washed clothing on the rocky bank as men bathed nearby. Dozens of boys splashed in a deep pool.

Ishaya Emmanuel, 15, has seen blood in his urine, but he won’t stop swimming in the river. “There is not enough water to wash and bathe,” he said. After swimming, he often feels itchy, a sign that the worms likely are digging into his skin.

Acknowledging the shortage of praziquantel, the World Health Organization, or WHO, recommends that doctors ration the drugs. According to WHO guidelines, if testing finds that more than 50 percent of children have the disease, an entire village should be given praziquantel. If 50 percent to 20 percent have the disease, only children should receive the pills. If less than 20 percent have the disease, the village will not be treated.

The Carter Center launched a program in 1999 with the government of Nigeria to treat the disease in three states. The program could afford to purchase 200,000 doses a year. So health officials devised a plan to rotate treatment, delivering pills to the most endemic towns, bringing down disease rates and then moving the drugs to other heavily infected areas.

In places where more than 50 percent of the population once suffered from the disease, rationing drugs brings infection rates to under 20 percent of the population in most communities. But when drugs are removed, rates of infection inevitably climb.

In Nasarawa, after the pills were withdrawn for two years, the rate of disease spiked to 63 percent.

On the riverbank or in classrooms, village children were hesitant to talk about the scourge. But when coaxed in private, they acknowledged having the symptoms.

Ramalan Haruna, 13, a small boy in a dirty yellow T-shirt, saw blood and felt pain while urinating. “It was a stinging pain. I was worried when I saw the blood,” Haruna said.

Adam Sulaiman, 12, has seen blood in his urine too. He complained to his parents, but a medicine they got for him did not work. “We will be happy when they give us drugs,” Sulaiman said.

In February, government health workers returned to Nasarawa to distribute praziquantel. At a village health clinic, children held glass vials of urine samples _ red with blood. The next day they were to receive the pills to treat the infection.

“When you treat a kid with praziquantel, they do better on their tests, they are more alert in the classroom. They grow taller and they gain weight. They do all the sorts of things that children like this are supposed to,” Richards said.

Carter Center officials are searching for donors to expand the program. A Japanese foundation gives $40,000 per year, but it goes only so far.

Nigeria needs more praziquantel than any other country in the world. But while it works in cooperation with the Carter Center in the villages, the government of Africa’s largest oil-producing country has yet to fulfill promises to provide more money.

Former President Jimmy Carter, who founded the Carter Center in part to treat neglected diseases, has twice asked the Nigerian government to help pay for pills. In a 2005 meeting, top government officials promised $2 million but never followed through, Carter Center officials said. Carter traveled again to Nigeria in February and received another pledge for $2 million _ half of what is needed.

“Each one of these children would require a 20-cent investment once a year,” Richards said on the riverbank. “We should be able to afford that.”

___

To find out more about the global fight against diseases, including snail fever, go to the Carter Center’s Web site at http://cartercenter.org and the World Health Organization site at http://who.int

___

(c) 2007, Chicago Tribune.

Visit the Chicago Tribune on the Internet at http://www.chicagotribune.com/

Distributed by McClatchy-Tribune Information Services.

_____

PHOTOS (from MCT Photo Service, 202-383-6099): NIGERIA-SNAILFEVER

For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA. 1041717

Publication date: 2007-03-19
© 2007, YellowBrix, Inc.

Who Gets the Kidney?

Thursday, March 22nd, 2007

Source: Chicago Tribune
Publication date: 2007-03-19

The following editorial appeared in the Chicago Tribune on Friday. March 16:

For years, the system for parceling out kidneys to those who need transplants hasn’t changed all that much. If you need a kidney transplant, you basically get in line and wait your turn. It may take two years or 10, depending on what part of the country you live in, among other things. A 70-year-old may get an organ before a 15-year-old. When your name reaches the top of the list, and a suitable organ becomes available, you receive the transplant, unless you’re too sick to survive the surgery.

This has been considered the fairest way to distribute a precious commodity in short supply. But that system is inefficient. It wastes some kidneys. It favors some merely because of where they live. People with short expected life spans receive kidneys that could last much longer, and vice versa. It needs to change.

Fortunately, there’s a dramatic new formula under discussion by the nation’s organ transplant network that seeks to change how kidneys are doled out. Under this concept, doctors would assess the benefit of a kidney transplant largely by estimating the number of extra years of life a transplant could confer. That is, how long a patient with failing kidneys might expect to survive after a transplant versus how long the same patient might live without the transplant, on dialysis alone. Kidneys would go more often to those who could live longest after the transplant.

Put simply: Youth would rule. Younger people would receive transplants at the expense of older people.

This will obviously disturb some people, who argue the policy suggests the life of a 30-something person is more valuable than that of an older person.

That is clearly not the intent. Instead, the goal is to wring the most benefit from each transplanted kidney. A similar concept is already part of the system to determine who receives a lung transplant.

The current policy of distributing kidneys looks equitable on the surface. But it isn’t because the wait time affects different people in different ways, says Dr. Mark Stegall, chief of transplantation surgery at the Mayo Clinic and the head of the committee that is mulling the proposed changes. Some people who die on the waiting list could have lived a long time with a transplant, but not on dialysis, he says. For others, the time gained by transplant over dialysis is small.

Transplanting organs into those who can live longest and healthiest won’t always serve the greater good. What if the 65-year-old who doesn’t get the kidney is on the brink of a medical discovery that would save millions? What if the 25-year-old who gets the organ fritters his or her life away, never producing anything of value? Should it matter, say, if the patient is a skydiver or in a risky profession? Or if the patient is a smoker? Obese? A drug abuser? An alcoholic?

Those questions are largely, and rightly, beyond the scope of what’s being discussed. The point is to create a system based as much as possible on objective medical criteria.

And let’s remember, this change is necessary because of one sad fact: Transplantable organs are in short supply. There’s roughly one kidney from a deceased donor for every seven people on the waiting list. They must be rationed. The hope here is that debates like this will encourage more people to donate so that such proposals would be unnecessary. The most direct incentive would be to pay modest compensation to the families of those who donate. Unfortunately, that idea hasn’t gained much traction.

And so, every day doctors are forced to make these life and death calculations. Researchers have estimated that under a new formula, life expectancy for kidney transplant patients would improve by about 30 percent. That’s huge. Translated, it means that thousands of transplant recipients in the U.S. would be expected to live an extra 11,457 years under the new allocation scheme. Think about all those extra years with a father or mother, a sister, a brother, a cousin, a friend. What an amazing gift.

___

(c) 2007, Chicago Tribune.

Visit the Chicago Tribune on the Internet at http://www.chicago.tribune.com

Distributed by McClatchy-Tribune Information Services.

_____

GRAPHIC (from MCT Graphics, 202-383-6064): 20070306 Kidney demand

For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

Publication date: 2007-03-19
© 2007, YellowBrix, Inc.

A New Look into Cancer’s Roots: Scientists Revive Study of Stem Cells’ Link to Disease

Thursday, March 22nd, 2007

Source: The Baltimore Sun, Maryland
Publication date: 2007-03-19

By Chris Emery, The Baltimore Sun

Mar. 19–Scientists hope that someday stem cells will cure diseases.

Pamela Joseph fears that cancer stem cells will kill her first.

As her doctors explain it, stem cells are the source of multiple myeloma, a blood cancer the 56-year-old Clarksville woman has been fighting since 2005. Stem cells might also be the reason that the cancer — which has killed one member of Joseph’s family — is incurable.

The notion of stem cells as potential villains is counterintuitive, given their highly publicized promise for repairing damaged tissues and organs. But some experts say that certain stem cells may be just as good at restoring cancers that doctors are trying to eradicate.

Learning how to destroy cancer stem cells, they theorize, might lead to that most elusive of breakthroughs — the cure for cancer.

This is an old notion, only recently revived. Scientists first explored the cancer-stem cell connection nearly 40 years ago but abandoned it when the scientific techniques of the period weren’t up to the task.

Now, however, advances in molecular biology and the current boom in stem cell research have spurred renewed interest in the idea — and renewed skepticism.

Scientists at the University of Maryland and the Johns Hopkins University are investigating cancer stem cells, making Baltimore one of the few hubs for the nascent science. In January, the Maryland Stem Cell Commission received four proposals requesting state funding for the research.

“This is a very hot topic,” said Dr. Richard J. Jones, one of Joseph’s doctors at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.

To explain it, Jones compares cancer to a dandelion, that bane of the well-manicured lawn: the flawed adult cells that make up the bulk of a cancer tumor are like dandelion flowers. Like a lawn doctor mowing down the flowers, a cancer doctor uses chemotherapy and radiation to eradicate mature cancer cells.

But just as dandelion flowers return, so, too, does cancer because the offending root — cancerous stem cells — remains intact.

“We have some pretty good lawnmowers,” Jones said of cancer treatments. “But they don’t get at the stem cells.”

The theory holds that cancerous adult cells come from a relatively small number of stem cells. The stem cells can renew themselves through cell division and generate a variety of cell types — properties that make them promising for treating disease.

The same attributes, however, may enable them to become tiny factories that feed and renew cancers.

Simple as the concept seems — stem cells produce mature cancer cells — studying it is a complex matter.

Researchers at the University of Toronto demonstrated in 1971 that only a small percentage of the cancerous cells taken from leukemia-afflicted mice could grow and divide. They called these “tumor stem cells.”

Six years later, a group at the University of Arizona developed a way to culture human versions of the cells in the laboratory.

But technological limits prevented those scientists from completely separating stem cells from other cell types, much less proving that stem cells gave rise to mature cancer cells.

“There was a big debate about whether they were actually stem cells,” said Anne V. Hamburger, a member of the Arizona team that developed the technique.

Just as importantly, the research failed to produce new therapies, said Hamburger, now a professor of pathology at the University of Maryland Greenebaum Cancer Center.

“The whole idea went out of fashion,” she said. “There was no funding for that type of work, so I moved in other directions.”

As other scientists followed suit, the research ground to a halt. “It disappeared,” Hamburger said. “It was a little mystifying.”

A couple of decades later, science caught up to the theory. Researchers developed methods for using antibodies — important proteins of the immune system — to identify and isolate different kinds of cells in the laboratory.

In 1997, John Dick of the University of Toronto made the first definitive identification of cancer stem cells in leukemia. In 2003, Dr. Michael Clarke, now of Stanford, first isolated them from the solid tumors of breast cancer patients and showed that only cells with properties of stem cells generated new cancers.

Since then, cancer stem cells have also been found in brain and lung cancers.

But whether the cells are the source of tumors remains to be proven, according to Kenneth S. Zaret, a cell biologist at Fox Chase Cancer Center in Philadelphia. “That’s really the big question now,” he said, adding that stem cells might produce some cancers but not others.

The source of cancer stem cells is also unclear, he said. They could start as stem cells or be mature cells that regain stem cell properties because of genetic mutations.

Dr. Martin D. Abeloff, director of Johns Hopkins’ cancer center, said the reasons that cancers recur may be complicated.

“For years we’ve treated people, and their diseases melted away quickly — but then returned,” he said. “The concept of having a stem cell would explain part of that. But like most things we deal with, it won’t be as straightforward as we would like. It merits, like most research, a healthy skepticism.”

Proponents of the cancer stem cell theory also acknowledged many unknowns. “The majority of scientists are still waiting to be convinced,” Jones said.

But if the theory pans out, he said, it could transform cancer therapy. Treatments targeting stem cells could lead to longer-lasting remissions or eradication of cancers.

Dr. William Matsui, another Johns Hopkins cancer researcher, said therapies developed for one type of cancer might be applicable to others, because the stem cells at the root of different cancers are likely to be similar. “It holds the potential to be the cure for cancer everyone talks about,” he said.

To bolster their argument, the Hopkins scientists hope to produce some hard clinical evidence. They are conducting a clinical trial of Rituxan, a drug that might target the stem cells involved in multiple myeloma — Pamela Joseph’s form of cancer.

Multiple myeloma is a blood plasma cell cancer that causes a weakening of the bones, kidney failure, anemia and death. A drug called Gleevec sends the cancer into remission, but it always comes back.

“That drug mows dandelions, but it doesn’t get at the root,” said Dr. Carol Ann Huff, one of the Hopkins researchers.

Rituxan was largely abandoned as a treatment for multiple myeloma after a 2003 study suggested it was ineffective.

But Huff and her colleagues think it might just take a little patience for the drug to work. Rituxan might take longer than other drugs, they say, but if it destroys the stem cells that lurk in the body and bring the cancer back, the drug might rid patients of the cancer once and for all.

To test the theory, they have added Rituxan to the chemotherapy cocktail some of the patients in the clinical trial receive. If those patients fare better than others, it could be evidence that the drug does target cancer stem cells.

Pamela Joseph decided to join the clinical trial after researching various multiple myeloma therapies with the help of her husband, Malcolm Joseph.

His father, Malcolm Joseph Sr., also developed multiple myeloma and lost the use of one of his arms as a result. Despite that, the retired Army command sergeant continued to drive from his home in New York’s Bronx borough to Baltimore to visit family.

“He was a good guy and a tough guy,” his son recalls. He succumbed to the disease after three years, in 2004. He was 78 years old.

Doctors diagnosed the same form of cancer in Pamela Joseph less than a year after her father-in-law died. “It was devastating,” her husband said. “It’s hard to talk about.”

During a recent chemotherapy session, Pamela said she’s hopeful her doctors’ theories about stem cells will help her avoid her father-in-law’s fate.

“Who knows? Maybe I’ll be the lucky first person,” she said, knitting in an armchair at the cancer center as a machine pumped Rituxan into her veins. Her cancer is in remission.

Other previously abandoned drugs might also prove to be effective at eradicating cancer stem cells. “We think the concept is right,” Jones said. “But we’re not sure we have the right drug.”

Meanwhile, scientists at the University of Maryland are testing older drugs and trying to develop new ones for suppressing cancer stem cells. They’re also trying to learn whether stem cells collected from cancer patients are sensitive to various chemical compounds.

But it’s not easy. Cancer stem cells are difficult to find and attack, said Angelika M. Burger, a drug researcher at Maryland.

“Stem cells never die. They can reproduce; they can sleep and hide away,” she said “When they are hidden, they may not be reached by our current drugs.”

Burger and colleagues at Maryland requested research funding from Maryland’s stem cell commission this year, as did the Hopkins team. The commission is expected to make its awards this month.

Hamburger, now a member of the Maryland research team, has revived her lab work from the 1970s.

“Science has evolved a lot, but the research is still pretty technically difficult to do,” she said. And for the time being, she’s enjoying the scientific deja vu.

“It’s really interesting to see the whole thing cycle around,” she said. “There’s still a lot of room for proof. But I think there is a lot more acceptance this time.”

chris.emery@baltsun.com

—–

Copyright (c) 2007, The Baltimore Sun

Distributed by McClatchy-Tribune Business News.

For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

Publication date: 2007-03-19
© 2007, YellowBrix, Inc.

The Sequel Superfoods:: Here Are More High-Powered Foods to Add to Your Must-Eat List

Thursday, March 22nd, 2007

Source: Saint Paul Pioneer Press (St. Paul, Minn.)
Publication date: 2007-03-19

By Rhoda Fukushima, Pioneer Press, St. Paul, Minn.

Mar. 19–Red wine is out, but cocoa is in as a “superfood” that is good and good for you.

Not so long ago, blueberries, salmon, green tea and red wine were on many of the “superfoods” lists. They’re still there, but the emerging health benefits of other foods — from cocoa to pomegranates — have lengthened those lists.

“We’re learning so much more about what is in foods,” says registered dietitian Bea Krinke, who teaches public-health nutrition at the University of Minnesota. “Who knew 10 years ago that a particular berry is really good for you?”

As those lists continue to change, we asked registered dietitians Jennifer Nelson, director of clinical dietetics at the Mayo Clinic, and Elizabeth Somer, author of “Food and Mood,” for their top 10 power foods today (meant to be enjoyed, of course, as part of a balanced diet).

BLACK BEANS (OR OTHER BEANS)

COCOA

COLLARD GREENS (OR OTHER DARK-GREEN, LEAFY VEGETABLES)

OATS

POMEGRANATES

WALNUTS (OR OTHER NUTS)

TOMATO SAUCE

WHITE TEA (OR OTHER TEAS)

YOGURT WITH LIVE CULTURE (OR OTHER FERMENTED DAIRY PRODUCTS WITH LIVE CULTURES)

—–

Copyright (c) 2007, Pioneer Press, St. Paul, Minn.

Distributed by McClatchy-Tribune Business News.

For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

Publication date: 2007-03-19
© 2007, YellowBrix, Inc.

When Given the Tools, Kids Can Control Symptoms

Thursday, March 22nd, 2007

Source: USA TODAY
Publication date: 2007-03-19

By Mary Brophy Marcus

Peri and Bailey Johnson might as well set their sights on medical school. Only 7 and 5 years old, respectively, the two can recite a laundry list of allergy and asthma drugs, work a nebulizer like a registered nurse and help their parents dose out their medications.

“They even tell us when it’s time to go to the urgent care,” says their mother, Kathryn Johnson, a public relations executive in Glenn Dale, Md.

Johnson and her husband, Edward, want their daughters, who both have seasonal allergies and chronic asthma, to feel in control of, not overwhelmed by, their medical conditions. “The girls have been very in tune from an early age. We include them in all of their care,” Johnson says.

Experts say parents such as the Johnsons who ensure that their children are diagnosed and treated and who let them participate in their treatment can greatly improve the young patients’ quality of life.

“There are a lot of children out there going undiagnosed or incorrectly diagnosed who aren’t sleeping or functioning well in school because of it. They could be helped,” says Stuart Abramson, an allergist and a professor of pediatrics at Baylor College of Medicine.

Experts say 20% to 40% of children in the USA have allergies. About 9% have asthma.

Seasonal allergies occur when allergens, such as pollen, are breathed in through the nose and trigger the release of histamines. Histamines cause inflammation and fluid production in the linings of the nose, sinuses and eyelids.

Sneezing, itchy eyes and a stuffy nose are common symptoms in children and adults alike. But some symptoms are particular to children. “Shiners — bluish discoloration under the eyes — as well as a horizontal crease across the bridge of the nose where a child has repeatedly pushed and itched are telltale signs,” Abramson says.

Allergies and asthma tend to run in families. “But the dozen or so genes that cause asthma are only just beginning to be understood,” says Dale Umetsu, professor of pediatrics at Harvard Medical School.

Over-the-counter medicines can help mild allergies, but allergists recommend skin testing when those do not work. Doctors step kids up to prescription drugs when symptoms are interfering with sleep, mood and school. Allergy shots are worth looking into for severe allergies, Abramson says.

Be consistent with treatment, know your child and his triggers, and encourage his involvement, Umetsu says.

Johnson’s family folds medication routines right in with breakfast, tooth-brushing and baths. “It can be time-intensive,” she says. “But it’s not like chewable vitamins. You can’t just blow it off one day. Staying on top of it keeps them healthy.” (c) Copyright 2005 USA TODAY, a division of Gannett Co. Inc.

Publication date: 2007-03-19
© 2007, YellowBrix, Inc.

Footprints of History

Monday, March 19th, 2007

Source: History Today
Publication date: 2007-03-01
Arrival time: 2007-03-14

By Riello, Giorgio; McNeil, Peter

Giorgio Riello and Peter McNeil find shoes a fascinating key to social mores, and discuss what choice and design of footwear can tell us about morality, mobility and sexuality in Europe over the centuries.

SHOES, LIKE OTHER OBJECTS, can illuminate specific aspects of the past. Through their survival, and material appearance - their texture, weight and design, they can convey abstract historical concepts, and also by their human associations and suggestions of physicality. For example, consider the images of the piles of shoes belonging to the millions of Jews killed in concentration camps. How powerfully the humble mismatched shoes stand for the presence of persons whose dignity and humanity have been erased. But a shoe produced and worn at a specific time also embodies the values, ideals and aesthetic choices of an era. Shoes can tell us a lot about an individual, but they also convey messages that are understood across society: high heels stand for an exaggerated femininity; red shoes for pleasure and desire; and sneakers for modern pace in the city, leisure and relaxation. The story of shoes in the longue dure is characterized by themes of morality, mobility and extremism as we shall see.

The shape, colours and design of footwear has always been influenced by the difference between the genders, and in turn the desires, ambitions and sensual signals of men and women. Even if the foot is the least gendered part of the body, men’s shoes are still immediately recognizable from women’s. This is not because of functional dissimilarities or anatomical diversities between the sexes, but because shoes are one way by which we construct gender identity. Shoes can tell us a lot about the place of a man or a woman within society and the physical space that they inhabit. But as the roles of the two sexes have changed over time, so have shoes and their use in highlighting distinctions and divisions in society.

Costume historians have noted that from the fourteenth century men and women’s dress began to look substantially different. In this period, the tunic-like shapes of early medieval clothes previously worn by both genders gave way to different aesthetic forms of the clothed body for men and women. Men started wearing hose, revealing the shape of their legs and the size of their calves and underlying their virility. In contrast, women started wearing long skirts entirely covering their legs and feet. This ‘great gender distinction’ in attire was accompanied by, and to a great deal influenced, the emergence of fashion in Europe. Both sexes started using their clothes as indicators of social status. One’s position in society no longer depended on birth, but on the way one looked. And as new money from trade and banking allowed for increased expenditure on clothing, a rich merchant’s wife could look as magnificent as a princess.

The use of clothing to express aspirations, to look smart, and gain acceptance among particular social groups seems a perfectly innocent practice today. However this was not the case in the Middle Ages when both church and state were actively interested in preserving distinctions and divisions within society. This was done through the sumptuary laws - laws that established who was entitled to wear what. If a noble lady could wear gold trimmings, the wife of a merchant would rank lower in material expectations and could wear only silver trimmings. The wife of an artisan could not expect to wear any trimmings at all.

However, this was a vision of a static society that was more an idea than a reality. Historians are not sure how widespread the enforcement of sumptuary laws was and how frequently they were challenged. One of the items of apparel that was most discussed (and banned) in sumptuary laws across Europe in the fifteenth and sixteenth centuries was a type of footwear, worn mostly by women but sometimes also by men, known as pianetta. Flanelle varied considerably in size, but were characterized by thick soles which could be up to twenty inches high. Few examples survive but they are frequently to be seen in frescoes, paintings and prints, suggesting their widespread use.

Pianelle became popular as a way of protecting ladies’ feet and their precious gowns from the filthy streets of medieval Europe. They were made mostly of cork and sometimes of light wood to allow maximum mobility and were covered in soft, often light-coloured leather. It has been suggested by Maria Giuseppina Muzzarelli that pianette derived from ‘kub-kabs’ or nalins, wooden ‘clogs’ made with a bridge-type structure, worn in Turkey and Syria (at the same time), which were also well known in Venice. Similar footwear is to be found in India and Japan, but here their use was less for practical reasons than to express a ceremonial transformation in a bounded space such as a wedding or to indicate the borders of social and psychological ‘pollution’.

In fact, in spite of their construction the idea that pianelle enabled women to venture out into the streets of a medieval city is incorrect. These were expensive shoes that prevented women from engaging in practical or manual activities. The lack of mobility was considered a positive, rather than a negative, attribute. Those who could afford it, would have chosen to wear pianelle. As in the case of footbinding in Imperial China, a woman incapable of moving freely was a sign of her husband’s status and wealth. She was a spouse with no manual responsibilities.

But as with footbinding, pianelle contained a second layer of meaning. Their lack of functionality was also a sign of their erotic value. An association between sexuality and shoes can be traced back to Ancient Greece at least, and several European languages retain colourful idioms of relating sex and shoes. In medieval and Early Modern Sicily, for instance, prostitutes were obliged to wear clogs called tappini from which stems the Italian colloquial verb tappinare, meaning a sexual act performed by a prostitute. Similarly the term zoccola (a feminine form of the word zoccolo, meaning ‘clog’) is still used in modern Italian as slang for ‘prostitute’.

Pianette, more than any other type of shoe, were considered erotic in a way that displeased the defenders of morality. Their wearers were accused of being ungodly and dishonest. Preachers observed how the Gospel of Matthew said that no person should alter his or her physical stature. This was against God. As Tertullian in his De Cultu Feminarum (’The Ornaments of Women’) had explained in the third century AD, to increase one’s stature was not just a contravention of God’s creation but also a deception, as one’s physical shape, size and proportions were hidden from the judgement of suitors. Some shoes were even decried for making the toes extended, like the claws of base animals.

Pianelle had such a large area for possible decoration that this also made them the perfect example of the wrong type of ‘vanity’. Embroideries and warm colours were morally unacceptable. The fourteenth-century Catalan Franciscan preacher Frances Eiximenis condemned shoes such as pianelle worn to attract the interest of passers-by. Both the height and the unbalance caused by the front rise in the shoe, provided, according to Baldassar Castiglione, ‘grandissima gratia’ (’very much grace’) to the posture and walk. The foot itself and the leg were mostly hidden behind long skirts, although in The Courtier (1528), Castiglione advised ladies to use the pianelle with discretion to ’show with some womanly disposition a little bit of leg, covered by a graceful and tight stocking’.

In the fifteenth century, under religious pressure and with the aim of curbing conspicuous expenditure, the legislators of many Italian cities decided to use the law to obstruct or ban women from indulging in high-heeled shoes. In 1401, for instance, the legislators of Bologna forbade the use of painted, carved, or embroidered pianelle or shoes with toes longer than 0.7 inches. Those who did not comply were fined and their footwear confiscated. Notwithstanding these impositions, the height and beauty of pianelle continued to increase over the following centuries. Romagnolo Tommaso Garzoni, writing in the late sixteenth-century, described ‘Venetian ladies… transformed into giants’, who according to John Evelyn (1620-1706) ’stood so tall that they had to set their hands on the heads of two matron-like servants or old women to support them’.

If the moral laxity associated with pianelle was contenuous, the fact that they prevented women from moving freely was welcomed in some quarters. An old Venetian senator is supposed to have argued in the seventeenth-century that the height of pianette had to be increased rather than decreased by law, otherwise wives and daughters ‘would go to all the parties and scorn their houses and such bad government would ruin the family’.

The act of walking, and the benefits of limited mobility continued to be the subject of debate in the ensuing centuries. In the first half of the eighteenth century, the poor condition of the streets precluded ‘walking for pleasure’ beyond private parks or pleasure gardens. Streets were dirty, there were few pavements, rubbish was everywhere and, in places like Britain, inclement weather didn’t help. But for the better off, walking was a \risky business in other ways. The street, more than anywhere, was the place where the fragility of a hierarchical system based on social separation was most apparent. The mob, the world of vagrants, the poor and the underworld of petty criminality had to be kept at a distance.

As towns grew, they became internally differentiated both in terms of urban facilities and of social clusters. Fences, walls and the privatization of streets and squares were the outcome of spatial segregation. Space was increasingly ‘appropriated’ and safeguarded. Physical safety was regulated by proprietary rights and often backed by financial investment and by significant policing efforts. Rank implied the respect for behavioural rules that were particularly strict. As a workman had no place in a fancy London shop, so a gentleman was not welcome in an East End inn. Inequality in the use of space was legitimized by a clear sense of social hierarchy. At the Palais Royale in Paris, for instance, in the later part of the eighteenth century, guards stopped people who were not considered respectable enough to gain access.

In venturing outdoors women still used a variety of devices to keep themselves above ground level. The Renaissance pianella inspiration, evolved into a practical device to be attached to the shoe, rather than being part of the shoe itself. Henri Misson, in his Memoirs and Observations (1698) noticed how

… the streets of London are so dirty that the women are forc’d to raise themselves upon Pattens, or Galoshes of Iron to keep themselves out of the dirt and wet.

Their use was still widespread in the 1770s when Pierre Jean Grosley said that ‘All the women that walk the streets of London, wear these pattens, which make an odd sort of rattling’. The terrible state of roads created a metropolitan underworld of shoeblacks and ‘crossing sweepers’. These often feature in prints of eighteenth-century urban life, normally paired with either a fashionable woman or a fop shod in delicate slipper-like shoes. Much of the visual joke relates to the degradation of an occupation on the ground, near the filth all the time, cleaning those devices designed to keep others above it.

Distance from filth was an important physical requirement in an age where keeping oneself clean was not easy even for the upper echelons of society. High heels assisted in this. We are now used to the idea of high heels or slender stilettos as feminine ‘weapons of seduction’, but in the eighteenth century the high heel was a sign of power rather than sexuality. Like the pianette, the high heel also constrained mobility. It was worn both by men and women, but only those who could afford not to engage in any manual activity. At the opposite end of the spectrum, those whose physical labour constituted their only source of income had to be able to move freely to carry out their daily activities. Their use of low heels, rounded toes and strong leather uppers were unmistakable signs of their inferior social position.

The high heel commanded an enhanced physical bearing that also had to match the social stature or rank of the wearer. The relationship between high heels and social rank had its maximum expression in the famous red heels of Louis XIV. Protocol established that only the King and his court could wear red heels in France. By the mid-eighteenth century, red heels were increasingly fashionable in Britain. Charles Fox popularized them in the 1770s by wearing them with a blue hair-powder wig. But Fox was simply radicalizing a passion for high heels that had reached its peak during the reign of George II (r. 1727-60). In the 1740s Frederick, Prince of Wales, had shoes with heels 2 inches high. In the 1780s heels were still so high that ladies had to use walking sticks. The Comte de Vaublanc wrote in his Memoirs (1786) that ‘without this effort of shifting the weight of her body backward, the doll would have fallen on her feet’. In the 1820s the Nouvelle Encyclopdie des Arts et Mtiers commented sarcastically that high heels seemed to be invented ‘for protecting ladies from the inconvenience of leaving their houses’.

By this date high heels had been out of fashion for at least a generation. One of the reasons for their demise was the construction of spaces where pedestrians could easily walk. Pavements began to be built in London in the 1750s. When in 1786 the German writer Sophie Von La Roche visited the city, she observed

How happy the pedestrian on these roads, which alongside the houses are paved with large, clean paving-stones some feet wide, where many thousands of neatly clad people, eminent men, dressy women, pursue their way safe from the carriages, horses and dirt.

By the first decade of the nineteenth century pavements had appeared in several parts of Europe. The American traveller John Griscom noticed how walking was a pleasant activity even in provincial centres like Manchester.

Aesthetics are also a factor to be considered in the study of shoes. In a period excited by Neo-classical taste, flat ’slipper’- like shoes with ties around the ankle, often in glossy satin, were a fashionable choice to make women’s dress appear more Classical in parts of Europe where sandals were inappropriate for the weather. The improvement of the urban fabric was surely a factor in the spread of the new ‘Greek’ fashion. Women now wore shoes that were, according to Prince Pckler-Muskau, ‘as light as paper’, accompanied by galoshes, instead of the impractical patterns. Even Queen Victoria bowed to the latest fashion: her wedding shoes worn at her marriage in February 1840 were a pair of flat ballerina-like satin slippers.

The development of specialized shoe-makers for either men’s or women’s shoes in the early modern period points to the significance of gender in framing shoe history. Around the time that ladies started wearing shoes ‘as light as paper’, men decided that the boot was a more appropriate type of footwear for them. This was a radical shift. Half a century earlier, in 1748, when the Swedish traveller Pehr Kalm visited Britain, he observed that an Englishman did not use boots in any situation ‘except when he was riding and sitting on a horse’. Although sturdy and practical for bad weather, boots were not considered gentleman’s proper attire. The ‘Tottenham top boot’ derives its name from the Irish MP Charles Tottenham who in 1731 was heavily fined for wearing top boots in the Houses of Parliament. In Britain and in many other parts of continental Europe, the wearing of boots was considered alien to any notion of ‘gentility’, one of the key virtues of a gentleman.

The French Revolution and the following Napoleonic wars had a decisive role on masculine footwear and entirely altered social attitudes. Boot-wearing was both legitimized and fostered by war, beginning with the introduction of the Hessian boot in 1789. Men in boots seemed to be participating in the general mobilization of the nation. Boots became a sign of involvement in public affairs and democracy: by the end of the eighteenth century boots were worn for all occasions.

Nineteenth-century military campaigns in the Crimea and many parts of the expanding British Empire further reshaped the image of boots. Their widespread use in urban settings was increasingly connected to belligerent values adopted by men of all ages and classes. The association between Lord Wellington (whose polished neat Blcher boots became known as Wellingtons) as the head of the army and his bravura on the military field was well captured in an 1826 caricature showing him as the ‘Head of the Army’ in which his very persona becomes his boot. The boot became synonymous with order, manly attitude and rejection of comfort and decoration appropriate to army life.

The boot provided not just a firm elongated calf, but also a particular posture and gait. In his Thorie de la demarche (Theory of Walking), Honor de Balzac observed how

Military men have an instantly recognizable gait. Almost all of them are firmly planted on their lower backs like a bust on a pedestal; their legs bustle about under their abdomen…

Marching transformed the act of walking into a military art. The sound of boots provided the harmony for military music: 75 steps per minutes as ‘adagio , 120 for ‘andante’ and up to 300 for ‘forte and ‘fortissimo’.

But beyond the polished veneer of boots, longstanding social divisions remained. Infantrymen and other privates wore ankle Blcher boots made of sturdy leather. The soldier’s ankle boot resembled the low-cut labourer’s wooden-soled clog or hob-nailed boot, while the officer’s knee-length Hessian and Wellington, unsuitable for walking, advertised its equestrian origins. But it was not just the shape that identified different types of wearers. Officers’ boots were crafted by the best bootmakers in England or France. The celebrity of George Hoby, Wellington’s bootmaker, was second to none.

Ordinary soldiers wore boots produced in standard sizes by sweated shoemakers in metropolitan garrets and sold by contractors to the army in bulk. These clunky boots were the source of endless pain for generations of soldiers. Newspapers periodically reported British soldiers’ sufferings in this respect. When in 1813 British troops returned to Portsmouth from fighting at Corunna in Spain, people were shocked to see that soldiers ‘dragged themselves along the quay on lacerated, festering, rag-bandaged feet’. During the Crimean War ill-adapted footwear contributed to many injuries and deaths. The health of soldiers’ feet was central to war.

As nineteenth-century men affirmed their right to move freely, and their ability to dominate domestic and imperial spaces, middle and upper-class women were culturally and socially relegated to a subordinate position. Their shoes could communicate little about their social position. Women’s feet were almost totally out of sight, under long gowns and encased in \patent-leather footwear bottoned-up over the ankle.

By the early twentieth century, women’s presence in the public arena was becoming more obvious. They demanded political rights and used the street to assert their message. Dressed stylishly, they pounded the pavement in heeled button-boots, or enjoyed tennis in feminine high-heeled sports-shoes. Their shoes rejected arguments that the Vote would defeminize women. For the suffragettes, heels were a confirmation of their femininity in a man’s world of politics. The achievement of the female franchise in 1918 saw the birth of the ‘New Woman’ stripped of Victorian paraphernalia and layers of fabric. In this transformation the woman’s foot was both discovered and uncovered. The shoe entered a new centre-stage of erotic display connected to long legs, and new fashionable pleasures of mixing footwear with ensembles of skirts and dresses.

The 1920s was a time of recodification of the meaning of shoes. If ladies could walk around revealing their toenails, society was not comfortable with all of these new ‘fashions’. Masculine identity seemed to be under threat and men’s shoes once again became a contested area for gender definition. In Britain in the interwar period suede shoes became an indicator of ‘inverts’ (as homosexuals were called). Terence Greenbridge in his 1930 book Degenerate Oxford? lamented that Oxford students conformed to two types: the athlete and the aesthete, observing:

Oxford Romanticism is responsible for the mass-production of effeminate men… wearing rather brightly coloured coats, cut short and very tight in the waist, their grey flannel trousers will be of a conspicuously silver hue and flow loosely, their feet will be shod with gay suede shoes. They will speak with artificial voices of a somewhat high timbre, also they will walk with a mincing gait.

Certainly, before Elvis made them popular on both sides of the Atlantic in the 1950s, blue suede shoes were used as a sign identifying a male homosexual wearer in a closeted world, but only to those who had the key to that code. In the postwar period, an era far away from the triumph of Empire, the boot, too, became appropriated by gay subcultures keen to engage in playful exaggerations of masculine identity. The cowboy boot, for example, appeared in kitsch gay art of the 1950s by Quaitance and Tom of Finland and in novels with titles like The Booted Master. The toughness of the boot also became associated with stereotypes of lesbian identity. In contemporary Brazil, the word lesbian is sapatao, which literally means ‘big shoe’.

Today we are at another moment of radical transformation not just for the shape, forms and materials of shoes, but also for the meanings that they convey. Since the early 1970s, the sports shoe, ‘trainer’ or ’sneaker’ has completely changed the definition and notion of a shoe. Produced in high-tech rubber with big brand logos on the outside, trainers promise to enhance our bodily capacities. Designers flock to design them, and youth to buy and customize them. They proclaim that exercise can deliver self improvement, enhancing not just ability, but also self-esteem, attractiveness, bodyshape, health and well-being. To younger generations they suggest limitless choice and Romantic ideas of self-definition and individuality. They tell us that shoes are an amplifying tool, and as in the case of Venetian ladies on their doorsteps, we should not dither, but simply ‘just do it’.

Fashion victim: Naomi Campbell takes a tumble in Vivienne Westwood’s pianette-inspired platforms, 1993.

Ready-made shoes are displayed for sale in ‘The Saint Healing a Shoemaker’ by Jaime Serra, 14th century.

A room of 800,000 shoes at the Nazi death camp of Majdanek in Poland.

Late 16th-century low pianelle in gold and red velvet (below), as worn by Venetian ladies such as these (right) from a 15th-century panel.

Lady’s green silk shoe, 1700-20.

A midwife wearing pattens over her shoes as she braves the elements and dirty cobbles on her way to a labour (Rowlandson, 1811); right a pair of the pattens of the same date.

The cutting of long toes, 15th century. Fashionable across Europe from the early 14th century, these were seen as showing a lack of respect for Christ.

Frau Wilhelmine von Cotta displays a pair of elegant flat slippers beneath her classically-inspired light dress in Gottlieb Schick’s 1802 portrait.

Well-heeled: Louis XIV’s were red (detail from portrait by Hyacinthe Rigaud, 1701).

Shoehorned: ‘A Wellington Boot or the Head of the Armye’, 1827 - the Duke became as famous for his footwear as his military achievements.

Bootcamp: a military parade in Germany, 1896.

Van Gogh conveys a sense of the universal dignity of labour in this vivid ‘portrait’, ‘Three Pairs of Shoes’, 1886-87.

Patent leather Wellington Boots with red trim, English 1870.

An advertisement for Blundstone Boots, that appeared in Viz magazine in 1993.

Somewhere over the rainbow; sexuality, mobility and magic as worn by Judy Garland on the Yellow Brick Road, 1939.

Have it all: a 1980s advertisement for Adidas trainers.

FOR FUTHER READING

Nancy E. Rexford, Women’s Shoes in America, 1795-1930 (Kent University Press. 2000); Giorgio Riello, A Foot in the Past: Consumers, Producers and Footwear in the Long Eighteenth Century (Oxford University Press. 2006); Valerie Steele, Shoes: A Lexicon of Style (Rizzoli, 1999); June Swann, Shoes (B.T. Batsford Ltd, 1982).

See p. 62 for related articles on this subject in the History Today archive at ww.historytoday.com

Giorgio RMb and Peter McNeil are the editors of Shoes: A History from Sandals to Sneakers (Berg, 2006).

Copyright History Today Ltd. Mar 2007

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Publication date: 2007-03-01
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