Snow to hit evening commute

A winter storm warning has been issued for Lake and McHenry counties, with heavy wet snow falling at the rate of one to two inches as hour in some northern suburbs.

Some areas, such as Gurneee, had 5 inches by 4 p.m. Those areas are expected to get 6 to 8 inches of snow by the time the storm moves out overnight, according to National Weather Service meteorologist Bill Nelson..

“Parts of Cook and DuPage counties will see around 2 to 5 inches,” Nelson said. Areas farther south will see only an inch or two.

As of 4:30 p.m. the Chicago put out 199 of its snow and salt trucks and expected to patrol main streets throughout the evening rush.

The Illinois Tollway also has mobilized its full fleet of 182 snowplows during rush hour and throughout the evening across the 286-mile system, according to a release.

By 4 p.m., Gurnee had 5 inches, Beach Park 4.6 inches, Wadsworth 4.5 inches, Kenosha 4.3 inches, Spring Grove 4 inches, Beach Park 3.1 inches, Antioch 2.8 inches and Bull Valley 2.1 inches.

North and northwest suburbs were seeing numerous accidents, from Barrington to Antioch, according to Traffic.com.

In McHenry County, police were warning motorists to avoid U.S. Route 31 between Crystal Lake and McHenry because the road was "impassable" where it crosses over a hill.

State police said expressways were largely clear but the weather service warned of a slow evening commute.

"The threat for a period of heavy snow could result in reduced visibilities under a mile at times and rapid accumulation on area roads during the evening commute," the weather service warned.

Photos: Chicago winter 2012-13

Still, the storm was nothing like the one barreling toward New England with forecasts of up to two feet of snow. A blizzard warning has been issued for New York City, Connecticut and the Boston area.

Forecasters warned the snow would begin lightly on Friday morning but ramp up to blizzard conditions by afternoon, leading Boston Mayor Thomas Menino to order the city's schools closed Friday. He asked businesses to consider allowing staff to stay home.

"We are hardy New Englanders, let me tell you, and used to these types of storms. But I also want to remind everyone to use common sense and stay off the streets of our city. Basically, stay home," Menino told reporters. "Stay put after noontime tomorrow."

The National Weather Service said Boston could get one to two feet of snow on Friday and Saturday, which would be its first major snow fall in about two years. Light snow is expected to begin falling around 7 a.m. EST on Friday, with heavier snow and winds gusting as high as 60 to 75 miles per hour as the day progresses.

"It's the afternoon rush-hour time frame into the evening and overnight when the height of the storm will be," said Kim Buttrick, a meteorologist at the National Weather Service in Taunton, Massachusetts. "That's when we expect the storm to begin in earnest."

The heaviest snow was expected around Boston, the region's most populous city, with cities from Hartford, Connecticut to Portland, Maine, expected to see at least a foot.

If more than 18.2 inches of snow fall in Boston, the storm will rank among the 10 biggest snowfalls on record in the city. The heaviest snowfall ever recorded in Boston was a 27.6 inch dump that accompanied the blizzard of February 17-18, 2003.

The storm's timing brought back memories of the blizzard of 1978, Boston's second-heaviest recorded snow fall, which roared in on an afternoon, dropping 27.1 inches of snow, trapping commuters on roadways and leaving dozens dead across the region, largely as a result of downed electrical lines.

Peter Judge, a spokesman for the Massachusetts Emergency Management Agency, said one of the state's biggest worry is power outages.

"It being winter, folks losing their power means they're also losing their heat, and if you lose heat during the middle of the storm, you're not going to be able to go out to get to a shelter," he said, adding that the agency would begin 24-hour operations at its emergency compound at noon (1700 GMT) on Friday and would be in close contact with local utilities.

Unlike the 1978 blizzard, which had been forecast to drop far less snow than it actually did, he said he hoped several days of news coverage about this storm would prompt people to stay off the roads.

"People have been warned, they have been told what the issues are," Judge said. "We don't expect people to be surprised."

Reuters contributed to this report.

chicagobreaking@tribune.com

Twitter: @chicagobreaking

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Well: The 'Monday Morning' Medical Screaming Match

I did not think I would ever see another “morbidity and mortality” conference in which senior doctors publicly attacked their younger colleagues for making medical errors. These types of heated meetings were commonplace when I was a medical student but have largely been abandoned.

Yet here they were again on “Monday Mornings,” a new medical drama on the TNT network, based on a novel by Dr. Sanjay Gupta, CNN’s chief medical correspondent and one of the executive producers of the show. Such screaming matches may make for good television, but it is useful to review why new strategies have emerged for dealing with medical mistakes.

So-called M&M conferences emerged in the early 20th century as a way for physicians to review cases that had either surprising outcomes or had somehow gone wrong. Although the format varied among institutions and departments, surgery M&Ms were especially known for their confrontations, as more experienced surgeons often browbeat younger doctors into admitting their errors and promising to never make them again.

Such conferences were generally closed door — that is, attended only by physicians. Errors were a private matter not to be shared with other hospital staff, let alone patients and families.

But in the late 1970s, a sociology graduate student named Charles L. Bosk gained access to the surgery department at the University of Chicago. His resultant 1979 book, “Forgive and Remember,” was one of the earliest public discussions of how the medical profession addressed its mistakes.

Dr. Bosk developed a helpful terminology. Technical and judgment errors by surgeons could be forgiven, but only if they were remembered and subsequently prevented by those who committed them. Normative errors, which called into question the moral character of the culprit, were unacceptable and potentially jeopardized careers.

Although Dr. Bosk’s book was more observational than proscriptive, his depiction of M&M conferences was disturbing. I remember attending a urology M&M as a medical student in which several senior physicians berated a very well-meaning and competent intern for a perceived mistake. The intern seemed to take it very well, but my fellow students and I were shaken by the event, asking how such hostility could be conducive to learning.

There were lots of angry accusations in the surgical M&Ms in the pilot episode of “Monday Mornings.” In one case, a senior doctor excoriated a colleague who had given Tylenol to a woman with hip pain who turned out to have cancer. “You allowed metastatic cancer to run amok for four months!” he screamed.

If this was what Dr. Bosk would have called a judgment error, the next case raised moral issues. A neurosurgeon had operated on a boy’s brain tumor without doing a complete family history, which would have revealed a disorder of blood clotting. The boy bled to death on the operating table. “The boy died,” announced the head surgeon, “because of a doctor’s arrogance.”

In one respect, it is good to see that the doctors in charge were so concerned. But as the study of medical errors expanded in the 1990s, researchers found that the likelihood of being blamed led physicians to conceal their errors. Meanwhile, although doctors who attended such conferences might indeed not make the exact same mistakes that had been discussed, it was far from clear that M&Ms were the best way to address the larger problem of medical errors, which, according to a 1999 study, killed close to 100,000 Americans annually.

Eventually, experts recommended a “systems approach” to medical errors, similar to what had been developed by the airline industry. The idea was to look at the root causes of errors and to devise systems to prevent them. Was there a way, for example, to ensure that the woman with the hip problem would return to medical care when the Tylenol did not help? Or could operations not be allowed to occur until a complete family history was in the chart? Increasingly, hospitals have put in systems, such as preoperative checklists and computer warnings, that successfully prevent medical errors.

Another key component of the systems approach is to reduce the emphasis on blame. Even the best doctors make mistakes. Impugning them publicly — or even privately — can make them clam up. But if errors are seen as resulting from inadequate systems, physicians and other health professionals should be more willing to speak up.

Of course, the systems approach is not perfect. Studies continue to show that physicians conceal their mistakes. And elaborate systems for preventing errors can at times interfere with getting things done in the hospital.

Finally, it is important not to entirely remove the issue of responsibility. Sad to say, there still are physicians who are careless and others who are arrogant. Even if today’s M&M conferences rarely involve screaming, supervising physicians need to let such colleagues know that these types of behaviors are unacceptable.

---

Barron H. Lerner, M.D., professor of medicine at New York University Langone Medical Center, is the author, most recently, of “One for the Road: Drunk Driving Since 1900.”

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EveryBlock shuts down

Hyper local news and social media site EveryBlock.com has shut down, the company said Thursday.

"Though EveryBlock has been able to build an engaged community over the years, we're faced with the decision to wrap things up," a item on the EveryBlock.com blog said.

The posting said Everyblock faced increasing challenges to build a profitable business. It had 10 employees, including President Brian Addison.

The company was founded in 2007 by Naperville native Adrian Holovaty and acquired by MSNBC.com in 2009. NBC News acquired MSNBC.com last year.

NBC News Chief Digital Officer Vivian Schiller said EveryBlock's financial losses "were considerable," although she declined to offer specific financial results.

"Hyper local is a very tough business. This isn't about anything being a failure, but more about our need to stay focused on the strengths of NBC News' digital portfolio," she added in an email.

Schiller said the company looked for various options for EveryBlock, such as a sale, but none of the options ended up being viable.

"EveryBlock was among the more innovative and ambitious journalism projects at a time when journalism desperately needed innovation and ambition. RIP," Holovaty wrote Thursday in a blog post on his site Holovaty.com.

Holovaty wrote that he believes EveryBlock, founded with the help of a $1.1 million grant from the John S. and James L. Knight Foundation, was a successful attempt to push innovation in newspapers and journalism.

"It was a great site, beautifully designed and lovingly crafted. It made a difference for people, particularly in Chicago," he wrote.

Holovaty left the site in August to pursue other interests.

Hyper local sites in general have surged in popularity in recent years, but with the success came an explosion of competitors, making generating revenue extremely difficult. In 2007, about 1 in 8 Americans lived in a town with a local blog, according to data from Placeblogger.com, which indexes local weblogs. Today, more than half do.

Still, limited revenue streams make for a shaky future.

"Most of these companies have the structural integrity of a wet cardboard box," said Lisa Williams, Placeblogger's founder and CEO.

Williams said the sudden shutdown of EveryBlock and others like highlights the boom-and-bust cycles in technology businesses, but also underscores the impatience of the big companies who acquire them.

"Whenever someone invests in you there's always a ticking clock attached to money," she said. "It's a very high-turn business. You have to either get big or get out."

In the Chicago area, hyper local news has proved itself to be a competitive and challenging niche, with both local and out-of-town organizations trying to gain traction.

The Chicago News Cooperative, which had a publishing deal with the New York Times, closed down in 2012 after a little more than two years. AOL's Patch has had a rough time, with one investor estimating last year that the national collection of hyperlocal sites, including dozens in Illinois, lost $147 million in 2011.

Tribune Co.  partnered last year with Journatic, a Chicago-based company, to provide hyperlocal content for the Chicago Tribune's TribLocal.  Tribune Co. then suspended Journatic over ethical lapses, and after a lengthy investigation resumed limited use of Journatic with added safeguards.

The Chicago Tribune also at one time hosted a search box on its web site that directed readers to EveryBlock data.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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Cops: Salon bandit was paying for cocaine habit

Jason Logsdon, 41, of Evanston has been charge with 11 counts of armed robbery.

The man accused of holding up hair salons in Chicago and the suburbs used a BB gun, picked places where there would be no male workers, and told police the robberies paid for his crack cocaine habit, authorities say.

Jason Logsdon, 41, also used his girlfriend's car during at least one of the robberies, which finally led to his arrest this week, police said. He was tracked down in Skokie after someone at his last robbery on the North Side of Chicago provided a partial license plate number, authorities said.

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Police said they recovered the BB gun along with a red coat that the Evanston man wore during the robberies.

Logsdon is accused of robbing a hair salon in Broadview, five in Chicago, one in Morton Grove, two in Niles and two in Skokie. The DuPage County state’s attorney’s office is pursuing additional charges against Logsdon for two robberies in Lombard, one in Glen Ellyn and one in Bensenville, officials said.

Logsdon, wearing a blue long-sleeved shirt and jeans, kept his head lowered during a hearing where Judge Marcia Orr ordered him held without bond. "I am considering the number of crimes in the short time in which they were committed," she said.

His public defender described Logsdon as a student at Le Cordon Bleu College of Culinary Arts in Chicago. He was expecting to graduate in February, according to his lawyer. A spokesman at the school said he could not confirm or deny that information.

Logsdon is unemployed but has worked as a chef before, his lawyer said. He has lived in Evanston four years. He was arrested in 2003 for a DUI in Missouri, but otherwise has a clean record, lawyers said.

Logsdon was arrested after a salon in the Wicker Park neighborhood was hit. A man stole about $250 in cash from the Great Clips salon in the 1200 block of a well-trafficked North Ashland Avenue around 10:45 a.m. Monday, police said.

The man brandished a handgun before presenting a dark bag to three salon workers, which one of them filled with money, Chicago Police News Affairs Officer Daniel O'Brien said. Wearing a red and gray jacket, blue jeans and a hat and scarf, the man walked north on Ashland and hopped in a gray colored sedan, which left driving southbound, police said.

No one was injured, police said.

A witness from that robbery provided a license plate number that was one digit off, according to Brian Baker, Skokie’s commander in charge of the investigative division.

Chicago police ran variations on the number until they found a vehicle with a similar make and model as reported by the witness. The woman who owned the car had “no knowledge that these (robberies) were occurring,” Baker said.

chicagobreaking@tribune.com

Twitter: @ChicagoBreaking

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Dick Morris dropped by Fox News

LOS ANGELES (TheWrap.com) – Dick Morris will no longer be serving as a contributor at Fox News, a spokesperson for the network told TheWrap.

Morris’ contract had recently expired, and Fox will not be renewing it, the spokesperson said.

Morris, a former adviser to President Bill Clinton who later turned into a harsh critic for the Clintons, had been a longtime contributor to Fox, but has not appeared on the cable network in recent months.

But while Morris may no longer be a presence on Fox News’ airwaves, he isn’t disappearing from television news – at least not immediately.

Morris announced on his website Tuesday that he will appear on Wednesday’s edition of CNN’s “Piers Morgan Tonight.”

“You read it right! I will be a guest on The Piers Morgan Show on CNN, yes CNN, this Wednesday night at 9 PM EST,” Morris wrote. “I’ll spell out what the Republican Party must do to win national elections again and will discuss how House Speaker Boehner has become Obama’s captive. Tune in!”

Morris’ exit at Fox News comes less than two weeks after news broke that former vice presidential candidate Sarah Palin, who had been a contributor for the cable news network since January 2010, had parted ways with the network. That departure came following reports that Fox News chairman and CEO Roger Ailes was so angry about Palin announcing her plans for the 2012 presidential election on a rival outlet that he wanted to bench her.

In recent months, Fox News has added former “The Man Show” co-host Adam Carolla and former congressman and presidential candidate Dennis Kucinich, who’s known for his liberal views, to its roster of contributors. The network has also re-upped Karl Rove, the former senior adviser to George W. Bush, through the 2016 presidential election.

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Personal Health: Effective Addiction Treatment

Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.

But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you’re not alone. And chances are, it’s not your fault.

Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.

According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.

A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that “the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.” The report added, “Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works.”

The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered “a form of medical malpractice.”

The failings of many treatment programs — and the comprehensive therapies that have been scientifically validated but remain vastly underused — are described in an eye-opening new book, “Inside Rehab,” by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed “Sober for Good.”

“There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches,” A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.

Ms. Fletcher’s book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.

Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher’s exhaustive exploration in the first place.

In an interview, Ms. Fletcher said she wanted to inform consumers “about science-based practices that should form the basis of addiction treatment” and explode some of the myths surrounding it.

One such myth is the belief that most addicts need to go to a rehab center.

“The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually,” she wrote.

Contrary to the 30-day stint typical of inpatient rehab, “people with serious substance abuse disorders commonly require care for months or even years,” she wrote. “The short-term fix mentality partially explains why so many people go back to their old habits.”

Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, “You don’t treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it.”

Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr “to serve as a model to demonstrate what comprehensive 21st century treatment should look like.”

“While some people are helped by one intensive round of treatment, the majority of addicts continue to need services,” Dr. Willenbring said. He cited the case of a 43-year-old woman “who has been in and out of rehab 42 times” because she never got the full range of medical and support services she needed.

Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.

“We have some pretty good drugs to help people with addiction problems, but doctors don’t know how to use them,” he said. “The 12-step community doesn’t want to use relapse-prevention medication because they view it as a crutch.”

Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.

Check on the credentials of the program’s personnel, who should have “at least a master’s degree,” Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.

Does the facility’s approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don’t choose it just because it’s the best known approach.

Meet with the therapist who will treat you and ask what your treatment plan will be. “It should be more than movies, lectures or three-hour classes three times a week,” Ms. Fletcher said. “You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all.”

Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, “To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems.”

Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.

Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, “Get Your Loved One Sober,” with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol.

This is the first of two articles on addiction treatment.

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Chicago sees surge in foreclosure auctions

More than 35,000 homes and small multifamily buildings in the Chicago area completed the foreclosure process last year, the highest number since the housing crisis began, and the vast majority of them became bank-owned.

An increase in foreclosure auctions was expected since lenders shelved many foreclosure cases while state and federal authorities investigated allegations of faulty foreclosure processes. Still, the heightened level of auctions — 35,244 in 2012, compared with 20,281 in 2011 — along with an increase in initial foreclosure filings, shows the local housing market has a long road to recovery, according to the Woodstock Institute.

"There's going to be pain in the housing market in the short term," said Katie Buitrago, senior policy and communications associate at Woodstock. "There's still high levels of filings. Five years into it, there is still work to be done to help people save their homes."

The Chicago-based public policy and research group is expected to release its report on 2012 foreclosure activity Wednesday.

The year-end numbers show that, with few exceptions, all Chicago neighborhoods and suburban communities saw high double-digit percentage gains in auctions last year. Across the six-county area, 91.3 percent of the foreclosed properties were repossessed by lenders. At the same time, notices of initial default sent to homeowners, the first step in the foreclosure process, increased by 2.9 percent last year, to 66,783.

Real estate agents have worried for more than two years about a glut of foreclosed properties — a shadow inventory — that banks would list for sale en masse and cause home values to plunge. That largely has not happened, but the vast number of distressed properties in the market has kept a lid on local home values.

On Tuesday, for instance, Fannie Mae and Freddie Mac's websites listed 2,415 Cook County homes for sale that the two agencies had repossessed.

Chicago-area home prices, including distressed sales, fell 2.3 percent in December from a year ago, housing analytics firm CoreLogic said Tuesday. Illinois was one of only four states to see home-price depreciation.

The increase in auctions "is a mixed blessing," Buitrago said. "We've been having a lot of trouble in the region with vacant properties that have been languishing for years. The longer they're vacant, the more likely they are to be a destabilizing force in their communities."

Woodstock found that within the city of Chicago, there were 20 communities where more than 1 in 10 owner-occupied one- to four-unit residential buildings and condos went through foreclosure from 2008 to 2012. Five of those neighborhoods are included in the city's 18-month-old Micro-Market Recovery Program, a coordinated effort to stabilize neighborhoods and property values hit hard by foreclosures and vacant buildings.

Also designed to benefit hard-hit areas are the recent establishment of a Cook County Land Bank and legislation waiting for Gov. Pat Quinn's signature that will fast-track the foreclosure process for vacant, abandoned homes while providing financial resources to foreclosure prevention efforts.

mepodmolik@tribune.com

Twitter @mepodmolik

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Te'o, Cutler make top five in poll of most-disliked athletes

Manti Te'o listens to a question during an off-camera interview with ESPN's Jeremy Schaap. (Reuters Photo / February 5, 2013)

4:15 p.m. CST, February 5, 2013

Forbes.com reports: The dead girlfriend hoax that engulfed Manti Te'o didn't do much for his popularity: The former Notre Dame linebacker placed second only to disgraced cyclist Lance Armstrong in a survey that ranked America's most disliked athletes.

Both were new additions this year to list, as was Chicago Bears quarterback Jay Cutler, who placed fourth.

Get the full story: Forbes.com

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Well: Warning Too Late for Some Babies

Six weeks after Jack Mahoney was born prematurely on Feb. 3, 2011, the neonatal staff at WakeMed Hospital in Raleigh, N.C., noticed that his heart rate slowed slightly when he ate. They figured he was having difficulty feeding, and they added a thickener to help.

When Jack was discharged, his parents were given the thickener, SimplyThick, to mix into his formula. Two weeks later, Jack was back in the hospital, with a swollen belly and in inconsolable pain. By then, most of his small intestine had stopped working. He died soon after, at 66 days old.

A month later, the Food and Drug Administration issued a caution that SimplyThick should not be fed to premature infants because it may cause necrotizing enterocolitis, or NEC, a life-threatening condition that damages intestinal tissue.

---

Catherine Saint Louis speaks about using SimplyThick in premature infants.

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Experts do not know how the product may be linked to the condition, but Jack is not the only child to die after receiving SimplyThick. An F.D.A. investigation of 84 cases, published in The Journal of Pediatrics in 2012, found a “distinct illness pattern” in 22 instances that suggested a possible link between SimplyThick and NEC. Seven deaths were cited; 14 infants required surgery.

Last September, after more adverse events were reported, the F.D.A. warned that the thickener should not be given to any infants. But the fact that SimplyThick was widely used at all in neonatal intensive care units has spawned a spate of lawsuits and raised questions about regulatory oversight of food additives for infants.

SimplyThick is made from xanthan gum, a widely-used food additive on the F.D.A.’s list of substances “generally recognized as safe.” SimplyThick is classified as a food and the F.D.A. did not assess it for safety.

John Holahan, president of SimplyThick, which is based in St. Louis, acknowledged that the company marketed the product to speech language pathologists who in turn recommended it to infants. The patent touted its effectiveness in breast milk.

However, Mr. Holahan said, “There was no need to conduct studies, as the use of thickeners overall was already well established. In addition, the safety of xanthan gum was already well established.”

Since 2001, SimplyThick has been widely used by adults with swallowing difficulties. A liquid thickened to about the consistency of honey allows the drinker more time to close his airway and prevent aspiration.

Doctors in newborn intensive care units often ask non-physician colleagues like speech pathologists to determine whether an infant has a swallowing problem. And those auxiliary feeding specialists often recommended SimplyThick for neonates with swallowing troubles or acid reflux.

The thickener became popular because it was easy to mix, could be used with breast milk, and maintained its consistency, unlike alternatives like rice cereal.

“It was word of mouth, then neonatologists got used to using it. It became adopted,” said Dr. Steven Abrams, a neonatologist at Texas Children’s Hospital in Houston. “At any given time, several babies in our nursery — and in any neonatal unit — would be on it.”

But in early 2011, Dr. Benson Silverman, the director of the F.D.A.’s infant formula section, was alerted to an online forum where doctors had reported 15 cases of NEC among infants given SimplyThick. The agency issued its first warning about its use in babies that May. “We can only do something with the information we are provided with,” he said. “If information is not provided, how would we know?”

Most infants who took SimplyThick did not fall ill, and NEC is not uncommon in premature infants. But most who develop NEC do so while still in the hospital. Some premature infants given SimplyThick developed NEC later than usual, a few after they went home, a pattern the F.D.A. found unusually worrisome.

Even now it is not known how the thickener might have contributed to the infant deaths. One possibility is that xanthan gum itself is not suitable for the fragile digestive systems of newborns. The intestines of premature babies are “much more likely to have bacterial overgrowth” than adults’, said Dr. Jeffrey Pietz, the chief of newborn medicine at Children’s Hospital Central California in Madera.

“You try not to put anything in a baby’s intestine that’s not natural.” If you do, he added, “you’ve got to have a good reason.”

A second possibility is that batches of the thickener were contaminated with harmful bacteria. In late May 2011, the F.D.A. inspected the plants that make SimplyThick and found violations at one in Stone Mountain, Ga., including a failure to “thermally process” the product to destroy bacteria of a “public health significance.”

The company, Thermo Pac, voluntarily withdrew certain batches. But it appears some children may have ingested potentially contaminated batches.

The parents of Jaden Santos, a preemie who died of NEC while on SimplyThick, still have unused packets of recalled lots, according to their lawyer, Joe Taraska.

The authors of the F.D.A. report theorized that the infants’ intestinal membranes could have been damaged by bacteria breaking down the xanthan gum into too many toxic byproducts.

Dr. Qing Yang, a neonatologist at Wake Forest University, is a co-author of a case series in the Journal of Perinatology about three premature infants who took SimplyThick, developed NEC and were treated. The paper speculates that NEC was “most likely caused by the stimulation of the immature gut by xanthan gum.”

Dr. Yang said she only belatedly realized “there’s a lack of data” on xanthan gum’s use in preemies. “The lesson I learned is not to be totally dependent on the speech pathologist.”

Julie Mueller’s daughter Addison was born full-term and given SimplyThick after a swallow test showed she was at risk of choking. It was recommended by a speech pathologist at the hospital.

Less than a month later, Addison was dead with multiple holes in her small intestine. “It was a nightmare,” said Ms. Mueller, who has filed a lawsuit against SimplyThick. “I was astounded how a hospital and manufacturer was gearing this toward newborns when they never had to prove it would be safe for them. Basically we just did a research trial for the manufacturer.”

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Deficit hits 5-year low, but cuts drag economy

WASHINGTON -- The federal deficit will drop to less than $1 trillion for the first time in five years, but massive spending cuts that have improved the budget outlook are also slowing the economy, according to a report released Tuesday by the Congressional Budget office.

The nonpartisan arbiter of federal budgets said the combination of new tax revenue from the "fiscal cliff" deal as well as looming cuts that kick in March 1 will push the deficit down to $845 billion for fiscal 2013. Deficits have topped $1 trillion in recent years.

The projections will fuel the coming budget debates, which started Tuesday as President Obama was calling on Congress to steer around the coming budget cuts.

The budget office said the cuts will contribute to an economy that lags in 2013. The unemployment rate likely will remain above 7.5% through the year. It predicted that the gross domestic product will be well below its potential, growing by just 1.4%, more than half a percentage point slower than would happen if the spending cuts were averted.

At the same time, the nation's debt load is expected to fluctuate but ultimately rise to record levels this decade, largely because of increased spending on healthcare and the federal safety net for older Americans with the aging of the baby boom population.

Additionally, the outlook shows how difficult it will be for House Republicans to accomplish their goal of balancing the budget in 10 years with potentially deep austerity measures.

Even though revenue is rising and spending is decreasing, the overall budget outlook remains stark. By the end of the decade, public debt is set to rise to 77% of GDP, a decade of highs on par with debt levels in World War II.

"The projected path of the federal budget remains a significant concern," the CBO wrote.

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Lisa.mascaro@latimes.com

Twitter: @LisaMascaroinDC

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