Wednesday, February 24, 2010

Noteworthy inventions of the ancient Chinese

When you have a written language that passes down knowledge, uninterrupted (no dark ages)for thousands of years, you can come up with some pretty great inventions.

Possibly the four greatest inventions are: Paper (~200 BC), the Printing Press (~650 AD), Gunpowder (1000 AD), and the Compass (~0 AD). But they came up with many other advancements, including:

* Acupuncture ~220 BC (may date much further back)
* Archaeology, catalogues and epigraphy ~1000 AD
* Anti-malarial properties of artemisia ~Used since 800 AD, confirmed scientifically in 1972
* Armillary sphere, hydraulic-powered ~52 BC
* Automatic opening doors, foot-activated trigger ~600 AD
* Banknotes ~700 AD
* Beer with High-alcohol content ~1000 BC
* Bell
* Bellows, hydraulic-powered ~50 AD
* Belt drive ~15 BC
* Blast furnace ~300 BC
* Bomb, cast iron ~1300 AD
* Borehole drilling (for mining)~0 AD
* Bristle toothbrush ~1500 AD
* Bulkhead partition ~1200 AD
* Calendar year at 365.2425 days ~550 BC
* Cast iron ~500 BC
* Chain drive, endless power-transmitting ~1100 AD
* Chemical warfare using bellows, mustard smoke, and lime ~300 BC
* Chopsticks ~1200 BC
* Chromium, use of ~210 AD
* Circumnavigation of the globe ~ 1420 AD
* Civil service examinations ~0 AD
* Co-fusion steel process (600 AD)
* Coffin ~5000 BC
* Coke as fuel ~1100 AD
* Contour canal (made with locks for traveling uphill) ~200 BC
* Crossbow, handheld ~500 BC
* Cupola furnace (for melting and casting iron)~ 200 BC
* Dagger Axe
* Deficiency diseases, correction by proper diet ~200 AD
* Diabetes, recognition and treatment ~700 AD
* Dominoes ~1200 AD
* Drawloom (for making fabric)~400 BC
* Endocrinology, isolation of sex and pituitary hormones from urine ~1110 AD
* Escapement (used in clockworks) ~700
* Exploding cannonballs ~1350 AD
* Fermented beverages ~
* Field mill ~350 AD
* Finery forge (for making wrought iron)~200 BC
* Fire lance: The fire lance was a proto-gun ~1000 AD
* Fireworks ~1000 AD
* Fishing reel ~400 AD
* Flamethrower, double piston and gunpowder-activated
* Flare, military signalling ~1100 AD
* Forensic entomology ~1247 AD
* Fork ~2000 BC
* Gas cylinder ~0 AD
* Gimbal ~180 AD
* Hand cannon ~1200
* Heavy moldboard iron plow ~500 BC
* Horse harness and collar ~400 BC
* India ink ~3000 BC to 200 AD (scholars disagree)
* Inoculation, treatment of smallpox ~ 1550 AD
* Jacob's staff (for measuring size at distance)~1050 AD
* Junk Ships ~200 AD
* Kite ~500 BC
* Land mine ~ 1300 AD
* Lacquer
* Leeboard: To avoid leeward drift caused by the force of wind while sailing ~300 BC
* Maglev wind power generators 2006 AD
* Manned flight with kites ~ 550 AD
* Match, non-friction: The earliest type of match for lighting fire was made in China ~ 577 AD,
* Mechanical theater ~ 340 AD
* Millet, cultivation of
* Multistage rocket ~1300 AD
* Natural gas as fuel ~ 350 BC
* Naval mines ~1400 AD
* Negative numbers in mathmatics ~179 AD
* Noodle ~2000 BC
* Oar, rowing ~6000 BC
* Open-spandrel segmental arch bridge, fully stone 605 AD
* Pinhole camera ~ 400 BC
* Playing cards ~ 850 AD
* Plowshare ~3500 BC
* Porcelain ~ 700 AD
* Pound lock, for raising rivers and enabling ship navigation (984 AD)
* Restaurant menu ~ 1000 AD
* Rice, cultivation of ~7000 BC
* Rocket bombs, aerodynamic wings and explosive payloads ~ 1400 AD
* Rotary fan, for purposes of air conditioning manual (~ 0 AD) and water-powered (~800 AD)
* Rudder, stern-mounted and vertical axial ~ 100 BC
* Salt, use of ~6000 BC
* Silk ~3630 BC
* Soybean, cultivation of ~2000 BC
* Steamer, pottery appliance for cooking ~5000 BC
* Seismometer 132 AD
* Steel made through oxygenation of cast iron ~ 150 BC
Stirrup 302 AD
* Suspension bridge using iron chains ~ 1402 AD
* Tea ~ 2000 BC
* Thyroid hormones to treat goiters ~ 600 AD
* Tofu ~ 150 BC
* Toilet paper 589 AD
* Traction trebuchet catapult ~ 400 BC
* Tuned bells ~ 800 BC
* Underwater salvage operations ~ 219 BC
* Urn (pottery burial) ~7000 BC
* Wheelbarrow ~ 0 AD

Saturday, February 20, 2010

Another "Miracle Drug" found to be harmful

This is one of the things I love about practicing Chinese medicine. No one beats the Chinese in terms of longitudinal study. We don't use anything on our patients that have been studied for less than 1000 years. This new diabetes drug Avandia causes heart attacks. Read about it here.

Wednesday, February 17, 2010

Sugar may be bad for you, but HFCS is much worse

The following is an article by Dr. Joseph Mercola, found on regarding the epidemic problem of High Fructose Corn Syrup.

Study after study are taking their place in a growing lineup of scientific research demonstrating that consuming high-fructose corn syrup is the fastest way to trash your health. It is now known without a doubt that sugar in your food, in all it's myriad of forms, is taking a devastating toll.

And fructose in any form -- including high-fructose corn syrup (HFCS) and crystalline fructose -- is the worst of the worst!

Fructose is a major contributor to:

• Insulin resistance and obesity
• Elevated blood pressure
• Elevated triglycerides and elevated LDL
• Depletion of vitamins and minerals
• Cardiovascular disease, liver disease, cancer, arthritis and even gout

A Calorie is Not a Calorie
Glucose is the form of energy you were designed to run on. Every cell in your body, every bacterium -- and in fact, every living thing on the Earth--uses glucose for energy.

If you received your fructose only from vegetables and fruits (where it originates) as most people did a century ago, you'd consume about 15 grams per day -- a far cry from the 73 grams per day the typical adolescent gets from sweetened drinks. In vegetables and fruits, it's mixed in with fiber, vitamins, minerals, enzymes, and beneficial phytonutrients, all which moderate any negative metabolic effects.
It isn't that fructose itself is bad -- it is the MASSIVE DOSES you're exposed to that make it dangerous.

There are two reasons fructose is so damaging:

1. Your body metabolizes fructose in a much different way than glucose. The entire burden of metabolizing fructose falls on your liver.

2. People are consuming fructose in enormous quantities, which has made the negative effects much more profound.

Today, 55 percent of sweeteners used in food and beverage manufacturing are made from corn, and the number one source of calories in America is soda, in the form of HFCS.

Food and beverage manufacturers began switching their sweeteners from sucrose (table sugar) to corn syrup in the 1970s when they discovered that HFCS was not only far cheaper to make, it's about 20 percent sweeter than table sugar.

HFCS is either 42 percent or 55 percent fructose, and sucrose is 50 percent fructose, so it's really a wash in terms of sweetness.

Still, this switch drastically altered the average American diet.

By USDA estimates, about one-quarter of the calories consumed by the average American is in the form of added sugars, and most of that is HFCS. The average Westerner consumes a staggering 142 pounds a year of sugar! And the very products most people rely on to lose weight -- the low-fat diet foods -- are often the ones highest in fructose.

Making matters worse, all of the fiber has been removed from these processed foods, so there is essentially no nutritive value at all.

Fructose Metabolism Basics
Without getting into the very complex biochemistry of carbohydrate metabolism, it is important to understand some differences about how your body handles glucose versus fructose. I will be publishing a major article about this in the next couple of months, which will get much more into the details, but for our purpose here, I will just summarize the main points.

Dr. Robert Lustig[i] Professor of Pediatrics in the Division of Endocrinology at the University of California, San Francisco, has been a pioneer in decoding sugar metabolism. His work has highlighted some major differences in how different sugars are broken down and used:

• After eating fructose, 100 percent of the metabolic burden rests on your liver. But with glucose, your liver has to break down only 20 percent.

• Every cell in your body, including your brain, utilizes glucose. Therefore, much of it is "burned up" immediately after you consume it. By contrast, fructose is turned into free fatty acids (FFAs), VLDL (the damaging form of cholesterol), and triglycerides, which get stored as fat.

• The fatty acids created during fructose metabolism accumulate as fat droplets in your liver and skeletal muscle tissues, causing insulin resistance and non-alcoholic fatty liver disease (NAFLD). Insulin resistance progresses to metabolic syndrome and type II diabetes.

• Fructose is the most lipophilic carbohydrate. In other words, fructose converts to activated glycerol (g-3-p), which is directly used to turn FFAs into triglycerides. The more g-3-p you have, the more fat you store. Glucose does not do this.

• When you eat 120 calories of glucose, less than one calorie is stored as fat. 120 calories of fructose results in 40 calories being stored as fat. Consuming fructose is essentially consuming fat!

• The metabolism of fructose by your liver creates a long list of waste products and toxins, including a large amount of uric acid, which drives up blood pressure and causes gout.

• Glucose suppresses the hunger hormone ghrelin and stimulates leptin, which suppresses your appetite. Fructose has no effect on ghrelin and interferes with your brain's communication with leptin, resulting in overeating.

If anyone tries to tell you "sugar is sugar," they are way behind the times. As you can see, there are major differences in how your body processes each one.

The bottom line is: fructose leads to increased belly fat, insulin resistance and metabolic syndrome -- not to mention the long list of chronic diseases that directly result.

Panic in the Corn Fields
As the truth comes out about HFCS, the Corn Refiners Association is scrambling to convince you that their product is equal to table sugar, that it is "natural" and safe.

Of course, many things are "natural" -- cocaine is natural, but you wouldn't want to use 142 pounds of it each year.

The food and beverage industry doesn't want you to realize how truly pervasive HFCS is in your diet -- not just from soft drinks and juices, but also in salad dressings and condiments and virtually every processed food. The introduction of HFCS into the Western diet in 1975 has been a multi-billion dollar boon for the corn industry.

The FDA classifies fructose as GRAS: Generally Regarded As Safe. Which pretty much means nothing and is based on nothing.

There is plenty of data showing that fructose is not safe -- but the effects on the nation's health have not been immediate. That is why we are just now realizing the effects of the last three decades of nutritional misinformation.

As if the negative metabolic effects are not enough, there are other issues with fructose that disprove its safety:

• More than one study has detected unsafe mercury levels in HFCS[ii].

• Crystalline fructose (a super-potent form of fructose the food and beverage industry is now using) may contain arsenic, lead, chloride and heavy metals.

• Nearly all corn syrup is made from genetically modified corn, which comes with its own set of risks.

The FDA isn't going to touch sugar, so it's up to you to be proactive about your own dietary choices.

What's a Sugarholic to Do?
Ideally, I recommend that you avoid as much sugar as possible. This is especially important if you are overweight or have diabetes, high cholesterol, or high blood pressure.

I also realize we don't live in a perfect world, and following rigid dietary guidelines is not always practical or even possible.

If you want to use a sweetener occasionally, this is what I recommend:

1. Use the herb stevia.

2. Use organic cane sugar in moderation.

3. Use organic raw honey in moderation.

4. Avoid ALL artificial sweeteners, which can damage your health even more quickly than fructose.

5. Avoid agave syrup since it is a highly processed sap that is almost all fructose. Your blood sugar will spike just as it would if you were consuming regular sugar or HFCS. Agave's meteoric rise in popularity is due to a great marketing campaign, but any health benefits present in the original agave plant are processed out.

6. Avoid so-called energy drinks and sports drinks because they are loaded with sugar, sodium and chemical additives. Rehydrating with pure, fresh water is a better choice.

If you or your child is involved in athletics, I recommend you read my article Energy Rules for some great tips on how to optimize your child's energy levels and physical performance through good nutrition.

[i] Robert H. Lustig, MD: UCSF Faculty Bio Page, and YouTube presentation "Sugar: The bitter truth" and "The fructose epidemic" The Bariatrician, 2009, Volume 24, No. 1, page 10)
[ii] "Why is the FDA unwilling to study evidence of mercury in high-fructose corn syrup?" 20 Feb 2009, Grist

Monday, February 15, 2010

Chinese Hippocratic Oath excerpt

"A Great Physician should not pay attention to status, wealth or age; neither should he question whether the particular person is attractive or unattractive, whether he is an enemy or friend, whether he is a Chinese or a foreigner, or finally, whether he is uneducated or educated. He should meet everyone on equal grounds. He should always act as if he were thinking of his close relatives."
- Sun Si Miao, Tang Dynasty. Sun Si Miao wrote the text On the Absolute Sincerity of Great Physicians which is regarded as the equivalent to the Hippocratic Oath in Western Medicine

Saturday, February 13, 2010

new, better rules for Organic dairy farming

Thanks to my friend Graeme for sending me this story from the New York Times.

Published: February 12, 2010
The Department of Agriculture issued new rules on Friday meant to settle a dispute in the organic agriculture industry over how much time cows at organic dairies must spend grazing on pasture.
The ruling was cheered by many in the organic industry who said it would shore up consumer confidence in organic milk and could force some larger dairies in Western states to change how they operate.
“This is the biggest deal in the organic community for many years,” said Miles V. McEvoy, the deputy administrator of the National Organic Program, the arm of the agriculture department that regulates the organic farming industry.
“Because of the controversy and the complaints against some of the larger Western dairies, it has really affected consumer confidence in the organic label. That’s why it’s so important for us to set the standard and say that organic livestock are pasture-based.”
The new rules clarify an older requirement that said only that organically raised livestock had to have access to pasture. That left a loophole for some dairies that would put cows out to pasture only during periods when the animals were not giving milk or would feed their animals almost exclusively on grain or other feeds.
The new regulations, which go into effect in June, are much more specific. They say that animals must graze on pasture for the full length of the local grazing season. The season will be determined by local conditions and agriculture authorities, like organic certifiers or county conservation officials, not by the dairy alone. While the grazing season must last at least 120 days, in many areas it will be much longer.
The rules also say that animals must get at least 30 percent of their food from pasture during the grazing season.
Mr. McEvoy said the rules would be enforced by organic certifiers who will be required to make at least one inspection a year. In some cases, additional spot checks will be made.
“There’s this feeling that it will level the playing field between the larger farms in the West and the smaller farms throughout the nation,” said Nancy Hirshberg, a vice president for Stonyfield Farm, who supported the rule change. Stonyfield markets milk from about 1,400 organic dairy farms across the country, which in most cases have about 50 to 75 cows each. She said that all the farmers who supplied Stonyfield already operated in accordance with the new rules.
Aurora Organic Dairy, based in Colorado, has been the focus of much criticism in recent years for how it pastures its animals. For many it has come to represent the contradictions embodied in large-scale organic farming. The dairy has about 15,000 cows on five farms in Colorado and Texas, with a total of about 4,400 acres of pasture, said Sally Keefe, Aurora’s vice president for government affairs.
Agriculture department data shows that in 2008 there were 2,031 organic dairies in the country, with an average of 108 cows on each one, although many had far fewer.
While Ms. Keefe said she was still reviewing the final rule on Friday, she said she expected little would have to change in the dairy’s operations.
“We already graze for at least 120 days a year, most years it’s well north of that,” Ms. Keefe said. “And we believe that we already comply with the dry matter intake requirements,” she said, referring to the rule that cows get at least 30 percent of their food from pasture during the grazing season.
Aurora, which supplies organic milk for the private label brands of several supermarket chains, agreed to make significant changes in 2007 after the agriculture department threatened to revoke its organic certification. Among the changes, the dairy agreed to give its animals greater access to pasture.
The new rules also apply to cattle raised for beef. In the case of beef cattle, however, the requirement that 30 percent of food must come from pasture is lifted during the so-called finishing period, which is when the animals are being fattened for slaughter and are often fed on grain. During that period they must still be allowed to graze, however.

Tuesday, February 9, 2010

Sugary soft drinks linked to pancreatic cancer

WASHINGTON (AFP) – People who drink at least two sugary sodas a week have an increased risk of developing cancer of the pancreas, and researchers suspect the culprit is sugar, a new study shows.
Analyses of data collected on 60,524 Singapore Chinese adults showed that people who drank two or more sugar-sweetened soft drinks a week were at greater risk of developing pancreatic cancer compared with individuals who did not, the study published in Cancer Epidemiology, Biomarkers and Prevention says.
No link was found between drinking juice and pancreatic cancer, which is one of the most rapidly fatal cancers in adults, with less than five percent of patients surviving five years or more after being diagnosed with the illness.
The study was the first to look at the role fizzy drinks and juice play in the development of pancreatic cancer in Asians, whose diet and lifestyle are becoming more and more Western, the study says. Previous studies had looked at Europeans and Americans.
Participants in the study who consumed two or more sodas per week tended to be younger men who smoke, drink alcohol, eat higher-calorie diets and are less physically active.
They also ate more red meat, the study found.
The findings of the study were adjusted for other dietary factors which have been linked with pancreatic cancer, such as consumption of red meat.
"But the adjustments did not change the link between soda and the risk of pancreas cancer," said Mark Pereira of the University of Minnesota's division of epidemiology and community health, one of the authors of the study.
"We suspect sugar is the culprit, but we cannot prove it from this study," Pereira told AFP, adding that the researchers only looked at carbonated sugar-sweetened beverages, not sports drinks or diet soft drinks.
"A typical serving of soda is 20 ounces and contains 65 grams of sugar. By comparison, a typical serving of orange juice is eight ounces and contains 21 grams of sugar," Pereira said.
Fizzy drinks are "the leading sources of added sugar in the US diet" and greatly contribute to hyperglycemia, or high blood sugar, and hyperinsulemia -- when the amount of insulin in the blood is higher than normal -- the study says.
Insulin is produced by the pancreas and helps regulate blood sugar.
If the findings of the study are confirmed, then cutting out sugar-sweetened sodas would be a way to reduce the risk of developing pancreatic cancer, and this would be "important due to the poor prognosis and minimal effect of conventional treatment methods" for the cancer, the study says.
The data analyzed for the soda study came from the Singapore Chinese Health Study, which enrolled more than 63,000 Singapore Chinese who lived in government housing estates -- as nearly nine in 10 people in Singapore do -- and looked at their diets, physical activity and medical history, among others.
(This study is interesting, but I wonder what type of sugar they use in Singapore- high-fructose corn syrup or cane sugar or what?  It's also interesting that these beverages damage the pancreas, which controls insulin production, so it is quite likely that these drinks contribute to diabetes).  

Wednesday, February 3, 2010

It's safer to deliver a baby in Kuwait or Bosnia than in California

This story comes courtesy of California Watch via  For accompanying chart click here, Q&A click here.
By Nathanael Johnson
The mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of cesarean sections.
For the past seven months, the state Department of Public Health declined to release a report outlining the trend.
California Watch spoke with investigators who wrote the report and they confirmed the most significant spike in pregnancy-related deaths since the 1930s. Although the number of deaths is relatively small, it's more dangerous to give birth in California than it is in Kuwait or Bosnia.
"The issue is how rapidly this rate has worsened," said Debra Bingham, executive director of the California Maternal Quality Care Collaborative, the public-private task force investigating the problem for the state. "That's what's shocking."
The problem may be occurring nationwide. The Joint Commission, the leading health care accreditation and standards group in the United States, issued a "Sentinel Event Alert" to hospitals on Jan. 26, stating: "Unfortunately, current trends and evidence suggest that maternal mortality rates may be increasing in the U.S."
The alert asked doctors to consider morbid obesity, high blood pressure and diabetes, along with hemorrhaging from C-sections, as contributing factors.

In 2007, the U.S. Centers for Disease Control and Prevention reported that the national maternal mortality rate had risen, but experts such as Dr. Jeffrey C. King, who leads a special inquiry into maternal mortality for the American College of Obstetricians and Gynecologists, chalked up the change to better counting of deaths. His opinion hasn't changed.
"I would be surprised if there was a significant increase of maternal deaths," said King, who has not seen the California report.
But Shabbir Ahmad, a scientist in California's Department of Public Health, decided to look closer. He organized academics, state researchers and hospitals to conduct a systematic review of every maternal death in California. It's the largest state review ever conducted. The group's initial findings provide the first strong evidence that there is a true increase in deaths - not just the number of reported deaths.
Changes in the population - obese mothers, older mothers and fertility treatments - cannot completely account for the rise in deaths in California, said Dr. Elliott Main, the principal investigator for the task force.
"What I call the usual suspects are certainly there," he said. "However, when we looked at those factors and the data analyzed so far, those only account for a modest amount of the increase."
Main said scientists have started to ask what doctors are doing differently. And, he added, it's hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased. The task force has found that changing clinical practice could prevent a significant number of these deaths.
One maternity expert who was not involved in the report, Dr. Thomas R. Moore, chair of the Department of Reproductive Medicine at UC San Diego, said about the data: "This could be a sentinel finding, and I could see other states taking a closer look and finding the same thing."
Low numbers, high consequences
Despite the increase in the mortality rate, pregnancy is still safe for the vast majority of women.
In 2006, 95 California women died from causes directly related to their pregnancies - out of more than 500,000 live births. That's a small number by public health standards. If California had met the goal set by the U.S. Department of Health and Human Services to bring the state's maternal mortality rate down to a level achieved by other countries, the number of dead would be closer to 28.
It's not clear who is most at risk, but researchers have long known that African-American mothers are between three and four times more likely to die from pregnancy-related causes than the rest of the population. That racial association is not stratified by socio-economic status: Even high-income black women are at a greater risk.
While the maternal mortality rate among black women is rising, the task force found a more dramatic increase in deaths among white, non-Hispanic mothers. There is not yet enough data to show if the risk of death is associated with poverty.
What's certain is that each maternal death shatters families. That cold sum - 95 dead - represents 95 stories of people such as Tatia Oden French. In 2001, she was newly wed and had just finished her doctorate in psychology. She was about to have a baby girl she would name Zorah Allie Mae French.
"She's the type of person that just walked into the room and lit it up," said her mother, Maddy Oden.
During the labor, Maddy Oden was at home in Oakland, waiting for a call announcing the birth of her granddaughter. Instead, she needed an emergency C-section. "I woke up at 4 in the morning, and I knew that something was wrong," Oden said.
Then the phone rang. French was in trouble. Powerful contractions had forced amniotic fluid into her bloodstream, stopping her heart and killing the baby. When Oden got to her daughter at an Oakland hospital there was only one thing she could do: "We said a prayer," Oden said, "and I closed her eyes."
The subsequent lawsuit was dismissed: The doctor had not deviated from the standard of care.
Rather than track down the cause of every death and assign blame, the California task force is focused on finding solutions. And Bingham and Main have found that doctors and nurses are eager to help after seeing the numbers.
In 1996, the maternal death rate in California was 5.6 per 100,000 live births, not far from the national goal of 4.3 per 100,000. Between 1998 and 1999, the World Health Organization changed its coding system, which may have increased reporting of deaths. The California rate was 6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is small, the rate tends to fluctuate from year to year.
In 2003, when California revised its death certificate, the rate jumped to 14.6. And in 2006, the last year for which data is available, the rate stood at 16.9.
The best estimates show that less than 30 percent of the increase is attributable to better reporting on death certificates. Even accounting for these reporting and classification changes, the maternal death rate between 1996 and 2006 has more than doubled, Main said.
Not yet public
When researchers unveiled their initial findings to a conference of the American College of Obstetricians and Gynecologists in 2007, there were gasps from the audience, according to participants at the San Diego event. The idea that California was moving backward even in an era of high-tech birthing was implausible to some. Confirmation of the trend was noted in the 2008 report written by 27 doctors and researchers. The report was described in detail to California Watch.
The state of California has yet to share the report with the public. Researchers say that, after reviewing the report in 2008, officials in the Department of Public Health asked for technical clarifications. Revisions were complete and approved in the first half of 2009, according to Ahmad.
Al Lundeen, the department's director of public affairs said, "There was no effort to hold that report back. It just needed some more revisions."
Researchers say that it is important for the public to be aware now that these trends are worsening. Diane Ashton, the deputy medical director for the March of Dimes, has seen the numbers. She says they demand a concerted response.
"Even though they tend to be small numbers in terms of maternal mortality, it is important - it's very important - that these trends be looked at," she said. "And efforts need to be made to try and reverse them when they are going in the wrong direction."

Rising C-section birth rate

Nearly one in three babies is now born by C-section. Many scientists have acknowledged that at some point, as the number of surgeries spiral upward, the risks will outweigh the benefits. But the C-section remains a useful tool, and in the middle of labor, doctors say, it's hard to balance the potential long-term harm against immediate crisis.
Today, doctors face a condition called placenta accreta, where the placenta grows into the scar left by a previous C-section. In surgery, doctors must find and suture a web of twisted placental vessels snaking into the patient's abdomen, which can hemorrhage alarming amounts of blood. Often, doctors must remove the uterus.
Main said this complication from C-sections has increased eight-to-10 fold in the past decade. Nonetheless, most women survive the ordeal. The point, says Catherine Camacho, deputy director of the state's Center for Family Health, is that the rise in deaths is indicative of a larger problem.
"For every maternal death, there are 10 near misses; for every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there is another 10 morbidity cases related to childbirth," Camacho wrote in an e-mail.
Other factors are contributing to the rise in deaths, but the researchers in California are most interested in the areas where they have control, such as the high C-section birth rate: It's easier for doctors to improve medical care than to fix more intractable problems like poverty and obesity.
Inducing labor before term more common
In 2002, Dr. David Lagrew, the medical director of the Women's Hospital at Saddleback Memorial Medical Center in Orange County, noticed that a lot of women were having their labor induced before term without a medical reason. And he knew that having an induction doubled the chances of a C-section.
So he set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions. As a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.
All this, however, came at a cost: The hospital had to take a cut in revenue for reducing the procedures it performed. Lagrew doubts that any hospital has increased its C-section rate in pursuit of profit, but he does note that the first hospitals to adopt controls on early elective inductions have been nonprofits.
According to a report issued by the advocacy group Childbirth Connection, "Six of the 10 most common procedures billed to Medicaid and to private insurers in 2005 were maternity related." On average, a C-section brings in twice the revenue of a vaginal birth. Today, the C-section is the single most common surgical procedure performed in the United States.
"If all these guys were losing money on every C-section, well, what's the old saying? Whenever they tell you it's not about the money, it's about the money," Lagrew said.
The California task force isn't waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women's medical conditions and to reduce inductions - as Lagrew did at Memorial Care.
Although the state hasn't released the task force's report, the researchers and doctors involved forwarded data to the national Joint Commission, which issued incentives for hospitals to reduce inductions and fight what it called "the cesarean section epidemic."
"You don't have to be a public health whiz to know that we are facing a big problem here," Bingham said.