The New Old Age Blog: United States Lags in Alzheimer's Support

This month, the United States Senate Special Committee on Aging released a report examining how five nations — the United States, Australia, France, Japan and Britain — are responding to growing numbers of older adults with Alzheimer’s disease and dementia.

Every country has a strategy, but some are much further ahead than others. Notably, France began addressing Alzheimer’s disease and dementia in 2001 and is in the midst of carrying out its third national plan. (Scroll down at this link to find the English version of the 2008-2012 French plan.)

By contrast, the United States released its first national plan to address Alzheimer’s in May.

The Senate report highlights several trends under way in all five countries, including efforts to coordinate research more effectively, diagnose Alzheimer’s disease more reliably and improve training in dementia care by medical practitioners.

Most relevant to readers of this blog is another trend with increasing international scope: an accelerating effort to keep patients with Alzheimer’s disease and other forms of dementia at home and arrange for care and treatment there, rather than in institutions.

Anyone who’s followed reader response to Jane Brody’s column this week on aging in place knows the burden that this can place on families, especially if government support for home-based services (companions or home health aides who help with bathing, dressing, toileting and other tasks), adult day care or respite care is scarce or nonexistent, as is the case for most middle-class families in the United States.

Is care at home for patients with Alzheimer’s necessarily more humane? Only if caregivers have the resources — financial, physical and emotional — to handle this draining, exhausting, immeasurably difficult job. And only if the institutions that serve people with more advanced forms of Alzheimer’s disease and other types of dementia are so poorly financed, staffed and operated that we wouldn’t feel comfortable leaving loved ones in their care.

Three charts in the new Senate report underscore the extent to which the United States differs from other countries in what is expected of family caregivers. The first, on Page 60, shows countries’ support for paid long-term care services for residents age 65 and older. This includes all residents who need long-term care, including those with Alzheimer’s disease, other forms of dementia and other disabling chronic illnesses. Not included are services provided by unpaid family caregivers.

Look at where the United States ranks compared with Australia, Japan, France and the 30 other developed countries that belong to the Organization for Economic Cooperation and Development. Paid support for long-term care is much less in our country than in theirs.

The second chart, on Page 64, gives a sense of how much paid support for long-term care is provided in people’s homes. Again, the data is not specific to Alzheimer’s disease or dementia, although these are primary reasons older adults need long-term care.

And again, the United States falls short in terms of the amount of paid care it provides in home settings, even though older people tend to prefer these settings over institutions.

The third chart, on Page 75, brings results in the other two down to the level of families. When paid long-term care support is scarce or unavailable, you would expect a heavier load to fall on unpaid caregivers, and this is what the chart shows. Look at the number of caregivers in the United States who put in 10 to 19 hours a week (34.2 percent) or 20 hours or more a week (30.5 percent), and compare those with similar figures for France, Australia and Britain, all of which provide more paid long-term care than we do. Where are informal caregivers working the hardest? Right here at home in the United States.

For me, the take-away is clear. Other countries with which the United States is closely aligned have embraced long-term care as an essential social responsibility while we have not. Unless and until we do so, caregivers here will be among the most harried, stressed and burdened among wealthy, developed countries in the world.

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A risky return to the U.S.

The barrilero never stops moving.

All day he wheels cardboard barrels stuffed with used clothing through the narrow aisles of the warehouse. He dumps the apparel atop tables for sorters, who separate nylons from cottons, satins from silks, denims from plaids. If a sorter is standing around with no garments, it's the barrilero's fault. Supervisors hover nearby.

Tons of old clothing come in every week, and tons go back out, to India and Pakistan, where it's sold at outdoor markets.

The factory hired the barrilero in September, a few weeks after the now-21-year-old showed up at the manager's door looking for work. Right away, the manager had recognized him as Anthony, that cute kid who walked his factory floor selling Helen Grace chocolates to workers years ago.

Anthony didn't say much about where he'd been, or what he'd been doing since. He was polite, upbeat, and his knock on the door still had the soft touch of a child. But his hair was falling out, and there was something unfamiliar in his eyes.

"He seemed sadder," the manager said, "like he wanted to say something but didn't know how."

There were many things the barrilero would keep to himself. First among them: His name wasn't Anthony.

::

Luis Luna returned to his hometown of South Gate in May. His arms and legs were scraped raw from cactus needles and his eyes kept blinking, still starved of moisture from his eight-day journey through the Arizona desert the week before.

His friend, Julio Cortez, said it was hard to believe that this gaunt young man with patches of missing hair was the same person he knew at Southeast Middle School.

"I was in shock to see him back and see all he had gone through," Cortez said. "It made me sad and angry."

Cortez, a 22-year-old Cal State Long Beach student, took Luis to buy some clothes. Another former classmate gave Luis a cellphone. Luis slept on couches and in spare bedrooms and spent his days passing out resumes filled with the jobs of his teen years: flipping burgers, waiting tables at I-Hop. He fudged the dates to account for the 15 months he spent in Mexico after he was deported for being in the country illegally.

Luis had been pulled over three years ago for a broken headlight in Pasco, Wash., where he and his mother lived. He was cited for driving without a license, jailed and ordered out of the country in February 2011.

He had a wife back in Washington, but she had left him, in part because of the long separation. Luis decided to build a new life in Southern California, where he had grown up and where he still had friends

Weeks after arriving, he was still jobless and borrowing money to eat when he decided his future might lie in his past. He started retracing the route he took as a boy selling chocolates at warehouses and factories. The assembly line workers, truck drivers and managers knew him as Anthony, the name his mother told him to use to hide his identity.

They could vouch for his strong work ethic — that he'd been working for a living since he was 5 years old.

He eventually found the barrilero job, and a place to live. A swap meet vendor who picked through the bins of cast-offs looking for vintage garments told Luis he had extra space at his house.

Luis goes home to a converted two-car garage with no address in a middle-class neighborhood with trim lawns and streets lined with late-model cars. Much of his clothing is stuffed in a battered dark green suitcase that sits at the foot of his bed. The only other furniture is a mini refrigerator and two lawn chairs.

In some ways, he's a typical youngster with edgy tastes. He has a sleeve tattoo, wears skinny jeans and earrings, and is part of a deejay crew that plays at house parties. He cheers his beloved Los Angeles Lakers and hangs out in hookah bars, and is constantly texting flirty messages.

But his future is dimmer than most. Many of his friends are planning for life after college. Some are applying for work permits and temporary reprieves from deportation, taking advantage of an Obama administration program, announced in June, to help young people who were brought into the country as children.

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App Guide: Puzzle Games

Crosswords work great on touchscreens. But sometimes, to really kill the time, you need something more colorful and animated.

Orbital

Orbital is like a cosmic snooker match. You aim a cannon that fires colorful glowing orbs onto a grid. Each sphere is destroyed when it taps another one three times. You have to ensure that they ricochet around and collide the necessary times yet don’t rebound so far that they risk hitting your cannon at the bottom of the screen.

WIRED Lovely particle-heavy graphics. Can play music from your library.

TIRED You’ll need your own music; the included soundtrack is a dud.

$2.99 iOS | $3 Android | $2.99 WP | Orbital

Scribblenauts Remix

There’s a star on top of a tree. Type in something that your character might use to get it down and that thing will appear onscreen. Type “ladder” or “ax” and voilà—there it is. The game presents scores of challenges, and the fun is in thinking of the most roundabout ways to achieve the goal—try to claim your prize with a helicopter or a lumberjack or a flamethrower or …

WIRED The game’s remarkably large vocabulary lets you go nuts.

TIRED Movement controls lack precision.

$0.99 iOS | Scribblenauts Remix

World Of Goo

Finally, a game that lets you control a puddle of disgusting gelatinous nodules! Tug at the goo balls with your finger to build them up into a tower that reaches the exit pipe at the top of the level. Your viscous architecture needs to be structurally sound or the realistic physics will pull it down.

WIRED One of the most challenging and creative teasers out there. Level design gets increasingly inspired.

TIRED Controls are a bit too imprecise for phone screens (though fine on a tablet).

$2.99 iOS | $4.99 Android | World Of Goo

Drop7

Think of this as Tetris with a touch of math. Random digits appear at the top of the screen, and you have to drop them onto a grid; instead of creating shapes, you make sudoku-like chains and sequences. Few things in mobile gaming compare to the satisfaction of clearing a Drop7 screen with a brutally effective numerical combo.

WIRED Easy to learn but well-nigh impossible to master, especially on the hardcore difficulty level.

TIRED Minimalist electronica score gets annoying.

$2.99 iOS | $2.99 Android | Drop7

Amazing Alex

Help a juvenile genius build elaborate Rube Goldberg devices out of household objects. Bonus points for rigging your contraptions so they collect all three gold stars on the way to reaching their goal. Each level is a unique physics puzzle—position benches to guide the descent of a soccer ball, or arrange shelves to direct a floating balloon.

WIRED Engaging brain teasers from the folks who brought you Angry Birds.

TIRED Lacks the oh-God-have-I-really-been-playing-for-an-hour addictiveness of Angry Birds.

$0.99 iOS | $0.99 Android | Amazing Alex

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Marvel’s Peter Parker in perilous predicament

PHILADELPHIA (AP) — After 50 years of spinning webs and catching a who’s who of criminals, Peter Parker is out of the hero game.

But Spider-Man is still slinging from building to building — reborn, refreshed and revived with a new sense of the old maxim that Ben Parker taught his then-fledgling nephew that “with great power, comes great responsibility.”

Writer Dan Slott, who’s been penning Spidey adventures for the better part of the last 100 issues for Marvel Entertainment, said the culmination of the story is a new, dramatically different direction for the Steve Ditko and Stan Lee-created hero.

“This is an epic turn,” Slott said. “I’ve been writing Spider-Man for 70-plus issues. Every now and then, you have to shake it up. … The reason Spider-Man is one of the longest running characters is they always find a way to keep it fresh. Something to shake up the mix.”

And in the pages of issue 700, out Wednesday, it’s not just shaken up, it’s turned head over heels, spun in circles, kicked sky high and cracked wide open.

Parker’s mind is trapped in the withered, decaying dying body of his nemesis, Doctor Octopus aka Otto Octavius. Where’s Doc Ock? Inside Parker’s super-powered shell, learning what life is like for the brilliant researcher who happens to count the Avengers and Fantastic Four as friends and family.

The two clash mightily in the pages of issue 700, illustrated by Humberto Ramos and Victor Olazaba. But it’s Octavius who wins out and Parker is, at least for now, gone for good, but not before one more act of heroism.

Slott said that it’s Parker, whose memories envelop Octavius, who shows the villain what it means to be a hero.

“Gone are his days of villainy, but since it’s Doc Ock and he has that ego, he’s not going to try and just be Spider-man, he’s going to try to be the best Spider-Man ever,” said Slott.

Editor Stephen Wacker said that while Parker is gone, his permanence remains and his life casts a long shadow.

“His life is still important to the book because it affects everything that Doctor Octopus does as Spider-Man. Seeing a supervillain go through this life is the point — trying to be better than the hero he opposed,” Wacker said.

“Doc has sort of inspired by Peter’s life. That’s what I mean when he talks about the shadow he casts,” he said.

The sentiment echoes what Uncle Ben said in the pages of “Amazing Fantasy” No. 15, Slott said.

Editor Stephen Wacker called it a fitting end to the old series, which sets the stage for a new one — “The Superior Spider-Man” early next year — because it brings Peter Parker full circle, from the start of his crime-fighting career to the end.

“In his very first story, his uncle died because of something he did so the book has always been aimed at making Peter’s life as difficult as possible,” Wacker said. “The book has always worked best when it’s about Peter Parker’s life, not Spider-Man’s.”

And with Octavius influenced by Parker’s life — from Aunt May to Gwen Stacy to Mary Jane — it will make him a better person, too.

“Because Doctor Octopus knows all of those things and will make decisions on what he saw Peter going through,” Wacker said. “In a way, he gets the ultimate victory as he becomes a better hero.”

___

Follow Matt Moore at www.twitter.com/MattMooreAP

___

Online:

http://bit.ly/V4q8FT

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Creating the Ultimate Housework Workout

Robert Wright for The New York Times

Chris Ely, an English butler, and Carol Johnson, a fitness instructor at Crunch NYC, perfecting a houseworkout.

CAN housework help you live longer? A New York Times blog post by Gretchen Reynolds last month cited research linking vigorous activity, including housework, and longevity. The study, which tracked the death rates of British civil servants, was the latest in a flurry of scientific reports crediting domestic chores with health benefits like a lowered risk for breast and colon cancers. In one piquant study published in 2009, researchers found that couples who spent more hours on housework had sex more frequently (with each other) though presumably not while vacuuming. (The report did not specify.)

Intrigued by science that merged the efforts of a Martha with the results of an Arnold (a buffer buffer?), this reporter challenged a household expert and a fitness authority to create the ultimate housework workout — a houseworkout — in her East Village apartment. Perhaps she could add a few years to her own life while learning some fancy new moves for her Swiffer. Christopher Ely, once a footman at Buckingham Palace, and Brooke Astor’s longtime butler, was appointed cleaner-in-chief. Mr. Ely is a man who approaches what the professionals call household management with the range and depth of an Oxford don. Although he is working on his memoirs (he described his book as a room-by-room primer with anecdotes from his years in service), he was happy enough to put his writing aside for an afternoon. His collaborator was Carol Johnson, a dancer and fitness instructor who develops classes at Crunch NYC, including those based on Broadway musicals like “Legally Blonde” and “Rock of Ages.”

Mr. Ely arrived first, beautifully dressed in dark gray wool pants, a black suit coat and a crisp white shirt with silver cuff links. He cleans house in a white shirt? “I know how to clean it,” he countered, meaning the shirt. When Ms. Johnson appeared (in black spandex and a ruffly white chiffon blouse, which she switched out for a Crunch T-shirt), theory, method and materials were discussed.

“If you’re dreading the laundry,” Ms. Johnson said, “why not create a space where it’s actually fun to do by putting on some music?” If fitness is defined by cardio health, she added, it will be a challenge to create housework that leaves you slightly out of breath. “I’m thinking interval training,” she said. As it happens, one trend in exercise has been workouts that are inspired by real-world chores, or what Rob Morea, a high-end Manhattan trainer, described the other day as “mimicking hard labor activities.” In his NoHo studio, Mr. Morea has clients simulate the actions of construction workers hefting cement bags over their shoulders (Mr. Morea uses sand bags) or pushing a wheelbarrow or chopping wood.

Mr. Ely averred that service — extreme housekeeping — is physically demanding, with sore feet and bad knees the least of its debilitating byproducts. Mr. Ely still suffers from an injury he incurred while carrying a poodle to its mistress over icy front steps in Washington When the inevitable occurred, and Mr. Ely wiped out, he threw the dog to his employer before falling hard on his backside. And the right equipment matters: After two weeks’ employ in an Upper East Side penthouse, he was handed a pair of Reeboks by his new boss, the better to withstand the apartment’s wall-to-wall granite floors. (For cleaning, Mr. Ely wears slippers, deck shoes or socks.)

Mr. Ely, whose talents and expertise are wide-ranging (he can stock a wine cellar, do the flowers, set a silver service, iron like a maestro and clean gutters, as he did once or twice at Holly Hill, Mrs. Astor’s Westchester estate), is a minimalist when it comes to materials. He favors any simple dish detergent as a multipurpose cleaner, along with a little vinegar, for glass, and not much else. “Dish detergent is designed for cutting grease; there’s nothing better,” he said. He’s anti-ammonia, anti-bleach. He said bleach destroys fabric, particularly anything with elastic in it. “Knickers and bleach are a terrible combination,” he said. “I had a boss who thought he had skin cancer. His entire trunk had turned red and itchy.” It seems his underpants were being washed in bleach. (Collective wince.) “It’s horrible stuff.”

As for tools, he likes a cobweb cleaner — this reporter had bought Oxo’s extendable duster, which has a fluffy orange cotton duster that snaps onto a sort of wand, but Mr. Ely prefers the kind that looks like a round chimney brush. (If you live in a house, he also suggests leaving the cobwebs by the front and back doors, so the spiders can eat any mosquitoes coming or going.) Choose a mop with microfiber fronds (he suggested the O Cedar brand) because it dries quickly and doesn’t smell. And a sturdy vacuum. Also, stacks of microfiber cloths or a terry cloth towel ripped up.

But first, to stretch. Ms. Johnson took hold of this reporter’s Bona floor mop (it’s like a Swiffer, but with a reusable washcloth) and Mr. Ely followed along with an old-fashioned string mop. Though Mr. Ely has a kind of loose-limbed elegance, he is not exactly limber. He grimaced as he parroted Ms. Johnson, who used her mop as Gene Kelly did his umbrella, stretching her arms overhead, one by one, twisting from side to side, sucking in her stomach, rising up on tip toes. (Mr. Ely said his old poodle-hurling injury was kicking in.) Ms. Johnson adjusted his chin — “You’re going to hurt yourself if you keep sticking your neck out,” she warned — and Mr. Ely raised a black-socked foot napped with cat hair and chastised this reporter: “Would you look at that?” (The cat had vanished early on, but his “debris,” as Mr. Ely put it, was still very much in evidence. The reporter hung her head. Did she know that cat spit is toxic? Mr. Ely wondered.)

“We’re warming up the spine,” said Ms. Johnson. “Squeeze your abdominals.”

Mr. Ely looked worried: “I don’t think I have abdominals!”

MR. ELY’S technique is to clean a room from top to bottom. That means he begins with the cobweb cleaner, wafting it along ceiling corners, moldings, soffits and, uh, the top of the fridge (major dust harvest there). His form was pretty, like a serve by Roger Federer, if not exactly aerobic. For Mr. Ely kept stopping to lecture this reporter — on condensation; on the basic principles of heat transfer and why one needs to vacuum the refrigerator coils; on the movement of moist air in a kitchen; on floor care, which involved a long story about a Belgian monastery whose inhabitants never washed the kitchen floor; on how to dust the halogen spot lights (use a cotton cloth, not a microfiber one, and make sure the lights are off, and cool).  “I do rabbit on, don’t I?” he said. Ms. Johnson gamely hustled him along, noting that anytime you raise your arms over your head you can raise your heart rate. “What about a balance exercise?” she cajoled, executing a neat series of leg lifts. “That’s good for the butler’s booty!”

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Contested UTLA panel elections signal internal fissures

The young staff at the Alexander Science Center has been hard hit by seniority-based layoffs, the main factor behind a turnover of at least 28 teachers in the last five years — this in a school with a faculty of about 28.

Teachers say that the students at the USC-adjacent campus have suffered from the lack of stability and that the faculty has felt frustrated and voiceless.

But now, three instructors from the Alexander science school are among the freshman class of delegates to the House of Representatives for United Teachers Los Angeles, the teachers union in the L.A. Unified School District.

The House is the union's official decision-making body: It selects candidates to endorse in elections and has the final say on policy — taking precedence over the president and the board of directors.

The recent elections, concluded this month, were the most contested in years, by far.

Of 32 election districts, 22 featured contested bids for seats that typically could be had for the asking through a self-nomination process. In all, 396 candidates vied for 209 positions, with 100 won by teachers not in the current House.

The ideology of the new delegates is varied, and still evolving. They are concerned about job security, teacher turnover, performance evaluations and funding levels. But they are also worried about what some see as a combative but ineffectual and sometimes wrongheaded union and a demanding, ossified district bureaucracy.

The level of interest in the House elections surprised union leaders and veteran teachers alike — some of whom greeted the nouveau activism with concern. They note that outside groups encouraged teachers to run and worry that such groups will try to influence union policy.

Two outside groups are local arms of national organizations, Educators 4 Excellence and Teach Plus. A third group, Teachers for a New Unionism, is headed by Mike Stryer, a Fairfax High teacher on leave who lost a bid for the school board four years ago. His team reached teachers through home mailings, urging them to run.

All the groups are funded by major nonprofits, such as the Bill & Melinda Gates Foundation, which has huge investments in education research and sometimes controversial policy positions. And all assert their desire for a union that better serves the interests of teachers as well as students.

Some in UTLA perceive an unholy alliance among these groups, their sponsoring foundations and L.A. schools Supt. John Deasy, a former Gates official.

"Taking over our House of Reps is clearly their strategy to destroy us," wrote teacher Anne Zerrien-Lee in an email posted to an online teachers forum.

"We have enough enemies outside of UTLA that we shouldn't have to deal with school district and Gates puppets within," said regional union leader Scott Mandel in an interview.

Without question, the outside groups see things differently than the leadership of UTLA.

Notably, the union has wanted to limit, as much as possible, the effect of test scores on a teacher's performance evaluation. The outside groups or their funders have backed the use of standardized test scores — or formulas based on them — as one key measure of a teacher's effectiveness.

Secondly, the outside groups want layoffs based on teacher effectiveness rather than seniority; the unions defend the seniority system as the most equitable approach.

Still, Teach Plus wasn't trying to recruit candidates who passed a litmus test, said Executive Director John Lee.

"Our desire wasn't to have a Teach Plus caucus but to connect teachers with leadership opportunities," Lee said.

The new delegates emphasize their loyalty to their profession and to their mission.

"I love teaching," said 35-year-old Antoinette Pippin, a fourth-grade teacher at Alexander Science Center. "I love my students, but I'm seeing a lot of things right now that are bad for my students and bad for teachers."

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10 More Mind-Blowing, Skill-Building Raspberry Pi Projects

Raspberry Pi, the credit-card sized, $35 Linux computer, has been on the market for under a year, but excited hackers are using the platform for dozens of new, cool projects and accessory products every month.

Since our last Raspberry Pi roundup we've found 10 more amazing projects that show how versatile this diminutive PCB is. From voice-activated coffeemakers to wall-hanging plotters, the Raspberry Pi is proving to be a fruitful addition to the maker's toolbox.

Above: Black Stripes V-Plotter

A design drone with a Raspberry Pi brain, developed to turn full-color photographs into huge black-and-white murals. It's an evolution of the popular "V-Plotter" style artbot; the on-board RPi turns bitmap data into vectors that can be drawn with a robotically controlled marker. While the frame and plotter have a distinct Home Depot vibe, the output of the Black Stripes drawing robot is gallery worthy.

The code for the project is closed source, but the team does accept commissions for murals starting at 149 euros (~$200).

Photos: Black Stripes

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Britain’s royal family attends Christmas services

LONDON (AP) — Britain‘s royal family is attending Christmas Day church services — with a few notable absences.

Wearing a turquoise coat and matching hat, Queen Elizabeth II arrived at St. Mary Magdelene Church on her sprawling Sandringham estate in Norfolk. She was accompanied in a Bentley by granddaughters Beatrice and Eugenie.

Her husband, Prince Philip, walked from the house to the church with other members of the royal family.

Three familiar faces were missing from the family outing. Prince William is spending the holiday with his pregnant wife Kate and his in-laws in the southern England village of Bucklebury. Prince Harry is serving with British troops in Afghanistan.

Later Tuesday, the queen will deliver her traditional, pre-recorded Christmas message, which for the first time will be broadcast in 3D.

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Chicken Farms Try Oregano as Antibiotic Substitute

Jessica Kourkounis for The New York Times

Chickens raised for Bell & Evans, like these in Pennsylvania, eat feed laced with oregano oil.

FREDERICKSBURG, Pa. — The smell of oregano wafting from Scott Sechler’s office is so strong that anyone visiting Bell & Evans these days could be forgiven for wondering whether Mr. Sechler has forsaken the production of chicken and gone into pizza.

Oregano lies loose in trays and tied into bunches on tabletops and counters, and a big, blue drum that held oregano oil stands in the corner. “Have you ever tried oregano tea?” Mr. Sechler asked, mashing leaves between his broad fingers.

Off and on over the last three years or so, his chickens have been eating a specially milled diet laced with oregano oil and a touch of cinnamon. Mr. Sechler swears by the concoction as a way to fight off bacterial diseases that plague meat and poultry producers without resorting to antibiotics, which some experts say can be detrimental to the humans who eat the meat. Products at Bell & Evans, based in this town about 30 miles east of Harrisburg, have long been free of antibiotics, contributing to the company’s financial success as consumers have demanded purer foods.

But Mr. Sechler said that nothing he had used as a substitute in the past worked as well as oregano oil.

“I have worried a bit about how I’m going to sound talking about this,” he said. “But I really do think we’re on to something here.”

Skeptics of herbal medicines abound, as any quick Internet search demonstrates. “Oil of oregano is a perennial one, advertised as a cure for just about everything,” said Scott Gavura, a pharmacist in Toronto who writes for the Web site Science-Based Medicine. “But there isn’t any evidence, there are too many unanswered questions and the only proponents for it are the ones producing it.”

Nonetheless, Mr. Gavura said he would welcome a reduction in the use of antibiotics in animals.

At the same time, consumers are growing increasingly sophisticated about the content of the foods that they eat.

Data on sales of antibiotic-free meat is hard to come by, but the sales are a tiny fraction of the overall meat market. Sales in the United States of organic meat, poultry and fish, which by law must be raised without antibiotics, totaled $538 million in 2011, according to the Organic Trade Association. By comparison, sales of all beef that year were $79 billion.

Still, retailers like Costco, Whole Foods and Trader Joe’s, as well as some restaurant chains, complain that they cannot get enough antibiotic-free meat.

Noodles & Company, a fast-growing chain of more than 300 restaurants, recently added antibiotic-free pork to the choices of ingredients that customers can add to their made-to-order pastas. It ensured its supply by ordering cuts of meat that were not in relatively high demand and by committing in advance to buy a year’s worth, said Dan Fogarty, its executive vice president for marketing.

“We’re deliberately voting with our pocketbooks,” he said.

In a nationwide telephone survey of 1,000 adults in March, more than 60 percent told the Consumer Reports National Research Center that they would be willing to pay at least 5 cents a pound more for meat raised without antibiotics.

“Before, it was kind of a nice little business, and while it’s still microscopic in the grand scheme of things, we’re seeing acceptance from retailers across the country, not just in California and on the East Coast,” said Stephen McDonnell, founder and chief executive of Applegate, an organic and natural meats company.

Mr. McDonnell said a confluence of trends, from heightened interest in whole and natural foods to growing concerns about medical problems like diabetes, obesity and gluten allergies, were contributing to the demand for antibiotic-free meat.

There is growing concern among health care experts and policy makers about antibiotic resistance and the rise of “superbugs,” bacteria that are impervious to one or more antibiotics. Those bacteria can be passed on to consumers, who eat meat infected with them and then cannot be treated.

In November, the Centers for Disease Control and Prevention and 25 national health organizations and advocacy groups issued a statement on antibiotics that, among other things, called for “limiting the use of medically important human antibiotics in food animals” and “supporting the use of such antibiotics in animals only for those uses that are considered necessary for assuring animal health.”

In 2011, there were several prominent recalls involving bacterial strains that are resistant to antibiotics, including more than 60 million pounds of ground beef contaminated with salmonella Typhimurium and about 36 million pounds of ground turkey spoiled with salmonella Heidelberg.

Consumer Reports released a study last month that found the bacteria Yersinia enterocolitica in 69 percent of 198 pork chop and ground pork samples bought at stores around the country. Some of the bacteria were resistant to one or more antibiotics.

Analysis of Food and Drug Administration data by the Center for Science in the Public Interest found that 80 percent of all antibiotics sold in the United States are used in animals. The majority of those antibiotics are used to spur growth or prevent infections from spreading in the crowded conditions in which most animal production takes place today.

The European Union has banned the use of antibiotics to accelerate growth, and the European Parliament is pushing to end their use as tools to prevent disease as well.

The oregano oil product Mr. Sechler uses, By-O-Reg Plus, is made by a Dutch company, Ropapharm International. In the late 1990s, Bayer conducted trials on the product, known as Ropadiar in Europe, comparing its ability to control diarrhea in piglets caused by E. coli with that of four of the company’s products.

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U.S. drone strategy in Yemen is fraught with peril

AL SARRAIN, Yemen — The U.S. drone flew over a cluster of mud houses on a ridge and, according to Yemeni officials, locked onto Adnan Qadhi, a mercurial man of many guises, including radical militant, peace mediator, preacher of violence and army general.

Villagers said Qadhi climbed out of his utility vehicle the night of Nov. 7 to make a cellphone call shortly before the missile struck. His photo — broad face peering from beneath a tilted red beret, stars on his epaulets — now hangs in a small grocery store in a land where farmers work narrow fields below the villas of politicians, tribal leaders and a former president that rise like fortresses on nearby hilltops.

Some here call him a martyr, others a fanatic. But the life and death of Qadhi, a senior officer in the 1st Armored Division who preached holy war in mosques and donned government-issued fatigues, epitomizes the political instability, tribal intrigue, crisscrossing allegiances and radical Islamist passions the United States must sort out when targeting militants in Yemen. At times, Washington risks being drawn into internal conflicts and becoming increasingly despised in the Arab world's poorest nation.

Extremists here have a history of shifting tactics and circumstances. They were pressed into service by the government of former President Ali Abdullah Saleh when needed, then arrested and jailed when the political winds changed. Later they vanished from prisons by the scores, set loose across tribal lands. Yemeni security officials say that era is ending, and they're stepping up military offensives to rout extremists — fighters from Libya, Somalia and other nations, and assassins on motorcycles intent on killing intelligence officials.

At the same time, the Obama administration has intensified airstrikes against the Yemeni group Al Qaeda in the Arabian Peninsula, which plotted in 2009 and 2010 to blow up American airliners. A 2011 drone attack killed Anwar Awlaki, an American-born Muslim preacher and militant recruiter. Weeks later, a U.S. airstrike killed Awlaki's 16-year-old son, who tribesmen and relatives say had no links to terrorism.

The Long War Journal, a website that tracks U.S. drone activity, reports that since 2002, America has launched 57 airstrikes in Yemen, killing 299 militants and 82 civilians. The number of strikes has risen dramatically from four in 2010 to 40 so far this year.

"Why do these Americans come and interfere in Yemen?" said Radhwan Dahrooj, the grocer in Al Sarrain. "Why do they kill our people? If they have charges against someone why do they not arrest him and bring him to justice?"

Qadhi was sentenced to prison four years ago for plotting an attack on the U.S. Embassy in Sana, the capital, that killed at least 16 people, no Americans among them. With the help of clansmen and army officials, he was released shortly afterward and resumed his old life: militant and officer in the 1st Armored Division, led by Maj. Gen. Ali Mohsin Saleh Ahmar, a commander described in a 2005 U.S. diplomatic cable as "dealing with terrorists and extremists."

When uprisings against President Saleh swept the country in 2011, the brigade mutinied and battled with competing tribes and security units for control of Sana.

What began as a peaceful revolution against Saleh tipped the nation — already fighting a rebellion in the north and a secessionist movement in the south — into deeper turmoil. Al Qaeda in the Arabian Peninsula and its affiliate Ansar al Sharia exploited the unrest, taking over territory in the south. That gave Qadhi an opportunity to expand his militant ambitions even as he slipped into another of his guises, currying favor with the government by mediating a truce between Yemeni officials and an Al Qaeda faction.

The U.S., which this year has given Yemen $337 million in military and security aid, would not confirm that a drone targeted Qadhi. Yemeni officials and villagers, who heard a plane circling that night, said a U.S. airstrike killed him not far from his home in Beit al Ahmar. Though Qadhi was an active Al Qaeda recruiter and often accused Washington in his sermons of wanting to keep Yemen divided and in chaos, it is not clear what specific danger he was seen as presenting to the United States.

Washington has no precise rules on the criteria for targeting militants with drone strikes. But President Obama has said that an extremist must present an imminent threat to the U.S. or its allies, as Yemen's Al Qaeda branch is considered to do, and that arrest would be impossible.

A former senior U.S. intelligence official said Qadhi's arrest for the 2008 embassy attack would not have been enough to put him on an assassination list. White House counter-terrorism advisor John Brennan has said that militants battling solely to overthrow the government in Sana are not targeted. But Qadhi's 1st Armored Division was certainly a threat to the Yemeni government and the country's stability.

Yemeni officials said the nation's new president, Abdu Rabu Mansour Hadi, approved the strike against Qadhi after determining that an attempt to arrest him in his neighborhood could have led to more deaths. The officials said they were unaware of intelligence linking Qadhi to any active plot.

The danger in the drone program is the potential for U.S. intelligence and airstrikes to be manipulated by Yemenis seeking to weaken the competing clans and political factions. For example, Obama and his top generals felt misled in 2010 when Obama signed off on an airstrike against a senior militant that killed six people, including the deputy governor of Mareb province. The strike was based entirely on intelligence provided by the Yemenis, who had not told the U.S. that the governor would be there, a former senior U.S. official said.

Since Hadi took office in February, the cooperation and trust between the Yemeni government and the U.S. has vastly improved, U.S. and Yemeni officials say.

There are many potential drone targets. For decades, young men have left Yemen to become foot soldiers and bomb makers among the militants in Afghanistan, Algeria, Pakistan, Iraq and Libya. Some of them have come home.

One was Rashad Mohammed Saeed, who left at 15 and became a confidant of Osama bin Laden, fighting beside him in Afghanistan. He returned to Yemen around 2000 and in an interview said he had put aside his weapons to start the Renaissance Union Party, made up of former militants who run for parliament seats.

Like militants in other countries, he is struggling to reconcile a decades-long philosophy of violence and the more peaceful, and successful, political approach — at least in Tunisia and Egypt — of the protest movements that ignited the so-called Arab Spring. He worries about what many here describe as an incessant invisible buzz in the sky.

"We have entered politics. Do you think the U.S. will leave us alone to choose our own leaders and way of life?" Saeed asked. "Our party is close to Al Qaeda. We're trying to get them to lay down their weapons. Yemen doesn't need this violence now. We just need protection from drones. I may be a target myself."

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