Published since 1952 by the American Psychiatric Association, the DSM has been the mental health community’s chief reference for classifying and treating patients. But a new generation of professionals is leading the charge against “a book more difficult than Ikea instructions,” in the words of successful life coach Toni Pagliarulo, 26, a star on the Bravo series “Long Island Shrinks.” “My clients become close, personal friends,” the expert adds. “As soon as I meet them on Skype and see what they wear, how they talk, I pretty much know what they’re about.”

To be sure, the inclusion of “Cra Cra” has seasoned academics concerned about a dumbing down of psychiatric terminology. “I’m frankly appalled,” says Harvard psychiatry professor emeritus Morrie Schwartzberg, M.D., Ph.D., who served on the task force assembled to revise the new edition. “But as much as I argued with the young people on our team, I couldn’t sway them,” he says. “Soon they were calling me ‘Cra Cra’ and rotating their index fingers next to their heads. Then they escorted me by force into the very psychiatric institution that I helped create and kept me on lockdown until the final draft was submitted.”

Schwartzberg’s harrowing experience aside, there may be positive uses for “Cra Cra.” “Right now, I have to check one of 10 different boxes on insurance forms,” says licensed New Jersey social worker Whit Victory, 25, a self-described “psychotherapist” who refused to be quoted anonymously and demanded his website (DrVictory.com) be included with his comment in this well-sourced health article. “If I can just tell an insurer that my patient–say, John Miller, the cross-dressing gym teacher at Montclair High School–is off-the-charts ‘Cra Cra,’ it saves me time and money, and then we can really make healthcare efficient in this country.

As for legal issues, ‘Cra Cra’ may cause initial confusion for some, but it could also lead to speedier trials. “My last case concerned a cop who sexually abused 12 co-workers in 40 minutes, and then proclaimed himself ‘Penis God of the Golden State’ from the roof of his office,” says Brian McFrey, 33, a first-term San Diego judge. “We don’t know exactly what’s wrong with this guy, but our psychologists are using giant words to describe his ‘disorder.’ This is taking up days and tax dollars. To me the dude’s just ‘Cra Cra.’ Can we just call him that, and give him his fine? I don’t know why shrinks are so wordy, but hopefully things will only improve with the next version of the book — meaning, maybe we won’t even need one.”

The post “Cra Cra” Now Official Diagnosis in New DSM (DSM-5) appeared first on The Faster Times.

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Guest Post by Dr. Mariela Glandt

When Dr. Mariela Glandt, an endocrinologist, volunteered to treat African refugees in Tel Aviv, she had no idea she would meet a type 1 diabetic like Samuel Agant, 28, from South Sudan. Below, Dr. Glandt shares Samuel’s story of living on the streets of Tel Aviv with type 1 diabetes, without a work permit, without food, and without a constant supply of insulin.

Samuel Agant, 28, was born in a small town called Rumbek in South Sudan. For his entire life, he has struggled to survive. He has faced devastation, destruction, and displacement caused by the Second Sudanese Civil War.

Samuel’s father was killed when Samuel was only five years old. His mother, three brothers, and sister had to flee to another side of the country. At that time, Samuel was left in the care of his maternal uncle, who was later killed himself. At 15, after a childhood spent in hiding, Samuel was totally alone. He headed to Khartoum, and then, with the help of a relative, sought refugee status in Egypt. Waiting in vain for resettlement in Egypt, he spent more than five years in Cairo, taking whatever cleaning jobs he could find.

“I got sick in Egypt in 2005,” Samuel said. “One day I felt immensely thirsty and I began drinking 7-Up. I couldn’t stop drinking. I then drank seven bottles of water throughout the night, and urinated constantly. My lips and my heart felt dry. I was weak. I went to the Catholic Church. They had a doctor there and he immediately told me he thinks I have diabetes. They gave me medicine at the church. I had no idea what diabetes was, so I went to a cyber-cafe and looked it up in Google. I felt down. This was really bad. When you get diabetes at a young age it is bad. Until then I was so young and strong. I played sports. I didn’t know why this happened to me. I don’t know of anyone in my family who had diabetes. I thought that maybe it happened because I left my country.”

In Egypt, Samuel struggled to take care of his diabetes. In the aftermath of what is known as the “Mustafa Mahmoud Massacre” – the violent Egyptian police raid of a refugee protest camp – Samuel and a group of Sudanese friends fled violence once again. Samuel had heard that diabetes could be cured in Israel. He and his friends paid of Bedouin smugglers to take them across the Sinai desert to Israel. Hidden in a vehicle under piles of blankets, they reached the Israeli border in 2007.

Samuel and his friends were arrested at the Israeli border and imprisoned for nine months. Upon his arrival in Israel, Samuel had been without insulin for several days. He went into DKA and was hospitalized. Prison was tough, but ironically, also good for Samuel. In prison he received ongoing medical care, ate three meals a day, and felt strong enough to exercise. It was the first time he had felt well in years. “They didn’t put handcuffs on me like they did on my friends because they knew I was diabetic. They knew I had no interest to run or escape,” he said with a laugh.

According to Samuel, he and his friends were released from prison following UN intervention. He received insulin from the clinic of Physicians for Human Rights when it was available. He lived with friends in various places in Israel and worked when work was available and whenever he felt strong enough to do so. He has been hospitalized at least five times in Israel due to severe cases of DKA. “If I don’t find insulin for two days, I get really sick,” Samuel said.

In the past weeks, the Israeli government has deported hundreds of South Sudanese refugees back to the now independent South Sudan. Samuel, however, could not be deported due to UN intervention: Having no chance of finding an ongoing supply of insulin in South Sudan, going back means a death sentence. Thus protected by the UN, Samuel stayed in Tel Aviv while most of his friends were deported.

Paradoxically, however, while in Tel Aviv Samuel does indeed have a chance for getting insulin, he has no money, and he has no ongoing supply of food or shelter. In the past, he had his South Sudanese friends to rely on for help. As refugees, these friends stuck together. They were a family. “We collected our hands together to defend our lives,” he said. Left behind in Tel-Aviv with nothing, and having had his work permit revoked by the Israeli government, Samuel is at his lowest point yet. For the most part he manages to find about a dollar’s worth of food a day – usually an apple and a container of yogurt (two or three hundred calories feeding his 6-foot plus frame). Even if he could legally work, he is far too weak to do so. He has no permanent housing, and is currently sleeping in a room with several other men.

Samuel is a tall and impressive man. He is also extremely thin and visibly suffers from malnutrition. Fluent in English, he talks of his life with acceptance and serenity, as well as with hopefulness. “I want to study and find work,” he says. “I want to stay here and receive medicine and be treated.”

At the end of my meeting with him in Levinsky Park – the center of the refugee quarter in Tel Aviv – it was Samuel who reassuringly said: “Everything is going to be okay.” I was visibly worried. I had brought some food with me, and made sure he had enough insulin for the upcoming days. I gave him instructions about dosages and food types. Samuel said, “No one can ever know what will happen tomorrow. The poor, the rich – we are all the same. We all live our lives without knowing what can happen tomorrow. We all die in the end. It’s the same for everyone.”

“True,” I told him. “But I promise to do everything I can to try to help you. No one is going to die here any time soon.”

Dr. Glandt has volunteered to follow Samuel’s medical care. With our donations, she will see that he has access to enough food to regain his strength, and hopefully much more than that. One of the things our community does best is making sure no one feels alone. Let’s help Samuel learn that diabetes is not a death sentence, and that he is not alone.

Even tiny amounts of money are significant to Samuel. Please help! You can donate here.

Dr. Galit Ailon contributed to this article.

Dr. Mariela Glandt is a practicing endocrinologist. She is the head of the Diabetes Medical Center in Tel Aviv and also works at Bronx Lebanon Hospital in New York. She is the medical director of ASweetLife.

The post Diabetic Refugee from South Sudan Finds His Way to Israel appeared first on The Faster Times.

Just as 2011 was rounding into 2012, I wrote a post for my personal blog opining that this would be just the right time for Nike to bring back their Huarache line of running shoe. I wrote about it being the first running shoe I ever truly coveted, and the last; I wrote about the sui generis quality of its slipper-like design; and I wrote about how the barefoot craze inspired by Born to Run (2009) had brought a fervor for ultra-minimalism to running shoes. I had no way of knowing that, as I wrote, Nike was already shipping the Huarache to stores.

This wasn’t the first time they’d brought the shoe back. After yanking it in the early nineties, the Huarache reappeared, mysteriously, in 2000, only to disappear once again, just as mysteriously. This isn’t the kind of behavior that builds brand loyalty, which is why I’d never worn a pair of Nikes since.

But when Nike made the Huarache reappear this year, I put all such high-minded principle aside. Not only had they reintroduced the world’s greatest running shoe; they’d actually improved upon it. The upper still consisted of a poly cloth-like material supported by leather and plastic straps, but the toe material had been replaced by a mesh that allowed for greater breathability. (Breathability was an issue with the original Huarache, according to Running Times, which, in a post-mortem for the shoe several years back, identified this as a factor behind its obsolescence.) That’s a relatively minor change, but the other change was anything but minor: the Nike Air technology in the midsole replaced with Nike Free technology.

Stilted stiffness, in other words, had been replaced with a pliant but cushioned flexibility. I’d never worn Free before, with its sole sectioned off in a grid designed to allow for supreme conformity of foot with terrain. As I took the shoes out for the first time in all kinds of terrain–grass and dirt and concrete and, yes, rubber tread–the old freedom of weightlessness was there, but it was accompanied by an altogether different freedom: the freedom of uncanny balance and traction. I felt like I was prancing with a cat’s paws.

This was no minor matter. Shoe-design technology, by now, has become so refined, any improvement that occurs from one shoe to the next is infinitesimal to the point of imperceptibility. It’s a game of centimeters. Which was why it was so breathtaking to see Nike make it once again a game of inches. I don’t know if the shoe’s selling well enough to warrant further production. Or if it’s selling so well that Nike (as they’ve been rumored, from inside, to do) will discontinue it with the express intention of creating more fervent demand. I want to say to Nike that if you pull this shit again, we’re through—that I won’t come running back next time.

That’s what I want to say, even as I know that life is too short–and there’s just too much running to do–for such high and heavy inflexibility.

The post The Only Running Shoe You Need (for Now): Nike Huarache appeared first on The Faster Times.

Presented with the plan, some people can cut grains and sugar out of their diet with relief rather than resistance. They finally have permission to eat the meat and fat they crave, and their joints no longer hurt. With this set of instructions, success rates in my practice are higher than ever before, but success is not universal. Other people struggle with the concepts, the implementation or both.

Let’s take some time with the first common struggle, namely Hurdle #1: accepting the fact that carbohydrates cause the problem.

What’s a carbohydrate? Carbs are anything that is not a protein (meat, eggs, fish and poultry) or a fat (butter, lard, oils) – essentially, all fruits, vegetables, grains, and sweets. Dairy and nuts share a mixture of protein, fat, and carbs.

Once, I carefully explained to a very intelligent person that every time you eat, you must eat protein and fat together and never eat carbohydrates alone. We discussed it, she agreed, and soon thereafter grabbed an apple for a snack. In response to my raised eyebrows, she exclaimed, “But you didn’t mean fruit did you?” Fruit has been celebrated in our culture as a healthy snack with disregard for the effects of our unnatural (way outside of how we evolved) consumption of multiple fruits of all seasons on a daily basis.

Any carbohydrate, including fruit, whole grains, asparagus, and cotton candy, becomes a potential problem when it asks your body to make insulin. Your body makes insulin in proportionate response to the amount your blood sugar goes up from eating a carbohydrate food.

Sugary sweets, white flour, and sweet liquids (even fruit smoothies with protein powder) are absorbed quickly by the body and rapidly raise your blood sugar level, which prompts your body to produce insulin to reduce the elevated blood sugar. Insulin whisks blood sugar away to fat cells where it can be stored. To make sure no other sugars sneak into the bloodstream, insulin locks up all the sugars stored in fat cells and holds them there until insulin levels fall again. Insulin leaves your bloodstream cleaned of sugar’s traces, as clean as before you ate the carbs.

Unfortunately the process of clearing out the blood sugar tends to make you feel as if you have no fuel for life. Even though you have plenty of sugars stored in your fat cells, your bloodstream is empty and you are hungry and possibly even hypoglycemic (shaky, sweaty, weak). Which makes you want to eat again.

Not all carbs cause the problem to the same extent. From worst to best – from quickly to slowly absorbed carbs – the list looks like this:

Eliminate: cotton candy, soda pop, most desserts, refined (white) flour, sweetened coffee drinks, fruit juice and fruit smoothies, fat-free dairy* and any carbohydrate eaten by itself.

Minimize: whole grains (rice, breads, crackers), root vegetables, sweet fruits, shelled peas, and very slightly sweetened cream or dark chocolate.

Moderate: most other vegetables not included above, nuts*, and berries.

Eat all you want: leafy greens (spinach, lettuce, kale, cabbage, chard).

(*Carb content is significant, but also contains protein and/or fat)

Many of the foods in the middle two categories have been celebrated as health foods, a recognition they deserve only in comparison to the uppermost group. Whole grains may be better than cotton candy, and may play a small role in a weight maintenance plan, but they are not part of a weight loss plan.

I encourage you to introduce this simple suggestion: every time you eat, reach first for protein and fat. Let me know how it goes for you.

My next blog post will address an even larger challenge, Hurdle #2: But what can I eat? Or, if carbs are the problem, fat is the solution.

The post An Apple is Not Okay appeared first on The Faster Times.

The problem is that the reigning wisdom about weight loss (Eat less! Exercise more!) is exactly what we’ve all been hearing for decades while we watch our national waistline get bigger and bigger. The only thing that is clear is that evidently it’s not clear to most of us how weight loss happens.

We could have a very lengthy discussion of the science of weight loss, (or you could lose yourself for hours on the blogs of Gary Taubes, Peter Attia, Mike Eades, Denise Minger, Mark Sisson and others), but I think I’ll simplify it right here by giving you two choices. There are two ways to lose weight, each with its own set of rules.

Method 1, or Calorie Counting: Eat less, a fair amount less than you eat now. Eliminate fat. Walk more. Take the stairs instead of the elevator. Pick lean pieces of meat. Restrict sweet carbohydrates, all fats and many proteins. Count everything, and balance intake with output. Fill up on salads and vegetables and whole grains of every variety. Flavor with spices, no butter.

-OR-

Method 2, or Carb Restriction: Eat a lot less carbohydrates. Eliminate all carbohydrates except for all the leafy greens you want and some other non-root vegetables. However, freely enjoy meat, fish, poultry and eggs at every meal. Allow yourself to eat all the normal fats that come with your food. Extra fat in the form of cream, cheese, avocado, butter and coconut oil are encouraged. Salt your food. You might want to get a little more exercise.

Actually, both of these methods work in the short term. It’s the long term where there’s a serious catch to each one: are you ready?

Calorie Counting (Method 1) will require ever-stricter rationing as you go through life, as your metabolism slows down to deal with less fuel. (Method 2 will allow gentle relaxation of the rules over time, as your metabolism speeds up.) Method 1 involves vigilant oversight that on a regular basis you exercise off (5 days a week, at least 60 minutes of moderate to vigorous exercise is recommended) more calories than you consume, so figure a way to keep counting forever.

Carb Restriction (Method 2)’s catch is that you must eat the fat: the fat on the meat, the yolks of the eggs, some cheese, avocadoes and butter. Without the fat your body will not switch to fat-burning, but rather convert the protein you eat into carbohydrates (it can do that!). Also, because Method 2 differs wildly from what you’re probably used to, you may have some adjustment discomfort.

Do I need to say that I think you cannot follow Method 1 and maintain good health. Method 2 may require some coaching, but results in vibrant health and permanent weight loss.

Next time I’ll talk about the challenges some people face with Method 2 and some of the solutions they’ve found.

The post Weight Loss Miracle of the Week appeared first on The Faster Times.

The only dreams like this are the kind you want to wake up from anyway–that’s how you’ll know you’re not dreaming when the Sonic Bomb makes its alert. And by the time this knowledge has been acquired–by the time your Sonic Bomb has been shut off and you’ve decided to confront the day–the day has already met you more than halfway. That’s the kind of shift in consciousness that occurs.

So while there are alarm clocks that do all kinds of things–alarm clocks that simulate natural sunlight, that provide sonic ambience, that project the time in a blue glow on your ceiling, even that are powered by water–it’s good to know there’s also an alarm clock that, you know, wakes you the fuck up. Now, a lot of alarm clocks wake you up, it’s true, but for those of us who prefer to seal out the world and its sounds in our somnolence–who prepare with earplugs for the unfortunate contingencies of noisy neighbors and other incidental intrusions–we need to know that we’re not going to pay with tardiness for our insistence on sleep uninterrupted. Beause if you think that gadget you got at Brookstone to wake you up to the chirping of birds is gonna serve you from within a truly insulated sleep, then you’re obviously still dreaming anyway, and you’re already late.

The Sonic Bomb relies on no such smugness–it sends an all-points bulletin to three different senses: it flashes red, it vibrates your bed (through a wire-attached pod you place under your mattress), and then it beeps. When set at its loudest, it beeps very loudly. Personally, it’s proven very effective even when wearing NPR 33 earplugs. And the instant it goes off, I’ve already forgotten that I’d even been asleep—it doesn’t feel like I’ve been woken up so much as delivered, deftly and instantly, into consciousness. The Sonic Bomb makes the transition from dreaming to reality seem somehow both effortless and irrevocable in its entirety, by denying you the luxury of your own denial, and delivering a whole different luxury altogether.

The post The Rude Awakening You Need appeared first on The Faster Times.

The morning after President Obama’s State of the Union speech that featured plans for reinvigorating U.S. manufacturing, Marketplace Morning Report asked former Obama Administration economic advisor Jared Bernstein why a company like Apple doesn’t create more jobs in the U.S. “Well,” replied Bernstein, “because the infrastructure for consumer electronics – particularly the assembly for consumer electronics – for many decades has been building up in Asia. And they just have a robust, flexible supply chain there that we simply don’t have when it comes to consumer electronics.”

Thanks to the release of Apple’s 2012 Supplier Responsibility report, we now know the names of 156 companies that account for more thank 97 percent of what Apple pays to its suppliers. But this report only scratches the surface when it comes to what makes this consumer electronics infrastructure and supply chain so “flexible” and “robust” from the perspective of a company like Apple.

What the report does tell us is that this supply chain involves an enormous workforce putting in long hours. At nearly half the audited suppliers, Apple reported that a majority of their workers have been working weekly hours that exceed 60 hours per week at least one week out of 12 – and working more than 6 consecutive days at least once a month. It also tells us that about half of the suppliers audited did not pay proper overtime “as required by laws and regulations,” while about a third failed to provide legally required benefits and a third deducted wages as a disciplinary measure.

The report also tells us that half the facilities audited had inadequate safety exit procedures, including narrow corridors and poorly marked or inaccurate evacuation routes. Close to half also had noncompliance in some aspect of fire prevention, preparedness and response, including unmarked fire extinguishers and insufficient fire drills. About a third lacked first-aid supply procedures or had inadequate procedures to ensure compliance with first-aid measures. In 2011, there were explosions at Apple supplier facilities in Chengdu (Foxconn) and in Shanghai (Ri-Teng/Pegatron). Four people were killed and 18 injured in Chengdu and 59 injured in Shanghai.

While the report provides some important information about working conditions in the facilities making Apple products, there are many other factors that affect the health of the workers who assemble computers, smart-phones and other consumer electronics.

Applying a code of conduct to a complex supply chain Apple has just announced that it will be implementing the Fair Labor Association’s code of conduct. One of the code’s provisions ties compensation standards to local minimum and prevailing wage standards.

While lower wages are sometimes assumed to be appropriate given the lower cost of living in Asia, low wages have prompted numerous protests and strikes over the past year in China and elsewhere in Asia, including protests involving thousands of workers in Shenzhen, Dongguan, and Chengdu where Apple suppliers are located. In January 2012, the minimum wage in Shenzhen, where Apple supplier Foxconn (among other such manufacturers) has facilities, was raised to 1500 yuan/month ($236) from 1320 yuan/month ($208). In Chengdu, in Sichuan province, where the explosion and fire caused by combustible dust occurred in May 2011, wages have been raised to rates that range from 800 ($126) to 1050 ($166) yuan/month. Malaysia and Singapore have no nationally established minimum wage.

Apple’s 2012 Supplier Responsibility report mentions only China, Malaysia, and Singapore as supplier locations, but a search through the suppliers’ lists of global manufacturing facilities shows that Apple suppliers may also be located in India, Indonesia, South Korea, Taiwan, Romania, Poland, Ukraine, Russia, Turkey, Slovakia, Thailand, the Philippines, among many other countries. The number of possible countries where suppliers may be located means many different sets of wage standards and many different standards and practices regarding labor unions and other worker organizations and how worker organizing is regarded. It also means many different expectations and practices regarding how and where workers live – whether they’re expected to live in company dormitories or not and what that means for wages, benefits, and other working conditions.

Tracking compliance with a code of conduct is also complicated because many of the 156 companies listed on the Apple supplier list have suppliers of their own. Of the 229 facilities Apple audited for the 2012 report, 112 (or nearly half) lacked adequate procedure for auditing their supplier and do not perform adequate supplier audits. Only 55% of the audited facilities had adequate corrective action systems in place and only 56% had what Apple calls management accountability and responsibility either in place or in compliance with existing standards.

Industry-wide problems Apple has made news with its supplier disclosure and adoption of the Fair Labor Association code of conduct, but the labor problems highlighted by its supplier responsibility report are not unique to Apple. These issues, particularly when it comes to overtime and wages, are chronic in Chinese and other Asian electronics manufacturing plants that work as suppliers to other major electronics firms, including Dell, HP, and IBM. Not detailed by Apple, but called out by the China Labor Watch in its July 2011 report on electronics work in China, is the lack of proper employment agreements that resulted in workers not being fully informed about their rights, benefits or training – a problem I have heard about first-hand from electronics workers in the Philippines.

When it comes to chemical exposure, Apple has documented the use of n-hexane, ID, in its supplier Wintek’s facility in Suzhou where the chemical sickened 137 workers in 2010. In its 2011 Supplier Responsibility report Apple also reported that another unnamed supplier and its subcontractor had been using n-hexane. But no other details of chemical exposure are provided in either the 2011 or 2012 reports. Yet among the suppliers listed by Apple, in addition to those at Wintek facilities, among the other companies where chemical exposure and related worker safety issues have been documented are Foxconn, Samsung, Catcher Technology Co., and Quanta. And there are longstanding and/or historical chemical exposure issues involving US electronics manufacturing facilities in the U.S., among them Fairchild Semiconductor, IBM, and Intel that have effected both individual and communities. In addition, I have heard anecdotally first-hand about chemical exposure issues in electronics manufacturing facilities in Taiwan, Indonesia, South Korea, and the Philippines.

It’s also worth noting, that Foxconn, whose facilities in China have been highlighted in recent reporting by the New York Times, in addition to producing for Apple, has also been acting as a supplier for other companies, among them Amazon, Dell, HP, Lenovo Microsoft, Nokia Panasonic, Samsung, and Sony. By now it’s painfully clear that the “robust” Asian electronics infrastructure to which analysts like Jared Bernstein refer depends on the region’s enormous, low-wage, risky-condition workforce.

What will it take to change this, I asked Ted Smith of the International Campaign for Responsible Technology. “These situations will continue until there is an informed and empowered workforce and workforce organizations of a serious kind to watch over what’s going on,” said Smith. “As long as there’s no counterforce, this is what will continue to happen.”

Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Salon, The Washington Post, The Nation, Mother Jones, Grist, and the Huffington Post. Chasing Molecules was chosen by Booklist as one of the Top 10 Science & Technology Books of 2009 and won a 2010 Gold Nautilus Award for investigative journalism.

The post What Apple Isn’t Telling Us About Its Workers appeared first on The Faster Times.

My mother was diagnosed with Multiple Sclerosis (MS) when I was five-years-old. At the time, there were no effective treatments for the disease. My mother tried every medication doctors prescribed, an experimental surgery, and even non-conventional therapies. Everything failed. I tried to help her too, using the tools I had as a child – hope, prayers, and my imagination. I imagined ways to make her better. And I hoped and prayed with all of my might that she would stop seeing two of everything, that she would stop shaking, and that she would be able to walk and talk again. MS is an autoimmune disease, and the concept of autoimmunity was incomprehensible to me. Why would a body do that to itself? Why can’t we make it stop?

My mother’s case, unlike a lot of cases of MS, had almost no remissions. Her condition worsened until her death in 1989. Less than two years after she died, I met Mike, the man who would become my husband. With Mike I began to build a new life, a good life. My obsessive thinking about autoimmunity moved to the background of my mind until Mike started to lose weight and was always thirsty.

Six months later, twenty pounds lighter, with blurred vision and numb feet, Mike was diagnosed with type 1 diabetes, an autoimmune disease which destroys the body’s insulin producing beta cells. We hardly knew what that meant, but we did know a diabetes cure was nowhere in sight. Thankfully, unlike my mother’s MS, diabetes was treatable. In fact, Mike’s doctor told him that there was a drug in clinical trials that might be able to stop the progression of diabetes. Stop the progression. Though not in the same context, I’d been waiting to hear those words for most of my life. They sounded too good to be true and they filled me with hope. We asked no questions. Mike underwent a number of tests after which he was accepted into the clinical trial for a drug known as Diapep277.

Diapep277 was discovered in 1990 by Professor Irun Cohen and his team at the Weizmann Institute’s Department of Immunology. They were studying the mechanism by which the immune system attacks and destroys the insulin producing beta cells in the pancreas. In mouse studies they discovered that heat shock protein 60 (HSP60) was involved in the attack. HSP60 is a ubiquitous protein, part of a highly conserved family of intracellular chaperones, but with a special location in insulin-secretory granules of beta cells. HSP60, Cohen found, works like an antigen, that is, it triggers the T-cells in the immune system to attack. Cohen’s team also found that a small peptide fragment of HSP60, p277, works as a signal to the immune system to stop the immune attack on the beta cells, thereby preventing the progression of diabetes. Cohen and his team were led to p277, he told me, by studying the responses of T-cells and antibodies to HSP60 in mice that spontaneously develop a form of type 1 diabetes.

When Mike enrolled in the Phase II trail of Diapep277, he was told it was a potential diabetes vaccine. This notion of vaccine was somewhat confusing. Mike, after all, had type 1 diabetes. Diapep277 wasn’t going to prevent it like the chicken pox vaccine prevents chicken pox. But the notion of a vaccine is more complex than that. “The immune system, like the brain, learns from experience,” said Cohen. “A vaccine is a signal or set of signals that teaches the immune system how to respond to a particular situation. We could call Diapep a ‘therapeutic vaccine’ – probably it would be clearer to call it a specific modulator of the immune system – a signal that helps the immune system to make desirable decisions in how it should relate to the body.”

Mike’s Diapep277 trial took place in 2002-2003. The study coordinator told him the participants were divided into three groups – high dose recipients, low dose recipients, and a placebo group. Then, Mike did not know which group he was in. He now knows he did receive Diapep277. Throughout the study, doctors monitored Mike closely. They were checking for residual beta cell function by a measurement of C-peptide (C-peptide is a protein produced along with insulin, and its presence in the body is a sign of insulin secretion, or beta cell function.) In order to measure beta cell function, Mike was given glucagon injections and then blood was drawn to learn his body’s response to the glucagon. The study also measured his HbA1c. “What was most surprising was the lack of side effects,” says Dr. Mariela Glandt who led a follow-up trial to Mike’s under Prof. Itamar Raz at Hadassah Hosptial in Jerusalem. “Patients had no complaints.”

Phase II results were promising and a combined analysis of all the adult phase II studies revealed that DiaPep277 significantly inhibits the decline in stimulated C-peptide secretion, thus preserving endogenous insulin secretion, or in simple terms, it slows the progression of type 1 diabetes.

In 2007, Andromeda Biotech Ltd., a then newly formed wholly owned subsidiary of Clal Biotechnology Industries, purchased the Diapep277 program. Two years later, Teva Pharmaceutical took an equity position in Andromeda. Teva licensed worldwide rights to DiaPep277 from Andromeda Biotech and invested $170 million in the company last year to fund a clinical trial to confirm earlier results for DiaPep277. (Coincidentally, for me, Teva’s longtime blockbuster drug has been Copaxone, for the treamtment of MS.)

In November 2011, Andromeda Biotech announced Phase III study results equally, if not more promising, than the Phase II results. The new results from patients who were treated with DiaPep277 showed that the study has met its primary endpoint- significant preservation of C-peptide levels demonstrated in patients treated with DiaPep277 compared to the placebo arm.

The study also achieved a key secondary endpoint, showing that a greater proportion of DiaPep277 treated patients maintained good metabolic control compared to the placebo, measured by HbA1c levels equal or less than 7% at the end of the study. “The results I have seen thus far are better than I expected,” said Cohen. “Large clinical trials have so many confounding variables that even treatments that are effective can fail to reach statistical significance. In this case, all the declared endpoints seem to have been achieved.”

For scientists and researchers involved in a clinical trial, achieving declared endpoints is indeed a success. The patient, however, doesn’t necessarily measure success in the same way. Mike wears an insulin pump, checks his blood sugar ten times a day, and battles both episodes of hyper and hypoglycemia. “I ate rice last night and woke up with a blood sugar of 200, despite taking insulin,” Mike said. “This morning I went out for a one-hour run and my blood sugar stayed at 190 the entire time.”

If Diapep277 did anything to slow down the progression of Mike’s diabetes, it was never noticeable. If it will help in the long-term, we don’t know. Over the years, Mike’s study hasn’t followed him. And we wonder how long the effects of the Diapep277 injections lasted. I asked Cohen about this. “The effect seems to need boosting every three months or so,” he said.

Also interesting to note is that a 2007 study showed that in children, treatment with Diapep277 “appears to have no beneficial effect in preserving beta-cell function or improving metabolic control.” Cohen said a more thorough analysis of the data indicates that there is a positive response in the children who do not carry the most decisive susceptibility genes. “Apparently, the disease progresses too quickly for Diapep to help in the children who have a more intense, accelerated course of beta cell destruction. I would like to believe that the solution will be to detect and treat persons early in the course of the autoimmune reaction, before the loss of beta cells become irreversible.”

The key, then, if Diapep277′s continuing trials prove successful, will be to identify the right people and treat them at the right time- as early in the disease process as possible. But the development of screening tests is a complicated and expensive process. “I’d been sick for more than six months when I was diagnosed with diabetes,” Mike says. My fasting blood sugar was over 400. My HbA1c was 15.7%. Maybe I was too far gone to be helped by Diapep. Maybe if I’d received the injections as soon as I started to feel thirsty, there would have been a noticeable difference.”

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Bananas in Ecuador, Nicaragua, Belize, and the Philippines; broccoli in Guatemala; carpets in India, Nepal, and Pakistan; cocoa in Ghana, Ivory Coast, Nigeria, and Cameroon; coffee in Colombia, the Dominican Republic, Guatemala, Kenya, Mexico, and Panama; cotton in Egypt, Brazil, China, Uzbekistan, and Turkey; electronics and toys in China, clothing in China, India, Malaysia, Thailand, and Argentina; rice in Brazil, India, and the Philippines; melons, onions, and tomatoes in Mexico What these products – along with diamonds, gold, sugarcane, shoes, rare earth and strategic metals – have in common is that they’re among the 130 different products made by child and forced labor in 71 countries listed in reports released earlier this month by the U.S. Department of Labor’s Bureau of International Labor Affairs (ILAB).

Two of these reports are required by Acts of Congress, The Findings on the Worst Forms of Child Labor and the List of Goods Produced by Child or Forced Labor; an Executive Order mandates the other, The List of Products Produced by Forced or Indentured Child Labor. All describe the incidence of child and forced labor and what’s being done to address these issues, including making education accessible and affordable. What these reports do not do is trace these goods to market. But by showing how widespread this labor is and that it involves so many high-volume exports, they raise the distinct possibility that everyday consumer purchases could include the products of child and forced labor.

The products list, said Secretary of Labor Hilda Solis on the release of these reports, is “a tool to generate action. It is meant to help foreign governments, industry groups, companies, unions, workers and consumers make informed decisions about the goods they produce and consume.”

The countries where this work is taking place literally ring the globe. In addition to those listed above, the others include Afghanistan, Cambodia, Vietnam, Ethiopia, Liberia, Zimbabwe, Uganda, Sierra Leone, the Democratic Republic of the Congo, Mali, Angola, Bangladesh, Nepal, Indonesia, Peru, Bolivia, El Salvador, Honduras, Jordan, Russia, Ukraine, Turkmenistan, and Kazakhstan. In addition to the long list of goods produced by child and forced labor, these reports – released annually for the past ten years – also document instances of child soldiering and prostitution, and of children engaged in enforced or entrapped domestic work.

Work done by child laborers According to the International Labor Organization (ILO), approximately 215 million children work as child laborers around the world. By rough calculation, this is slightly less than 10 percent of the world’s children under age 15. About 115 million – or 54 percent – of these child workers from age 5 to 17 engage in various forms of hazardous labor, says the ILO. This includes work underground, under water, in high or confined spaces, with dangerous machinery, carrying heavy loads, or with toxic substances. The number of people “trapped in forced labor worldwide,” the ILO estimates to be 12.5 million. But the ILO also notes that for many countries, data on child labor is either out-of-date, unreliable, or for some countries, is altogether unavailable, so there may be additional countries where child and forced labor not counted here is also taking place.

Agricultural crops account for the largest category of good manufactured by child and forced labor, followed by manufactured products, and then products mined and quarried. Of the agricultural crops, cotton, sugarcane, tobacco, coffee, and cattle top the list. In its surveys of child labor, the ILO includes children’s work on farms owned or operated by their parents and does not distinguish between different sizes or types of farms when assessing child labor. This is in contrast to U.S. labor regulations that allow “youths of any age” to “work at any time in any job on a farm owned or operated by their parents.”

A number of the listed agricultural products come from countries that are among the world’s top exporters, including to the United States. For example, according to the United Nations Food and Agricultural Organization, Ecuador, Belize, and the Philippines are among the world’s largest exporters of bananas; all are listed by the ILAB reports as producing bananas with child labor. Colombia and Guatemala are leading exporters of coffee to the U.S. The Ivory Coast and Ghana supply much of the U.S.’ cocoa imports; all of these countries are also listed by the ILAB child labor reports. (Cocoa producers in Ghana and the Ivory Coast are currently engaged with a program known as the Harkin-Engel Protocol that aims to reduce “the worst forms of child labor” by 70 percent in cocoa production in those countries by 2020.) Egypt and Uzbekistan, also listed by the ILAB reports, are among the world’s top cotton exporters.

The US response to child labor While they’re intended to spur action, these reports do not trigger any enforcement of regulations. But, as the Department of Labor explained in an email, once an item appears on the list of goods produced with child or enforced labor, any U.S. government procurement officer in any U.S. government agency or government branch buying any of the listed products must make sure that the “vendor selling the item has made a good faith effort to ensure that the goods being sold are not made by forced or indentured child labor.” Additionally, “Under the procurement regulations implementing the Executive Order, federal contractors who supply products on a list published by the Department of Labor must certify that they have made a good faith effort to determine whether forced or indentured child labor was used to produce the items listed.” In addition to electronics and toys from China, shrimp from Thailand, diamonds from Sierra Leone, and stones from India, the current list includes pornography from Russia.

Importing goods made by “forced labor, including forced labor of children,” is also prohibited, explained the Department of Labor. In addition child labor standards are incorporated into all U.S. free trade agreements since the 1994 North American Agreement on Labor Cooperation, a side agreement to the North American Free Trade Agreement (NAFTA). But given the large number of high volume production items on the ILAB report lists, enforcement and implementation of standards clearly remains a challenge.

One country not included in the ILAB reports is the United States. The Department of Labor (DOL) explains this by saying it is beyond the mandate of the program under which these reports are compiled. But DOL also says it “recognizes that both child and forced labor occur in the U.S.,” that the department is “committed to ensuring that U.S. labor laws are strictly enforced,” and that since 2009 it has added 350 new field investigators to increase enforcement. In 2010 the Department of Labor increased penalties for business violating child labor standards, and is currently taking public comment on its proposal to increase protections for young people working on U.S. farms, rules that have not been updated since they were established in 1970.

When it comes to manufactured products, bricks, garments, carpets, and footwear lead the list of goods made by children and those in forced labor. Gold, diamonds, and coal, are the mined products most widely produced by child and forced labor.

However, for no category of goods – neither agricultural, mineral, nor manufactured products – do the reports name individual companies or businesses. The Department of Labor explains this by saying, “It would be difficult for ILAB to attempt to track the identity of every company and industry using a good produced with child labor or forced labor. In addition, it is the Department’s experience that child labor and forced labor frequently occur in small local enterprises, for which company names, if they are available, have little relevance.” The names of these companies may be obscure, but in this age of global supply chains, they may be far from irrelevant as companies reach around the world for labor, raw materials, and locally out-of-season produce.

Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Salon, The Washington Post, The Nation, Mother Jones, Grist, and the Huffington Post. Chasing Molecules was chosen by Booklist as one of the Top 10 Science & Technology Books of 2009 and won a 2010 Gold Nautilus Award for investigative journalism.

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