Docs facing questions about 'Michael Jackson drug' (AP)

LOS ANGELES � Doctors sometimes call the anesthesia drug by its nickname � milk of amnesia. Patients are calling it the "Michael Jackson drug."

Ever since propofol was blamed in the singer's death, patients who seldom asked or cared about what kind of sedation they were getting were suddenly peppering their doctors with questions about the potent drug.

"You won't believe how many people with their eyes wide open ask me: `Are you going to give me the Michael Jackson drug?' They're scared to death," said Dr. H.A. Tillmann Hein, president of the Texas Society of Anesthesiologists.

While some initially balk at going under, fearing they will end up like Jackson, they come around after Hein explains that propofol, widely used for surgeries and other procedures for more than 20 years, is safe when used by a trained professional in a hospital or clinic.

Propofol gained notoriety in 2009 after an autopsy found Jackson died of an overdose. Prosecutors have accused his personal physician, Dr. Conrad Murray, of giving the 50-year-old pop icon a lethal dose at the singer's rented Los Angeles mansion.

Murray has pleaded not guilty to involuntary manslaughter. His lawyers contend the amount of propofol Murray gave him to battle insomnia while prepping for his comeback tour was too small to cause the singer's death.

While Jackson's death thrust propofol into the spotlight, the circumstances of the case are rare.

Since the drug is hard to get (it's usually kept in medical settings) and hard to use (it's injected through an IV), there's little abuse in the general public. Almost all cases of recreational propofol use and deaths involve medical professionals.

Even before Jackson died, the federal government had considered adding the drug to its roster of controlled substances amid concerns about growing abuse in the medical community.

For the past two years, anesthesiologists have tried to counter the bad rap that propofol has gotten in the Jackson case.

Before Jackson's death, less than 10 percent of patients that Dr. John Dombrowski saw asked about propofol. Now more than half do, mostly about what monitoring safeguards are in place in case problems occur.

"It's important to have this conversation so people aren't fearful," said Dombrowski, who runs the private Washington Pain Center.

While doctors are seeing more patients with questions, they say no one has refused care after they are reassured that their situations are different than those of Jackson.

About 40 million Americans undergo anesthesia each year, with the vast majority receiving propofol. Because it is fast-acting and clears quickly from the body, people can return to normal activities sooner than older anesthetics.

During the past two weeks, prosecution witnesses said Murray flouted the standard of care by giving propofol in Jackson's home to help the superstar sleep and by leaving the room while he was sedated. Propofol is not approved to treat sleep disorders.

Propofol expert Dr. Steven Shafer of Columbia University testified Wednesday for the prosecution without a fee, saying he wanted to restore public confidence in doctors who use propofol, which he called "an outstanding drug" when properly administered.

Like many anesthesiologists, Shafer said he has received questions from many patients in the operating room about whether they will receive "the drug that killed Michael Jackson."

"I get that question daily. This is a fear that patients do not need to have," said Shafer, who wrote the package insert that guides doctors in the use of the anesthetic and demonstrated to jurors the appropriate way to administer the drug.

Within the medical profession, there have been growing concerns in recent years about abuse by health care workers. Published studies have uncovered several overdose deaths and cases of medical professionals who self-administer propofol to get high.

"It takes away anxiety, fear and pain," said anesthesiologist Dr. Paul Wischmeyer of the University of Colorado, Denver, who has studied propofol abuse. "That's the draw of the drug."

The U.S. Drug Enforcement Administration's proposal to make propofol a controlled substance is pending.

At UAB Hospital in Birmingham, Ala., officials are already treating propofol like other controlled drugs such as morphine and Valium by requiring stricter accounting of how it is disposed of.

Before that change went into effect eight months ago, doctors would dump leftover propofol bottles and used syringes in a biohazard container after an operation. Now the hospital requires another witness to be present to document the disposal.

Hospital officials first considered that change several years ago after reports of abuse by health care workers around the country. The Jackson case heightened awareness, chief pharmacy officer Mark Todd said.

"It got some momentum" after Jackson's death, Todd said. "It helped move it along."

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Online:

American Society of Anesthesiologists: http://www.asahq.org

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Follow Alicia Chang's coverage at http://twitter.com/SciWriAlicia

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Report: Food labels need Energy Star-like ratings (AP)

WASHINGTON � Just like that Energy Star tag helps you choose your appliances, a new report says a rating symbol on the front of every soup can, cereal box and yogurt container could help hurried shoppers go home with the healthiest foods.

Thursday's report urges the Food and Drug Administration to adopt new food labeling that clears the confusing clutter off today's packages and gives consumers a fast way to compare their choices.

It wouldn't replace the in-depth Nutrition Facts panel that's now on the back or side of food packages. But few shoppers stop to read or heed that fine print in the middle of the grocery aisle.

The Institute of Medicine says it's time to put right upfront the most important information for health: how many calories per serving � and just how big that serving is � along with stars or some other symbol to show at a glance how the food rates for certain fats, sodium and added sugars.

"American shoppers are busy shoppers," said Ellen Wartella, a psychology professor at Northwestern University who chaired the IOM committee that studied the issue at the government's request.

"We want a really simple system that says if you have three marks, that product is healthier than one with two marks."

How to get Americans to eat more wisely is a huge problem as obesity and diet-related diseases are skyrocketing. The FDA already was working to change the food-labeling system to make it more user-friendly. The agency didn't say if it would adopt a ratings approach but called Thursday's report a thoughtful analysis that would help it decide next steps.

"FDA agrees consumers can benefit from a front-of-pack labeling system that conveys nutrition information in a manner that is simple and consistent with the Nutrition Facts panel," said spokeswoman Siobhan DeLancey.

But the IOM's recommendation would face an uphill battle with food manufacturers who are pushing their own version of on-the-front food labels and don't like the idea of ranking one food as healthier than a competitor's.

"We believe the most effective programs are those that trust consumers and not ones that tell consumers what they should and should not eat," said Scott Faber, a lobbyist for the Grocery Manufacturers Association.

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Associated Press writer Mary Clare Jalonick contributed to this report.

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Mexico tackles epidemic of childhood obesity (AP)

MEXICO CITY � Anghella Torres is just 4 years old, but already she weighs 66 pounds (30 kilos) � twice what she should. Because of her excess girth, her little feet constantly hurt from bearing the extra weight.

Anghella knows she is obese and she doesn't like it. And now, even though she doesn't know how to read or count calories, she is on a diet. With the help of her grandmother and caretaker, Elizabeth Sucilla, Anghella is following a modest diet and exercise program established for her by a nurse at a local public hospital earlier this year.

"I have to stop eating candies," she said.

Her new regimen also requires her to cut down on the deep-fried potato wedges she ate every other day in the streets and spoonfuls of heavy cream she downed like yogurt.

Mexico, which claims to have the fattest children in the world, is trying to encourage others to follow Anghella's lead. Public schools have banned junk food and are requiring more hours of physical education while the federal government has launched a media campaign that invites families to enroll their kids in a public weight-loss program.

Yet three-quarters of Mexico City's 2,400 public schools don't have playgrounds or gyms for exercise. And 80 percent of the schools don't have water fountains. Experts stress the importance of drinking more water and fewer sugary drinks to prevent and reverse weight gain.

President Felipe Calderon said earlier this year that Mexico had the highest rate of obesity for children ages 5 to 19 in the world. And although he did not cite any source, University of North Carolina nutrition professor Barry Popkin, who has studied childhood obesity in many countries, agrees that it "is the highest I know of in the world."

While a large number of children in Mexico's poor, rural villages are still underweight, the country as a whole has seen the second-fastest growth rate for childhood obesity of nine countries examined by Popkin in a 2007 study, including the United States. The fastest growth rate of the nine is in Australia, according to the study, which compares health statistics in the countries over the past two decades.

The problem in Mexico is especially pronounced in the capital, Mexico City, and near the U.S.-Mexico border, according to a study by Mexico's National Institute of Public Health.

Children and teenagers make up Mexico's largest age group, representing 39 percent of the country's 112 million people. More than 28 percent of children between 5 and 9, and 38 percent of preteens and teenagers ages 10 to 19, are overweight or obese, according to statistics from the Mexican Social Security Institute.

In the U.S., the Centers for Disease Control and Prevention says 12.5 million, or 17 percent, of children and adolescents ages 2 to 19 are obese. First lady Michelle Obama has tackled the issue with her "Let's Move" campaign, pushing for better school lunches, more access to fruits and vegetables and more physical activity. And Congress last year passed a new law requiring school lunches to be healthier.

In Brazil, a newly industrialized nation like Mexico, 19 percent of children ages 5 to 9 are overweight, and 15 percent are obese, according to government statistics. Officials did not have statistics available for teenagers.

Mexico's public health institute says the problem lies not just with children: Seventy percent of Mexican adults are overweight or obese as well. Officials have decided to target children and teens first, however, because they are the largest age group and fighting their habits now would prevent large numbers of diabetes cases and other illnesses in the future, the officials said.

"The earlier obesity shows up, the higher the risk the kid will become an obese adult and contract other diseases like diabetes, hypertension," said Leticia Martinez, chief nutritionist for Mexico's public health institute. "We see this as an emergency."

Health officials define obesity as having too much body fat. In Mexico, the U.S. and elsewhere, obesity is determined through BMI, a measure of body fat based on height and weight.

Mexico's childhood obesity spans social classes, though the poor are less informed and equipped to deal with the epidemic.

Starting this year, pre-kindergarten and elementary schools completely banned the sale of soft drinks and junk food and replaced previous breakfast programs with dishes rich in vegetables, such as squash blossoms and carrots. Middle schools are only selling sugar-free drinks, low-calorie snacks and small bags of chips that appear in new food guidelines approved by the departments of health and education.

During recess at the Republica Italiana elementary school, children run out of classrooms and form three lines, each one of which leads to a different food option.

Their choices include a turkey hot dog on a wheat bun with tomatoes and no mayonnaise; "nopales," or edible cactus paddles, with sliced peppers on a corn tortilla; sunflower seeds or a scoop of unsweetened lemon sorbet; and slices of cucumbers and carrots.

Principal Yamile Bobadilla says there's nothing she can do about vendors who still gather outside of the school gates to sell sodas, greasy pizzas and chips.

Some of the children, and even some parents, have complained about the junk food ban, she said, adding, "They see me as the witch."

The country's healthy-weight campaign has other challenges: Officials acknowledge there aren't enough dietitians in the public schools to help all of the children in need. They also note a prevailing cultural notion that a chubby baby is a healthy baby.

"Any efforts to improve the school environment are very important to combat the epidemic," said Chessa Lutter, a regional adviser on food and nutrition for the Pan American Health Organization.

Starting in the 2010-2011 school year, education officials began increasing the number of physical education hours from one to three per week based on their conclusion that some children are obese because they don't exercise. On a recent morning at Republica Italiana, several groups of kids were sent out to the school yard to run, play softball or twirl hula-hoops.

Bobadilla said some children still faint and suffer from extreme fatigue because of their weight problems.

Guillermo Ayala, who leads the food guidelines' task force at the Education Department, also heads an effort to have every child in Mexico City weighed and measured by a team of physical education coaches and nurses. Schools with a high number of children who have gained or not lost weight will face administrative sanctions, he said.

Outside the classroom, government-sponsored TV spots show kids struggling under heavy sacks of grain, symbols of the extra pounds (kilos) many are carrying around with them. The ads invite parents to enroll their children in a government-run program of diet and exercise. About 5.3 million children participate every year, but officials don't keep track of how many of them are overweight.

Anghella's grandmother Sucilla took her to a public hospital in May at the suggestion of the girl's day care providers, who said something would have to be done about the child's diet and exercise before she started school in August.

A nurse at the hospital suggested that Anghella start taking regular walks, drinking a lot of water and eating more whole grains, vegetables and fruits.

She goes often to visit the nurse, who weighs her regularly.

At home, when her small hand tries to reach for a sweet roll on the table, Sucilla slaps it and says, "You know why, my little girl."

Anghella said she doesn't like it when adults say she's fat.

"No, sweetheart. You are cuddly," Sucilla tells her. But she then adds, "I worry because I don't want my little girl to be an obese girl."

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