A growing number of American children are taking drugs for a wide range of chronic conditions related to childhood obesity, according to prescription data from three large organizations. The numbers, from pharmacy plans Medco Health Solutions, Express Scripts and the marketing data collection company Verispan, indicate that hundreds of thousands of children are taking medication to treat Type 2 diabetes, high blood pressure, high cholesterol and acid reflux — all problems linked to obesity that were practically unheard-of in children two decades ago. The data, disclosed publicly in recent months or provided at the request of The New York Times, shows that concerns that children will be taking adult medications — heightened recently by a controversial recommendation by a national pediatricians group — are already a reality. This month, the American Academy of Pediatrics said that more children, as young as 8, should be given cholesterol-lowering drugs. The recommendation was quickly attacked by some experts as a license to put children on grown-up drugs. While the drugs do help treat the conditions, some doctors fear they are simply a shortcut fix for a problem better addressed by exercise and diet. Even so, some pharmaceutical companies are developing new versions, including flavored ones, of adult medications for children. While some of the percentage increases in the three analyses are significant, doctors empha-size that prescriptions of these drugs to children still represent less than 1 percent of their sales. Express Scripts and Medco developed estimates of how many children might be taking such drugs by extrapolating their data — involving a total of more than four million children — across the broader population. The companies use different assumptions to reach their estimates, but the data suggests that at least several hundred thousand children are on various obesity-related medications. The greatest increase occurred in drugs for Type 2 diabetes, with Medco’s data showing a 151 percent jump from 2001 to 2007. Medco’s data, released in May, showed that use of drugs to treat acid reflux problems in children, often aggravated by obesity, increased 137 percent over seven years. Its analysis also showed an 18 percent increase in drugs to treat high blood pressure and a 12 percent increase in cholesterol-lowering medications during the seven-year period. Express Scripts found a 15 percent increase over three years in drugs to treat cholesterol and other fats in the blood, a category that is primarily statins. “We were amazed at how quickly the rates of drugs used have climbed,” said Dr. Donna R. Halloran, an assistant professor at St. Louis University who worked on the Express Scripts analysis, presented at a meeting of the American Public Health Association in November. Verispan data recorded a 13 percent increase in high blood pressure prescriptions in the under 19 age group from 2005 to 2007. Its numbers show, however, a less than 1 percent increase during the period in cholesterol-lowering drugs in children. Doctors and some financial analysts have said that less pronounced increases in cholesterol drugs compared with some other medications — seen in all three analyses — reflect a wariness by some doctors about using those drugs in children. Some experts have expressed concern that the increases in many of these obesity-related drugs reflect a systemic failure, with doctors and parents turning to them because they find lifestyle changes too difficult to implement or enforce. “I think a lot of people in pediatrics, myself included, are struggling with what is the right management to do for these kids,” said Dr. Russell L. Rothman, an assistant professor at Vanderbilt University, who recently surveyed doctors and found wide variations in how children were being treated. “You see elevated blood pressure, or elevated sugars, or elevated cholesterol and you try exercise and diet and you don’t see any improvement,” Dr. Rothman said. “I worry that some providers and some families are looking for the quick fix, and are going to want to start medication immediately.” Some pediatricians say they have been treating children with statins for several years. Dr. David Collier, director of a pediatric weight management center at East Carolina University in Greenville, N.C., an area where 45 percent of the children are overweight, is among doctors who support the recent recommendations that statins may be warranted in some children as young as 8. “We have been using statins for two or three years now,” he said. One of his statin patients, he said, was a 6-year-old girl. Dr. Collier, who describes his location as “right smack dab in the middle of the stroke belt,” believes that aggressive therapy is needed to prevent a health crisis. “It’s hard to overstate the size of the problem,” he said. Dr. Francine R. Kaufman remembers a patient, a 13-year-old girl, whose weight had ballooned to 267 pounds. The teenager appeared destined for the same fate as her grandmother, who lost a leg to Type 2 diabetes. “To control her high blood sugar level, her high blood pressure, and her high cholesterol, this young girl left my office with five medications,” Dr. Kaufman, a pediatric endocrinologist in Los Angeles, told a Senate subcommittee last week during hearings on obesity in children. The girl stood out as unusual more than 10 years ago, but children with the same array of problems are increasingly seen in the diabetes center where she practices at Children’s Hospital Los Angeles, Dr. Kaufman said. Diet and exercise are tried first, but “lifestyle is really tough,” Dr. Kaufman said. Some of her patients live in neighborhoods without grocery stores and attend schools that do not offer physical education programs. “They deserve to be treated,” Dr. Kaufman said. “I think the slant from most of the media is that pediatricians are jumping to put kids on medications. That’s not true at all. Since lifestyle is so difficult, we have no other choice but to go to pharmacotherapy.” At Camp Pocono Trails, a weight loss camp in Reeders, Pa., that enrolls about 700 children each summer, owner Tony Sparber said that campers are arriving with medications, a pharmacopeia that include statins and diabetes medications. “You just look at these kids’ medical forms,” Mr. Sparber said. “You see kids with some very high-risk numbers. Cholesterol in the high 200s.” Experts say that the trend could balloon health care costs. As many as 30 percent of children nationwide are overweight. And children who start such medication often rely on the drugs for a lifetime and are prone to health problems as adults. Despite a push by the Food and Drug Administration to foster drug studies in children, many experts believe that many clinical studies in children have not been extensive enough. And adult doses are often not correct for children. The agency publishes a list of drugs for which pediatric versions are needed. So far, the size of the pediatric market is not big enough to make it profitable for companies to make special children’s formulas of drugs for disorders that commonly go along with obesity and high-fat diets. That appears to be changing. Madeira Therapeutics, based in Leawood, Kan., is formulating a liquid statin for children that will be sold in either grape, cherry or bubblegum flavor, according to the company’s chief executive, Peter R. Joiner. Madeira became interested in the drug to treat children with a genetic cholesterol condition, familial hypercholesterolemia, which strikes 1 in 500 children regardless of their diet. The recent American Academy of Pediatrics statement adds to the potential market, according to Mr. Joiner. The company, whose liquid statin may be available by late 2010, is also interested in a liquid oral diabetes medication. “Because of the obesity epidemic in the United States, we see diabetes as another important area for contribution,” Mr. Joiner said. A nonprofit group in Cambridge, Mass., the Institute for Pediatric Innovation, is working to encourage the reformulation of medications for children. Dr. Stephen P. Spielberg, the former dean of Dartmouth Medical School, is leading the effort. “What we’ve learned over the years is that the way in which the body handles medicines, the half life of a medicine, how it’s metabolized, how it’s excreted by the body, does vary, from babies all the way up to adolescents,” Dr. Spielberg said. Hypertension medications present a particular challenge in dosing for children. “Even in clinical trials where adult pills were crushed and such, you often can’t even demonstrate that the medication works,” he added. Medco cautioned that hypertension data can be misleading because some children with attention deficit disorder are treated with hypertension drugs. The most significant increase in the use of drugs for children has been in oral medication for Type 2 diabetes. And some doctors believe much of those prescriptions were “off-label” use of the drug, metformin, to treat prediabetes, which may affect two million children nationwide. But some doctors object to the use of metformin for that purpose in children, even though studies have shown it may prevent diabetes in young adults. “There are no studies like this in children,” said Dr. Tamara S. Hannon, a pediatric endocrinologist at the Children’s Hospital of Pittsburgh. “The argument may be that we know what happens in adults, so the same should happen in children. It’s been proven untrue in several cases in the history of medicine.”

WASHINGTON – Senator Barack Obama arrived in Afghanistan early Saturday morning, opening his first overseas trip as the presumptive Democratic presidential nominee, to meet with American commanders there and later in Iraq to receive an on-the-ground assessment of military operations in the two major U.S. war zones. Mr. Obama touched down in Kabul about 11:45 a.m., according to a pool report released by his aides. In addition to attending briefings with military leaders, he hoped to meet with President Hamid Karzai of Afghanistan before flying to Iraq later in the weekend. His trip was cloaked in secrecy, which advisers said was due to security concerns set forth by the Secret Service. His whereabouts have been unknown since he departed Chicago. He left Andrews Air Force Base near Washington on Thursday afternoon, according to a pool report, and turned up in Afghanistan on Saturday. Before he left the United States, he gave a brief outline of his trip to two pool reporters traveling with him from Chicago to Washington. No reporters accompanied him to Afghanistan. “Well, you know, I’m more interested in listening than doing a lot of talking,” Mr. Obama said. “And I think it is very important to recognize that I’m going over there as a U.S. senator. We have one president at a time, so it’s the president’s job to deliver those messages.” Mr. Obama’s arrival opened a weeklong foreign trip that includes visits to Iraq and two other stops in the Middle East as well as appearances in three European capitals. His tour of Afghanistan and Iraq are part of a Congressional delegation — similar to trips that Senator John McCain, the presumptive Republican nominee, made in the spring — in which he is joined by Senators Chuck Hagel, Republican of Nebraska, and Jack Reed, Democrat of Rhode Island, both of whom have been mentioned as possible vice presidential running mates. The international trip by Mr. Obama is intended to counter Republican criticism — and one advanced by Senator Hillary Rodham Clinton during the Democratic primary campaign — that he has too little experience in foreign affairs to serve as a world leader. His advisers said Mr. Obama chose to begin his trip in Afghanistan because he believes that the region is among the most important foreign policy challenges facing the United States. “Well, I’m looking forward to seeing what the situation on the ground is,” Mr. Obama told reporters on Thursday before he left Washington. “I want to, obviously, talk to the commanders and get a sense, both in Afghanistan and in Baghdad of, you know, what the most, ah, their biggest concerns are. And I want to thank our troops for the heroic work that they’ve been doing.” It is the first trip to Afghanistan for Mr. Obama, a member of the Foreign Relations Committee. This week, he proposed deploying about 10,000 more troops to battle resurgent forces in Afghanistan, a plan intended to shift the American military focus from the Iraq war to what he calls the central fight against terrorism. The proposal has become a centerpiece of Mr. Obama’s foreign policy and a major point of disagreement with Mr. McCain, who maintains that both places are major battlegrounds and disputes Mr. Obama’s suggestion that the war in Iraq has distracted the United States from its efforts in Afghanistan. Mr. McCain has suggested to voters that Mr. Obama lacks the experience to serve as commander in chief. He particularly criticized the Illinois Democrat for not having held a single hearing in his capacity as chairman of the Foreign Relations Committee’s subcommittee on European affairs. “He’s going to go to the American people and say, ‘I want to be commander in chief,’ ” Mr. McCain told reporters on Thursday, “and yet he has been the chairman of the subcommittee that oversights NATO and he has never had a hearing, nor has he ever visited Afghanistan.’ ” But that criticism was dismissed this week by Senator Joseph R. Biden Jr. of Delaware, the chairman of the Foreign Relations Committee, who said issues related to Afghanistan were intentionally being addressed “at the full committee level.” Mr. Obama’s trip is drawing considerable attention in the United States and abroad. It is being carefully choreographed by his campaign strategists to coincide with a new television advertisement in 18 states intended to highlight his ideas on foreign policy and portray him as ready to serve as commander in chief, which is one area where polls show that voters give an edge to Mr. McCain. In addition to visiting Iraq and Afghanistan, Mr. Obama is extending his overseas tour, his first as a presidential candidate, to include a visit to Amman, Jordan, on Monday, followed by stops in Jerusalem, the Palestinian territories, Berlin, France and London. Now that Mr. Obama has decided to take the trip, the McCain campaign is not sure what to make of it. Jill Hazelbaker, the communications director for Mr. McCain, offered a hint of the Republican criticism of the trip on Thursday by dismissing it as “the first-of-its-kind campaign rally overseas.” But Mr. McCain sought to temper the message, saying: “I’m glad he is going to Iraq. I am glad he is going to Afghanistan. It’s long, long overdue if you want to lead this nation.” Robert Gibbs, a senior campaign strategist for Mr. Obama, dismissed that suggestion. He said the trip was rooted in substance, rather than politics. “The trip is not at all a campaign trip, a rally of any sort,” Mr. Gibbs told reporters on Friday. He said Mr. Obama would hold “a series of substantive meetings with our friends and our allies to talk about the common challenges that we face and the national security dangers for the 21st century.” In the next week, Mr. Obama is scheduled to meet several foreign leaders, including German Chancellor Angela Merkel, British Prime Minister Gordon Brown, French President Nicolas Sarkozy, Jordan’s King Abdullah, Israeli Prime Minister Ehud Olmert and President Shimon Peres and Palestinian President Mahmoud Abbas. Tags:INTERNATIONAL NEWS POWER POLITICS US WORLD AFFAIRS

SAN FRANCISCO — For many people on Friday, the iPhone was the iCan’t. Apple suffered extensive network gridlock Friday morning, as many of the six million users of the original iPhone tried to upgrade to new software while the first buyers of the new iPhone 3G were trying to activate their purchases. The setback was a classic example of the problems that can follow when complex systems have single points of failure. In this case, the company appeared to almost invite the problems by having both existing and new iPhone owners try to get through to its systems at the same time. “There are certainly lessons in preparedness,” said Richard Doherty, a consumer electronics industry consultant who is president of the Envisioneering Group in Seaford, N.Y. He compared the day with Christmas morning, “the acid test for many years” for electronics companies because customers contact them in droves after opening presents and trying to get gadgets to work. The problems led to slow-moving lines of would-be iPhone 3G purchasers at Apple and AT&T stores, while current iPhone users found that their phones had stopped working when they tried to upgrade them to the latest software. The iPhone must connect to Apple servers through the iTunes program for authentication before it will function again after a software upgrade. Apple did not comment publicly on the problems, but privately executives acknowledged the missteps and said the combination of the software upgrades and new iPhone 3G owners trying to complete their activation swamped the company’s servers. At Apple and AT&T stores on Friday morning, employees began telling buyers to take their new iPhones home and activate them there. A year ago, when the original iPhone went on sale, customers performed the activation at home. But Apple and its cellphone partners changed the process this time, in part because the carriers are partially subsidizing the cost of the phones, so they are eager to make sure that phone buyers are locked into a contract. Many of the original iPhones were bought in the United States and then taken overseas for use on foreign carriers. A number of industry executives have said that the change in policy was intended to reduce the number of phones that were bought and then modified for use on unauthorized cellular networks. Early indications were that the company was facing strong demand for the new phones. In many cases the customers were existing iPhone users looking to upgrade to the iPhone 3G model. Apple’s stores opened at 8 a.m. At the store in downtown San Francisco at 11:30 a.m., there was still a line of more than 300 customers stretching down one block and around the corner waiting for iPhones. Some customers said they had hired placeholders to stand overnight in line. Mark Siegel, a spokesman for AT&T, Apple’s cellular partner in the United States, said the company had experienced extraordinary demand and that most of its stores nationwide were sold out of the iPhone during the day. He said he had heard reports that some customers were already camped out in front of stores waiting for the next shipment of iPhones on Saturday, but he could not identify a particular store. Mr. Siegel said the rush of customers and upgrades had overwhelmed Apple’s servers, and that he sympathized with the company’s predicament. “Apparently the iTunes system has just been overwhelmed by demand and Apple is working very hard to get this fixed,” he said. He acknowledged that part of the problem was the new policy of requiring authorization in the stores. In a related issue, customers had problems with Apple’s switchover from its .Mac Web service to a new service called MobileMe that is intended to seamlessly share information between Macintosh computers and the iPhone. Apple’s stumble was an unusual one for a company that has taken pains in recent years to become more customer-oriented. The technology blog Gizmodo dubbed it the iPocalypse. When the original iPhone was introduced, AT&T took the blame for most of the early service problems. Sergio Martinez, an editor at Teak Motion Visuals in San Francisco, said in an e-mail message that he had run into trouble with the software upgrade. “Like everyone else across the world, I have had no luck upgrading,” he wrote. “Bill Gates must be enjoying this one.” Tags:INTERNATIONAL NEWS Internet SCIENCE US

FRANKFURT — The European Central Bank, spooked by soaring prices for food and fuel, raised interest rates on Thursday, joining several other central banks in battling a global eruption of inflation. With the quarter-point increase, the central bank followed those in Sweden and Norway that raised rates this week, citing inflation. The Federal Reserve in the United States, where short-term interest rates are only half of those in Europe, has so far declined to join them. The European Central Bank’s decision deepens a recent divergence in monetary policy on either side of the Atlantic, ending a long period when it tended to follow the course set by the Fed. But the sharp rise in inflation has put Europe’s bank into a policy bind because it has been accompanied, in recent days, by evidence that the economy here is deteriorating much like that of the United States. Manufacturing activity in the 15 countries that use the euro shrank in June for the first time in three years, according to a survey of European purchasing managers. In Spain and Ireland, where a collapse in housing prices has magnified the problems, there is a real risk of recession. Still, the European Central Bank, hewing to its inflation-fighting mandate, pressed on with the expected increase, lifting the benchmark rate to 4.25 percent from 4 percent. Among other thing, it is intended as a warning to unions not to use higher inflation as a lever to demand hefty pay raises. It was not clear, before an afternoon news conference chaired by the bank’s president, Jean-Claude Trichet, whether the increase would be a one-off gesture or the start of a cycle of tighter monetary policy. Several economists said they doubted the bank could tighten much further, given the parlous economic situation. “The E.C.B. is hiking at a time when confidence is plummeting,” said Thomas Mayer, the chief European economist of Deutsche Bank. “The question is, ‘what do you do when asset prices fall at the same time that consumer prices rise?’ The central bankers seem to have reached the end of the line.” Indeed, the bank has come under intense political pressure in recent days not to tighten credit at such a fragile moment for Europe’s economy. The French president, Nicolas Sarkozy, said higher rates would do little to stem the rising price of oil. Germany’s finance minister, Peer Steinbrück, warned that an increase could further depress growth. The central bank, under Mr. Trichet, has steadfastly rebuffed efforts to influence its policy. But even within its 21-member governing council, the unhealthy combination of inflation and stagnation has opened a split — with inflation hawks calling for a rate increase, while the doves resisted it. The hawks are led by Axel A. Weber, the president of Germany’s Bundesbank, which bequeathed its long tradition of inflation fighting to the European Central Bank. Germany is also an exception among major European countries, in that its economy is still expanding, even if more modestly lately. “It’s clear that Weber convinced Trichet and the majority of the council to go for it,” Mr. Mayer said. “But the weakening growth numbers will lead the others to resist further rate increases.” The position of the hawks was reinforced on Monday with new statistics that showed inflation in Europe rose to an annual rate of 4 percent in June, twice the ceiling set by the European Central Bank. With oil prices continuing to surge — it traded at a new record of$145 a barrel in Asia on Thursday — some economists expect inflation to spike even higher in August, perhaps to 4.25 percent. “There is a genuine question about what to do about inflation that is entirely driven by oil prices,” said Holger Schmieding, chief European economist at Bank of America in London. “One option is to let it filter through the system; the other option is to attack it now.” In raising rates, even at a time of such uncertainty, the European Central Bank has opted for the latter. Tags:INTERNATIONAL NEWS MONEY WEALTH