The top 10 healthiest diets in America

By Tracey Minkin

 If losing weight is at the top of your resolution list, you're not alone. An estimated 80 million Americans go on diets every year, spending more than $30 billion annually on programs and products.

Relax -- some diets are more about burning calories than counting calories.

That's a lot of money, a lot of advice, and a lot of emotional investment. So, which diets really work -- and work safely? To find the weight-loss programs with that golden balance of nutrition, calorie-control, motivation, and activity, Health harnessed a panel of experts to put more than 60 well-known diets to the test and narrow them down to the top 10. Here's the list:

• The Structure House Weight Loss Plan (Fireside)

Don't recognize this plan? That's because for more than 30 years its author, Gerard J. Musante, PhD, has been working quietly and very successfully running the actual Structure House, a Durham, North Carolina-based residential treatment center for obese adults. That's a lot of time spent with patients and a lot of attention paid to the broad factors that affect weight loss -- particularly the relationship people have with food.

But can an excellent residential program transfer to an effective at-home plan? The answer, according to our experts (meet them at right), is a resounding "yes," which is how this below-the-radar plan grabbed highest honors from its better-known rivals. iReport.com: Tell us about your New Year's resolutions

With top-shelf scores on every aspect of healthy weight-loss, Structure House won an "outstanding!" from obesity expert Tim Church, MD, on its exercise component (often a weak spot in diet programs). And several panelists raved about the plan's motivational components. "It focuses on the 'why' behind overeating," says registered dietitian Maureen Callahan, "and helps dieters learn to put their lives in balance."

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• MayoClinic.com: Keep the weight off permanently
• MayoClinic.com: Feel full on fewer calories

Health's Senior Food and Nutrition Editor Frances Largeman-Roth agrees: "This book takes a holistic approach to weight loss, asking you to fill your life with things other than food -- outdoor activities and time with friends and family, for instance. Plus, the recipes, such as Balsamic Dijon Chicken and Classic Pesto, won high marks for tastiness, another factor in long-term weight-loss success. Health.com: Lose weight on fast food--- really!

• The Step Diet (Workman Publishing)

We all know that walking 10,000 steps a day can really make a huge difference healthwise. But now we also know that the diet inspired by this fundamental, healthy approach to movement and activity is a big winner. And it even comes with a pedometer, a device that studies have shown can be a huge motivator for staying active and losing weight.

Our panelists agree that establishing a lifestyle regimen that combines intentional walking with spur-of-the-moment step-building (parking farther away, taking the stairs) is a healthy, all-ages, all-levels-of-fitness diet prescription. "This is more about calories burned than calories cut," Health's Frances Largeman-Roth says. Health.com: 5 tips to keep office snacking from derailing your diet

The nutritional approach of the Step Diet, devised by weight-control experts from the University of Colorado, is profoundly simple: Cut food intake to 75 percent of what you currently eat. "This plan is for people who like things simple," nutrition expert Christine Palumbo says. "Simply cut back on what you normally eat." With suggestions (not hard-core regimens) for making healthy meals and a food diary for building mindfulness, this plan can work well for dieters who like to have daily control and choices.

Our panelists also noted that the cut in calories combined with the steady increase in activity can lead to a safe, healthy rate of weight loss and a naturally active lifestyle. "This is a doable, concrete approach to adding daily physical activity and losing pounds," dietitian and fitness expert Samantha Heller says.

• Weight Watchers

It's a classic for a reason. It works.

And over the years, this gold-standard weight-loss program that harnesses the power of group support to help motivate dieters has kept up with science, not to mention changing lifestyles. For this aspect, Weight Watchers earned the highest motivational marks (including several perfect scores) from our panel of experts, who also lauded the plan's overall healthy weight-loss pace and exercise component.

Most noteworthy: Weight Watchers, while maintaining its meetings-based system, has added an online version for those dieters who, in the words of panelist Largeman-Roth, "aren't into group hugs." Health.com: Diet tricks the stars use to stay thin

What's more, dieters following the program can choose from two distinct weight-loss approaches. The first, Weight Watcher's famous points-based Flex Plan, which is packed with major education on making wise and healthy food choices, gets kudos for providing both motivation and a simple framework for success. The second, the Core Plan, focuses dieters on eating nutritious, satisfying foods--without counting calories.

The Weight Watchers program offers strategies that will work for every dieter. And the support specifically for men was a real bonus, as was the ability to get tasty, already-prepared (and points counted) meals at your local grocery store.

• The EatingWell Diet (The Countryman Press)

This new entry into the field in 2007 has built beautifully on the latest understanding of the broad approach necessary for effective weight loss. Author Jean Harvey-Berino, PhD, RD, developed the fundamentals of the EatingWell Diet at the University of Vermont, where she chairs the department of nutrition and food science. The focus on behavioral changes--including finding and facing eating triggers, eating and shopping mindfully, and cultivating regular, joyful exercise habits--combined with a 28-day mix-and-match menus gained the highest overall rankings on calorie-intake and weight-loss-rate criteria from our panelists. Health.com: Reviews of more than 40 popular diets

"Hallelujah," says registered dietitian Maureen Callahan. "Here's a diet plan that tells the truth about weight loss. Dieters lose about 21 pounds in six months, or about a pound a week. This kind of steady weight loss is the real thing, the kind that stays off." Another nifty extra: a Diet Food Diary that includes a calorie-count chart.

• The Volumetrics Eating Plan (Harper Collins)

Nutritionist Barbara Rolls, PhD, has tapped into a fundamental human quality: We like to feel full. This may sound obvious, but it's based, in fact, on extensive work Rolls has done as director of the Laboratory for the Study of Human Ingestive Behavior at Pennsylvania State University. Rolls says you'll eat better and lose weight if you focus on the energy density of foods. And her Volumetrics plan explains how low-density foods like fruits and vegetables, as well as soups and stews, fill you up without overloading you with calories.

This diet scored highest for its safe weight-loss-rate and nutritional components because it's "based on sound nutrition principles and overall healthy food choices," judge Samantha Heller says. And our panelists found the plan's 150-plus recipes appealing. Another plus, judge Christine Palumbo says, is Volumetric's creative approach of showing photos of low- and high-density foods side by side -- a simple way to help dieters visualize good choices.

Though exercise plays a secondary role in the Volumetrics plan, it is required. And a guide for logging 30 to 60 minutes of daily activity provides motivation. But Health's Frances Largeman-Roth wondered if some dieters would need more exercise challenges and support.

• The Best Life Diet (Simon & Schuster)

Bob Greene is forever linked with superstar (and dieter) Oprah Winfrey. And his high-profile guide, which offers a sane, healthy approach to overall lifestyle changes, earned consistently high marks from our experts. Roshini Rajapaksa, MD, who looked at the motivational elements of each diet, was impressed by the realistic goals embraced by the Best Life plan, as well as the weekly menus and recipes offered on its Web site (which also features message-board support groups, a good source of dieting motivation).

Best Life has three phases that each dieter is encouraged to embark upon at his or her own pace, a strategy that leads to slimming, nutritional eating and increased physical activity. Dietitian Christine Palumbo gave this staged approach a perfect 10: "For people who like to ease into lifestyle changes in order to get used to them oh-so-gradually," she says, "this is a good bet."

Greene doesn't advocate keeping strict track of calories, which may make the Best Life more challenging for rule-loving dieters, yet panelists applauded his holistic approach to healthy eating. "He's emphasizing healthy foods in reasonable portions," nutrition expert Maureen Callahan says.

"Dieters shouldn't feel deprived on this plan," Health's Frances Largeman-Roth says. "However, the fact that this diet doesn't have 'magic' foods or promise rapid results may make it less attractive to dieters looking for a silver bullet." And that may be its best recommendation of all.

• The Solution (Collins)

"This program excels at helping people figure out why they're overeating," Callahan says, "and that's what's going to keep the weight off." Squarely facing the emotional and behavioral underpinnings of overeating, dietitian Laurel Mellin's method is based on The Shapedown Program, a successful weight-management plan she created for overweight children and adolescents in the late 1970s. Mellin views obesity not so much in terms of diet and exercise but as another expression of the interaction of mind, body, and lifestyle. And The Solution, designed for dieters of all ages, targets five root causes of weight problems: unbalanced eating, low energy, body shame, setting ineffective limits, and weak self-nurturing skills.

The food aspects of this program center on four "light" lists--grains, proteins, milk foods, and fruit and vegetables. And Mellin's guidelines and food suggestions got high marks on healthy balance from our panelists. Largeman-Roth liked the variety of the plan, as well as its overall moderation. And Palumbo awarded it a hat-trick of perfect 10s in all nutritional aspects.

• You: On a Diet (Free Press)

"No wonder Dr. Oz is Oprah's favorite doctor!" Palumbo raves, hailing the friendly diet book that is the centerpiece of the "You" docs Mehmet C. Oz and Michael F. Roizen's mini-empire of healthy lifestyle guides and products (including a very interactive Web site). This diet, Palumbo adds, "teaches and motivates about weight (and waist) loss with a sense of good humor and fun."

Indeed, the book offers a lot of education amidst the menu plans, which include recipes for Stuffed Whole Wheat Pizza, Grilled Peanut Shrimp with Sesame Snow Peas, and Sweet Beet and Gorgonzola Salad. Panelist Samantha Heller praised its easy-to-understand nutrition information, while Dr. Rajapaksa gave points for its good explanations of how the body works. The weight-loss trajectory centers on cutting about 500 calories per day, and panelists liked the easy calculations that help readers figure out their own calorie needs.

Palumbo also credited the plan with adding to the healthy (but not terribly exciting) 30 minutes of daily walking some equally valuable recommendations of stretching, metabolism boosting, muscle building, and strength training. Added benefit: Illustrations show how to do the exercises sans a trip to the gym.

• The Sonoma Diet (Meredith Books)

There's an undercurrent of celebration in this best-selling diet that continues to inspire with delicious recipes using staples of Mediterranean eating: fruits, vegetables, whole grains, olive oil, fish, and nuts.

Dietitian and PhD Connie Guttersen's plan opens with a strident 10-day jump-start phase called "Wave One," designed to purge habits of eating sugar and highly processed foods, which judges Maureen Callahan and Samantha Heller caution may be a little too calorie-restrictive for some beginning dieters. But subsequent phases--active weight loss and maintenance--garnered high marks from our panel. Exercise is encouraged but not actively prescribed, a missed opportunity in the minds of several judges.

Overall, our panelists loved the creative recipes and menus. And they applauded the plate-and-bowl approach to portion control, a hallmark of long-term, sustainable eating habits. "This diet teaches you to eat slowly and savor your meals," judge Palumbo says.

• The Spectrum (Ballantine)

Famous in the 1990s for advocating a program to combat heart disease, Dr. Dean Ornish, MD, has been criticized for prescribing nutritional edicts that are just too hard to sustain. The Spectrum, Ornish's newest diet, both broadens and softens his program by moving along four separate paths to health--nutrition, exercise, stress management, and personal relationships.

Our panelists liked the plan's holistic approach, particularly rewarding its counsel on reducing stress and giving it high marks for including a meditation DVD with the book. And our nutrition judges were glad to see that Ornish has tempered his tough stance on fats to a more sustainable level, but one panelist feels he's still too strict. "There's no reason not to eat nuts, seeds, and avocados; use maple syrup and honey; or have a glass of wine, periodically," panelist Heller says. She notes, though, that Ornish's whole-body approach, which includes a vegetarian lifestyle, stress management, and exercise, is on target in terms of health, disease prevention, and reaching a healthy weight.

Judge Palumbo awarded Ornish's plan some of her highest scores. "This 'diet' plan addresses the lifestyle diseases of the 21st century," she says, "such as diabetes, certain cancers, and cardiovascular disease. This book is ideal for people who are looking for an intelligent, thoughtful, science-based weight-loss program."

FDA Reconsiders Consumer Advice on Fish

WASHINGTON (AP) — For years, the federal government has recommended that pregnant women and young children limit their consumption of fish to avoid exposure to potentially harmful amounts of mercury.

Now, two top consumer protection agencies are at odds on whether that advice should be reconsidered to encourage all people to eat more fish, in order to promote healthy hearts.

The Food and Drug Administration has been circulating a draft report within the government that argues the health benefits of eating fish outweigh the potential ill effects of mercury. But the Environmental Protection Agency has fired off a memo to the White House calling the 270-page FDA study "scientifically flawed and inadequate" and an "oversimplification" lacking analytical rigor.

Environmental groups are crying foul. They say it's a sneak attempt to undercut important public health advice in the waning hours of a Bush administration that has treated science as a stepchild.

"The FDA was once a fearsome protector of the public health. Now it's nothing more than a patsy for polluters," Richard Wiles, executive director of the Environmental Working Group, said in a statement.

The food industry is praising the FDA's shift. One organization, the Center for Consumer Freedom, called it "long overdue and a huge public-health victory" that "just might be the best Christmas present health-conscious Americans could hope for."

The interagency feud spilled into the open Friday when the Environmental Working Group released copies of the dueling memos. The dispute was first reported by the Washington Post.

The FDA is embroiled in another controversy over the science of food safety. Recently, a panel of outside advisers challenged the agency on bisphenol A, or BPA, a chemical used to make plastic for food packaging and other consumers goods. The independent experts said that FDA's conclusion that low doses of BPA are safe was scientifically flawed.

The battle over mercury is now attracting the interest of Congress. "FDA should not change anything it cannot back up with the best science, because we know that mercury can cause brain and cardiovascular damage," said Sen. Barbara Boxer, D-Calif., who chairs the Environment and Public Works Committee. "FDA should not play politics with the health of our families."

At the FDA, officials sought to tamp down the controversy and dispel concerns that the agency is about to toss out the government's current mercury guidance.

"It would be a mistake to assume that this draft report represents the FDA's official position because a final determination on these matters has not been reached," said spokesman Michael Herndon. "Following the discussion among government agencies, FDA intends to seek public comment. This will all be done in a very public and transparent manner, and the FDA will make no final determination until all the relevant comments and scientific analysis has been carefully considered."

Mercury occurs naturally and is also released in the environment through pollution. Very high levels in the bloodstream can damage the nervous system of developing fetuses and young children, causing learning disabilities and other problems. Fish absorb mercury in the water and as they feed on plankton and other smaller fish. Some fish, like king mackerel and swordfish, accumulate higher levels of mercury.

Fish and shellfish are the biggest sources of human exposure to mercury. Fetuses and young children are the most susceptible to harm. About 8 percent of U.S. women of childbearing age have enough mercury in their blood to be at risk of having babies with subtle learning disabilities, the Centers for Disease Control and Prevention estimates.

Because of such concerns, the FDA and EPA have recommended that women of child-bearing age and young children not eat shark, swordfish, king mackerel or tilefish, which contain high levels of mercury. The agencies also advised that they eat no more than two meals a week of fish and shellfish that are lower in mercury, a total of 12 ounces. And since "white" albacore tuna has more mercury than chunk light tuna, they recommended no more than six ounces a week.

The FDA's draft report said the latest studies seem to indicate that the risks may not be as dire as previously thought. The agency also sought to weigh the risk of mercury against the benefits of eating more fish.

Current research suggests "a beneficial impact on fetal neurodevelopment from the mother's consumption of fish, even though they contain methylmercury," the report said.

"The net effect is not necessarily adverse, and could in fact be beneficial," it added.

But the EPA said, "this FDA report bases its conclusions on models that use very limited inputs from studies that have significant problems for risk analysis."

Many Children Now Rely on Alternative Remedies

One of every nine children under age 18 practices yoga, goes to achiropractor, takes a supplement like fish oil or uses some other alternative treatment, according to a new government survey that for the first time included questions regarding children’s use of complementary medicine.

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Children and Alternative Medicine

Natural, non-vitamin products are the most common alternative therapies used by children, with almost 4 percent taking a supplement like echinacea, fish oil, flaxseed oil, herb pills, prebiotics or probiotics, according to the survey, conducted by the National Center for Complementary and Alternative Medicine.

Almost 3 percent of children see a chiropractor or an osteopath for manipulation, 2.2 percent do deep breathingexercises and 2.1 percent do yoga.

“It’s a substantial amount of use in children, given that children tend to be healthier than the adult population,” said Richard L. Nahin, acting director of the center’s division of extramural research and co-author of the report.

But some experts say the figures may be even higher and that as many as 40 percent of healthy children and more than 50 percent of children with chronic health conditions are using alternative therapies.

Dr. Lawrence D. Rosen, a pediatrician who has also researched use of these therapies by children said the survey results may depend on how questions were asked and how alternative therapy is defined.

“This is a wake-up call,” said Dr. Rosen, who practices integrative medicine in Oradell, N.J. “The main thing pediatricians and patients need to recognize is that we all need to be talking about this. Parents need to be comfortable discussing it, and pediatricians need to feel comfortable bringing it up.”

The survey’s findings will help shape research initiatives, Mr. Nahin said, adding that many products, especially dietary supplements, have not been rigorously tested in clinical trials in adults or children even as their use has become more widespread.

“In most cases, there is no clear recommendation one can make whether a child should use a product or not,” Mr. Nahin said. The survey results are based on data from more than 23,000 interviews with American adults and more than 9,400 interviews with adults on behalf of children in their households. The survey was conducted in 2007 as part of the annual National Health Interview Survey.

It included questions about 36 common alternative therapies, including 10 that are provider-based, like chiropractic care, and 26 that do not require a provider, such as meditation. The last such survey of adult use of alternative therapies was conducted in 2002.

Use of complementary therapies among adults has remained fairly steady in recent years, with 38 percent of adults using some form of alternative medicine in 2007, up from 36 percent in 2002.

But while adults tend to rely on alternative therapies for chronic conditions like back orneck pain, children more often use them for both chronic problems, like attention deficit hyperactivity disorder, and acute illnesses, like headaches and colds.

Adult use of complementary medicines for colds appears to have dropped significantly, to 2 percent in 2007 from 9.5 percent in 2002, while use of yoga, massage, acupuncture, meditation, deep breathing exercises and naturopathy has increased.

The single most influential factor driving children’s adoption of alternative therapies appears to be whether their parents also use them. Children whose parents or relatives use alternative therapies are five times more likely to use them than children whose parents do not.

Teens were more likely to use alternative therapies than younger children, with 16.4 percent of adolescents ages 12 to 17 using these therapies, compared with 10.7 percent of children ages 5 to 11 and 7.6 percent of children ages 4 or younger. White children were twice as likely as black children to use alternative therapies, the survey found.

But the lines separating the therapies considered mainstream from those considered alternative is constantly shifting, said Dr. Kathi Kemper, chair of the American Academy of Pediatrics section for complementary and integrative medicine and a professor of pediatrics at Wake Forest University in Winston-Salem, N.C.

“They included fish oil in this survey, but I’ve been asking psychiatrists if they use fish oil and it looks like 80 percent of psychiatrists are recommending it, as are cardiologists,” Dr. Kemper said. Massage for newborns, hypnosis and acupuncture for pain are also going mainstream, she added.

AZ's Asthma drug cleared by FDA panel

The benefits of AstraZeneca's asthma medication Symbicort outweigh its risks, a federal advisory panel said Thursday, removing a looming threat to the marketability of one of the company's top brands.

Symbicort and its closest competitor, Advair, avoided the fate of two other long-acting asthma drugs. The advisory panel to the Food and Drug Administration said Serevent and Foradil are too risky and should no longer be used for asthma.

The FDA has been reviewing the safety of long-acting beta agonists, or LABAs, which relax the muscles around airways to help asthmatic patients breathe more easily. Symbicort and Advair combine a LABA with an inhaled steroid to reduce inflammation, while Serevent and Foradil are LABA-only medications.

The FDA's own drug safety experts had recommended restrictions on all four drugs, including that none of them be used to treat asthmatic children. But the agency's respiratory specialists said the risks were manageable and no curbs were needed.

With its own experts deadlocked, the FDA called in an unusually large panel of 27 outside advisers. The medical and scientific experts said Advair and Symbicort should continue to be used with all patients.

The panel voted 26-0 with one abstention for Symbicort's use in adults, and 20-5 with two abstentions for asthma patients ages 12 to 17. AstraZeneca also has filed an application with the FDA to market Symbicort for asthma in patients 6 years and older.

The FDA usually follows the recommendations of its outside experts, although it is not required to do so.

Advair, made by GlaxoSmithKline, was the fourth-best selling drug in the world last year, with sales of $7.1 billion. Symbicort, a newer product introduced in the U.S. in 2006, brought in $1.57 billion in sales last year for AstraZeneca, whose U.S. headquarters is in Fairfax.

In preparation for the advisory panel meeting, the FDA analyzed findings from 110 clinical trials involving nearly 61,000 patients, comparing patients who took a medication containing a LABA with those who used a steroid alone to control their asthma. The agency found that each of the drugs except Advair carried an increased risk of hospitalization or death.

But AstraZeneca last week said the FDA examined only a small portion of the information it sent at the agency's request. The drug maker said its analysis of clinical trials involving more than 23,000 patients found no evidence of an increased risk of asthma-related deaths or hospitalizations for patients taking Symbicort.

HK finds Bird Flu on Chicken Farm

The birds at the farm have already been slaughtered

The authorities in Hong Kong say they have found the deadly H5N1 strain of the bird flu virus on a chicken farm.

It is the first such discovery in Hong Kong in more than five years.

A government spokeswoman said the outbreak was probably due to an external source, possibly eggs smuggled into Hong Kong from mainland China.

Since the H5N1 virus emerged in South East Asia in late 2003, millions of birds have been culled, and more than 220 people have died.

Almost all infected people are thought to have contracted the disease from poultry.

But scientists fear the virus could mutate into a form which could be easily passed from human to human, triggering a pandemic and potentially putting millions of lives at risk.

Chickens slaughtered

The government announced on Tuesday that bird flu had been found at a farm near the border with China, and immediately ordered the slaughter of tens of thousands of chickens.

A spokeswoman for the Agriculture, Fisheries and Conservation Department has now confirmed the strain of the virus as H5N1.

The first reported major bird flu outbreak among humans happened in Hong Kong in 1997, when six people died.

Hong Kong was also affected by the second outbreak in 2003, and farmers in the territory are now required to vaccinate their birds.

Worldwide Measles Deaths Drop Dramatically

They plunged 74 percent from 2000 to 2007, report shows

By Steven Reinberg
HealthDay Reporter

THURSDAY, Dec. 4 (HealthDay News) -- Worldwide deaths from measles plunged 74 percent between 2000 and 2007, according to a new report, and experts say the trend is clear evidence that an international campaign to increase measles vaccination rates is working.

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According to the U.S. Centers for Disease Control and Prevention report, the number of deaths fell from 750,000 to 197,000. Moreover, measles deaths in the Eastern Mediterranean region, which includes countries such as Afghanistan, Pakistan, Somalia and Sudan, dropped by 90 percent, from 96,000 to 10,000 deaths, beating by three years the United Nations' goal of cutting measles deaths in that area 90 percent by 2010.

"The progress made today is a major contribution to achieving the United Nations Millennium Development target of reducing child mortality by two-thirds by 2015," Dr. Peter Strebel, of the World Health Organization's Department of Immunization, Vaccines, and Biologicals, said during a morning teleconference Thursday.

For the first time, measles vaccinations around the world reached 82 percent in 2007, up from 72 percent in 2000, Strebel said. "And we are reaching more children with measles vaccine through routine vaccination services," he added.

This success is a result of the Measles Initiative, the experts said. Started in 2001, the initiative is a collaborative effort by the World Health Organization, the CDC, the American Red Cross, the United Nations Foundation and UNICEF.

The new findings are published in the Dec. 5 issue of the CDC's Morbidity and Mortality Weekly Report.

Despite this success, Strebel thinks efforts to eradicate measles need to be stepped up, or else the gains could be lost.

Ann M. Veneman, executive director of UNICEF, said during the teleconference that worldwide child deaths from measles have dropped to 9.2 million.

"That's unacceptable, but an improvement and a 60 percent reduction in the rate of child mortality since 1960," Veneman said. "The success of the Measles Initiative shows the result of government commitment to children and the benefit of providing community-based integrated health programs."

The greatest reductions in measles deaths occurred in Africa, where deaths dropped 89 percent, and the Eastern Mediterranean, where deaths dropped 90 percent, according to the report.

But more needs to be done, Veneman said. "It is estimated that 500 children a day die of measles. This is an unacceptable reality when there is a safe and effective and inexpensive vaccine to prevent the disease," she said.

Of the 197,000 measles deaths in 2007, an estimated 90 percent were children who died before their 5th birthday, Veneman said. "In 2007, 67 percent of the measles deaths were in one country -- India," she noted.

The Measles Initiative is working with the Indian government to make sure all children are getting two doses of measles vaccine, Veneman said. India was the last country to adopt the two-dose strategy, she explained.

From 2000 to 2007, approximately 11 million measles deaths throughout the world were prevented due to measles control activities. Increased vaccinations alone prevented 3.6 million deaths, according to the report.

To continue making progress against measles, the CDC identified six areas of concern. First, vaccine programs need to be developed in India. Second, vaccine systems need to improve to ensure that more than 90 percent of children get their first shot on time. Third, there needs to be follow-up to ensure the second shot is given. Fourth, there needs to be better surveillance of suspected cases of measles. Fifth, there needs to be better management of measles cases. And sixth, more money is needed to keep measles programs going.

"The gains made in fighting measles and other diseases must provide momentum and a sense of urgency to accelerate progress and save the lives of more and more children," Veneman said.

Measles has been on the rise in the United States, reaching the highest level in more than a decade. While measles deaths in the United States are rare, this year there have been about 130 reported cases of the disease. Almost half of these cases were among children whose parents declined vaccinations.

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More information

For more on measles, visit the U.S. Centers for Disease Control and Prevention.

Warning Given on Use of 4 Popular Asthma Drugs, but Debate Remains

WASHINGTON — Two federal drug officials have concluded thatasthma sufferers risk death if they continue to use four hugely popular asthma drugs — Advair, Symbicort, Serevent and Foradil. But the officials’ views are not universally shared within the government.

The two officials, who work in the safety division of the Food and Drug Administration, wrote in an assessment on the agency’s Web site on Friday that asthma sufferers of all ages should no longer take the medicines. A third drug-safety official concluded that Advair and Symbicort could be used by adults but that all four drugs should no longer be used by people age 17 and under.

Dr. Badrul A. Chowdhury, director of the division of pulmonary and allergy products at the agency, cautioned in his own assessment that the risk of death associated with the drugs was small and that banning their use “would be an extreme approach” that could lead asthmatics to rely on other risky medications.

Once unheard of, public disagreements among agency experts have occurred on occasion in recent years. The agency is convening a committee of experts on Wednesday and Thursday to sort out the disagreement, which has divided not only the F.D.A. but also clinicians and experts for more than a decade.

Sudden deaths among asthmatics still clutching their inhalers have fed the debate. But trying to determine whether the deaths were caused by patients’ breathing problems or the inhalers has proved difficult.

The stakes for drug makers are high. Advair sales last year were $6.9 billion and may approach $8 billion this year, making the medication GlaxoSmithKline’s biggest seller and one of the biggest-selling drugs in the world. Glaxo also sells Serevent, which had $538 million in sales last year. Symbicort is made by AstraZeneca and Foradil by Novartis.

Whatever the committee’s decision, the drugs will almost certainly remain on the market because even the agency’s drug-safety officials concluded that they were useful in patients suffering from chronic obstructive pulmonary disease, nearly all of whom are elderly.

Dr. Katharine Knobil, global clinical vice president for Glaxo, dismissed the conclusions of the agency’s drug-safety division as “not supported by their own data.” Dr. Knobil said that Advair was safe and that Serevent was safe when used with a steroid.

Michele Meeker, a spokeswoman for AstraZeneca, said that the F.D.A.’s safety division improperly excluded most studies of Symbicort in its analysis, and that a review of all of the information shows that the drug does not increase the risks of death or hospitalization.

Dr. Daniel Frattarelli, a Detroit pediatrician and member of the American Academy of Pediatrics’s committee on drugs, said that he was treating children with Advair and that his committee had recently discussed the safety of the medicines.

“Most of us felt these were pretty good drugs,” Dr. Frattarelli said. “I’m really looking forward to hearing what the F.D.A. committee decides.”

About 9 percent of Advair’s prescriptions go to those age 17 and under, according to Glaxo. Ms. Meeker could not provide similar figures for Symbicort.

In 1994, Serevent was approved for sale, and the F.D.A. began receiving reports of deaths. A letter to the New England Journal of Medicine described two elderly patients who died holding Serevent inhalers. Glaxo warned patients that the medicine, unlike albuterol, does not work instantly and should not be used during an attack.

In 1996, Glaxo began a study of Serevent’s safety, but the company refused for years to report the results publicly. In 2001, the company introduced Advair, whose sales quickly cannibalized those of Serevent and then far surpassed them.

Finally in 2003, Glaxo reported the results of its Serevent study, which showed that those given the medicine were more likely to die than those given placebo inhalers. Glaxo said problems with the trial made its results impossible to interpret.

Asthma is caused when airways within the lungs spasm and swell, restricting the supply of oxygen. The two primary treatments are steroids, which reduce swelling, and beta agonists, which treat spasms. Rescue inhalers usually contain albuterol, which is a beta agonist with limited duration. Serevent and Foradil are both beta agonists but have a longer duration than albuterol and were intended to be taken daily to prevent attacks.

Advair contains Serevent and a steroid. Symbicort, introduced last year, contains Foradil and a steroid. In the first nine months of this year, Symbicort had $209 million in sales.

The problem with albuterol is that it seems to make patients’ lungs more vulnerable to severe attacks, which is why asthmatics are advised to use their rescue inhalers only when needed. The long-acting beta agonists may have the same risks.

But drug makers say this risk disappears when long-acting beta agonists are paired with steroids. The labels that accompany Serevent and Foradil instruct doctors to pair the medicines with an inhaled steroid.