Online loopholes in alcohol bill

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30 September 2011 Last updated at 15:20 GMT The bill is aimed at ending offers such as discounts for multiple purchases Online deals are being used to get round new laws banning discounted promotions on alcohol in Scotland.

The legislation, which comes into force on Saturday, will stop deals such as two-for-the price-of one and group discounts on wine.

Tesco has emailed customers to say they can still get wine discounts because cases will be dispatched from a depot in England.

Some other retailers are expected to cut the price of individual products.

The Alcohol Bill, passed at Holyrood last year, aims to ban "irresponsible" drinks promotions and restrict advertising of alcohol around premises.

Changes in licensing laws mean customers buying drink in stores or with online grocery orders will not get discounts.

'Watch closely'

But, Tesco advised shoppers in Scotland they can still benefit from cut-price deals.

Continue reading the main story

This move by the supermarkets demonstrates precisely the difficulties with the SNP's plans for blanket minimum pricing of alcohol”

End Quote Murdo Fraser Conservative health spokesman In an email promotion, Tesco said: ''Great news! All orders placed at TescoWine by the case will still qualify for these discounts when applicable as your wine is dispatched to you from our distribution centre in Daventry, England.''

The alcohol will then be transported across the border from England into Scotland.

A Tesco spokesman said retailers had been highlighting that internet sales would be excluded by the new legislation for some time.

A Scottish government spokesman said: "Internet sales represent only a very small proportion of the alcohol sold in Scotland, but it is an area that we watch closely to see if further action is necessary."

MSPs have warned that other retailers are also looking at removing the quantity discounts and advertising, but will instead sell the same bottles of alcohol for whatever the combined discount price was to begin with.

Labour's health spokeswoman Jackie Baillie said: "We are concerned that, despite reassurances from the SNP government at the time, there still appears to be gaping loopholes in the legislation that are now being exploited by supermarkets."

Conservative health spokesman Murdo Fraser said: "This move by the supermarkets demonstrates precisely the difficulties with the SNP's plans for blanket minimum pricing of alcohol, plans which will easily be got around by internet sales."

The Alcohol Bill also introduces a requirement for age verification and a new tax which could be imposed on licence holders.

The social responsibility levy aims to ensure retailers and licensed premises, such as nightclubs, contribute to the wider cost of their activities to the community.

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Will we really keep getting fatter?

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29 September 2011 Last updated at 12:32 GMT By Michael Blastland GO FIGURE - Seeing stats in a different way The media constantly warns of an obesity epidemic Pick up a paper and you'll read that people are destined to get fatter and fatter, but is this right, asks Michael Blastland.

Ready to play a data detective game? The case is obesity.

Your task is to decide which way the trend is going. Isn't that obvious? Here's the first piece of evidence.

Exhibit A: What people say about obesity in the UK.

We're in the midst of a fat explosion, basically, would be my summary of the public argument and media coverage, with recent projections that half of UK men will be obese by 2030 - and women not far behind.

That's the top end of expectations, rounded upwards, of course. The bottom end is that about 40% of UK men will be obese by 2030.

Exhibit B: The source of the reports.

The figures came from a series of articles in the Lancet. The authors point out that they are extrapolations of current data and the past might not be a good guide to the future.

Exhibit C: What is the currently available data?

Here in a chart is the latest data for England - not the whole UK, note.

The lines show the percentage of adult men and women who are either overweight or obese, according to the Health Survey for England, as measured by body mass index.

Where do you reckon these wobbly lines are going? Still soaring upwards or turning flat-ish? And if flat-ish, what does that mean? Is it a temporary break in a long-term rise, or a real and lasting change of direction?

Some commentators suggest that this is not a rising tide but flat water.

What's your judgement? Time for more evidence.

Exhibit D: The data for obesity only, excluding the merely overweight.

What do you reckon now? Not such an evident flattening in the last decade but still a slower rate of increase, perhaps. Or still too soon to tell? And then there's the figure for 2009, the latest available, dipping like that. What do we make of it, if anything? It is only one year, after all. Mass weight-loss during the recession?

Whatever the explanation, if even the best-case recent projections are to prove accurate we'll need about a 90% rise in obesity in 21 years, after something a little above flat in the preceding nine years.

Exhibit E: Predictions for obesity made in the past.

These have tended to be on the high side. The one reported here suggested the figure for men would reach 33% by 2010 and 28% for women. That now looks way too pessimistic. But does the past, including past projection errors, provide any guide?

Exhibit F: How the latest projections look compared with the latest data.

Is it plausible that we will go from here to there? I wouldn't rule it out. But I'd also say that it looks as if the 2030 projections assume the recent decade is an aberration. But what do you think?

All right, enough with the exhibits. But you might still say you want more evidence. Good. Like, what's happening among children?

Or you might want international comparisons, or methodological evidence about whether the measurement changed in any way, by altering who's included in the survey or adjusting for non-response, which these surveys used not to do.

And how about the most serious cases of obesity, the morbidly obese or the numbers operated on for obesity by the NHS? Both sharply up in the last few years.

Then of course there's the rest of the UK. Scotland continued to go up a bit throughout the 2000s for adults, not so for children.

But perhaps most interesting of all, since these are average rates of obesity, are there differences of class?

Then it's decision time.

So, what do you think, Sherlock? We're all capable of a bit of sleuthing here, once presented with some data.

So you might say there's a lot of hype in obesity stats. You might say the lines are still mostly on the way up, even if not so fast, and that's bad enough. We're much fatter than we used to be a generation ago, no doubt about that.

But current trends are less clear, despite the headlines, let alone what will happen in the longer term. Or maybe you don't think so.

Go Figure has trouble understanding why data like this can't simply be presented to the public so that we can listen to the experts, look at their figures, then make up our own minds.

The data for England is here.

The current figures for Wales are here, and similar to England's.

And here for Scotland.

Interpreting ups and downs is seldom easy. Even when numbers go clearly in one direction, they tend to go up and down along the way. And whenever there are significant ups and downs and flats and wobbles, the question is how long you need to look before you know which way things are really going.

And this is only the "what" question, as in "what's happening?" We haven't touched the "why?".

The next few years will be fascinating. But watch the evidence, not the headlines. Fat could be in the balance.

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Leek soil linked to E. coli cases

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30 September 2011 Last updated at 00:31 GMT By James Gallagher Health reporter, BBC News Richard Westcott reports on the findings

Soil stuck on leeks and potatoes may have been the source of an E. coli outbreak in the UK earlier this year, according to the Health Protection Agency (HPA).

There were 250 cases scattered across England, Wales and Scotland between December 2010 and July 2011.

The Food Standards Agency said it was a "myth" that dirt did no harm.

The HPA stressed that the vegetables were safe to eat, but reminded people to ensure their food was washed.

Most of the cases were mild, but 74 people needed to go to hospital and one patient, who had underlying health problems, died.

Details of the outbreak were reported weekly to health professionals, but have only just been publicised to the general public.

A spokesperson said: "At the outset it was not clear what was causing the outbreak and we had no information that would have enabled the public to take any steps to protect themselves."

The disease was caused by a rare strain of E. coli called O157 PT8 which is different from the strain that caused the widespread outbreak in Germany.

'Timely reminder'

Infected people were 40 times more likely to have been in a household where loose leeks were handled and 12 times more likely to have been in a household which bought sacked potatoes than people who stayed infection-free.

Dr Bob Adak, head of the HPA's outbreak control team, said: "The vegetables could have carried traces of contaminated soil.

"It is possible people caught the infection from cross-contamination in storage, inadequate washing of loose vegetables, insufficient hand washing after handling the vegetables or by failing to thoroughly clean kitchen equipment, utensils or surfaces after preparing the vegetables."

Dr Andrew Wadge, chief scientist at the Food Standards Agency, said: "It's sadly a myth that a little bit of dirt doesn't do you any harm.

"Soil can sometimes carry harmful bacteria and, although food producers have good systems in place to clean vegetables, the risk can never be entirely eliminated.

"This outbreak is a timely reminder that it is essential to wash all fruits and vegetables, including salad, before you eat them."

Leek and potato soil linked to E. coli outbreak

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Twitter 'offers world mood clues'

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29 September 2011 Last updated at 18:43 GMT By James Gallagher Health reporter, BBC News The researchers say Twitter provides a real-time reflection of mood. Researchers have trawled through more than half a billion messages on Twitter, looking for changes in people's mood across days and seasons.

They said people start off brightly in the morning, but mood deteriorates throughout the day until a boost late in the evening.

Unsurprisingly, they found people tended to be happier on Saturdays and Sundays than during the working week.

Changes in the hours of daylight also had an effect.

It has been difficult for scientists to investigate changes in mood. The authors of this study argue that traditional laboratory tests are limited as they are based on university students self-reporting their mood.

Some academics have begun looking at social networking sites to gather data on a wider and more diverse group of people.

Mood rhythm

The team at Cornell University, New York, argued that monitoring Twitter provides a real-time reflection of mood.

They looked at messages from 2.4 million people's public tweets from 84 countries and used language detection software to score positive and negative feelings.

Positive feelings started high, but began to fall in mid-morning and then picked up again in the evening. Generally, positive words appeared more at the weekend than during the week.

However, the researchers say work is not necessarily to blame as the shift in mood pattern "was similar on weekends and weekdays" which instead "points to sleep and the biological clock" as the cause.

Negative feelings were lowest in the morning and increased throughout the day. The researchers said: "This pattern also suggests that people may be emotionally refreshed by sleep."

Researchers said day length affected positive tweets, but not negative ones suggesting "that winter blues is associated with diminished positive affect but not increased negative affect".

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'Grave' health board cash warning

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29 September 2011 Last updated at 16:12 GMT The boss of Cardiff and Vale University Health Board says it needs to save £87m and called for 'urgent action' The head of the health board for Cardiff and Vale of Glamorgan has warned staff its finances are in a "grave" state.

Cardiff and Vale University Health Board (UHB) has ordered a recruitment freeze and war on waste because of "unprecedented" financial pressures.

The board said it related largely to cost pressures, not to government cuts.

The health board's responsibilities include the University Hospital of Wales in Cardiff, Wales' largest.

In a "special edition" of a newsletter to staff this month, Cardiff and Vale chief executive Jan Williams says: "The current financial position is grave and I cannot stress enough the need for everyone to work together to meet the challenge."

'Urgent' Continue reading the main story

The current financial position is grave and I cannot stress enough the need for everyone to work together to meet the challenge”

End Quote Jan Williams Cardiff and Vale University Health Board "Urgent action" is needed to meet a legal obligation to break even by next March, she says.

The first half of the year has been "very challenging" and the board "faces unprecedented financial and performance pressures".

It needs to save £87.8m. Plans are in place for £56.3m, "some of which have risks that must be managed carefully".

As part of "immediate and decisive action to drive down costs", the board has decided to put an immediate hold on external recruitment. People will not be hired from outside without the chief executive's personal approval.

The cost of paying locum doctors and agency workers is being looked at, and a voluntary early release scheme is being offered to staff.

Ms Williams urges staff to "wage war on waste" and asks them to "be as flexible as possible" at work.

It comes at a time of mounting concern in Cardiff Bay about health service reorganisation.

'Damning indictment'

Conservative assembly leader Andrew RT Davies said: "The document is an extremely damning indictment of Labour's mismanagement of the Welsh NHS."

He attacked the Welsh Government for failing to maintain health spending - its biggest item of expenditure at £6bn - in line with inflation and called on Health Minister Lesley Griffiths to make a statement in the Senedd.

Mrs Griffiths said funding for health and social services had remained the same this year in cash terms. Cardiff and Vale health board's share was more than £1bn per year.

She said: "Yet again the Tories are wrong. We are not cutting the NHS budget.

"We had to take a number of tough decisions to protect the NHS budget as a result of the savage cuts imposed on Wales by the Tory-led UK Government.

Financial pressures

"Welsh Labour's commitment to the NHS - and its founding principles of care free at the point of need - is absolutely clear and supported by people all over Wales in the recent election."

A spokesman for the health board said the savings it needed to make were not due to cuts from the Welsh Government "but relates largely to cost pressures associated with the delivery of services, including inflation, additional staffing and drug costs".

"The financial pressures we face this year have been well documented and discussed openly at our public board meetings over a number of months," he said.

"The UHB is doing all it can to address these financial challenges, which includes working closely with staff and staff representatives to identify where resources can be released and waste reduced, while maintaining our high standard of patient care.

"It is absolutely right to involve staff in this way and it is disappointing that our efforts to engage staff in what is a critical debate are being reported in this way."

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Students' mental health 'at risk'

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29 September 2011 Last updated at 23:55 GMT By Branwen Jeffreys Health correspondent, BBC News Students face greater pressures on mental health Doctors are warning that the current generation of students has a greater risk of anxiety and depression than previous ones.

The Royal College of Psychiatrists says there are now many more students from less privileged backgrounds who are less prepared for university life.

Students also face rising debt and uncertain job prospects, it warns.

It is concerned universities may see counselling and support services as an easy target for cuts.

In a report seen exclusively by the BBC, the college says the massive expansion in the numbers of young people going into higher education has had a significant impact.

Universities are now educating a different type of student from the privileged minority of 20 years ago. Changes in wider society are also being seen on campus, with an increase in students from fractured families. At the same time, the financial cost of going to university has increased.

Dr John Callender, one of the report authors, said: "Many are having to work long hours in paid work on top of full-time academic studies. Many are less well-supported by their families than was the case in years gone by.

"The reasons for this are things like increased rates of marital breakdown and students being drawn from poorer social backgrounds."

He said there are also intense social pressures for many young people, living away from home and trying to live up to the expectation that these years should be a happy and sociable time.

Dropping out

During their years at university, it is thought about 4% of students will turn to counselling services for support. Recent research has suggested that these services are facing increasing demands for their advice.

For Liam Bore, being able to talk to someone made the difference between staying at university and dropping out.

Continue reading the main story

Sometimes there is a lot of pressure on them to succeed. They can be carrying the hopes of a whole family”

End Quote Eileen Smith Report joint author He found himself struggling to maintain his studies after the death of two school friends was followed only a year later by the loss of his mother.

"My concentration wasn't good, I couldn't take on what was going on in the lessons, and that had a big impact on my grades."

With support from the counselling service at the University of Hertfordshire, Liam has negotiated extra time to complete his final assignments and now hopes to leave with a good degree.

Some universities are investing more in support services, in recognition that if students leave their course, it can damage their prospects and lead to the university losing their fees.

Eileen Smith, the head of counselling at the University of Hertfordshire and a joint author of the report, has been advising first-year students about the help available as part of their freshers' week.

She agrees this is a generation for whom the pressures are greater, as many are the first in their family to reach university.

"They might find it harder to negotiate with tutors, they're less sure what to expect, and less confident about asking for help.

"Sometimes there is a lot of pressure on them to succeed. They can be carrying the hopes of a whole family."

The report warns that despite the growing demands, there are concerns for the future of some welfare services, with reports of some universities in England already freezing posts as a result of the financial pressures on higher education.

The RCPsych says this is a crucial time in the lives of young people, whether for temporary support, or early diagnosis of major mental illnesses.

It wants academic staff to receive more training, and greater incentives for GPs interested in running dedicated health services for students.

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Stem-cell breast ops warning

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30 September 2011 Last updated at 06:46 GMT By Neil Bowdler Health reporter, BBC News The procedure involves grafting fat harvested from the patient by liposuction Senior plastic surgeons have issued a warning over a breast enlargement procedure being offered by private UK clinics.

The British Association of Aesthetic Plastic Surgeons (BAAPS) say "stem-cell breast augmentations" are unproven and should not be offered commercially.

The warning came at the group's annual conference in Birmingham.

One Harley Street clinic offering the surgery responded by saying they were "confident" the treatment was safe.

Research 'hijacked'

The surgery involves using fat harvested from the patient's stomach or thighs via liposuction and using it to build up the breast.

Prior to transplantation, around half of of the fat is processed to enrich the stem-cell content - naturally occurring regenerative cells found within the fat.

The hope is that this enrichment process can improve the prospects for the fat graft.

The same technology is being used in reconstructive surgery where "cell-enriched fat grafting" is now being offered in several centres around the world to reconstruct breasts following cancer surgery.

Trials are currently under way at NHS centres in London, Glasgow, Swansea, Norwich and North Tyneside.

But BAAPS believes more clinical testing needs to be done to establish its safety before it is used commercially on healthy women.

Continue reading the main story

We have to make sure whatever treatment we offer for breast augmentation is safe in the long-term”

End Quote Eva Weiler-Mithoff Consultant plastic surgeon "To think that this unproven research is hijacked and used in the commercial sector is really an appalling thought," former BAAPS president and consultant plastic surgeon Adam Searle told the BBC. "Not least when it's being utilised by inadequately trained practitioners."

Private London clinics, The Harley Street Skin Clinic and The Private Clinic of Harley Street, have been advertising stem-cell breast augmentations for some time. The latter says they will have treated some 200 patients by the end of this year.

In a statement, Dr Valentina Petrone of the The Private Clinic, said the views of BAAPS were welcome, but insisted the surgery was safe and every precaution was taken.

"The Private Clinic, is confident in respect to the safety of this treatment. Furthermore ongoing studies reassures us even more. We have strict patient selection criteria and clinical protocols in place.

"We, of course, look forward to completion of studies and any other findings as they become available over time and will, if necessary, adapt our protocols accordingly."

Cancer concern

The BAAPS warning came the same week new clinical data on cell-enriched fat grafting was presented to an conference in Nottingham.

Eva Weiler-Mithoff, a consultant surgeon at Canniesburn Plastic Surgery Unit in Glasgow, presented details of a 12-month trial to a meeting of the Oncoplastic Reconstructive Breast Surgery group.

The trial involved around 70 patients in seven centres in four countries. The data is yet to undergo peer review and was sponsored by Cytori Therapeutics, the US makers of a machine which can enrich the fat.

Consultant plastic surgeon Eva Weiler-Mithoff discusses the findings of a 12-month clinical trial

Ms Weiler-Mithoff told the BBC the procedure appears to be effective in cancer patients in filling in defects in the breast and in improving the appearance and feel of the breast. Nor were there any serious side-effects or recurrence of breast cancer to date.

"Traditional fat-grafting (in breast reconstructive surgery) does not work terribly well because there is not enough circulation to support the survival of the fat graft," she said.

"We know if we augment the fat graft with the naturally occurring regenerative cells in fat tissues we can improve the circulation around the fat graft and the survival of the fat graft."

But she said longer-term results were needed - at least five to10 years of data - before the technique could be deemed safe for use in cosmetic surgery.

"We still don't have enough long-term outcome data to say it's safe in the sense that it doesn't encourage the cancer to come back or new breast cancer to develop," she said.

"Because breast cancer is such a common disease we have to make sure whatever treatment we offer for breast augmentation is safe in the long-term."

A previous Japanese study involving 40 Japanese women undergoing cosmetic stem-cell breast augmentation also deemed the procedure to be effective, but also called for additional study.

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Antenatal advice 'perpetuates C-section myths'

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30 September 2011 Last updated at 00:45 GMT By Leigh East Csections.org Caesareans can occur 'even after straightforward pregnancies' One in four births are by Caesarean section.

But in this week's Scrubbing Up, campaigner Leigh East - who has written a book about Caesarean births - warns pregnant women are not given a positive enough picture of C-sections - meaning many end up with "unnecessary" feelings of regret and failure if they need one.

Sit any group of women down to talk about Caesareans and you will hear all sorts of alarming 'facts'.

Common ones are: that you will have to have a Caesarean if your baby is breech; you cannot pick up your baby or drive for six weeks; bonding will be damaged and once you have had a Caesarean your next birth will have to be a Caesarean too.

What is really alarming about these "facts" is that not one of them need be true.

Hard as it may be to hear, antenatal education does little to disabuse women of these misconceptions.

Rather, it frequently perpetuates the idea that this important procedure is merely a last resort best avoided.

In reality, in addition to being lifesaving in emergency situations, Caesareans have significant benefits in certain pre-labour situations where attempting a vaginal delivery carries greater risks to mother or baby.

Add to these those women who view a Caesarean as preferable to the perceived fear and uncertainty of vaginal birth and there are a lot of women affected by Caesarean birth.

Preparation 'benefits'

Unfortunately the majority of women still understand so little about C-sections that it should come as no surprise to find that many find their experience, if they have one, extremely traumatic, so severe in fact that some go on to develop post-traumatic stress disorder, while those who want or need to plan a Caesarean are left totally unaware of the opportunities for making their birth feel special and personal.

One in four women in the UK will have a Caesarean, with unplanned sections accounting for two thirds of these.

It is a possible outcome of even the most straightforward pregnancy, yet is barely touched on in many antenatal classes.

This reluctance to talk positively about Caesareans has forced them to the periphery of antenatal education.

Books and classes are often biased, making it impossible for women to have open, rational discussions with those responsible for their care.

Most remain unaware of the huge benefits of preparing for the possibility of Caesarean birth, either planned or emergency.

It is well known that a woman's preconceptions can affect her labour and realistic expectations are significant in determining both how she ultimately perceives her birth and how she approaches her recovery.

But all too often the risks of vaginal birth are significantly downplayed while Caesareans are portrayed as an intervention to avoid wherever possible, with those planning a Caesarean labelled selfish or "too posh to push".

This leaves women in the dark about what they face - and unable to develop a flexible approach to birth.

'Toxic combination'

With over half of UK births involving intervention, women need to know more about their options so they can assess the risks for themselves.

Feelings of distress and loss of control become associated with their birth and can have a significant impact both physically and emotionally on mother and baby.

While some would prefer to leave things in the hands of their carers, many more would prefer to play an active role in making decisions about the birth.

To achieve this they need realistic information about the experience they face.

In the case of Caesareans, knowing how to prepare for the procedure, being aware of the opportunities open to them during surgery, learning alternative positions for breastfeeding and ways to improve recovery can all radically improve the experience for many women, even if a Caesarean was not their original preference.

Fortunately the National Institute of Clinical Excellence (NICE) is starting to address the issue, saying women should be presented with "evidence based information" so they can make an "informed decision".

This is a huge step forward, but it is still entirely reliant on those individuals providing the care also providing balanced information.

Unfortunately the toxic combination of out of date or inadequate information and biased advice means that women will continue to face their birth with huge gaps in their knowledge leading to unnecessary trauma.

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Crackdown on fake medicine trade

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29 September 2011 Last updated at 13:38 GMT By Tom Symonds Home Affairs correspondent Danny Lee-Frost, from the MHRA, described the investigation as officers moved in on an alleged drug-retailing operation

Investigators are cracking down on the multi-million pound trade in fake and unlicensed medicines, as concerns grow over potential health risks. BBC News joined investigators on one of their raids.

More people are diagnosing their medical problems and buying medicines online - boosting the growing trade in fake and illegitimate drugs supplied without a prescription.

Enforcement agencies warned that those taking the drugs are risking their health, as they launched an international operation to tackle the problem.

The Medicines and Healthcare products Regulation Agency (MHRA) says more than a million doses of medicines worth approximately £2m have been seized from the UK's postal service and ports during its latest crackdown.

An additional 100,000 doses were discovered in raids by police and investigators - with a value of at least £200,000.

'Jackpot'

Valium and Viagra - described by the MHRA as lifestyle drugs - are the most commonly sold.

But the agency warns that the counterfeiters are starting to offer drugs for cancer, heart conditions, epilepsy, asthma and depression.

Continue reading the main story

They are not interested in your health, they are interested in taking your money”

End Quote Danny Lee-Frost Enforcement investigator BBC News joined a dozen MHRA officers as they moved in on an alleged drug-retailing operation in Brighton.

Although the MHRA has discovered a pharmaceutical drugs factory in London, the drugs it seizes are usually manufactured in China or India, so in this raid they are looking for evidence of imported "product".

The investigation begins with intelligence gathered from monitoring a website advertising Kamagra - an Indian version of Viagra not licensed for sale in Britain.

Accompanied by police officers, the team raids an address on a housing estate and arrests one man.

Senior enforcement investigator Danny Lee-Frost says: "No-one involved in those websites is medically qualified. None of the products are licensed or tested.

"They are selling them to you as a drug dealer would, they are not interested in your health, they are interested in taking your money. And the money is big."

The house is searched, documents and computers seized, several safes sliced open with angle-grinders and more than £1,000 in cash discovered - but no drugs.

The investigators switch their focus to paperwork in the house which suggests the owner has been paying rent on a further two storage spaces. A team heads off to the first to investigate.

Importers face prosecution under the Medicines Act

It turns out to be a room in a small office building. Again nothing is found. But upstairs, one of the MHRA's investigators discovers a box, half-full of pills.

They are Valium tablets - quite possibly counterfeit, according to Mr Lee-Frost.

It is a small but useful find for the investigators, meaning the man they arrested can potentially be prosecuted. Pleased with their work so far, they drive over to the other address.

A rundown house in a residential area, it has bars on the windows and a bolted door. Using keys seized earlier, the investigators open the door.

Inside a grubby front room is a pile of boxes containing green tablets in sheets of blister packs.

The pills are Kamagra, according to Mr Lee-Frost. This version of Viagra is popular in India but illegal to sell in the UK - and certainly illegal to supply without a prescription.

The drug is easily distinguishable from legitimate Viagra, which is normally blue. It has been sent from Pakistan.

'Dog urine'

"We have seen some truly horrendous places where products have been stored," says Mr Lee-Frost.

"Residential premises, stuff under the kitchen sink covered in dog urine, rats gnawing at them. They are just commodities."

The haul has a potential value in excess of £100,000 and the person who imported it could be prosecuted under the Misuse of Medicines act.

He could be sued by Pfizer, the owner of the Viagra brand, and is also being investigated for money-laundering.

Importers can break the medicines law in two ways - selling drugs not licensed for the UK and selling fake drugs made abroad, which can contain less active ingredient than they should.

The health risks of fake drugs are hard to quantify, the MHRA says

One haul of a counterfeit cancer drug was tested and found to contain 98% of the active ingredient.

But it was badly manufactured and would not properly dissolve in the body, posing an enormous health risk.

Another trick is to package Viagra as a natural Chinese herbal remedy, designed to enhance sexual performance. It would work, says the MHRA, but Viagra should not be taken without speaking to a doctor.

Nine times in the last three years illegitimate drugs have made it as far as a pharmacy.

The agency finds it extremely hard to quantify the risks. Records are not kept of patients who have suffered the ill-effects of illegal drugs, partly because it is rarely obvious they have been the cause of health problems.

In some ways the biggest threat this market could pose is to the brand names and trademarks of the big pharmaceutical producers.

But the MHRA insists there are health risks - citing a recent survey of GPs suggesting one in four had treated patients made ill by drugs bought online.

Trouble sleeping

Another developing trend is for students to buy a certain drug used to treat the condition narcolepsy.

Roy Lambden: "I don't want another family to go through what we've been through"

It is being bought online by those who want to stay up all night studying.

Last December a young paramedic, Lorna Lambden, was having trouble sleeping after her shifts. She bought an anti-depression drug also used for insomnia.

It is thought she took fewer than four pills, but was found dead. Her father, Roy, told the BBC on Thursday the medicine "stopped her heart".

"You don't realise the dangers of prescription drugs. There's a reason there is a prescription."

He blamed the illegal online pharmacies, and said: "It's no different from selling hard drugs. It's become so easy to buy prescription drugs rather than booking an appointment with a doctor."

"I don't want another family to go through what we've been through. Those drugs are too readily available, it's too easy for people to take them. If people don't buy them those companies will go out of business."

The MHRA's advice is simple: Do not buy anything off the internet without a prescription. Legal internet pharmacies should always ask for one.

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Rates of diabetes-related amputation vary across U.S.

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By Amy Norton

NEW YORK | Fri Sep 30, 2011 12:19pm EDT

NEW YORK (Reuters Health) - Rates of foot and leg amputations among Americans with diabetes may vary widely according to where they live, a new study suggests.

About 26 million Americans have diabetes, and an estimated 65,000 had a lower limb amputation in 2006, the most recent year with available data.

One recent study found that the rate of amputation may be declining among Americans with diabetes. But the new findings, reported in the journal Diabetes Care, suggest that in some parts of the country that rate can be almost double the national average -- at least among older Americans.

Amputation is a complication of diabetes because the disease often causes nerve damage over time. When people lose sensation in their feet and legs, they may more easily get a cut, blister or sore -- even from ill-fitting shoes -- and be less likely to notice it until it's infected.

Those wounds can be difficult to heal because diabetes often causes poor blood circulation to the lower limbs. In severe cases, doctors may choose to amputate a foot or leg to prevent a dangerous, systemic infection.

The current study found that in 2008, certain pockets of Arkansas, Louisiana, Mississippi, Oklahoma and Texas had the highest rates of diabetes-related amputation among Medicare beneficiaries -- at about 7 to 8 per 1,000.

That compared with a national rate of 4.5 per 1,000 in the same year. And certain locations -- like portions of Arizona, Florida, Michigan and New Mexico -- had particularly low rates. There, older adults with diabetes had amputations at a rate of 2.4 to 3.5 per 1,000.

"The rate of amputation really varies greatly," said lead researcher Dr. David J. Margolis, of the University of Pennsylvania in Philadelphia. "We don't know why that is, we just know that it's there."

The researchers were able to account for some factors -- like the prevalence of diabetes in a given area, the number of people diagnosed with diabetic foot ulcers, and an area's income and racial mix. That explained some of the geographical variation, Margolis told Reuters Health, but not all of it.

He cautioned that the relatively high rates of amputation in certain regions do not necessarily mean the rates are "too high." It's possible, for example, that doctors in those areas see more people with severe diabetes complications and based on experience, have found that an earlier amputation is often better.

"We don't know that they are doing 'too many,'" Margolis said. "For all we know, they could be doing the right amount."

There are no general guidelines on when to do an amputation in someone with severe diabetic ulcers, so it's up to the doctor's judgment and what the patient wants.

"It's not a clear-cut decision," Margolis noted.

The findings are based on data from Medicare, the government insurance program for older Americans, for the years 2006 to 2008. About 5 million beneficiaries had diabetes each of those years.

It's not known whether the same geographical variations in amputation would be true of younger Americans with diabetes, the researchers say.

More research is now needed to understand the reasons for the variations among Medicare beneficiaries, Margolis said. For now, people with diabetes can take steps to protect their limbs, he noted.

Experts recommend that people with diabetes check their feet everyday to catch cuts, swelling or other injuries early. They should also have their doctor examine their feet at least once a year.

Diabetic nerve damage often causes pain at first, Margolis said. So if you have pain, tell your doctor and talk about what you should do to protect your feet and legs.

Nerve damage can also change the shape of the feet, Margolis pointed out. In some cases, your doctor might recommend special therapeutic shoes, so you are not trying to wedge your changed feet into regular shoes.

SOURCE: bit.ly/nk6Jh8 Diabetes Care, online September 20, 2011.

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U.S. health benefits recommendations coming October 7

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U.S. President Barack Obama waits to speak at the Families USA's 16th annual Health Action Conference at the Hyatt Regency Washington on Capitol Hill in Washington January 28, 2011.

Credit: Reuters/Larry Downing

WASHINGTON | Thu Sep 29, 2011 9:56pm EDT

WASHINGTON (Reuters) - A key recommendation for medical coverage standards under President Barack Obama's healthcare overhaul will be released on October 7, according to the organization preparing the report.

The Department of Health and Human Services has asked the influential Institute of Medicine, an independent agency in Washington, to recommend how HHS should determine the basic health benefits for millions of Americans who will qualify for coverage sold through insurance exchanges beginning in 2014.

IOM spokeswoman Christine Stencel on Thursday said the agency will release the report on October 7, just a week later than the self-imposed deadline of the end of September.

Stencel has previously told Reuters that IOM will not produce specific benefits standards for the exchanges. Instead, the group is working toward recommendations on criteria and methods that would allow HHS to determine and update the essential health benefits package.

The findings will inform the final HHS decision expected by the end of the year. HHS has been subject to intense lobbying over which health services should be mandated by the government.

(Reporting by Alina Selyukh in Washington; editing by Carol Bishopric)

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Smoking still high in U.S. mining, food service

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A miner smokes a cigarette during a break at the Gongxigou coal mine on the outskirts of Baokang, Hubei province, December 4, 2007.

Credit: Reuters/Stringer

By David Beasley

ATLANTA | Thu Sep 29, 2011 4:47pm EDT

ATLANTA (Reuters) - Cigarette smoking remains stubbornly high among workers in the mining, food services and construction industries despite dramatic overall declines in the United States in recent decades, a federal study released Thursday showed.

Thirty percent of workers in mining, hotel/motel and food services smoke, according to the Centers for Disease Control and Prevention, which analyzed data from 2004-2010.

The construction industry had the next highest smoking rate at 29.7 percent.

"Since the first surgeon general's report in 1964, we've almost cut the smoking prevalence in half overall," said Ann Malarcher, senior scientific adviser at the CDC. "But then there are groups that are still at very high rates and are being left behind."

The management and education sectors had among the lowest percentage of smokers. Only 9.7 percent of educators smoke, according to the study.

Low education levels are a factor in high smoking rates, along with poverty and gender, Malarcher said.

"One of the things that has been studied is that persons with lower levels of education tend to have less access to health information," she said. "They tend to be less knowledgeable about the dangers of tobacco use."

The CDC survey found the highest smoking rates among workers ages 18-24, males, those with high school or less education and those without health insurance. Midwestern workers had the overall highest rates.

The CDC recommends that employers increase their anti-smoking efforts, including imposing smoke-free workplace policies and providing health insurance coverage for smoking cessation treatments.

Adult smoking has decreased 42.4 percent since 1965, the CDC said. But the decline has slowed in the past five years, dropping to 19.3 percent of adults in 2010 from 20.9 percent in 2005.

Smoking and exposure to secondhand smoke is the leading cause of preventable death and disease in the United States, killing an estimated 443,000 Americans each year. Smoking costs about $193 billion annually in direct health care expenses and lost productivity.

(Editing by Colleen Jenkins, Greg McCune and Bill Trott)

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Middle-aged women happier with moderate exercise

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n">(Reuters) - Middle-aged women encouraged to exercise at moderate intensity were much happier and more likely to continue working out than peers who exercised more intensely, according to a study.

Researchers led by Steriani Elavsky of Penn State University in Pennsylvania recruited 255 women between 40 and 60 years old to do either moderate or vigorous exercise, then followed the volunteers to monitor their reactions.

Overall, women who did moderate exercise were about twice as likely to feel energized and confident they could do more exercise in the future, and more of them also showed decreased feelings of sadness and anxiety than the vigorous-exercise group.

"Exercise makes you feel better but it is going to be more pleasant when performed at moderate intensity as compared to vigorous, especially when you have been previously inactive or may be overweight," Elavsky told Reuters Health.

They were activities "that would allow you to talk in short sentences while you are doing them, but would not allow you to sing," she added.

Middle-aged women are among the least active and their level of physical activity declines with age. Understanding whether exercise of different intensities has different effects on mood and whether these predict overall physical activity in midlife women is an important question to address, Elavsky added.

Elavsky and colleagues at the Middle East Technical University in Ankara, Turkey studied the 255 women, who were not on hormone therapy and who kept a daily diary of activities and feelings for two weeks. She presented their findings at the North American Menopause Society meeting in Washington D.C.

At the beginning of the study, the women completed two bouts of moderate or vigorous exercise. The vigorous workout involved exercising on a treadmill to the point where they could no longer tolerate the intensity, and moderate exercise involved a 30-minute session, also on a treadmill, at a pace the women selected for themselves but could be considered moderate.

All women also wore an accelerometer, a small device the size of a match box, to track their energy expenditure and their time spent in activities of different intensities.

The study found that moderate intensity exercise caused more women to report later that they were in a better mood and to have greater feelings of energy, psychological wellbeing and "self-efficacy."

Moderate physical activity was also much better in these terms for obese and out of shape women, Elavsky said.

Vigorous exercisers showed smaller benefits to mood, and those who were overweight or had symptoms of illness reported "significant decreases in calmness" after the exercise bouts.

Examples of moderate intensity exercise include brisk walking, ballroom and line dancing, biking on level ground or with few hills, canoeing, general gardening including raking, trimming shrubs, sports such as baseball, softball, volleyball, tennis (doubles) and water aerobics.

Elavsky added she hopes her study will reaffirm to women that exercise can be a powerful way to enhance their wellbeing, and that they don't have to go all out with their level of exertion.

"The effects we observed were large and moderate intensity is sufficient, in fact it is optimal," she said.

"We also hope that clinicians will realize the importance of considering the proper exercise intensity when making recommendations about exercise."

(Reporting from New York by Fran Lowry at Reuters Health; editing by Elaine Lies)

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Fish oil pills don't improve kids' braininess

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By Kerry Grens

NEW YORK | Thu Sep 29, 2011 5:16pm EDT

NEW YORK (Reuters Health) - Despite some evidence that taking fish oil pills during pregnancy can help children's brain development, a new study suggests that the supplements make no difference in measures of intellect when the kids are six years old.

The findings support the results of an earlier Norwegian study that also found no differences in IQ among seven-year-olds whose mothers did or did not take fish oil supplements while pregnant and breastfeeding.

Fatty acids, such as docosahexaenoic acid (DHA), that are found in fish and other foods are considered to be important for the developing fetus.

The question, however, has been whether adding more of these fats to mothers' diets through supplements will further benefit the baby.

In the current experiment, researchers asked expectant mothers during the second half of their pregnancies to take fish oil, fish oil plus a folate supplement, folate alone or a pill that did not contain any supplements.

Nearly seven years later, the team, led by Dr. Cristina Campoy at the University of Granada in Spain, gave intelligence tests to 154 children from this group.

The kids performed similarly on the tests, regardless of what type of pill their mothers had taken during pregnancy.

The results, published in the American Journal of Clinical Nutrition, do not mean that fatty acids like DHA are not important.

In fact, the researchers found that the children of women who had high levels of DHA in their red blood cells around the time they gave birth scored above average on the intelligence tests at age six.

These mothers, however, were not necessarily given fish oil supplements. Rather, the result could reflect mothers' intake of DHA from various sources over a longer period of time, and might mean that long term fatty acid intake "is more beneficial than receiving supplementation alone during pregnancy," the authors wrote in their study.

A recent study in Australia also found that DHA supplements did not help the visual development of babies (see Reuters Health story of May 26, 2011).

The current study did not measure the diets of the children, something that could have influenced the results, said Dr. Ingrid Helland at Oslo University Hospital, who led the earlier Norwegian research.

"It might be that subtle beneficial effects of (prenatal fish oil) supplementation are being overshadowed by other factors (genetics, social stimulation, nutrition etc)," Helland wrote in an email to Reuters Health.

She is not totally giving up on the idea that taking fish oil might be beneficial.

"If a friend would ask me if she should take supplements or not, I would recommend supplementation, but emphasize that we still do not have any scientific proof that it benefits the child," said Helland.

SOURCE: bit.ly/nW3xdX American Journal of Clinical Nutrition, online August 17, 2011.

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Safe drug-injection site can stay: Supreme Court of Canada

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A poster shows how to use a syringe safely inside a safe injection site for drug addicts on Vancouver, British Columbia's eastside August 23, 2006.

Credit: Reuters/Andy Clark

By David Ljunggren

OTTAWA | Fri Sep 30, 2011 11:14am EDT

OTTAWA (Reuters) - Vancouver's Insite clinic, the only such safe-injection site for drug addicts in North America, can stay open, the Supreme Court of Canada ruled on Friday in a landmark defeat for the federal government.

The country's top court, slapping down the Conservative government with some harsh language, ruled unanimously that closing the site would threaten the lives of drug users and therefore violate their human rights.

The government, which is pushing a tough-on-crime agenda, said keeping Insite open made a mockery of laws designed to stamp out illegal drug use. The Health Department had said it would not extend a special exemption to drug laws that allowed the site to operate.

The court said such a decision would break the principles of fundamental justice and was arbitrary, ordering the health minister to maintain the exemption.

"It is also grossly disproportionate: the potential denial of health services and the correlative increase in the risk of death and disease to drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite's premises," it ruled.

Insite operates in Vancouver's poor Downtown Eastside district, one of the most deprived urban areas in Canada. The clinic was set up in 2003 to allow intravenous drug users to shoot up in a place that had medical supervision.

A study in the Lancet medical journal this year said the site had cut drug overdose deaths by 35 percent in the area. Police and local officials had campaigned for it to stay open.

The site's operators - who argued that drug addiction was a disease - said that, before the site opened, drug users were regularly dying of overdoses on the streets. The Downtown Eastside has around 4,600 intravenous drug users.

Recovered heroin addict Dean Wilson, a member of the board of the users' group, jumped in the air, whooped loudly and clenched his fists in delight when told of the ruling.

"This just substantiates what I've been saying for a long time, that what we've been doing is the right thing. This has nothing to do with the law-and-order platform, this has to do with gold standard medical intervention for a group of very very ill people," he told reporters.

Heroin and cocaine addicts receive clean needles to inject themselves with their own drugs under supervision by a nurse. They can then stay in a special "chill-out" room before returning to the streets.

Federal Health Minister Leona Aglukkaq will comment on the court ruling later Friday, a spokesman said.

The Conservatives, who won a majority in the May general election, plan to push through tougher laws on crime and open new prisons - moves that critics say are expensive and will put many more people in jail.

"They always took this political ideological partisan position," said Libby Davies, a legislator for the opposition New Democrats, whose parliamentary constituency includes the Downtown Eastside.

"I want to say to them: Have you now understood, have you learned the importance of what Insite is about? ... There have been no deaths from overdoses inside Insite," she said.

The case name is Attorney General of Canada et al. v. PHS Community Services Society, et al. (Case no: 33556).

(Reporting by David Ljunggren; editing by Rob Wilson)

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Delaware mulls ban on so-called bath salts

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n">(Reuters) - Delaware is moving to ban so-called bath salts, powerful stimulants that can mimic the effects of cocaine, LSD or methamphetamine, officials said on Thursday.

The state's Controlled Substances Advisory Committee planned an emergency meeting on Friday to consider an immediate ban on the substances, which typically can be bought at tobacco shops and gas stations, and online, authorities said.

Bath salts have emerged as legal alternatives to cocaine and methamphetamines, and versions of the substances have been banned in the European Union, Australia, Canada and Israel. Many U.S. states also ban them, and moves are afoot in other states to make them illegal.

Delaware aims to ban three synthetic chemical compounds used to produce bath salts marketed under such names as "Ivory Wave," "Purple Wave," "Vanilla Sky" or "Bliss," officials said.

"We have every reason to make these drugs illegal," said Governor Jack Markell in a statement. "These drugs present a danger to public safety. They have no legitimate use and can cause incredible damage to the lives of the user and those around the user."

The committee that is meeting on Friday can make a recommendation to Delaware's Secretary of State, who has the authority to enact an immediate ban, said a spokeswoman for the governor's office.

The U.S. Food and Drug Administration has not approved the chemicals for human consumption or medical use, and there is no oversight of their manufacture, Delaware officials said.

Bath salts are commonly smoked, snorted or injected. Users experience an intense high, euphoria, extreme energy, hallucinations, insomnia and are easily provoked to anger, according to the federal Drug Enforcement Administration.

(Reporting by Ellen Wulfhorst, Editing by Greg McCune)

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California lettuce recalled over listeria fears: FDA

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WASHINGTON | Fri Sep 30, 2011 11:01am EDT

WASHINGTON (Reuters) - True Leaf Farms of Salinas, California, is recalling 90 cartons of chopped romaine lettuce because of potential contamination from listeria monocytogenes, the Food and Drug Administration (FDA) said on Friday.

The recalled romaine was shipped between September 12 and 13 to Church Brothers, a food service distributor in Oregon who distributed it to at least two other states, Washington and Idaho, according to a Thursday statement on the FDA website.

The romaine affected by the recall has a September 29 use-by date, the statement said.

(Reporting by Ian Simpson; Editing by Greg McCune)

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Records of 4.9 mln stolen from car in Texas data breach

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By Jim Forsyth

SAN ANTONIO | Thu Sep 29, 2011 5:58pm EDT

SAN ANTONIO (Reuters) - A massive data breach, in which the personal and medical records of millions of military patients and their families were compromised, happened when the records were stolen out of a data contractor's car in San Antonio, officials told Reuters on Thursday.

The information for some 4.6 million active and retired military personnel, as well as their families, was on back up-tapes from an electronic health care record used to capture and preserve patient data from 1992 through September 7 of this year, according to Science Applications International Corp (SAIC).

The families used the federal government's TRICARE health provider. SAIC is the suburban Washington firm that handles military health provider TRICARE's data.

The tapes went missing on September 14 when they were "among items stolen from an employee's car in San Antonio," SAIC spokesman Vernon Guidry told Reuters.

They were in the car, he said, because they were "being transferred from one federal facility to another in compliance with the terms of their contract."

He said there's no indication the car thief was after the tapes or even knew what they were.

SAIC is working with San Antonio police and a private investigator to recover the tapes, Guidry said.

After announcing the breach on Thursday, SAIC officials scrambled to reassure patients the "risk of harm to patients is judged to be low, despite the data elements involved."

"Retrieving the data on the tapes would require knowledge of and access to specific hardware and software and knowledge of the system and data structure," SAIC said in a statement released Thursday.

NO FINANCIAL DATA

TRICARE officials say the data on the tapes include Social Security numbers, addresses and phone numbers, and some personal data such as clinical notes, laboratory tests, and prescriptions. No financial data, such as credit card or bank account information, are on the tapes, officials said.

The SAIC statement said the company withheld information about the breach until Thursday so it could "determine the degree of risk this data loss represented before making notifications" so as "to not raise undue alarm in our beneficiaries."

Guidry said the data cover 4.9 million patients who received treatment at military hospitals and military treatment facilities in San Antonio. The breach also includes information for patients who may have been receiving treatment at other military medical facilities, but whose laboratory work or other diagnostic work was done at San Antonio hospitals.

Despite the assurance that the risk is low, computer security expert Dwayne Williams, associate director of the Technology Research Group at the University of Texas San Antonio, said patients should take preemptive steps.

"If somebody intentionally went after this data, they are going to have the right hardware and software to read these files," he said. "This equipment is available and can be purchased on the Internet.

SAIC and TRICARE have set up emergency response centers for patients to call to get help in dealing with the security breach, and help them to place a fraud alert on their credit reports.

TRICARE has a total of 9.6 million enrollees worldwide. It is the HMO and medical service provider for America's active duty and retired military personnel, their families, military reservists, and some civilian Department of Defense workers.

TRICARE said in the statement that it is working with SAIC to "review current data protection security policies and procedures to prevent similar breaches in the future."

Williams said situations like this are "scary," but they're part of modern life.

"If you are a citizen in the modern society, if you have a credit card, if you shop online, if you have information stored, you should anticipate that some day your information will get stolen," he said.

"Data breaches are getting bigger and more common. You should take steps to protect your identity."

(Edited by Karen Brooks and Greg McCune)

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Tainted cantaloupe warnings continue

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Jensen Farms is recalling Rocky Ford whole cantaloupes that were shipped between July 29 and September 10.Listeria can take three weeks or longer to make a person sickTainted cantaloupes are linked to 13 deaths; 72 illnesses have been reported in 18 statesIt is the deadliest U.S. outbreak of a food-borne illness in more than a decade

(CNN) -- Federal health officials are expanding efforts to ensure no additional bacteria-tainted cantaloupes get to consumers in what has become the deadliest U.S. outbreak of a food-borne illness in more than a decade.

The Food and Drug Administration said it has teamed up with state officials in the effort.

"FDA and its state partners are conducting checks at retail stores, wholesalers and distributors to make sure they have received notification about the Jensen Farms' whole cantaloupe recall and that they have taken appropriate action to notify their customers and remove the recalled whole cantaloupes from the shelves," the agency said in a statement Wednesday.

Thirteen people have died in what has become the deadliest U.S. outbreak of a food-borne illness since 1998, according to records from the Centers for Disease Control and Prevention.

The outbreak -- blamed on the bacteria Listeria monocytogenes -- was first reported September 12. It was traced to consumption of Rocky Ford cantaloupes grown at Jensen Farms' fields in Granada, Colorado.

What you need to know about Listeria

As of Monday, it had grown to 18 states, 72 illnesses and 13 deaths, according to the CDC's latest statistics.

"Because some of the wholesalers and distributors may have further distributed the recalled cantaloupes to food processors, it is possible that additional products that contain cantaloupe from Jensen Farms could be recalled," the FDA said. "There is no indication of foreign distribution at this time."

In 1998, 21 people died from consuming tainted hot dogs, according to a CDC database.

Food poisoning 101

In the current outbreak, four people who ate contaminated cantaloupes died in New Mexico, two each in Colorado and Texas, and one each in Kansas, Maryland, Missouri, Nebraska, and Oklahoma.

Public health officials also have reported illnesses in California, Florida, Illinois, Indiana, Montana, North Dakota, Virginia, West Virginia, Wisconsin and Wyoming.

Listeria can grow even at low temperatures and can also can take three weeks or longer to make a person sick, so more cases may emerge in the coming weeks, officials said.

Listeriosis causes fever, muscle aches, diarrhea and other gastrointestinal symptoms. It is rarely a serious concern for healthy children and adults, according to the CDC, but it is particularly dangerous for older adults, people with weakened immune systems. In pregnant women, it can cause miscarriages, stillbirth and premature delivery.

Pregnant women may experience only mild flu-like symptoms, said Dr. David Acheson, a former chief medical officer for the FDA who is now the managing director for food and import safety practice at Leavitt Partners, a firm which advises clients on health care and food safety. Listeria can be devastating to a fetus, he said, particularly in the second or third trimesters, so pregnant women who may have been exposed and have any flu-like symptoms should see a doctor. Symptoms can be more pronounced in the elderly or those with compromised immune systems, he said.

About 1,600 people become seriously ill because of the bacteria each year, the CDC reports, and about 260 die.

How to keep your food safe

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The decade's 10 biggest food-borne illness outbreaks

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The decade's 10 biggest food-borne illness outbreaks - CNN.comvar cnnCurrTime=new Date(1317399953000),cnnCurrHour=12,cnnCurrMin=25,cnnCurrDay="Fri",cnnIsIntl=true,clickID=212106,cnn_cvpAdpre="edition.",cnnCVPAdSectionT1="edition.cnn.com_health_t1",cnnCVPAdSectionInPage="edition.cnn.com_health_inpage",cnnShareUrl="%2F2011%2F09%2F30%2Fhealth%2Fhigh-profile-food-borne-illnesses-gallery%2Findex.html",cnnShareTitle="The%20decade's%2010%20biggest%20food-borne%20illness%20outbreaks",cnnShareDesc="",cnnFirstPub=new Date('Friday Sep 30 06:32:25 EST 2011'),cnnSectionName="health",cnnSubSectionName="hth : news",cnnPageType="Story",cnnBrandingValue="default";cnnPartnerValue="";cnnOmniBranding="",cnnAuthor="Jacque Wilson, CNN",disqus_category_id=207582,disqus_identifier="/2011/09/30/health/high-profile-food-borne-illnesses-gallery/index.html",disqus_title="The decade's 10 biggest food-borne illness outbreaks",cnn_edtnswtchver="edition",cnnIsStoryPage=true,cnn_metadata = {};cnn_metadata = {section: ["health","hth : news"],friendly_name: "The decade's 10 biggest food-borne illness outbreaks",template_type: "content",template_type_content: "gallery",business: {cnn: {page: {author: "Jacque Wilson, CNN",broadcast_franchise: "",video_embed_count: "0",publish_date: "2011/09/30",photo_gallery: "The decade's 10 worst food-borne illness outbreaks"},video: {video_player: ""}}},user: {authenticated: "",segment: {age: "",zip: "",gender: ""}}};if (typeof(cnnOmniPartner) !== "undefined") {if (cnn_metadata.template_type_content === "") {cnn_metadata.template_type_content = "partner";}}var photo_gallery = "The decade's 10 worst food-borne illness outbreaks";Event.observe(window,'load',function(){window.setTimeout("cnn_strysavemrv()",500);});function cnn_strysavemrv(){saveMrvUrl('The decade\'s 10 biggest food-borne illness outbreaks - CNN.com',cnn_strysaveurl);}if(typeof CNN==='undefined'){var CNN=Class.create();}CNN.expandableMap=[''];function _loginOptions(){};var disqus_url=(typeof disqus_identifier!=='undefined') ? 'http://www.cnn.com/2011/09/30/health/high-profile-food-borne-illnesses-gallery/index.html' : 'http://www.cnn.com'+location.pathname;cnnad_newTileIDGroup(['728x90_top','336x850_rgt']);cnnad_newTileIDGroup(['607x95_adlinks','336x280_adlinks']); EDITION:  INTERNATIONAL U.S. MÉXICO ARABIC Set edition preference Sign up Log in Home Video World U.S. Africa Asia Europe Latin America Middle East Business World Sport Entertainment Tech Travel iReport Share this on:FacebookTwitterDiggdeliciousredditMySpaceStumbleUponLinkedInViadeo The decade's 10 biggest food-borne illness outbreaksBy Jacque Wilson, CNNSeptember 30, 2011 -- Updated 1504 GMT (2304 HKT)if (typeof cnnArticleGallery == "undefined") {var cnnArticleGallery = {};if(typeof cnnArticleGallery.currentImageList =="undefined"){cnnArticleGallery.currentImageList = [];}}var expGalleryPT00 = new ArticleExpandableGallery();expGalleryPT00.setImageCount(11);.cnn_html_slideshow_metadata > .cnn_html_media_utility::before {padding-right: 1px;content: '>>';font-size: 9px;line-height: 12px;color: red;}.cnnstrylccimg640 {margin: 0 27px 14px 0; /*note the exclusion of the top margin*/}.captionText {filter: alpha(opacity=100);opacity: 1;}.cnn_html_slideshow_media_caption a, .cnn_html_slideshow_media_caption a:visited, .cnn_html_slideshow_media_caption a:link, .captionText a, .captionText a:visited, .captiontext a:link {color: #004276;outline: medium none;Tainted cantaloupes have left 13 people dead in what has become the deadliest U.S. outbreak of a food-borne illness in more than a decade, according to the CDC. Incidence rates of infection actually decreased 23% in the U.S. between 1996 and 2010 but news of a contaminated food product always creates headlines. Here are the 10 most high-profile food-borne illness outbreaks since 2001.cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":true,"x":0,"y":0,"pos":1}Between February and August, the Cargill Meat Solutions Corp. recalled more than 36 million pounds of ground turkey after tests revealed a strain of salmonella. The outbreak killed one person and sickened 111. cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":false,"x":0,"y":0,"pos":2}In the summer of 2010 more than 1,600 people were reportedly sickened by salmonella found in eggs produced by Hillandale Farms in Iowa, which voluntarily recalled approximately a half-billion eggs in 14 states.cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":false,"x":0,"y":0,"pos":3}Authorities shut down a processing plant in Texas in October 2010 after four deaths were tied to listeria-infected celery produced at the site. The Texas Department of State Health Services ordered SanGar Fresh Cut Produce to recall all products shipped from its San Antonio plant. cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":false,"x":0,"y":0,"pos":4}Between April and August 2008, 1442 people in 43 states were infected with salmonella from Mexico-grown jalapeno and Serrano peppers. At least 300 people were hospitalized and the infection may have contributed to two deaths, according to the CDC. Walmart stores in four states recalled jars of Serrano peppers as a result. cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":false,"x":0,"y":0,"pos":5}The second-deadliest outbreak this decade occurred between September 2008 and April 2009 when nine people died from salmonella-infected peanut butter. The Peanut Corp. of America had sold the tainted peanut butter in bulk to King Nut, which recalled its products. More than 700 people were infected and 166 were hospitalized. cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":false,"x":0,"y":0,"pos":6}In the summer of 2006, more than 230 people became infected with E. coli from spinach grown on a single California field on a single day. Unfortunately, the CDC wasn't able to narrow down how that field became contaminated. Investigators did trace the prepackaged spinach back to Natural Selection Foods and baby spinach sold under the Dole brand name. Five people died during the outbreak and 103 were hospitalized. cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":false,"x":0,"y":0,"pos":7}During 2005 and 2006, four large outbreaks of salmonella infections hit 21 states in the U.S. Tainted tomatoes being served in restaurants were found to the be the cause. Investigators from the CDC determined that the produce was grown on two farms in Virginia.cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":false,"x":0,"y":0,"pos":8}Pre-sliced Roma tomatoes purchased at deli counters in Sheetz Gas Stations infected 429 people -- hospitalizing 129 -- in the summer of 2004. Two other smaller outbreaks in the U.S. and Canada also occurred that summer and were linked back to a tomato-packing house in Florida. cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":false,"x":0,"y":0,"pos":9}Listeria was again the cause of the third-deadliest outbreak in the United States in the past decade. An infection of deli meat, specifically sliced turkey, killed eight and infected 54 others in 2002. Three pregnant women also had fetal deaths. Two processing plants recalled 30 million pounds of meat following the outbreak. cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":false,"x":0,"y":0,"pos":10}Interestingly, just over 10 years ago news organizations were running similar headlines about cantaloupe -- except this time it was salmonella that had infected the fruit. Two were killed, nine hospitalized and 50 infected in this outbreak that started in Mexico. cnnArticleGallery.currentImageList[cnnArticleGallery.currentImageList.length] = {"currentPicture":false,"x":0,"y":0,"pos":11}HIDE CAPTIONCantaloupeGround turkeyEggsceleryPeppersPeanut butterSpinachTomatoesRoma tomatoesDeli meatsCantaloupe<<<1234567891011>>>

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