Chelation doesn't help kids with autism: study

NEW YORK (Reuters Health) - Removing heavy metals from the body through a process traditionally used to treat mercury and lead poisoning doesn't help relieve autism symptoms, a new analysis suggests.
During chelation therapy, patients are given injections of a chemical that binds to heavy metals, lowering their concentration in the blood and ultimately allowing the metals to be excreted through urine.
Chelation gained traction as an alternative treatment for autism due to a theory that mercury poisoning might play a role in the developmental disorder. However, evidence hasn't supported that idea and it's been essentially discarded in the scientific community, researchers said.
The procedure also carries safety concerns, including risks of kidney damage and gastrointestinal problems.
Lead researcher Tonya Davis from Baylor University in Waco, Texas, said the study team's goal was not to tell parents which treatments they should or shouldn't seek for their children.
"I see that they want to try everything, and they are well intentioned," she told Reuters Health.
"But there are risks involved with any treatment choice, and some of those risks are very serious. So far science does not support (chelation) as being an effective treatment, and that's a big risk to take when you have limited resources and limited time."
The Centers for Disease Control and Prevention estimates that one in 88 kids in the U.S. has an autism spectrum disorder.
Davis and her colleagues found five studies that tested the effects of chelation in kids with autism. Those studies each had between one and 41 children, from age three to 14.
Researchers had given the kids chelation therapy - sometimes along with vitamin supplements or other treatments - between one and 12 times a week for up to seven months. They used tests and questionnaires or anecdotal reports from parents to see how symptoms changed over time.
The study with only one child, a four-year-old boy, found chelation had positive effects on autism symptoms based on a parent report. The other four studies all showed mixed results, with some kids improving on some symptom measures.
However, none of the studies provided any certainty that those benefits were due to chelation itself, and not another treatment or just kids getting older, the researchers wrote in the journal Research in Autism Spectrum Disorders.
Davis said she and her colleagues were surprised to find so few studies measuring the effects of chelation, given how many families they each knew that were using it. That lack of evidence was a concern, she said, along with the questionable study designs and conclusions.
"I just hope that parents get as much information as they can" before trying a new treatment, Davis said.
A typical package of chelation treatments runs for about $2,000 to $5,000. In addition to treating lead poisoning, chelation has also been used for cancer and heart disease.
But when it comes to autism, even calling chelation an alternative therapy is a stretch, said one autism researcher not involved in the new study.
"There's really no evidence that mercury causes autism or has a place in causing autism, and also we know that chelation can be dangerous as well. Even the underlying theories don't make sense," said Dr. Joyce Mauk, head of the Child Study Center, an organization that treats kids with developmental disabilities in Fort Worth, Texas.
"Most children with developmental disabilities, what gets them better is a really skilled therapist and lots of work," Mauk told Reuters Health.
"If you hear about something when all you do is inject something or take a pill, it's unlikely to work."
SOURCE: Research in Autism Spectrum Disorders, January 2013.

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Violence, fear & suspicion imperil Pakistan's war on polio

ISLAMABAD, Pakistan (Reuters) - Pakistani health worker Bushra Bibi spent eight years trekking to remote villages, carefully dripping polio vaccine into toddlers' pursed mouths to protect them from the crippling disease.
Now the 35-year-old mother is too scared to go to work after masked men on motorbikes gunned down nine of her fellow health workers in a string of attacks this week.
"I have seen so much pain in the eyes of mothers whose children have been infected. So I have never seen this as just a job. It is my passion," she said. "But I also have a family to look after ... Things have never been this bad."
After the deaths, the United Nations put its workers on lockdown. Immunizations by the Pakistani government continued in parts of the country. But the violence raised fresh questions over stability in the South Asian nation.
Pakistan's Taliban insurgency, convinced that the anti-polio drive is just another Western plot against Muslims, has long threatened action against anyone taking part in it.
The militant group's hostility deepened after it emerged that the CIA - with the help of a Pakistani doctor - had used a vaccination campaign to spy on Osama bin Laden's compound before he was killed by U.S. special forces in a Pakistan town last year.
Critics say the attacks on the health workers are a prime example of the government's failure to formulate a decisive policy on tackling militancy, despite pressure from key ally the United States, the source of billions of dollars in aid.
For years, authorities were aware that Taliban commanders had broadcast claims that the vaccination drive was actually a plot to sterilize Muslims.
That may seem absurd to the West, but in Pakistan such assertions are plausible to some. Years of secrecy during military dictatorships, frequent political upheaval during civilian rule and a poor public education system mean conspiracy theories run wild.
"Ever since they began to give these polio drops, children are reaching maturity a lot earlier, especially girls. Now 12 to 13-year-old girls are becoming women. This causes indecency in society," said 45-year-old Mir Alam Khan, a carpet seller in the northern town of Dera Ismail Khan.
The father of four didn't allow any of his children to receive vaccinations.
"Why doesn't the United States give free cures for other illnesses? Why only polio? There has to be an agenda," he said.
While health workers risk attacks by militants, growing suspicions from ordinary Pakistanis are lowering their morale. Fatima, a health worker in the northwestern city of Peshawar, said that reaction to news of the CIA polio campaign was so severe that many of her colleagues quit.
"People's attitudes have changed. You will not believe how even the most educated and well-to-do people will turn us away, calling us U.S. spies and un-Islamic," said the 25-year-old who did not give her last name for fear of reprisals.
"Boys call us names, they say we are 'indecent women'."
Pakistan's government has tried to shatter the myths that can undermine even the best-intentioned health projects by turning to moderate clerics and urging them to issue religious rulings supporting the anti-polio efforts.
Tahir Ashrafi, head of the All Pakistan Ulema Council, said the alliance of clerics had done its part, and it was up to the government to come to the rescue of aid workers.
"Clerics can only give fatwas and will continue to come together and condemn such acts," he said. "What good are fatwas if the government doesn't provide security?"
RISK OF POLIO RETURNING
That may be a tall order in Pakistan, where critics allege government officials are too busy lining their pockets or locked in power struggles to protect its citizens, even children vulnerable to diseases that can cripple or disfigure them.
Pakistani leaders deny such accusations.
Politicians also have a questionable track record when it comes to dealing with all the other troubles afflicting nuclear-armed Pakistan.
The villages where health workers once spent time tending to children often lack basic services, clinics, clean water and jobs. Industries that could strengthen the fragile economy are hobbled by chronic power cuts.
Deepening frustrations with those issues often encourage Pakistanis to give up on the state and join the Taliban.
So far it's unclear who is behind the shootings. The main Taliban spokesman said they were opposed to the vaccination scheme but the group distanced itself from the attacks.
But another Taliban spokesman in South Waziristan said their fighters were behind an attack on a polio team in the northwestern town of Lakki Marwat on Monday. "The vaccinations were part of "a secret Jewish-American agenda to poison Pakistanis", he said.
What is clear is the stakes are high.
Any gaps in the program endanger hard-won gains against a disease that can cause death or paralysis within hours.
A global effort costing billions of dollars eradicated polio from every country except Nigeria, Afghanistan and Pakistan.
Vaccinations cut Pakistan's polio cases from 20,000 in 1994 to 56 in 2012 and the disease seemed isolated in a pocket in the north. But polio is spread person-to-person, so any outbreak risks re-infecting communities cleared of the disease.
Last year, a strain from Pakistan spread northeast and caused the first outbreak in neighboring China since 1999.
Oliver Rosenbauer, a spokesman for the World Health Organization, said the group had been coming closer to eradicating the disease.
"For the first time, the virus had been geographically cornered," he said. "We don't want to lose the gains that had been made ... Any suspension of activities gives the virus a new foothold and the potential to come roaring back and paralyze more children."
MOURNING FAMILIES
Condemnation of the killings has been nearly universal. Clerics called for demonstrations to support health workers, the government has promised compensation for the deaths and police have vowed to provide more protection.
For women like Fehmida Shah, it's already too late. The 44-year-old health worker lived with her family in a two-room house before gunmen shot her on Tuesday.
Her husband, Syed Riaz Shah, said she spent her tiny salary - the equivalent of just $2 a day - on presents for their four daughters. Even though the family was struggling, she always found some spare money for any neighbor in need.
"She was very kind and big hearted. All the women in our lane knew her," he said.
"The entire neighborhood is in shock. Pray for my daughters. I will get through this. But I don't know how they will."

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Link between pot, psychosis goes both ways in kids

NEW YORK (Reuters Health) - Marijuana (cannabis) use may be linked to the development of psychotic symptoms in teens - but the reverse could also be true: psychosis in adolescents may be linked to later pot use, according to a new Dutch study.
"We have focused mainly on temporal order; is it the chicken or the egg? As the study shows, it is a bidirectional relationship," wrote the study's lead author Merel Griffith-Lendering, a doctoral candidate at Leiden University in The Netherlands, in an email to Reuters Health.
Previous research established links between marijuana and psychosis, but scientists questioned whether pot use increased the risk of mental illness, or whether people were using pot to ease their psychotic symptoms, such as hallucinations and delusions.
"What is interesting in this study is that both processes are going on at the same time," said Dr. Gregory Seeger, medical director for addiction services at Rochester General Hospital in upstate New York.
He told Reuters Health that researchers have been especially concerned about what tetrahydrocannabinol (THC), the active property in pot, could do to a teenager's growing brain.
"That's a very vulnerable period of time for brain development," and individuals with a family history of schizophrenia and psychosis seem to be more sensitive to the toxic effects of THC, he said.
A 2010 study of 3,800 Australian teenagers found that those who used marijuana were twice as likely to develop psychosis compared to teens who never smoked pot (see Reuters Health article of March 1, 2010 here:).
But that study also found that those who suffered from hallucinations and delusions when they were younger were also more likely to use pot early on.
CHICKEN v. EGG
For the new study, published in the journal Addiction, the researchers wanted to see which came first: pot or psychosis.
Griffith-Lendering and her colleagues used information on 2,120 Dutch teenagers, who were surveyed about their pot use when they were about 14, 16 and 19 years old.
The teens also took psychosis vulnerability tests that asked - among other things - about their ability to concentrate, their feelings of loneliness and whether they see things other people don't.
Overall, the researchers found 940 teens, or about 44 percent, reported smoking pot, and there was a bidirectional link between pot use and psychosis.
For example, using pot at 16 years old was linked to psychotic symptoms three years later, and psychotic symptoms at age 16 were linked to pot use at age 19.
This was true even when the researchers accounted for mental illness in the kids' families, alcohol use and tobacco use.
Griffith-Lendering said she could not say how much more likely young pot users were to exhibit psychotic symptoms later on.
Also, the new study cannot prove one causes the other. Genetics may also explain the link between pot use and psychosis, said Griffith-Lendering.
"We can say for some people that cannabis comes first and psychosis comes second, but for some people they have some (undiagnosed) psychosis (and) perhaps cannabis makes them feel better," said Dr. Marta Di Forti, of King's College, London, who was not involved with the new research.
Di Forti, who has studied the link between pot and psychosis, told Reuters Health she considers pot a risk factor for psychosis - not a cause.
Seeger, who was also not involved with the new study, said that there needs to be more public awareness of the connection.
"I think the marijuana is not a harmless substance. Especially for teenagers, there should be more of a public health message out there that marijuana has a public health risk," he said.
Griffith-Lendering agrees.
"Given the severity and impact of psychotic disorders, prevention programs should take this information into consideration," she said.

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Obesity declining in young, poorer kids: study

NEW YORK (Reuters Health) - The number of low-income preschoolers who qualify as obese or "extremely obese" has dropped over the last decade, new data from the Centers for Disease Control and Prevention show.
Although the decline was only "modest" and may not apply to all children, researchers said it was still encouraging.
"It's extremely important to make sure we're monitoring obesity in this low-income group," said the CDC's Heidi Blanck, who worked on the study.
Those kids are known to be at higher risk of obesity than their well-off peers, in part because access to healthy food is often limited in poorer neighborhoods.
The new results can't prove what's behind the progress, Blanck told Reuters Health - but two possible contributors are higher rates of breastfeeding and rising awareness of the importance of physical activity even for very young kids.
Blanck and her colleagues used data on routine clinic visits for about half of all U.S. kids eligible for federal nutrition programs - including 27.5 million children between age two and four.
They found 13 percent of those preschoolers were obese in 1998. That grew to just above 15 percent in 2003, but dropped slightly below 15 percent in 2010, the most recent study year included.
Similarly, the prevalence of extreme obesity increased from nearly 1.8 percent in 1998 to 2.2 percent in 2003, then dropped back to just below 2.1 percent in 2010, the research team reported Tuesday in the Journal of the American Medical Association.
Whether kids are obese is determined by their body mass index (BMI) - a measure of weight in relation to height - and by their age and sex.
For example, a four-year-old girl who is 40 inches tall would be obese if she was 42 pounds or heavier. A two-year-old boy who is 35 inches tall qualifies as obese at 34 pounds or above, according to the CDC's child BMI calculator. (The CDC's BMI calculator for children and teens is available here:.)
The new findings are the first national data to show obesity and extreme obesity may be declining in young children, Blanck said.
"This is very encouraging considering the recent effort made in the field including by several U.S. federal agencies to combat the childhood obesity epidemic," said Dr. Youfa Wang, head of the Johns Hopkins Global Center on Childhood Obesity in Baltimore.
Blanck said between 2003 and 2010 researchers also saw an increase in breastfeeding of low-income infants. Breastfeeding has been tied to a healthier weight in early childhood.
Additionally, states and communities have started working with child care centers to make sure kids have time to run around and that healthy foods are on the lunch menu, she added.
Parents can encourage better eating by having fruits and vegetables available at snack time and allowing their young kids to help with meal preparation, Blanck said.
Her other recommendations include making sure preschoolers get at least one hour of activity every day and keeping television sets out of the bedroom.
"The prevalence of overweight and obesity in many countries including in the U.S. is still very high," Wang, who wasn't involved in the new study, told Reuters Health in an email.
"The recent level off should not be taken as a reason to reduce the effort to fight the obesity epidemic."

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Kids Lead Crowd-Funded Scientific Mission to Nicaragua: Science Education Is the Tide That Lifts All Boats

Enzo, Haley and Emma are ordinary kids working on an extraordinary mission. They are joining up with a team of Special Forces medics and elite, global surgeons to deliver medical aid to the Rama Indians of Nicaragua in the spring of 2013.
In partnership with HumaniTV, the journey will be beamed to tens of thousands of kids around the globe by satellite as the three middle school students trek through the jungles of Central America performing research on sustainable agriculture and seeing first hand how science and innovation improves peoples' lives.
"We want to send a message to kids that science isn't just about getting a better job and making more money," says team captain and the creator of Exploration nation, twelve year old Enzo. "If it wasn't for science, we'd still be sitting in a cave somewhere chomping on a mammoth bone in the dark."
The high profile expedition was created by Enzoology Education, a social enterprise that produces Exploration Nation and HumaniTV, an online network featuring humanitarian aid programming to send the message that "science education is the tide that lifts all boats".
Enzo, Haley and Emma are part of the cast of Exploration Nation, an education program that features real kids doing real science research around the globe. These adventures are captured on video and coupled with lesson plans designed to inspire and motivate elementary and middle school students to take up careers in science.
America's Future as a Global Innovator Lies at the Feet of our Youngest Citizens
According to a 2009 study by Raytheon, about 60% of students lose their interest in science before the age of 13. The study is just one that shows how students start elementary school genuinely excited about science. By the time they hit seventh grade, the majority feel that science is "boring" and irrelevant to their lives.
Dave Wilson, director of academic programs at National Instruments, stated "In order for students to remain engaged in math and science, they need to actually experience the theory that educators put before them. Bringing the theory to life through hands-on experiences really helps students understand and learn better and makes the concepts more relevant to them." National Instruments is well known for its technical innovation and dedication to science and math education.
"Many science principles have been the same for hundreds of years." says Robert Bourdelais of Ward's Natural Science. "We are using 19th century methods to teach 21st century kids. Students today need to touch and feel science and learn by doing. A lecture environment doesn't inspire today's young students. The way we teach them needs to evolve and align with ever changing technology which is becoming the center of our modern world."
It should be no surprise that presenting science in a dry, isolated context to today's super stimulated kids results in students becoming more and more disconnected from how innovation is at the core of human existence. The irony of this belief is lost on the most wired generation in history.
It is a terrible irony that young people don't believe science to be relevant to their lives when they are totally immersed in some of the most advanced technological innovation in the history of mankind. Even worse is the idea that any one of these kids has the potential to cure cancer, solve the energy problem or invent the next insanely great thing. Let's just hope those kids are not in the 60% who fall through the cracks.
How Does Helping the Indigenous People of Nicaragua Help America's Students?
According to world renowned paleontologist Dr. Jack Horner, "I think it's time to do away with traditional classrooms where information is simply disseminated to students who are then expected to regurgitate that same information. We must now create environments where students have to think or create and solve problems or write using their imaginations in order to pass classes..." Horner says. "We need to show kids that active participation in science is exciting and important while motivating them to have their own adventures instead of hearing it second-hand."
Team XN: Expedition Central America is designed to inspire students to get actively involved in hands-on scientific study and show them how innovations in agriculture, renewable fuels, ethnobotany and medicine improve the living conditions of all people - especially the impoverished.
The Rama Indians of the Mosquito Coast in Nicaragua are on the receiving end for the Expedition. "We chose the Rama to illustrate what life would be like minus innovation." says Dr. Alfredo Lopez Salazar, owner of the Rio Indio Lodge in Nicaragua and a long time supporter of the indigenous populations in Central America. Dr. Lopez continues, "The Rama have a sophisticated tradition of thriving in the rain forest and an intimate knowledge of the plants and animals that surround them. But they currently struggle to fulfill their basic needs, such as medical care."
Team XN: Expedition Central America
The team of kids and doctors will bring access to a wide range of medical procedures, basic drugs like antibiotics and analgesics as well as water purification and curriculum materials for the only school in the village.
The fourteen day trek through the jungle will include several stops to create a series of lesson programs for Exploration Nation on subjects ranging from sustainable tropical agriculture and renewable energy to ethnobotany and austere medicine. These lessons will include instructional materials and video for elementary and middle school students.
The Expedition is also broadcasting live to classrooms across the United States each day of the journey, free for any educators who want to follow the adventure as a learning experience for their students. The team is raising money for the expedition using a crowd funding strategy a growing trend in the scientific community.

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Boehner says Obama pushing U.S. toward "fiscal cliff"

WASHINGTON (Reuters) - Republican House Speaker John Boehner accused President Barack Obama of pushing the country toward the "fiscal cliff" on Friday and of wasting another week without making progress in talks.

With three weeks left before a combination of steep tax hikes and deep spending cuts kicks in unless Congress intervenes, Boehner said the administration had adopted a "my way or the highway" approach and was engaging in reckless talk about going over the cliff.

"This isn't a progress report because there is no progress to report," Boehner told reporters at the Capitol. "The president has adopted a deliberate strategy to slow-walk our economy right to the edge of the fiscal cliff."

The day's rhetoric did point the way to a possible compromise that has been discussed for weeks on the main sticking point, tax hikes for the wealthy.

While Obama wants tax rates raised to 39.6 percent from 35 percent, he has not ruled out a smaller increase, perhaps to 37 percent. On Friday, Boehner, House Minority Leader Nancy Pelosi and Vice President Joe Biden indicated flexibility on the "37 percent solution."

Biden was most explicit, saying that raising the rate was "not a negotiable issue; theoretically we can negotiate how far up."

"There are a lot of things that are possible to put the revenue that the president seeks on the table," Boehner said when asked about the same thing.

Pelosi, questioned later about Boehner's remark, said, "It's not about the rate, it's about the money."

But the bleak report from Boehner prolonged the economic uncertainty surrounding the fiscal cliff, which has already riled markets, slowed down business decisions and disrupted the budgeting processes for government at all levels across the country.

Economists say going over the cliff could throw the economy back into a recession.

Obama has called for extending the tax cuts set to expire on December 31 for middle-class taxpayers, but letting them rise for the wealthiest 2 percent of Americans. Boehner and Republicans oppose his plan, preferring to find new revenues by closing loopholes and reducing deductions.

Boehner characterized as "reckless talk" Treasury Secretary Timothy Geithner's comment this week that the administration was prepared to go over the cliff if tax rates for the wealthiest were not increased.

The downbeat assessment was in line with what Boehner has offered for weeks as the two sides hold their ground on Obama's call for raising tax rates and Republican calls for cuts in entitlements like the Medicare and Medicaid healthcare programs for seniors and the poor.

Congressional aides said there were no plans for meetings on the issue this weekend. Future talks will be limited to Boehner and Obama and their staffs as the deadline approached, aides said.

Boehner said his telephone conversation with Obama on Wednesday and renewed staff talks on Thursday had not made any progress.

'MORE OF THE SAME'

"The phone call was pleasant, but it was just more of the same. Even the conversations the staff had yesterday were just more of the same. It's time for the president, if he's serious, to come back to us with a counteroffer," Boehner said.

Boehner and the House of Representatives leadership submitted their terms for a deal to the White House on Monday, after Obama offered his opening proposal last week.

The plans from both sides would cut deficits by more than $4 trillion over the next 10 years but differ on how to get there. Republicans want more drastic spending cuts in entitlement programs, while Obama wants to raise more revenue with tax increases and to boost some spending to spur the sluggish economy.

With polling showing most Americans would blame Republicans if the country goes off the cliff, more House Republicans have been urging Boehner to get an agreement quickly, even if it means tax hikes for the wealthiest.

But Boehner could have a challenge selling an eventual agreement to conservative Tea Party sympathizers in the House, some of whom are openly critical of the concessions the speaker has already made.

Boehner has been under fire from the right for proposing $800 billion in new revenue and for removing from House committees four conservative Republican lawmakers who were seen as bucking the leadership.

"When he couples this conservative purging with a negotiated tax increase of $800 billion, we are starting to see more and more signs that he's not dedicated to fiscally conservative beliefs," Andrew Roth of the influential anti-tax group Club for Growth told Fox News.

If the question of whether to raise tax rates is resolved, the two sides will then try to figure out a way to deal with the spending cuts, perhaps postponing or trimming them. They will also work toward a longer-term deficit-reduction package to be taken up after the new Congress is sworn in next month.

At a news conference on Friday, Pelosi threw her support behind a White House proposal to give Obama power to raise U.S. borrowing authority without legislation from Congress.

The debt ceiling issue, which provoked a 2011 showdown that led to a downgrade of the U.S. credit rating, has become entwined in the fiscal cliff debate. The debt limit will need to be raised in the next few months.

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Charleston, like many cities, on edge of "fiscal cliff"

CHARLESTON, South Carolina (Reuters) - For 37 years straight, Joseph P. Riley Jr. has sat behind the mayor's desk here, shaping this city and its budget.

On a recent afternoon, Riley, 69, reached for a draft copy of next year's spending plan and wondered aloud about what might get cut should politicians in Washington fail to find an agreement this month, unleashing $600 billion worth of spending reductions and tax hikes next year.

Hiring new police officers for the city of 123,000 could be put on hold, Riley said. A new piece of equipment for the fire department would have to wait. Sanitation workers might be in trouble, too.

"The thought that they would allow the economic harm that would ensue if we went over the fiscal cliff is mind-boggling," said Riley, a Democrat who was elected to his 10th term last year.

Charleston, a beautiful city steeped in history and awash in tourist dollars, would seem at first glance a world apart from the harm that could be caused by the combination of spending cuts and higher taxes. Economists predict its arrival could send the United States hurtling back into a recession.

At its edges, however, Charleston harbors the people who are most vulnerable to Washington's intransigence, making the city an emblem of a country's worry and of the powerlessness people feel in the face of Washington's indecision.

The sting of automatic cuts would be felt acutely by those who work in the defense sector and the poor. They form two prominent groups in Charleston County who may share little but the knowledge that federal belt-tightening is less a nuisance than an existential threat.

In South Carolina, defense spending accounts for $15.7 billion in annual economic activity - more than one in 10 dollars spent in the state - and nearly 140,000 jobs.

The Charleston area alone, which includes a large Air Force base and a Navy facility, holds more than 66,000 defense jobs and nearly half of the state's military economic activity, according to a report released last month by the South Carolina Department of Commerce.

While Charleston, like the rest of the state, has seen a boom in military spending over the last decade, the area has the state's second-highest concentration of people living in poverty, according to 2010 U.S. census data. More than one in four children live in poverty in the surrounding county.

From the anticipated cuts to the military to the shrinking of the safety net, Charleston shows what's at stake should the United States fall off the fiscal cliff.

'DEVASTATION'

A fast-talking engineer originally from Detroit, Michigan, Rebecca Ufkes founded UEC Electronics with her husband in neighboring Hanahan 17 years ago. Walking past employees in blue lab coats assembling components for military vehicles and commercial products last week, Ufkes described the chilling effect the possibility of cuts have had on Charleston's defense industry.

In September, Ufkes traveled to Washington as a part of a lobbying effort organized by the Aerospace Industry Association, hoping to impress politicians with the dangers facing her 200-person company and its competitors should the anticipated $500 billion in defense cuts, over 10 years, come to pass.

She came away encouraged by her state's largely Republican representation in Washington but frustrated by other lawmakers.

"South Carolina is a very pro-business state," she said. "They are very keen on economics. It's just that we are only one of 50 states."

Ufkes, 48, said she worries not only about the uncertainty that has left defense contractors unsure where to invest but the impending tax increases, which she said will put her company, active in the commercial marketplace as well, at a disadvantage against foreign rivals.

"Probably the solution is not going to be perfect for UEC," she said, "but I don't want it to be devastating. Compromise and devastation are not the same thing."

With a mug declaring, "Failure is not an option," sitting on her desk, Ufkes predicted that her company would make it, no matter how devastating the cuts are.

"If we don't survive," she said. "I don't know who will."

NO 'GIFTS'

Five miles (eight km) from Ufkes' cutting-edge electronics manufacturer is the struggling North Charleston neighborhood of Chicora-Cherokee, where Bill Stanfield and his wife, Evelyn Oliveira, arrived fresh out of Princeton Theological Seminary 10 years ago.

They founded Metanoia, a development organization focusing on bettering the community by securing housing loans, planting a garden, and running after-school and summer programs.

Through government services like AmeriCorps, the national volunteer group, and funds from sources like the U.S. Department of Housing and Urban Development, Stanfield said his group received nearly a fifth of its funding from the federal government last year.

With politicians facing immense pressure over limiting cuts to entitlements like the Medicare health insurance program for seniors and the Social Security retirement program, advocates for the poor say they expect painful reductions in spending on education and housing.

"I don't know if our housing program would survive," Stanfield, 39, said.

Cuts to education will hit South Carolina hard, where the schools have bled money over the last five years.

According to the left-leaning Center on Budget and Policy Priorities, South Carolina's cuts to education have been the fifth largest in the country, slicing 18 percent off of per-student spending during that period.

The Obama administration, which Republicans consider a profligate spender, has felt like lean times in neighborhoods like Chicora-Cherokee, Stanfield said.

"You know Mitt Romney said that people voted for Obama because of gifts?" Stanfield said. "There's this misconception that President Obama has been a gravy train of funding. There was more funding under President Bush of these organizations than under Obama."

'GAME OF CHICKEN'

Last month, Riley, the Charleston mayor, went to Washington with a group of fellow city leaders, Democrats and Republicans, to lobby the White House and Congress to save cities from drastic cuts.

Vice President Joseph Biden and Democratic leaders from the House of Representatives and Senate met with the mayors. House Speaker John Boehner and other Republican leaders in Congress declined their invitation, Riley said.

While Riley supports Obama's proposal to increase taxes on income earned over $250,000, a sticking point in the negotiations, he and other mayors cautioned that ending the tax-free status of municipal bonds would strangle cities' access to needed capital.

Riley returned to Charleston feeling like a deal, which could prevent the harshest blows from hitting his city, its residents and jobs, was in the offing. Now, he said, he is not so sure.

"It looks like it's a game of chicken," he said, "and there are signals that they are going to go through with it."

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Surprise: New insurance fee in health overhaul law

WASHINGTON (AP) — Your medical plan is facing an unexpected expense, so you probably are, too. It's a new, $63-per-head fee to cushion the cost of covering people with pre-existing conditions under President Barack Obama's health care overhaul.

The charge, buried in a recent regulation, works out to tens of millions of dollars for the largest companies, employers say. Most of that is likely to be passed on to workers.

Employee benefits lawyer Chantel Sheaks calls it a "sleeper issue" with significant financial consequences, particularly for large employers.

"Especially at a time when we are facing economic uncertainty, (companies will) be hit with a multi-million dollar assessment without getting anything back for it," said Sheaks, a principal at Buck Consultants, a Xerox subsidiary.

Based on figures provided in the regulation, employer and individual health plans covering an estimated 190 million Americans could owe the per-person fee.

The Obama administration says it is a temporary assessment levied for three years starting in 2014, designed to raise $25 billion. It starts at $63 and then declines.

Most of the money will go into a fund administered by the Health and Human Services Department. It will be used to cushion health insurance companies from the initial hard-to-predict costs of covering uninsured people with medical problems. Under the law, insurers will be forbidden from turning away the sick as of Jan. 1, 2014.

The program "is intended to help millions of Americans purchase affordable health insurance, reduce unreimbursed usage of hospital and other medical facilities by the uninsured and thereby lower medical expenses and premiums for all," the Obama administration says in the regulation. An accompanying media fact sheet issued Nov. 30 referred to "contributions" without detailing the total cost and scope of the program.

Of the total pot, $5 billion will go directly to the U.S. Treasury, apparently to offset the cost of shoring up employer-sponsored coverage for early retirees.

The $25 billion fee is part of a bigger package of taxes and fees to finance Obama's expansion of coverage to the uninsured. It all comes to about $700 billion over 10 years, and includes higher Medicare taxes effective this Jan. 1 on individuals making more than $200,000 per year or couples making more than $250,000. People above those threshold amounts also face an additional 3.8 percent tax on their investment income.

But the insurance fee had been overlooked as employers focused on other costs in the law, including fines for medium and large firms that don't provide coverage.

"This kind of came out of the blue and was a surprisingly large amount," said Gretchen Young, senior vice president for health policy at the ERISA Industry Committee, a group that represents large employers on benefits issues.

Word started getting out in the spring, said Young, but hard cost estimates surfaced only recently with the new regulation. It set the per capita rate at $5.25 per month, which works out to $63 a year.

America's Health Insurance Plans, the major industry trade group for health insurers, says the fund is an important program that will help stabilize the market and mitigate cost increases for consumers as the changes in Obama's law take effect.

But employers already offering coverage to their workers don't see why they have to pony up for the stabilization fund, which mainly helps the individual insurance market. The redistribution puts the biggest companies on the hook for tens of millions of dollars.

"It just adds on to everything else that is expected to increase health care costs," said economist Paul Fronstin of the nonprofit Employee Benefit Research Institute.

The fee will be assessed on all "major medical" insurance plans, including those provided by employers and those purchased individually by consumers. Large employers will owe the fee directly. That's because major companies usually pay upfront for most of the health care costs of their employees. It may not be apparent to workers, but the insurance company they deal with is basically an agent administering the plan for their employer.

The fee will total $12 billion in 2014, $8 billion in 2015 and $5 billion in 2016. That means the per-head assessment would be smaller each year, around $40 in 2015 instead of $63.

It will phase out completely in 2017 — unless Congress, with lawmakers searching everywhere for revenue to reduce federal deficits — decides to extend it.

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Study: Talk Therapy May Help Depression when Medications Inadequate

A first-of-its-kind large scale research study concluded that the addition of talk therapy to a medication regimen helps to relieve the symptoms of depression, the leading cause of disability in the United States in those ages 15 years to 44 years, according to the National Institute of Mental Health .

Cognitive Behavioral Therapy as an Adjunct to Medication Treatment

Only one-third of people with depression receive relief of symptoms from medication alone, so what can be done to help the millions of people who have the illness? Researchers from the universities of Glasgow, Bristol and Exeter in the United Kingdom determined to find out by recruiting more than 450 study participants, ages 18 to 79, each of whom were among the two-thirds of those diagnosed with depression that medication alone did not resolve their symptoms.

The randomized controlled trial measured results at both six months and 12 months, and based the scores on self-reporting of depression symptoms and relief of depression symptoms by the participants. At both intervals, 46 percent of those receiving cognitive behavioral therapy, CBT, reported an abatement of at least 50 percent of their depression symptoms versus 22 percent of those receiving medication alone.

What Is the Impact of the Study Conclusions to Treatment for Depression?

Before this study, there was little measurable scientific evidence that CBT was a useful adjunct treatment for depression in people whose depressive symptoms did not respond to medication alone. Now, both mental health professionals and medical physicians alike can prescribe talk therapy for these individuals with reasonable certainty that nearly half of those who participate in such therapy will have some relief of symptoms.

But the study's conclusions also indicate that additional research is needed to provide relief of symptoms of depression in 54 percent of the people whose symptoms are resistant to both medication and talk therapy.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy, talk therapy, is a widely used type of mental health counseling in which a mental health counselor provides a structured environment for aiding the individual to recognize inaccurate or negative thinking, explains MayoClinic.com .

Bottom Line

While it is reassuring to learn that many of the millions of individuals diagnosed with depression whose symptoms have not responded to antidepressant medications alone can find at least some relief of symptoms through CBT, the availability of such services in the United States is woefully lacking. Mental Health America , an advocacy group for mental health and substance abuse issues, reported that people with depression go, on average, 10 years before receiving treatment and fewer than one-third of those that do receive "minimally adequate care."

Mental health service availability varies from state to state; those with the least amount of services have the highest rates for suicide, the most significant negative outcome of depression.

The statistics represent only those people who are diagnosed with depression. There are likely many more people who have depression symptoms who are not reporting it, such as baby boomers and their seniors, according to the American Psychological Association , whose data is not represented, meaning even less service availability.

In a nation that prides itself on being the greatest on earth, we have far to go in mental health treatment.

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More Than Half of Hispanic Coloradans Lack Dental Insurance

The organization Colorado Trust reported on Monday that the results of a new Colorado Health Access Survey shows that more than half of Hispanics in the state do not have dental insurance. The overall number of people in the state without dental insurance grew 17 percent in in two years. Here are the details.

* The results of the 2011 Colorado Health Access Survey, released this month, show that 52.8 percent of Hispanic Coloradans lack dental insurance. This is higher than the rate of uninsured white Coloradans, at 39.1 percent, and black Coloradans, at 29.9 percent.

* The number of Hispanic Coloradans without dental care increased by 11 percent from 2008-09 to 2011, the survey showed.

* Among both kindergarten and third-grade children, the survey stated, more Hispanic children have at least one cavity than black or white children. The prevalence of untreated tooth decay is higher among Hispanic children in the state.

* According to Colorado Trust, having dental insurance is associated with seeking and receiving dental care. In 2011, 76.9 percent of the people who had dental insurance visited a dental professional. That number declined to 44.5 percent among those without insurance.

* Some factors affecting dental care besides insurance status include costs for services not covered by insurance and a lack of dental providers in rural areas of the state, Colorado Trust reported.

* The study found that Coloradans were more likely to forego dental care due to cost than any other type of care.

* Seniors 65 and older made up the age group most likely to not have dental insurance in Colorado, according to the study. Those living in rural areas were the least likely to visit a dental professional.

* Around 2.1 million people in the state did not have dental insurance in 2011, including 36.3 percent of the employed, working-age adults in the state. 18.6 percent of employed, working-age adults in Colorado lacked health insurance in 2011.

* Colorado Medicaid limits dental benefits to enrollees age 20 and younger, and traditional Medicare does not provide a dental benefit, the study stated.

* "Oral health care should not be considered optional or a luxury," said Ned Calonge, M.D., President and CEO of The Colorado Trust. "Going without basic dental care often leads to oral disease with unnecessary pain, more invasive care and higher costs, and can result in even bigger health problems."

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