Queens Doctor Is Charged in 2 Patients’ Deaths

A doctor accused of running a prescription pain medication mill out of a basement office in Queens was charged with manslaughter on Thursday in the deaths of two former patients.

John Marshall Mantel for The New York Times

Dr. Stan Xuhui Li, center, in court Thursday. Dr. Li is charged with manslaughter for prescribing pain medicine for medically unsound reasons to 20 patients. Seven later died from overdoses.

An indictment filed in State Supreme Court in Manhattan accused the doctor, Stan Xuhui Li, of prescribing pain medicine for medically unsound reasons to 20 patients, seven of whom died from overdoses.

Joseph Haeg, 37, and Nicholas Rappold, 21, the two patients whose deaths led to the manslaughter charges, had visited Dr. Li within three days of their deaths, and the pill bottles were found next to their bodies, prosecutors said.

Mr. Haeg had received 15 prescriptions from Dr. Li in the three months before his death in December 2009, and more than 500 pills of controlled substances in his last month, according to court records.

During Mr. Rappold’s last visit with Dr. Li, he received prescriptions for Xanax and oxycodone. He was found dead in his parked car in Queens in September 2010, and the cause of death was acute intoxication by the combined effects of Xanax and oxycodone, according to court records.

Bridget G. Brennan, New York City’s special narcotics prosecutor, said her office was not aware of any other cases in which a physician was charged with homicide under New York State law in the death of a patient. She said her office took the unusual step in part because Dr. Li’s prescriptions could be proved to be the cause of the deaths, and because he ignored obvious signs of his patients’ deteriorating health.

“Dr. Li flouted the fundamental principle in medicine: first do no harm,” Ms. Brennan said. “He jeopardized lives by repeatedly prescribing dangerous controlled substances and narcotic drugs for cash, not medical need.”

Prosecutors also said that Dr. Li, 58, prescribed controlled substances to another man, David Laffer, last year, just one week before Mr. Laffer fatally shot four people while stealing thousands of pain pills from a pharmacy in Medford, N.Y. Dr. Li has not been charged in that episode.

Dr. Li was arrested last year and charged with criminal sale of a prescription for a controlled substance and reckless endangerment in the death of Michael Cornetta, 40, who overdosed in November 2010. Dr. Li’s license to practice medicine was suspended in January.

He was also charged on Thursday with several counts related to making false insurance claims and altering patient records that he supplied to the state’s Office of Professional Medical Conduct, which is responsible for physician discipline.

Dr. Li had been free on bail since shortly after his arrest last year. He was rearrested near his home in Hamilton, N.J., on Nov. 27. He appeared in court wearing a blue plaid shirt and pleaded not guilty to all the charges.

His lawyer, Raymond W. Belair, said Dr. Li would fight the charges and try to keep his medical license. He described Dr. Li as a “careful and caring physician” who should not be held responsible if his patients were taking doses in excess of the prescribed levels or “doctor shopping” to get more prescriptions.

“Everything that has taken place here has taken place in the context of a pain-management situation,” Mr. Belair said in court.

Justice Michael R. Sonberg ordered Dr. Li held in bail of $750,000 in bond or $250,000 in cash.

Dr. Li worked as an anesthesiologist in New Jersey, but on weekends prescribed hundreds of pain pills from a building in Flushing. Patients would line up around the corner, be given numbers as they entered and then be called by number rather than by name, prosecutors said.

Charlotte Fishman, an assistant district attorney, said in court that Dr. Li had collected more than $450,000 in cash from selling prescriptions over the two years before his arrest.

“He literally filled his pockets with money on those weekend days,” Ms. Fishman said.

Dr. Li faces up to 15 years in prison on each of the manslaughter charges.

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McAfee Antivirus Software Pioneer Arrested in Guatemala City

MEXICO CITY — The antivirus software pioneer John McAfee was arrested in Guatemala City on Wednesday after he slipped over the border from his home in Belize where police want to question him in their investigation of the murder of his neighbor.

Jorge Dan Lopez/Reuters

John McAfee spoke during an interview in Guatemala City on Wednesday.

The interior minister, Mauricio Lopez Bonilla, told The Associated Press that Mr. McAfee, 67, had been arrested on charges of entering Guatemala illegally. He said that Mr. McAfee had been arrested at a hotel in the capital and taken to a detention center for migrants who are in the nation illegally.

Mr. McAfee had been on the run for almost a month since his neighbor, Gregory Faull, on the Belizean island of Ambergris Caye was found dead at his home on Nov. 11. Police there cited Mr. McAfee as a “person of interest” in their investigation, but Mr. McAfee disapppeared.

But he did not disappear from the Internet. He kept up a continuous stream of comment on his blog and on Twitter, accusing the Belizean authorities of persecuting him.

On Tuesday, he resurfaced in Guatemala, dressed in a suit, his blond curls dyed dark brown.

Accompanied by his 20-year-old Belizean girlfriend, Samantha Venagas, and his Guatemalan lawyer, Telésforo Guerra, Mr. McAfee said that he would seek political asylum in Guatemala. Mr. Guerra, a former Guatemalan attorney general, told reporters at a chaotic news conference outside the Supreme Court that his client was being persecuted because he refused to pay Belizean authorities off any longer.

Mr. McAfee has not been associated with the software company that bears his name since 1994, when he sold it and began to pursue his other interests. He ran a yoga retreat and then built a complex in New Mexico to indulge his hobby of flying motorized ultralight airplanes.

He moved to Belize about four years ago, buying properties on the mainland and on Ambergris Caye. It was there that he clashed with Mr. Faull, who complained about the unleashed dogs that Mr. McAfee kept on his property.

On Nov. 9, several of the dogs were found dead. They had been poisoned.

During his time in Belize, Mr. McAfee had apparently become interested in developing a designer drug called MDPV. He posted extensively about his experiments on a Web site.

But he attracted the attention of Belizean authorities, who raided one of his properties in April. He spent a night in jail, but law enforcement officials found no evidence that he was producing methamphetamine and dropped the charges.

After that experience, though, Mr. McAfee appeared to become increasingly convinced that he was being persecuted by the Belizean government. Officials deny that they are persecuting him.

Mr. Guerra told Guatemalan reporters late Wednesday that since there was no warrant for Mr. McAfee’s arrest and since his client was not a fugitive, he would seek to have his client released and returned to the hotel where he would remain under guard.

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Antismoking Outlays Drop Despite Tobacco Revenue

Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday.

Paul J. Richards/Agence France-Presse — Getty Images

State antismoking spending is the lowest since the 1998 national tobacco settlement.

States are on track to collect a record $25.7 billion in tobacco taxes and settlement money in the current fiscal year, but they are set to spend less than 2 percent of that on prevention, according to the report, by the Campaign for Tobacco-Free Kids, which compiles the revenue data annually. The figures come from state appropriations for the fiscal year ending in June.

The settlement awarded states an estimated $246 billion over its first 25 years. It gave states complete discretion over the money, and many use it for programs unrelated to tobacco or to plug budget holes. Public health experts say it lacks a mechanism for ensuring that some portion of the money is set aside for tobacco prevention and cessation programs.

“There weren’t even gums, let alone teeth,” Timothy McAfee, the director of the Office on Smoking and Health at the Centers for Disease Control and Prevention, said, referring to the allocation of funds for tobacco prevention and cessation in the terms of the settlement.

Spending on tobacco prevention peaked in 2002 at $749 million, 63 percent above the level this year. After six years of declines, spending ticked up again in 2008, only to fall by 36 percent during the recession, the report said.

Tobacco use is the No. 1 cause of preventable death in the United States, killing more than 400,000 Americans every year, according to the C.D.C.

The report did not count federal money for smoking prevention, which Vince Willmore, the vice president for communications at the Campaign for Tobacco-Free Kids, estimated to be about $522 million for the past four fiscal years. The sum — about $130 million a year — was not enough to bring spending back to earlier levels.

The $500 million a year that states spend on tobacco prevention is a tiny fraction of the $8 billion a year that tobacco companies spend to market their products, according to a Federal Trade Commission report in September.

Nationally, 19 percent of adults smoke, down from over 40 percent in 1965. But rates remain high for less-educated Americans. Twenty-seven percent of Americans with only a high school diploma smoke, compared with just 8 percent of those with a college degree or higher, according to C.D.C. data from 2010. The highest rate — 34 percent — was among black men who did not graduate from high school.

“Smoking used to be the rich man’s habit,” said Danny McGoldrick, the vice president for research at the Campaign for Tobacco-Free Kids, “and now it’s decidedly a poor person’s behavior.”

Aggressive antismoking programs are the main tools that cities and states have to reach the demographic groups in which smoking rates are the highest, making money to finance them even more critical, Mr. McGoldrick said.

The decline in spending comes amid growing certainty among public health officials that antismoking programs, like help lines and counseling, actually work. California went from having a smoking rate above the national average 20 years ago to having the second-lowest rate in the country after modest but consistent spending on programs that help people quit and prevent children from starting, Dr. McAfee said.

An analysis by Washington State, cited in the report, found that it saved $5 in tobacco-related hospitalization costs for every $1 spent during the first 10 years of its program.

Budget cuts have eviscerated some of the most effective tobacco prevention programs, the report said. This year, state financing for North Carolina’s program has been eliminated. Washington State’s program has been cut by about 90 percent in recent years, and for the third year in a row, Ohio has not allocated any state money for what was once a successful program, the report said.

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Antismoking Outlays Drop Despite Tobacco Revenue

Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday.

Paul J. Richards/Agence France-Presse — Getty Images

State antismoking spending is the lowest since the 1998 national tobacco settlement.

States are on track to collect a record $25.7 billion in tobacco taxes and settlement money in the current fiscal year, but they are set to spend less than 2 percent of that on prevention, according to the report, by the Campaign for Tobacco-Free Kids, which compiles the revenue data annually. The figures come from state appropriations for the fiscal year ending in June.

The settlement awarded states an estimated $246 billion over its first 25 years. It gave states complete discretion over the money, and many use it for programs unrelated to tobacco or to plug budget holes. Public health experts say it lacks a mechanism for ensuring that some portion of the money is set aside for tobacco prevention and cessation programs.

“There weren’t even gums, let alone teeth,” Timothy McAfee, the director of the Office on Smoking and Health at the Centers for Disease Control and Prevention, said, referring to the allocation of funds for tobacco prevention and cessation in the terms of the settlement.

Spending on tobacco prevention peaked in 2002 at $749 million, 63 percent above the level this year. After six years of declines, spending ticked up again in 2008, only to fall by 36 percent during the recession, the report said.

Tobacco use is the No. 1 cause of preventable death in the United States, killing more than 400,000 Americans every year, according to the C.D.C.

The report did not count federal money for smoking prevention, which Vince Willmore, the vice president for communications at the Campaign for Tobacco-Free Kids, estimated to be about $522 million for the past four fiscal years. The sum — about $130 million a year — was not enough to bring spending back to earlier levels.

The $500 million a year that states spend on tobacco prevention is a tiny fraction of the $8 billion a year that tobacco companies spend to market their products, according to a Federal Trade Commission report in September.

Nationally, 19 percent of adults smoke, down from over 40 percent in 1965. But rates remain high for less-educated Americans. Twenty-seven percent of Americans with only a high school diploma smoke, compared with just 8 percent of those with a college degree or higher, according to C.D.C. data from 2010. The highest rate — 34 percent — was among black men who did not graduate from high school.

“Smoking used to be the rich man’s habit,” said Danny McGoldrick, the vice president for research at the Campaign for Tobacco-Free Kids, “and now it’s decidedly a poor person’s behavior.”

Aggressive antismoking programs are the main tools that cities and states have to reach the demographic groups in which smoking rates are the highest, making money to finance them even more critical, Mr. McGoldrick said.

The decline in spending comes amid growing certainty among public health officials that antismoking programs, like help lines and counseling, actually work. California went from having a smoking rate above the national average 20 years ago to having the second-lowest rate in the country after modest but consistent spending on programs that help people quit and prevent children from starting, Dr. McAfee said.

An analysis by Washington State, cited in the report, found that it saved $5 in tobacco-related hospitalization costs for every $1 spent during the first 10 years of its program.

Budget cuts have eviscerated some of the most effective tobacco prevention programs, the report said. This year, state financing for North Carolina’s program has been eliminated. Washington State’s program has been cut by about 90 percent in recent years, and for the third year in a row, Ohio has not allocated any state money for what was once a successful program, the report said.

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Apple to Resume U.S. Manufacturing

For the first time in years, Apple will manufacture computers in the United States, the chief executive of Apple, Timothy D. Cook, said in interviews with NBC and Bloomberg Businessweek.

“Next year, we will do one of our existing Mac lines in the United States,” he said in an interview to be broadcast Thursday on “Rock Center With Brian Williams” on NBC.

Apple, the biggest company in the world by market value, moved most of its manufacturing to Asia in the late 1990s. As an icon of American technology success and innovation, the California-based company has been criticized in recent years for outsourcing jobs abroad.

“I don’t think we have a responsibility to create a certain kind of job,” Mr. Cook said in the Businessweek interview. “But I think we do have a responsibility to create jobs.”

The company plans to spend $100 million on the American manufacturing in 2013, according to the interviews, a small fraction of its overall factory investments and an even tinier portion of its available cash.

In the interviews, Mr. Cook suggested the company would work with partners and that the manufacturing would be more than just the final assembly of parts. He noted that parts of the company’s ubiquitous iPhone, including the “engine” and the glass screen, were already made in America. The processor is manufactured by Samsung in Texas, while Corning makes the glass screen in Kentucky.

Over the last few years, sales of the iPhone, iPod and iPad have overwhelmed Apple’s line of Macintosh computers, the basis of the company’s early business. Revenue from the iPhone alone made up 48 percent of the company’s total revenue for its fiscal fourth quarter ended Sept. 30.

But as recently as October, Apple introduced a new, thinner iMac, the product that pioneered the technique of building the computer innards inside the flat screen.

Mr. Cook did not say in the interviews where in the United States the new manufacturing would occur. But he did defend Apple’s track record in American hiring.

“When you back up and look at Apple’s effect on job creation in the United States, we estimate that we’ve created more than 600,000 jobs now,” Mr. Cook told Businessweek. Those jobs include positions at partners and suppliers.

Steve Dowling, a spokesman for Apple, declined on Thursday to provide additional details on Apple’s plans, referring to Mr. Cook’s interviews.

Apple has for years done the final assembly of some Macs in the United States, mainly systems that customers buy with custom configurations, like bigger hard drives and more memory than on standard machines.

Mr. Cook’s statements suggested Apple is planning to build more of the Mac’s ingredients domestically, although with partners. He told Businessweek that the plan “doesn’t mean that Apple will do it ourselves, but we’ll be working with people, and we’ll be investing our money.”

While Apple’s products are typically made in Asian factories owned by other companies, Apple itself often purchases the sophisticated manufacturing equipment required to make its cutting-edge designs, spending billions of dollars a year on such machines.

Foxconn Technology, which manufactures more than 40 percent of the world’s electronics, is one of Apple’s main overseas manufacturing contractors. Based in Taiwan, Foxconn is China’s largest private employer, with 1.2 million workers, and it has come under intense scrutiny over working conditions inside its factories.

In March, Foxconn pledged to sharply curtail the number of working hours and significantly increase wages. The announcement was a response to a far-ranging inspection by the Fair Labor Association, a monitoring group that found widespread problems — including numerous instances where Foxconn violated Chinese law and industry codes of conduct.

Apple, which recently joined the labor association, had asked the group to investigate plants manufacturing iPhones, iPads and other devices. A growing outcry over conditions at overseas factories prompted protests and petitions, and several labor rights organizations started scrutinizing Apple’s suppliers.

Almost all of the 70 million iPhones, 30 million iPads and 59 million other products Apple sold in 2011 were manufactured overseas. Apple employs 43,000 people in the United States and 20,000 overseas. An additional 700,000 people engineer, build and assemble iPads, iPhones and Apple’s other products, mostly abroad.

At a meeting with Silicon Valley executives in 2011, President Obama asked Steven P. Jobs, then the Apple chief executive, what it would take to make iPhones in the United States. Mr. Jobs, who died later that year, told the president, “Those jobs aren’t coming back.”

Nick Wingfield contributed reporting.

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Britons Are Warned of Lingering Austerity

Andrew Winning/Reuters

A closed business in London. A nonpartisan agency monitoring the data said it expected the economy to shrink this year.

LONDON — Britons, many already weary of government austerity budgets that some economists say are impeding the country’s recovery, are going to have to wait even longer for relief.

The architect of the austerity program, George Osborne, the chancellor of the Exchequer, told Parliament on Wednesday that the government had missed one of its self-imposed debt-cutting goals and would have to extend the belt-tightening into 2018, a year longer than previously promised.

Although Mr. Osborne maintained that the debt reduction plan was still on track, his presentation drew heckling and laughter from some opposition lawmakers, particularly after he argued that new tax measures would show that “we’re all in this together.”

The next general election in Britain will take place in 2015, well before the end of austerity measures that have included cuts in welfare services and the elimination of tens of thousands of public sector jobs.

On Wednesday, the Office for Budget Responsibility, a nonpartisan body that is monitoring the economy, said it now expected full-year data to show that the economy shrank 0.1 percent this year, instead of growing 0.8 percent, as the office had previously forecast.

It also said the economy would grow 1.2 percent next year as opposed to the 2 percent predicted earlier.

“It’s a hard road but we are getting there,” Mr. Osborne told Parliament. “Britain is on the right track. Turning back now would be a disaster.”

Reducing the budget deficit and truly getting the economy back on track has been the overriding objective binding the uneasy coalition between Prime Minister David Cameron’s Conservative Party and Liberal Democrat lawmakers that has governed Britain since 2010.

Both parties have been betting that imposing the most severe government spending cuts in recent decades will reap economic rewards before the next general election. But the last missed target for cutting debt, combined with a painfully slow recovery, risks undermining the entire political strategy and stoking tensions within the coalition. And it undermines the coalition’s message that it is better equipped to deal with the economy than the Labour Party.

“The government’s strategy is to combine deficit reduction with economic recovery, but at the moment we are not getting much of either,” said Andrew Smith, chief economist at the auditing and advisory firm KPMG.

The government has been defending its austerity measures, which include tax increases and spending cuts, by saying they help to keep Britain’s borrowing costs low and so will contribute to a revival of the British economy. Compared with the Continent, Britain has a relatively better economic outlook, and its borrowing costs are much lower.

Mr. Osborne said the British economy was facing “a multitude of problems” at home and abroad, making the recovery more difficult. He mentioned uncertainty about averting the so-called fiscal cliff crisis in the United States in January, slowing growth in China and the euro zone recession.

“They really need some growth now,” said David Tinsley, an economist at BNP Paribas. “Making the cuts when the economy is stuck is really difficult.”

Ed Balls, economic spokesman for the Labour Party, said Wednesday that Mr. Osborne’s statements illustrated an economic failure of government. “The defining purpose of the government, the cornerstone of the coalition, the one test they set themselves — to balance the books and get the debt falling by 2015 — is now in tatters,” he said.

Labour, which is leading in some recent national polls, has been criticizing Mr. Osborne’s austerity plan as going too far and trying to cut debt too quickly without offering any investments to fuel economic growth. But economists said that with public finances stretched as they were, there was little Mr. Osborne could spend on a revival.

He announced a one percentage point cut in the corporation tax, to 21 percent, and canceled a planned increase in the fuel tax paid by consumers. He also said the government planned to be much stricter on going after tax dodgers.

“I know these tax measures will not be welcomed by all,” Mr. Osborne said. “But we must show we’re all in this together.”

So far, Mr. Osborne has managed to balance the competing demands of Conservatives, who generally favor tax and benefit cuts, and Liberal Democrats who would rather increase the burden on the wealthy if necessary. But blaming the weakness of the British economy for the euro zone crisis may become a less effective political weapon if the single-currency area begins to stabilize.

“The strains are muted because people understand the seriousness of the situation and the absence of any obvious way of getting out of it,” said one senior member of the Liberal Democrats, who was not authorized to speak publicly. “But as it goes on for longer, the strains under which the coalition begins to operate will become greater.”

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Storm Hits Hiring in November; Service Sector Expands

NEW YORK (Reuters) - Private-sector hiring took a hit in November due to the impact of storm Sandy that ravaged consumers and businesses in the northeastern United States, but the huge services sector continued to expand albeit at a modest pace.

The ADP National Employment Report, which is closely watched as it comes two days ahead of the government's monthly employment report, showed that the private sector added 118,000 jobs during the month, below expectations for a gain of 125,000.

The report largely confirmed economists' forecast for a weak reading in the Labor Department payrolls report on Friday. Economists expect the economy added 93,000 jobs in November, down from 171,000 the month before, according to a Reuters poll.

"It's close to what the market was expecting. If Friday's employment report from the U.S. Labor Department comes in similar to this, that would be a good outcome," said Terry Sheehan, economic analyst at Stone and McCarthy Research Associates in Princeton, New Jersey.

A separate report on the U.S. services sector showed a similar dip in hiring during the month. But forward-looking indicators pointed to faster growth as a rise in new orders and business activity helped offset a slowdown in employment and prices.

The Institute for Supply Management said its services index rose to 54.7 last month from 54.2 the month before, with 50 being the divide between growth and contraction. The reading topped economists' forecasts for growth of 53.5, according to a Reuters survey.

"The much larger service side of the U.S. economy remains relatively healthy," said Joseph Trevisani, chief market strategist at Worldwide Markets, Woodcliff Lake, New Jersey.

"It has so far avoided the contraction in manufacturing, but worse is probably coming in the first quarter of next year as the economy continues to slow."

A separate report on Monday showed that the manufacturing sector contracted after two months of growth.

U.S. stocks were little changed after the data but drifted lower by midmorning. The S&P 500 index, a broad measure of U.S. stocks, traded down 0.4 percent at 1,401.74 points.

Also on Wednesday, a report showed new orders received by U.S. factories unexpectedly rose in October as demand for motor vehicles and a range of other goods offset a slump in defense and civilian aircraft orders, a hopeful sign for the manufacturing sector.

That chimed with another report showing U.S. nonfarm productivity increased at a much faster clip than initially thought in the third quarter as businesses held the line on hiring even as output surged, with unit labor costs falling at their fastest pace in almost a year.

Mark Zandi, chief economist of Moody's Analytics, who helps compile the ADP report, said underlying jobs growth was closer to 150,000 in November after discounting the impact of the storm as well as seasonal jobs brought forward at the start of the holiday season.

"Abstracting from the storm, the job market turned in a good performance during the month," he said. "Superstorm Sandy wreaked havoc on the job market in November, slicing an estimated 86,000 jobs from payrolls."

Zandi said he was seeing little indication that budget negotiations in Washington aimed at averting the so-called "fiscal cliff," a series of automatic tax hikes and spending cuts due in 2013, were having a significant impact of hiring.

"I don't sense that businesses have pulled back on their hiring or increased their layoffs as a result of the angst surrounding the fiscal issues," said Zandi.

The current impasse over the fiscal cliff, which could impact the economy to the tune of $600 billion next year, has been blamed for fueling uncertainty and causing corporate managers to delay business decisions.

(Reporting By Edward Krudy; Editing by Clive McKeef and Chizu Nomiyama)

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Well: For Athletes, Risks From Ibuprofen Use

Phys Ed

Gretchen Reynolds on the science of fitness.

Many active people use the painkiller ibuprofen on an almost daily basis. In surveys, up to 70 percent of distance runners and other endurance athletes report that they down the pills before every workout or competition, viewing the drug as a preemptive strike against muscle soreness.

But a valuable new study joins growing evidence that ibuprofen and similar anti-inflammatory painkillers taken before a workout don’t offer any benefit and may be causing disagreeable physical damage instead, particularly to the intestines.

Studies have already shown that strenuous exercise alone commonly results in a small amount of intestinal trauma. A representative experiment published last year found that cyclists who rode hard for an hour immediately developed elevated blood levels of a marker that indicates slight gastrointestinal leakage.

Physiologically, it makes sense that exercise would affect the intestines as it does, since, during prolonged exertion, digestion becomes a luxury, said Dr. Kim van Wijck, currently a surgical resident at Orbis Medical Center in the Netherlands, who led the small study. So the blood that normally would flow to the small intestine is instead diverted to laboring muscles. Starved of blood, some of the cells lining the intestines are traumatized and start to leak.

Thankfully, the damage seems to be short-lived, Dr. van Wijck said. Her research has shown that within an hour after a cyclist finished riding, the stressed intestines returned to normal.

But the most common side-effect of ibuprofen is gastrointestinal damage. And since many athletes take the drug for pain before and after a workout, Dr. van Wijck set out to determine the combined effect of exercise and ibuprofen.

For the new study, published in the December issue of Medicine & Science in Sports & Exercise, researchers at Maastricht University in the Netherlands recruited nine healthy, active men and had them visit the university’s human performance lab four times.

During two of the visits, the men rested languorously for an hour, although before one of the visits, they swallowed 400 milligrams of ibuprofen the night before and also the morning of their trip to the lab. (Four hundred milligrams is the recommended non-prescription dosage for adults using the drug to treat headaches or other minor pain.)

During the remaining visits, the men briskly rode stationary bicycles for that same hour. Before one of those rides, though, they again took 400 milligrams of ibuprofen the night before and the morning of their workout.

At the end of each rest or ride, researchers drew blood to check whether the men’s small intestines were leaking. Dr. van Wijck found that blood levels of a protein indicating intestinal leakage were, in fact, much higher when the men combined bike riding with ibuprofen than during the other experimental conditions when they rode or took ibuprofen alone. Notably, the protein levels remained elevated several hours after exercise and ibuprofen.

The health implications of this finding are not yet clear, although they are worrying, Dr. van Wijck said. It may be that if someone uses ibuprofen before every exercise session for a year or more, she said, “intestinal integrity might be compromised.” In that case, small amounts of bacteria and digestive enzymes could leak regularly into the bloodstream.

More immediately, if less graphically, the absorption of nutrients could be compromised, especially after exercise, Dr. van Wijck said, which could affect the ability of tired muscles to resupply themselves with fuel and regenerate.

The research looks specifically at prophylactic use of ibuprofen and does not address the risks and benefits of ibuprofen after an injury occurs. Short-term use of Ibuprofen for injury is generally considered appropriate.

Meanwhile, the Dutch study is not the first to find damage from combining exercise and ibuprofen. Earlier work has shown that frequent use of the drug before and during workouts also can lead to colonic seepage. In a famous study from a few years ago, researchers found that runners at the Western States 100-Mile Endurance Run who were regular ibuprofen users had small amounts of colonic bacteria in their bloodstream.

Ironically, this bacterial incursion resulted in “higher levels of systemic inflammation,” said David C. Nieman, a professor of health and exercise science at Appalachian State University who conducted the study and is himself an ultramarathoner. In other words, the ultramarathon racers who frequently used ibuprofen, an anti-inflammatory, wound up with higher overall levels of bodily inflammation. They also reported being just as sore after the race as runners who had not taken ibuprofen.

Animal studies have also shown that ibuprofen hampers the ability of muscles to rebuild themselves after exercise. So why do so many athletes continue enthusiastically to swallow large and frequent doses of ibuprofen and related anti-inflammatory painkillers, including aspirin, before and during exercise?

“The idea is just entrenched in the athletic community that ibuprofen will help you to train better and harder,” Dr. Nieman said. “But that belief is simply not true. There is no scientifically valid reason to use ibuprofen before exercise and many reasons to avoid it.”

Dr. van Wijck agrees. “We do not yet know what the long-term consequences are” of regularly mixing exercise and ibuprofen, she said. But it is clear that “ibuprofen consumption by athletes is not harmless and should be strongly discouraged.”

Read More..

Well: For Athletes, Risks From Ibuprofen Use

Phys Ed

Gretchen Reynolds on the science of fitness.

Many active people use the painkiller ibuprofen on an almost daily basis. In surveys, up to 70 percent of distance runners and other endurance athletes report that they down the pills before every workout or competition, viewing the drug as a preemptive strike against muscle soreness.

But a valuable new study joins growing evidence that ibuprofen and similar anti-inflammatory painkillers taken before a workout don’t offer any benefit and may be causing disagreeable physical damage instead, particularly to the intestines.

Studies have already shown that strenuous exercise alone commonly results in a small amount of intestinal trauma. A representative experiment published last year found that cyclists who rode hard for an hour immediately developed elevated blood levels of a marker that indicates slight gastrointestinal leakage.

Physiologically, it makes sense that exercise would affect the intestines as it does, since, during prolonged exertion, digestion becomes a luxury, said Dr. Kim van Wijck, currently a surgical resident at Orbis Medical Center in the Netherlands, who led the small study. So the blood that normally would flow to the small intestine is instead diverted to laboring muscles. Starved of blood, some of the cells lining the intestines are traumatized and start to leak.

Thankfully, the damage seems to be short-lived, Dr. van Wijck said. Her research has shown that within an hour after a cyclist finished riding, the stressed intestines returned to normal.

But the most common side-effect of ibuprofen is gastrointestinal damage. And since many athletes take the drug for pain before and after a workout, Dr. van Wijck set out to determine the combined effect of exercise and ibuprofen.

For the new study, published in the December issue of Medicine & Science in Sports & Exercise, researchers at Maastricht University in the Netherlands recruited nine healthy, active men and had them visit the university’s human performance lab four times.

During two of the visits, the men rested languorously for an hour, although before one of the visits, they swallowed 400 milligrams of ibuprofen the night before and also the morning of their trip to the lab. (Four hundred milligrams is the recommended non-prescription dosage for adults using the drug to treat headaches or other minor pain.)

During the remaining visits, the men briskly rode stationary bicycles for that same hour. Before one of those rides, though, they again took 400 milligrams of ibuprofen the night before and the morning of their workout.

At the end of each rest or ride, researchers drew blood to check whether the men’s small intestines were leaking. Dr. van Wijck found that blood levels of a protein indicating intestinal leakage were, in fact, much higher when the men combined bike riding with ibuprofen than during the other experimental conditions when they rode or took ibuprofen alone. Notably, the protein levels remained elevated several hours after exercise and ibuprofen.

The health implications of this finding are not yet clear, although they are worrying, Dr. van Wijck said. It may be that if someone uses ibuprofen before every exercise session for a year or more, she said, “intestinal integrity might be compromised.” In that case, small amounts of bacteria and digestive enzymes could leak regularly into the bloodstream.

More immediately, if less graphically, the absorption of nutrients could be compromised, especially after exercise, Dr. van Wijck said, which could affect the ability of tired muscles to resupply themselves with fuel and regenerate.

The research looks specifically at prophylactic use of ibuprofen and does not address the risks and benefits of ibuprofen after an injury occurs. Short-term use of Ibuprofen for injury is generally considered appropriate.

Meanwhile, the Dutch study is not the first to find damage from combining exercise and ibuprofen. Earlier work has shown that frequent use of the drug before and during workouts also can lead to colonic seepage. In a famous study from a few years ago, researchers found that runners at the Western States 100-Mile Endurance Run who were regular ibuprofen users had small amounts of colonic bacteria in their bloodstream.

Ironically, this bacterial incursion resulted in “higher levels of systemic inflammation,” said David C. Nieman, a professor of health and exercise science at Appalachian State University who conducted the study and is himself an ultramarathoner. In other words, the ultramarathon racers who frequently used ibuprofen, an anti-inflammatory, wound up with higher overall levels of bodily inflammation. They also reported being just as sore after the race as runners who had not taken ibuprofen.

Animal studies have also shown that ibuprofen hampers the ability of muscles to rebuild themselves after exercise. So why do so many athletes continue enthusiastically to swallow large and frequent doses of ibuprofen and related anti-inflammatory painkillers, including aspirin, before and during exercise?

“The idea is just entrenched in the athletic community that ibuprofen will help you to train better and harder,” Dr. Nieman said. “But that belief is simply not true. There is no scientifically valid reason to use ibuprofen before exercise and many reasons to avoid it.”

Dr. van Wijck agrees. “We do not yet know what the long-term consequences are” of regularly mixing exercise and ibuprofen, she said. But it is clear that “ibuprofen consumption by athletes is not harmless and should be strongly discouraged.”

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Gadgetwise Blog: No More Need to 'Tap and Swipe'

Part of the appeal of apps like Angry Birds and Cut the Rope is their simplicity. Just tap and swipe. But some of the more advanced app games require more complex finger maneuvers, making you wish you could use a physical controller.

Enter Discovery Bay Games, the maker of the new Duo Gamer game controller for Apple devices.

Duo Gamer connects wirelessly to an iPad or iPhone to play a range of adventure games from the app publisher Gameloft, including titles like Modern Combat 3: Fallen Nation and Asphalt 7: Heat.

Duo Gamer mimics the shape and size of video game controllers and has similar buttons, like a D-pad, triggers and left and right thumb sticks. It’s comfortable to hold, and the buttons are easy to use. It’s not designed for hours of gameplay, but most game apps don’t last that long anyway.

In the hands of a casual game player, the Duo Gamer controls are intuitive, especially if you already have experience using a controller. First-person shooter games like Modern Combat are much easier to play with Duo Gamer than they are using tap and swipe movements because you can focus on the game and forget about where your thumbs are. I had less success with the Asphalt racing game, which is more fun to play using the gyroscope in the iPad 2 to steer the cars.

Duo Gamer comes with an iPad stand, but no content of its own. At $80, it should include some free games, but you have to pay separately for the Gameloft apps. It would be great if Discovery Bay had partnerships with other app publishers as well. The more games that are available, the better Duo Gamer becomes.

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