Pharmacy Blames Cleaners in Meningitis Outbreak

Jan 4, 2013 11:41am

Credit: Minnesota Department of Health/AP Photo

The pharmacy at the heart of the fungal meningitis outbreak says a cleaning company it hired should share the blame for the tainted steroid injections that caused more than 600 illnesses in 19 states, killing 39 people.

Click here to read about the road to recovery for fungal meningitis victims.

The New England Compounding Pharmacy, which made the fungus-tainted drugs, sent a letter to UniFirst Corp., which provided once-a month cleaning services to the Framingham, Mass., lab, “demanding” it indemnify NECC for the meningitis outbreak, according to a UniFirst filing with the Securities and Exchange Commission.

“Based on its preliminary review of this matter, the company believes that NECC’s claims are without merit,” UniFirst wrote in its quarterly filing.

The New England Compounding Center recalled 17,000 vials of tainted steroid injections on Sept. 26 before recalling all drugs and shutting down on Oct. 6.

The Food and Drug Administration investigated NECC’s lab and found that a quarter of the steroid injections in one bin contained “greenish black foreign matter,” according to the report.  The FDA also identified several cleanrooms that had bacterial or mold overgrowths.

UniFirst’s UniClean business cleaned portions of the NECC cleanrooms to NECC’s specifications and using NECC’s cleansing solutions, UniFirst spokesman Adam Soreoff said in a statement. It provided two technicians once a month for about an hour and a half.

“UniClean was not in any way responsible for NECC’s day-to-day operations, its overall facility cleanliness, or the integrity of the products they produced,” Soreoff said. “Therefore, based on what we know, we believe any NECC claims against UniFirst or UniClean are unfounded and without merit. ”

Click here for our fungal meningitis outbreak timeline, “Anatomy of an Outbreak.”

NECC was not immediately available for comment.

The House of Representatives subpoenaed Barry Cadden, who owns NECC,  to a hearing in Washington, D.C. on Nov. 14. He declined to testify when members of Congress pressed him on his role in ensuring that the drugs his company produced were safe and sterile.

“On advice of counsel, I respectfully decline to answer on the basis of my constitutional rights and privileges including the Fifth Amendment of the Constitution of the United States,” he said at the hearing.

Members of Congress also questioned whether the FDA could have prevented the outbreak.

Compounding pharmacies, which are intended to tailor drugs to individuals with a single prescription from a single doctor, are typically overseen by state pharmacy boards rather than the FDA because they are so small. However, in 2006, the FDA issued a warning letter to NECC, accusing it of mass-producing a topical anesthetic cream, and jeopardizing another drug’s sterility by repackaging it.

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Abbas sees Palestinian unity as Fatah rallies in Gaza

GAZA (Reuters) - President Mahmoud Abbas predicted the end of a five-year split between the two big Palestinian factions as his Fatah movement staged its first mass rally in Gaza with the blessing of Hamas Islamists who rule the enclave.

"Soon we will regain our unity," Abbas, whose authority has been limited to the Israeli-occupied West Bank since the 2007 civil war between the two factions, said in a televised address to hundreds of thousands of followers marching in Gaza on Friday, with yellow Fatah flags instead of the green of Hamas.

The hardline Hamas movement, which does not recognize Israel's right to exist, expelled secular Fatah from Gaza during the war. It gave permission for the rally after the deadlock in peace talks between Abbas's administration and Israel narrowed the two factions' ideological differences.

The Palestinian rivals have drawn closer since Israel's assault on Gaza assault in November, in which Hamas, though battered, claimed victory.

Egypt has long tried to broker Hamas-Fatah reconciliation, but past efforts have foundered over questions of power-sharing, control of weaponry, and to what extent Israel and other powers would accept a Palestinian administration including Hamas.

An Egyptian official told Reuters Cairo was preparing to invite the factions for new negotiations within two weeks.

Israel fears grassroots support for Hamas could eventually topple Abbas's Palestinian Authority (PA) in the West Bank.

"Hamas could seize control of the PA any day," Israeli Prime Minister Benjamin Netanyahu said on Thursday.

The demonstration marked 48 years since Fatah's founding as the spearhead of the Palestinians' fight against Israel. Its longtime leader Yasser Arafat signed an interim 1993 peace accord that won Palestinians a measure of self rule.

Hamas, which rejected the 1993 deal, fought and won a Palestinian parliamentary election in 2006. It formed an uneasy coalition with Fatah until their violent split a year later.

Though shunned by the West, Hamas feels bolstered by electoral gains for Islamist movements in neighboring Egypt and elsewhere in the region - a confidence reflected in the fact Friday's Fatah demonstration was allowed to take place.

"The success of the rally is a success for Fatah, and for Hamas too," said Hamas spokesman Sami Abu Zuhri. "The positive atmosphere is a step on the way to regain national unity."

Fatah, meanwhile, has been riven by dissent about the credibility of Abbas's statesmanship, especially given Israel's continued settlement-building on West Bank land. The Israelis quit Gaza unilaterally in 2005 after 38 years of occupation.

"The message today is that Fatah cannot be wiped out," said Amal Hamad, a member of the group's ruling body, referring to the demonstration attended by several Abbas advisers. "Fatah lives, no one can exclude it and it seeks to end the division."

In his speech, Abbas promised to return to Gaza soon and said Palestinian unification would be "a step on the way to ending the (Israeli) occupation".

(Editing by Dan Williams, Alistair Lyon and Jason Webb)

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Pakistani warlord's death a 'major development': US

WASHINGTON: The Pentagon welcomed reports Thursday that a prominent Pakistani warlord was killed in a drone strike, saying his death would represent a "major development."

Local officials in Pakistan said Mullah Nazir, the main militant commander in South Waziristan, was taken out when an unmanned US aircraft fired two missiles at his vehicle.

But a Pentagon spokesman could not confirm the account.

"If the reports are true, then this would be a significant blow, and would be very helpful not just to the United States but also to our Pakistani partners," spokesman George Little told reporters.

Nazir sent insurgents to Afghanistan to wage war on NATO-led troops and operated out of the tribal zone where militants linked to the Taliban and Al-Qaeda have bases on the Afghan border.

Pakistani officials said the drone strike on Wednesday killed Nazir and five of his loyalists, including two senior deputies.

Nazir, one of the highest-profile drone victims in recent years, had a complicated relationship with the Pakistani government, having agreed to a peace deal with Islamabad in 2007. Pakistani officials had hoped he could counter Pakistani Taliban insurgents.

He was understood to be close to the Al-Qaeda-linked Haqqani network, a faction of the Afghan Taliban blamed for some of the most high-profile attacks in Kabul and elsewhere in Afghanistan in recent years.

"This is someone who has a great deal of blood on his hands," Little said. "This would be a major development."

Washington has long urged Islamabad to crack down on the Haqqani network without success.

Drone bombing raids in Pakistan are run by the CIA and not by the Pentagon. Although an open secret, the CIA does not publicly discuss the drone air war, which officials believe has severely weakened Al-Qaeda's leadership in Pakistan.

According to figures compiled by a Washington think tank, US drone strikes against Islamist militants decreased in Pakistan's tribal regions for the second year in a row but intensified in Yemen.

In Pakistan, 46 strikes were carried out in 2012, compared to 72 in 2011 and 122 in 2010, the New America Foundation said, based on its compilation of reports in international media.

But Yemen saw an equally dramatic spike in the covert bombing runs, with strikes against Al-Qaeda in the Arabian Peninsula (AQAP) militants rising from 18 in 2011 to 53 in 2012.

- AFP/jc

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Amendment to anti-rape law to top agenda in MHA meet today

NEW DELHI: Timeline to fill police vacancies, rationalization of VIP security, modernization of forces including networking of police stations across the country and imparting special training to cops for handling cases relating to sexual offences against women will dominate the agenda of the meeting of chief secretaries and top cops of states here on Friday.

Convened in the backdrop of the Delhi gang-rape incident, the day-long meeting will also deliberate on possible amendments which can be brought in to make the existing laws much more stringent against rapists and also against offenders of crime against Schedules Castes and Schedule Tribes.

"Though the final decision about amending the law will be taken after submission of the Justice (retired) J S Verma Committee report, we will seek the opinions of director generals of police and chief secretaries of states," said an official, privy to the agenda of the meeting.

He said the suggestions emerged in the meeting would be passed on to the Verma panel.

The much-awaited Crime and Criminal Tracking Network and System (CCTNS) project to create an integrated database for enhancing efficiency and effectiveness of policing and sharing data among 14,000 police stations and over 6,000 higher offices across the country will formally be launched by the home minister Sushilkumar Shinde on the occasion.

The project includes creation of a nationwide networking infrastructure for the IT-enabled state-of-the-art tracking system that will revolve around investigation of crime and detection of criminals.

Issues relating to crime against women and atrocities on SCs\STs will be discussed in two different sessions where senior officials from the home ministry — led by home secretary R K Singh — would chalk out strategies to prevent such offences across the country.

"Discussion on amendments in the SCs and STs (prevention of atrocities) Act is also part of the agenda. Focus will be on building consensus around strengthening institutional mechanism and creating standard operating procedures to prevent crime against women and weaker sections of the society," said the official.

State would also be asked to focus on imparting 'special' training to cops for handing cases relating to sexual assault against women and emphasize on setting up of fast-track courts in consultation with respective High Courts for trying pending rape cases.

States have been asked to come with data on police vacancies as most of them failed to recruit cops despite being requested by the Centre in every high-level meet on security at the time when over one-fifth of the country's sanctioned police force remains just on paper.

Latest figures show that all states and Union Territories (UTs) had collectively reported police vacancy to the tune of nearly 4.20 lakh during 2011. The actual strength of the police force in the country as on December, 2011, was 16.60 lakh as against the sanctioned strength of 20.86 lakh, with Uttar Pradesh leading the pack in reporting police vacancies. The other states which report huge vacancy include Andhra Pradesh, Bihar, Jharkhand, Maharashtra, Haryana and West Bengal.

"Since the shortage of cops for actual policing is compounded by excessive deployment of police personnel for VIP security, the states will be asked to rationalize the system in such a manner that only those get State security who actually need it," said the official.

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CDC: 1 in 24 admit nodding off while driving

NEW YORK (AP) — This could give you nightmares: 1 in 24 U.S. adults say they recently fell asleep while driving.

And health officials behind the study think the number is probably higher. That's because some people don't realize it when they nod off for a second or two behind the wheel.

"If I'm on the road, I'd be a little worried about the other drivers," said the study's lead author, Anne Wheaton of the Centers for Disease Control and Prevention.

In the CDC study released Thursday, about 4 percent of U.S. adults said they nodded off or fell asleep at least once while driving in the previous month. Some earlier studies reached a similar conclusion, but the CDC telephone survey of 147,000 adults was far larger. It was conducted in 19 states and the District of Columbia in 2009 and 2010.

CDC researchers found drowsy driving was more common in men, people ages 25 to 34, those who averaged less than six hours of sleep each night, and — for some unexplained reason — Texans.

Wheaton said it's possible the Texas survey sample included larger numbers of sleep-deprived young adults or apnea-suffering overweight people.

Most of the CDC findings are not surprising to those who study this problem.

"A lot of people are getting insufficient sleep," said Dr. Gregory Belenky, director of Washington State University's Sleep and Performance Research Center in Spokane.

The government estimates that about 3 percent of fatal traffic crashes involve drowsy drivers, but other estimates have put that number as high as 33 percent.

Warning signs of drowsy driving: Feeling very tired, not remembering the last mile or two, or drifting onto rumble strips on the side of the road. That signals a driver should get off the road and rest, Wheaton said.

Even a brief moment nodding off can be extremely dangerous, she noted. At 60 mph, a single second translates to speeding along for 88 feet — the length of two school buses.

To prevent drowsy driving, health officials recommend getting 7 to 9 hours of sleep each night, treating any sleep disorders and not drinking alcohol before getting behind the wheel.

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Online:

CDC report: http://www.cdc.gov/mmwr

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Sandy Hook Parents Cope With Students' Return

Sandy Hook parents put their children on school buses this morning and waved goodbye as the yellow bus rolled away, but this first day back since the pre-Christmas massacre is anything but normal for the families of Sandy Hook Elementary School.

Erin Milgram, the mother of a first grader and a fourth grader at Sandy Hook, told "Good Morning America" that she was going to drive behind the bus and stay with her 7-year-old Lauren for the entire school day.

"I haven't gotten that far yet, about not being with them," Milgram said. "I just need to stay with them for a while."

Today is "Opening Day" for Sandy Hook Elementary School, which is re-opening about six miles away in the former Chalk Hill school in Monroe, Conn.

Lauren was in teacher Kaitlin Roig's first grade class on Dec. 14 when gunman Adam Lanza forced his way into the school and killed 20 students and six staffers.

Roig has been hailed a hero for barricading her students in a classroom bathroom and refusing to open the door until authorities could find a key to open the door.

The 20 students killed were first-graders and the Milgrams have struggled to explain to Lauren why so many of her friends will never return to school.

"She knows her friends and she'll also see on the bus... there will be some missing on the bus," Milgram said. "We look at yearbook pictures. We try to focus on the happy times because we really don't know what we're doing."

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"How could someone be so angry?" Lauren's father Eric Milgram wondered before a long pause. "We don't know."

The school has a lecture room available for parents to stay as long as they wish and they are also allowed to accompany their children to the classroom to help them adjust. Counselors will be available throughout the day for parents, staff and students, according to the school's website.

The first few days will be a delicate balancing act between assessing the children's needs and trying to get them back to a normal routine.

"We don't want to avoid memories of a trauma," Dr. Jamie Howard told "Good Morning America." "And so by getting back to school and by engaging in your routines, we're helping kids to do that, we're helping them to have a natural, healthy recovery to a trauma."

Connecticut Gov. Dannel Malloy announced at a news conference today that he has created a 15-member Sandy Hook Advisory Commission, which will be led by Hamden Mayor Scott Jackson. The commission will review gun control laws and regulations, school safety and mental health issues.

"It would be stupid for us not to have this conversation," Malloy said, speaking from the State Capitol in Hartford.

Security is paramount in everyone's mind. There is a police presence on campus and drivers of every vehicle that comes onto campus are being interviewed.

"Our goal is to make it a safe and secure learning environment for these kids to return to, and the teachers also," Monroe police Lt. Keith White said at a news conference on Wednesday.

A "state-of-the-art" security system is in place, but authorities will not go into detail about the system saying only that the school will probably be "the safest school in America."

White said at a news conference today that the security presence would be evaluated on a day-by-day and week-by-week basis moving forward.

"We are trying to keep a balance," he said. "We don't want them [the students] to think that this is a police state. This is a school and a school first."

Every adult in the school who is not immediately recognizable will be required to wear a badge as identification, parent and school volunteer Karen Dryer told ABCNews.com.

"They want to know exactly who you are at sight, whether or not you should be there," Dryer said.

Despite the precautions and preparations, parents will still be coping with the anxiety of parting with their children.

"Rationally, something like this is a very improbable event, but that still doesn't change the emotional side of the way you feel," Eric Milgram said.

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Syria rebels in push to capture air base

AZAZ, Syria (Reuters) - Rebels battled on Thursday to seize an air base in northern Syria, part of a campaign to fight back against the air power that has given President Bashar al-Assad's forces free rein to bomb rebel-held towns.

More than 60,000 people have been killed in the 21-month-old uprising and civil war, the United Nations said this week, sharply raising the death toll estimate in a conflict that shows no sign of ending.

After dramatic advances over the second half of 2012, the rebels now hold wide swathes of territory in the north and east, but are limited in exerting control because they cannot protect towns and villages from Assad's helicopters and jets.

Hundreds of fighters from rebel groups were attempting to storm the Taftanaz air base, near the northern highway that links Syria's two main cities, Aleppo and the capital Damascus.

Rebels have been besieging air bases across the north in recent weeks, in the hope this will reduce the government's power to carry out air strikes and resupply loyalist-held areas.

A rebel fighter speaking from near the Taftanaz base overnight said the base's main sections were still in loyalist hands but insurgents had managed to infiltrate and destroy a helicopter and a fighter jet on the ground.

The northern rebel Idlib Coordination Committee said the rebels had detonated a car bomb inside the base.

The government's SANA news agency said the base had not fallen and that the military had "strongly confronted an attempt by the terrorists to attack the airport from several axes, inflicting heavy losses among them and destroying their weapons and munitions".

Rami Abdulrahman, head of the opposition-aligned Syrian Observatory for Human Rights which monitors the conflict from Britain, said as many as 800 fighters were involved in the assault, including Islamists from Jabhat al-Nusra, a powerful group that Washington considers terrorists.

Taftanaz is mainly a helicopter base, used for missions to resupply army positions in the north, many of which are cut off by road because of rebel gains, as well as for dropping crude "barrel bombs" of explosives on rebel-controlled areas.

"WHAT IS THE FAULT OF THE CHILDREN?"

Near Minakh, another northern air base that rebels have surrounded, government forces have retaliated by regularly shelling and bombing nearby towns.

In the town of Azaz, where the bombardment has become a near nightly occurrence, shells hit a family house overnight. Zeinab Hammadi said her two wounded daughters, aged 10 and 12, had been rushed across the border to Turkey, one with her brain exposed.

"We were sleeping and it just landed on us in the blink of an eye," she said, weeping as she surveyed the damage.

Family members tried to salvage possessions from the wreckage, men lifting out furniture and children carrying out their belongings in tubs.

"He (Assad) wants revenge against the people," said Abu Hassan, 33, working at a garage near the destroyed house. "What is the fault of the children? Are they the ones fighting?"

Opposition activists said warplanes struck a residential building in another rebel-held northern town, Hayyan, killing at least eight civilians.

Video footage showed men carrying dismembered bodies of children and dozens of people searching for victims in the rubble of the destroyed building, shouting "God is greatest". The provenance of the video could not be independently confirmed.

In addition to their tenuous grip on the north, the rebels also hold a crescent of suburbs on the edge of Damascus, which have come under bombardment by government forces that control the center of the capital.

On Wednesday, according to opposition activists, dozens of people were incinerated in an inferno caused by an air strike on a petrol station in a Damascus suburb where residents were lining up for precious fuel.

The civil war in Syria has become the longest and bloodiest of the conflicts that rose out of uprisings across the Arab world in the past two years.

Assad's family has ruled for 42 years since his father seized power in a coup. The war pits rebels, mainly from the Sunni Muslim majority, against a government supported by members of Assad's Shi'ite-derived Alawite minority sect and some members of other minorities who fear revenge if he falls.

The West, most Sunni-ruled Arab states and Turkey have called for Assad to leave power. He is supported by Russia and Shi'ite Iran.

(Additional reporting by Khaled Yacoub Oweis in Amman and Dominic Evans in Beirut; Writing by Peter Graff; Editing by Ruth Pitchford)

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Hillary Clinton seen leaving hospital building

WASHINGTON: US Secretary of State Hillary Clinton was seen leaving a hospital building Wednesday three days after being admitted for a blood clot discovered close to her brain.

CNN showed images of the 65-year-old top US diplomat wearing dark glasses and walking unaided to a black van, accompanied by her smiling husband, former president Bill Clinton, her daughter Chelsea and top aides.

State Department officials refused AFP requests to confirm she had been discharged, and it was not known whether she planned to go home or would be returning to hospital for more treatment.

Earlier, State Department spokeswoman Victoria Nuland said Clinton, who is being treated with blood thinners to break up the potentially dangerous clot, had been busy keeping in touch by telephone.

"She has been talking to her staff, including today. She's been quite active on the phone with all of us," Nuland told journalists.

Clinton was admitted to the New York Presbyterian Hospital on Sunday after a routine scan revealed the clot in a vein in the space between her skull and her brain, and had been due to remain there for at least 48 hours.

Her doctors Lisa Bardack, from the Mount Kisco Medical Group, and Gigi El-Bayoumi, of George Washington University, said in a statement on Monday that Clinton had not suffered a stroke or any neurological damage.

"In all other aspects of her recovery, the secretary is making excellent progress and we are confident she will make a full recovery. She is in good spirits, engaging with her doctors, her family, and her staff," they said.

The globe-trotting diplomat had not been seen in public for almost four weeks, since succumbing to a stomach virus on returning from a trip to Europe on December 7, which forced her to cancel a planned visit to North Africa.

The effects of the stomach bug caused her to become dehydrated. She then fainted and suffered a concussion, which is thought to have brought on the blood clot.

After her fall, Clinton, who has travelled almost a million miles in her four years in office, was ordered to rest by doctors.

But Nuland said that on Saturday, before the MRI at the hospital revealed the clot, Clinton had spoken for about 30 minutes with the UN-Arab League peace envoy to Syria, Lakhdar Brahimi.

She also spoke by phone with Qatari Foreign Minister Sheikh Hamad bin Jassim al-Thani to discuss the situation in Syria, as well as about the "need to support the Palestinian Authority" and Afghanistan.

- AFP/jc

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Kalyan’s re-entry into BJP put on hold to avoid disqualification

LUCKNOW: The re-entry of former Uttar Pradesh chief minister Kalyan Singh into the BJP isn't happening on January 21.

The reason is technical as BJP leaders say if Kalyan joins now, he will face disqualification as an independent MP under the anti-defection law.

But this will not have any impact on the proposed rally in Lucknow on January 21 where Kalyan's Jan Kranti Party will merge with the BJP, said UP BJP chief Laxmikant Bajpayi.

Kalyan is likely to be present at the rally on January 21, which will also be attended by Gadkari and several senior BJP leaders including Rajnath Singh, Murli Manohar Joshi and Varun Gandhi.

"I see no technical problem in Kalyan attending the rally," Bajpayi said.

Kalyan will have to wait to rejoin the BJP until the Lok Sabha elections are announced, as joining before that may lead to his disqualification as Etah MP.

Bajpayi confirmed that Singh won't re-join the BJP now.

"If he is disqualified, he would have to contest a by-election from Etah and then after a few months, Lok Sabha's term would come to an end. Kalyan Singh will have to again contest the election, so it will be pragmatic for him not to join BJP for now," Bajpayi said.

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Brain image study: Fructose may spur overeating

This is your brain on sugar — for real. Scientists have used imaging tests to show for the first time that fructose, a sugar that saturates the American diet, can trigger brain changes that may lead to overeating.

After drinking a fructose beverage, the brain doesn't register the feeling of being full as it does when simple glucose is consumed, researchers found.

It's a small study and does not prove that fructose or its relative, high-fructose corn syrup, can cause obesity, but experts say it adds evidence they may play a role. These sugars often are added to processed foods and beverages, and consumption has risen dramatically since the 1970s along with obesity. A third of U.S. children and teens and more than two-thirds of adults are obese or overweight.

All sugars are not equal — even though they contain the same amount of calories — because they are metabolized differently in the body. Table sugar is sucrose, which is half fructose, half glucose. High-fructose corn syrup is 55 percent fructose and 45 percent glucose. Some nutrition experts say this sweetener may pose special risks, but others and the industry reject that claim. And doctors say we eat too much sugar in all forms.

For the study, scientists used magnetic resonance imaging, or MRI, scans to track blood flow in the brain in 20 young, normal-weight people before and after they had drinks containing glucose or fructose in two sessions several weeks apart.

Scans showed that drinking glucose "turns off or suppresses the activity of areas of the brain that are critical for reward and desire for food," said one study leader, Yale University endocrinologist Dr. Robert Sherwin. With fructose, "we don't see those changes," he said. "As a result, the desire to eat continues — it isn't turned off."

What's convincing, said Dr. Jonathan Purnell, an endocrinologist at Oregon Health & Science University, is that the imaging results mirrored how hungry the people said they felt, as well as what earlier studies found in animals.

"It implies that fructose, at least with regards to promoting food intake and weight gain, is a bad actor compared to glucose," said Purnell. He wrote a commentary that appears with the federally funded study in Wednesday's Journal of the American Medical Association.

Researchers now are testing obese people to see if they react the same way to fructose and glucose as the normal-weight people in this study did.

What to do? Cook more at home and limit processed foods containing fructose and high-fructose corn syrup, Purnell suggested. "Try to avoid the sugar-sweetened beverages. It doesn't mean you can't ever have them," but control their size and how often they are consumed, he said.

A second study in the journal suggests that only severe obesity carries a high death risk — and that a few extra pounds might even provide a survival advantage. However, independent experts say the methods are too flawed to make those claims.

The study comes from a federal researcher who drew controversy in 2005 with a report that found thin and normal-weight people had a slightly higher risk of death than those who were overweight. Many experts criticized that work, saying the researcher — Katherine Flegal of the Centers for Disease Control and Prevention — painted a misleading picture by including smokers and people with health problems ranging from cancer to heart disease. Those people tend to weigh less and therefore make pudgy people look healthy by comparison.

Flegal's new analysis bolsters her original one, by assessing nearly 100 other studies covering almost 2.9 million people around the world. She again concludes that very obese people had the highest risk of death but that overweight people had a 6 percent lower mortality rate than thinner people. She also concludes that mildly obese people had a death risk similar to that of normal-weight people.

Critics again have focused on her methods. This time, she included people too thin to fit what some consider to be normal weight, which could have taken in people emaciated by cancer or other diseases, as well as smokers with elevated risks of heart disease and cancer.

"Some portion of those thin people are actually sick, and sick people tend to die sooner," said Donald Berry, a biostatistician at the University of Texas MD Anderson Cancer Center in Houston.

The problems created by the study's inclusion of smokers and people with pre-existing illness "cannot be ignored," said Susan Gapstur, vice president of epidemiology for the American Cancer Society.

A third critic, Dr. Walter Willett of the Harvard School of Public Health, was blunter: "This is an even greater pile of rubbish" than the 2005 study, he said. Willett and others have done research since the 2005 study that found higher death risks from being overweight or obese.

Flegal defended her work. She noted that she used standard categories for weight classes. She said statistical adjustments were made for smokers, who were included to give a more real-world sample. She also said study participants were not in hospitals or hospices, making it unlikely that large numbers of sick people skewed the results.

"We still have to learn about obesity, including how best to measure it," Flegal's boss, CDC Director Dr. Thomas Frieden, said in a written statement. "However, it's clear that being obese is not healthy - it increases the risk of diabetes, heart disease, cancer, and many other health problems. Small, sustainable increases in physical activity and improvements in nutrition can lead to significant health improvements."

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Online:

Obesity info: http://www.cdc.gov/obesity/data/trends.html

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

Mike Stobbe can be followed at http://twitter.com/MikeStobbe

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