MD-Writer Blog

Current education policy has moved away from No Child Left Behind, President Bush’s program, which emphasized standardized tests, to Race to the Top, President Obama’s initiative, which continues the testing but adds a focus on individual teachers and students.

Like most Americans concerned about the future of our nation and the upcoming generation of students, I’ve been troubled by our problems with education. But now I feel encouraged. I think the policymakers have finally got it right.

Last January, the president spoke about the new policy at an elementary school in Virginia. He said, “We urged states to use cutting-edge data systems to track a child’s progress throughout their academic career, and to link that child’s progress to their teachers so we know what’s working and what’s not working in the classroom.”

Perhaps in that spirit, this week the L.A. Times announced the upcoming publication of a new database tracking the performance of public school teachers in that city. The news organization analyzed seven years of students’ math and English test scores, obtained from the L.A. school system, to estimate the effectiveness of teachers. According to the article, the statistical method, called “value-added analysis,”

rates teachers based on their students’ progress on standardized tests from year to year. Each student’s performance is compared with his or her own in past years, which largely controls for outside influences often blamed for academic failure: poverty, prior learning and other factors.

Jason Felch, the reporter on the investigation, interviewed on NPR’s “All Things Considered” last evening, explained the reasons for tracking teachers and publishing the database:

Well, the big takeaway from our series and after, you know, spending a lot of time analyzing this data is that individual teachers really matter. The difference between teachers can be enormous, and which teacher a child gets is often left up to chance. So it would be difficult to have the information about which teachers are effective and which teachers are less effective and not make that public.

I remember my fifth grade teacher. It took me years to realize that for personal reasons of her own, she actively sought to undermine my education. One day during an assembly of the students, I competed against other students answering questions on science. She arranged for my correct answer to be announced false to eliminate me from the competition and teach me a lesson.

In contrast: My high school physics teacher, who was motivated by the subject and his passion to teach. Physics and math were beautiful things to him. He wrote the equations on the blackboard in an elegant hand that expressed his love for the subjects. His enthusiasm and his conceptual clarity transferred themselves to my classmates and me.

Although, I’m not an expert in education, I’ve had some degree of educational success, graduating from an Ivy League college and a top tier medical school. I think standardized learning—measured by tests—and the learning of fundamental concepts—imparted by excellent teachers—are both important for educational success. But teachers tip the balance.

At last, the country is moving ahead on education. The first leg was the standardized learning and the tests to measure it, under President Bush’s program. Under President Obama, the second leg is the excellence of performance by teachers. The nation is stepping forward, perhaps soon to walk, eventually to run.

Researchers at Boston University School of Medicine have found that amyotrophic lateral sclerosis (ALS, Lou Gehrig’s Disease) may result from repetitive trauma to the brain. The disease characteristically begins with muscle weakness and lack of coordination. People have difficulty getting out of chairs, climbing stairs, and sometimes swallowing. Slowly, inexorably, the paralysis spreads up and down from the brain through the spinal cord, affecting almost all movements, including speech and respiration.

I witnessed the horrifying progression of the disease in my uncle, who succumbed in three or four years. He lost all motion, but he remained alert and aware throughout, since only motor functions are affected. Among my last memories of him: I was 10. He sat across the dining room table from me, trying to tell me something. He had something very important to communicate, and he tried very hard, again and again, to tell me. But his speech was so inarticulate, his voice unbroken by consonants, his tone uninflected by vowels, that I could not understand. He tried, it seemed to me, for an hour, although it was probably only a few minutes. I left him, apologizing, unable to endure more. I wonder to this day what he must have experienced, imprisoned in his skin.

The cause of the disease has always been a mystery. It is primarily genetic in only a few cases; most are sporadic. But the medical scientists studied the brains and spinal cords of 12 athletes—football players, a military veteran, a boxer and others—who had suffered multiple blows to their CNS and developed neurodegenerative diseases of the brain and spinal cord. On examination, they all had abnormal deposits of two proteins, one called tau and another called TDP-43 in their brains. But three of the 12, who had been diagnosed with ALS, also had TDP-43 in their spinal cords. Those three were the only ones of the 12 to show the protein there.

TDP-43 has also been found in the CNS of persons who suffered from the sporadic form of ALS, according to the report of the research in ScienceDaily yesterday.

In my uncle’s case, I always wondered whether his illness might have been connected to his job as a milkman. The occupation no longer exists. The delivery service worked in times when milk came in the early morning, unhomogenized and sometimes even unpasteurized, direct from local farms and plants. It faded away with refrigeration and supermarkets. But I remember, for a few years early in my life, the milkbox on the front stoop and the whiteness-filled bottles deposited each morning by the man with the truck. How many heavy crates of milk did my uncle lift day after day? How far did he walk carrying bottles? It was his right arm and right leg that first showed the telltale weaknesses.

Heavy lifting is not cerebral concussion, of course. But in an article in June, the scientists noted that repetitive injury to the CNS plays a central role in many cases degenerative CNS disease characterized by abnormal accumulations of tau protein. They said

Trauma to the central nervous system is one of the most consistent candidates for initiating the molecular cascades that result in Alzheimer’s disease (AD), Parkinson’s disease (PD), and amyotrophic lateral sclerosis.

So perhaps my uncle’s years heavy lifting and carrying, his long life of yanking on his muscles and nerves, did play a role in his disease.

This weekend, the NY Times ran a story on the Obama’s administration’s covert war on al Qaeda. But war is not the right word. What the reporters described is a clandestine Special Forces campaign.

The reporters wrote that the CIA has become a paramilitary organization, conducting attacks with missiles and other weapons, and the Pentagon has be come like the CIA, conducting spy missions. Private companies under government contract have also participated.

Such operations have played major roles in the wars Iraq and Afghanistan and in operations in Yemen. Congressional oversight has lagged, because existing legislation doesn’t apply to these special military programs, the Times reports.

I read the story with ambivalence. On the one hand, I know in my heart that if I were president, I would, like Obama, authorize any covert operation that could reasonably succeed in tracking down and eliminating Bin Laden and other terrorists.

On the other hand, I imagine and worry about the possible misuse of such capabilities by a future government of the United States. In the nightmare scenario I envision, Will Smith plays Robert Dean fleeing agents of the NSA in the 1998 movie “Enemy of the State.” Dean, an innocent bystander caught up in a rogue security operation, possesses a videotape showing a murder committed by the agents of the government.

In the most hellish scene, Smith runs and jumps from rooftop to rooftop, dashes up and down stairs, sprints down streets and through tunnels, etc., in Washington, DC, pursued by agents in helicopters, cars and on foot, all the while tracked by surveillance cameras.

Back when the movie was filmed, there were no drones. But if there were an actual Robert Dean today, he could be surveilled from on high by drones and targeted by missiles.

Ours is a nation that was founded in rebellion. The signers of the Declaration are reputed to have joined in rebellion because Benjamin Franklin told them, “We must hang together, gentlemen…else, we shall most assuredly hang separately.”

What would happen today if an unjust government misused its power against the citizenry? I don’t mean the stuff of Tea Party paranoia, which is making the rounds today on some networks on the internet. I mean suppose it really happened. What would happen if the government started using some of the awesome counterterrorism capabilities it is now developing to pursue al Qaeda on American citizens inside this nation?

I worry about that when I read a story such as this one in the Times Saturday. I applaud the aggressive pursuit of Bin Laden at the same time as I remember that the existence of al Qaeda itself is attributable to blowback from CIA clandestine operations. Could the blow one day come back to our own nation?

When I was a schoolchild, my teachers taught that America was first settled by Pilgrims, who sought to worship God in the manner they chose. Practicing their religion was so important that they crossed the treacherous expanse of the Atlantic in the little Mayflower, to begin new lives in the wilderness, thousands of miles from the civilization of their births. My teachers’ point was that freedom of religion is one of the original and central founding principles of our American nation—one worth facing great hardship and sacrifice, including loss of life.

Why is it that so many Americans don’t seem to understand that?

The Anti-Defamation League—of ALL groups—has joined a cacophonous chorus of opposition to the ground zero mosque. According to the statement of purpose on its website, the association is dedicated to “to secure justice and fair treatment to all.” But not including Muslims, apparently. After considering “the anguish of the families and friends of those who were killed on September 11, 2001″, the organization declared:

Proponents of the Islamic Center may have every right to build at this site, and may even have chosen the site to send a positive message about Islam. … But ultimately this is not a question of rights, but a question of what is right.

ADL fights discrimination against Jews, but it apparently doesn’t see a contradiction in supporting discrimination against Muslims. How would ADL react if the religious center were synagogue, I wonder. Would it claim it isn’t “a question of rights?”

But Fox News and its commentators are sounding the sourest notes. A story on the politics of the mosque showed a picture of a demonstrator with a sign equating building the house of worship at that site with glorifying the murders of the three thousand 9/11 victims. It’s clear from the text that Fox News accepts that view and is trying to demagogue it.

Didn’t these people take any American history? We learned about the Pilgrims in elementary school.

Freedom of religion is part of the first of the amendments for a reason. That’s how important the founding fathers thought it was. Since there would be no objections to a church or a synagogue, there should be none to a mosque. That’s how America works, or is supposed to, anyway.

The hullabaloo shows how many Americans, including some of the most fiercely patriotic, have failed to take to heart the history of our country and what the founders intended.

The First Amendment of the Bill of Rights requires that government not favor or discriminate against any establishment of religion. As Americans, we should all uphold that principle, and we should avoid demonizing any single religion and denying its followers their rights because of what a few of them have done.

Should the FCC regulate Internet providers as a telecommunications services or as providers of information? That is the issue now under negotiations behind closed doors at the FCC between its chairman and representatives of Internet companies, according to a report today by Bloomberg. Josh Silver of the media watchdog group, Freepress, has raised the specter of a “secret deal” that might preclude Julius Genachowski, chairman of the FCC, from ensuring “net neutrality.” In a statement [pdf] on cyber infrastructure last May, President Obama pledged to “remain firmly committed to net neutrality so we can keep the Internet as it should be — open and free.”

In a broadcast email Thursday, the Center For Democracy and Technology explained:

In general terms, the issue of Internet neutrality concerns whether operators of Internet access networks should be free to favor some Internet traffic over others, or instead should be required to handle traffic in an essentially neutral manner. Non-discrimination has long been the norm for services classified as “telecommunications services” under the Communications Act. But since a series of orders beginning in 2002, the FCC has regarded broadband Internet access not as a telecommunications service, but as an “information service.”

The issue arose in 2007 when the broadband provider Comcast was selectively interfering with some customers’ use of peer-to-peer file-sharing applications to transfer files over the Internet. In reaction to complaints, the FCC issued an order that Comcast was violating federal Internet policy to the effect that Internet providers “should not block subscribers’ ability to access the content, applications, or services of their choice.” But Comcast took the matter to court, and in June the DC Circuit Court of Appeals held that since the FCC classifies cable Internet providers as information services, it cannot enforce upon them non-discrimination and consumer protection principles pertaining to telecommunications services.

It is the commission’s intention to reclassify Internet providers like Comcast as telecommunications service providers, in order to be able to ensure non-discrimination (a.k.a. net neutrality). That intention is what is now under negotiation.

In my view, there should be no question about whether the Internet is properly a telecommunications medium and Internet providers are telecommunications services. Indeed, my telephone service is an Internet-based service. My telephone service provider, Vonage, has given me a modem that sends my telephone calls over the Internet, through Internet service provided by Comcast. Clearly, Comcast is an integral component of my telecommunications.

Moreover, almost none of my Internet use involves receiving or sending information to or from Comcast, with a couple of exceptions. I use the online TV schedule associated with my Comcast cable TV service; I receive and pay Comcast bills online; and I download antivirus software provided by the company. None of those things, however, is critical to my use of the Internet, and I could forego them.

What is critical to me is that my access to the Internet remain completely unfettered. I do not want to be required by Comcast to pay a premium for access to certain content, whether the cost to me is billed directly to me or I pay higher fees to content providers charged higher rates for Internet transmissions. If I were required to pay extra, I would inevitably miss content that I would want to access. I think almost all Internet users feel as I do.

I intend to write the FCC, my senators, my Congressman, and my president about the negotiations now in process at the FCC. Perhaps my readers would consider doing so as well.

Our hi-tech civilization makes use of tens of thousands of chemicals, most of which haven’t been tested for noxious effects. Inhaled, ingested, or in contact with skin, the substances sometimes cause respiratory disease, damage the nervous system, interfere with hormones, or trigger cancer. In a Scientific American article Tuesday, Paul Blanc, a professor of occupational and environmental medicine at U.C. Berkeley, answered questions about toxic chemicals.

People may get exposed to harmful chemicals in common consumer products, Blanc said. He mentioned waterproofing sprays used on shoes and leather, as one good example. The aerosols contain fluoropolymers that can cause severe lung damage.

I used one such product two days ago, Kiwi Protect-all from Sara Lee Household and Body Care. At that time, I had no idea that severe lung damage could result from ingredients in the can. This morning, I checked the label, which says only that it contains “petroleum distillates,” hardly informative. I also went to the the Kiwi website, but that divulges even less info. However, my call to a telephone number on the can to contact for “questions” confirmed that Protect-all does contain fluoropolymers.

When I applied the spray to new running shoes, I did take the precaution of using it in a screened porch with lots of airflow. Still, if I had known, I would have taken more care, like holding my breath while spraying and leaving the porch before taking a breath.

What can be done to control the use of toxic substances and increase the information available to consumers?

The Congress is now considering new legislation to overhaul the decades old Toxic Substances Control Act. It is “an antiquated law that in its current state, leaves Americans at risk of exposure to toxic chemicals,” according to Sen. Frank Lautenberg (D-NJ), who introduced the new bill, the Safe Chemicals Act of 2010. He explains on his website that the Environmental Protection Agency “does not have the tools to act on dangerous chemicals and the chemical industry has asked for stronger laws so that their customers are assured their products are safe.” The description of the bill says:

The “Safe Chemicals Act of 2010” requires safety testing of all industrial chemicals, and puts the burden on industry to prove that chemicals are safe in order stay on the market. Under current policy, the EPA can only call for safety testing after evidence surfaces demonstrating a chemical is dangerous. As a result, EPA has been able to require testing for just 200 of the more than 80,000 chemicals currently registered in the United States and has been able to ban only five dangerous substances. The new legislation will give EPA more power to regulate the use of dangerous chemicals and require manufacturers to submit information proving the safety of every chemical in production and any new chemical seeking to enter the market.

Even if the bill were to become law soon (probably unlikely in this election year), the U.S. would be catching up to Europe. In 2007, the EU’s European Chemical Agency (ECHA) inaugurated REACH, a program for “Registration, Evaluation, Authorisation and Restriction of Chemicals.”

According to the ECHA website, REACH

applies to all chemicals: not only chemicals used in industrial processes but also in our day-to-day life, for example in cleaning products, paints as well as in articles such as clothes, furniture and electrical appliances. … All manufacturers and importers of chemicals must identify and manage risks linked to the substances they manufacture and market.

Concern about thousands of potentially harmful chemicals in consumer products growing in this country, too. In May, Nicholas Kristof, the NY Times columnist wrote about a new report from the President’s Cancer Panel, which warns that “our lackadaisical approach to regulation may have far-reaching consequences for our health.”

Perhaps something will get done, and before long, I won’t be surprised by a news article informing me that a consumer product I used just a couple days previously might possibly cause me to suffer from a severe disease.

This month I officially became a senior citizen and enrolled in Medicare. So I am interested to discover that the federal government has just released a comprehensive statistical report on the age group of which I am now a member. Who are we and how do we fare? While there are few surprises in the new report, I think the data are worth checking.

In 2008, 39 million people in the U.S. were age 65 and over, 13% of the population.

We seniors live in all cities, states and regions, but the highest concentrations of us, up to 1/3 of the local populations, reside in the sun states (Florida, Arizona, New Mexico, Texas), the Great Plains from far north to the deep south, and along the East and Northwest coasts.

Eighty percent of us are non-Hispanic whites, 9% are black and 7% Hispanic. More than half of us are married, but more men are married than women, who more often have lost spouses to death. About 40% of the women live alone, compared to 20% of the men.

Three-quarters of us have at least a high school education, and one-fifth have a bachelor’s degree. These educational rates have tripled and quadrupled since 1965.

Older Americans’ income has been increasing. During the last four decades, the proportion of us living in poverty has gone down from 15% to 10%. The poverty rate of seniors is now about the same as that of all Americans. The proportion of seniors in the low-income category has declined from one-third to one-quarter. In contrast, high-income seniors have increased from less than one-fifth of us to more than one-third.

Among white Americans, median household income for older Americans is $29,000. In 2007, the median household net worth was $280,000, which was six times that of older black households, $46,000.

The proportion of men still working has been trending upward and is now near 40% among 65-69 year-olds and more than 10% for those over 70. The proportion of the women still working is growing also and is now near 25% of 65-69 year-olds, but it is less than 10% of those over 70. Forty percent of seniors’ income is derived from Social Security, 1/3 from earnings and 1/5 from pensions. Social Security provides more than half the income of 60% of seniors.

The current life expectancy at age 65 in the U.S. is 18.5 years, which is less than many other industrialized nations by a year or two. It is longer for women than men by around 5 years. Life expectancy at age 85 is about 6-7 years.

Death comes most frequently due to heart disease, cancer, stroke, respiratory illness, Alzheimer’s disease, and diabetes. Hypertension, arthritis, heart disease, cancer, diabetes, and respiratory diseases are the most common chronic diseases. But more than half of seniors of all ages rate their own health as good to excellent.

Most seniors in America have adequate diets. But few get regular physical exercise—only about 1/5 do, compared to 1/3 of younger adults. And obesity is increasing. It currently affects 32% of us, compared with 22% in 1988–1994.

Health care costs are rising fast for older Americans, going from $9,224 in 1992 to $15,081 in 2006. The fraction of older Americans’ income going to health care has also increased for those in or near poverty, growing from 12% to 28% during the last three decades.

Cyclists also grow old (a side note, but one that is marginally related to the content of this post):

I’ve been following the Tour de France all month. The race for the yellow jersey has been a struggle between two young powerful riders, Alberto Contador (Spain) and Andy Schleck (Luxembourg), who are now less than 8 seconds apart in cumulative time. Lance Armstrong, at age 38, has not played a prominent role. He suffered through two crashes during one stage more than a week ago, and as a result, he lost much time. He is now out of the running for the podium.

But today, during a mountain stage in the Pyrenees, Lance broke away from the pack and attempted show his stuff is still strong and win the stage. Several other riders joined him in the breakaway, and the group moved 8-10 minutes ahead of the peloton. In the last few kilometers, the riders in the group sprinted for the finish line, each trying to win. Lance tried his best but came in sixth.

Interviewed after the race, the great cyclist was clearly feeling his age. “I wasn’t the oldest rider in the group,” he said, referring to another cyclist, 39, who also joined the breakaway. Those were his last words to the camera today.

As we age, we lose both physical stamina and cognitive ability. There’s no doubt that this happens and it seems inevitable. But is it?

I do my best to keep physically fit. This morning, I jogged seven miles, on my way to and from an hour-long circuit weight exercise class. And I try to get in at least 400 kcal of physical exercise six days a week. It helps hugely with fitness, stamina and vitality, but I nevertheless notice some continuing loss of strength and resilience.

The same thing happens mentally. I’m not as sharp as I once was. One task that makes that particularly clear is searching for a word in a list or on a page. When younger, my eyes would quickly pick it out. Nowadays, I usually fail to find the word and have to resort to the search box.

Can cognitive decline be slowed by brain exercise the way physical decline can be slowed by physical exercise?

On the assumption that it can be, I regularly exercise my brain. Writing this blog each day is one way. Another is French class. I’ve taken French classes during the academic year for the last five years, and I listen to French language radio on the internet. I continue to read lots of scientific papers.

But well-done research showing that brain exercise slows age-related cognitive decline is lacking. That’s why it was encouraging when one such report appeared Wednesday in ScienceDaily.

Scientists at UCSF studied healthy older subjects, 60-89. Half of them (15) participated in a program of visual perceptual training intended for commercial use. Fifteen other subjects did not participate in the training and served as the control group.

The program consisted of 10 hours of visual discrimination exercises over a three to five week period. The participants watched computer screens and were asked to judge patterns of waves expanding or contracting or groups of dots moving in various directions. They had to press buttons to indicate how the wave patterns changed or the dots moved. The exercises were conducted so that the discrimination tasks became more difficult as the subjects improved.

The scientists administered tests of working memory and encephalograms to all participants before and after the training period. Working memory—the ability to keep information in awareness for short periods of time—is essential for all ongoing activities, like conversing, cooking, and walking to the store.

The results of the study showed that the subjects who underwent training improved not only in visual discrimination performance but also in working memory. The scientists demonstrated this by showing all the subjects dots moving on a computer screen, and then after a few minutes asking them to recall of the direction of motion of the dots. The trained subjects performed more accurately on this recollection task than the untrained ones.

The scientist also found differences in the EEGs of the trained subjects in comparison to the untrained ones. They assessed the amount of neuronal activity in the visual association cortexes of the two groups, i.e., in the region of the brain that does visual discrimination. They found that the amount of activity was lower in the trained group, suggesting that their brains had learned to process the information more efficiently.

A reporter asked one of the reseachers, Adam Gazzaley, whether older adults would need to keep doing repetitive mental drills, like visual discrimination tasks, to maintain improvements in working memory. He replied:

Well, I like to keep physically fit. I work out almost every day, and I know that if I stopped, I would get out of shape. Maybe it’s the same with the brain. You’ve got to continue to work it.

The take-home message, apparently, is regular exercise. Exercise your body. Exercise your brain.

Older people seem to be acting younger. This weekend, the NY Times ran an article about 70-year–olds acting like their grandchildren. Bob Dylan and Paul Simon are still performing at 70. And of course, Betty White hosted Saturday Night Live at the age of 88.

And people are asking: Is 60 the new 40? One reason, perhaps, is that life expectancy—the average age of death—has risen rapidly in the past century. Tables on the CDC website show that Americans are living 30 years longer now than in 1900. Not surprisingly, they also show that the longer people live, the older their average age at death. The average life expectancy today is 78, but that is the expectancy at birth, for a newborn baby. If you are 75 now, you can expect on average to live 12 more years. And although the chances of dying increase as you get older, if you reach 100, that may no longer happen: The probability of dying may actually decline past 100, or at least the probability may stop rising.

Something else seems to be going on, too, as suggested by the Times’ story about elderly folks who don’t act their age in the traditional sense. The article quotes one ageing researcher saying that the 70s are “now seen as an active time of life: you’re just past retirement, that’s your time to explore and play mentally.”

A study reported last month of older adults 60-86 by researchers at N.C. State found that they made most decisions just as well as younger adults 17-28. It was only for complex decisions based on a large amount of data that the younger group performed better. On the other hand, in a Duke University study that appeared last month, older adults did as well younger ones in making economic decisions.

Having just turned 65 and become eligible for Medicare, I’ve been feeling that I’ve passed a line that used to be on my horizon. I am now, officially and irreversibly, a member of a group that society considers elderly. But I don’t feel that different.

Besides my appearance, the most obvious thing about my age is that I’m not as strong as I once was, and my body takes longer to heal. Muscle strains and aches no longer go away overnight, and it may require days of taking anti-inflammatory analgesics for the pain to subside. I often worry about my memory, but to be accurate, I’m not sure it is much worse than it ever was.

I continue to expect to have fun and do interesting things. I do not plan to rest and relax more than I used to. Although I will take longer to get things done, that’s probably because I’m retired and have more time.

Perhaps most significantly, I don’t fear that I’m nearing death. I think about it and know its true. When I was younger, if I had thought that people my age have on average less than 20 years to live (that’s what the CDC tables say), it would have been a source of anxiety. It doesn’t affect me that way now.

During the summer I live near the shore in New England and a long bike path that runs by my house. My houseguests and I are out in the sun often, and we always use sunscreen. So I was surprised and concerned to learn that sunscreen products sold in this country do well at filtering UVB rays, but they may not be effective for the UVA rays that can also cause skin cancer and wrinkles.

The CDC explains on its website:

• UVA is the most common kind of sunlight at the earth’s surface, and reaches beyond the top layer of human skin. Scientists believe that UVA rays can damage connective tissue and increase a person’s risk of skin cancer.
• Most UVB rays are absorbed by the ozone layer, so they are less common at the earth’s surface than UVA rays. UVB rays don’t reach as far into the skin as UVA rays, but they can still be damaging

Last month just after the summer solstice, when the sun is highest and brightest in the sky, the NY Times reported that the SPF rating now on sunscreen products indicates how well they filter the UVB rays but not the UVA.

The FDA has been planning to require sunscreen products to show a graphical UVA rating—one star to four stars for low, medium, high or highest UVA filtering. The Times says that change has been in the works for three years and may not appear on products in stores until 2012. In response, the FDA explains the delay by saying that the agency must review a great deal of research and many comments received from consumer organizations and sunscreen manufacturers. Consumer groups, however, say the agency already has enough information to justify quicker action.

In the meantime, WebMD recommends broad spectrum products that contain “ecamsule, avobenzone, oxybenzone, titanium dioxide, sulisobenzone, or zinc oxide.” Some of these products, however, are expensive and may be available only from Europe. I use reasonably priced sunscreens available in the U.S. that contain avobenzone and oxybenzone. But the problem is that there is no indication of how well they actually work.