Global Update: Meningitis Vaccine Gets Longer Window Without Refrigeration

In what may prove to be a major advance for Africa’s “meningitis belt,” regulatory authorities have decided that a new meningitis vaccine could be stored without refrigeration for up to four days.

The announcement was made last week at a conference in Atlanta of the American Society of Tropical Medicine and Hygiene. While a few days may seem trivial, the hardest part of protecting poor countries is often keeping a vaccine cold while moving it from electrified cities to villages with no power. In antipolio drives, for example, the freezers, generators and fuel needed to make ice for the shoulder bags of vaccinators can cost more than the vaccine.

The new vaccine, MenAfriVac, made in India for 50 cents a dose, was introduced in 2010. In bad years, epidemics during the hot harmattan winds have killed as many as 25,000 Africans and disabled 50,000 more. In Chad this year, vaccination drove down cases to near zero in districts where it was used, while others nearby had serious outbreaks.

Experts decided that the vaccine is safe for four days as long as it stays below 104 degrees.

While temperatures get higher than that in Africa, said Dr. Godwin Enwere, medical director for the Meningitis Vaccine Project, teams normally get the vaccine out of coolers at dawn, drive to villages and finish before the day heats up. Other experts said it should be kept in the shade and monitored with colored paper “dots” that darken after hours in the heat.

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Hostess, union mediation fails; Twinkies return to chopping block

Looks like it’ll be a bake sale after all. Hostess Brands Inc. said Tuesday afternoon that mediation efforts with the Bakery, Confectionery, Tobacco and Grain Millers Union were about as successful as a Twinkie without the cream filling.

That means the pastry maker will return to bankruptcy court in White Plains, N.Y., on Wednesday morning to argue its case for liquidating and selling off its assets.

The company “will have no further comment” until then, it said.

[Updated: 4:35 p.m. Nov. 20: The failed talks will likely be devastating news to legions of Americans who stockpiled Ding Dongs and Ho Ho’s over the weekend -- after Hostess first said Friday that it was shutting down -- then rejoiced when the company agreed Monday to attempt a reconciliation with its union.

Far worse off, however: the more than 18,000 workers who will lose their jobs as Irving, Texas-based Hostess close its operations. The brand was powered by hundreds of distribution centers, bakeries and outlets spread around the country, including in Southern California.

The company blamed a strike by BCTGM union members for its decision to close; workers who walked off their jobs accused Hostess of boosting executive pay while plundering worker benefits and slashing wages.

The mediation, suggested by Judge Robert Drain, may have been doomed from the start, according to experts. A line of potential buyers has formed in the last few days, among them Hurst Capital and, according to reports, Flowers Foods, Sun Capital Partners and Bimbo Group.]

ALSO:

Hostess shutdown sparks grief, Twinkie runs, criticism

Hostess, maker of Twinkies, to go out of business; strike cited

Twinkies hope? Hostess puts off liquidation, agrees to mediation

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An ethics debate over embryos on the cheap

Dr. Ernest Zeringue was looking for a niche in the cutthroat industry of fertility treatments.

He seized on price, a huge obstacle for many patients, and in late 2010 began advertising a deal at his Davis, Calif., clinic unheard of anywhere else: Pregnancy for $9,800 or your money back.

That's about half the price for in vitro fertilization at many other clinics, which do not include money-back guarantees. Typically, insurance coverage is limited and patients pay again and again until they give birth — or give up.

Those patients use their own eggs and sperm — or carefully select donors when necessary — and the two are combined in a petri dish to create a batch of embryos. Usually one or two are then transferred to the womb. Any embryos left over are the property of the customers.

Zeringue sharply cuts costs by creating a single batch of embryos from one egg donor and one sperm donor, then divvying it up among several patients. The clinic, not the customer, controls the embryos, typically making babies for three or four patients while paying just once for the donors and the laboratory work.

People buying this option from Zeringue must accept concessions: They have no genetic connection to their children, and those children will probably have full biological siblings born to other parents.

Inside the industry, Zeringue's strategy for making embryos on the cheap has spurred debate about the ethical boundaries of creating life.

"I am horrified by the thought of this," said Andrew Vorzimer, a Los Angeles fertility lawyer alarmed that a company — not would-be parents — controls embryos. "It is nothing short of the commodification of children."

Other experts say they see no problem with the arrangement, although the business model and the issues it raises are to be discussed at a meeting in January of the ethics committee of the American Society for Reproductive Medicine.

Zeringue said the concerns are overblown.

Most of his customers have run out of money and patience by the time they come to his clinic, he said: "They're kind of at the end of the line."

::

Natosha Dukart and her husband, Brad, an oil field worker, spent more than $100,000 without producing a child. They ran up credit cards, flipped houses and moved four times to help finance round after round of IVF.

It was never clear if the problem was her eggs or his sperm.

After eight unsuccessful attempts, Natosha took to the Internet and found Zeringue's clinic, California IVF: Davis Fertility Center Inc., and its embryo program, California Conceptions. With no financial risk, there was nothing to lose.

"It was an easy choice," Natosha said.

She sent their photographs to the clinic and filled out a form saying they wanted a Caucasian baby. Two months later, they received a profile of an embryo the clinic had frozen in storage. Both donors had brown eyes and healthy family histories.

The Dukarts liked the description and this February traveled from their home near Calgary to Davis in an attempt to get Natosha pregnant.

"It was just as emotional as it was with our own embryos," she said.

Last month, at age 39, she gave birth to a healthy 7-pound girl with blue eyes and dark hair. The couple named her Milauna.

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Wranglers say 'Hobbit' animals died on unsafe farm

WELLINGTON, New Zealand (AP) — Animal wranglers involved in the making of "The Hobbit" movie trilogy say the production company is responsible for the deaths of up to 27 animals, largely because they were kept at a farm filled with bluffs, sinkholes and other "death traps."

The American Humane Association, which is overseeing animal welfare on the films, says no animals were harmed during the actual filming. But it also says the wranglers' complaints highlight shortcomings in its oversight system, which monitors film sets but not the facilities where the animals are housed and trained.

A spokesman for trilogy director Peter Jackson on Monday acknowledged that horses, goats, chickens and one sheep died at the farm near Wellington where about 150 animals were housed for the movies, but he said some of the deaths were from natural causes.

The spokesman, Matt Dravitzki, agreed that the deaths of two horses were avoidable, and said the production company moved quickly to improve conditions after they died.

"The Hobbit: An Unexpected Journey," the first movie in the planned $500 million trilogy, is scheduled to launch with a red-carpet premiere Nov. 28 in Wellington and will open at theaters in the U.S. and around the world in December.

The animal rights group People for the Ethical Treatment of Animals (PETA) says it's planning protests at the premieres in New Zealand, the U.S. and the U.K.

Kathy Guillermo, a senior vice president at PETA, said whistleblowers on The Hobbit contacted the organization after it had taken an active role in exposing problems on other movie sets. The organization sent a letter to Jackson last week outlining its concerns.

"We want to send a clear message to Hollywood that they need to be very careful when using animals and take all the precautions that need to be taken," Guillermo said.

The Associated Press spoke to four wranglers who said the farm near Wellington was unsuitable for horses because it was peppered with bluffs, sinkholes and broken-down fencing. They said they repeatedly raised concerns about the farm with their superiors and the production company, owned by Warner Bros., but it continued to be used. They say they want their story aired publicly now to prevent similar deaths in the future.

One wrangler said that over time he buried three horses, as well as about six goats, six sheep and a dozen chickens. The wranglers say two more horses suffered severe injuries but survived.

Wrangler Chris Langridge said he was hired as a horse trainer in November 2010, overseeing 50 or so horses, but immediately became concerned that the farm was full of "death traps." He said he tried to fill in some of the sinkholes, made by underground streams, and even brought in his own fences to keep the horses away from the most dangerous areas. Ultimately, he said, it was an impossible task.

He said horses run at speeds of up to 30 mph and need to be housed on flat land: "It's just a no-brainer."

The first horse to die, he said, was a miniature named Rainbow.

"When I arrived at work in the morning, the pony was still alive but his back was broken. He'd come off a bank at speed and crash-landed," Langridge said. "He was in a bad state."

Rainbow, who had been slated for use as a hobbit horse, was euthanized. A week later, a horse named Doofus got caught in some fencing and sliced open its leg. That horse survived, but Langridge said he'd had enough.

He and his wife, Lynn, who was also working as a wrangler, said they quit in February 2011. The following month, they wrote an email to Brigitte Yorke, the Hobbit trilogy's unit production manager, outlining their concerns.

Chris Langridge said he responded to Yorke's request for more information but never received a reply after that.

Wrangler Johnny Smythe said that soon after Langridge left, a horse named Claire was found dead, its head submerged in a stream after it fell over a bluff. After that, he said, the horses were put in stables, where a third horse died.

Smythe said no autopsy was performed on the horse, which was named Zeppelin. Veterinary records say the horse died of natural causes, from a burst blood vessel, but Smythe said the horse was bloated and its intestines were full of a yellow liquid; he believes it died of digestive problems caused by new feed.

Smythe said the six goats and six sheep he buried died after falling into sinkholes, contracting worms or getting new feed after the grass was eaten. He said the chickens were often left out of their enclosure and that a dozen were mauled to death by dogs on two separate occasions.

Smythe said he was fired in October 2011 after arguing with his boss about the treatment of the animals.

A fourth wrangler, who didn't want to be named because she feared it could jeopardize her future employment in the industry, said another horse, Molly, got caught in a fence and ripped her leg open, suffering permanent injuries.

Dravitzki, the spokesman for Peter Jackson, said the production company reacted swiftly after the first two horses died, spending hundreds of thousands of dollars upgrading housing and stable facilities in early 2011.

"We do know those deaths were avoidable and we took steps to make sure it didn't happen again," he said.

Dravitzki said Zeppelin died of a burst blood vessel and that he knew only of three goats, one sheep and about eight chickens that had died aside from that. He said two of the goats died in a cold snap but the third, like the sheep, was old and had likely died of natural causes. He said the chicken maulings were the result of careless staff oversight.

The American Humane Association said in its report on "An Unexpected Journey" that it investigated the farm at the production company's request. Dravitzki said the company contacted the AHA after Smythe alleged mistreatment of animals.

Mark Stubis, an association spokesman, said it investigated the farm in August 2011, months after the first deaths.

"We made safety recommendations to the animals' living areas. The production company followed our recommendations and upgraded fence and farm housing, among other things," the group said.

Dravitzki said the company had already made many of the recommended changes by the time the AHA made them.

Stubis said the association acknowledges that what happens off-set remains a blind spot in its oversight.

"We would love to be able to monitor the training of animals and the housing of animals," Stubis said. "It's something we are looking into. We want to make sure the animals are treated well all the time."

Dravitzki questioned the timing of the allegations with the premiere so close but said the producers are investigating all the claims "and are attempting to speak with all parties involved to establish the truth."

He said the company no longer leases the farm and has no animals left on the property. He said he didn't know if animals will be needed for future filming in the trilogy, but added that Jackson himself adopted three of the pigs used.

Hollywood has made animal welfare a stated priority for years.

In March, HBO canceled the horse racing series "Luck" after three thoroughbred horses died during production. The network said it canceled the show because it could not guarantee against future accidents.

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Really?: The Claim: Eye Problems Can Cause Headaches in Children

Really?

Anahad O’Connor tackles health myths.

THE FACTS When a child complains of frequent headaches, many pediatricians order an eye exam. “In some pediatric ophthalmology practices, it’s a daily occurrence,” said Dr. Zachary Roth, a resident in ophthalmology at Albany Medical Center in New York.

Often, a child may experience headaches while reading or doing schoolwork, leading parents to think the child needs glasses. But are eye problems really a cause of childhood headaches?

In a recent study, Dr. Roth and his colleagues examined 158 children under age 18 who were referred to ophthalmologists for frequent headaches. Then, they evaluated the children’s medical records and looked at the results of earlier vision exams.

Ultimately, the researchers could not find any significant link between headaches and diagnoses of vision problems. In three-quarters of the subjects, the headaches went away over time, both in those who received new glasses and those who did not.

The study, which was presented at a recent American Academy of Ophthalmology conference, was not designed to look for causes of the headaches. But there were “quite a few” children with family histories of migraine, Dr. Roth said. Sinus problems and stress headaches also appeared to be common issues, he added.

“I think the take-away message is that it’s very unlikely for headaches to be caused by an eye problem,” he said. “The experience of all the ophthalmologists we talked to is that it almost never seems to be related to the eyes, so it’s probably more fruitful to investigate other causes.”

THE BOTTOM LINE Vision problems are often blamed for childhood headaches, but in reality, the two are rarely related.

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Dow gains 207 in best day since election

The stock market finally shook its post-election slump.

Investors seized on hope that Washington will reach a deal on the federal budget and drove stocks to their biggest gain in two months. A pair of strong corporate earnings reports also helped.

The Dow Jones industrial average closed up 207 points, or 1.7 percent. Since President Barack Obama and a divided Congress were returned to power Nov. 6, the Dow had fallen six out of eight days and slid a total of 650 points.

Obama and congressional leaders are in talks to avoid going over a “fiscal cliff” on Jan. 1, when tax increases and mandatory government spending cuts are set to take effect.

While Obama and Republicans appear at odds on whether tax rates for the wealthiest Americans should rise, lawmakers suggested over the weekend that progress is possible.

“I can tell you that the fiscal cliff is focusing the mind,” said Illinois Sen. Richard Durbin, a Democrat, said on CNN's “State of the Union.” He said he had heard from Republicans “the beginning of a negotiation.”

Comments like those comforted investors, who are grasping for signs that the negotiations might go somewhere.

“It is quite clear that both sides want to come to a compromise and that a reasonable compromise is available,” David Kelly, chief global strategist for J.P. Morgan Funds, wrote in a note to clients.

Other financial analysts noted that there have been few substantive developments to drive the market's swings, and suggested the market's surge will be short-lived.

“I don't think anything has changed. It's just the talk from day to day,” said Stephen Carl, principal and head equity trader at The Williams Capital Group, an investment bank. “We'll see what happens tomorrow.”

This week's market will be tougher to decipher, Carl said, because volume is increasingly light leading up to the Thanksgiving holiday. Big price swings are more likely when there are fewer buyers and sellers in the market.

The Standard & Poor's 500 index rose 27.01 points, or 2 percent, to 1,386.89. The Nasdaq composite average gained 62.94, or 2.2 percent, to 2,916.07.

The S&P 500 and Nasdaq were lifted by Apple, which had its biggest one-day gain since April. It rose $38.05, or 7.2 percent, to $565.73. Some analysts cast doubt on a sell-off that had pushed the stock down more than 20 percent from its recent peak.

Corporate earnings reports also boosted the indexes. Lowe's said its third-quarter profit surged 76 percent. That followed a strong report from Home Depot last week. Lowe's rose $1.98, or 6.2 percent, to $33.96.

Tyson Foods, the country's biggest meat company, beat analysts' expectations for its quarterly earnings. Tyson added $1.84, or 10.9 percent, to $18.72.

Materials stocks, a category that includes foresting companies, metal producers and miners, soared, supported by the latest sign that a recovery in the housing market has stabilized.

The National Association of Realtors said sales of previously occupied homes in the U.S. rose in October, helped by a stronger job market and record-low mortgage rates. The pace of sales is roughly 11 percent higher than a year ago.

Stocks fell in each of the past four weeks as traders fretted about the possibility that lawmakers will fail to prevent the spending cuts and tax increases from taking effect.

Economists have warned that the hit to the economy could total $700 billion for 2013 and push the United States back into recession, although the damage from the “cliff” would come slowly, and lawmakers could always reach a deal after Jan. 1.

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Feinstein has 'concern' about Rice's Benghazi talking points

Sen. Dianne Feinstein said Sunday that she has initiated a review of talking points used by U.N. Ambassador Susan Rice on the attack on the American diplomatic facility in Libya, with the goal of determining why the public comments appeared to conflict with the initial assessment of U.S. intelligence sources.

Feinstein, chair of the Senate Intelligence Committee, defended Rice against what she called the “politicization” of her comments on the battery of Sunday news shows in the wake of the Sept. 11 attack that led to the death of four Americans, including Ambassador Chris Stevens.

But the California senator also said she had “some concern” with the process that produced the unclassified “speaking points” that Rice worked off of, in which she said it was the administration’s preliminary view that the attacks were a spontaneous reaction to an anti-Islamic video, rather than a planned terrorist attack.

Feinstein, appearing on NBC’s “Meet the Press,” said that the now-former director of the Central Intelligence Agency, David H. Petraeus, had “very clearly said that it was a terrorist attack” in a meeting with lawmakers the day after the attack in Benghazi.

PHOTOS: U.S. ambassador killed in Libya

Asked then why Rice would not call the attack "terrorism" days later, Feinstein said it was because Petraeus’ view was based on information that was not yet cleared for public review.

“She could speak publicly only on unclassified speaking points. I have some concern with those speaking points,” Feinstein said. “We gave the direction yesterday that this whole process is going to be checked out. We are going to find out who made changes in the original statement. Until we do, I really think it's unwarranted to make accusations.”

Rep. Mike Rogers (R-Mich.), chair of the House Intelligence Committee, stopped short of saying information was withheld from initial talking points for political reasons.

Still, he said, “I know the narrative was wrong, and the intelligence was right.”

“The narrative, as it went from at least the CIA and other intelligence agencies, was accurate,” he said. “There were some policy decisions made based on the narrative that was not consistent with the intelligence that we had. That's my concern, and we need to say hey, we need to figure out how that happened.”

The episode involving Rice’s testimony on the Sept. 14 news shows is at the heart of Republicans’ questioning the administration’s handling of the Benghazi attack. More recently, it has become the basis for some lawmakers vowing to block the potential nomination of Rice to replace Hillary Rodham Clinton as secretary of State in President Obama’s second term.

Feinstein said it was not right for Rice to be “pilloried” for comments that were consistent with the approved statement she was given to speak off of. Sen. Lindsay Graham (R-S.C.) said that in considering a possible Rice nomination he was “not going to give her a plus for passing on a narrative that was misleading to the American people.”

PHOTOS: 2016 presidential possibilities

“I am very disappointed in Susan Rice … telling a story that was disconnected from reality that did make the president look good at a time when, quite frankly, the narrative should have been challenged not reinforced that Al Qaeda was dismantled,” he said.

Rep. Peter King (R-N.Y.) said that before appearing on the television shows, Rice should have had a fuller understanding of events.

“She certainly could have gotten the classified briefings. She would have sat down with the National Security Council, and she would have known that those talking points had been watered down, and she could have caveated that in her statement, which she didn't,” King said on ABC’s “This Week.” “President Obama said, don't blame Susan Rice because she had nothing to do with Benghazi. Then why did they send her out as the representative to the American people?”

Sen. John McCain (R-Ariz.) said on CBS’ “Face the Nation” that Rice has “a lot of explaining to do,” and should explain her comments if she is nominated.

“They said they wanted to not give classified assessment of what happened because they didn’t want to betray sources. Well if the classified assessment changed the unclassified assessment, then why in the world would you keep that information from the American people,” McCain said.

Sen. Dick Durbin (D-Ill.), a member of the Foreign Relations Committee, said it would be “totally unfair” to hold Rice responsible for simply relaying information she was given. He also accused McCain and Graham of hypocrisy for using the incident to potentially block a Rice nomination.

“Eight years ago when President Bush suggested Condoleezza Rice for secretary of State, some people said, ‘Well wait a minute, wasn’t she part of misleading the American people about intelligence information that led to our invasion of Iraq?’ And it was Sen. McCain and Sen. Graham who stood up and said, ‘Don’t hold her accountable for the intelligence that was given to her,’” Durbin said.

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michael.memoli@latimes.com

Twitter: @mikememoli

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Singing stars arrive for American Music Awards

Pink on a song with Lauryn Hill? The pop star hopes so.

Pink said on the red carpet of the American Music Awards that she'd like to collaborate with the acclaimed singer-rapper.

Cyndi Lauper said her musical playlist includes Pink, Nicki Minaj and Carly Rae Jepsen's "Call Me Maybe." Boy band The Wanted is excited to see "Gangnam Style" star PSY and Colbie Caillat wants to watch No Doubt rock the stage.

The stars walking the red carpet before the AMAs were ready to take their seats as fans. Arrivals included Taylor Swift, 50 Cent, Gloria Estefan, Ludacris, Kelly Rowland, Lady Antebellum, J. Cole, Luke Bryan, the Backstreet Boys and Linkin Park.

"What makes the American Music Awards special is the fans choose the winning artists," said Chester Bennington of Linkin Park, who is nominated for favorite artist alternative rock and will perform at the show.

Carrie Underwood arrived in a magenta dress and Kerry Washington was in a banana Stella McCartney number Sunday. Heidi Klum and Ginnifer Goodwin were also on the scene.

Along with Rihanna, Minaj is the top nominee at Sunday's American Music Awards, but the rapper-singer isn't concerned with her four nominations.

"I don't do music for awards," the 29-year-old said in an interview. "It's so crazy because people always have to remind me that I'm nominated for an award when I go to award shows."

"I know they're going to come. I'm sitting here looking at my awards right now," she continued with a laugh. "I never stress it. I think of myself as 'I'll have a career long enough to get all those different awards.'"

In the pop/rock category, Minaj is up for favorite female artist and album for "Pink Friday: Roman Reloaded." She's also nominated for favorite artist and album in the hip-hop/rap category, two awards she won last year.

Minaj isn't up for the night's top award, though. Rihanna, Maroon 5, Drake, Katy Perry and Justin Bieber will battle it out for artist of the year.

But the American Music Awards are all about performances, and Sunday's show will be no exception. Taylor Swift and Carrie Underwood will perform. Justin Bieber will share the stage with Minaj. Ludacris and Chris Brown will perform with Swizz Beatz. And Stevie Wonder is set to provide the soundtrack for a tribute to the late Dick Clark.

"I'm really going there to perform 'Freedom,'" Minaj said of her new single. "I'm very, very proud of the record and I'm happy that people are going to get to hear it. I'm performing a hip-hop song on the AMAs, and I think . that's just a big look for hip-hop."

Rae Jepsen, Kelly Clarkson and Usher are also among those set to sing during the three-hour program, which is to be broadcast live on ABC.

Other multiple nominees include Usher, Bieber, Drake, Maroon 5 and One Direction, who have three nods each. Perry, Underwood, Brown, Clarkson, Pitbull, fun., Gotye, J. Cole and Luke Bryan are all double nominees.

American Music Awards nominees were selected based on sales and airplay, and fans chose the winners by voting online.

The 40th anniversary show will also include the tribute to Clark, its creator.

"Dick changed the face of music back in the late '50s," producer Larry Klein said. "Dick is the one who made rock 'n' roll acceptable to come into people's homes... We're paying tribute to Dick because of the legacy that he's left everybody and also the creativity of what he did on this show."

___

AP Entertainment Writer Sandy Cohen contributed to this report from Los Angeles. Follow (at)APSandy's American Music Award updates at www.twitter.com/APEntertainment.

___

Online:

http://beta.abc.go.com/shows/american-music-awards

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News Analysis: Steroids and Back Pain: An Uneasy Match

RANDALL KINNAIRD’S legal clients had steroids injected into their backs last summer for a wide range of reasons. Of the 25, one got three shots in a two-month period when pain never totally disappeared. Another got one as a preventive measure because she was going on a trip to Europe and was worried that cobblestones would aggravate an old injury.

Now the 25 — or their survivors — have engaged Mr. Kinnaird, one of Nashville’s leading lawyers, to sue the New England Compounding Center. Three have died, one is paralyzed, several more are still hospitalized and all suffer blinding headaches — victims of the meningitis that resulted from vials of steroid medicine contaminated by fungus.

The New England Compounding Center certainly seems deserving of its current status as the prime culprit in a tragic outbreak that has killed 32 and sickened 438. The bottles of supposedly sterile steroid medication it shipped were reportedly so tainted that white fuzz could be seen floating in some vials.

But, experts say, the now notorious Compounding Center has a nationwide network of unwitting enablers and accomplices: There are the doctors who overprescribe an invasive back-pain therapy that, in studies, has not proved useful for many of the patients who get it. And there are the patients, living in an increasingly medicalized society, who want a quick fix for life’s aches and pains.

The use of steroid injections to treat back pain has skyrocketed in the past 15 years — out of proportion to growth in the number of patients with back pain, or the aging of the population. The frequency of steroid injections dispensed to Medicare patients rose 121 percent from 1997 to 2006. Washington State found that the use of back injections grew 12.6 percent between 2006 and 2009, at a cost to the state of $56 million. Some people received more than 10 shots a year.

The increase in treatment has not led to less pain over all, researchers say, and is a huge expense at a time of runaway health costs. “There are lots of places doing lots of injections for conditions that haven’t been shown to benefit,” says Dr. Janna Friedly, a researcher at the University of Washington, who added, “Sadly, some of the patients who got meningitis were probably in that category — they did not have conditions where steroid injections were indicated.”

Studies are at best inconclusive about exactly which groups of back-pain patients are likely to benefit from steroid shots. Though some patients clearly get much-needed relief, health researchers are nearly unanimous that the treatment is vastly overused in the United States.

But Dr. Laxmaiah Manchikanti, head of the American Society of Interventional Pain Physicians, said the increasing number of spine injections was just part of “an exponential increase in all interventional techniques” and is a good thing, reflecting a better understanding of chronic pain and patients’ demands for improved pain relief.

Though doctors are still arguing, most academic researchers say there is no evidence that steroid injections are useful in easing straightforward chronic low back pain. Professional guidelines say such shots should generally not be used for back pain that is less than four to six weeks old, which studies show almost always gets better with noninvasive treatments. Although many Medicare patients get spinal injections to treat a condition called spinal stenosis, a narrowing of spaces between bones of the spine, Dr. Friedly said, shots are not used for that condition in many European countries.

Spinal injections, which can cost between $600 and $2,500, including the fees for treatment rooms, have been fostered and promoted by the rising number of pain clinics and pain specialists — mostly anesthesiologists and rehab doctors — who invest in extra training to learn procedures like spinal injections.

“There used to be only a small number of people who did this, but that’s gone way up, and reimbursement has gone up, too,” says Scott Forseen, a doctor who studies the treatment of back pain at the Georgia Health Sciences University. The number of spinal injections given in any geographical area correlates better with the number of local specialists trained in the procedure rather than the amount of back pain, Dr. Friedly says. There is an old saying in medicine: “When you go to Midas, you get a muffler.”

The shots — which may include a steroid and an anesthetic — are often dispensed at for-profit pain clinics owned by the physicians holding the needle. “There’s a lot of concern about perverse financial incentive,” Dr. Friedly added.

Mr. Kinnaird’s clients got their injections at the St. Thomas Outpatient Neurosurgery Clinic, a limited-liability corporation half owned by doctors, which occupied a floor of one of Nashville’s major hospitals. It gave 5,000 injections a year, or about 20 each business day, and epidural steroid injections are listed on its Web site as its “top procedure.”

Since guidelines for injections are being disputed among doctors’ groups, it is hard in most cases to say if a particular patient should or should not have been offered an injection, says Marc Lipton, a Michigan attorney who is representing more that 20 patients with fungal meningitis. Though he believes that steroid shots are overused, he says many of the patients he represents were treated appropriately, for example, receiving an injection for pain from a herniated disc in an attempt to stave off back surgery. He and other lawyers are, for now, targeting the Compounding Center in product liability lawsuits.

But, says Dr. Forseen: “You have to use injections selectively, and selectivity has gone way down. In some places, people get injections because they’ve walked in the door.”

Patients have proved eager consumers of the new medical offering, desirous of a quick cure rather than waiting the weeks or months for the normal healing process to occur.

Mr. Kinnaird, the lawyer, says: “If I hurt my back in the ’70s, my doctor would say, go to the beach, get a few beers, relax, you’ll be fine. Now if you hurt your back, you go to the doctor and right away there’s an M.R.I., and they need to fix something. Maybe you should take an injection.”

And steroid shots are not a cure-all, even for the conditions for which doctors agree an attempt is worthwhile: low back pain accompanied by signs of nerve injury like tingling or weakness in a leg. One-third of such patients will get better, one-third will show some improvement and some will show no improvement at all, Dr. Forseen said.

When Oregon’s Health Evidence Review Commission earlier this year explored narrowing reimbursement for injections to certain conditions, it got an earful of public comment from groups like the International Spine Intervention Society.

“Obviously they are not utilizing the literature correctly,” said Dr. Manchikanti, adding that attempts to limit the shots were motivated in part by an effort to control costs and by competition from other medical specialties.

Private insurers vary considerably in coverage for the procedure, though some will pay after two weeks of back pain.

Back pain is, of course, a debilitating condition. And modern medicine has produced some miraculous cures. But from now on when doctors and patients are tempted to say “what’s the harm in trying an injection” to dispense with a nagging back — they will be more aware of just how big the risk can be.

A physician and a reporter for The New York Times.

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A John Lautner-designed home in L.A.

Known for his forward-thinking engineering, architect John Lautner designed the Foster Carling house with a retractable wall of glass separating the outdoor part of the swimming pool from an interior portion in the living room. External steel beams support the hexagonal living space, which is free of internal columns.

Location: 7144 Hockey Trail, Los Angeles 90068

Asking price: $2.995 million

Year built: 1950

House size: Two bedrooms, two bathrooms, 1,999 square feet

Lot size: 16,002 square feet

Features: Redwood planking, raised fireplace, polished concrete floors, built-in furniture, bar, basement, alarm system, carport, skyline views.

About the area: In the third quarter, 86 single-family homes sold in the 90068 ZIP Code at a median price of $930,000, according to DataQuick. That was a 3.8% price increase from the third quarter last year.

Agent: John Galich, Rodeo Realty, (310) 461-0468

—Lauren Beale

To submit a candidate for Home of the Week, send high-resolution color photos on a CD, written permission from the photographer to publish the images and a description of the house to Lauren Beale, Business, Los Angeles Times, 202 W. 1st St., Los Angeles, CA 90012. Send questions to homeoftheweek@latimes.com.

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