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Our World — 19 April 2008

MUSIC: "Our World" theme

Straight ahead on "Our World" ... Health insurance comes to developing countries ... tracking the flu virus ... and an Earth Day expedition to the ancient giant redwoods of California ...

STRACHEN: "I am a firm believer that every leader should be made to — mandatory! — sit in an ancient forest and just think. It is a place where you think can clearly."

Those stories, what making decisions can take out of you, and more. I'm Art Chimes. Welcome to VOA's science and technology magazine, "Our World."

Reports published this week in a respected medical journal cast a shadow over the role of drug companies in the research studies involving their own medicines.

In this case, the company is Merck, and the drug is an anti-inflammatory known here in the U.S. as Vioxx and called Ceoxx/Ceeoxx in some other markets.

The medicine was pulled from the market in 2004 after studies indicated an increased risk of heart attack and stroke in patients using the drug. Thousands of former Vioxx users sued Merck, which set up a multi-billion dollar fund to settle the lawsuits.

During the legal proceedings, Merck was required to release internal company documents, and those documents were used as the basis for the papers published Tuesday in JAMA, the Journal of the American Medical Association.

One paper described how Merck analyzed safety studies in a way that gave government regulators data that showed only moderate risk of using the drug by focusing only on fatalities that occurred while people were actually taking Vioxx.

PSATY: "If these findings had been made public back in 2001, many fewer people would have taken Vioxx. And because it is associated with an increased risk of mortality and heart attacks, many fewer people would have been harmed."

Dr. Bruce Psaty and colleagues at the University of Washington in Seattle reviewed the Merck documents. They found an alternative, internal analysis that showed more deaths occurring shortly after patients stopped using Vioxx.

PSATY: "Merck did not provide this analysis to the FDA or to the public. When the FDA asked the company about these analyses the company dismissed the mortality findings and did not see any possible concern."

In a separate article in JAMA, the authors found evidence to indicate that Merck employees or contractors wrote some two dozen articles in support of Vioxx, and then recruited outside, university-affiliated researchers as authors, making the studies look more independent than they actually were.

Some of the authors of both articles, though not Dr. Psaty, have been consultants for some Vioxx patients in their lawsuits against Merck.

In a statement, Merck said the authors of the JAMA articles made "significant errors" in their interpretation of the documents. The head of Merck Research Laboratories, Dr. Peter S. Kim, expressed his disappointment that what he called "false and misleading statements" made their way into a medical journal.

You've probably heard some scary stories about avian, or bird influenza. It's a deadly disease of poultry that over the past ten years has infected hundreds of humans around the world. Scientists fear that if the virus ever mutates to more easily spread from person to person, it could trigger a serious pandemic. So far, though, its impact has been limited to humans who have gotten the disease directly from infected animals.

Meanwhile, as people worry about the potential threat of avian flu, the more common seasonal flu is a real threat, every year.

This year's flu season, at least here in the United States, has been more severe than usual, according to government officials. This year's flu vaccine doesn't provide very good protection against a dominant form of the virus that's infecting people.

Flu vaccines are based on scientists' best judgment of which flu strains will emerge in any given year. And they don't always get it right. That's why a new study published this week may be important. The authors found that new bugs start out in China and Southeast Asia, then travel around the world, eventually reaching South America where they lose steam and die out. That knowledge may give public health officials a head start on which flu strains to include in the formulation of an annual influenza vaccine. VOA's Jessica Berman reports.

BERMAN: Until now, scientists have disagreed about the global migration of the influenza A virus which, according to the World Health Organization, infects between three and five million people each year and is responsible for up to a half-million deaths.

Some infectious disease experts believe the flu emerges after migrating between the northern and southern hemispheres. Others feel it evolves after circulating throughout the tropics or China.

But according to researchers writing this week in the journal Science, the annual influenza A virus originates in China and Southeast Asia and then it follows a predictable path around the globe.

Lead author Colin Russell of the University of Cambridge in Britain says there's little variation in that path.

RUSSELL: "Once viruses leave East and Southeast Asia, they rarely return. And thus regions outside of East and Southeast Asia are essentially the evolutionary graveyards of influenza viruses."

According to the analysis, the dead end for most annual flu viruses is Latin America. Experts say strains that seem to be emerging in Latin America don't pick up any traction.

Study co-author Derek Smith is with the World Health Organization's Global Influenza Surveillance Network, which meets every year in February to try to determine which strains of the flu virus to include in a vaccine for the following year.

Smith says knowing precisely where the flu virus is coming from should make it easier to develop an effective vaccine more quickly and easily.

SMITH: "Because we can now pinpoint, at least over the last five years, where the source of these H3 viruses has been, this allows us to focus on new strains that are emerging in East and Southeast Asia and to put less focus let's say on new strains that are emerging in South America."

Smith emphasizes that the current flu vaccine works extremely well to protect 300 million people every year and people should continue to take it. But researchers hope the latest findings will lead to a flu vaccine that provides greater protection. Jessica Berman, VOA News, Washington.

Time again for our Website of the Week, when we showcase interesting and innovative online destinations.

One of the most remarkable things about the World Wide Web is how it levels the playing field. Anyone on the web can be an expert. With a few keystrokes I can share my political analysis or my opinions about this week's movie releases.

But really, wouldn't you give more weight to a real expert?

That's the idea behind this week's website, which gathers online reviews of movies, books, video games, music and TV shows.

DOYLE: "Metacritic is a hub review website. It's a very simple and easy way to get movie reviews, game reviews, music reviews online, without having to do a lot of research."

Marc Doyle is a co-founder of, which collects the reviews for each film, album or game, and then computes an average by giving more weight to well-known critics from established organizations who have more credibility than unknown critics from obscure publications or websites.

DOYLE: "Basically we're looking for the people that you know: New York Times, L.A. Times, Roger Ebert, Joe Morganstern of the Wall Street Journal, as opposed to the little Joe Blow from Westwood One or something that nobody's ever heard of. And so really it's something that we get to know going through this process, and I think our users have been pretty happy with it so far."

So, for example, Radiohead's new CD, "In Rainbows," gets 88 on a 100-point scale based on 42 reviews, while the latest film in the National Treasure franchise, "Book of Secrets," posted a middling 48 based on 26 reviews.

What's great about Metacritic is that you can see the consensus judgment at a glance. The scores are even color-coded to make it easier. And, naturally, users can leave their own ratings and comment, too.

Metacritic includes movies and DVDs, TV shows, books, music, and games. I would have thought that the movie reviews might get the most visitors, but Doyle says actually it's the games section that gets the most traffic. He thinks that's because with movies, you're only investing a few dollars and a couple of hours of your time.

DOYLE: "But with games, you're now looking at a $60 investment and possibly 30, 40, 50 hours of a time investment in the game. So you really want to get that education before you dive in."

Movies, games, music and more reviewed, weighed and ranked on, or get the link from our site,

MUSIC: "That's Entertainment"

And we hope we get at least four stars here on VOA's science and technology magazine, Our World. I'm Art Chimes in Washington.

We all make a multitude of choices every day. We choose what to wear, what to eat. I have to choose what stories we use on "Our World." Well, it turns out that psychologists are finding that making all those choices — even fun or easy ones —can be mentally taxing, and over time, can decrease a person's ability to make good choices. Rose Hoban has our report.

HOBAN: Roy Baumeister is a psychology professor at Florida State University. He wondered if having to make too many choices could deplete a person's will — their ability to stick to a difficult task. He set about studying this in a number of ways.

BAUMEISTER: "We had about a dozen experiments that we have run … we had people come in and make a series of decisions. One, we had choices about consumer goods. Would you rather have a red T-shirt or a blue T-shirt, would you rather have an almond-scented candle or vanilla-scented candle? Make a series of choices. They are compared to people who were in the control condition, [who] thought about all the same items, were asked questions about them, but they did not make choices."

HOBAN: Then Baumeister had all the subjects do something that required self-discipline. The task was completely unrelated to the other experiments they had participated in — say, holding their hand in a bowl of ice water for a length of time.

BAUMEISTER: "Put your hand in really cold water, it wants to be pulled out so you sort of use your discipline to force itself to do it. And we found out that people who made choices yanked their hands out of the water quite a bit faster than the ones who would not make decisions. So making those decisions used up something that was no longer available to help them hold their hand in ice water."

HOBAN: Baumeister found that it didn't matter whether the decisions were difficult or easy, unpleasant or fun; after making many decisions, subjects didn't have the perseverance to follow through on an unpleasant task. He says, in the long run, even making choices that you enjoy will wear you out.

Baumeister says this knowledge could help people make important choices in a better way.

BAUMEISTER: "So realize that self-control and every decision comes out of the same pot, the same limited resource. And when that resource has been depleted, you're liable to cut corners and possibly make mistakes and make decisions that you may regret later."

HOBAN: Baumeister says this principle applies when you're shopping, too… don't be lured into making expensive purchases at the end of a shopping trip.

His research has been published in the Journal of Personality and Social Psychology. I'm Rose Hoban.

Every year, medical care gets more sophisticated. It also gets more expensive. Insurance can help by spreading the cost, and adding some predictability to our health care budgets.

Health insurance has been a fixture in wealthier, industrialized countries for decades, but it's also providing many residents of developing countries, often for the first time, the chance to get medical care that was previously unaffordable.

In the South American country of Colombia, for example, health insurance coverage was greatly expanded starting in 1993. Previously it had mainly covered only those working in regular jobs - the so-called formal sector. Health systems consultant Ursula Giedion says in the new insurance plans, subsidies were provided for the poor, who got only limited hospital coverage, but otherwise had the same benefits as those paying full price.

GIEDION: "At this point we have a quite comprehensive package of care for those in the contributory regime. And then we have this benefits package for the poor. We have a lot of primary care, much of which was included on the basis of considerations of cost-effectiveness and assuring the entry into the health system. And then we have catastrophic illnesses. In these two components, the two packages are exactly equal."

That's an important point about getting people into the health care system. Perhaps surprisingly, use of free services, such as vaccinations, went up as more people got insurance coverage, even though they had been free before. One explanation was offered by Phillip Musgrove, deputy editor of the health policy journal, Health Affairs.

MUSGROVE: "If people have not been going for some kinds of care because of the difficulties — the cost and the distance, particularly the cost — and suddenly they can, they're going to be talking to doctors and nurses who are going to be asking thinks like, 'Are your kids fully vaccinated? You know, we do that for free here.' And so I suspect that there is a good deal of informal referral going on, and it's getting people to think that, yes, they can use the health care system."

There's no "one size fits all" model of health insurance, and experts say it has to be tailored to the local situation. In China, for example, a pilot program isn't even called insurance; it's known as Rural Mutual Health Care. William Hsiao of Harvard University helped set up the program to see if it could deliver health care more efficiently.

HSIAO: "We have quite a bit of evidence [that] at least a third of the money we're spending today in many developing countries [is] wasted. Really, they do not produce efficient services for the people."

Where China once had a comprehensive system, economic reforms have left a majority of the people today without health insurance. Under the pilot Mutual Health Care program, says Hsiao, members are more likely to get the care they need.

HSIAO: "In two years, their utilization increased by 70 percent, roughly. Then let me address the issue, how does that impact on people by income class or health condition? The lowest income, in the bottom 25 percentile, increased their outpatient visits by 100 percent."

Brookings Health Fellow Maria-Luisa Escobar pointed out that developing countries that adopt health insurance models are typically implementing the plan much faster than wealthier countries have — over years, rather than decades. And she noted that health insurance can be very disruptive of existing health care systems, which is why it's important to get it right.

ESCOBAR: "It creates, by force almost, a lot of changes. So [it] is this very different type of instrument that not only protects [from] the risk of out-of-pocket expenditures, but it is an instrument that is capable of generating so many different forces in the health system that, if it is well done and well implemented, can improve the situation in many countries."

The impact of health insurance in developing countries was the focus of a symposium this week in Washington, sponsored by the Brookings Institution.

Tuesday is Earth Day, an annual event to raise awareness of the need to protect the environment and the planet's rich diversity of life. One of the most majestic species on Earth is the giant redwood, occupying a unique ecological niche along the California coast. VOA's Adam Phillips recently paid a visit to learn more about these spectacular trees.

PHILLIPS: It is midday in California's Año Nuevo State Park, home to one of the last original stands of old-growth redwood trees left in the West. These giants can stand ramrod straight nearly 120 meters high before their branches of needled leaves form the crowns, mostly obscuring the sun.

After one's eyes adjust to the dim golden-green light, the first thing one notices is the hush.

STRACHEN: "These trees are very unique. Any human being that walks amongst them and sits for a while, all of a sudden realizes how magnificent this forest is."

PHILLIPS: Gary Strachen has been a park ranger here for more than three decades.

STRACHEN: "These huge, huge, huge trees. I can't get too existentialist, but they do give off a spirit, and they inspire. And that's the key right there. And I think humans now have realized, worldwide, that it's important to keep and protect ancient forests like this."

PHILLIPS: These ancient forests are found only in the areas of California near the ocean, explains Portia Halbert, an environmental scientist for the state.

HALBERT: "They are limited to this area of California where there is 'fog drip.' When fog comes in from the ocean, the fog collects on the little needles of the tree and then it drops around the tree roots, and the plant is able to live in our Mediterranean climate. We have rain about six-seven months out of the year and then it's completely dry the rest of the year. And so this fog drip allows the trees to live through a very long dry period."

PHILLIPS: Unlike most trees, which have deep roots to reach underground water, Halbert explains that redwoods rely on the moisture that pools on the forest floor.

HALBERT: "These trees have all of their roots within about one meter of the ground. All of the trees are growing together. Their roots are connected and they keep each other upright, and you'll have trees that are more likely to fall down when adjacent trees fall down because they've lost that support of their neighbors."

PHILLIPS: When those trees do fall, they tend to stay where they are and to decompose very slowly. That's because insects, which normally eat and break down fallen trees, don't like tannin, the chemical that gives redwood bark its deep russet color.

But all woodlands need some way to clear out dead wood and other debris. Halbert says that redwood ecosystems rely on the lightning fires, which naturally occur every 50 to 75 years. The blazes begin above ground, often travel down to the shared root systems beneath the groves, then upward inside the trunks.

HALBERT: "And the fire will burn and burn and burn like an oven inside the tree. And so sometimes the fire will burn so long and so hot that it will hollow out the entire middle portion of a tree. You can stand inside a redwood tree and look up and see the sky. But the tree is totally alive because its living tissue isn't damaged. The bark is protected on the outside and the inner tissue is protected on the inside."

PHILLIPS: Today, there are birds in the skies above the trees, such as the giant pileated woodpecker and the marbled murrelet, a web-footed seabird that spends most of its time far offshore in the Pacific Ocean. It was once a great mystery where this bird nested. But in 1974, scientists learned that it actually flies up to 80 kilometers inland to lay its eggs in the tops of old growth trees like these.

STRACHEN: "If you are sitting in here at dusk or early in the morning, it will be all quiet and all of a sudden you will hear [whistle] coming through the canopy, you know. And you'd see this black streak. It looks like a stealth jet. And it'd be flying so fast right through the canopy. And that is the marbled murrelet. And they call right before they're going to land at their nest."

PHILLIPS: Vigorous efforts in California to preserve habitats like this have allowed this ancient bird to continue to thrive in the Golden State.

STRACHEN: "And I am a firm believer that every leader in the world — whether it be a corporate leader or a political leader — should be made to — mandatory! — sit in an ancient forest and just sit there and think. It is a place where you think can clearly."

PHILLIPS: … thinking, perhaps, about the value of protecting old growth forests like this. In a redwood grove in California's Año Nuevo State Park this is Adam Phillips reporting.

That's our show for this week. If you'd like to get in touch, email us at Or use the postal address —

Our World
Voice of America
Washington, DC 20237 USA

Rob Sivak edited the show. Eva Nenicka is the technical director. And this is Art Chimes, inviting you to join us online at or on your radio next Saturday and Sunday as we check out the latest in science and technology ... in Our World.