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Clinical Trials
A Comparison of Two Anti-HIV Drug Regimens for Youth Who Have Failed Prior Therapy
National Institute of Allergy and Infectious Diseases (NIAID)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Information provided by (Responsible Party)
National Institute of Allergy and Infectious Diseases (NIAID)
First received: January 25, 2005
Last updated: May 17, 2012
Last Verified: May 2012
History of Changes
HIV infected children and adolescents who have taken many anti-HIV drugs may have limited treatment options and are at high risk for progressing to AIDS. The purpose of this study is to determine whether an anti-HIV treatment regimen of 2 protease inhibitors (PIs) and 2 nucleoside reverse transcriptase inhibitors (NRTIs) is more effective than a regimen of 4 NRTIs in treatment-experienced children and adolescents who have failed previous anti-HIV treatment.
HIV Infections
Drug : Abacavir sulfate
Drug : Emtricitabine
Drug : Lamivudine
Drug : Lopinavir/ritonavir
Drug : Saquinavir
Drug : Tenofovir disoproxil fumarate
Drug : Zidovudine
Phase 2
|Study Type:
|Study Design:
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
|Official Title:
|A Phase II, Randomized, Open-Label Study to Evaluate the Safety and Effectiveness of Two Antiretroviral Therapeutic Strategies: A Dual PI-Based HAART Regimen Versus a Multi-NRTI ART Regimen, in ART-Experienced Children and Youth Who Have Experienced Virologic Failure
Further study details as provided by National Institute of Allergy and Infectious Diseases (NIAID):
Primary Outcome Measures
- Tolerability of dual PI-based HAART versus multi-NRTI HAART salvage regimens (time to first intolerant event)
- 95% confidence interval (CI) for change in CD4% computed for PI-containing groups versus PI-sparing group
- 95% CI for change in BMD (both percent change in BMD and change in z-score from baseline) for each treatment group
- growth and development markers
- toxicity
- adherence
- pharmacokinetics
- special virologic and immunologic parameters
|Study Completion Date:
|May 2007
Detailed Description:
HIV infected children and adolescents on anti-HIV treatment regimens have traditionally had
more difficulty with non-adherence and drug resistance than adults, often resulting in
virologic failure. Additionally, HIV infected children with extensive exposure to
antiretrovirals (ARVs) are likely to have fewer therapeutic options for salvage therapy, and
their physicians find it difficult to choose regimens that will keep the HIV infection under
control. This study will compare the efficacy of three 4-drug ARV salvage regimens in
treatment-experienced, HIV infected children and adolescents who have experienced virologic
This study will last at least 96 weeks. Participants will be randomly assigned to one of three groups. Group 1A will receive a dual-PI based regimen of lopinavir/ritonavir (LPV/r), saquinavir (SQV), and the NRTIs emtricitabine (FTC) and abacavir sulfate (ABC). Group 1B will receive a dual-PI based regimen of LPV/r, SQV, FTC, and tenofovir disoproxil fumarate (TDF). Group 2 will receive an NRTI-only regimen of ABC, lamivudine, zidovudine, and TDF.
There will be 11 study visits during Step I of this study. Medical history, a physical exam, and blood collection will occur at all visits. Dual-energy x-ray absorptiometry (DEXA) scans will occur at study entry and at Weeks 24, 48, 72, and 96. Urine collection will occur at most visits; participants will also take part in adherence modules at most visits. Participants will be asked to complete a pill count form at Weeks 4 and 24. Additionally, some study participants will be asked to participate in an intensive pharmacokinetics study at Week 4.
|Ages Eligible for Study:
|4 Years to 21 Years
|Sexes Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria for Step I:
- HIV infected
- No currently available therapeutic options that would likely result in long-term suppression of virus to less than 400 copies/ml
- Two measurements within 4 months prior to screening and at screening of either CD4% of less than 15% and HIV viral load of greater than 10,000 copies/ml OR HIV viral load greater than 30,000 copies/ml
- Previous exposure to non-nucleoside reverse transcriptase inhibitors (NNRTIs), NRTIs, and PIs AND have experienced virologic failure. More information on previous treatment regimen requirements is available in the protocol.
- Prior or current virologic failure with genotypic or phenotypic resistance OR historical virologic failure with a PI- or NNRTI-containing regimen
- Resistance to 2 or more drugs in most recent treatment regimen within 26 weeks prior to study screening
- Able and willing to swallow study medications
- Parent or guardian willing to provide informed consent, if applicable
- Willing to use acceptable methods of contraception
- Previous cumulative exposure to TDF for more than 24 weeks OR more than 14 days of TDF exposure during the 24 weeks prior to study entry
- Grade 1 lipase or higher within 28 days prior to study entry
- Grade 3 or higher laboratory abnormality (except for lipase) within 28 days prior to study entry
- History of allergy or hypersensitivity to any of the study drugs
- Active CDC Stage C opportunistic infection or serious bacterial infection requiring therapy at the time of screening
- Chemotherapy for active cancer
- Require certain medications
- Abnormal kidney function
- Any clinically significant diseases other than HIV infection or findings during medical history screening that, in the opinion of the investigator, may interfere with the study
- Pregnancy or breastfeeding
Exclusion Criteria for Step I:
Contacts and LocationsChoosing to participate in a study is an important personal decision.Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.For general information, see Learn About Clinical Studies.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00102206
Locations Show More
|United States, Illinois
|Chicago Children's CRS
|Chicago, Illinois, United States, 60614
|United States, New York
|Columbia IMPAACT CRS
|New York, New York, United States
|SUNY Stony Brook NICHD CRS
|Stony Brook, New York, United States, 11794-8111
|United States, North Carolina
|DUMC Ped. CRS
|Durham, North Carolina, United States, 27710
Sponsors and CollaboratorsNational Institute of Allergy and Infectious Diseases (NIAID)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
|Study Chair:
|Andrew Wiznia, MD
|Jacobi Medical Center
|Study Chair:
|Ann J. Melvin, MD, MPH
|Seattle Children's Hospital and Regional Medical Center
More Information
|Responsible Party:
|National Institute of Allergy and Infectious Diseases (NIAID)
|ClinicalTrials.gov Identifier:
|NCT00102206 History of Changes
|Other Study ID Numbers:
|Study First Received:
|January 25, 2005
|Last Updated:
|May 17, 2012
Keywords provided by National Institute of Allergy and Infectious Diseases (NIAID):Treatment Experienced
Additional relevant MeSH terms:
HIV Infections
ClinicalTrials.gov processed this data on April 08, 2020
This information is provided by ClinicalTrials.gov.

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"You build on failure. You use it as a stepping stone. Close the door on the past. You don't try to forget the mistakes, but you don't dwell on it. You don't let it have any of your energy, or any of your time, or any of your space."
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If it worked for the Man in Black, it works for us.
Changents has closed the door on the past.
Thank you for sharing our passion for Change Agents.
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Strike it Out game for an adult and child. Can you stop your partner from being able to go?
Use your addition and subtraction skills, combined with some strategic thinking, to beat your partner at this game.
Dotty Six game for an adult and child. Will you be the first to have three sixes in a straight line?
Dotty Six is a simple dice game that you can adapt in many ways.
Explore Alex's number plumber. What questions would you like to ask? Don't forget to keep visiting NRICH projects site for the latest developments and questions.
This article introduces the idea of generic proof for younger children and illustrates how one example can offer a proof of a general result through unpacking its underlying structure.
Exploring the structure of a number square: how quickly can you put the number tiles in the right place on the grid?
Watch our videos of multiplication methods that you may not have met before. Can you make sense of them?
This project challenges you to work out the number of cubes hidden under a cloth. What questions would you like to ask?
Watch the video to see how to fold a square of paper to create a flower. What fraction of the piece of paper is the small triangle?
A brief video looking at how you can sometimes use symmetry to distinguish knots. Can you use this idea to investigate the differences between the granny knot and the reef knot?
Can you visualise whether these nets fold up into 3D shapes? Watch the videos each time to see if you were correct.
These models have appeared around the Centre for Mathematical Sciences. Perhaps you would like to try to make some similar models of your own.
Alf and Tracy explain how the Kingsfield School maths department use common tasks to encourage all students to think mathematically about key areas in the curriculum.
The Enigma Project's James Grime has created a video code challenge. Watch it here!
Video showing how to use the Number Plumber
Design and test a paper helicopter. What is the best design?


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Developers not focused on holiday festivities at the end of December may have noticed that a stable framework specification of the HTML5 web markup language has been laid down.
Put in place by the World Wide Web Consortium (W3C) as part of its HTML5 overseeing role, the specification is said to be good for the "next several" years. Version HTML 5.1 is now a working draft as well.
NOTE: Though not yet W3C standards, the specification is now described as "feature complete", meaning businesses and developers have (according to the W3C) a "stable target" for implementation and planning.
The future HTML 5.1 specification is currently being engineered to support improved web video performance, a development that is backed by both the W3C and television industry firms. Alongside this, the first draft of the Canvas 2D Level 2 drawing API was also announced.
W3C CEO Jeff Jaffe said that as of now, developers will know what skills to cultivate to reach smart phones, cars, televisions, ebooks, digital signs and, as he puts it, "devices not yet known" as they are created.
Kendo UI, a division of Telerik, surveyed over 4,000 software developers worldwide in the period between September 5th and September 26th of 2012 regarding their usage, attitudes, and expectations surrounding HTML5 and its adoption for development initiatives.
The majority of developers surveyed by Kendo UI (82%) believe that HTML5 will be important to their job within the next 12 months. This is a finding that contradicts other reports, such as the Gartner Hype Cycle for Emerging Technologies (2012), which suggests that we will see widespread HTML5 adoption 5 to 10 years in the future.
The W3C says that its goal is "not just interoperability across browsers" at this time with HTML5, but also across devices used.
According to official statements from w3c.org, to reduce browser fragmentation and extend implementations to the full range of tools that consume and produce HTML, W3C now embarks on the stage of W3C standardization devoted to interoperability and testing (called "Candidate Recommendation").
"During this stage, the W3C HTML Working Group will conduct a variety of activities to ensure that the specifications may be implemented compatibly across browsers, authoring tools, email clients, servers, content management systems, and other web tools. The group will analyze current HTML5 implementations, establish priorities for test development, and work with the community to develop those tests. The HTML Working Group has planned for this implementation phase to last into mid-2014, after which W3C expects to publish the final HTML5 Recommendation, available Royalty-Free to implementers under the W3C Patent Policy."


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A unique venue, a devoted audience, and awesome emerging talent. Were you there?
On Saturday 30th July in London, we witnessed 2 magical performances from:
This show wouldn't have been possible without our wonderful Hosts. If you want to become a Sofar Host and get guaranteed entry to any Sofar all around the world, then why not apply?Apply to Host


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Good morning Nicola and Ella,
Just to say that I love your joyful play as portrayed in your DUO pictures, perhaps one day I might find the courage to join you for a cuddle.
Love Emma
spent an hour with the lovely Nicola recently. Knows exactly how to make you feel good. Knows how to get you to make her feel good. I will definitely be back
I spent 2 fantastic hours with beautiful Nicola on Monday 8th Sept. Her girlfriend experience is an absolute joy. No rush, no pressure, I didn't want to leave. I'm already saving up my pennies and planning my next visit! Thanks Nicola.
Jack (again)
2.30 on Sept 11th. Spent another amazing couple of hours with the lovely Nicola. This lady is utterly amazing, she's gorgeous, she's sexy, she's witty, she's had the best conversation. She has the softest skin!! I could spend days with Nicola and never be bored. Thanks again Nicola – they don't know what they're missing!! I'll be in touch soon. Jack x.
Jack (and yet again!)
Another wonderful visit with the beautiful Nicola. What a woman! I can't stay away! Don't know where the rest of you guys are going but you're missing out! There again, that means she has more time to see me! Thanks Nicola, see you again soon! Jack xx
Met this delightful lady for the first time last week. She is really lovely and makes you feel both welcome and relaxed.
Our time together was the best I've had in a very long time – and it won't be the last!
If I was asked to award marks, Nicola would get 10/10 and then some.
See you again soon Nic. X.
Yet another blissful visit with Nicola. If I win the lottery, I shall employ her full time so none of you suckers will get a look in.!
She tells me it's been very quiet recently and I really can't work out why more guys aren't seeing this truly beautiful lady.
Thanks again Nicola, be seeing you soon!
Love Jack xxx
Wow Nicola, what an amazing experience with you. Your smile - natural, your pictures - genuine and wow you're so clean. I thoroughly enjoyed licking your bits. Again, your an amazing lady. I'm so glad I found you. Simply the best !!! :-)
Hello Nicola, Thank you for taking time out of your weekend to see me, I had a lovely time and I hope you enjoyed it as much as you appeared to be.
Hi Nicola, just stumbled across your profile on here (Adultwork) and thought this lady looks kind of familiar, how are you? Lovely to meet you last Wednesday, you and Viv completely blew my mind, two lovely and sexy mature ladies at the same time, wow I'd really thought I'd died and gone to heaven.
Hope to see you again soon.
Greg xxxxxxxx
I was lucky enough to share time with Nicola's time today.
Nicola is pretty and put me completely at ease as she is easy going and has a lovely body Great time that I will always remember
Richard G
My sincere thanks for your company yesterday evening; great to converse with a real lady and I'm so glad that we seem to share a delightfully old fashioned view of life and how most things have lost the plot completely. Didn't realize that we both worked for the same outfit in our "youth" – they've screwed that up as well!!
I hope to see you again before too long.
Thanks for putting up with my endless banter, love the Chanel No 5, you can't beat quality.....
Superb flat, a gorgeous lady and a real eye opener. Nicola made me feel special in ways that I had no idea about before. I would like to think that Nicola enjoyed the time as much as I did; she is a very genuine person. Such a lovely time, I will be sure to visit again. If you're feeling nervous or it's your first time, I recommend you give Nicola a call – she will change your world!!
Thanks for all the lovely memories and fun we've shared Nicola – Happy Valentine's
Love ya babe OliO XxxX
Thank you for your friendship on that day I left feeling that I had known you for a long time. Terry .
thanks nicolaXXXX
I've been in for this sort of thing. Within minutes we were swapping life
stories, always a good sign.
After some kissing and cuddling we decamped to the bedroom where I
discovered that Nicola has the nicest and best-kept pair of hands I've come
across on any girl I've visited. She's very skilled with them too – leave
you to imagine what I mean by that! Nicola also likes to be pampered,
which I always think adds to the fun.
Would definitely recommend anyone considering visiting to give it a whirl;
you won't be disappointed.
This was my first time with an escort, after over a year in the wilderness.
I felt comfortable almost straight away, she let me take things at my pace. Nicola is a warm and tender woman whom for two wonderful hours let me escape reality and feel loved and wanted again. No faking from Nicola either, she was enjoying our time together and it made ME feel good to be able to give her multiple orgasms during our brief time together.
Oh Nicola, thank you so much, I will be back again :) )
Thanks Nic – I will see you again soon!
I do not have any 'special' requirments, I am happy to just spend time with a woman and let the physical stuff flow. So we chatted, undressed each other and spent lots of time exploring each others bodies. Nicola gave me a really wonderful time both with her company and the sex.
I left very satified and happy and will certainly return. Thank you Nicola for a fantastic sexy time.
Nicola has a great flat in Bedford lovely and cosy with great facilities and is vey discreet.
I don't have any special requirements other than good mutual pleasure and this I have found is where Nicola comes into her own. She gives and loves to receive the most intimate of pleasure and the time I have spent with her gets better and better….
Thanks Nicola hope to get another mention and see you soon


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A personal jewelry collection can represent years' worth of careful investments, often including priceless family heirlooms that could never be replaced. Protect and organize your adornments with a beautiful jewelry armoire or box from JCPenney.
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Sunday, June 15, 2008
Love and Marriage
[Weekend rant. Homophobics and those uncomfortable with their own sexuality ought not read further.]
During training, in San Francisco, our landlords were Dan and Del, a couple who'd been together for several years, and who remained together for another twenty-five or more, until Del died. Loving, thoughtful, and kind, they were the best landlords ever; eventually we bought the house we'd been renting from them, and they gave us a great deal. Terrific guys. We visited them whenever we returned to SF. I talked to Dan recently, not long after Del had died, in his seventies I think.
Here are a few things that I consider inarguable.
First: By logic, and by mounting scientific evidence, sexual preference is largely determined by genetics or other biologic factors. (Logic = in a society that discriminates and harasses and to a large extent reviles, who'd choose to be gay?) I recognize there's a spectrum, and that people at all points on the spectrum are capable of experimentation. But for most -- and especially those committed enough to choose to marry -- it seems beyond obvious that homosexuality is not a matter of choice. Corollary: You can't catch gay. Additional corollary: if you think your god considers gays sinners, it seems he's the one making them, which says more about your god than about gays.
Second: For all of recorded history, in every culture, in every religion, in every country, there have been homosexuals. It's part of life. (And considering their contributions, a very positive part of it.)
Third: There is no argument against gay rights other than religious. In order to oppose gay rights, you have to believe one thing that's demonstrably wrong, and another that's unproveable; that is, you have to believe both that homosexuality is a choice, and that it is an abomination in the eyes of your particular version of the Person- or Persons-in-the-Sky. But on this planet there are lots of views of the sky-people and what they do and don't want. One is entitled to one's, but not to foist it on others.
"Defense of Marriage" is a bogus argument of the bumper sticker variety: I've seen no discussion, nor any attempt to have one, other than simple declaration, that explains why my heterosexual marriage of thirty-seven years is in any way threatened or diminished in value if gays are allowed to marry. None. What evidence there is on the subject is to the contrary: in Massachusetts there has been no decline in heterosexual marriage since gay marriage was approved. The same is true in countries that allow it. (The opposite, in fact, seems to be the case.) Which is, of course, exactly as expected: there simply is no line that can be drawn between allowing gays to marry and the decline of heterosexual marriage. Nor need it be said: heterosexual marriage has been on the decline for decades; gay marriage appears only recently.
Fourth: Lots of good-hearted people feel uncomfortable about and around homosexuals. Many religions, in fact, seem in very large measure predicated on dealing with sexual discomfort of all sorts. Hide women. Separate them from men. Marry a bunch of them and keep them silent. Sexual pleasure is sinful. Especially the personal kind. Religious mores, as they apply to sexuality, seem based on repression, which in turn is based on fear of one's own sexuality, displaced on others.
I don't like anything about brussels sprouts. I don't even like looking at them. Yet it doesn't threaten me that others do; nor do I feel the need for a law to keep others from eating them. From a secular point of view, there is no reason to oppose gay marriage. It has no impact on society, one way or the other. Objections are based on religion, or on personal discomfort, neither of which are the business of civil law. Unless it can be shown that gay marriage is in some way a threat to our country (it can't), there is no justification for passing laws to prevent it. (Asking questions about gay adoption is legitimate, I'd say; but it's a separate issue.
It's fair to ask if there's harm to kids living in a gay household. But the evidence is to the contrary. Which is also intuitive: growing up in a love-filled home ought to be good for any kid. (How many kids are in homes where they're not wanted?) And since sexual preference is biologic, it would be expected to have no impact on that of the child. Questions? Sure. Grow up more tolerant? The horror! Moreover, the logical extension of preventing it would be to forbid lesbian women from having babies. I'd think even religious conservatives would recoil from the state mandating who can bear children. Right? Right?...)
Among the oft-heard and stupid phrases one hears in the public square, at or near the top of the list is "the homosexual agenda." (Although, recently, "terrorist fist jab" has a special sort of transcendent lunacy that's hard to top.) It's freighted with hatred and fear, and implicit misunderstanding. Those who use the phrase, it seems to me, must be a little uncertain about their own sexuality: afraid they might be susceptible. After all, those who doth protest too much... That there is an "agenda" at all is pretty laughable, other than the desire to have the same civil rights as everyone else. Or is there something more sinister? Laws outlawing bad fashion? Outing closet thespians? Seems to me wanting an end to harassment and the right to marry hardly qualifies as an agenda. Unless breathing does, too.
Two adults love each other. They want to marry. Where's the harm? If a church doesn't approve of gay marriage, it shouldn't perform them. If you don't like gay marriage, don't do it.
Stick that on your bumper!
Oh. And happy Fathers' Day, GDad and GPop.
46 comments:
- ER's Mom said...
Thank-you for expressing beautifully what many people think.
- rlbates said...
Ditto er's mom. To take it farther, I don't understand why gay couples can't foster/adopt children. Isn't having someone to love and care for a child a good thing?
- Devorrah said...
I couldn't agree more. There are several gay people in my family, and I wondered if one of my sons would be gay (not even close). I would have loved them no matter, of course. I tell them that all the intolerant rednecks get the gay sons, and what do I get--straight kids!
- Sid Schwab said...
ramona: in many states, they can. Far as I know.
devorrah: good one!
- Tanya said...
How can a committed relationship between 2 people, whether gay or straight, be a bad thing for society? If 2 people choose to care for and support each other, doesn't that make us as a society stronger? And remember-it hasn't been so far back in our history that interacial marriages were unacceptable. We seem to have weathered that one without the collapse of our society.
2 gay people got married here last week, and I've been noticing more potholes in the streets ever since...
*rolls eyes*
Great post!
I agree with you wholeheartedly, and with all of your commenters here.
The thing that disturbs me most is that people are using petition to amend the constitution to remove a right of other people. The U.S. Bill of Rights were written to protect the people from the government, and it is a gross misuse of government to decide based on religious belief who we can and cannot have for a committed life partner.
I don't think that genetic predisposition towards homosexuality should be considered a necessary argument for the defeat of the California initiative to the amendment. Choosing is a right that should at last be recognized 219 years after the adoption of the United States Constitution. The Cal Supreme Court finally recognized that the laws against gay marriage are no more based on society's needs than were the "anti-miscegenation" laws.
Marrying the one you love is not a "special right."
The "gay agenda" is freedom.
- scalpel said...
Your article presents many illogical assumptions as fact. "Why would anyone choose to be gay?" you ask. Therefore homosexuality must be genetic, you state. And your assumption that any opposition to gay "marriage" must be based upon religious reasons is similarly off base.
Why would anyone choose to deform themselves with a hundred facial piercings, or a facial tattoo? Are those decisions genetic as well?
There are many people who don't fit into "normal" society, and they often find a group of like-minded individuals to join. More power to them, I say - let them "marry" whoever they want or tattoo their faces to their hearts' content, but the government doesn't have to sanction their lifestyle quirks.
In my view, homosexuality is mostly genetic, sort of like a dysfunctional mutation, but as you said, there is likely a spectrum of interdependent factors with bisexuals being an example of the center of the spectrum.
Perhaps affected individuals would be more likely to have their "marriages" being officially government-approved if homosexuality were considered a genetic defect (disability) under the ADA. I haven't seen many folks championing that option, though.
- Sid Schwab said...
scalpel: wow.
- scalpel said...
Sorry to break up your little Kumbaya party, but someone had to.
- Sid Schwab said...
It's not that I mind contrary opinions. I do, of course, perfer that they are less wrong, as a matter of discourse. Like suggesting I said that "therefore homosexuality must be genetic." And it gets wronger from there. But I don't mind. Really, I don't. It's just that I like to be able to breathe after reading comments.
- rlbates said...
Sid, here in Arkansas the debate continues about gay couples or individuals being allowed to foster care children or adopt.
You can say that "there is no argument against gay rights other than religious," and you did, and it's your blog. And I can say that you are evil because you don't think that Brussels sprouts are delicious, And I would be wrong about that. You are a good enough writer to state your case without the tired attempts to discredit opposing arguments by simply declaring them non-existent.
My argument against "gay rights" is that it's not an argument against gay rights as such. Homosexuals have no more and no fewer rights than heterosexuals in the USA. Every unmarried adult in the USA has the right to marry any other unmarried adult of the opposite sex at any time, with mutual consent. Same rights to vote, enter contracts, own property, everything else. This argument is about same sex marriage, not gay rights.
Marriage exists, in my opinion, to perpetuate the human species in the optimal fashion. Humanity would not die out in the absence of marriage, as the sexual urge is strong enough to cause women, voluntarily or not, to become impregnated, and have enough offspring survive to keep us from dying out. The institution of marriage allows reproduction to occur in an organized fashion, with a man and woman providing care and protection for their children to allow a better life for all.
It doesn't always work out like this, of course. Lots of marriages end up in divorce, usually but not always to the detriment of the kids. Yes, a very small number of homosexual couples adopt or otherwise produce kids, and lots of older folks marry who are incapable of reproducing. Still, the majority of marriages do end up with children, and I believe that in the majority of cases, these children do better in intact families.
The traditional family has taken a beating in recent years, and likely represents a minority of households, but its decline has paralleled, and I believe, resulted in the deterioration of society that has occurred over the past half century. I have nothing against homosexuals enjoying the same rights as everyone else, as they do. I do object to another pillar of society being cheapened and degraded to make a small minority of people, of what ever sexual preference, feel better.
You may ask what harm it does if two men marry. The harm is not that two men get married; the harm is that they may get married. Marriage means literally nothing if any two people can enter into it. Why can't I marry my brother if he has a better health plan? Why not my mother? - it would greatly simplify estate planning. What if I want to marry Lisa and Marie? - they're both really hot and both want to marry me because I'm a rich doctor, and they don't mind sharing.
Marriage should be preserved for people who can produce and optimize the raising of children. It's a special status. Others can sign a contract or enter into a "civil union."
As for "If you don't like gay marriage, don't do it," or it's analog, "If you don't like abortion, don't have one," my response is "If you think owning a slave is evil, don't own one."
- Sid Schwab said...
jb: okay, I should have said there are no cogent arguments other than religious. Yours fail in a number of ways. The most obvious, of course, is the procreation bit. You identify one of the problems yourself. The other is that homosexuals are not going to marry heterosexually and produce children anyway, so their marriage does nothing to decrease the gene pool. Yes there are some cases of gays marrying heterosexually and having kids and then getting divorced. Which is hardly the stable marriage you'd like to see, and represents a small number of the whole.
And, as I stated in my post, simply to state that marriage is between a man and a woman, or that gay marriage in some way "degrades" marriage is not to prove it. Far from it. "Marriage means literally nothing...." is simply a declaration without basis. I'm happy in mine, a little proud that it's lasted 37 years and counting, and I feel in no way diminished by the fact that on the other side of the country (or, hopefully, right here) people of the same sex enter into it. If you feel somehow diminished, I guess you could divorce (assuming you're married.) But it seems sort of a shame.
To argue that gays already have the right to marry as long as they marry someone of the opposite sex is to argue that misegenation laws were fine in that blacks and whites could marry as long as they didn't marry each other. The right to marry heterosexually, obviously, is not what they're asking for. So to argue that it should suffice is silly.
The final analogy, about slaves, is such a logical pretzelling that I won't deconstruct it. But I imagine if you think about it you'll see the fallacy.
- Tanya said...
jb-you said,"marriage exists in my opinion to perpetuate the human species in the optimal fashion."
My husband and I have been married for 32 years and are childless, not because we are physically incapable of reproducing but because we chose not to. So, according to your reasoning, we should never have been allowed to marry, since we refuse to procreate? Isn't that a pretty narrow view of what marriage means?
Agree with your post overall except for one fallacy - opposition to homosexuality is not always necessary based on religion. Witness the former Soviet Union - an avowed atheistic state, that nontheless had the penchant for imprisioning gays in psychiatric hospitals.
It may be a more accurate statement to say that conservative societies frequently have problems with homosexuality... it's not just a religion thing.
Other than that, I agree with your post overall. If we are a civil society with equal protection of the laws for all, then either homosexuals need to be afforded the exact same legal benefits that accrue to heretos who marry, or those benefits should be removed from the heterosexuals, and marriage should be nothing more than a religious ceremony.
- Sid Schwab said...
anonymous 6:06, I think you're right; maybe I should have said "in the US..." or in "modern times." I did include, later in the post, the idea of personal discomfort, which probably informs some of the Soviet attitude; also, there were various state-sponsored psychiatric "diagnoses" directed at people felt to be a threat to their authority. At some level they did consider homosexuality a psychiatric disease, and they were not alone in the world in that.
Ah... incandescent brilliance that those of us who teach premeds get out of bed for:
"Marriage should be preserved for people who can produce and optimize the raising of children. It's a special status."
He's saying that we should deny marriage privileges to the infertile and the postmenopausal.
- Patrick Bageant said...
Query: Isn't there a VERY strong conservative argument for gay marriage that essentially says "What I do inside my home is none of the government's goddam business"?
Shouldn't small-government people like Scalpel be in favor of *less* regulation inside the holy castle of the American home?
Shouldn't he be freaked out by suggestions JB's which (as I read it) argued that because married people procreate, the STATE should control who gets married?
Of course he should. We all should!
But the blather for and against this issue almost never touch on what actually upsets people. Procreation? Come on. Is that really the policy point on which this whole issue turns? Procreation?
Framing people's passion over this issue in terms of intellectual/policy discussions is such a mind-boggling load of crap. And notwithstanding the tenacity of the folks who work so hard to cook that crap, or the glee with which many people swallow it, I continue to believe you can't polish a turd,
People fall into two camps on the gay marriage question. Camp A, where Sid lives, is made up of people who feel that in the totality of te circumstances they are are more like gays than are different. This point of view sees legal distinctions as illusory at best and destructive at worst. Camp B, where (presumably) Scalpel lives thinks gays are mostly different and sees the legal distinctions as maintaining something important. (Or "sanctimonious," or whatever the buzz-word is.) The fight about marriage is not about procreation or whether civil unions are adequate as a matter of logic, or any other inapposite political blather -- it is about making the decision to reinforce perceptions of "other," or tear them down.
That is the complete extent of the "values" on which this debate supposedly turn: do we want to live in a society made up of us and them, or us and us? It's shameful to live in a political climate that actually thinks there may be more than one answer to that question.
- Patrick Bageant said...
. . . just like it's shameful to live in a society whose more educated members forget to perform a basic proofread!
Apologies for the typographical messes above.
- Sid Schwab said...
Patrick: typos or no, much better said than I did! Getting to the nubbin, like a lawyer ought.
- Sid Schwab said...
And, of course, there are LOTS of things going on now about which conservatives, of all people, ought to be enraged. Presidents claiming the ability to imprison anyone by declaring them an enemy, with no need to make the case. Deficits. Were these things being seen under the aegis of a Democrat, conservatives would, as night follows day, be up in arms, impeachment papers a-wavin.' Which is why "change" is needed in our body politic. But I digress.
- scalpel said...
I don't care what they do in their own homes. They can be best buddies, they can cohabitate, they can share financial arrangements, they can even approximate intercourse in various fashions (or not).
But it's still not marriage. People who want it to be so are in the distinct minority. Heck, even California will probably vote it down (again). The concept of gay marriage has been soundly defeated in every state that put it on the ballot. It's not discrimination, it's nature.
A group of nuns could get together and decide that I am their Mother Superior. They could really believe that and fervently support me in that position, but outside that small group, few would view me, a Jewish man, as a Mother Superior.
Words matter. That's why I made the point above about "gay rights," vs. "same sex marriage."
I don't know exactly when marriage evolved, but it dates back several thousand years, at least to biblical times. When I was growing up in the 50s, nothing had changed about the concept of marriage over those millenia- woman+man united until death parts them. Divorce was rare in most strata of society, same sex marriage laughable. Fast forward to today, a mere half century later. Divorce is the rule, not the exception. A noisy minority insists that the gender of the participants is irrelevant. As Scalpel points out, even in "progressive" California, it doesn't sit well with the majority. No matter. The judges will redefine what society thinks it needs to survive.
Where do I apply for that Mother Superior position? There must be a court somewhere that will decree that the Catholic church is a place of public accommodation, and that discriminating on the basis of religion is unlawful, as is discriminating on the basis of gender. I'm a two-fer.
Now you're being ridiculous, you will say.
Pot, meet kettle. Slope, meet slippery.
Standing athwart history...
- Silverstar said...
Marriage tied to procreation is a creation of the patriarchy. Until men figured out that they had something to do with the production of a child, and wanted to make sure it was theirs, I doubt marriage existed. I doubt it would exist as the conservatives dream of it if women could support children on their own, and I believe that is one reason that society continues to underpay women.
Having said that, I think marriage should be separated from partnership. If the state wants to grant all the rights of marriage to domestic partners of whatever shape or form, it should do so. If the churches don't want to marry any couple except a man and a woman, that is their perogative. Many people, especially the elderly in this state and others, opt for domestic partnerships because marriage would screw up their finances. I just think the gubmint should get out of the marriage business, and just grant domestic partnerships.
My brother has been with his partner for 32 years now. The state he lives in has a constitutional amendment that states marriage is between a man and a woman. My marriage, the longest in my family, lasted 21 years. And I never did "procreate" in that time. Maybe they should just quit giving married people special privileges, like filing joint returns.
- Patrick Bageant said...
I am so confused.
"Marriage evolved" . . . ?
If marriage "evolved," then how on earth could a judicial opinion affect its existence or the nature of what it is? That is like saying that a judicial opinion, by itself, could threaten the integrity of our pancreases.
Marriage didn't evolve. It isn't a feature of our bodies and behavior that improves fitness. We have evolved many such features -- e.g, one of them is called called vaginal intercourse between a man and a woman. But that's not marriage.
"Marriage" in a strict sense is a formal union. "Formal" means recognized by the by the State. Who the state recognizes in their union is a separate question from evolution, God's will, procreation, etc.
You bring up California. The California Supreme Court was asked whether the words of the California State Constitution precluded same sex marriage, as had been assumed all along. After careful scrutiny, that Court concluded that currently, as drafted, the language of that constitution is not sufficiently specific to limit the formal, state sanctioned, legal category of "marriage" to between only men and women.
That has nothing to do with evolution or procreation or what God intended, and as proof I point out that the opinion (the majority opinion) was written by one of the most conservative justices on the Court. It is merely a matter of analysis and interpretation. Posters above do point out correctly that the issue will be on the ballot in California. But the ballot question will not be "Californians, were the justices wrong?" The ballot question will ask to revise the language of the state constitution such that marriage is defined as between a man and a woman. And whether Californians decide to rewrite that part of the constitution (which is actually not a forgone conclusion -- as issues become more heated, voter turnout makes the state vote farther and farther to the left) will come down, ultimately, to the question "are gays mostly like the rest of us, or mostly different?"
The answer to that question seems pretty simple to me. There are differences between us. But they are not the kinds of differences the government should be busying itself over.
- mibsphil said...
Bravo, Sid!!!
(And every day I think about how proud I am to live in Massachusetts!)
"When I was growing up in the 50s, nothing had changed about the concept of marriage over those millenia- woman+man united until death parts them."
It is safe to say that this person does not know diddly squat about the history of marriage in western culture. It is also safe to say that he knows even less about marriage in other cultures. If he did, he would not suggest that the insitution of marriage was essentially static across cultures and across thousands of years.
Like so many, he's incompetent, and unware of it.
I agree with George. "Marriage, A History" by Stephanie Coontz, a notable feminist historian, documents the evolution of marriage. The "traditional marriage" touted by conservatives was a blip in history during the 1950s.
Also, Gayle Rubin's "The Traffic in Sex" does a great job in explaining the social function of marriage and kinship ties in relation to sex/gender systems.
- Sid Schwab said...
scalpel: I think you're right about California. It doesn't change my point, which is that the reasons are religious and personal discomfort. I think I'm right about that. I don't expect to be able to influence you, or California, and certainly not jb who prefers silly straw-man arguments. The good news is that polls indicate (yes, I think polls are bullshit quite often, especially when I disagree with them) indicate the younger generation cares much less about what gays do than the older, and gay rights will inevitably happen. So I recognize my views are not widely enough held to take hold for now; it doesn't make my argument wrong. It IS about religion and discomfort; and there is NO argument that demonstrates a "danger" to the institution of marriage if gays are allowed in.
jb: see above.
silverstar: I think your point about separation is an interesting one. Marriage, ceremonially, seems largely religious based; full legal partnership is not. Which is sort of like my saying that if a church doesn't want to marry gays, they need not and ought not. But there's no state interest in denying fully equal legal partnership that we understand as coming with marriage.
- gay CME guy said...
I'm no longer a 'religious' man, but I have to say, "AMEN", and thanks, from one of the 'MOs who hopes to see the laws righted in this nation in my lifetime.
I have the argument all too often that civil rights are NOT special rights. I won't drone on, as most everything I'd say had already been said, other than, Scalpel, it's people like you who scare me.
Devorrah, Would you like to 'adopt' this gay son? ;)
Thanks for the post Sid. As a friend's father (who was a minister) once said to us about gay rights and the church, "It's not going to move forward very far until the heterosexuals take up and lead the battle." While it angered and disheartened me at the time (~20 years ago) I came to see the truth in his statement. It takes a village to raise a child, and it takes a village to change homophobic laws and institutions.
- Devorrah said...
To Gay CME Guy: Sure! I only gave birth to two sons, but I have five who call me Mom (foster sons, past and present). Being a parent is more about love, constancy and acceptance, rather than just gestation and lactation. I tease my sons all the time about my disappointment in their heterosexuality (-: Seriously and sadly, though, their lives will be much easier because they are straight.
- egomosperficio said...
well written, sid. i share your views on brussel sprouts, by the way. don't worry, eventually the usa will come around and sanction gay marriages. i believe it is inevitable. contrary to what the conservatives always say, it won't wreck your society. we canadians have been doing just fine, thank you.
- Camilla said...
Wasn't there recent research hinting at a large gestational, rather than genetic factor in male homosexuality? Essentially, that if a women bears multiple sons, the younger are more likely to be gay, regardless of whether they are raised in the same family.
The details don't really matter as far as the politics go, of course (and thank you for such a civilized take on it), I was just surprised to see multiple people chime in with the "got to be genetic" line.
- GDad said...
Doctor Schwab,
Please accept my sincere gratitude not only for your wonderful post, but also for the well wishes. I'm honored to be recognized by such a dignitary. I hope someday to visit the left coast and make your acquaintance in person. I'll buy the first round.
- gay CME guy said...
I remember reading about the study Camilla mentions, but I didn't save the reference or the article. For the record, I'm the third of 3 sons.
- Sid Schwab said...
Yes. And I guess I was a little sloppy in my statement that it's about genetics. So I amended it to "genetics or other biologic factors."
Well, given that the divorce rate for "straight" people is at least 50%, gay marriages can hardly do worse.
- Enrico said...
Scalpel: you do recall the neoconservative demigod Dick Cheney has an abomination of a lesbian daughter, correct? If she were to wish to be married to her partner of many years, do you think the Dark Lord would disapprove?
Oh my.
Is this a heady logical argument to make? Of course not, it's silly, much like trying to remain in a "Father Knows Best" ideal fantasy world of a mom, dad, and 2.5 kid household being what's best. Procreation will occur because man as a species will do what it needs to do to survive, with or without the Family Research Council or Planned Parenthood.
Government sanctioning of homosexual marriage costs less by making all marriages equal and transparent rather than making one kind of marriage one way legally and civil unions abide by a different set of laws, etc.
Conservatives just don't want to have to deal with uncomfortable questions like, "Why does Timmy have two daddies?" or "How do two mommies make a baby?"
In almost every state, after a heterosexual couple cohabitates for a period of time (and meets certain requirements), they are considered "commonlaw married" even though they've never been officially married by clergy or justice. Yet conservatives would argue that homosexuals who are willing to appear before both to do the same are still in an inferior position legally than those who haven't even bothered. Give me a break.
- Enrico said...
Oh and Scalpel's ADA argument combined with the summation that it's not discrimination, it's nature?
Homosexuality *IS* nature. You'd think it would have been selected against to extinction serving no purpose to the gene pool, yet it remains in almost every sexually reproducing species, albeit in the minority.
So in the minority, what harm is there? Think of it as giving the retarded kid a job at Wal-Mart if you must. He's happy, feels productive, and while yes, you can argue that the skills of the Ivy League cashiers are being devalued, as a collective it's OK...the workforce will remain in equilibrium in the face of a few pro bono handouts. Just trying to speak in terms of your analogies, that's all.
- scalpel said...
Down's syndrome is nature too, but grocery stores don't have to give affected individuals the store manager job.
- Sid Schwab said...
scalpel: I hope you were chuckling when you wrote that. Otherwise, well,...... yikes.
- scalpel said...
All jokes have at least a kernel of truth behind them.
If homosexuality is exclusively genetic (which is doubtful) then it must be a dysfunctional mutation like Down's, because there is obviously no evolutionary benefit from homosexuality. If one believes in evolution, that is.
Being a sharp dresser and a fan of show tunes doesn't help one pass on one's DNA to future generations.
- Sid Schwab said...
"there is obviously no evolutionary benefit from homosexuality."
Actually, that's not necessarily true. I'm quite sure you've read Dawkins' "The God Delusion," right? In it he discusses the "side-effects" (not his term) of certain mutations as being of benefit. I won't re-hash it because I'm certain you have it underlined and highlighted in your copy.
Also, as you know, biological explanations for homosexuality are not limited to "genetic."
But the bottom line is this: neither you nor anyone else has come up with something other than a declarative statement why same-sex marriage is a danger to society. You just don't like the idea, and, by clear inference, you are made quite uncomfortable by the idea of homosexuality. Fine. Entitled, are you. But if you are willing to accept even the remote possibility that most gays have no choice in their own sexual orientation (or even if you aren't), you still ought to be able to come up with something other than your own revulsion as a reason why it's harmful, even if you hate it.
- scalpel said...
I have no revulsion toward gay people but admittedly some dislike of some of their activities. That's also how I feel about liberals in general, pretty much.
Same-sex "marriage" doesn't have to be a "danger to society" for the concept to be rejected by me or the other 70% of Americans who disagree with you. I'm actually more liberal than most, since I accept the concept of civil unions with most of the same benefits of marriage, but I wouldn't give them any tax breaks. Heck, why not tax them even more for the opportunity. Liberals love taxes, right?
- Leigh said...
"Biracial 'marriage' doesn't have to be a 'danger to society' for the concept to be rejected by me or the other 70% of Americans who disagree with you. I'm actually more liberal than most, since I accept the concept of shacking up with most of the same benefits of marriage, but I wouldn't give them any tax breaks."
There, fixed that for you. Do you now get even the beginnings of an idea about why you're wrong?
And btw, I have no revulsion toward conservative people but admittedly some dislike of some of their activities.


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text: Wednesday, December 19, 2012 Insufficient Exercise a Barrier to Decreasing CVD Deaths Poor exercise and eating habits could be the game-changer in the fight against heart disease and stroke deaths, according to the American Heart Association's (AHA) "Heart Disease and Stroke Statistical Update 2013." Between 1999 and 2009, the rate of deaths from cardiovascular disease (CVD) fell 32.7%, but still accounted for nearly 1 in 3 deaths in the nation. However, according to projections in the 2013 report, heart health may only improve by 6% if current trends continue. The biggest barriers to success are projected increases in obesity and diabetes, and only modest improvements in diet and physical activity. On a positive note, smoking, high cholesterol, and high blood pressure rates are projected to decline. Among heart disease and stroke risk factors, the most recent data show: 68.2% of adults are overweight or obese; 34.6% are obese; 31.8% are normal or underweight. 31.8% of children ages 2-19 are overweight or obese. 32% of adults report no aerobic activity. 17.7% of girls and 10% of boys, grades 9-12, report fewer than 1 hour of aerobic activity in the past week. 13.8% of adults have total cholesterol of 240 mg/dL or higher. 33% of adults have high blood pressure; African-Americans have among the highest prevalence of high blood pressure (44%) worldwide. 8.3% of adults have diagnosed diabetes; 8.2% have undiagnosed diabetes; 38.2% have prediabetes. AHA says it plans to focus on population-based ways to improve health factors for all Americans. Some of these include: Working with health care systems to support and reward providers who help patients improve their health behaviors and manage their health risk factors. Working with insurers to cover preventive health services and reward positive health behaviors and medication adherence. Working with the education community to make changes in schools that support healthy diets and physical activity for children. Building comprehensive worksite wellness programs. Building healthier communities with improved access to healthier foods and green space for physical activity. "Americans need to move a lot more, eat healthier and less, and manage risk factors as soon as they develop," said Alan S. Go, MD, chair of the report's writing committee. "If not, we'll quickly lose the momentum we've gained in reducing heart attack and stroke rates and improving survival over the last few decades." Free full text of the article is available in Circulation.


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Home Performance Legislative Outlook
A version of this article appears in the July/August 2013 issue of Home Energy Magazine.
July 01, 2013
The U.S. Congress has found little to agree upon over the last couple of years. As the 112th Congress closed in December with the fewest bills to reach the president's desk in 70 years, there has been frustration at every level of government.
To read complete online articles, you need to sign up for an Online Subscription.
Once an order has been placed there is an automatic $10 processing fee that will be deducted with any cancellation.
The Home Energy Online articles are for personal use only and may not be printed for distribution. For permission to reprint, please send an e-mail to email@example.com.


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John Feal started the FealGood Foundation to fight for recovery workers and has raised more than $400,000.
CNN's Alison Kosik profiles one Walgreen's distribution center in Windsor, Conn., where 40% of the employees are disabled.
Actor Adrian Grenier and producer Peter Glatzer won a webby award for shft.com, a website focused on environmental progress.
The British entrepreneur is pushing to end the war on drugs by expanding decriminalization.
Atlanta pastor Tony Smith saw that his congregation needed help to recover from job loss, so he purchased a home for church members to live in for free.
High school freshman Jordan Lane-Palmer was raised to understand the importance of saving money and budgeting.
Xerox CEO, Ursula Burns says if American students do not improve in math and science, our country will lose its competitive edge.
Xerox CEO, Ursula Burns doesn't believe it is too late for the country to regain its focus with regards to math and science and get back to basics.
City Harvest rescues 28 million pounds of food per year from 'all segments of the food industry and delivers it to New York's hungry.'


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Rosacea is not curable, but it can be managed. Treatment goals are to control the condition and improve appearance. Treatment depends on the subtype of rosacea and the severity of symptoms. A combination of medications and lifestyle changes works best. As a result, your doctor may recommend more than one treatment, depending on your specific condition.
Most dermatologists believe that early treatment prevents rosacea from getting worse. Early treatment may prevent blood vessels from enlarging and rhinophyma (enlarged nose) from developing. Do not diagnose and treat yourself, since many over-the-counter treatments can make rosacea worse.
Treatment by subtype:
- 1—Topical creams or gels, or pulsed light or laser surgery to narrow blood vessels and reduce redness.
- 2—Topical creams and/or low-dose antibiotics to reduce inflammation and skin lesions. Pulsed light or laser may also be used.
- 3—Similar treatment as subtype 2. Other medications may be used to help inhibit thickening of the skin. Surgical or laser treatments may help reshape an enlarged nose.
- 4—Antibiotics or steroids (as eye drops, eyelash ointment, or by mouth) to reduce inflammation and relieve dryness.
Talk to your doctor if you think or know you are pregnant, of childbearing age, or are breastfeeding. Some drugs cannot be taken before, during, or after pregnancy. You may need to use birth control during the course of treatment. Openly discuss the risks and benefits of treatment options.
Lifestyle changes will be a part of your treatment plan. These changes include avoiding triggers, using sun protection, having a skin care routine, and using certain types of cosmetics.
Your healthcare team may be made up professionals who specialize in skin (dermatology) and eye (ophthalmology) diseases.
Rosacea treatment includes:Lifestyle changesMedicationsSurgery
Revision Information
- Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
- Review Date: 11/2018 -
- Update Date: 12/28/2015 -


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Missouri mechanic, his wife named Powerball winner
Fri., Nov. 30, 2012
DEARBORN, Mo. (AP) — A 52-year-old Missouri mechanic and his wife claimed their share Friday of the record $588 million Powerball jackpot.
Lottery officials sent a statement Friday announcing that Mark and Cindy Hill, of Dearborn, held one of two winning tickets for the nation's biggest Powerball jackpot.
The Hills will split the $588 million prize with whoever holds a winning ticket sold at a convenience store in suburban Phoenix. No one has come forward yet with the Arizona ticket, lottery officials said.
The $587.5 million payout, which represents the second-largest jackpot in U.S. history, set off a nationwide buying frenzy, with tickets at one point selling at nearly 130,000 per minute. Before Wednesday's winners, the jackpot had rolled over 16 consecutive times without someone hitting the jackpot.
Lottery officials' announcement that the Hills had won only confirmed what many residents in Dearborn, a town of about 500 about 40 miles north of Kansas City, already knew. Lottery officials said Thursday that one winning ticket had been sold at a Trex Mart gas station and convenience store on the edge of town, and Mark Hill's name circulated quickly. While he and his wife did not speak to reporters, friends and relatives identified Mark Hill as the winner.
Myron Anderson, pastor of the Baptist Church in nearby Camden Point, said he heard Thursday that the Hills had won the huge lottery prize. Anderson said he has known Mark Hill since they attended high school together and that the couple have older children and a younger elementary school-age daughter.
"He's a really nice guy, and I know his wife, and they have this nice little adopted daughter that they went out of their way to adopt," Anderson said. Funeral services for Hill's father were at the Baptist church, but the family attends church elsewhere, he said.
"I hope it's good news for them," Anderson said. "I've heard awful horror stories about people who get all that money in their lap and how everybody treats them, and if you don't mind me saying, I mean just the fact that the press is going to be after them."
Kevin Bryan, a lifelong Dearborn resident, said the only other local lottery winner he could remember was a farmer who won about $100,000 in scratch-off game years ago "and bought himself a combine."
The winning ticket sold in Arizona was purchased at a 4 Sons Food Store in Fountain Hills near Phoenix, state lottery officials said.
In a Mega Millions drawing in March, three ticket buyers shared a $656 million jackpot, the largest lottery payout of all time.
Hill and the holder of the Arizona winning ticket have numerous decisions ahead, including how to accept their new wealth. The cash payout from the overall jackpot has been estimated at about $385 million, or about $192.5 million for each ticket. The winners can take their jackpots in lump sums or annual payments.
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Leukodystrophy is a breakdown of a component of the nervous system called the myelin, which is a significant part of what makes the white matter of the brain. Myelin protects the part of the nerve that sends signals throughout the brain. The breakdown of myelin makes it difficult for the brain to send these signals. Leukodystrophy is a rare disease.
Types of leukodystrophies include:
- Metachromatic leukodystrophy
- Krabbé disease
- Adrenoleukodystrophy
- Adrenomyelopathy
- Pelizaeus-Merzbacher disease
- Canavan disease
- Childhood ataxia with central nervous system hypomyelination (CACH), which is also called vanishing white matter disease
- Alexander disease
- Refsum disease
- Cerebrotendinous xanthomatosis
Most leukodystrophies begin in infancy or childhood. However, there are several types that may not begin until adolescence or early adulthood.
Leukodystrophy is caused by a genetic defect. This defect impairs the growth or development of the myelin. Each type of leukodystrophy is the result of a specific genetic defect. Most leukodystrophies are passed from parent to child, though some may develop in people without a family history.
Symptoms of leukodystrophy may include:
- Gradual decline of the health of an infant or child who previously appeared well
- Loss or increase in muscle tone
- Change in movements
- Seizures
- Abnormal eye movements
- Change in walking pattern
- Loss of speech
- Loss of the ability to eat
- Loss of vision
- Loss of hearing
- Change in behavior
- Slowdown of mental and physical development
Some leukodystrophies may involve other organ systems which can cause:
- Blindness
- Heart disease
- Enlargement of the liver and spleen
- Skeletal abnormalities, such as short stature, coarse facial appearance, and joint stiffness
- Respiratory disease leading to breathing problems
- Bronzing of the skin
- Cholesterol nodules to form on tendons
You will be asked about your symptoms and medical history. A physical exam will be done.
Images of the brain may be taken. This can be done with:
Your bodily fluids and tissues may be tested. This can be done with:
- Urine analysis
- Nerve or brain biopsy
- Blood tests, which include genetic testing
- Lumbar puncture
Tests may be done on your nerves. This can be done with:
- Nerve conduction testing
- Evoked potential test
In rare cases, a brain biopsy may be done.
Talk with your doctor about the best treatment plan for you. Treatment options include:
Management of Symptoms
Depending on the type of leukodystrophy and the symptoms, treatment may include:
- Medications to reduce symptoms and relieve pain
- Physical, occupational, and/or speech therapy
- Nutritional programs
- Education
- Recreational programs
Bone Marrow Transplant
In a few of the leukodystrophies, bone marrow transplant may help. It may be able to slow or stop the progression of the disease.
Enzyme Replacement Therapy
Replacement of the abnormal or absent enzyme is being explored for a few of the leukodystrophies. Research is being done in this area.
There is no known way to prevent leukodystrophy. For parents who have had a child with leukodystrophy, genetic counseling may be helpful. This counseling will help to determine the chances of having another child with the disease.
Revision Information
- Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
- Review Date: 03/2018 -
- Update Date: 02/12/2016 -


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Principal Proposed Uses
Other Proposed Uses
Glucomannan is a dietary fiber derived from the tubers of Amorphophallus konjac . Konjac flour (made from these tubers) is used to make a jelly called konyaku, a common food product in Japan.
Fiber-containing foods, such as oats, are known to help reduce cholesterol and improve constipation and may also help regulate blood sugar and assist in weight reduction by creating a feeling of fullness. However, many people have a hard time consuming enough fiber from food, so turn to fiber supplements, such as guar gum and pectin, to help fulfill their daily requirements. Glucomannan offers one advantage over these forms of fiber: much smaller doses are necessary. When glucomannan is placed in water, it can swell up to 17 times its original volume. These qualities make it potentially quite convenient as a fiber supplement.
Although glucomannan can be derived from other sources such as yeast, most studies have used glucomannan purified from the konjac root.
Therapeutic Dosages
Most of the studies described here used 3 to 5 g per day in divided doses before meals. However, there are concerns regarding the form of glucomannan used (see Safety Issues below).
Therapeutic Uses
Several small controlled studies have found glucomannan to be effective for improving the cholesterol profile. 1-7,37 Glucomannan appears to reduce LDL ("bad") cholesterol and, according to some studies, increase HDL ("good") cholesterol. In addition, it may improve blood pressure .
By expanding in the stomach, glucomannan might be useful for people trying to lose weight. Many people report a feeling of fullness after taking glucomannan, and some studies found a significant weight loss among those taking glucomannan compared to those on placebo . 8-12 However, not all studies of glucomannan for weight loss have had positive results. 13,14
Glucomannan may also help the body to regulate blood sugar levels, and therefore could be helpful in treating diabetes . 15,16,37 Additionally, glucomannan might be helpful for individuals who experience episodes of low blood sugar following stomach surgery. 17
Like other dietary fibers, glucomannan may help treat constipation . 18,19,38,40
Hyperthyroidism is a state in which levels of thyroid hormone are too high. A preliminary trial found some evidence that when glucomannan is added to standard treatment, normal thyroid hormone levels are restored more rapidly. 39
What Is the Scientific Evidence for Glucomannan?
High Cholesterol and High Blood Pressure
In a double-blind study , 63 people were given either 3.9 g per day of glucomannan or placebo for 4 weeks and then switched to the other treatment. 20 While taking glucomannan, participants showed significant reductions in total cholesterol, LDL cholesterol, and triglycerides, as compared to placebo. In addition, their systolic blood pressure (the upper number in the blood pressure reading) was also reduced. However, there was no significant increase in HDL cholesterol and no improvement in the ratio of LDL to HDL cholesterol.
Participants in another study were given either 3 g per day of glucomannan or placebo over an 8-week period. 21 The glucomannan group showed improvements in total and HDL cholesterol as well as a reduction in systolic blood pressure. Those taking glucomannan also lost weight, whereas the placebo group gained weight over the length of the trial.
Several other controlled studies have found similar results. 22-25,37 And, in a mathematical review combining the results of 14 studies, glucomannan significantly reduced total and LDL cholesterol levels. 42
Weight Loss
A few small double-blind studies suggest that glucomannan may be helpful for people trying to lose weight; however, in other studies, no such benefit was seen. 26-29,41
One double-blind, placebo-controlled trial of 20 women who were more than 20% over their ideal weight found glucomannan to be more effective than placebo at promoting weight loss. 30 All participants were instructed not to change their eating or exercise habits while on the treatment. Those in the treatment group took 1 g of glucomannan 3 times a day for 8 weeks and lost an average of 5.5 pounds during that period; in comparison, those in the placebo group gained an average of 1.5 pounds, a significant difference. The glucomannan group also had a reduction of total and LDL cholesterol as well as triglyceride levels.
Benefits were also seen in a double-blind, placebo-controlled trial of 28 overweight people who had just experienced a heart attack. 31
However, another double-blind trial of 60 obese children did not find a significant difference in weight loss between the glucomannan and the placebo groups. 32 In this study, the children received either 1 g of glucomannan or placebo twice a day for 8 weeks.
A study of individuals with diabetes tested the effectiveness of glucomannan fiber-enriched biscuits against wheat bran biscuits for blood sugar control. 33 While using the glucomannan biscuits, people experienced a significant improvement in glucose control as compared to the wheat bran biscuits.
Other studies have also found evidence that glucomannan can improve blood sugar control. 34,37,42
Safety Issues
In Japan, food products containing glucomannan have a long history of use and are believed to be safe. However, there are some concerns about taking glucomannan as a supplement.
Some people taking glucomannan complain of excess gas, stomach distension, or mild diarrhea. These symptoms usually abate within a couple of days of treatment or with a reduction of the dosage.
In a few cases, glucomannan tablets have caused obstruction of the esophagus when they expanded before reaching the stomach. 35,36 In response to these reports, tablets of this type have been banned. Capsules, however, do not seem to pose the same risk because their casing prevents the glucomannan from contacting water until it reaches the stomach. The dramatic expansion of glucomannan has also raised some concerns that it could cause an obstruction in the intestines; nonetheless, as of yet, there have been no reports of this actually happening.
One option to offset all expansion risk is to mix glucomannan powder in water so that it expands before it is ingested; however, this strategy defeats the convenience of this form of fiber.
Revision Information
- Reviewer: EBSCO CAM Review Board
- Review Date: 12/2015 -
- Update Date: 12/15/2015 -