Britain’s Military to Permit Former Captives to Sell Stories

Two days after they were paraded as heroes with a story to tell, some of the 15 British sailors and marines captured and released by Iran seemed Sunday to have decided they have a story to sell.
In a highly unusual decision, Britain’s Ministry of Defense — normally tight-lipped, to say the least — acknowledged Saturday that it had agreed to permit them to offer their experiences for sale to newspapers and television stations.
Such transactions are common enough among civilians, some of whom have traded the rights to their stories for considerable sums of money. But the notion of active military service members making a profit from their exploits — particularly when thousands of others serving in Iraq and Afghanistan face daily peril and sometimes death — has reinforced the criticism of the 15 Britons’ seemingly pliant behavior toward the Iranians holding them.
“Our armed forces are, I think, the most respected institution in the country pretty much, and they deserve to be after the job they have done in very difficult circumstances in Iraq and in Afghanistan,” William Hague, the opposition Conservative spokesman on foreign affairs, said in a television interview.
“But if, whenever people have been in a difficult situation, they are going to be allowed to sell their story quickly after that, then I think we are going to lose steadily that dignity and respect for our armed forces.”
Six of the 15 former captives spoke at a news conference on Friday, recounting moments when some of them thought they were about to be executed as they faced psychological pressure to make public “confessions” on state-run Iranian television that they had unlawfully strayed into Iranian territorial waters.
The Ministry of Defense’s decision to allow them to tell the stories of solitary confinement and blindfolding to the public seemed intended to offset criticism in newspapers here that the sailors and marines had succumbed too easily and too quickly to Iranian pressure. The critics said their behavior contrasted markedly with that of service personnel in earlier eras, when captured service members were under orders to provide their captors with only limited information.
“It seems reasonable to at least wonder whatever happened to divulging one’s name, rank and number,” the columnist Marina Hyde wrote in The Guardian.
Opposition even came from the possibly unexpected quarter of Max Clifford, one of Britain’s leading publicists, who, as a well-known agent on behalf of people selling their stories, has done as much as anyone to put the word checkbook into checkbook journalism.
“This is purely a propaganda exercise,” Mr. Clifford told The Press Association news agency. “In the past troops were always stopped from talking about what had gone on.”
“They can control it, and they do control it when it suits them,” he said, referring to the Ministry of Defense. “It didn’t suit them in this particular case.”
The Ministry of Defense said in a statement on Sunday that the sale of stories would strengthen its control over what the released sailors and marines had to say.
“It was clear that the stories they had to tell were likely to have emerged via family and friends, regardless of any decision the navy took,” the statement said.
By allowing them to sell their stories, by contrast, the statement said, the navy and the Ministry of Defense would have “sight of what they were going to say as well as providing proper media support to the sailors and marines in the same way as would have been the case in more ordinary circumstances.”
Mr. Clifford estimated that the sales could earn about $500,000, with the biggest amount likely to be paid to Leading Seaman Faye Turney, the only woman among the captives, who was said by Iranian television to have written letters home criticizing British and American policy.
Mr. Clifford said he had been approached by three or four of the service members about selling their stories.
In some ways, the unfolding saga of the 15 — captured on March 23 in the Persian Gulf — has become a parable for modern Britain in a time when warfare has become intertwined with the battle of perceptions and versions played out on 24-hour television news channels.
During the captivity, British, American and other broadcasters picked up and retransmitted Iranian video of the captives seeming to deny Britain’s official insistence that they were captured while performing a legal search in Iraqi waters.
“The released hostages are behaving like reality TV stars,” Col. Bob Stewart, a former commander of United Nations forces in Bosnia, told The Sunday Times of London. “I am appalled that the Ministry of Defense is encouraging them to profit in this way.”
There is an element, too, of the class distinctions that still stratify some parts of British society. “No one complains if a general writes his memoirs,” said Flight Lt. John Nichol, who was captured and tortured during the Persian Gulf war of 1991. “But there is snobbery about a junior rank telling their story.”
The most poignant criticism came from the relatives of the 140 British service members who have died in Iraq since the invasion in March 2003 and of the 52 who have died in Afghanistan since 2001.
“This is wrong and I don’t think it should be allowed,” Rose Gentle, the mother of a 19-year-old soldier killed in Basra in 2004, said of the decision to allow the sailors and marines to sell their stories.
One of the former captives, at least, had a different view on the sale of stories. “I am not interested in making money out of this,” said Lt. Felix Carman of the navy, the highest-ranking of the 15 captives, who spoke at length during Friday’s news conference. “My main aim is to tell the story.”
“There’s some people who might be making money, but that’s an individual’s decision, that’s very private, but that’s not something that myself or many of the others will do,” he said.

Costly Contraceptives

For almost 20 years, college health centers have been able to purchase contraceptives at nominal prices. This was not a tax-funded subsidy. It was a financial incentive that gave drug manufacturers an exemption from Medicaid pricing rules so they could sell contraceptives and other products to certain charitable groups, like the college clinics, at an extreme discount. In response to concerns that drug companies were abusing this privilege, language was sewn into legislation in 2005 to close a loophole. It also inadvertently slashed this important benefit for clinics and their patients.
On some college campuses, the price of brand-name contraceptives has risen from the neighborhood of $5 per month to $40 or even $50. Switching to a generic is an option in some cases, but it can still entail a 300 percent price increase. Generics often run at about $15 per month. Newer contraceptives, like the NuvaRing, which contains a very low hormone dose and does not require a daily action that is easily forgotten, are not yet available generically. Many students are priced out of the market.
The spike in price affects more than just consumers of contraceptive devices and pills. College and university health clinics sold these products for a small profit — buying them at, say, $3 and selling them at $5. Even on a small campus, these dollars add up quickly. The money was an important part of health center operating budgets, paying for classes and even subsidizing more expensive medications.
The Centers for Medicare and Medicaid Services could reapply these exemptions with the stroke of a pen. If they do not, Congress should restore this much-needed benefit.

WASHINGTON, April 7 — Senior members of Congress from both parties are working feverishly on legislation that could give consumers access to lower-cost copies of biotechnology drugs that now cost tens or hundreds of thousands of dollars a year.

Prospects for the legislation have increased since Democrats took control of Congress this year. Consumer groups, employers and insurers are lobbying for the bill, which they see as a way to hold down health costs.

The proposal faces formidable scientific and political obstacles. Brand-name pharmaceutical companies contend that biotechnology products, made from cells and living organisms, are so complex that a copy will never be identical to the original and therefore cannot be certified as safe without testing in humans.

Biotech medicines are the fastest-growing category of health spending, with sales of $40 billion last year, up 20 percent from 2005, according to IMS Health, a market research company. More than 400 biotech products are in the pipeline, for more than 100 diseases, including cancer, AIDS, diabetes and Alzheimer’s.

Conventional drugs are synthesized by putting atoms together from basic chemicals and are often in pill form.

Biotech drugs, also known as biologic products, are typically proteins made by modifying the DNA of bacteria, yeast or mammal cells, and they are often given by injection or infusion.

Supporters of the legislation received an unexpected boost when the chief medical officer of the Food and Drug Administration, Dr. Janet Woodcock, told Congress last month that the agency had the expertise and experience to decide what types of human and laboratory tests were needed to ensure that copies of a biotechnology drug worked as well as the original.

Brand-name drug manufacturers have urged Congress to require human trials before allowing the sale of any products billed as comparable or equivalent to biotechnology medicines already on the market.

But Dr. Woodcock said: “Where trials are not needed, it is of questionable ethics to repeat them. The use of human subjects for trials that are not needed is not desirable.”

Many biotech drugs are effective but expensive. Avastin, a cancer treatment made by Genentech, can cost $4,400 to $8,800 a month, with a maximum cost of $55,000 a year for people who qualify for the company’s patient assistance program.

Cerezyme, a drug made by Genzyme for Gaucher disease, costs $200,000 a year. Enbrel, made by Amgen for rheumatoid arthritis and psoriasis, costs an average of $16,000 a year.

Biotech treatments for multiple sclerosis range in price from $16,000 to $25,000 a year. “Many patients are denied access to these important drugs because even the co-payments can reach thousands of dollars a year,” said Arney Rosenblat, a spokeswoman for the National Multiple Sclerosis Society.

Consumers save billions of dollars a year by using low-cost generic versions of conventional drugs, which are approved by the government under a 1984 law.

One author of the 1984 law, Representative Henry A. Waxman, Democrat of California, is pushing a bill that would authorize the Food and Drug Administration to approve safe, lower-cost versions of biotechnology drugs.

Senators Charles E. Schumer and Hillary Rodham Clinton of New York, both Democrats, have introduced an identical bill, with support from several Republicans, including Senators Susan Collins of Maine and David Vitter of Louisiana.

The chief lobby for makers of biotech drugs, the Biotechnology Industry Organization, strongly opposes the bill, saying it would endanger patients and kill incentives for research and innovation.

The debate over biotech drugs is filled with paradoxes. Brand-name drug companies, which have for years criticized the regulation of drug prices in Europe, now point to Europe’s strict regulation of “follow-on biologics” as a possible model for the United States. Democrats, who have often criticized the F.D.A. as lax in enforcing drug safety laws, now say they trust the agency to decide whether copies of biotech drugs are safe and effective, without the full range of tests required for new products.

The Widening College Loan Scandal

Congress needs to address the college loan scandal that has unfolded since New York’s attorney general, Andrew Cuomo, began to investigate the troubling — and possibly illegal — payments to universities that steer students to so-called preferred lending companies. These kickbacks are part of a wider pattern of shady dealing that, we now find out, reaches into the federal government as well.
The Times reported last week that a senior official at the Department of Education who helped oversee the federal student loan program held shares of the parent company of the student loan company Student Loan Xpress. That came one day after financial aid officials at three universities that listed Student Loan Xpress as a preferred lender — Columbia University, The University of Texas at Austin and the University of Southern California — were found to have sold shares in the company. The official at Columbia, who earned more than $100,000 on the sale, bought his shares for about $1 each and sold them for about $10.
These cases show what lenders will do to win a slice of the business — last year students took out $85 billion in loans — and the all-too-frequent willingness of universities to go along. Financial aid officers are offered gifts and trips, and universities are offered hundreds of thousands of dollars in payments, if they place a company on their list of preferred lenders that most students use when looking for loans. Universities have also been offered large payments to switch from the government’s student loan program to private lenders whose huge profits are based in part on government subsidies.
This program is clearly in need of serious and immediate reform. For starters, Congress needs to make it illegal for colleges and universities to accept anything of value from lenders. It should also require universities to choose preferred lenders through an open process that guarantees the best rates and treatment for student borrowers.

Hot and Cold

Last week began with a Supreme Court decision declaring that the federal government had the authority to regulate greenhouse gas emissions and all but ordering the Bush administration to do so. It ended with a report from the Intergovernmental Panel on Climate Change — the world’s authoritative voice on global warming — warning that failure to contain these emissions will have disastrous environmental effects, especially in poorer countries, which are least able to defend themselves and their people against the consequences of climate change.
One would hope that these events would shake President Bush out of his state of denial and add his authority to the chorus of governors, legislators and business leaders calling for an aggressive regulatory and technological response to the dangers of global warming. They haven’t. When asked about the Supreme Court decision, the president said he thought he was already doing enough.
He argued further that there was little point in the United States’ doing any more unless other polluters like China acted as well. That ignores the reality that no developing country is going to move unless the United States — which produces one-fourth of the world’s emissions with only 5 percent of its population — takes the lead.
The report from the intergovernmental panel was the second of three due this year. The first concluded with “90 percent certainty” that humans had caused the rise in atmospheric temperatures over the last half-century. The most recent focused on the consequences, few of them positive.
The northern latitudes will have longer growing seasons. But elsewhere climate change will lead to more severe storms, the flooding of tropical islands and coastlines inhabited by hundreds of millions of people, the likely extinction of at least one-fourth of the world’s species and, in poorer countries in Asia and Africa, drought and hunger.
Some of these changes have begun. “We’re no longer arm-waving with models,” said Martin Parry, the co-chairman of the team that wrote the report. But the report also makes clear that while emissions already accumulated in the atmosphere make some damage inevitable, the worst can be avoided if the world’s nations take swift action to stabilize and then reverse emissions.
What must be avoided, the report said, is a rise of 3 to 5 degrees Fahrenheit, the point at which truly devastating effects will begin to kick in. But such a rise is almost inevitable over the next century if the world continues to do business as usual.
The panel’s next paper will discuss alternatives to business as usual. These policies will almost certainly require a major shift in the way energy is produced and used, as well as massive investments in new technologies. They will also be expensive. But what the world’s scientists are telling us, with increasing confidence, is that the costs of doing nothing will be far greater than the costs of acting now.

Breast Cancer Screening

The often confusing issue of screening for breast cancer just got more confusing. First, a major medical group disputed the need for regular mammograms for all women ages 40 to 49, as is currently recommended. Then a widely used computer system that was supposed to make mammograms more accurate was judged to make them less accurate. And guidelines just issued by the American Cancer Society recommend annual M.R.I. scans — in addition to mammograms — for all women at especially high risk of developing breast cancer, starting at age 30.

Nothing in the new material shakes the long-standing recommendation that all women age 50 or older should get regular mammograms. Women in their 40s, however, will need to weigh the pros and cons carefully. Most expert groups believe they should get mammograms every year or two. But clinical guidelines issued by the American College of Physicians take a more discriminating approach.

The guidelines acknowledge that regular mammograms for women in their 40s can reduce the risk of dying from breast cancer by a modest amount: for every 10,000 women screened, six might avoid death from breast cancer. But a very high percentage of the women screened, the college warns, will get false positive results that lead to unnecessary biopsies, increased costs and risk of injury. There is also a tiny risk that radiation from the screening might itself cause cancer. In the end, women deeply worried about breast cancer will want to get screened, while those who judge — with the help of their doctors — that they are at low risk may prefer to wait.

The latest verdicts on two advanced technologies were mixed. One new study found that M.R.I. scans could find tumors that mammograms had missed in a small percentage of women. The downside is that the costly scans are so sensitive they pick up lots of suspicious but harmless growths.

Another new study found that a costly computerized system to help radiologists read mammograms was no better at finding cancer than traditional mammography and led to many more false alarms that required needless biopsies. The computerized systems are used in some 30 percent of all mammography centers, where they are driving up costs for no clear medical benefit. Government and private insurers may need to reconsider whether the systems are worth covering.

The non-aligned movement

The quality of aid matters as much as the quantity
MAIMONIDES, a 12th-century rabbi and philosopher, argued that it is better to give anonymously, like the sages who secretly placed coins under the doors of the poor, than to flaunt your generosity. Better still, he said, to pool your charity—by contributing to a tzedakah box, for example—so that neither the poor nor their benefactor know the other's identity.
The club of 22 governments who dominate foreign aid would not rate very highly by the Torah's reckoning. This week they met in Paris to measure progress on two big commitments made in 2005. In July of that year, those world leaders who gathered for the G8 summit in Gleneagles in Scotland promised to increase aid to $130 billion, and double aid to Africa, by 2010.
But giving freely only gets you past the lowest rank of benefactors in Maimonides' scheme. An earlier pledge, made in Paris four months before, would have impressed him more. Donors promised to be more self-effacing in their charity, to “harmonise” their efforts with other benefactors, and “align” them with the priorities of governments they were trying to help.
Sadly, progress on both pledges is weak.
Such uncertainties should worry a prudent African finance minister. Can he count on seeing some of the extra $25 billion the continent is promised by 2010? Of the G8 leaders who signed that pledge, half have already departed, two are on their way out, and the remaining pair will be gone before 2010. Even if donors meet the target, the aid may arrive in a sudden and unmanageable rush a year or two before the deadline.
Only about 65% of aid actually arrives on schedule, according to the OECD. Finance ministers must cope with shortfalls and windfalls. Zambia was due to receive $930m in 2005, but ended up with just $696m. Vietnam which was expecting about $400m, got roughly $2 billion.
Because the aid they receive is such a capricious, volatile commodity, governments dare not make full use of it. They could hire legions of extra teachers, clinicians and civil servants, but only if they are prepared to fire them when the aid spigot is closed. They could put AIDS-sufferers on anti-retroviral therapies, but only if they are willing to discontinue treatment once the money stops. Not surprisingly, some governments choose to hoard aid rather than spend it. In 2001-03, Ghana received an extra $1.3 billion of aid; $1.2 billion collected in the vaults of its central bank.
Aid is also poorly co-ordinated. A trio of researchers compared donors with a gaggle of crop-growers, spraying water hither and thither, leaving some plants parched, others deluged. After the Indian Ocean tsunami, according to a report in El Pais, an Acehnese girl developed measles symptoms thanks to three identical jabs from different aid agencies.
Where donors and governments do see eye to eye, there may be little need for aid agencies at all. The British government, for example, could simply write a cheque to its Tanzanian counterpart. Some donors do just this, bankrolling governments they trust, and letting them manage the money themselves. About £1.2 billion ($2.4 billion) of British aid will top up government budgets in this way next fiscal year.
Other donors are less enthusiastic. They may want to trumpet their good deeds, or have real or imagined doubts about the recipient's book-keeping and budgeting. Even countries with “moderately strong” exchequers were not always trusted to audit their aid money, the OECD notes. “The very countries that helped us reform our systems, then don't use our systems,” complains Paul Lupunga, a senior Zambian official.
The Paris declaration says that donors must be accountable to beneficiaries. For now, most prefer to please their voters.

Air pressure

America's Supreme Court rules on the environment
THROUGHOUT George Bush’s presidency, the federal government has refused to countenance any regulation of the greenhouse gases that cause global warming. Whenever the subject comes up, officials tend to mumble about uncertainties. But on Monday April 2nd, in its most important environmental decision for many years, the Supreme Court at last settled one of the biggest outstanding questions: whether the government has the authority to curb emissions in the first place.
The court ruled, by the slenderest of margins, that the Clean Air Act—a law from the 1960s designed to combat smog and acid rain-gives the Environmental Protection Agency (EPA) the power to regulate carbon dioxide, the main greenhouse gas. It also said the EPA would need an excuse grounded in the original law if it decided not to use this power. It dismissed the justifications the EPA had provided for inaction—that emissions from American cars were insignificant in the grand scheme of things and that unilateral action by America would undermine efforts to achieve international consensus on global warming—as inadequate. Strictly speaking, the decision applies only to emissions from vehicles, but another, similar case involving coal-fired power plants is pending in a lower court. The EPA says it is now examining the ruling.
It might examine it for some time, of course. Any regulations it comes up with in response might still defer action into the distant future, since the law allows the EPA to delay implementation until appropriate technology can be acquired at a reasonable cost. Even if it proceeds quite swiftly, a new president and Congress with globe-cooling ideas of their own will be in place long before any new rules come into effect.
That suits the environmental lobby just fine. They hope the ruling will spur Congress to address global warming with proper legislation. After all, it makes little sense for such an important issue to be tackled tangentially through a 40-year-old law. At the very least, they can use the ruling to rally the faithful and shame climate-change sceptics in next year’s elections. And if 2009 sees the inauguration of a greener president, he or she will now have the power to dictate stricter fuel efficiency, in the form of lower CO2 emissions, without reference to Congress. If the lawsuit involving power plants goes the same way, the new president will be able to enforce across-the-board cuts in emissions by fiat. As Barbara Boxer, an environmentally-minded senator from California, stated gleefully, “This decision puts the wind at our back.”
That is true of California in particular. In 2002, the state assembly passed a law regulating emissions of CO2 from vehicles, based on a provision of the Clean Air Act that allows California to adopt stricter pollution standards than the federal government (other states can then choose to follow the Californian standards if they wish). Carmakers have challenged the law, in part on the ground that CO2 was not an air pollutant—a notion the Supreme Court has now comprehensively quashed.
California still needs a waiver from the EPA in order to enforce its own emissions standards. The EPA will presumably hesitate to withhold its permission after its setback in court. But it might argue that California does not face the “compelling and extraordinary conditions” the law requires before stricter standards can be imposed. That would prompt another protracted legal battle. On the one hand, global warming is, as its name suggests, a global problem. On the other, a big share of California’s water supply is threatened by decreasing snowfalls in the Sierra Nevada mountains-a change attributed to global warming.
The car industry, at any rate, seems rattled by the ruling. Its trade group quickly declared that the issue of global warming is best handled by at the federal level by Congress. Thanks to the Supreme Court, that now seems more likely.

All washed up

WE WERE right, all along. That is the thrust of the latest report from the Intergovernmental Panel on Climate Change (IPCC), a United Nations body set up to pronounce authoritatively on the science of global warming. In 2001 it predicted that global warming would lead to many ills, including greater numbers of extinctions, growing shortages of water, higher incidence of tropical diseases, and lower yields from agriculture, fishing and forestry in some places. Now the scientists who write the reports say they have much stronger evidence that such calamities are indeed occurring—faster, in many cases, than they originally thought.
The previous IPCC report, in February, examined the evidence that the globe was actually warming. It called the trend “unequivocal”, and expressed “very high confidence” that it was largely man-made. The new report assesses the likely impact of global warming. It was released on April 6th, after a week of negotiations between scientists and governments over the wording. Representatives of China, Russia, Saudi Arabia and America in partiuclar were said to have tried to water down the report, prompting a last-ditch all-night haggle.
The resulting document predicts the same sorts of consequences as its predecessor did in 2001, but with much greater confidence and precision, says Camille Parmesan, a professor at the University of Texas who vetted part of it. By her count, the chapter on current impacts alone rests on a review of over 1,000 academic studies, most of them already published—compared with about 100 last time around.
In a paper published in 2003, Professor Parmesan concluded that half of all species were already altering their behaviour or shifting their range in response to global warming. Others have found that some 26% of coral reefs have already died as a result of warming waters, and that the remainder will probably disappear if average water temperatures rise by another degree—along with the fisheries and tourism they sustain. In a synthesis of such studies, the report concluded that 30% of species face an increased risk of extinction if temperatures rise by 2ºC (3.6ºF).
This sort of finding suggests that the effects of global warming will be “non-linear”, says Paul Epstein, a Harvard University professor who has reviewed the entire report. For one thing, most projections of the impact derive from estimates of changes in average temperature. But many of the ill effects hinge on changes in the minimum temperature, which has been rising twice as fast. This trend is particularly strong near the poles, where the climate is changing fastest. Winters no longer get cold enough in many places to kill off different pests and diseases. So noxious species of ants and bees are marching northwards across America, ticks carrying Lyme disease are proliferating in Scandinavia and tropical highlands around the world are witnessing an invasion of mosquitoes carrying malaria, dengue fever and Japanese encephalitis. “The winter is the most wonderful thing that was ever invented for public health,” Dr Epstein says, “and we're losing it.”
Multiple factors will amplify the effects of global warming on agriculture and forestry. Warmer and drier conditions in many places will reduce yields. Meanwhile, pests such as tree-killing beetles and crop-killing fungi will both increase their range and breed more rapidly. And an increasing incidence of extreme weather, be it floods or droughts, will both damage crops directly and nurture species that prey on them. The poor, especially in tropical climes, will be hardest hit by all this, since they have little means of adapting to such changes.
The report is supposed only to inform policymaking, not to direct it. But the point of the frightening statistics about impending water shortages, epidemics and crop failures, says one of the authors, is to jolt politicians into preparing for the coming afflictions. In other words, the report intends to end the debate between those who think mankind's main effort should be trying to reverse climate change and those who would prefer to concentrate on adapting to its effects. Both strategies, it implies, are urgently needed.

Farewell, French Fries! Hello, Sliced Apples!

From the start, Mayor Bloomberg muscled his way into the city’s restaurants on a health platform. He banned smoking in bars and small restaurants. (Lighting up in restaurants with more than 35 seats had already been outlawed.) More recently, he shot down trans fat, forced large restaurant chains to post calorie counts and took on a cutting-edge culinary technique called sous vide.
The mayor’s raucous takeover of the public school system in 2002 led to a culinary bonus for the city’s 1.1 million school children. They now have an executive chef, whole wheat bread, salad bars and little plastic bags of sliced New York state apples. Even before the very public rat infestations and a string of high-profile closings, health inspectors were already making about 15,000 more restaurants visits annually than they did four years ago. In January and February, the health department closed 147 restaurants, double the number for the same two months last year.
And the Mayor has now turned his attention to hunger and poverty, working with the City Council to get more people to sign up for food stamps and looking with renewed vigor at how to get healthy food to people who live in neighborhoods with no grocery stores.
Perhaps the biggest statement Mayor Bloomberg has made about food policy came in the form of a hire. In January, Benjamin Thomases, 31, a New Yorker who holds an MBA from Columbia University, became the first official charged with coordinating the city’s policies on food.

Still, people engaged in agricultural reform, anti-hunger workers and even the average food-obsessed New Yorker wonder whether the Mayor is actually leading the city’s current food revolution or merely walking in front of a social change that was well under way before he took office.

“On food issues they’re very peculiar, this Bloomberg administration,” said Toni Liquori, an educator who has worked on food and public health projects in New York City for more than 20 years, including administering a $2 million Kellogg Foundation grant to improve the eating habits and health of New York City school children.

“What ends up happening is that one issue will pierce through and someone will charge with it, like trans fats or school meals,” she said. “But you also have a sense that it’s not like the administration is driving anything full tilt. It’s not as if they have embraced the full connection on food.”

Anti-hunger advocates, who have long been skeptical of Mayor Bloomberg’s commitment to the poor, credit the Mayor for taking a more serious interest in food as it relates to poverty this term.

“The tools are now all in place to achieve significant progress, but it depends on whether the city decides to use the tools,” said Joel Berg, executive director of the New York City Coalition Against Hunger and former member of the Clinton administration.

In many American cities, agricultural politics are being argued at the bar and alpha moms are organizing to take back school cafeterias. Chefs are making heroes out of cattle ranchers and the obesity crisis has prompted a new look at how and what to feed the poor. In an effort to build a cohesive public policy that brings all those food-related movements together, a handful of cities began forming food policy councils in the late 1990s.

The organizations, which are in part designed to advise governments on matters of food, usually include anyone who might have a stake in an urban diet. The councils with the most power are seated in city or state health departments, and might include farmers, food bank managers, school principals, backyard gardeners, grocers, chefs, labor leaders and clergy.

Both Berkeley and San Francisco have played with the model, as have Hartford, Conn., Toronto and Portland, Ore. Last week, New York state agricultural officials announced that the state would soon have its first food-policy council.

The nearest thing New York city government has now is Mr. Thomases, the food czar, who works deep inside the enormous collection of city departments called Health and Human Services. In an interview, however, he said that his job is not to set policy or offer vision.

And while organizations like food councils and positions like Mr. Thomases’ are a start, no major American city has yet established a Department of Food, in the way New York has a Department of Cultural Affairs or a Department of Environmental Protection. Although Gavin Newsom, the mayor of San Francisco, recently weighed in on the 2007 Farm Bill and many mayors have taken up the anti-obesity cause, no mayor of a large urban city has stood up and become, in essence, the Alice Waters of city food politics.

Mayor Bloomberg, who has donated millions to the Johns Hopkins school of public health that bears his name, brought in the antismoking, TB-fighting Dr. Frieden early on. Though he’s been labeled both a zealot and a revolutionary, Dr. Frieden doesn’t see himself as either. And he doesn’t see the changes in how New York eats as part of any larger foodie revolution.

The city, he points out, has had a long history of making people healthier by controlling food. In 1918, the Board of Health condemned oyster beds in the East River because they were contaminated with typhoid. Today, typhoid isn’t killing New Yorkers. Heart disease is.

“Obesity and diabetes are now the only health problems in the United States getting worse,” Dr. Frieden said. In light of the epidemic, Mayor Bloomberg’s hand in changing New York’s diet “has been relatively restrained,” he said.

Dr. Frieden, who has a runner’s body even though he swears he can’t lay off desserts, said it took a little bit of convincing to get the mayor behind the trans fat ban. But in the end, as with the smoking ban, it all came down to one question. The mayor asked, “Are you certain this is going to save lives?”

Not all of Dr. Freiden’s efforts to alter New York’s food landscape have been successful.

He realizes that a law forcing large restaurant chains to post calorie counts as prominently as menu prices might face a court challenge. And although the department often trots out its Healthy Bodegas Initiative as an example of innovative food policy work, the project has not gotten very far.

The idea was to encourage bodegas in neighborhoods with poverty and health problems to sell more nutritious food. An effort to get more 1 percent milk into some stores worked, but an attempt to persuade 60 bodegas in East Harlem and the South Bronx to sell packages of sliced New York apples and carrots didn’t take off.