Pinkwashing for breast cancer awareness questioned (AP)

PITTSBURGH � The country is awash in pink for breast cancer awareness month � and some women are sick of it.

While no one is questioning the need to fight the deadly disease, some breast cancer advocates are starting to ask whether one of the most successful charity campaigns in recent history has lost its focus.

"The pink drives me nuts," said Cynthia Ryan, an 18-year survivor of breast cancer who also volunteers to help other women with the disease. "It's the cheeriness I can't stand."

Activists have even coined a new word: pinkwashing.

They say that's when a company or organization does a pink breast cancer promotion, but at the same time sells and profits from pink-theme products.

Some of the pink products have generated plenty of discussion among breast cancer advocates.

A Smith & Wesson 9mm handgun with pink pistol grip? The manufacturer says a "Portion of the Proceeds Will Be Donated to a Breast Cancer Awareness Charity."

You can get the "Pink Ribbon Combo" at Jersey Mike's Subs, or the Sephora Collection Pink Eyelash Curler. One year, there was a pink bucket of Kentucky Fried Chicken.

The San Francisco group Breast Cancer Action has led the campaign to question pink products, but executive director Karuna Jaggar said it isn't saying all such products are bad.

She said there's no doubt that when the pink ribbon campaigns started about 20 years ago there was still a great need to raise awareness.

"At one time, pink was the means," Jaggar said. "Now, it's almost become the end in itself. In its most simplistic forms, pink has become a distraction. You put a pink ribbon on it, people stop asking questions."

Breast cancer activists agree that the use of a ribbon to promote awareness evolved in stages. They note that in 1979 there were yellow ribbons for the American hostages in Iran; in 1990, AIDS activists used red ribbons to call attention to victims of that disease; and 1991 saw the first major use of the pink ribbon, when the Susan G. Komen Foundation gave them out at a New York City race for cancer survivors.

But the ribbon symbol may tie into a far older tradition, according to the American Folk Life Center at the Library of Congress. It notes that various versions of the song "Round Her Neck She Wore A Yellow Ribbon" have been popular for 400 years, all with the theme of displaying the ribbon for an absent loved one.

And it's clear that too many loved ones are still lost to the disease, despite many advances in diagnosis and treatment. The National Cancer Institute estimates that about 40,000 women will die of breast cancer this year, and 230,000 new cases will be diagnosed.

But Jaggar, of Breast Cancer Action, wonders whether more awareness is what's needed to reduce those numbers.

And Breast Cancer Action does take exception to products it considers potentially harmful � like a perfume the Komen Foundation introduced this year, "Promise Me." Jaggar said the perfume contains some possibly toxic or hazardous ingredients, and Breast Cancer Action asked that Komen discontinue its sale.

Federal regulatory agencies don't consider small amounts of those ingredients to be a threat, and Komen's scientific and medical advisers didn't believe there was any problem. But Komen said that to allay any concerns the next batch of "Promise Me" will be reformulated without the ingredients that were criticized.

Leslie Aun, a spokeswoman for Susan G. Komen for the Cure, based in Dallas, said the advocacy group isn't apologizing for all the pink.

"Research doesn't come cheap. We need to raise money and we're not apologetic about it," Aun said.

Komen, founded in 1982, has contributed $685 million to breast cancer research and $1.3 billion to community programs that help with mammograms, transportation and other needs, Aun said.

Komen would love not to have to do marketing, but that's simply not realistic, she said.

"We don't think there's enough pink. We're able to make those investments in research because of programs like that," Aun said.

Samantha King, a professor at Queens University in Ontario and author of the book Pink Ribbons Inc., said that at first people warned that she'd get hate mail for writing critically about the pink campaigns.

"And in fact the opposite was true," King said. "I had underestimated the level of alienation that many women felt."

King said she felt the Komen Foundation crossed the line a few years ago, when they partnered with Kentucky Fried Chicken on the pink bucket of fast food.

"What's next, pink cigarettes for the cure?" King asked. "I think this really speaks to the fact that they've lost sight of their mission. Their primary purpose appears to be to sell products."

But perhaps not, said Ryan.

Over the last two years she's worked with homeless women who have breast cancer, in her hometown of Birmingham, Ala. Some of the women have an advanced stage of the disease, no health insurance and no place to call home. Yet when Ryan recently asked two of them what they wanted to help promote awareness among other homeless women, the response came quickly.

Pink handbags.

That answer promoted Ryan to take a hard look at her aversion to pink.

Now, she's not sure whether it's her place � or anyone else's � to proclaim that a particular pink-themed product is acceptable, or not.

"I'm conflicted," Ryan said, adding that she still worries that many people buy the pink products without really knowing where the money is going.

Jaggar said that different women will make a variety of choices. The point is to have them consider what the best choice is, instead of buying a pink product blindly.

For example, the lingerie company Aerie, based in Pittsburgh, draped thousands of bras on one of the many steel bridges in the city, to heighten awareness. Aerie said $1 from every sale during October will be donated to a breast cancer charity, up to $50,000.

Jaggar said that's the type of detail shoppers should pay attention to, and decide whether $1 out of a $20 or $30 sale is enough.

Jani Strand, a spokeswoman for Aerie's parent company, American Eagle Outfitters, said company officials feel strongly that it's a good thing to get young women talking about breast cancer.

Aerie's target audience is 20-year-old women, and Strand said the things that get that age group excited about a cause are different from what attracts older women.

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Vitamin E pills linked with prostate cancer risk (AP)

CHICAGO � There is more evidence that taking vitamin E pills can be risky. A study that followed up on men who took high doses of the vitamin for about five years found they had a slightly increased risk of prostate cancer � even after they quit taking the pills.

Doctors say it's another sign that people should be careful about using vitamins and other supplements.

"People tend to think of vitamins as innocuous substances, almost like chicken soup � take a little and it can't hurt," said lead author Dr. Eric Klein of the Cleveland Clinic. The study shows that is not true.

"If you have normal levels, the vitamin is probably of no benefit, and if you take too much, you can be harmed," Klein said.

Men randomly assigned to take a 400-unit capsule of vitamin E every day for about five years were 17 percent more likely to get prostate cancer than those given dummy pills. That dose, commonly found in over-the-counter supplements, is almost 20 times higher than the recommended adult amount, which is about 23 units daily.

The results mean for every 1,000 men who took vitamin E, there were 11 additional cases of prostate cancer, compared with men taking dummy pills.

The study was actually launched to try to confirm less rigorous research suggesting vitamin E might protect against prostate cancer. Overall, about 160 of every 1,000 U.S. men will develop prostate cancer in their lifetime.

Risks increase as men age. Detection can be tricky since symptoms such as frequent urination can also be caused by harmless conditions, and doctors disagree about the benefits of screening tests. Treatment is also complex since some slow-growing prostate cancers are not deadly but some procedures, including surgery, can damage sexual function and cause incontinence.

Just last week, a government-convened panel of experts recommended against routine PSA screening for prostate cancer. That draft advice is open for public comment.

What should vitamin E users do, given the new study results? About 13 percent of American men take it, according to a supplement trade group.

Dr. Otis Brawley, chief medical officer for the American Cancer Society, says they should stop taking large doses and talk to their doctors about risks and benefits from prostate cancer screening. Smaller doses, typically found in multivitamins, are probably fine, said Brawley, who was not involved in the research.

Vitamin E is found in foods such as nuts, seeds and vegetable oils. The nutrient helps nerves, muscles, blood vessels and the immune system function.

Vitamin E supplements have long been promoted for disease prevention, but scientific research has disproven many claims and suggested they might increase risks for some conditions, including heart failure.

Brawley noted that the study echoes previous thinking on beta-carotene, which once was thought to protect against cancer but more recently has been linked with increased risks for lung cancer, especially in smokers.

"There should be a global warning that ... excessive use of vitamins has not been proven to be beneficial and may be the opposite," Brawley said.

Experts generally agree that foods are the best sources for vitamins.

The new research appears in Wednesday's Journal of the American Medical Association. The National Cancer Institute and National Center for Complementary and Alternative Medicine paid for the multimillion-dollar study.

Joe Latina, a cabinet shop owner in Aurora, Ohio, was among study participants. He said researchers gave him pills they said "might slow down prostate cancer." Now 71 and cancer-free, he says he doesn't know whether he was given vitamins or dummy pills.

Latina said he "was kind of surprised" by the study results, but is not stressing out over the possibility that he still might get cancer.

"I'm a positive thinker," he said. "I'm not walking around saying, `Oh my God, the other shoe is going to drop. I don't think I have any way to control it."

The study involved more than 35,000 healthy men aged 50 and older, from the United States, Canada and Puerto Rico. They were randomly assigned to take daily vitamin E or selenium supplements, both pills or dummy pills. The study was halted after about five years when there were signs of no benefit and a possible increased risk for prostate cancer in vitamin E users. The researchers continued tracking the men even after they stopped taking pills.

The follow-up found that a potential link between selenium and diabetes was a false alarm, but it confirmed signs of a vitamin E-prostate cancer link. Over a total of about seven years, there were 76 cases of prostate cancer diagnosed per 1,000 men, versus 65 cases in men given dummy pills.

"The implications of our observations are substantial," the study authors said.

The results suggest that extra risks associated with taking relatively high doses of vitamin E continue even after supplements are stopped. The researchers said it is unclear how vitamin E would harm the prostate.

There was no increased risk for men who took both vitamin E and selenium, suggesting that selenium might somehow counter the harmful effects of vitamin E, the study authors said.

Duffy MacKay of the Council for Responsible Nutrition, a supplement makers' trade group, said the study shouldn't be interpreted as questioning the benefits of vitamin E as an essential nutrient, and he said there is evidence that many Americans don't get enough.

___

Online:

JAMA: http://www.jama.ama-assn.org

National Cancer Institute: http://www.cancer.gov

PSA recommendations: http://www.ahrq.gov

__

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner.

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WHO: Number of people with TB falls for 1st time (AP)

LONDON � The World Health Organization says the number of people with tuberculosis has fallen for the first time.

In a report issued Tuesday, WHO estimated 8.8 million people fell ill last year, dropping from a peak of about 9 million in 2005. Officials said fewer people are now dying from the disease, but that a third of cases worldwide are probably not reported.

The small decline in reported cases is partly due to increased availability of medical treatment for TB, WHO said. The U.N. health agency also said estimates are now more accurate because countries have better surveillance of tuberculosis patients.

The TB death rate is expected to be reduced by half by 2015 everywhere except Africa, where the AIDS epidemic has also fueled a spike in tuberculosis. India and China account for about 40 percent of the world's tuberculosis cases.

In recent years, health experts have also warned of the increasing threat of drug-resistant tuberculosis, a signal that many people with TB aren't being treated properly.

Last month, officials warned that drug-resistant tuberculosis is spreading fast in Europe and that there are few drugs left to treat it. WHO estimated countries need another $1 billion to fund tuberculosis programs in 2012.

In the report, officials said they didn't have enough data to know whether the global outbreak of drug-resistant tuberculosis is increasing, decreasing or stable.

Last year, a new rapid test for drug-resistant TB was unveiled in more than two dozen countries, allowing patients to be treated sooner and stopping the disease's spread.

"But the promise of testing more people must be matched with the commitment to treat all detected," Mario Raviglione, the director of WHO's TB department, said in a statement. "It would be a scandal to leave diagnosed patients without treatment."

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Online:

http://www.who.int

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Study: Gates project spared 100K Indians from HIV (AP)

An estimated 100,000 people in India may have escaped HIV infection over five years thanks to one of the world's biggest prevention programs, an encouraging sign that targeting high-risk groups remains vital even as more donors focus on treatment, a new study suggests.

While the initial findings regarding the $258 million Avahan project, funded by the Bill & Melinda Gates Foundation, come with large uncertainty due to data limitations and methodology, the study's authors say the overall message is clear: that investing in prevention can make a dent in one of the world's largest epidemics, with an estimated 2.4 million Indians infected.

The program was assessed from 2003 to 2008 in six Indian states, home to 300 million people and the country's highest HIV rates when it started. It involved needle exchanges, safe-sex counseling, condom distribution and other interventions to reach vulnerable groups, including truck drivers, injecting drug users, men who have sex with other men, and prostitutes, along with their clients and partners. The project's aim was to reduce the number of infections infiltrating the general population by targeting those who posed the highest risk.

The assessment published Tuesday in The Lancet medical journal suggests that higher Avahan grants per infected person correlated with fewer HIV cases in the general population in the southern states of Andhra Pradesh, Karnataka and Maharashtra. However, that was not the case in southern Tamil Nadu and the small northeastern states of Manipur and Nagaland.

Part of the difference may be linked to the epidemics, with sex the main mode of transmission in the crowded south and injecting drug use the top driver in the remote northeast, said co-author Dr. Lalit Dandona, a professor at the Public Health Foundation of India. In Tamil Nadu, the authors, who are also from the University of Washington, note that HIV levels were already lower there because other prevention programs were already running when Avahan began.

In Karnataka, the program was linked to a 13 percent drop in overall HIV rates, the largest observed. Maharashtra saw the smallest decline, just over 2 percent.

In all six states, an estimated 100,178 HIV infections were averted due to the program, which is the best possible outcome with the available data, Dandona said.

The study, also funded by the Gates Foundation, explains that the conclusions do come with a degree of uncertainty, mainly because pregnant women from antenatal clinics were used as the data source even though corrections for this were factored into the calculations.

Dr. Prabhat Jha, director of the Centre for Global Health Research in Canada, who has conducted large-scale HIV studies in India, said those data are typically used to monitor trends or changes in the epidemic, not to estimate infections averted in the general population.

"Right from the start, it just doesn't work," he said. "I'm not going to judge how high my plane is flying by how many times my ears pop. It doesn't tell you where you're at."

Jha also noted that other prevention programs were in place before Avahan began and that HIV infections were already in decline. Instead of focusing on infections averted, he said it makes more sense to assess the program more broadly.

"There is substantial evidence that most new HIV infections in India arise from sex work, so taking sex work seriously means it will generate benefits," he said. "Even if these are hard to quantify."

Avahan, which translates from Sanskrit as "call to action," has been criticized by some for throwing large sums of money at the problem and creating more waste than results. As the Gates Foundation's largest HIV prevention program in a single country, the organization donated an additional $80 million to the project in 2009. The Indian government is expected to take it over.

In an accompanying commentary, World Health Organization experts Ties Boerma and Isabelle de Zoysa said that despite many remaining questions about the project's overall success, the findings are an encouraging first step. "However, seven years into the project, many questions remain unanswered," they wrote.

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Paralyzed man uses mind-powered robot arm to touch (AP)

PITTSBURGH � Giving a high-five. Rubbing his girlfriend's hand. Such ordinary acts � but a milestone for a paralyzed man.

True, a robotic arm parked next to his wheelchair did the touching, painstakingly, palm to palm. But Tim Hemmes made that arm move just by thinking about it.

Emotions surged. For the first time in the seven years since a motorcycle accident left him a quadriplegic, Hemmes was reaching out to someone � even if it was only temporary, part of a monthlong science experiment at the University of Pittsburgh.

"It wasn't my arm but it was my brain, my thoughts. I was moving something," Hemmes says. "I don't have one single word to give you what I felt at that moment. That word doesn't exist."

The Pennsylvania man is among the pioneers in an ambitious quest for thought-controlled prosthetics to give the paralyzed more independence � the ability to feed themselves, turn a doorknob, hug a loved one.

The goal is a Star Trek-like melding of mind and machine, combining what's considered the most humanlike bionic arm to date � even the fingers bend like real ones � with tiny chips implanted in the brain. Those electrodes tap into electrical signals from brain cells that command movement. Bypassing a broken spinal cord, they relay those signals to the robotic third arm.

This research is years away from commercial use, but numerous teams are investigating different methods.

At Pittsburgh, monkeys learned to feed themselves marshmallows by thinking a robot arm into motion. At Duke University, monkeys used their thoughts to move virtual arms on a computer and got feedback that let them distinguish the texture of what they "touched."

Through a project known as BrainGate and other research, a few paralyzed people outfitted with brain electrodes have used their minds to work computers, even make simple movements with prosthetic arms.

But can these neuroprosthetics ever offer the complex, rapid movements that people would need for more practical, everyday use?

"We really are at a tipping point now with this technology," says Michael McLoughlin of the Johns Hopkins University Applied Physics Laboratory, which developed the humanlike arm in a $100 million project for DARPA, the Pentagon's research agency.

Pittsburgh is helping to lead a closely watched series of government-funded studies over the next two years to try to find out. A handful of quadriplegic volunteers will train their brains to operate the DARPA arm in increasingly sophisticated ways, even using sensors implanted in its fingertips to try to feel what they touch, while scientists explore which electrodes work best.

"Imagine all the joints that are in your hand. There's 20 motions around all those joints," says Pittsburgh neurobiologist Andrew Schwartz. "It's not just reaching out and crudely grasping something. We want them to be able to use the fingers we've worked so hard on."

The 30-year-old Hemmes' task was a much simpler first step. He was testing whether a new type of chip, which for safety reasons the Food and Drug Administration let stay on this initial volunteer's brain for just a month, could allow for three-dimensional arm movement.

He surprised researchers the day before the electrodes were removed. The robotic arm whirred as Hemmes' mind pushed it forward to hesitantly tap palms with a scientist. Then his girlfriend beckoned. The room abruptly hushed. Hemmes painstakingly raised the black metal hand again and slowly rubbed its palm against hers a few times.

These emotional robotic touches have inspired researchers now recruiting volunteers for soon-to-start yearlong experiments.

"It was awesome," is the decidedly unscientific description from the normally reserved Dr. Michael Boninger, rehabilitation chief at the University of Pittsburgh Medical Center. "To interact with a human that way. ... This is the beginning."

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Hemmes' journey began in 2004. He owned an auto-detailing shop and rode his motorcycle in his spare time. Then one summer evening he swerved to miss a deer. His bike struck a guardrail. His neck snapped.

His determination didn't. Paralyzed below the shoulders, he's tried other experimental procedures in hopes, so far unrealized, of regaining some arm function.

"I always tell people your legs are great ... but they just get you from here to there," Hemmes says as his caregiver waits to feed him a bite of a cheeseburger near his home in Butler, north of Pittsburgh. "Your arms and fingers and hands do everything else. I have to get those back, I absolutely have to."

His ultimate goal is to hug his 8-year-old daughter. "I'm going to do whatever it takes, as long as it takes, to do that again."

Hemmes entered an operating room at UPMC with a mix of nerves and excitement.

"It's good anxiety," he says. "There is so much riding on this."

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Think "I want that apple," and your arm reaches out and grasps it. You're not aware that neurons are instantaneously firing in patterns that send commands down the spinal cord � make the shoulder raise the arm, extend the elbow, flex the wrist and all five fingers.

A very similar firing occurs when you imagine movement or watch the movement you'd like to perform, explains Boninger, who with Schwartz is leading the Pittsburgh research together with a team of bioengineers, neuroscientists and physicians.

The DARPA arm was developed primarily for amputees. Separate research is under way to help them move it by using transplanted nerves to sense those brain commands. The paralyzed pose a more difficult challenge: getting those signals around a broken spinal cord.

For quadriplegic patients, scientists use implanted electrodes, called a "brain-computer interface" or BCI, to record that electrical activity. The signals move down through wires that tunnel under the skin and out by the collarbone, and are plugged into a computer or a robotic arm.

Until now, researchers mostly have tested miniature electrodes that poke inside the brain's motor cortex and record from individual cells, presumably allowing for precise movements. Pittsburgh's next test-patient will have two penetrating grids implanted in different parts of the cortex for a year to record from 200 cells altogether.

In contrast, Hemmes' chip sat on the surface of his motor cortex, a less invasive method that records from groups of cells. The size of two postage stamps, it's based on a kind of electrical signal mapping used to track seizures in epilepsy patients.

Both approaches need study, says Daofen Chen of the National Institutes of Health, who oversees neurorehabilitation research. He compares the options to eavesdropping on a party by sending in individual microphones or setting up a recorder at the window.

Boninger adds that scar tissue can blunt the penetrating electrodes over time, and the surface chips may be easier to convert to a wireless system, which is important for commercial use.

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Hemmes' operation took two hours. He had practiced imagining arm movements inside brain scanners, to see where the electrical signals concentrated. That's where neurosurgeon Elizabeth Tyler-Kabara cut, attaching the chip through an inch-wide opening on the left side of Hemmes' skull.

Two days later, Hemmes was hooked to a computer, beginning simple cursor movements. The next week, it was time to test if he could trigger real-life movement using the DARPA arm.

Hemmes reclined in his wheelchair, the robot arm bolted to a steel rod nearby. The task: make the arm reach out to grasp a ball mounted on a board.

The arm whirs forward, then stops, then goes again, then suddenly pulls back.

"It's doing the opposite of what I ask it do," Hemmes says in frustration. "When I think about reaching back, it goes forward."

Dr. Wei Wang, a member of the research team, watches Hemmes' brain patterns on a nearby computer screen, trying to match them to the robotic movements. Focus on your elbow, Wang advises.

Hemmes takes a deep breath and tries. The arm whirs forward this time, reaching the ball. The fingers clench around it.

"There's no owner's manual," Hemmes says, thrilled that the back-and-forth pays off. "I'm training my brain to figure how to do all this."

Letting go is harder, the motor growling as the arm tugs backward before the fingers fully release. Hemmes starts imagining his hand relaxing before pulling backward, and the robot hand follows.

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Sure, a robotic hand that one day mounts to a wheelchair could be useful. But no matter how well today's prosthetics move, they've got a problem: They don't sense what they touch. Normally, instant messages flash from the skin up to the brain to say "squeeze tighter" so we don't drop that coffee cup, or "tight enough" so we don't hug too hard.

Besides, Hemmes shares the dream of many quadriplegics. He doesn't want a bionic third hand. He wants to move his own hands again.

"These are all scientific goals that are very real," Boninger says.

Recreating sensation means crafting a two-way highway with those brain chips. That's what Duke University, in a study published last week in the journal Nature, did with its two monkeys. When the animals "touched" objects on a computer screen with their video game-like arms, electrical signals flashed back up to implanted electrodes � different signals for different textures, to tell the objects apart.

Sensors in the DARPA arm's fingertips allow for that same kind of feedback. McLoughlin says the plan is for one of the Pittsburgh study patients to begin testing touch capability next year, with a similar attempt at the California Institute of Technology to follow.

What about moving paralyzed limbs? Duke's plan is to turn its research into a robotic exoskeleton that would help the paralyzed move their bodies.

Hemmes is more intrigued by what's called functional electrical stimulation, zapping muscles with electrical currents to make them move. At Hemmes' request, Boninger's team attempted to fit his hand with a stimulator glove that might be linked to his electrode, but it was unsuccessful. The NIH's Chen says still other researchers are working on that kind of approach.

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Hemmes likened moving the DARPA arm to learning to drive a car with a manual transmission. It took practice, but by week four he was moving the arm sideways as well as back and forth.

The fingers still clenched pretty tight, though. So when his girlfriend Katie Schaffer spoke up � "I want to hold your hand," she said on his last day of testing � Hemmes didn't dare bend them.

The two met after his accident, so he'd never before reached out to her.

"I was just trying to be gentle. I didn't want to hurt her, and I finally got there," Hemmes says. "Definitely the tears were flowing."

He says he was ready for a break after almost daily scientific testing, so removing the electrode and wires the next day wasn't a disappointment. He's confident the researchers will call him back once the technology advances.

"I believe this is the future," he says. "Just let people know there's hope."

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Listeria outbreak draws Seattle lawyer to battle (AP)

SEATTLE � Bill Marler updates his many blogs each day about the latest foodborne illness outbreak and travels the world delivering speeches, imploring the food industry to improve its safety measures. All this while working the phones to get money for the victims.

Like it or not, the personal injury attorney behind most every lawsuit associated with foodborne outbreaks is also known away from the courtroom as one of the nation's leading food safety advocates. He's always raising red flags about what he considers lax industry testing or inadequate government oversight.

Marler created a niche for himself since winning his first settlement in 1993 � $15.6 million for a girl sickened by E. coli from a Jack in the Box hamburger. He's in the forefront again thanks to a listeria outbreak in cantaloupe that has sickened more than 100 people and killed at least 21.

His firm already has filed six lawsuits against Colorado grower Jensen Farms, where federal health authorities say the listeria outbreak originated, and a distributor. While Jensen recalled more than 300,000 cases of cantaloupe, neither the U.S. Centers for Disease Control and Prevention nor the Food and Drug Administration have determined the source of the outbreak.

Critics contend his advocacy work isn't based on the best available science and mainly serves to benefit his law firm. Colleagues call him a dedicated attorney who advocates for his clients and knows the subject matter as well or better than anyone else.

"A lot of people who don't know me very well see the workaholic, always traveling, the persona, but what I've tried to do with my job is to make it more of a vocation," he said. "I love what I do, and I believe in what I do."

His clients lavish praise on him.

Linda Rivera, 59, was hospitalized for two years after getting ill from E. coli in cookie dough. Her husband, Richard, said he had a list of three attorneys to call, and when the first two heard Marler was also on the list, they deferred.

"These people gave up cases, money, because they knew he was the best," he said. "It wasn't about money. Bill gave me peace of mind to know I can take care of Linda. He's definitely leaving a legacy and having an impact on food safety."

In his downtown Seattle offices overlooking Puget Sound, employees wear jeans to work and on this day Marler is casual in khakis and tennis shoes. The walls are lined with framed newspaper clippings and magazine articles depicting his victories, along with framed copies of checks from those cases.

Marler says his firm has won settlements totaling more than $600 million from some of the food industry's biggest players: Cargill, Wal-Mart, Dole.

But it hasn't all been smooth sailing.

Miffed about being denied a partnership just short of four years into his tenure at a Seattle firm and feeling unappreciated in the midst of the Jack in the Box case, Marler packed up his office on a Sunday evening and left a resignation letter on the founding partner's chair. His coworkers' were stunned on Monday to find his office empty.

Now 54, he says he's gotten smarter, though no less preoccupied with work. He donated the money for the bar bill at his last high school reunion, then forgot to attend. He said he makes a concerted effort to carve out time for his wife and three teenage daughters.

Rosemary Mucklow, director emeritus of the National Meat Association, said plenty of people in the meat industry don't like his lawsuit "happy" ways, but that Marler is always willing to try to find common ground. Several years ago, an apoplectic member called her to get Marler's publicity machine toned down, and Marler agreed to remove a photo from his web site.

"Happy to comply," Mucklow recalled Marler saying. "I've always remembered what he said. That's the difference with him and a lot of the lawyers I've done business with."

Alan Maxwell, an Atlanta-based attorney who has defended companies against Marler in a number of foodborne illness cases, said his clients don't always agree with Marler's public relations outreach, but most generally respect him and find him to be fair.

"The fact is Bill knows the subject matter as well as or better than any lawyer, not to mention many scientists in food safety," Maxwell said.

Two years ago, Marler petitioned the federal government to ban strains of E. coli that can cause illnesses equally as serious as the most virulent strain, O157:H7. As a result of those efforts, the U.S. Department of Agriculture recently announced plans to begin testing for the strains in beef trimmings, beginning next year, despite industry opposition.

He considers it one of his greatest professional successes, along with a decision by Odwalla, another defendant, to begin pasteurizing its juices following a 1996 E. coli outbreak.

But regulators shouldn't be applying a blanket ban to E. coli strains, argues Michael Doyle, director of the University of Georgia's Center for Food Safety. Rather, they should be focusing on strains that produce toxin resulting in severe illness.

"As a scientist, I would hope that his approach would be science based, because science is a critical part of public health," he said. "I think there could have been better science used in developing the new rule."

However, Doyle also said that Marler the lawyer is using the law to enhance food safety, and that's a good thing.

Marler's positions might not always be scientifically supported, said Dave Theno of Gray Dog Partners Inc., a consulting firm to the food industry, but because he's representing the consumer's best interests, it's up to industry to find a way to improve things.

Theno was the chief food safety officer for Jack in the Box Inc. and sat across the table from Marler in the 1990s E. coli cases. Today, Theno considers Marler a friend, colleague and co-advocate for food safety who has seen firsthand the suffering of victims.

"Unfortunately, these things don't happen overnight," he said. "But Bill and I have both been there, and when you're there, the world is never the same. This is a mission. It's not a job."

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