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tsukikage"The Doctor" by Howard Levy
After days of healing,
he would get away to fish.
Curator of fluff and feathers,
he tied his own flies,
designed his own waders
and up to the lake country
for trout and walleye.
I would ask him, what is it
out there on the water,
and he would say, all week
I swim lead for my school of patients,
take this, take that,
don't eat this, don't eat that,
I tell them swim away from the hook,
don't take that bait, that bug there
has sharp metal innards,
that worm glints steel,
but we are such dumb fish,
such sorry things that we all get pulled
from our lives.
So, weekends,
I choose to be the redresser of balances.
I know that he hid behind this facile
diagnosis because I went with him once
and as we stood thigh-deep
in the cold and clear lake,
he began his meticulous detailings,
the striations of the bottom rocks
and how each different sediment
reflects the light, the distribution
of firs along the shore,
the speckling of the speckled trout
and each thing, he said,
is a symptom and so a clue
into the fevered chemistry of beauty.
And if you're in the mood for a little contrast...
Eagan man charged in decapitation death of stepmother
A 23-year-old man is accused of killing his stepmother Friday after his parents tried to get medical help for him. His lawyer said he plans a mental illness defense.
Jim Adams, Star Tribune
Last update: January 05, 2006 – 8:31 AM
A 23-year-old Eagan man with a history of mental illness was charged Tuesday with the grisly slaying of his stepmother in his father's Burnsville home.
Stephen R. Miles is charged with one count of second-degree murder. He is being held in the Dakota County jail without bail pending an evaluation to determine his mental competency.
The charges said Miles hit his stepmother in the head with a hatchet and then decapitated her with a knife in the kitchen about 9 p.m. Friday.
Miles told police that his father and mother took him to the doctor Friday morning after he asked for help because something was wrong with his head. He said he didn't want to wait for his upcoming neurologist appointment. The complaint continued:
An emergency room physician at Fairview Southdale Hospital in Edina said no beds were available. The doctor suggested they go to the University of Minnesota Medical Center's Riverside campus in Minneapolis, but Stephen Miles wouldn't go, his father, Roland Miles, told police.
They returned to the Eagan home where Stephen Miles lived with his mother and grandmother. The father and son then went to the father's home to play chess.
Stephen Miles told police that when they arrived, his father's wife, Maris Jo Miles, 68, was upset that they had been at the Eagan home and asked them both to leave. Roland Miles asked his son to go outside and help him clear snow from the driveway.
Stephen Miles said he got a hatchet from the garage and went into the kitchen. He hit his stepmother in the head several times with the hatchet blade and cut off her head with a knife. Then he went outside and told his father what he had done. His father ran into the house, saw his wife's body and called 911.
Police found the son sitting by his father on a patio bench at the house. The knife and hatchet were found near the victim.
Police said Stephen Miles has no criminal or violent history. But police were called in October to his home in Eagan. Miles had not taken his medication and tried to pry a filling out of his mouth because he thought it was a tracking device, said police spokeswoman Danielle Anselment.
Miles' attorney, Marsh Halberg, said Miles has had mental health problems, including depression, since he was 6 years old but the episodes have grown worse recently.
Halberg said he will present a mental illness defense.
Fairview Health Services, which operates Fairview Southdale Hospital, said that it is doing a full review of the case but that no patient needing a bed is turned away. Spokesman Ryan Davenport said privacy laws prevent discussing the case, but added in a statement: "Any patient who presents for care at our emergency department receives medical evaluation and treatment."
***
Pawlenty heading to Detroit to try to head off plant closing
Pawlenty flies to Michigan today to plead with Ford Motor Co. executives for retention of Minnesota jobs.
Dane Smith, Star Tribune
Last update: January 04, 2006 – 9:30 AM
Gov. Tim Pawlenty will meet with reporters at the Ford Motor Co. plant in St. Paul today after his trip to Detroit in an attempt to persuade Ford executives to preserve 2,000 jobs at the plant, either by continuing Ranger pickup truck production there or by converting it to a new facility for "flexible fuel" vehicles or engines.
"Our goal is keeping Minnesotans employed," said Matt Kramer, commissioner of the state Employment and Economic Development Department; he will accompany Pawlenty. "What gets made here is Ford's decision."
Speculation that the plant is on a list of planned Ford closures was sparked by a Wall Street Journal article in early December. On Tuesday, Ford said it would announce details of its restructuring plan, including job cuts and plant closures, on Jan. 23.
Kramer said there is reason for optimism.
He said recent reports by the Detroit media suggest the St. Paul plant is not on the list of most likely shutdowns.
Kramer said the governor will emphasize that Minnesota is far ahead of other states in research and development on alternative fuels and that the state already has "the nucleus of a flexible-fuel strategy."
Pawlenty has tried to carve out a niche as the nation's leading governor in promoting alternative fuels. Minnesota, with no oil or gas but plenty of corn and other crops that can be converted to fuels, stands to benefit, he contends.
He helped push through legislation that would increase the ethanol content in Minnesota gasoline, and his official vehicle runs on 85 percent ethanol. He is the chairman of a National Governors Association panel on alternative fuels.
Minnesota, led by agribusiness giant Cargill and the University of Minnesota, already is a national leader in public and private initiatives to develop alternative fuels, Kramer said.
"What we intend to do is sit down with Ford and say that if you want to be part of the revolution in alternative fuels, you need to consider the matrix here ... Minnesota can help Ford."
Kramer said the options do not necessarily have to involve saving the existing plant.
"The plant is in the heart of a beautiful neighborhood and on a scenic river" and may be put to better use, he said. "We want the jobs in Minnesota and the Twin Cities, but it doesn't have to be in Highland Park," he said.
A little tension
Republican Pawlenty's trip sparked a little tension with U.S. Sen. Mark Dayton, a Democrat whose office has been exchanging e-mail with the governor about how to mount a bipartisan effort to avert a plant closing.
Sharon Ruhland, chief of staff for Dayton's Minnesota office, said she thought it was "kind of petty" for Pawlenty not to coordinate his trip and include other elected officials.
"More importantly, we want to do what we can to help. Mark has said he was ready to go and he absolutely would have gone," said Ruhland, who released a record of e-mail requests from Dayton's aides pressing for a bipartisan delegation of elected officials to begin lobbying Ford.
Pawlenty's spokesman, Brian McClung, said the governor "welcomes the involvement of Senator Dayton and the congressional delegation, and this meeting will not be the final word."
Ford hasn't even announced what it will do, McClung said, and "from our perspective this meeting is an informal fact-finding trip, an opportunity to explore Ford's needs and challenges. ... We expect there will be follow-up conversations."
Dane Smith • 651-292-0164
***
The latest must-have for teens: Caffeine
Even preteens are guzzling energy drinks and gourmet lattes, but experts question the effects on developing bodies and minds.
Joy Powell, Star Tribune
Last update: January 07, 2006 – 10:24 PM
The Caribou Coffee shop manager in Oak Park Heights recalls her amazement last fall when a boy who looked to be about 8 years old ordered a cappuccino.
He was an especially young example of a growing trend: preteens and older kids guzzling java and caffeine-laced energy drinks.
"I'd think it would stunt their growth," said the Caribou manager, Beth Haverman, who tries to steer her youngest customers toward caffeine-free drinks.
"When I was a kid, my parents would never let me drink coffee -- and I didn't want to."
Caffeine won't stunt growth, experts say, and it does have some benefits, including heightened alertness. But it also can cause jitters, dependence, sleeplessness and higher blood pressure. It's the most widely used mood-altering drug in the world.
In recent years, the U.S. thirst for gourmet coffee has dripped down from yuppies to college students to teenagers and even to some grade-school kids.
Today's youth, with more spending power than ever, increasingly fuel the $22 billion coffee industry and the $3 billion energy-drink industry.
Aggressive marketing is helping to shape young tastes amid a widening array of caffeine-based products.
"It's hip and trendy," said Robin Vought, a band teacher at Oak-Land Junior High School in Lake Elmo.
Vought added: "So kids who are trying to keep up with their peers not only need the clothes and jewelry and brand names on everything, they have to walk into school with a cup in their hand."
Labels offer mixed messages
There's little research into the effects of caffeine on developing minds and bodies, or on how easily children might get hooked on caffeine. But that doesn't worry the young.
On the slopes of Wild Mountain near Taylors Falls, 12-year-old Brady Telstad chugged a can of Red Bull Energy Drink before a long day of snowboarding. He said he has been drinking coffee since age 5 and got a cappuccino machine for Christmas.
When he wearily left the mountain, Telstad, a seventh-grader from West Lakeland Township, exclaimed: "I would have never lasted without that Red Bull."
The energy-drink industry is targeting young consumers with product names such as Monster, Full Throttle and Amp -- and is making claims that some researchers question.
Red Bull appeals both to athletes and those concerned about their weight. Promos on the can promise improved performance under stress, better concentration, quicker reaction speeds and a revved metabolism.
Although top-seller Red Bull does not offer a warning, labels on some other energy drinks caution that children, pregnant or nursing women, or those sensitive to caffeine should refrain.
The 16 oz. Monster Energy can advises consumers to limit themselves to three cans a day. It doesn't specify whether children should drink even less.
Monster is touted as "a wicked energy brew that delivers twice the buzz of a regular energy drink." It contains caffeine, the stimulating herb guarana, ginseng, sugars and more.
No U.S. laws stop stores from selling such products to children, though a few countries have not approved the products, pending more research on the interaction of caffeine with ingredients such as ma huang, ginseng and guarana.
From energy drinks to specialty coffees, legions of kids are gulping far more than recommended daily limits of caffeine, experts say.
"I would be concerned about long-term effects," said Dr. Michael McGinnis, chairman of the Committee on Food Marketing and the Diets of Children and senior scholar at the Institute of Medicine at the National Academy of Sciences.
Caffeine isn't the only concern. Lattes and other drinks loaded with whipped cream, chocolate, caramel and more can pack up to 500 calories each and supplant nutritious food, said Dr. Roger Clemens, a food scientist and a professor with the University of Southern California School of Pharmacy.
"The concern really is the calories that they're consuming and the absence of exercise," Clemens said.
Kid klatches
In the past 20 years, the spending power of children younger than 18 has soared to about $200 billion a year, McGinnis said, with children younger than 12 spending about $30 billion.
"The top four products that kids under 12 report that they can buy on their own without parents' permission are all food and beverages," McGinnis said.
Kids shell out about $2 for each energy drink, and plenty more for frothy coffee beverages.
"They want the lattes," said Caribou employee MaryBeth Peller at a Stillwater shop that packs in teens and preteens. "They want the holiday specials. They want the mochas. Coolers are big."
The sun wasn't up yet Thursday when four high school girls sat by a Caribou fireplace with drinks, text books and a beagle puppy. Among them was Sina Mc- Cune, 17, who often totes home a sugary coffee drink to placate her 12-year-old sister.
"I usually go to Dunn Bros. for friends and talking," McCune said. "I go to Starbucks to study homework, and I go to Caribou to chill."
Her friend, Carrie Adamic, 18, of Stillwater, said she acquired her taste for the brew a year ago. "I drink coffee straight up," Adamic said. "I think as you get older, you want coffee to stay awake."
Adamic, who works at a clothing store after school, is like many teenagers who start their frenetic days before dawn and end them late.
A caffeinated lifestyle
Red Bull, created in Austria, hit U.S. store shelves in 1997 and has driven sales by sponsoring extreme-sports events such as snowboarding. Other energy drink-makers followed with similar strategies.
Michael Coles, CEO of Minnesota-based Caribou, said he knows some preteens are drinking coffee, and he has received a few e-mails from kids as young as 10 who love his products. But there's nothing wrong with that, he said, as long as kids drink them responsibly.
"Certainly, nobody should come in and have five or six lattes," Coles said.
Experts agree that moderation is key.
Caffeine in big doses can induce sweating, high blood pressure and heart palpitations. Those palpitations won't necessarily hurt someone with a healthy heart, but they are a warning to back off the caffeine, said Jamie Stang, director of the maternal and child nutrition training program in the University of Minnesota School of Public Health.
"The idea that it's affecting the body to the point that it causes your heart to palpitate means it's affecting other systems as well, so it should be a warning sign that you've hit an overload level," Stang said. "At that point, it's going to be affecting your kidneys and liver and everything else."
Teenagers should consume no more than 100 milligrams of caffeine a day, some experts say -- the equivalent of about two cans of soda. A 12-ounce gourmet coffee drink, however, can contain about 190 milligrams of caffeine.
Vought, the band teacher, won't let her own teenagers drink coffee and said other parents should take a hard look at how much caffeine their kids are pounding down.
"Their bodies are so messed up anyway with their hormones," she said. "Anytime you introduce a foreign substance, it plays with nature."
Joy Powell • 612-673-7750
***
A billion Chinese, growing older
In just four years, China could be the third-largest market in the world for medical technology products. But the market is vastly different from any other, and often it's a confounding one for companies to negotiate.
Janet Moore, Star Tribune
Last update: January 07, 2006 – 5:51 PM
SHANGHAI - Come the first Monday of each month, a phalanx of patients descends upon Xin Hua Hospital here to have their pacemakers checked in an important, often lifesaving, ritual.
Sun Yu Hua, a technical sales representative for Medtronic Inc., strode past a line of them recently and hoisted one of the company's 24-pound programming devices onto a desk in a cramped cubicle. The throng grew anxious.
"Where have you been?" several shouted. "We've been waiting!" They elbowed their way into the 4-by-6-foot space. An elderly man in an adjacent cubicle peered over the partition at the programmer, which communicates with pacemakers and resembles a hefty laptop computer.
Sun flashed a dimpled smile but said nothing as the programmer booted up.
There are perhaps 300 of these devices in China, plus several hundred technical reps like Sun who negotiate the front lines of one of the most promising, yet confounding, medical technology markets in the world.
China, home to a quarter of the world's population, is projected to become the third-largest med-tech market by 2010 with $15 billion in sales, according to the investment firm Goldman Sachs. Estimates of the current market range from $2.6 billion to $10 billion.
It's a country that presents enormous opportunities for Minnesota companies such as Medtronic and St. Jude Medical Inc., and those with local ties, including Boston Scientific Corp. and Guidant Corp., which have set aggressive annual growth targets.
While China's aging population increasingly will need devices to pace their hearts and unclog their arteries, the companies that make them must ply a disorganized health care system, the threat of intellectual property theft, spotty government reimbursement for products and a lack of public awareness about device therapy.
Still, these manufacturers come. "As might be expected by its tremendous diversity and dramatic growth, China presents a remarkable mix of challenges and opportunities for the medical device industry," said Dr. Joseph Smith, chief medical officer and senior vice president for Guidant's cardiac rhythm management division, which is based in Arden Hills.
Fewer 'barefoot doctors'
Sun slipped several electrocardiogram patches from a Mylar sleeve and placed them on 68-year-old Zheng Guotai's ankle and wrist. She then moved a mouse-like device -- actually a type of antenna -- over his heart, and studied the transmitted data on the programmer's screen.
Typically a pacemaker needs to be checked twice a year. In the United States, this can be done over the Internet. But in China, where home Internet connections can be sparse, a check-up usually requires a trip to a hospital. A pacemaker's battery can last up to 10 years, and after that, it must be replaced.
That was the case with Sun's first patient. Dr. Qui Fen Lu, an attending cardiologist, told Zheng that he needed a new pacemaker -- and right away. Zheng appeared befuddled and argued the point amid growing chaos in the waiting room. A fire alarm sounded, but everyone ignored it.
Zheng finally relented and left to check into the hospital.
"The Chinese are enormously patient," said Nancy Travis, associate vice president of global strategy and analysis for the Advanced Medical Technology Association, or AdvaMed, a Washington-based industry association.
"To wait for hours to buy a train ticket or to see a doctor is accepted as a normal way of doing things," Travis said. "Privacy is not a great preoccupation, and this is a very crowded country."
Conditions may seem crude by Western standards, but these patients are among the few who can actually afford med-tech therapy.
Since the Communist revolution in 1949, China has relied on socialized medicine. Collective farms and factory communes paid for health care. In rural areas, "barefoot doctors" provided medical services in a basic but efficient manner.
As the economy has boomed, China's health care system has imploded, creating a situation that is ripe for reform. Currently, patients must pay cash upfront for most medical services and for many devices.
"The average Chinese family's disposable income is increasing rapidly, so there is more money to spend," said Victor Tsui, vice president and general manager of Fridley-based Medtronic's operations in China. "China has one of the highest savings rates in the world, and culturally we spend it on our children's education and health care."
Only 20 to 25 percent of the estimated 1.3 billion Chinese have some form of health insurance -- mostly residents on the urban and relatively affluent east coast, according to the Goldman Sachs report. So that leaves more than 970 million people who pay for most health care themselves.
Which is just as well, because government reimbursement for drugs and devices is not terribly exhaustive and varies between provinces and cities. The labyrinth of regulations is difficult to negotiate, Tsui said.
In truth, many Chinese do not treat their illnesses simply because they can't afford to. In a study published by the World Health Organization last year, half of the patients surveyed said they had been ill but did not seek treatment because of cost. Among those who did go to a hospital, nearly half discharged themselves against a doctor's advice because they could not afford continuing care.
Wealth shifts focus on ailments
At the same time, the need for medical devices grows, particularly for those treating heart maladies. In recent years, public health priorities in China have shifted from the reduction in infant mortality and control of infectious diseases -- often the case in developing nations -- to chronic diseases, such as heart disease, according to the New England Journal of Medicine. This is particularly true among China's increasingly affluent middle class.
China's rapid economic development also has brought with it adverse changes in lifestyle that mimic problems in the West, such as a higher dietary fat intake and insufficient physical activity. It's easy to spot for even the casual observer: Beijing's broad boulevards, once a haven for bicycles, are now clogged with traffic. The air is seriously fouled throughout the country. And the Chinese are fervent smokers -- one published report estimates the country has 320 million of them.
The study of 20,033 Chinese adults recently published in the New England Journal indicated that diseases of the heart were among the top three causes of death among those 40 and older.
In 2004, more than 20 percent of the Chinese population was at least 50 -- a percentage that is predicted to double by 2040. This aging population will put more pressure on an already-creaking health care system.
"The problem isn't that we don't have enough patients," said Dr. Liu Zhigang, a top cardiologist in Shanghai, as he conducted a recent pacemaker clinic at Shanghai Chest Hospital. "It's that patients still cannot afford these therapies."
Cultural hurdles impede sales
Beyond cost, another challenge for med-tech companies involves marketing their products to such a vast population and to the physicians who implant the devices.
"Twenty years ago, people didn't know why they died," said Tsui, of Medtronic. " 'Just because,' was the reason. These days, everybody knows the cause of death. The next stage is how to treat people. Now the understanding of disease is greatly improved."
Educating the public about medical technology products is key, because many patients essentially diagnose themselves if they have a medical problem, Tsui said.
"The alarming thing in China is the almost total absence of primary care," said Travis, of AdvaMed. "Even in cities, there are no independent doctors' offices or neighborhood clinics, so people have to go to the hospital for every health care need."
Because there are no general practitioners to steer patients to the appropriate specialist, patients often misdiagnose themselves and are treated for the wrong problem as a result.
Medtronic operates about 25 websites in Chinese to market its products to patients and doctors.
In addition, patients often use China's vaunted web of relationships, called guanxi, to help select the best doctors and hospitals.
If patients have the money, they usually see the doctor of their choice. It also is quite common for them to pay a little extra under-the-table or "red envelopes" for better doctors and service in hospitals, a thinly veiled form of bribery.
The government frowns upon these arrangements. At Xin Hua Hospital, an electronic billboard in the hospital's lobby states: "Beware of the Red Envelope" -- a reference to money envelopes traditionally received by children on Chinese New Year.
Physician training a priority
In addition to patient education, training among doctors in China varies widely. "In some cases, a specialist may have only one day of pacemaker training in medical school," Tsui said. So if a doctor is not aware of a specific med-tech treatment, then it's unlikely he will prescribe it.
"Doctors and nurses are very poorly paid [in China]," Travis said. "Training for doctors ranges from a two-year course to programs that are equivalent to those offered by Western medical schools. Specialists are generally well-trained, but there is no national body that sets standards and assesses competency."
That means the companies themselves must educate doctors about their products. In that vein, Medtronic is setting up a training center on pacemaker implantation in Shanghai. And Boston Scientific, whose cardiovascular division is based in Maple Grove, is working with China's Ministry of Health to offer seminars on their products for doctors at key hospitals.
"We see ourselves as partners in part of the solution here," said Daniel Moore, president for Intercontinental at Boston Scientific. "Part of that is, 'How do you partner beyond merely providing the product to help train these physicians so they can treat patients?' "
Dr. Liu said pacemaker implantation at Shanghai Chest Hospital has been growing about 10 percent a year, but he's still frustrated that patients in need of the therapy are not receiving it. Beyond the cost issue, he says, "doctors are not so familiar with pacemakers. When patients come, often they are taking medicine prescribed for the problem," a method of treatment that doesn't always work.
Competitors still few
Despite China's massive population and the growing need for cardiac devices, the Goldman Sachs report says most medical device companies see little potential in China and do not consider early market entry a priority. These latecomers, the report concludes, could miss the boat.
The Chinese medical device market grew by 19 percent in 2003 and is expected to sustain annual growth of about 15 percent during the next decade, which would make it the third-largest medical device market in the world by 2010, behind Japan and the United States.
Most major device companies with Minnesota ties have been doing business in China for years and compete largely among themselves for business, a situation no different from the United States.
To date, serious domestic competition has not emerged, partly because Chinese products are perceived by consumers to be of lower quality than devices made in the West.
But that could be changing. Shanghai-based Microport Medical Corp., which makes interventional and minimally invasive cardiac devices, is determined to compete on equal footing against rivals such as Boston Scientific and Johnson & Johnson.
When CEO Michael Zhang took over the company in 2002, it was $3.5 million in debt and its products -- by his own admission -- were "really bad." Thanks to an undisclosed cash infusion by the privately held Japanese pharmaceutical concern Otsuka Pharmaceutical Group, Microport is now debt-free and has developed a drug-coated heart stent, already a blockbuster device in the West. The company, now China's largest med-tech firm, hopes to go public on the Nasdaq Stock Market this year.
A native of Sichuan province, Zhang, 37, is a former engineer with Guidant who was educated at the University of Toledo in Ohio. A top lieutenant, 33-year-old Ruilin Zhao, vice president of business development and strategic planning, earned a doctorate from Harvard University and the Massachusetts Institute of Technology in health sciences and technology, and a master's in business administration from the Wharton School at the University of Pennsylvania.
The soft-spoken Zhang conceded that it's difficult competing against American companies but says there's enough demand in China for his company's products, particularly its drug-coated stent, called Firebird.
When asked about the product's unusual name, Zhang chuckled. "I really like cars," he said.
Janet Moore • 612-673-7752
$15 billion
What China's medical technology market is expected to be by 2010, putting it third in the world behind the United States and Japan.
After days of healing,
he would get away to fish.
Curator of fluff and feathers,
he tied his own flies,
designed his own waders
and up to the lake country
for trout and walleye.
I would ask him, what is it
out there on the water,
and he would say, all week
I swim lead for my school of patients,
take this, take that,
don't eat this, don't eat that,
I tell them swim away from the hook,
don't take that bait, that bug there
has sharp metal innards,
that worm glints steel,
but we are such dumb fish,
such sorry things that we all get pulled
from our lives.
So, weekends,
I choose to be the redresser of balances.
I know that he hid behind this facile
diagnosis because I went with him once
and as we stood thigh-deep
in the cold and clear lake,
he began his meticulous detailings,
the striations of the bottom rocks
and how each different sediment
reflects the light, the distribution
of firs along the shore,
the speckling of the speckled trout
and each thing, he said,
is a symptom and so a clue
into the fevered chemistry of beauty.
And if you're in the mood for a little contrast...
Eagan man charged in decapitation death of stepmother
A 23-year-old man is accused of killing his stepmother Friday after his parents tried to get medical help for him. His lawyer said he plans a mental illness defense.
Jim Adams, Star Tribune
Last update: January 05, 2006 – 8:31 AM
A 23-year-old Eagan man with a history of mental illness was charged Tuesday with the grisly slaying of his stepmother in his father's Burnsville home.
Stephen R. Miles is charged with one count of second-degree murder. He is being held in the Dakota County jail without bail pending an evaluation to determine his mental competency.
The charges said Miles hit his stepmother in the head with a hatchet and then decapitated her with a knife in the kitchen about 9 p.m. Friday.
Miles told police that his father and mother took him to the doctor Friday morning after he asked for help because something was wrong with his head. He said he didn't want to wait for his upcoming neurologist appointment. The complaint continued:
An emergency room physician at Fairview Southdale Hospital in Edina said no beds were available. The doctor suggested they go to the University of Minnesota Medical Center's Riverside campus in Minneapolis, but Stephen Miles wouldn't go, his father, Roland Miles, told police.
They returned to the Eagan home where Stephen Miles lived with his mother and grandmother. The father and son then went to the father's home to play chess.
Stephen Miles told police that when they arrived, his father's wife, Maris Jo Miles, 68, was upset that they had been at the Eagan home and asked them both to leave. Roland Miles asked his son to go outside and help him clear snow from the driveway.
Stephen Miles said he got a hatchet from the garage and went into the kitchen. He hit his stepmother in the head several times with the hatchet blade and cut off her head with a knife. Then he went outside and told his father what he had done. His father ran into the house, saw his wife's body and called 911.
Police found the son sitting by his father on a patio bench at the house. The knife and hatchet were found near the victim.
Police said Stephen Miles has no criminal or violent history. But police were called in October to his home in Eagan. Miles had not taken his medication and tried to pry a filling out of his mouth because he thought it was a tracking device, said police spokeswoman Danielle Anselment.
Miles' attorney, Marsh Halberg, said Miles has had mental health problems, including depression, since he was 6 years old but the episodes have grown worse recently.
Halberg said he will present a mental illness defense.
Fairview Health Services, which operates Fairview Southdale Hospital, said that it is doing a full review of the case but that no patient needing a bed is turned away. Spokesman Ryan Davenport said privacy laws prevent discussing the case, but added in a statement: "Any patient who presents for care at our emergency department receives medical evaluation and treatment."
Pawlenty heading to Detroit to try to head off plant closing
Pawlenty flies to Michigan today to plead with Ford Motor Co. executives for retention of Minnesota jobs.
Dane Smith, Star Tribune
Last update: January 04, 2006 – 9:30 AM
Gov. Tim Pawlenty will meet with reporters at the Ford Motor Co. plant in St. Paul today after his trip to Detroit in an attempt to persuade Ford executives to preserve 2,000 jobs at the plant, either by continuing Ranger pickup truck production there or by converting it to a new facility for "flexible fuel" vehicles or engines.
"Our goal is keeping Minnesotans employed," said Matt Kramer, commissioner of the state Employment and Economic Development Department; he will accompany Pawlenty. "What gets made here is Ford's decision."
Speculation that the plant is on a list of planned Ford closures was sparked by a Wall Street Journal article in early December. On Tuesday, Ford said it would announce details of its restructuring plan, including job cuts and plant closures, on Jan. 23.
Kramer said there is reason for optimism.
He said recent reports by the Detroit media suggest the St. Paul plant is not on the list of most likely shutdowns.
Kramer said the governor will emphasize that Minnesota is far ahead of other states in research and development on alternative fuels and that the state already has "the nucleus of a flexible-fuel strategy."
Pawlenty has tried to carve out a niche as the nation's leading governor in promoting alternative fuels. Minnesota, with no oil or gas but plenty of corn and other crops that can be converted to fuels, stands to benefit, he contends.
He helped push through legislation that would increase the ethanol content in Minnesota gasoline, and his official vehicle runs on 85 percent ethanol. He is the chairman of a National Governors Association panel on alternative fuels.
Minnesota, led by agribusiness giant Cargill and the University of Minnesota, already is a national leader in public and private initiatives to develop alternative fuels, Kramer said.
"What we intend to do is sit down with Ford and say that if you want to be part of the revolution in alternative fuels, you need to consider the matrix here ... Minnesota can help Ford."
Kramer said the options do not necessarily have to involve saving the existing plant.
"The plant is in the heart of a beautiful neighborhood and on a scenic river" and may be put to better use, he said. "We want the jobs in Minnesota and the Twin Cities, but it doesn't have to be in Highland Park," he said.
A little tension
Republican Pawlenty's trip sparked a little tension with U.S. Sen. Mark Dayton, a Democrat whose office has been exchanging e-mail with the governor about how to mount a bipartisan effort to avert a plant closing.
Sharon Ruhland, chief of staff for Dayton's Minnesota office, said she thought it was "kind of petty" for Pawlenty not to coordinate his trip and include other elected officials.
"More importantly, we want to do what we can to help. Mark has said he was ready to go and he absolutely would have gone," said Ruhland, who released a record of e-mail requests from Dayton's aides pressing for a bipartisan delegation of elected officials to begin lobbying Ford.
Pawlenty's spokesman, Brian McClung, said the governor "welcomes the involvement of Senator Dayton and the congressional delegation, and this meeting will not be the final word."
Ford hasn't even announced what it will do, McClung said, and "from our perspective this meeting is an informal fact-finding trip, an opportunity to explore Ford's needs and challenges. ... We expect there will be follow-up conversations."
Dane Smith • 651-292-0164
The latest must-have for teens: Caffeine
Even preteens are guzzling energy drinks and gourmet lattes, but experts question the effects on developing bodies and minds.
Joy Powell, Star Tribune
Last update: January 07, 2006 – 10:24 PM
The Caribou Coffee shop manager in Oak Park Heights recalls her amazement last fall when a boy who looked to be about 8 years old ordered a cappuccino.
He was an especially young example of a growing trend: preteens and older kids guzzling java and caffeine-laced energy drinks.
"I'd think it would stunt their growth," said the Caribou manager, Beth Haverman, who tries to steer her youngest customers toward caffeine-free drinks.
"When I was a kid, my parents would never let me drink coffee -- and I didn't want to."
Caffeine won't stunt growth, experts say, and it does have some benefits, including heightened alertness. But it also can cause jitters, dependence, sleeplessness and higher blood pressure. It's the most widely used mood-altering drug in the world.
In recent years, the U.S. thirst for gourmet coffee has dripped down from yuppies to college students to teenagers and even to some grade-school kids.
Today's youth, with more spending power than ever, increasingly fuel the $22 billion coffee industry and the $3 billion energy-drink industry.
Aggressive marketing is helping to shape young tastes amid a widening array of caffeine-based products.
"It's hip and trendy," said Robin Vought, a band teacher at Oak-Land Junior High School in Lake Elmo.
Vought added: "So kids who are trying to keep up with their peers not only need the clothes and jewelry and brand names on everything, they have to walk into school with a cup in their hand."
Labels offer mixed messages
There's little research into the effects of caffeine on developing minds and bodies, or on how easily children might get hooked on caffeine. But that doesn't worry the young.
On the slopes of Wild Mountain near Taylors Falls, 12-year-old Brady Telstad chugged a can of Red Bull Energy Drink before a long day of snowboarding. He said he has been drinking coffee since age 5 and got a cappuccino machine for Christmas.
When he wearily left the mountain, Telstad, a seventh-grader from West Lakeland Township, exclaimed: "I would have never lasted without that Red Bull."
The energy-drink industry is targeting young consumers with product names such as Monster, Full Throttle and Amp -- and is making claims that some researchers question.
Red Bull appeals both to athletes and those concerned about their weight. Promos on the can promise improved performance under stress, better concentration, quicker reaction speeds and a revved metabolism.
Although top-seller Red Bull does not offer a warning, labels on some other energy drinks caution that children, pregnant or nursing women, or those sensitive to caffeine should refrain.
The 16 oz. Monster Energy can advises consumers to limit themselves to three cans a day. It doesn't specify whether children should drink even less.
Monster is touted as "a wicked energy brew that delivers twice the buzz of a regular energy drink." It contains caffeine, the stimulating herb guarana, ginseng, sugars and more.
No U.S. laws stop stores from selling such products to children, though a few countries have not approved the products, pending more research on the interaction of caffeine with ingredients such as ma huang, ginseng and guarana.
From energy drinks to specialty coffees, legions of kids are gulping far more than recommended daily limits of caffeine, experts say.
"I would be concerned about long-term effects," said Dr. Michael McGinnis, chairman of the Committee on Food Marketing and the Diets of Children and senior scholar at the Institute of Medicine at the National Academy of Sciences.
Caffeine isn't the only concern. Lattes and other drinks loaded with whipped cream, chocolate, caramel and more can pack up to 500 calories each and supplant nutritious food, said Dr. Roger Clemens, a food scientist and a professor with the University of Southern California School of Pharmacy.
"The concern really is the calories that they're consuming and the absence of exercise," Clemens said.
Kid klatches
In the past 20 years, the spending power of children younger than 18 has soared to about $200 billion a year, McGinnis said, with children younger than 12 spending about $30 billion.
"The top four products that kids under 12 report that they can buy on their own without parents' permission are all food and beverages," McGinnis said.
Kids shell out about $2 for each energy drink, and plenty more for frothy coffee beverages.
"They want the lattes," said Caribou employee MaryBeth Peller at a Stillwater shop that packs in teens and preteens. "They want the holiday specials. They want the mochas. Coolers are big."
The sun wasn't up yet Thursday when four high school girls sat by a Caribou fireplace with drinks, text books and a beagle puppy. Among them was Sina Mc- Cune, 17, who often totes home a sugary coffee drink to placate her 12-year-old sister.
"I usually go to Dunn Bros. for friends and talking," McCune said. "I go to Starbucks to study homework, and I go to Caribou to chill."
Her friend, Carrie Adamic, 18, of Stillwater, said she acquired her taste for the brew a year ago. "I drink coffee straight up," Adamic said. "I think as you get older, you want coffee to stay awake."
Adamic, who works at a clothing store after school, is like many teenagers who start their frenetic days before dawn and end them late.
A caffeinated lifestyle
Red Bull, created in Austria, hit U.S. store shelves in 1997 and has driven sales by sponsoring extreme-sports events such as snowboarding. Other energy drink-makers followed with similar strategies.
Michael Coles, CEO of Minnesota-based Caribou, said he knows some preteens are drinking coffee, and he has received a few e-mails from kids as young as 10 who love his products. But there's nothing wrong with that, he said, as long as kids drink them responsibly.
"Certainly, nobody should come in and have five or six lattes," Coles said.
Experts agree that moderation is key.
Caffeine in big doses can induce sweating, high blood pressure and heart palpitations. Those palpitations won't necessarily hurt someone with a healthy heart, but they are a warning to back off the caffeine, said Jamie Stang, director of the maternal and child nutrition training program in the University of Minnesota School of Public Health.
"The idea that it's affecting the body to the point that it causes your heart to palpitate means it's affecting other systems as well, so it should be a warning sign that you've hit an overload level," Stang said. "At that point, it's going to be affecting your kidneys and liver and everything else."
Teenagers should consume no more than 100 milligrams of caffeine a day, some experts say -- the equivalent of about two cans of soda. A 12-ounce gourmet coffee drink, however, can contain about 190 milligrams of caffeine.
Vought, the band teacher, won't let her own teenagers drink coffee and said other parents should take a hard look at how much caffeine their kids are pounding down.
"Their bodies are so messed up anyway with their hormones," she said. "Anytime you introduce a foreign substance, it plays with nature."
Joy Powell • 612-673-7750
A billion Chinese, growing older
In just four years, China could be the third-largest market in the world for medical technology products. But the market is vastly different from any other, and often it's a confounding one for companies to negotiate.
Janet Moore, Star Tribune
Last update: January 07, 2006 – 5:51 PM
SHANGHAI - Come the first Monday of each month, a phalanx of patients descends upon Xin Hua Hospital here to have their pacemakers checked in an important, often lifesaving, ritual.
Sun Yu Hua, a technical sales representative for Medtronic Inc., strode past a line of them recently and hoisted one of the company's 24-pound programming devices onto a desk in a cramped cubicle. The throng grew anxious.
"Where have you been?" several shouted. "We've been waiting!" They elbowed their way into the 4-by-6-foot space. An elderly man in an adjacent cubicle peered over the partition at the programmer, which communicates with pacemakers and resembles a hefty laptop computer.
Sun flashed a dimpled smile but said nothing as the programmer booted up.
There are perhaps 300 of these devices in China, plus several hundred technical reps like Sun who negotiate the front lines of one of the most promising, yet confounding, medical technology markets in the world.
China, home to a quarter of the world's population, is projected to become the third-largest med-tech market by 2010 with $15 billion in sales, according to the investment firm Goldman Sachs. Estimates of the current market range from $2.6 billion to $10 billion.
It's a country that presents enormous opportunities for Minnesota companies such as Medtronic and St. Jude Medical Inc., and those with local ties, including Boston Scientific Corp. and Guidant Corp., which have set aggressive annual growth targets.
While China's aging population increasingly will need devices to pace their hearts and unclog their arteries, the companies that make them must ply a disorganized health care system, the threat of intellectual property theft, spotty government reimbursement for products and a lack of public awareness about device therapy.
Still, these manufacturers come. "As might be expected by its tremendous diversity and dramatic growth, China presents a remarkable mix of challenges and opportunities for the medical device industry," said Dr. Joseph Smith, chief medical officer and senior vice president for Guidant's cardiac rhythm management division, which is based in Arden Hills.
Fewer 'barefoot doctors'
Sun slipped several electrocardiogram patches from a Mylar sleeve and placed them on 68-year-old Zheng Guotai's ankle and wrist. She then moved a mouse-like device -- actually a type of antenna -- over his heart, and studied the transmitted data on the programmer's screen.
Typically a pacemaker needs to be checked twice a year. In the United States, this can be done over the Internet. But in China, where home Internet connections can be sparse, a check-up usually requires a trip to a hospital. A pacemaker's battery can last up to 10 years, and after that, it must be replaced.
That was the case with Sun's first patient. Dr. Qui Fen Lu, an attending cardiologist, told Zheng that he needed a new pacemaker -- and right away. Zheng appeared befuddled and argued the point amid growing chaos in the waiting room. A fire alarm sounded, but everyone ignored it.
Zheng finally relented and left to check into the hospital.
"The Chinese are enormously patient," said Nancy Travis, associate vice president of global strategy and analysis for the Advanced Medical Technology Association, or AdvaMed, a Washington-based industry association.
"To wait for hours to buy a train ticket or to see a doctor is accepted as a normal way of doing things," Travis said. "Privacy is not a great preoccupation, and this is a very crowded country."
Conditions may seem crude by Western standards, but these patients are among the few who can actually afford med-tech therapy.
Since the Communist revolution in 1949, China has relied on socialized medicine. Collective farms and factory communes paid for health care. In rural areas, "barefoot doctors" provided medical services in a basic but efficient manner.
As the economy has boomed, China's health care system has imploded, creating a situation that is ripe for reform. Currently, patients must pay cash upfront for most medical services and for many devices.
"The average Chinese family's disposable income is increasing rapidly, so there is more money to spend," said Victor Tsui, vice president and general manager of Fridley-based Medtronic's operations in China. "China has one of the highest savings rates in the world, and culturally we spend it on our children's education and health care."
Only 20 to 25 percent of the estimated 1.3 billion Chinese have some form of health insurance -- mostly residents on the urban and relatively affluent east coast, according to the Goldman Sachs report. So that leaves more than 970 million people who pay for most health care themselves.
Which is just as well, because government reimbursement for drugs and devices is not terribly exhaustive and varies between provinces and cities. The labyrinth of regulations is difficult to negotiate, Tsui said.
In truth, many Chinese do not treat their illnesses simply because they can't afford to. In a study published by the World Health Organization last year, half of the patients surveyed said they had been ill but did not seek treatment because of cost. Among those who did go to a hospital, nearly half discharged themselves against a doctor's advice because they could not afford continuing care.
Wealth shifts focus on ailments
At the same time, the need for medical devices grows, particularly for those treating heart maladies. In recent years, public health priorities in China have shifted from the reduction in infant mortality and control of infectious diseases -- often the case in developing nations -- to chronic diseases, such as heart disease, according to the New England Journal of Medicine. This is particularly true among China's increasingly affluent middle class.
China's rapid economic development also has brought with it adverse changes in lifestyle that mimic problems in the West, such as a higher dietary fat intake and insufficient physical activity. It's easy to spot for even the casual observer: Beijing's broad boulevards, once a haven for bicycles, are now clogged with traffic. The air is seriously fouled throughout the country. And the Chinese are fervent smokers -- one published report estimates the country has 320 million of them.
The study of 20,033 Chinese adults recently published in the New England Journal indicated that diseases of the heart were among the top three causes of death among those 40 and older.
In 2004, more than 20 percent of the Chinese population was at least 50 -- a percentage that is predicted to double by 2040. This aging population will put more pressure on an already-creaking health care system.
"The problem isn't that we don't have enough patients," said Dr. Liu Zhigang, a top cardiologist in Shanghai, as he conducted a recent pacemaker clinic at Shanghai Chest Hospital. "It's that patients still cannot afford these therapies."
Cultural hurdles impede sales
Beyond cost, another challenge for med-tech companies involves marketing their products to such a vast population and to the physicians who implant the devices.
"Twenty years ago, people didn't know why they died," said Tsui, of Medtronic. " 'Just because,' was the reason. These days, everybody knows the cause of death. The next stage is how to treat people. Now the understanding of disease is greatly improved."
Educating the public about medical technology products is key, because many patients essentially diagnose themselves if they have a medical problem, Tsui said.
"The alarming thing in China is the almost total absence of primary care," said Travis, of AdvaMed. "Even in cities, there are no independent doctors' offices or neighborhood clinics, so people have to go to the hospital for every health care need."
Because there are no general practitioners to steer patients to the appropriate specialist, patients often misdiagnose themselves and are treated for the wrong problem as a result.
Medtronic operates about 25 websites in Chinese to market its products to patients and doctors.
In addition, patients often use China's vaunted web of relationships, called guanxi, to help select the best doctors and hospitals.
If patients have the money, they usually see the doctor of their choice. It also is quite common for them to pay a little extra under-the-table or "red envelopes" for better doctors and service in hospitals, a thinly veiled form of bribery.
The government frowns upon these arrangements. At Xin Hua Hospital, an electronic billboard in the hospital's lobby states: "Beware of the Red Envelope" -- a reference to money envelopes traditionally received by children on Chinese New Year.
Physician training a priority
In addition to patient education, training among doctors in China varies widely. "In some cases, a specialist may have only one day of pacemaker training in medical school," Tsui said. So if a doctor is not aware of a specific med-tech treatment, then it's unlikely he will prescribe it.
"Doctors and nurses are very poorly paid [in China]," Travis said. "Training for doctors ranges from a two-year course to programs that are equivalent to those offered by Western medical schools. Specialists are generally well-trained, but there is no national body that sets standards and assesses competency."
That means the companies themselves must educate doctors about their products. In that vein, Medtronic is setting up a training center on pacemaker implantation in Shanghai. And Boston Scientific, whose cardiovascular division is based in Maple Grove, is working with China's Ministry of Health to offer seminars on their products for doctors at key hospitals.
"We see ourselves as partners in part of the solution here," said Daniel Moore, president for Intercontinental at Boston Scientific. "Part of that is, 'How do you partner beyond merely providing the product to help train these physicians so they can treat patients?' "
Dr. Liu said pacemaker implantation at Shanghai Chest Hospital has been growing about 10 percent a year, but he's still frustrated that patients in need of the therapy are not receiving it. Beyond the cost issue, he says, "doctors are not so familiar with pacemakers. When patients come, often they are taking medicine prescribed for the problem," a method of treatment that doesn't always work.
Competitors still few
Despite China's massive population and the growing need for cardiac devices, the Goldman Sachs report says most medical device companies see little potential in China and do not consider early market entry a priority. These latecomers, the report concludes, could miss the boat.
The Chinese medical device market grew by 19 percent in 2003 and is expected to sustain annual growth of about 15 percent during the next decade, which would make it the third-largest medical device market in the world by 2010, behind Japan and the United States.
Most major device companies with Minnesota ties have been doing business in China for years and compete largely among themselves for business, a situation no different from the United States.
To date, serious domestic competition has not emerged, partly because Chinese products are perceived by consumers to be of lower quality than devices made in the West.
But that could be changing. Shanghai-based Microport Medical Corp., which makes interventional and minimally invasive cardiac devices, is determined to compete on equal footing against rivals such as Boston Scientific and Johnson & Johnson.
When CEO Michael Zhang took over the company in 2002, it was $3.5 million in debt and its products -- by his own admission -- were "really bad." Thanks to an undisclosed cash infusion by the privately held Japanese pharmaceutical concern Otsuka Pharmaceutical Group, Microport is now debt-free and has developed a drug-coated heart stent, already a blockbuster device in the West. The company, now China's largest med-tech firm, hopes to go public on the Nasdaq Stock Market this year.
A native of Sichuan province, Zhang, 37, is a former engineer with Guidant who was educated at the University of Toledo in Ohio. A top lieutenant, 33-year-old Ruilin Zhao, vice president of business development and strategic planning, earned a doctorate from Harvard University and the Massachusetts Institute of Technology in health sciences and technology, and a master's in business administration from the Wharton School at the University of Pennsylvania.
The soft-spoken Zhang conceded that it's difficult competing against American companies but says there's enough demand in China for his company's products, particularly its drug-coated stent, called Firebird.
When asked about the product's unusual name, Zhang chuckled. "I really like cars," he said.
Janet Moore • 612-673-7752
$15 billion
What China's medical technology market is expected to be by 2010, putting it third in the world behind the United States and Japan.
