Fear is potent risk of Japanese nuclear crisis

When it comes to the nuclear power disaster unfolding in Japan, there is far more to fear than fear itself. But fear is one of the biggest - and could turn out to be the most potent - dangers.

Although radiation escaping from a nuclear power plant catastrophe can increase the risk of many cancers and other health problems, stress, anxiety and fear ended up in many ways being much greater long-term threats to health and well-being after Chernobyl, Three Mile Island and other nuclear accidents, experts said Monday.

"The psychological effects were the biggest health effects of all - by far," said Fred Mettler, a University of New Mexico professor emeritus and one of the world's leading authorities on radiation, who studied Chernobyl for the World Health Organization. "In the end, that's really what affected the most people."

Fears of contamination and anxiety about the health of those exposed and their children led to significantly elevated rates of suicidal thinking and anxiety disorders, and rates of post-traumatic stress disorder and depression about doubled, Mettler and others said.

"The effect on mental health was hugely important," said Evelyn Bromet, a professor of psychiatry at Stony Brook University who studied the aftermath of Three Mile Island and Chernobyl. "People's fears about getting cancer, or their children getting cancer, and family and friends dying from radiation exposure were very intense."

In the unprecedented disaster in Japan, where an earthquake triggered a tsunami that was followed by a major nuclear power plant emergency, all those negative psychological effects are being magnified in ways that no one can predict.

"You can imagine: There was an earthquake, and I survived that. And then here comes a tsunami, and I survived that. And then comes a nuclear reactor," said Mettler, the U.S. representative to the United Nations who studied Chernobyl. "With that kind of triple whammy, you can only imagine someone is going to be saying, 'What did I do? What's wrong with me?' "

Survivors of the bombings at Nagasaki and Hiroshima in 1945, Chernobyl and other nuclear accidents in Japan and Brazil were stigmatized by their societies, which caused discrimination that intensified emotional distress.

"After almost every radiological emergency, anyone or anything seen as or perceived as associated with the emergency came to be seen by others as tainted or something to be feared and even the object of discrimination," said Steven Becker of the University of Alabama at Birmingham.

Such stigmatization can interfere with victims receiving care and recovering from the event, said Becker, who studied the psychological and social impact of a much less severe nuclear accident in 1999 in Tokaimura, Japan. In that case, people in other parts of Japan refused to buy products from that region, and travelers were turned away from hotels and asked not to use public baths and swimming pools. Similar discrimination occurred after a 1987 radiation exposure event in Goiania, Brazil.

In the long run, such incidents can negatively transform entire cultures. In the areas affected by the 1986 Chernobyl accident, a crippling sense of hopelessness set in and was passed down through generations.

"What we know from experience is the psychological footprint from a nuclear disaster can not only be massive but in many ways greater than the effect of radiation," Becker said. "On an individual level, these range all the way from anxiety disorders, depression and substance abuse to a kind of culture of fatalism and hopelessness that has gripped the population in many areas, and it continues today, decades later."

Among all the threats humans face today, radiation consistently ranks near the top of the list of what people fear and the emotional reaction it produces.

"As soon as we hear anything about 'nuclear,' our brain goes very quickly looking for danger and says, 'Alert?' " said David Ropeik, an instructor at Harvard University who studies risk perception and wrote "How Risky Is It, Really? Why Our Fears Don't Always Match the Facts." "That's just how we do it psychologically."

There are many reasons why humans fear radiation so intensely. One reason is because radiation is silent, invisible and odorless. Another is because radiation is associated with cancer, which itself is one of the most feared words. Another reason is that in accidents, as opposed to medical treatments, exposure to radiation is involuntary. Other reasons are the searing images of victims of Nagasaki and Hiroshima, a generation raised fearing Cold War-mushroom-cloud annihilation and the way radiation is portrayed by popular culture.

"In the movies and in comic books, people getting exposed to radiation turn into monsters," said John Boice Jr., a radiation expert at the International Epidemiology Unit in Rockville.

In fact, radiation is a far less potent carcinogen than other toxic substances. Studies of more than 80,000 survivors of the Hiroshima and Nagasaki blasts have found that about 9,000 people subsequently died of some form of cancer. But only about 500 of those cases could be attributed to the radiation exposure the people experienced.

The average amount of radiation that victims in Hiroshima and Nagasaki were exposed to would increase the risk of dying from lung cancer by about 40 percent, Boice said. Smoking a pack of cigarettes a day increases the risk of dying of lung cancer by about 400 percent.

"Radiation is a universal carcinogen, but it's a very weak carcinogen compared to other carcinogens," Boice said. "Even when you are exposed, it's very unlikely you will get an adverse effect. But fear of radiation is very strong."

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Wisconsin's health-care fight illustrates challenges as states change leadership

MADISON, WIS. - Two weeks after President Obama signed the nation's health-care overhaul into law, then-Wisconsin Gov. Jim Doyle (D) issued an executive order creating an Office of Health Care Reform.

Over the next eight months, the Badger State made more headway than virtually anywhere else in the country at preparing to carry the statute out. It designed - and presented at the White House - the country's only prototype for how people and small businesses could navigate a new health insurance marketplace online. It produced a 205-page blueprint envisioning that marketplace as a "transformative force," steering people toward care of high quality and low cost.

Then, in late January, Doyle's Republican successor, Scott Walker, issued his own executive order, dissolving the health reform office and replacing it with the Office of Free Market Health Care.

"We view this as a fundamentally different approach than what the past [Wisconsin] administration was doing - and what . . . the Obama administration is pushing," Walker said in the first interview he has given about health-care reform since assuming office.

Wisconsin's U-turn, as sharp as anywhere in the country, illustrates how the views of state leaders are shaping the way the health-care overhaul envisioned by Congress will work on the ground. It illustrates, too, the treacherous terrain the Obama administration and congressional Democrats are walking by entrusting states to carry out major parts of the plan now that 29 governors are Republicans, including 18 who - like Walker - have taken office this winter. In Wisconsin, as in five other states, both chambers of the legislature also have just switched to GOP control.

"We've gone from one kind of boldness to another," said Robert Kraig, executive director of Citizen Action of Wisconsin and a leading liberal activist on health care in this university town with its granite-domed state Capitol.

But being dead set against the health law is not proving to be a simple matter of saying no to everything it contains. The new opposition is subtler but no less profound - a process of picking and choosing provisions to embrace or reject, of taking some grants offered by the federal government while spurning others, of striving to kill the law in Congress or the courts while preparing a conservative alternative.

Walker, best known for his effort to demolish rights to collective bargaining for government employees, thinks that the health-care statute is unconstitutional and that the government has no business influencing people's health-care choices. Doyle's aides estimated that the law would save Wisconsin $850 million by the end of the decade; Walker's estimate that it would cost $433 million.

Where Wisconsin is coming from

With states required by 2014 to carry out the law's core features - among them, widening access to private and public insurance - Wisconsin is in a more auspicious starting place than most. Just 6 percent of its residents lack health coverage, the second-lowest proportion in the country. And over the years, Wisconsin repeatedly has expanded Medicaid, called BadgerCare here, so that an unusually large share of people already has public insurance.

Those distinctions are part of the Walker administration's justification for resisting federal requirements. "Wisconsin . . . already has accomplished much of what [the law] aspires to do," said Dennis G. Smith, the new secretary of the state's Department of Health Services.

Smith, the driving force behind Wisconsin's about-face, arrived from Washington in January with a reputation as a mild-mannered, highly conservative thinker on health policy. Under President George W. Bush, he was in charge of Medicaid at the U.S. Department of Health and Human Services. More recently, he was at the Heritage Foundation, writing criticisms of the new federal law. He said in an interview that he did not have ties to Wisconsin or know Walker before mutual acquaintances, including Rep. Paul Ryan (R-Wis.), chairman of the House Budget Committee, suggested to both men that they should talk.

In a primary example of obeying the law selectively, Walker and Smith said they will create, as the statute envisions, one or more marketplaces called exchanges to help individuals and small businesses buy insurance. But the exchanges will not do everything the law says. "We believe it's got to be free-market driven, not government driven," Walker said.

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Report reveals steep increase in war amputations last fall

The majority of American soldiers undergoing amputation for war wounds last fall lost more than one limb, according to data presented Tuesday to the Defense Health Board, a committee of experts that advises the Defense Department on medical matters.

Military officials had previously released data showing that amputations, and especially multiple-limb losses, increased last year. The information presented to the 20-member board is the first evidence that the steepest increase occurred over the last four months of the year.

In September 2010, about two-thirds of all war-theater amputation operations involved a single limb (usually a leg) and one-third two or more limbs. The split was roughly 50-50 in October and November. In December, only one-quarter of amputation surgery involved only one limb; three-quarters involved the loss of two or more limbs.

The Marines, who make up 20 percent of the forces in Iraq and Afghanistan, were especially hard hit. Of the 66 wounded severely enough to be evacuated overseas in October, one-third lost a limb.

In the first seven years of the Iraq and Afghanistan wars, about 6 percent of seriously wounded soldiers underwent amputation.

Wounds to the genitals and lower urinary tract - known as genitourinary injuries - accounted for 11 percent of wounds over the last seven months of 2010, up from 4 percent in the previous 17 months, according to data presented by John B. Holcomb, a trauma surgeon and retired Army colonel.

The constellation of leg-and-genital wounds are in large part the consequence of stepping on improvised explosive devices - homemade mines - and are known as "dismounted IED injuries."

The data were assembled by Holcomb and two physicians at Landstuhl Regional Medical Center in Germany, where all seriously injured soldiers are taken on their way back to the United States.

The steep increase in both the rate and number of amputations clearly disturbed both Holcomb and members of the board, which met at a Hilton hotel near Dulles International Airport.

Holcomb, who spent two weeks at Landstuhl in December and is a former head of the U.S. Army Institute of Surgical Research, said he had heard of "unwritten pacts among young Marines that if they get their legs and genitals blown off they won't put tourniquets on but will let each other die on the battlefield."

Richard H. Carmona, who was U.S. surgeon general from 2002 to 2006 and is now on the board, said the information was "very disturbing."

He said it has made him ask: "What is the endgame here? Is the sacrifice we are asking of our young men and women worth the potential return? I have questions about that now."

Carmona, 61, served as an Army medic in Vietnam before going to college and medical school. He has a son who is an Army sergeant and is serving in Iraq.

Jay A. Johannigman, an Air Force colonel who has served multiple deployments as a trauma surgeon, said his stint at the military hospital at Bagram Airfield in Afghanistan last fall "was different" both personally and medically.

"We see the enormous price our young men and women are paying. It should not be for naught," he said. He didn't want to elaborate.

Why amputation-requiring injuries increased so much in recent months isn't entirely understood. It is partly a function of tactics that emphasize more foot patrols in rural areas. Some people have speculated the mines may be constructed specifically to cause the devastating wounds.

"Do the Marines know? Probably," said Frank Butler, a doctor and retired Navy captain who has spearheaded improvements in battlefield first aid over the last decade. "But they're not releasing a thing. And they shouldn't."

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Drums Alive: Feel the beat, feel the burn

Drums Alive wants you to have a ball - and a pair of drumsticks to whack it with. In this fitness class, you're not just listening to music. You're playing it. And that has the potential to really pay off.

"I'm always totally soaking wet by the end of class," says master instructor Patrick Leonard, who owns Baltimore's Universal Fitness at the Overlea, where he has offered Drums Alive for nearly a year. That's because while you're pounding away on an exercise ball with your arms, your lower body is engaged in traditional aerobic movements. So a typical routine might include striking the sides of the sphere as you bounce between lunges, or jumping while you click your sticks above your head and squatting so you can bang the floor.

It sounds weird, I know. But it has developed a faithful following in pockets around the world, particularly in Germany, where creator Carrie Ekins is based. Even though it was introduced in the States six years ago, it hasn't caught on nationally. In the District and surrounding suburbs, for instance, you won't find a single class. So, it's all the more remarkable that Charm City has become the U.S. hot spot for Drums Alive, thanks to the efforts of Leonard and fellow instructor Shawn Bannon.

In the past month alone, it has been launched at both Meadow Mill, a health club known for its plentiful squash courts, and a holistic wellness studio called the Living Well. The Jewish Community Center of Greater Baltimore just started pushing the program in a big way, adding not only the standard format to the schedule, but also variations for seniors, kids and families.

When Ekins says anyone can take part in Drums Alive, she's speaking from experience. "I've been blessed with a creative mind. But I've been unblessed in that I have bad bones and joints," says the former professional dancer, who came up with the program a decade ago when recovery from hip surgery forced her to use a wheelchair. Bored with the other stuff she could do with her hands, she started hitting boxes in her basement. As her condition improved, she stood up and began banging on exercise balls.

Toying with the idea, Ekins realized she'd stumbled onto a workout that can do more than make you fit. There's the immediate stress relief that comes from hitting things, but that's just the beginning. Drumming engages both hemispheres of the brain, which in turn boosts overall coordination. In recent studies, drumming has been credited with improving immune function, mood and creativity.

So a combination of drumming with aerobic exercise has the potential to be powerful medicine. And because rhythm is universal, the class lends itself to sampling music from around the globe, from African to American Indian to Irish. "You can learn to appreciate and respect other cultures," Ekins says. "Asian drumming is powerful. Latin just makes you want to shake."

That last part may be driving Drums Alive's popularity in Baltimore, where the fitness community can't get enough of Zumba, the Latin-dance-inspired exercise craze. Virtually all the instructors in the area are also Zumba-certified and looking to develop a repertoire that lets them do more than mambo and cha cha cha.

"I teach 16 Zumba classes a week. I wanted something else," says Joyce Lortz. She introduced Meadow Mill to Drums Alive in February by persuading the 30 or so folks in a Sunday morning Zumba class to stick around. It took only a couple of minutes for the crowd to start pounding the exercise balls in unison.

Sidney Pink, a 31-year-old in the back row, told me the experience reminded him of the Taiko Drum Master video game he and wife April played when they lived in Japan. "I'm becoming aware of the way cultural activities can be brought into the gym setting," he said. As for April, she wanted to bring something else: "My mom."

It's common for students to want to share Drums Alive - with parents, friends and children - because it thrives on a group dynamic, Bannon explains. The more people in the room, the louder each boom. "The energy is off the charts," he says.

At the Maryland Athletic Club in Timonium, where Bannon teaches, 53-year-old Janet Amirault has persuaded husband Alan Foote, 52, to join her in taking up drumsticks once a week. "Of the various things she did, this was the most interesting," Foote says. As for Armirault, who had a stroke caused by a genetic defect six years ago, she credits her six months in the program with strengthening her brain and her body. "This helps keep me alert. It forms neurons. To me, it's the magic exercise," she says.

It was clear Bannon agreed with that last week as he got the class warmed up to a Hawaiian tune. "Sticks are going to fly, and balls are going to roll," he warned. He turned out to be right on both counts. But the incidents caused no injuries, just giggles, and before long, the whole room was back on the beat.

Follow @postmisfits on Twitter.

Try it

Have you tried Drums Alive? Tell us what you thought in the comments of this story online. Here are two Baltimore locations with Drums Alive that don't require membership:

The Living Well. Saturdays at 9 a.m. $10 per class. 2443 N. Charles St., Baltimore. 410-212-5953. www.livewellbemore.com.

Universal Fitness. Tuesdays and Thursdays at 6:30 p.m. $5 per class. 6809 Belair Rd., Baltimore. 410-668-6060. overleafitness.webs.com.

Drums Alive locations that require membership:

Meadow Mill. Sundays at 11:15 a.m. Members only. 3600 Clipper Mill Rd., Baltimore. 410-235-7000. www.meadowmill.com.

JCC of Greater Baltimore. Power Beats on Sundays at noon and Tuesdays at 6 p.m., Golden Beats on Mondays at noon, Kids Beats on Thursdays at 4:30 p.m., Family Beats one Saturday a month at 3:30 p.m. Members only. 3506 Gwynnbrook Ave., Owings Mills. 410-356-5200. www.jcc.org.

Maryland Athletic Club. Tuesdays at 6:30 p.m. Members only. 110 W. Timonium Rd., Timonium. 410-453-9111. www.macwellness.com.

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Can't judge an exercise book by its cover

"We're all humans. We're basically the same," says Adam Campbell, the fitness director for Men's Health and author of both books. There aren't any exercises only men should be doing, or vice versa, so he saw no reason to alter the content of the books.

But he's aware of the importance of presenting information in a way that's palatable to each sex. So for a male audience, he uses such words as "define," "carve" and "build." When he switches to addressing women, it's "shape," "firm" and "tone."

Language can have a huge impact on how readers digest information, explains Women's Health Executive Editor Lesley Rotchford. "We want to speak to goals they have. A 'six-pack' isn't relatable," she says. (The flip side is also true: "You're not going to tell a guy to work out to fit into skinny jeans.") By using more female-friendly terms, the magazine is able to promote resistance exercises in a way that makes women more interested in doing them.

For the same reason, Campbell insisted on doing two books, one with images of men and the other with images of women. "Presentation matters. Seeing a woman doing a barbell squat looks very different than seeing a man doing the same thing," he says. "It's less intimidating."

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How men and women exercise differently

No one wants to think she's a cliche. But it's time for me to recognize that when it comes to my gym behavior, that's exactly what I am: a cardio-loving woman who has to be forced to hoist a dumbbell.

I would feel worse about this revelation if it weren't for the fact that my husband is just as stereotypical. Every workout is a chance to outdo himself, which inevitably results in soreness, shin splints and other woes. A few months ago, at a boot camp class, he generated so much heat that his head - no joke - started to steam. I can guarantee that I'll never work that hard.

Luckily, we can both blame it on biology, according to research by Weight Watchers. The organization is best known for counting points, but behind the scenes, staffers are sorting through a lot more complicated data. And some of the most fascinating stuff stems from contrasting male and female attitudes toward weight loss and activity, says chief scientist Karen Miller-Kovach.

For starters, a much higher percentage of the men surveyed believe that exercise is enough to slim down, whereas the women tend to embrace a smarter combination of eating healthier and moving more. "You rarely hear guys say, 'I'm going on a diet.' Instead it's, 'I need to hit the gym,' " Miller-Kovach notes. (That may also explain why men make up just 10 percent of Weight Watchers' membership.)

But the Weight Watchers surveys show men top women when it comes to actually enjoying exercise. "That doesn't mean women don't know they need to be physically active or don't do it," Miller-Kovach says. "But if you're a woman, you're looking at being active as a means to have wine with dinner. For guys, to sweat is a badge of honor."

Then, there's the approach: Women are likely to take small steps toward a goal while men are quick to make sweeping changes, according to the research. "It's the Hundred Years' War versus the Battle of Normandy," Miller-Kovach says. And where we choose to have that fight also differs. For men, it's the weight room. For women, it's anywhere else.

These are all generalizations, and, of course, there are plenty of outliers for both sexes. (Weight Watchers' research is proprietary, so exact figures are not available.) But you can witness these opposing strategies - and their accompanying weaknesses - if you look around almost any gym. Women clump by the cardio machines, regularly reading magazines and talking, thus lessening the effectiveness of their workouts. Men congregate around the largest of weights, which they proceed to pick up even if that requires heinous form.

Heavy, dude, but . . .

Lynda Espada, fitness director of the D.C. Jewish Community Center, says that, from her observations, "Women never want to push it. Men want to push it too much."

Partly, that's because women tend to worry about bulking up no matter how many times they've been told that they'd need to grab some steroids along with that heavier dumbbell to make it happen. For guys, it's the opposite. "They think the more weight, the bigger they will be and the better that is," says Espada, who notes that in reality, more weight than you're ready to handle leads to injuries rather than bulging muscles. "You can't be grunting and groaning and throwing weight around."

It's possible that men and women would get these messages more easily if they weren't so hung up on preconceived notions of what kind of exercise is appropriate for them. "Guys are thinking about high school even though what they learned doesn't apply to a 40-year-old," says Robert Sherman, the group fitness manager for Equinox's Washington area clubs. If Sherman had his way? He'd make sure every man made time for yoga and that every woman put strength classes on her schedule.

Change comes slowly

Over the past few years, that's started to happen more as older exercisers have been warned by their doctors to change up their routines and younger ones have brought their evolving attitudes to the gym.

But there's still an intimidation factor when it comes to the unknown. Espada understands when new female clients tell her they've shied away from weights because they've never been fully introduced to what to do with them. She felt the same way 20 years ago when she first breached the boys' club. "I start slowly so they get comfortable," she says. "And when they see they can do it, they realize it's fine."

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Meditation and mindfulness may give your brain a boost

They are the simplest instructions in the world: Sit in a comfortable position, close your eyes, clear your mind and try to focus on the present moment. Yet I am confident that anyone who has tried meditation will agree with me that what seems so basic and easy on paper is often incredibly challenging in real life.

I've dabbled in mantras and mindfulness over the years but have never really been able to stick to a regular meditation practice. My mind always seems to wander from pressing concerns such as the grocery list to past blunders or lapses, then I get a backache or an itchy nose (or both) and start feeling bored, and eventually I end up so stressed out about de-stressing that I give up. But I keep coming back and trying again, every so often, because I honestly feel like a calmer, saner and more well-adjusted person when I meditate, even if it's just for a few minutes in bed at the end of the day.

Now there's even more reason to give it another go: New research from Massachusetts General Hospital in Boston indicates that meditating regularly can actually change our brain structure for the better, and in just a few months.

The small study, published last month in Psychiatry Research: Neuroimaging, tracked 16 people who took a course on mindfulness-based stress reduction - a type of meditation that, besides focusing your attention, includes guided relaxation exercises and easy stretching - and practiced for about 30 minutes a day. After eight weeks, MRI scans showed significant gray matter density growth in areas of the brain involved in learning and memory, empathy and compassion, sense of self and emotional regulation, when compared with a control group. In addition, the researchers referred to an earlier study that found a decrease in gray matter in the amygdala, a region of the brain that affects fear and stress, which correlated with a change in self-reported stress levels.

"This is really, clearly, where we can see, for the first time, that when people say, 'Oh, I feel better, I'm not as stressed when I meditate,' they're not just saying that - that there is a biological reason why they're feeling less stress," says senior author Sara Lazar, a psychology instructor at Harvard Medical School. She notes that these findings build on prior research that has found positive brain changes in long-term meditators: "But this is proof that it's really meditation that's making the difference," as opposed to other potential factors such as diet or lifestyle, she says. "And it doesn't take long to get there."

None of this comes as a surprise to dedicated meditators or to doctors who regularly prescribe the practice.

"The study shows that meditation induces certain physiological brain changes that are consistent with many of the health benefits we see clinically," says family medicine and chronic pain specialist Gary Kaplan, director of the Kaplan Center for Integrative Medicine in McLean, who recommends meditation as part of a treatment plan for every one of his patients. He reports that patients who follow this advice typically sleep better, have less pain, less anxiety and depression, and a better general sense of well-being. Kaplan adds that this admittedly anecdotal evidence comes on top of at least a decade's worth of research showing that meditation can have a range of benefits such as reduced stress and blood pressure, migraine relief, an improved attention span and better immune function.

Given that meditation is readily accessible, cheap and portable and has few if any risks, there's really no harm in giving it a try, says Kaplan, who suggests that getting a book or CD on the topic or taking a basic class is a good way to start.

He acknowledges that the practice is far from easy, at least in part because the mind is bound to wander. "We spend a whole bunch of time time-traveling - a lot of time in the future, worrying, and a lot in the past, dwelling on regrets and grief and loss - and we spend very little time in the present, focused on what's going on at this moment," he explains. "So allowing that chatter to quiet and becoming present in the moment, while being gentle with the thoughts that come in and out of the mind and any anxiety that's there, that can be difficult."

For those who are skeptical or who continue to struggle, Hugh Byrne, a senior teacher with the Insight Mediation Community of Washington, suggests some tips for getting going - and sticking with it:

Seek the right style. There are many forms of meditation, with different objectives, and it's important to do some research and find the one that works best for you, whether it involves walking, chanting or deep-breathing exercises.

Practice, practice, practice. It's essential to cultivate a regular, daily routine to get your mind in the habit of meditating, even if it's just five or 10 minutes to start, says Byrne, who recommends slowly increasing that to 30 minutes or more every day.

Be mindful all day long. Meditation "isn't just about bringing awareness to your experience while you're sitting cross-legged with eyes closed," says Byrne. "It's also a practice that you can bring into the rest of your life: when you're eating, sitting in a traffic jam, or relating to a partner, spouse, kids or colleagues at work." He suggests finding a few minutes here and there to get centered.

Don't be discouraged by a wandering mind. It's totally normal. "The important thing is just to notice when you move into planning the future or ruminating on the past or daydreaming, just notice that and gently bring attention back to the present," says Byrne. "And come back into the body, without judgment or criticism."

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