Injured veterans star in play about war's lingering effects

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22 January 2012 Last updated at 09:05 GMT The show's actors have all been injured themselves On a brightly-lit stage at the Theatre Royal Haymarket, two young men are comparing their injuries, and trading good-natured jibes. One has lost two legs, the other 'only' one.

The men are not actors, but still serving in the armed forces, and their wounds are all too real.

Marine Cassidy Little and Rifleman Daniel Shaw, an infanteer from 4 Rifles, are just two of the 30 injured or wounded servicemen and women who have joined the Bravo 22 Company project - the brainchild of theatre producer Alice Driver - to bring their experiences to the stage on Sunday.

The Two Worlds of Charlie F is probably the closest most West End audiences will get to the front-lines in Afghanistan, and the slow and painful process of recovery endured by the injured.

The characters are based on the men and women's own stories, written and produced by professionals at the theatre's Masterclass Trust.

'Amazing experience'

The language of the play is wholly authentic, with the drama of the fictional Charlie F and his comrades moving seamlessly between black humour and pathos, though rarely self-pity.

During rehearsals, the forthright orders from director Stephen Rayne are reminiscent of a sergeant major.

Rifleman Shaw, 20, volunteered to take part in the project while at Tedworth House Recovery Centre, after losing both legs to a roadside bomb in Helmand in 2009.

"The play has been an amazing experience, and I feel good doing it, but there are a few emotions that do come back on stage, and it's the same for everyone," he says.

"But it's in the past and you have to get over it. Regardless of your injuries, there's no point crying about it."

He hopes the play will help the audience understand the physical and mental impact of the soldiers' injuries, and what their families have to face.

"My mum and dad and my ex-girlfriend are coming to see it. I've explained to them what happens in the play - especially when it gets quite emotional - and I've warned them not to fret."

Captain Anna Poole, who plays a captain, says the last time she was on stage was tap-dancing at school, 23 years ago.

She, too, is matter-of-fact about her injury, after losing a leg as the result of an accident while competing for Great Britain in a luge contest in 2005.

"It is incredibly nerve-racking to go up on stage," the 34-year-old admits.

"A lot of the guys say they would rather be storming compounds back out in Afghanistan than going on stage. It's a different type of fear, but it's also great fun."

The Bravo 22 Company project does not shy away from showing the hurt and pain suffered by the injured and their families, and also deals with tough subjects such as sex post-injury or emotional estrangement when partners or relatives find it hard to cope.

Some 30 veterans are taking part in the production

"It's a very personal play, with quite raw emotions," says Capt Poole.

"It's been quite difficult to watch some of it, because you know whose girlfriend had those experiences, or which guys you've seen go through a lot of grief, when they come out of their operation and can't put on their prosthetic limbs.

"It's been a cathartic process for many of us, and the audience will struggle not to get their hankies out. "

Those taking part say they are grateful for support from the Royal British Legion, Masterclass and the MoD in letting them tell the "grittier" side of the recovery process.

"A lot of documentaries focus on the point of being injured, but what they don't show is this incredible patch in the middle when your ups and downs are astronomical," Cpt Poole says.

"I hope the play will give people a better understanding, and the knowledge that when they contribute to military charities, they are helping people like us rehabilitate - no matter where or how those injuries were sustained."

Capt Poole is due to leave the Army soon, and is studying glass-blowing - a rather different future to the one she had imagined - but one she is looking forward to with enthusiasm.

Rifleman Shaw is also looking to the future with hope, despite his life-changing injuries.

"It's just time. Everyone needs time. For myself, I woke up one morning and said - right, got no legs. What else can I do? OK, I'll do everything I can do, rather than crying about what I can't do."

'Two worlds at once'

The play is one of the first to deal with the personal consequences of the UK's two most recent wars; its title an allusion to the different worlds inhabited by the wounded, pre- and post-injury.

The Welsh playwright, Owen Sheers, began by talking to the wounded, first alone and then in groups, gathering their stories.

"It wasn't always easy for them to talk about it," said Sheers, who is also a novelist and poet, and last month became the Welsh Rugby Union's first artist-in-residence.

"Quite often I was the first person they'd told stuff to, and that was an indication of what this project meant for them, being willing to go back to some quite painful places," he said.

Playwright Owen Sheers says many of the soldiers had not spoken of their experiences before

"What a lot of wounded servicepeople struggle with is inhabiting a series of two worlds at once.

"They will lay their heads down to sleep and in an instant they will be back on the frontline, but then they'll wake up next to their wife.

"I hope the audience will get a soldier's eye-view of what it means to be injured or wounded and go through this recovery period, and be reminded of what those three letters 'war' actually mean, and how far the consequence of one person's war and wounding stretches.

"We've been involved in conflict for 10 years, yet it's very easy to live in Britain and not be aware that we are a country at war.

"I think that is irresponsible - and I think we need to be aware for all our sakes about the absolute realities of what war means."

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Mind Reading: Two Harvard Docs Talk About Making the Best Medical Choices

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Critical medical decisions can be difficult to make — even for two Harvard doctors. But Dr. Jerome Groopman, who is also a staff writer for the New Yorker, and his wife, Dr. Pamela Hartzband, have thought a great deal about doing it correctly.

In their recent book, Your Medical Mind: How to Decide What Is Right for You, they explain that a better understanding of your own personal values and history can help you cut through the swamp of statistics and make smart decisions.

TIME: So what are the different types of medical mindsets?

P.H.: The first one would be 'minimalist,' and the opposite of that is 'maximalist.' The minimalists like to do the least possible for medical problems and the maximalist wants to be ahead of the curve and do anything and more. For me, I am minimalist and [Dr. Groopman] is a maximalist.

J.G.: Another major category, which we also differentiate is 'believers' and 'doubters.' Believers are people who believe there must be a good solution for their medical problems someplace, and they just have to find it. Doubters are very focused on side effects and on unintended consequences. They are concerned that the treatment might be worse than the problem.

[We wondered about] how does anyone come to this? I'm a believer and maximalist, and [it comes from] how I was raised. We put in the book a structure so that each reader can look at his or her own lifestyle and understand how they arrived at that mindset.

I was brought up in a traditional Jewish home where doctors were like gods. My parents looked at natural healing and folklore practices from the shtetl as being totally nonsense. Anything that was without science or technology was thought to be foolish. The development of being a maximalist in part I think came from experience. For example, my father [died] at a young age of a massive heart attack. I looked to medicine to focus on the absolute maximum to treat people — in particular, thinking about my father's loss. In my own field, which is blood diseases and cancer, in order to try to save as many as you might, you had to go to extremes.

MORE: Mind Reading: Why Bad Math Can Ruin Your Health

P.H.: In my family, there was a lot of skepticism about expert opinion. It started when I was a baby. My father, who was an engineer and very interested in science, decided that it would be a good idea to approach childrearing in a scientific way.

My mother was an artist and freethinker and she had other ideas. She thought that the experts and doctors don't know anything. My parents have fortunately enjoyed very good health. They're in their 80s and that reinforces a minimalist and doubter point of view. If you believe you have generally good health, you don't want to do anything that might make matters worse.

One of the most difficult medical questions right now seems to be screening, particularly for prostate cancer. The studies suggest that men have to make a horrible choice between possibly dying of cancer or potentially becoming impotent and incontinent because of needless treatments after a false-positive result.

J.G.: [The studies haven't resolved the question. The big studies that were supposed to do so only measured deaths, not how people live.] They weren't measuring men living their last years with prostate cancer in their bones, which as a cancer specialist, I can tell you isn't a pleasant way to live. But [these men usually] die of heart attack or stroke, so they're not counted as deaths from prostate cancer.

To my mind, this is a gray zone. There is no clear answer. There are two different groups that come up with recommendations. The U.S. Preventive Services Task force says no screening, and the Urological Association says everyone should be screened. The middle ground is that each individual patient and doctor makes a choice that's right for that man. You have to be very careful. You need to really look deeply at these kinds of controversies.

Patients and doctors don't like uncertainty. The reality is that most of medicine is in the gray zone. So to say all PSA screening is worthless is wrong and to say every single man must have it is wrong too.

Our book really engages uncertainty and it says that you as an individual can understand the information and then you can understand yourself.

MORE: Prostate Cancer Screening: What You Need to Know

Do you think it's better to take one of these positions—like minimalist or maximalist— over the other?

J.G.: No. Take a simple thing like issue of [cholesterol-lowering] statins. The only person who can really judge the risks and benefits within the context of her or his life is the patient.

[A woman we describe in the book who had to make this decision] was a doubter and a minimalist. She decided, It's not worth it to me to take statins if my chance of having a heart attack is 1 in 100. She really thought it through. If she has a heart attack [and survives], she'll be disappointed but not regretful.

You also describe a woman who went against her own preferences and had surgery that was harmful to her.

P.H.: She couldn't stand up to her doctor. [And she regretted her choice.]

J.G.: One of the big messages of the book is that doctors have their own medical minds and that's why experts disagree when they are looking at the same information. This book empowers patients to stand up and express their own medical minds, because the language is powerful. Pam and I have been using [these terms] with our own patients to help them understand what choice is right for them.

If [the woman who had had the failed surgery] had had the language to say, 'My mindset is that I'm a minimalist and a doubter and if I need to do something, my first choice is to do something natural, and if that doesn't work, I'm willing to look at other options,' [she would probably have been able to say no to the surgery]. People feel intimidated to basically come up with a different answer for themselves. This book says don't be intimidated.

P.H.: And you can see if your point of view is very different from your doctor's. If you have different mindsets, hopefully you can communicate and work together. The doctor has to understand so [he or she] can help to work toward a resolution of the problem that is consistent with your point of view.

How does this idea fit with the push to have evidence-based guidelines for treatment that will just tell you what to do?

P.H.: Guidelines can be extremely helpful and they represent a lot of work and gathering of information and weighing back and forth of evidence. But they're not gospel. They're often based on studies that don't apply to many different people — pregnant women, for example, or older people or people with other medical problems.

J.G.: There are three key limitations of guidelines. The first is that they often don't apply to patients in the real world. Second, they represent the medical mindset of the community [that created the guidelines], which may not correspond to your doctor's medical mind or yours. Third, for internal medicine, like diabetes and heart disease, [guidelines often change]. There was a study done of 100 best practices guidelines. In one year, 14% were reversed; in two years, 23%; and in five-and-a-half years, half. It's not only because of new information, it's because a new community comes together, and they have different biases about risks and benefits.

When you drill this far down, you see all the uncertainties and it becomes easy to say, 'It's all subjective.' By that logic, people who say vaccines cause autism can be said to have just as much of a case as those who say they don't.

J.G.: There are certain parts of medicine that are completely amenable to strict guidelines. For example, infection control — you don't want someone putting a catheter in your vein without washing their hands first. [In] safety and emergency care, it's the same for everyone. But that is just one small slice of medicine.

How do you find and evaluate the information to make these decisions?

J.G.: The first question every patient should ask is, 'What is my chance of having a certain outcome with no treatment?' [In the case of statins, for example, a heart attack.] That gives the sense of, for you as an individual, what are you facing? It clears away the confusing clutter of statistics. Either your doctor can provide the information, or there are [risk] calculators at government or other well-respected websites. [You need to find out] what is my risk for something if I do nothing, and then you can really assess the positive impact and negative potential complications of the treatment.

P.H.: And when you're looking at these numbers, you want to be careful how the numbers are framed because that can be very confusing, too. In the case of the woman with elevated cholesterol, she's told her risk of heart attack would be reduced by 30% by taking a statin. Even as a minimalist and a doubter, that sounds like a big number because your mind plays tricks on you. It sounds like you're at 100% risk and now it's reduced by 30%. But it's not. Her risk from doing nothing is 1 in 100.

Or, for example, with bisphosphonates for osteoporosis, they will reduce the risk for fracture by 50%. What's your risk if you don't take them? If it's 2% and it goes to 1%, you still might want to take them, but at least you understand what that really means for you.

The next thing to do is, once you've looked at the numbers framed in a certain way, then you want to flip the frame and experience it the other way. When you talk about side effects of statins, it depends on the dose and which one you take. It varies between 1% and 10%. Ten percent sounds like a lot, but if you say 90% don't have side effects, that sounds a lot better.

J.G.: I think you as journalist and we as doctors and writers have a real responsibility to communicate with people in an understandable way. People make life and death decisions based on their interpretations of this information and it's very easy to be misled. A lot of this book is about how not to be misled.

See more of Healthland's "Mind Reading" series.

Maia Szalavitz is a health writer for TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland's Facebook page and on Twitter at @TIMEHealthland.

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This race isn't about running

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Chris Fenton completed his sixth marathon of the year in Appleton, Wisconsin, in September. The Leukemia & Lymphoma Society's team raises money for blood cancer researchChris Fenton is running 10 marathons in six months in honor of his motherSharing personal stories helps runners focus on the goal, donors open wallets

(CNN) -- While the coastal town of Savannah, Georgia, fills with spectators on Saturday for the Rock 'n' Roll marathon, Chris Fenton and Laura Devrieze will be focused on the finish line.

For Fenton, crossing that line means completing his 10th marathon in six months. For Devrieze, it means finishing her first. For both, it's about running 26.2 miles for a parent with cancer.

Fenton and Devrieze are a part of the Leukemia & Lymphoma Society's Team in Training program. As the world's largest endurance sports training program, Team in Training has raised $1.2 billion for blood cancer research.

The program started 23 years ago when Bruce Cleland formed a group to run the New York City Marathon in honor of his daughter, a leukemia survivor.

Approximately 45,000 runners are signed up this year for the New York marathon, which takes place on November 6. Many are associated with one of the 200 registered charities; in 2010 the race raised more than $30 million for different causes.

Train with Sanjay: 2012 Fit Nation Triathlon Challenge

Leukemia & Lymphoma Society communications manager Kristin Hoose says having a cause helps athletes focus on a goal, and having an athlete to support helps donors open their wallets.

"When people share their personal stories, and those of their heroes ... people see that their $10 can make a big difference."

A mother's strength

Chris Fenton was on a business trip in Kuala Lumpur, Malaysia, when he got a message from the secretary. His sister had called from Manhattan. Fenton looked at his watch and realized it was close to midnight in the States. Something was wrong.

"You hear those words for the first time: 'Mom has cancer.' You just kind of drop the phone and go into shock and say 'Oh my god. Oh my god. Oh my god,'" he said.

Chris Fenton with his mom, Barbara, left, and his Aunt Vicki, who has also survived cancer.

His mom, Barbara, is the matriarch of the Fenton family. As the second oldest of 14 children and a mother of six, Barbara received an outpouring of love after her non-Hodgkin lymphoma diagnosis. She had always taken care of everyone else, now they would take care of her.

Treatment was hard. Barbara endured four courses of chemo and four of radiation therapy. In October 2001, she went into remission.

Fenton's left Achilles tendon is screaming at him as he talks about his mom -- now the picture of health at 78 -- from home in Kohler, Wisconsin.

"She's settling in, loves to be a grandmother and spoil the grandkids, and (is) just kind of enjoying the golden years," he says with a laugh.

A long-time runner, Fenton started his journey to honor his mom in May. He's running 10 marathons (to celebrate her 10th anniversary of going into remission) in six months -- the time it took from diagnosis to remission. Since May, he has logged more than 200 official miles. Saturday marks his final race.

"I'm still a middle-of-the-pack plodder," he says, "but I'm able to find my way around a marathon course."

He has raised close to $100,000 over the last 10 years and hopes to continue supporting blood cancer research with Team in Training.

"My mom's story had a positive outcome. There are a lot of people who don't."

A father's joy

People loved Harry Devrieze. With thinning dark hair and bright blue eyes, he had a smile that lit up a room. Friends and family were his priority and he never hesitated to lend a helping hand.

The owner of a construction business, he often came by his daughter Laura's house in Carrollton, Georgia, to make repairs. It was from him that she learned plumbing, drywall and her way around the Home Depot store.

Laura Devrieze smiles with her dad, Harry, at a family member's graduation party.

"He loved doing that -- he loved fixing things, he loved gardening, he loved working around the house."

Two years ago, Harry developed a rare, aggressive form of non-Hodgkin lymphoma. After chemotherapy, he was giving a clean bill of health, but the cancer returned and was discovered in January.

The Devrieze family was almost surprised by the intensity of the disease the second time around. The toll it took on Harry's body was more menacing.

"This was a full attack on his bones, his lungs, his muscles," Devrieze remembers.

It was during this time that she went to her first Team in Training meeting and signed up for the Rock 'n' Roll marathon. Running gave her time to clear her mind and be by herself. Her dad supported Devrieze's decision to race and to raise money for the Leukemia & Lymphoma Society.

"It was always important for him for me to be involved and kind of have a cause," Devrieze says. "He's the reason I was doing it, but he didn't want to be the reason I was doing it."

While she ran 5 miles, then 10, then 15, her dad started preparing for a stem cell transplant. He spent the month of May at Emory University Hospital. On Saturdays, Devrieze joined Team in Training in Atlanta for a run and then went to visit him.

Harry was released from the hospital in late June after the transplant didn't take. He passed away on August 16, 2011 at age 70.

For a couple of weeks, Devrieze refused to run, clutching to the friends and family Harry had held so close. Then she picked up her shoes and moved with the pain.

For Devrieze, Saturday will be yet another reminder of her loss. Her dad won't be there to watch her cross the finish line. That's why she's all the more determined to do exactly that.

"He was very proud and very excited. This is the longest I've ever run. It's mind over body, and having a greater purpose ... makes the mind part work better."

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Hospital 'sorry' about revivals

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27 October 2011 Last updated at 05:03 GMT The hospital's own guidelines say do not attempt resuscitation forms should be updated regularly York Hospital has been criticised for not asking relatives of some patients if they should be resuscitated.

The Care Quality Commission (CQC) said York Teaching Hospital NHS Trust had failed to meet its own guidelines.

It said Do Not Attempt Resuscitation (DNAR) forms should be updated regularly, with relatives' views taken into account.

The trust said it was "sorry" if any distress had been caused and it would "listen" to the CQC's recommendations.

Inspectors visited the York Hospital, St Helen's Rehabilitation Hospital and White Cross Court Rehabilitation Hospital in July 2011.

'Difficult topic'

They found that DNAR forms at York Hospital and St Helen's were not being completed correctly.

The documents were also not being reviewed as required by the hospital's own guidelines.

This meant that some patients may have had an instruction in place which was out of date, incorrect or no longer in their best interests, inspectors said.

Jo Dent, regional director of CQC for Yorkshire and Humber, said: "We found DNAR forms which had been completed by a doctor but that there was no evidence to say that patients had been involved in the decision, or evidence that relatives, even where they were taking an active role in the patient's progress, had been consulted."

She added: "Doctors we spoke to agreed it was best practice to discuss these decisions with the family or next-of-kin and the patient themselves, where possible.

"But one doctor also told us that it was a difficult topic to raise with relatives and patients and that these decisions were often made when relatives were not around."

'Best interests'

Patrick Crowley, chief executive at York Teaching Hospital NHS Foundation Trust said the trust was "disappointed to be found wanting in any area".

He said everyone within the organisation recognised the "importance and sensitivity" of discussions with patients and their families regarding DNAR decisions.

"We are aware of individual cases where patients and relatives have understandably found this difficult and we are sorry if this has caused any undue distress," he said.

"We want to listen to this feedback to help us develop our processes and ensure we demonstrate that we are acting in patients' best interests."

Mr Crowley added that a new system was introduced not long before the CQC's visit, and that the trust was continuing to roll that out across the organisation.

However, he added that while the CQC found "a small number" of concerns, the reports also highlighted "many examples" of good practice.

CQC has given the trust 28 days to provide a report that says what action they are going to take to address the problem.

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Worried about vitamin safety? Experts offer advice

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In this Thursday, Oct. 13, 2011 photo illustration, multivitamins are poured from a bottle in Philadelphia. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) In this Thursday, Oct. 13, 2011 photo illustration, multivitamins are poured from a bottle in Philadelphia. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) The nutritional label of a box of multivitamins is photographed in Philadelphia on Thursday, Oct. 13, 2011. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke) The nutritional label of a box of multivitamins is photographed in Philadelphia on Thursday, Oct. 13, 2011. Two studies released in Oct. 2011 raised gnawing worries about the safety of vitamin supplements and a host of questions. Vitamins have long had a "health halo" - many people think they won't hurt and at worst might be unnecessary. The industry calls them an insurance policy against bad eating. But our foods increasingly are pumped full of them - even junk foods and drinks often are fortified with nutrients to give them a healthier profile - so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit. (AP Photo/Matt Rourke)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); Two studies this week raised gnawing worries about the safety of vitamin supplements and a host of questions. Should anyone be taking them? Which ones are most risky? And if you do take them, how can you pick the safest ones?

Vitamins have long had a "health halo." Many people think they're good for you and at worst might simply be unnecessary. The industry calls them an insurance policy against bad eating.

But our foods are increasingly pumped full of them already. Even junk foods and drinks often are fortified with nutrients to give them a healthier profile, so the risk is rising that we're getting too much. Add a supplement and you may exceed the upper limit.

"We're finding out they're not as harmless as the industry might have us believe," said David Schardt, a nutritionist at the consumer group Center for Science in the Public Interest.

This week, a study of nearly 40,000 older women found a slightly higher risk of death among those taking dietary supplements, including multivitamins, folic acid, iron and copper. It was just an observational study, though, not a rigorous test.

Another study found that men taking high doses of vitamin E — 400 units a day — for five years had a slightly increased risk of prostate cancer.

As many as one-third of Americans take vitamins and nearly half of people 50 and older take multivitamins, surveys suggest. Americans spent $9.6 billion on vitamins last year, up from $7.2 billion in 2005, according to the Nutrition Business Journal. Multivitamins top the list, at nearly $5 billion in sales.

Yet there is no clear evidence that multivitamins lower the risk of cancer, heart disease or any other chronic health problems. No government agency recommends them "regardless of the quality of a person's diet," says a fact sheet from the federal Office of Dietary Supplements. And vitamins aren't required to undergo the strict testing required of U.S.-approved prescription medicines.

Some fads, such as the antioxidant craze over vitamins A and E and beta-carotene, backfired when studies found more health risk, not less. And studies that find more disease in people with too little of a certain vitamin can be misleading: Correcting a deficiency so you have the right daily amount is different from supplementing beyond recommended levels.

The best way to get vitamins is to eat foods that naturally contain them, said Jody Engel, a nutritionist with Office of Dietary Supplements. "Foods provide more than just vitamins and minerals, such as fiber and other ingredients that may have positive health effects."

Schardt adds: "It's virtually impossible to overdose on the nutrients in food."

Some folks may need more of certain nutrients and should talk with their doctors about supplements:

— Postmenopausal women regarding calcium and vitamin D to protect bones.

— Women planning on pregnancy regarding folate, or folic acid, to prevent birth defects.

— People over age 50 and vegans who may need vitamin B12. "As we get older, a number of us no longer produce enough acid in the stomach to extract the B12 in food," Schardt explained.

— Pregnant women, who may need extra iron.

— Breastfed infants and possibly other infants concerning vitamin D.

Vitamin D is a nutrient many of us may need to supplement. Last fall, the Institute of Medicine, a panel of scientists who advise the government, raised the recommended amount but also warned against overdoing it. People ages 1 to 70 should get 600 international units a day, older folks 800 units.

If you do need a supplement, beware: Quality varies. Consumerlab.com, a company that tests supplements and publishes ratings for subscribers, has found a high rate of problems in the 3,000 products it has tested since 1999.

"One out of 4 either doesn't contain what it claims or has some other problems such as contamination or the pills won't break apart properly," said company president Dr. Tod Cooperman.

For example, one gummy bear calcium product had 250 percent of the amount of vitamin D claimed on the label. Another liquid product made with rose hips had just over half the amount of vitamin C listed.

"You don't have to pay a lot. Price is not necessarily linked to quality," he said. "The quality doesn't really relate to where you're buying it. I know many people are surprised by that or don't want to believe it, but that is the case. We find good and bad products in every venue."

Mark Blumenthal, executive director of the American Botanical Council, suggests looking for "seals of approval" or certifications of quality from groups that spot-test supplements such as the USP, or United States Pharmacopeia; NSF International and NPA, the Natural Products Association.

Experts offered this advice:

— Keep it simple. The more ingredients there are in a supplement combo, the more chance that one of them will not be the right amount, Cooperman said.

— Consider a supplement combo tailored to your gender and age, the Office of Dietary Supplements suggests. Multivitamins often contain little iron, and ones for seniors give more calcium and vitamin D than products aimed at younger adults.

— Take vitamin D with dinner. A study found significantly more absorption of that nutrient when it was consumed at the largest meal, which tends to have more fat, than at breakfast, Cooperman said.

— Watch out for vitamin K — it promotes clotting and can interfere with common heart medicines and blood thinners such as warfarin, sold as Coumadin and other brands.

— Current and former smokers are advised to avoid multivitamins with lots of beta-carotene or vitamin A; two studies have tied them to increased risk of lung cancer.

— For cancer patients, "vitamins C and E might reduce the effectiveness of certain types of chemotherapy," Engel said.

— People having surgery should know that some vitamins can affect bleeding and response to anesthesia.

With any supplement — ask your doctor.

__

Online:

Vitamin facts: http://ods.od.nih.gov/factsheets/list-VitaminsMinerals

and http://ods.od.nih.gov/factsheets/MVMS-HealthProfessional

FAQs: http://ods.od.nih.gov/Health_Information/ODS_Frequently_Asked_Questions.aspx

Dietary advice: www.dietaryguidelines.gov

Vitamin E and prostate study: http://jama.ama-assn.org/content/306/14/1549

Video interview with author: http://jama.ama-assn.org/content/306/14/1549/suppl/DC1

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Public 'in denial about diets'

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13 October 2011 Last updated at 13:40 GMT By Nick Triggle Health correspondent, BBC News Dame Sally Davies: "People are not honest with themselves about what they're eating and drinking "

People need to be more honest about how much they eat and drink if obesity levels are to be cut, ministers say.

The message formed a central theme of the new obesity strategy for England as the government tried to stress the importance of personal responsibility.

In doing so, it rejected calls to introduce legislation to change behaviour, such as a "fat tax".

But the strategy was labelled "pathetic and stupid" by experts, who warned it would do little to solve the problem.

Instead of proposing using regulation, the strategy talked about creating the right environment for individuals to make healthier choices.

This included getting councils to use their powers to encourage more physical activity through schemes such as cycling networks and green spaces.

It also said industry had a role to play and promised to build on the responsibility deal, which was announced at the start of this year and saw private firms sign up to a series of pledges, including introducing calorie counts on menus and reducing salt levels in food.

Reverse the tide

Mr Lansley said: "We have to halt and then reverse the tide of obesity in this country.

"Government has a role to play, but it is clear that we cannot do this alone."

When asked about why the government was not more keen on legislation, he said by working in partnership, more could be achieved faster.

However, he admitted officials would continue to monitor the international evidence where countries were trying tougher legislation.

Continue reading the main story Alongside the obesity strategy, ministers also announced new recommended levels of energy intake following a review by advisers.It is the first time for 20 years that they have been changed.Despite calling for people to eat less, the guidelines actually increase the amount people can eat to maintain a healthy weight.For a man of average height, the daily amount has increased from 2,550 calories to 2,605.For women it has increased from 1,940 to 2,079.But before you get too carried away, officials stressed that most people are already eating more than the new guidelines.More than 60% of adults and 23% of four to five-year-olds are overweight or obese in England, making it one of the most overweight nations in Europe.

As part of the strategy, Mr Lansley said the government was looking for rates to start falling by 2020.

To achieve this, individuals need to be honest about what they are eating, Professor Sally Davies, the chief medical officer said.

"It is about what we eat, how we cook it and about portion size."

She said one of the problems was that people were not even honest with themselves about their diets, never mind health professionals.

Figures set out in the strategy suggest that the average adult consumes 10% more calories than they should.

But Professor Philip James, of the International Association for the Study of Obesity, said it was a "stupid" and "pathetic" response to the problem.

"It is not simply a question of personal responsibility. There is an environmental problem in terms of the food system we have."

He went on to say that the junk food industry "manipulated" individuals into consuming their products and that was why legislation was needed.

And Charlie Powell, campaigns director of the Children's Food Campaign, said: "This is a deeply disappointing and utterly inadequate response which represents a squandered opportunity to address the obesity crisis.

"High in rhetoric and lacking in substance, it is nothing less than an abdication of the government's responsibility to protect public health."

Shadow public health minister Diane Abbott added: "This is very disappointing. We need to do much more to tackle this problem."

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Q&A: Key answers about listeria in fruit

AppId is over the quota
AppId is over the quota
Some questions consumers may have about listeria in cantaloupes.

Q: What is listeria?

A: Listeria is a hardy bacteria found in soil and water that can be carried by animals. It is often found in processed meats because it can contaminate a processing facility and stay there for a long period of time. It is also common in unpasteurized cheeses and unpasteurized milk. It is less common in produce like cantaloupe, but there have been a couple of other listeria outbreaks in fruits and vegetables in recent years. When a person contracts the disease, it can cause fever, muscle aches, gastrointestinal symptoms and even death. One in five people who have listeria can die.

Q: Am I at risk?

A: Listeria generally only affects the elderly, people with compromised immune systems, pregnant women and newborns whose mothers were infected before birth. The median age of victims in this outbreak is 78 years old. Healthy, younger adults and most children can usually consume listeria with no ill effects or mild illness.

Q: So can I eat cantaloupe?

A: You should avoid cantaloupe from Jensen Farms, the Colorado grower that distributed the tainted fruit.

Q: How do I know if I have a cantaloupe from Jensen Farms?

A: The recalled cantaloupe may be labeled "Colorado Grown," ''Distributed by Frontera Produce," ''Jensenfarms.com" or "Sweet Rocky Fords." It may also be labeled "USA." Not all of the recalled cantaloupes are labeled with a sticker, the Food and Drug Administration said, so it may be hard to tell. Neither the government nor Jensen Farms has released a list of retailers who sold the fruit, so health officials advise consumers ask retailers about the origin of their cantaloupe.

Q: I think I may have had one of the contaminated cantaloupes in my home. But I'm not sure. What should I do?

A: The government's motto is "when in doubt, throw it out." And if you think you had tainted fruit in your home, clean and sanitize all surfaces it may have touched.

Q: I scrub all of my fruits and vegetables before I eat them. So I am okay, right?

A: Scrubbing is never a bad idea, but it may not rid produce of all contaminants, especially on cantaloupe which has a thick, rough skin with a lot of places for pathogens to hide. Health officials think people may have been sickened when people cut into their cantaloupes, bringing listeria on the outside of the fruit to the inside. If you think you may have a tainted cantaloupe in your house, the best recourse is to throw it out.

Q: It looks like the cantaloupes weren't even shipped to my state. Should I still be concerned?

A: The FDA said Jensen Farms shipped to 25 states, but it may have been resold in other states. Illnesses have been discovered in several states where cantaloupes weren't shipped, including in Maryland where a person died.

Q: Why have there been so many deaths?

A: Listeria is less well-known than other pathogens like salmonella and E. coli, which cause many more illnesses in tainted food every year. But listeria is more deadly. One in five people who contract it can die.

Q: When is this outbreak going to be over?

A: FDA and CDC officials said Wednesday that they expect the number of illnesses and even deaths to rise through October. Listeria has an incubation period of a month or more, so people who ate contaminated fruit last week may not see illnesses until next month.

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HEALTH MANAGEMENT. FDA warns about cantaloupe linked to illness, deaths

CHICAGO (Reuters) - The Food and Drug Administration warned consumers on Thursday not to eat cantaloupe grown in part of Colorado after two deaths from what it said was the first Listeria outbreak traced to the melon.
Jensen Farms, grower of the cantaloupe in the Rocky Ford region of Colorado, voluntarily recalled the melons earlier in the week. The melons were sent to at least 17 states.
A specific strain of Listeria, a bacteria that can lead to a deadly flu-like illness, was found as the cause of 22 Listeriosis cases and traced back to the Jensen Farms cantaloupe, the FDA said.
Food-borne Listeria outbreaks are typically associated with deli meats and hot dogs, the FDA said. The only two produce-based outbreaks of listeria were from sprouts in 2009 and fresh-cut celery in 2010, according to the FDA.
In the current outbreak, people were infected in seven states -- 12 in Colorado, four in New Mexico, two in Texas, and one in Oklahoma, Nebraska, Indiana and West Virginia, according to the Centers for Disease Control.
In Colorado, a man filed a lawsuit against Jensen Farms and Wal-Mart Stores Inc after falling ill from a cantaloupe he purchased from one of the retail giant's stores, law firm Montgomery Little & Soran, PC said on Thursday.
Charles Palmer, 71, said in the complaint filed in El Paso County District Court that he has been hospitalized for more than two weeks with Listeriosis after eating cantaloupe grown by Jensen Farms in Colorado's Arkansas Valley.
Palmer was rushed to a hospital on August 31 after his wife said he was unresponsive days after eating a cantaloupe bought at a Colorado Springs Wal-Mart, the lawsuit said.
Greg Rossiter, spokesman for Wal-Mart, said the company wishes Palmer well, and was conducting an investigation.
He said that out of "an abundance of caution," the retailer pulled all Rocky Ford cantaloupes from its shelves after officials identified the Colorado connection.
Jensen Farms voluntarily recalled all the cantaloupes it shipped to 17 states between July 29 and September 10, Ryan Jensen, a partner in the farm, said in a statement.
"Jensen Farms continues to stay committed to the highest levels of food safety and maintains many third party safety audits, as we have for many years," he said. "We continually look for ways to enhance our protocol."
Palmer's attorney, William Marler, said in a statement that the farm and Wal-Mart have "a public responsibility to all consumers to sell and distribute food that is free and clear of all adulterants."
"In this case, a lapse in food safety assurance has relegated an innocent man to a hospital bed for a long time," he said.
The FDA specifically cautioned older adults, people with immune system diseases and pregnant women from eating cantaloupe grown in the Rocky Ford region.
The recall was in effect for Illinois, Wyoming, Tennessee, Utah, Texas, Colorado, Minnesota, Kansas, New Mexico, North Carolina, Missouri, Nebraska, Oklahoma, Arizona, New Jersey, New York and Pennsylvania. The FDA said the cantaloupe might be in other states as well.
(Additional reporting by Keith Coffman in Colorado; Editing by Dan Whitcomb, Greg McCune and Cynthia Johnston)

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