Year in Review: Meningitis Outbreak Still a Challenge

As part of the Year in Review series, MedPage Today reporters are revisiting major news stories and following up with an analysis of the impact of the original report, as well as subsequent news on the topic. Here’s what’s happened with the fungal meningitis outbreak since we published our first report.

The fungal meningitis outbreak that made headlines in the fall was “unprecedented,” in the words of the of the clinicians at the eye of the storm.

What’s more, “we’re not out of the woods yet,” said Tom Chiller, MD, deputy director of the CDC’s mycotic diseases branch.

The outbreak was unprecedented for its size, for the spectrum of disease, for the clinical challenges that faced doctors, and for the way the pattern of illness has changed since the outbreak began, Chiller told MedPage Today.

It also has enormous implications for patients, their families, hospitals, and insurers, said Carol Kauffman, MD, a fungal infections expert at the University of Michigan in Ann Arbor, Mich.

“The extent and repercussions of this outbreak, in comparison to other smaller outbreaks, are really amazing,” Kauffman told MedPage Today. “The huge morbidity and, for some, mortality, is enormous.”

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The outbreak, which has been linked to an injectable drug widely used to control chronic pain, has also seen the FDA under attack for not doing more to monitor so-called “compounding pharmacies.”

And the FDA has responded by saying it did not have clear authority to intervene, even though worries about the pharmacy in question, the New England Compounding Center (NECC) of Framingham, Mass., date back to at least 2002.

The agency is now asking for its authority to be clarified, although an organization representing compounding pharmacies has told lawmakers the FDA had all the power it needed, but just dropped the ball.

The bottom line from a public health standpoint is that as of Dec. 17, the CDC had recorded 620 cases of disease and 39 deaths. And more are likely, according to Chiller: “We’re still in the middle of this thing.”

Compounding Out of Bounds

The outbreak can be said to have started in the summer, when NECC made 17,675 vials of preservative-free methylprednisolone acetate, an injectable steroid, and shipped them to 76 healthcare facilities in 23 states.

That was problematic in itself: The company was licensed as a compounding pharmacy, meaning in principle it was allowed only to make up small quantities of specialized drugs, after getting a prescription from a doctor for an individual patient.

Instead, it was acting more like a large-scale drug manufacturer, and had been for some years, according to Massachusetts officials, which should have placed it under the FDA’s authority.

The manufacturing scale played a key role in what ensued: more than 13,000 people were exposed to the drug when they got injections – mainly into the spine – to control chronic pain.

They were also exposed to a fungal contaminant in the steroid vials, later found to be a black mold called Exserohilum rostratum, which only rarely causes human disease.

Oddly, the index case for the outbreak, reported to health authorities on Sept. 18, was a 56-year-old man in Nashville who had a case of meningitis apparently associated with the fungus Aspergillus fumigatus.

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Death! Sex! How Comic Books Bump Their Sales

In comic book publishing, the decision to kill off a long-running and beloved character may seem, at first glance, like a terribly unwise business move. But when Marvel Comics released its latest issue of Amazing Spider-Man—#700, which ends with Peter Parker, the webbed crusader’s alter ego, getting murdered—the issue began flying off the shelves.

“The sales are phenomenal,” says Axel Alonso, the editor in chief at Marvel Comics, “Amazing Spider-Man #700 has sold nearly 250,000 copies in print alone; final digital orders aren’t in yet. This is the best-selling comic book at this price-point of the last decade, at least.”Photograph Courtesy Marvel

Marvel isn’t the first comics company to lift sales by employing a shocking new creative direction. In fact, it’s actually a common practice, which gained attention in the 1970s but reached new heights in the early 1990s, when DC Comics destroyed its most famous character, Superman, in a publishing event that fueled sales across the world.

Here are four of the most surefire, lucrative, and reliably controversial methods that comic book creators use to gain readership and boost the bottom line.

I. Embrace alternative lifestyles

Gay characters are nothing new—an X-Men superhero called Northstar came out of the closet in 1992—but the subject is still controversial enough to cause a public outcry. The comic Life With Archie No. 16, which featured the first same-sex wedding in the series’ otherwise conservative history, hit newsstands in early 2012 and quickly became a target for One Million Moms, a conservative group that called for Toys R Us to stop selling the comic or be boycotted. The threat didn’t work. “[The Million Moms] really propelled the book,” says Archie Comics Chief Executive Jon Goldwater. “It was selling well anyway, but they made it a collector’s item. Last I heard it was selling on eBay for $ 50.” Dan Parent, a writer and illustrator who has worked for Archie for 20 years and penned the gay wedding issue, says he’d “love to send the Million Moms a big box of chocolates and flowers, to thank them for helping the Life With Archie book to sell out. It was a marketing dream.”

II. Court ethnicity

Marvel Comics unleashed an entirely new Spider-Man in August 2011. The costume was the same, but under it was a half-African American, half-Latino teenage boy named Miles Morales. Glenn Beck discussed the new biracial Spider-Man on his radio show. “The new Spider-Man looks just like president Obama,” he said. “I think a lot of this stuff is being done intentionally.” Stan Lee, the legendary comic book writer who co-created Spider-Man, dismisses the conspiracy theories. In fact, he says bringing a little ethnicity to comics is nothing new for his company. “Years ago at Marvel, in the 60s, we had a war book called Sgt. Fury and his Howling Commandos,” he says. “We introduced a black soldier, an Italian soldier, a Jewish soldier. We had every ethnic group represented in this platoon. And I was told, ‘Oh this book will never sell in the South.’ Or ‘it will never sell in the West.’ Or the North, or the East, or wherever the marketing department was worried somebody would be offended. But it was one of our best-selling books ever!”

III. Sex it up

Superheroes have always been synonymous with sex—their costumes aren’t skintight by accident—but in recent years, the characters have gotten far more steamy and intense. Several new titles released as part of DC Comics “New 52″ relaunch in 2011 included intimate scenes with over-the-top NSFW drawings. Catwoman #1, published in September 2011, gained attention for the eponymous character’s violent sex scene with Batman.

But sex in comics can come bearing consequences—as an issue of Dark Horse’s Buffy the Vampire Slayer series proved in February. Buffy, after discovering she’s pregnant, decides to get an abortion. “We wanted to court controversy,” admits Scott Allie, the editor in chief at Dark Horse Comics. “We were fed up with America’s glamorization of teenage pregnancy and wanted to do a story that explored the reasonable choice of terminating a pregnancy.” He says they anticipated the media headlines and even worked with their marketing department to encourage them, but “I don’t know that they really impact sales. Since it is a genuinely controversial issue, it probably costs us as many sales as it gets us.” In the end, Allie says, the issue sold well, but not in record numbers. “I think in order to do controversy in a way that would really boost sales, we’d have to try a little harder,” he says. “And that’s not a great reason to do it.”

IV. Kill your icons

Comic books have been killing off popular characters since the early 1970s, when Peter Parker’s girlfriend Gwen Stacy was murdered by the Green Goblin, which, at the time, was akin to superhero heresy. Since then, seemingly immortal characters like Superman, Robin the Boy Wonder, and Captain America have all been killed off at one time or another, usually followed by a tsunami-size media response and a comic-buying frenzy. “As far as what kind of controversy equates to biggest sales, it’s always been and always will be the death of a major character,” says Brandon Zuern, the store manager of Austin Books & Comics in Austin, Tex. “I think death in comics is way overused, but people keep buying them.” The best part of killing an iconic character is that the fans do most of the work for you. “The story kind of markets itself,” says Marvel Comics Editor in Chief Alonso. “You just get the word out, and people want to know more. ‘Peter Parker Death’ has been the No. 1 trending topic on Yahoo for the last two days, which speaks volumes about their love for Peter Parker.”

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Suspected US drone kills 3 al-Qaida men in Yemen

SANAA, Yemen (AP) — Three al-Qaida militants were killed in a suspected U.S. drone strike in southern Yemen, Yemeni security officials said, the fourth such attack this week and a sign attacks from unmanned aircraft are on the upswing in the country.

The officials said the three men were hit as they were riding in a Land Cruiser in el-Manaseh village on the outskirts of Radda in Bayda province. Dozens of local al-Qaida-linked fighters protested the drone strikes after traditional Islamic Friday prayers.

Earlier this week another suspected U.S. drone strike killed two militants in Radda itself, Yemeni security officials say, and seven were killed in two other strikes in the southeastern province of Hadramawt. Four suspected drone strikes a week is uncommon in Yemen.

According to statistics gathered by the Long War Journal before Saturday’s attacks, the United States “is known to have carried out 41 airstrikes” this year against al-Qaida in the Arabian Peninsula (AQAP), as the group’s branch in Yemen is known. That makes for an average of around three to four strikes per month.

The Journal, a product of the Foundation for Defense of Democracies that was founded by former U.S. officials, says that since December 2009, the CIA and the US military’s Joint Special Operations Command are known to have conducted at least 54 air and missile strikes inside Yemen, excluding Saturday’s suspected attack.

AQAP overran entire towns and villages — including Radda — last year by taking advantage of a security lapse during nationwide protests that eventually ousted the country’s longtime ruler. Backed by the U.S. military, Yemen’s army was able to regain control of the southern region but al-Qaida militants continue to launch deadly attacks on security forces that have killed hundreds.

Also on Saturday, two gunmen on a motorbike shot and killed an intelligence officer in the southeast, security officials said. They said that the officer, Mutea Baqutian, was on his way to work in Mukalla, capital of Hadramawt province, when the men stopped his car, gunned him down, and fled.

The government has blamed al-Qaida militants for similar assassinations of several senior military and intelligence officials this year. The bullet-riddled body of Major al-Numeiry Abdo al-Oudi, deputy director of the security department of al-Qitten in Hadramawt, was found in the town’s suburbs last week. He had been kidnapped earlier in the month.

All officials spoke on condition of anonymity according to regulations.

Meanwhile, Maj. Gen. Ahmed Seif, who is commander of Yemen’s central military region, said the Defense Ministry has deployed an infantry brigade in the northeastern province of Marib to stop armed tribesmen who maintain cordial ties with al-Qaida from attacking oil pipelines and power generating stations, as well as to counter al-Qaida militants.

State TV meanwhile aired a meeting between President Abed Rabbo Mansour Hadi and eight Yemeni sailors who were rescued last week by forces of Somalia’s semiautonomous Puntland region after being held for nearly three years by Somali pirates.

The Puntland government says that its forces captured the hijacked Panama-flagged MV Iceberg 1 on Sunday after a siege that lasted two weeks. They freed the eight Yemeni sailors together with five Indians, two Pakistanis, four Ghanaians, two Sudanese and a Filipino. The ship was hijacked March 29, 2010.

Hadi congratulated the eight sailors for their safety and ordered the government to compensate them for their suffering.

Eqbal Yassin, a relative of one of the freed sailors, told The Associated Press that the hijackers had allowed some sailors to phone their relatives and convey the pirates’ demand for $ 5 million ransom. He said he was told by his relative that the hijackers killed a Yemeni sailor who tried to escape. He gave no further details.

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Apple still said to account for 87% of North American tablet traffic as Kindle Fire, Nexus 7 gain

Apple’s (AAPL) share of the global tablet market is in decline now that low-cost Android slates are proliferating, but the iPad still appears to be the most used tablet by a huge margin. Ad firm Chitika regularly monitors tablet traffic in the United States and Canada and in its latest report, Apple’s iPad was responsible for almost 90% of all tablet traffic across the company’s massive network.

[More from BGR: Samsung looks to address its biggest weakness in 2013]

Using a sample of tens of millions of impressions served to tablets between December 8th and December 14th this year, Chitika determined that various iPad models collectively accounted for 87% of tablet traffic in North America. That figure is down a point from the prior month but still represents a commanding lead in the space.

[More from BGR: New purported BlackBerry Z10 specs emerge: 1.5GHz processor, 2GB RAM, 8MP camera]

The next closest device line, Amazon’s (AMZN) Kindle Fire tablet family, had a 4.25% share of tablet traffic during that period, up from 3.57% in November. Samsung’s (005930) Galaxy tablets made up 2.65% of traffic, up from 2.36%, and Google’s (GOOG) Nexus 7 and Nexus 10 tablets combined to account for 1.06% of tablet traffic in early December.

“Despite these gains by some of the bigger players in the tablet marketplace, there has been a negligible impact to Apple’s dominant usage share,” Chitika wrote in a post on its blog.

This article was originally published by BGR

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MSF warns Kenya not to send more refugees to stricken camp

LONDON (Reuters) – Conditions in a camp for Somali refugees in Kenya are deplorable and a government plan to send in thousands more would pose a major risk to health, medical charity Medecins Sans Frontieres (MSF) said on Friday.

Kenya has more than half a million refugees from Somalia, which has lacked an effective central government since the outbreak of civil war in 1991.

A series of bombings, shootings and hand-grenade attacks blamed on Somali militants prompted the government on December 18 to stop registering asylum seekers and refugees in urban areas.

A Kenyan official said more than 100,000 refugees must now head to the remote Dadaab camp in the country’s remote north. Amnesty International said the order breached international law.

Dadaab camp was set up 20 years ago and already houses four times the population it was built for. Hunger and disease outbreaks are common.

MSF says its inhabitants suffer from overcrowding and poor sanitation that recent floods had worsened.

“The assistance provided here in Dadaab is already completely overstretched and is not meeting the current needs,” said Elena Velilla, MSF’s head of mission in Kenya.

In the last month, the number of children admitted to Dadaab’s hospital for severe acute malnutrition has doubled to around 300, MSF said. Sixty-three of those were taken to intensive care this week after developing serious complications.

Most of the sick are also suffering from acute watery diarrhea or severe respiratory tract infections, MSF said.

(Reporting by Kate Kelland; Editing by Tom Pfeiffer)

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Pending home sales hit two-and-half year high in November

WASHINGTON (Reuters) – Contracts to buy previously owned U.S. homes rose in November to their highest level in 2-1/2 years, an industry group said on Friday, further evidence of a strengthening housing market recovery.

The National Association of Realtors said its Pending Home Sales Index, based on contracts signed last month, increased 1.7 percent to 106.4 – the highest level since April 2010 when the home-buyer tax credit expired.

Economists polled by Reuters had expected signed contracts, which become sales after a month or two, to rise 1.0 percent after a revised 5.0 percent increase in October. It was the third straight month of gains.

“Home sales are recovering now based solely on fundamental demand and favorable affordability conditions,” said NAR chief economist Lawrence Yun.

Pending home sales were up 9.8 percent in the 12 months through November.

The housing market has turned the corner after a dramatic collapse, which dragged the economy through its worst recession since the Great Depression of the 1930s.

Home sales and prices are rising, encouraging builders to undertake new construction projects.

Home resale contracts were up in three of the country’s four regions. They were unchanged in the South.

(Reporting By Lucia Mutikani; Editing by Neil Stempleman)

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C. African Republic president seeks foreign help

BANGUI, Central African Republic (AP) — The president of Central African Republic on Thursday urgently called on France and other foreign powers to help his government fend off rebels who are quickly seizing territory and approaching the capital, but French officials declined to offer any military assistance.

The developments suggest Central African Republic could be on the brink of another violent change in government, something not new in the history of this resource-rich, yet deeply impoverished country. The current president, Francois Bozize, himself came to power nearly a decade ago in the wake of a rebellion.

Speaking to crowds in Bangui, a city of some 600,000, Bozize pleaded with foreign powers to do what they could. He pointed in particular to France, Central African Republic’s former colonial ruler.

About 200 French soldiers are already in the country, providing technical support and helping to train the local army, according to the French defense ministry.

“France has the means to stop (the rebels) but unfortunately they have done nothing for us until now,” Bozize said.

French President Francois Hollande said Thursday that France wants to protect its interests in Central African Republic and not Bozize’s government. The comments came a day after dozens of protesters, angry about a lack of help against rebel forces, threw rocks at the French Embassy in Bangui and stole a French flag.

Paris is encouraging peace talks between the government and the rebels, with the French Foreign Ministry noting in a statement that negotiations are due to “begin shortly in Libreville (Gabon).” But it was not immediately clear what, if any, dates have been set for those talks.

French Foreign Minister Laurent Fabius, meanwhile, spoke via phone with Bozize, asking the president to take responsibility for the safety of French nationals and diplomatic missions in Central African Republic.

U.S. officials said Thursday the State Department would close its embassy in the country and ordered its diplomatic team to leave. The officials spoke on condition of anonymity because they were unauthorized to discuss the evacuation publicly.

The United Nations Security Council issued a press statement late Thursday reiterating its concern about the situation in the country and condemned the attacks.

“The members of the Security Council reiterate their demand that the armed groups immediately cease hostilities, withdraw from captured cities and cease any further advance towards the city of Bangui,” the statement reads.

Bozize’s government earlier reached out to longtime ally Chad, which pledged to send 2,000 troops to bolster Central African Republic’s own forces. But it was unclear if the Chadian troops had all arrived, and even then, it is far from certain if the combined government forces could withstand rebel attacks.

At least four different rebel groups are involved, though their overall numbers could not immediately be confirmed.

Central African Republic, a landlocked nation of some 4.4 million people, is roughly the size of France. It has suffered decades of army revolts, coups and rebellions since gaining independence in 1960 and remains one of the poorest countries in the world.

The rebels behind the most recent instability signed a 2007 peace accord allowing them to join the regular army, but insurgent leaders say the deal wasn’t fully implemented.

Already, the rebel forces have seized at least 10 towns across the sparsely populated north of the country, and residents in the capital now fear the insurgents could attack at any time, despite assurances by rebel leaders that they are willing to engage in dialogue instead of attacking Bangui.

The rebels have claimed that their actions are justified in light of the “thirst for justice, for peace, for security and for economic development of the people of Central African Republic.”

Despite Central African Republic’s wealth of gold, diamonds, timber and uranium, the government remains perpetually cash-strapped. Filip Hilgert, a researcher with Belgium-based International Peace Information Service, said rebel groups are unhappy because they feel the government doesn’t invest in their areas.

“The main thing they say is that the north of the country, and especially in their case the northeast, has always been neglected by the central government in all ways,” he said.

But the rebels also are demanding that the government make payments to ex-combatants, suggesting that their motives may also be for personal financial gain.

Bozize, a former military commander, came to power in a 2003 rebel war that ousted his predecessor, Ange-Felix Patasse. In his address Thursday, Bozize said he remained open to dialogue with the rebels, but he also accused them and their allies of financial greed.

Those allies, he implied, are outside Central African Republic.

“For me, there are individuals who are being manipulated by an outside hand, dreaming of exploiting the rich Central African Republic soil,” he said. “They want only to stop us from benefiting from our oil, our diamonds, our uranium and our gold.”

___

Larson reported from Dakar, Senegal. Associated Press writer Sarah DiLorenzo in Paris contributed to this report.

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Police using Twitter to offer virtual ridealongs

SIOUX FALLS, S.D. (AP) — Riding side by side as a police officer answers a call for help or investigates a brutal crime during a ridealong gives citizens an up close look at the gritty and sometimes dangerous situations officers can experience on the job.

But a new approach to informing the public about what officers do is taking hold at police departments across the United States and Canada 7/8— one that is far less dangerous for citizens but, police say, just as informative.

With virtual ridealongs on Twitter, or tweetalongs, curious citizens just need a computer or smartphone for a glimpse into law enforcement officers‘ daily routines.

Tweetalongs typically are scheduled for a set number of hours, with an officer — or a designated tweeter like the department’s public information officer— posting regular updates to Twitter about what they are seeing as they perform their normal on-duty routine. The tweets, which also include photos and links to videos of the officers, can encompass an array of activities — everything from an officer responding to a homicide to a noise complaint.

Police departments say virtual ridealongs reach a wider range of people at once and help add transparency to the job.

“People spend hard-earned money on taxes to allow the government to provide services. That’s police, fire, water, streets, the whole works, and there should be a way for those government agencies to let the public know what they’re getting for their money,” said Steve Allender, chief of the Rapid City Police Department in South Dakota, which started offering tweetalongs several months ago after watching departments like those in Seattle, Kansas City, Mo., and Las Vegas do so.

On the Wednesday before Thanksgiving, Tarah Heupel, the public information officer for the Rapid City Police Department, rode alongside Street Crimes Officer Ron Terviel as he patrolled Rapid City. Heupel posted regular updates every few minutes about what Terviel was doing, including the officer citing a woman for public intoxication, responding to a call of three teenagers attempting to steal cough syrup and body spray from a store and locating a man who ran from the scene of an accident. Photos were included in some of the tweets.

Michael Taddesse, a 34-year-old university career specialist in Arlington, Texas, has done several ridealongs with police and regularly follows multiple departments that conduct tweetalongs.

“I think the only way to effectively combat crime is to have a community that is engaged and understands what’s going on,” he said.

Ridealongs where “you’re out in the elements” are very different than sitting behind a computer during a tweetalong and the level of danger is “dramatically decreased,” he said. But in both instances, the passenger gains new information about the call, what laws may or may not have been broken and what transpires, he added.

For police departments, tweetalongs are just one more way to connect directly with a community through social media.

More than 92 percent of police departments use social media, according to a survey of 600 agencies in 48 states conducted by the International Association of Chiefs of Police’s Center for Social Media. And Nancy Kolb, senior program manager for IACP, called tweetalongs a “growing trend” among departments of all sizes.

There is no set protocol and departments are free to conduct the tweetalong how they see fit, she said.

In Ontario, Canada, the Niagara Regional Police Service conducted their first virtual ridealong in August over a busy eight-hour Friday night shift. The police department‘s followers were able to see a tweet whenever the police unit was dispatched to one of the more than 140,000 calls received that night.

Richard Gadreau, the social media officer for the police department, said officers routinely take people out on real ridealongs, but there is a waiting list and preference is given to people interested in becoming an officer.

With tweetalongs, many calls also mean many tweets. Kolb said departments are cognizant of cluttering peoples’ Twitter feeds.

That’s why the Rapid City Police Department decided to create a separate account for the tweetalong, Allender said.

Kolb also said officers are careful not to tweet personal or sensitive information. Officers typically do not tweet child abuse or domestic abuse cases, and they usually only tweet about a call after they leave the scene to protect officers and callers.

But Allender, the chief of police in Rapid City, said tweetalongs also show some of the more outrageous calls police deal with on a regular basis — like the kid who breaks out the window of a police car while the officer is standing on the sidewalk.

“Real life is funnier than any comedy show out there and not to make fun of people, embarrass them or humiliate them, but people do funny things,” Allender said. “… I mean, that guy deserves a little bit of ridicule, and everyone who would be watching would agree. That’s just good clean fun to me.”

___

Follow Kristi Eaton on Twitter at http://twitter.com/kristieaton

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Film explores African-Americans’ unhealthy “soul food” habit

(Reuters) – After interviewing food historians, scholars, cooks, doctors, activists and consumers for his new film “Soul Food Junkies,” filmmaker Byron Hurt concluded that an addiction to soul food is killing African-Americans at an alarming rate.

The movie, which will premiere on January 14 on U.S. public broadcasting television, examines how black cultural identity is linked to high-calorie, high-fat food such as fried chicken and barbecued ribs and how eating habits may be changing.

In the deeply personal film, Hurt details his father’s fight and eventual death from pancreatic cancer. A high-fat diet is a risk factor for the illness, according to researchers at Duke University in North Carolina.

“I never questioned what we ate or how much,” 42-year-old New Jersey-based Hurt says in the film that travels from New Jersey and New York to Virginia, Georgia, Mississippi, Louisiana and Chicago.

“My father went from being young and fit to twice his size.”

Hurt, who also made “Hip-Hop: Beyond Beats and Rhymes,” decided to examine the link between calorie-loaded soul food and illnesses among blacks after his father was diagnosed in 2006.

He delves into his family history, as well as slavery, the African diaspora and the black power movement in the film and provides photographs, drawings, historic film footage and maps.

In Jackson, Mississippi, Hurt joined football fans for ribs and corn cooked with pigs’ feet and turkey necks. He also visited Peaches Restaurant, founded in 1961, where freedom riders and civil rights activists including Martin Luther King Jr. ate.

Hurt, whose family came from Milledgeville, Georgia, grew up on a diet of fried chicken, pork chops, macaroni and cheese, potatoes and gravy, barbecued ribs, sweet potato pie, collard greens, ham hocks and black-eyed peas.

“The history of Southern food is complex,” he said. “In many ways, the term soul food is a reduction of our culinary foodways.”

The origins of the diet lie in the history of American slavery, according to food historian Jessica B. Harris, who appears in the film. Slaves ate a high-fat, high-calorie diet that would allow them to burn 3,000 calories a day working, she explained.

Southern food began to be called soul food during the civil rights and black power movements of the 1960s, according to Hurt.

“There’s an emotional connection and cultural pride in what they see as the food their population survived on in difficult times,” he said.

But Hurt said African-Americans are being devastated by nutrition-related diseases.

Black adults have the highest rates of obesity and a higher prevalence of diabetes than whites, and are twice as likely to die of stroke before age 75 than other population groups, according to the U.S. Centers for Disease Control and Prevention.

Besides tradition and habit, poverty and neighborhoods without good supermarkets also contribute to an unhealthy diet, Hurt said.

“Low-income communities of color lack access to vegetables and have an overabundance of fast food and highly processed foods that are high in calories and fats. I always know when I’m in a community of color because I see … very, very few supermarkets and health food stores,” he added.

In her book, “High on the Hog: A Culinary Journey from Africa to America,” Harris said the prevalence of overprocessed foods, low-quality meats, and second- or third-rate produce in minority neighborhoods amounts to “culinary apartheid.”

In the film, Marc Lamont Hill, an associate professor of English education at Columbia University in New York, described minority health problems related to poor diet as “21st-century genocide.”

Hurt says the government can help by increasing urban access to quality food and requiring calorie counts to be displayed on restaurant menus.

Nonprofit organizations such as Growing Power Inc., which runs urban farms in Chicago and Milwaukee, provide fresh vegetables to minority neighborhoods.

Brian Ellis, 21, said all he ate was fast food when he started working at one of Growing Power’s urban farms in Chicago when he was 14.

“Then I started eating food I’d never seen before like Swiss chard,” said Ellis, who appears in the film. “I never knew what beets were. I’d never seen sprouts before. I’m not that big of a beet fan, but I love sprouts. I could eat sprouts all day.”

(Editing by Patricia Reaney and Mohammad Zargham)

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US ‘heading over fiscal cliff’

27 December 2012 Last updated at 11:40 ET

“It looks like that’s where we’re headed,” Harry Reid said of the fiscal cliff

The US appears to be heading over the “fiscal cliff”, with prospects dim for a deal to avoid tax rises and spending cuts, the US Senate leader says.

Speaking on the Senate floor, Democrat Harry Reid said there did not seem to be enough time to craft a deal before Monday night’s end-of-year deadline.

Senators and President Barack Obama have returned to Washington, while the House of Representatives is in recess.

Analysts say heading over the “cliff” could tip the US into recession.

Bickering over the cliff has divided Washington in recent weeks, with President Obama and House Speaker John Boehner unable to reach a deal before Christmas.

The president wants to ensure that taxes do not rise for Americans earning under $ 400,000 (£250,000), and insists on raising new tax revenue in any deal.

‘Dictatorship of the speaker’

But many Republicans oppose new taxes, and an alternative plan proposed by Mr Boehner – which would have seen taxes rise only on those earning over $ 1m – failed in the House late last week.

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• On 1 January 2013, tax increases and huge spending cuts are due to come into force – the so-called fiscal cliff


• Deadline was put in place in 2011 to force president and Congress to agree ways to save money over the next 10 years


• Fear is that raising taxes while massively cutting spending will have huge impact on households and businesses


• Experts believe it could push the US into recession, and have a global impact on growth

Republicans left Washington for Christmas and said responsibility for avoiding the cliff rested with the Democratic-led Senate.

But in the Senate chamber on Thursday Mr Reid said the requirement to get at least 60 of 100 votes to move to a vote on any legislation almost certainly doomed any new plan unless Republicans gave it strong backing.

“It looks like that’s where we’re headed,” Mr Reid said of the fiscal cliff.

The Senate leader said the House of Representatives was “being operated with a dictatorship of the speaker”, accusing Mr Boehner of holding up a vote on a Senate-passed bill to avoid the fiscal cliff.

“John Boehner seems to care more about keeping his speakership than about keeping the nation on sound financial footing,” Mr Reid said. Mr Boehner faces an internal re-election contest among House Republicans on 3 January.

The term fiscal cliff refers to the combination of almost $ 600bn (£370bn) of tax rises and spending cuts due to come into force on 1 January if Congress does not pass new legislation.

Sweeping tax cuts passed during the presidency of George W Bush will expire, affecting people of all income levels.

‘Extraordinary accounting’

In addition, spending cuts mandated by a law passed to break a previous fiscal impasse in Congress will come into force.

The cuts are expected to affect federal government departments and the defence sector, as well as hitting unemployment insurance and veterans’ support.

On Wednesday, Treasury Secretary Timothy Geithner warned Congress the Treasury would have to enact a series of extraordinary accounting measures to free up about $ 200bn from the government’s official borrowing figure.

Those measures would stop the government from hitting its $ 16.4tn “debt ceiling” – the legal limit set by Congress on how much the US government can borrow – for about another two months beyond 31 December.

But Mr Geithner warned that without them, the government would run out of cash on Monday and “the United States would otherwise default on its legal obligations”.

BBC News – Business

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