Will Obama's order lead to surge in gun research?

MILWAUKEE (AP) — Nearly as many Americans die from guns as from car crashes each year. We know plenty about the second problem and far less about the first. A scarcity of research on how to prevent gun violence has left policymakers shooting in the dark as they craft gun control measures without much evidence of what works.

That could change with President Barack Obama's order Wednesday to ease research restrictions pushed through long ago by the gun lobby. The White House declared that a 1996 law banning use of money to "advocate or promote gun control" should not keep the Centers for Disease Control and Prevention and other federal agencies from doing any work on the topic.

Obama can only do so much, though. Several experts say Congress will have to be on board before anything much changes, especially when it comes to spending money.

How severely have the restrictions affected the CDC?

Its website's A-to-Z list of health topics, which includes such obscure ones as Rift Valley fever, does not include guns or firearms. Searching the site for "guns" brings up dozens of reports on nail gun and BB gun injuries.

The restrictions have done damage "without a doubt" and the CDC has been "overly cautious" about interpreting them, said Daniel Webster, director of the Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health.

"The law is so vague it puts a virtual freeze on gun violence research," said a statement from Michael Halpern of the Union of Concerned Scientists. "It's like censorship: When people don't know what's prohibited, they assume everything is prohibited."

Many have called for a public health approach to gun violence like the highway safety measures, product changes and driving laws that slashed deaths from car crashes decades ago even as the number of vehicles on the road rose.

"The answer wasn't taking away cars," said Dr. Georges Benjamin, executive director of the American Public Health Association.

However, while much is known about vehicles and victims in crashes, similar details are lacking about gun violence.

Some unknowns:

—How many people own firearms in various cities and what types.

—What states have the highest proportion of gun ownership.

—Whether gun ownership correlates with homicide rates in a city.

—How many guns used in homicides were bought legally.

—Where juveniles involved in gun fatalities got their weapons.

—What factors contribute to mass shootings like the Newtown, Conn., one that killed 26 people at a school.

"If an airplane crashed today with 20 children and 6 adults there would be a full-scale investigation of the causes and it would be linked to previous research," said Dr. Stephen Hargarten, director of the Injury Research Center at the Medical College of Wisconsin.

"There's no such system that's comparable to that" for gun violence, he said.

One reason is changes pushed by the National Rifle Association and its allies in 1996, a few years after a major study showed that people who lived in homes with firearms were more likely to be homicide or suicide victims. A rule tacked onto appropriations for the Department of Health and Human Services barred use of funds for "the advocacy or promotion of gun control."

Also, at the gun group's urging, U.S. Rep. Jay Dickey, a Republican from Arkansas, led an effort to remove $2.6 million from the CDC's injury prevention center, which had led most of the research on guns. The money was later restored but earmarked for brain injury research.

"What the NRA did was basically terrorize the research community and terrorize the CDC," said Dr. Mark Rosenberg, who headed the CDC's injury center at the time. "They went after the researchers, they went after institutions, they went after CDC in a very big way, and they went after me," he said. "They didn't want the data to be collected because they were threatened by what the data were showing."

Dickey, who is now retired, said Wednesday that his real concern was the researcher who led that gun ownership study, who Dickey described as being "in his own kingdom or fiefdom" and believing guns are bad.

He and Rosenberg said they have modified their views over time and now both agree that research is needed. They put out a joint statement Wednesday urging research that prevents firearm injuries while also protecting the rights "of legitimate gun owners."

"We ought to research the whole environment, both sides — what the benefits of having guns are and what are the benefits of not having guns," Dickey said. "We should study any part of this problem," including whether armed guards at schools would help, as the National Rifle Association has suggested.

Association officials did not respond to requests for comment. A statement Wednesday said the group "has led efforts to promote safety and responsible gun ownership" and that "attacking firearms" is not the answer. It said nothing about research.

The 1996 law "had a chilling effect. It basically brought the field of firearm-related research to a screeching halt," said Benjamin of the Public Health Association.

Webster said researchers like him had to "partition" themselves so whatever small money they received from the CDC was not used for anything that could be construed as gun policy. One example was a grant he received to evaluate a community-based program to reduce street gun violence in Baltimore, modeled after a successful program in Chicago called CeaseFire. He had to make sure the work included nothing that could be interpreted as gun control research, even though other privately funded research might.

Private funds from foundations have come nowhere near to filling the gap from lack of federal funding, Hargarten said. He and more than 100 other doctors and scientists recently sent Vice President Joe Biden a letter urging more research, saying the lack of it was compounding "the tragedy of gun violence."

Since 1973, the government has awarded 89 grants to study rabies, of which there were 65 cases; 212 grants for cholera, with 400 cases, yet only three grants for firearm injuries that topped 3 million, they wrote. The CDC spends just about $100,000 a year out of its multibillion-dollar budget on firearm-related research, New York Mayor Michael Bloomberg has said.

"It's so out of proportion to the burden, however you measure it," said Dr. Matthew Miller, associate professor of health policy at the Harvard School of Public Health. As a result, "we don't know really simple things," such as whether tighter gun rules in New York will curb gun trafficking "or is some other pipeline going to open up" in another state, he said.

What now?

CDC officials refused to discuss the topic on the record — a possible sign of how gun shy of the issue the agency has been even after the president's order.

Health and Human Services Secretary Kathleen Sebelius said in a statement that her agency is "committed to re-engaging gun violence research."

Others are more cautious. The Union of Concerned Scientists said the White House's view that the law does not ban gun research is helpful, but not enough to clarify the situation for scientists, and that congressional action is needed.

Dickey, the former congressman, agreed.

"Congress is supposed to do that. He's not supposed to do that," Dickey said of Obama's order. "The restrictions were placed there by Congress.

"What I was hoping for ... is 'let's do this together,'" Dickey said.

___

Follow Marilynn Marchione's coverage at http://twitter.com/MMarchioneAP

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Jan Perry hopes her plain talk will resonate with voters

For would-be Los Angeles Mayor Jan Perry, it was a bittersweet ground breaking last week for a residential high-rise a block from her apartment near Walt Disney Concert Hall.

Dignitaries hailed Perry as a leading force behind downtown's revival. "She has unbelievable tenacity," Los Angeles County Supervisor Gloria Molina told invited guests gathered at the vacant building site for a ceremonial shoveling of dirt.

But there was a poignant, unspoken subtext to the praise. Perry no longer represents the area, or even her own building. Last year, fellow City Council members carved most of downtown out of her district, in the aftermath of a public feud with council President Herb Wesson. Her new district covers a larger expanse of the most impoverished stretches of South L.A.

For Perry, it was a humiliating break with years of linking her political identity to the downtown development boom. The new apartment tower site, like her Bunker Hill home, is now part of Councilman Jose Huizar's domain.

"He's got big shoes to fill, following Jan," Molina told the groundbreaking audience, paying a compliment that highlighted Perry's loss.

In a city with a powerful council that can easily thwart a mayor's will, an important question for Perry is how effectively she could work with former colleagues on her governing agenda.

For nearly all major issues, the mayor must win eight of the council's 15 votes. Given her history of tension with other members, Perry could face a tougher challenge than some of her mayoral rivals in building council support when she needs it, said Jaime Regalado, emeritus professor of political science at Cal State L.A.

"You absolutely need to play nice," he said.

In the campaign, Perry plays up her willingness to speak her mind. She tries to maximize the contrast with her more cautious, top-tier rivals in the March 5 primary, Councilman Eric Garcetti of Silver Lake and City Controller Wendy Greuel of Studio City.

"I don't calculate what I do in terms of what it will mean for me, long term," she said in an interview at a coffee house across from the Music Center.

But even she, in moments of reflection, will acknowledge her plain speaking carries risks. It was her conspicuous refusal to support Wesson's election as council president, she said, that cost her the coveted Central City business district.

"I like to cut to the chase in my words and my deeds," Perry said.

With most of the Los Angeles political establishment split between Greuel and Garcetti, Perry hopes she can project an authenticity that will resonate with voters, and trump her opponents' money and better-known names.

She starts with a base of black voters, mainly in South L.A. But African Americans normally make up only 15% of the city's vote, so Perry must build broader support to secure a spot in the May 21 runoff.

Closest to home, she is competing mostly with Garcetti for Latinos. Perry's district, just south of downtown, is predominantly Latino. Like Garcetti, who is half Mexican, Perry often speaks Spanish, if less fluently, at public events. At a recent house party for women in Boyle Heights, she passed out cheese-and-jalapeno pastries and fielded questions in Spanish.

Perry is also vying for Jewish support. Raised as a Protestant in the suburbs of Cleveland, she converted to Judaism in the 1980s while earning a master's degree in public administration at USC. She studied Judaism under Rabbi Chaim Seidler-Feller, now executive director of Hillel at UCLA.

"I was, like many people at that age, searching for my purpose and a way to make sense of who I was," she recalled.

"She doesn't fit in a box," said Parke Skelton, a campaign consultant who worked on Perry's council races. "African American, Jewish, pro-business Democrat who's had her ups and downs with labor — it's kind of an interesting one-person coalition."

A key target for Perry is conservative white voters, especially in the San Fernando Valley, where Greuel and Republican radio talk-show personality Kevin James are tussling for dominance.

At a Northridge breakfast for business owners last week, Perry took credit for thousands of jobs created by L.A. Live and other downtown projects she has promoted with city tax subsidies. Getting Los Angeles growing again and on a sound fiscal footing is her top priority, she tells such groups.

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U.S. Sees Hazy Threat From Mali Militants

WASHINGTON — As Islamic militants methodically carved out a base in the desert of northern Mali over the past year, officials in Washington, Paris and African capitals struggling with military plans to drive the Islamists out of the country agreed on one principle: African troops, not European or American soldiers, would fight the battle of Mali.

But the surprise French assault last Friday to blunt the Islamists’ advance upended those plans and set off a cascading series of events, culminating in a raid on Wednesday by militants on a foreign-run gas field in Algeria. That attack threatens to widen the violence in an impoverished region and drag Western governments deeper into combating an incipient insurgency.

And yet the rush of events has masked the fact that officials in Washington still have only an impressionistic understanding of the militant groups that have established a safe haven in Mali, and they are deeply divided about whether some of these groups even pose a threat to the United States.

Moreover, the hostage situation in Algeria has only heightened concerns that a Western military intervention could transform militant groups that once had only a regional focus into avowed enemies of the United States — in other words, that the backlash might end up being worse than the original threat.

Largely for these reasons, the Obama administration adopted a strategy over the past year to contain the Islamists in Mali until African troops were ready to confront them, rather than to challenge them directly with an American military campaign of drone strikes or commando raids.

During Congressional testimony in June, Johnnie Carson, the assistant secretary of state for African affairs, played down the terrorist threat to the United States from Mali, saying that the Qaeda affiliate operating there “has not demonstrated the capability to threaten U.S. interests outside of West or North Africa, and it has not threatened to attack the U.S. homeland.”

Some Pentagon officials have long taken a more hawkish stance, and they cite intelligence reports that fighters with ties to Al Qaeda in the Islamic Maghreb, which has a loose affiliation to the remnants of Osama bin Laden’s terrorist network, played a role in the deadly attack in September on the American diplomatic compound in Benghazi, Libya. They have pushed for targeted strikes against Islamist leaders in northern Mali, arguing that killing the leadership could permanently cripple the strength of the militants.

The administration has embraced a targeted killing strategy elsewhere, notably in Pakistan, Yemen and Somalia, after top White House, Pentagon and C.I.A. officials determined that militants in those countries were bent on attacking the United States.

Asked if fighters from Al Qaeda in the Islamic Maghreb posed such an imminent threat, Gen. Carter F. Ham, the top American commander in Africa, said, “Probably not.” But, he said in an interview, “they subscribe to Al Qaeda’s ideology” and have said that their intent is to attack Westerners in Europe and, “if they could, back to the United States.”

Defense Secretary Leon E. Panetta made it clear on Wednesday that he considered the group a serious danger. “This is an Al Qaeda operation,” he told reporters while traveling in Italy, “and it is for that reason that we have always been concerned about their presence in Mali, because they would use it as a base of operations to do exactly what happened in Algeria.”

It is too early to judge the impact of the French-led offensive in Mali, which came after an urgent plea by Mali’s government for help in repelling Islamist fighters who were rapidly moving south. But on Wednesday, some American officials said that the hostage episode in Algeria could be just the beginning of a wave of attacks against foreigners in the region. And there is a chance that if the Americans taken hostage on Wednesday are killed by their captors, American officials might reconsider their pledges not to commit ground troops to the battle.

Michael R. Gordon contributed reporting from Washington, and Elisabeth Bumiller from Rome.

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Baby Boy on the Way for Kara DioGuardi

Mom & Babies
Celebrity Baby Blog

01/16/2013 at 08:15 PM ET

Cindy Ord/Getty

Kara DioGuardi is going to be a mom!

The Grammy-nominated songwriter, who also served as a judge on American Idol‘s eighth and ninth seasons, confirms to PEOPLE exclusively that she and husband Mike McCuddy will welcome their first child via gestational surrogate in the coming weeks.

“We are eagerly awaiting the healthy and happy birth of our son Greyson James Carroll McCuddy,” DioGuardi, 42, tells PEOPLE.

After years of struggling with fertility issues and multiple failed IVF attempts, the couple, who wed in 2009, decided to explore other paths to parenthood — including adoption and surrogacy.

In the end, says DioGuardi, “We made a personal decision to try with a surrogate. I asked someone we knew, a friend. And on the first try, it worked.”

“We’re praying for our surrogate, that she gets through this and that it’s as easy on her as it can possibly be, because she’s been a gem throughout the whole process,” says the songwriter and music publisher.

“I’ve got two people on my mind: her and the baby. She’s given us this incredible gift.”

– Marisa Laudadio

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Large study confirms flu vaccine safe in pregnancy

NEW YORK (AP) — A large study offers reassuring news for pregnant women: It's safe to get a flu shot.

The research found no evidence that the vaccine increases the risk of losing a fetus, and may prevent some deaths. Getting the flu while pregnant makes fetal death more likely, the Norwegian research showed.

The flu vaccine has long been considered safe for pregnant women and their fetus. U.S. health officials began recommending flu shots for them more than five decades ago, following a higher death rate in pregnant women during a flu pandemic in the late 1950s.

But the study is perhaps the largest look at the safety and value of flu vaccination during pregnancy, experts say.

"This is the kind of information we need to provide our patients when discussing that flu vaccine is important for everyone, particularly for pregnant women," said Dr. Geeta Swamy, a researcher who studies vaccines and pregnant women at Duke University Medical Center.

The study was released by the New England Journal of Medicine on Wednesday as the United States and Europe suffer through an early and intense flu season. A U.S. obstetricians group this week reminded members that it's not too late for their pregnant patients to get vaccinated.

The new study was led by the Norwegian Institute of Public Health. It tracked pregnancies in Norway in 2009 and 2010 during an international epidemic of a new swine flu strain.

Before 2009, pregnant women in Norway were not routinely advised to get flu shots. But during the pandemic, vaccinations against the new strain were recommended for those in their second or third trimester.

The study focused on more than 113,000 pregnancies. Of those, 492 ended in the death of the fetus. The researchers calculated that the risk of fetal death was nearly twice as high for women who weren't vaccinated as it was in vaccinated mothers.

U.S. flu vaccination rates for pregnant women grew in the wake of the 2009 swine flu pandemic, from less than 15 percent to about 50 percent. But health officials say those rates need to be higher to protect newborns as well. Infants can't be vaccinated until 6 months, but studies have shown they pick up some protection if their mothers got the annual shot, experts say.

Because some drugs and vaccines can be harmful to a fetus, there is a long-standing concern about giving any medicine to a pregnant woman, experts acknowledged. But this study should ease any worries about the flu shot, said Dr. Denise Jamieson of the Centers for Disease Control and Prevention.

"The vaccine is safe," she said.

___

Online:

Medical journal: http://www.nejm.org

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Producer of pornographic fetish films gets 4 years in prison

A Los Angeles-based creator of pornographic fetish films was sentenced to four years in federal prison Wednesday for producing and selling obscene material.

Ira Isaacs, 61, received the sentence after a six-year prosecution that included two mistrials and led to the public admonishment of federal Judge Alex Kozinski, who recused himself from the proceedings after The Times reported that he placed pornographic images on an Internet server that could be accessed by the public. Kozinski is the chief judge of the U.S. 9th Circuit Court of Appeals.

Isaacs' trial came during a wave of obscenity prosecutions that began under the Bush administration in 2005 with the formation of an Obscenity Prosecution Task Force.

Doing business under the name L.A. Media since 1999, Isaacs produced, starred in, and distributed pornographic films through a website he advertised as "the Web's largest fetish VHS, DVD superstore." Some of his films, which depict bestiality and sexual situations involving human excrement, were shown to the jury during his third trial last April.

Although the defense argued that Isaacs' work was protected by the 1st Amendment, there was a consensus at trial about the appeal of the films, which had titles such as "Hollywood Scat Amateurs No. 7." "They were so disgusting I couldn't even watch them," said Isaacs' attorney Roger Diamond, who said he averted his eyes and read a book as the 90-minute films were played in court. "But that doesn't mean they're not free speech."

Isaacs said his films were supposed to shock and disgust people in a way that challenges their conception of art. He turned down a plea bargain that would have saved him from incarceration and said he had no regrets.

"It makes people think, 'What is art? Can art be gross?' " he said.

According to federal law, material must meet a three-part test to be considered criminally obscene: It must appeal to a prurient interest, lack scientific, artistic and political value and be patently offensive.

Prosecutor Michael Grant said Isaacs had never mentioned artistic intentions until he was in front of a court.

"Since 1999, he has operated a business with one goal in mind: make money off of individuals that enjoy sick materials," Grant said in court.

Diamond asked the judge to lighten the sentence to probation because he said Isaacs was financially destitute and had accepted responsibility for his crimes.

But U.S. District Judge George H. King, who presided over the case, said Isaacs had sought to "cloak himself" in the 1st Amendment with a "cynical post-hoc justification" and was not "a defender of the 1st Amendment."

Addressing Isaacs directly, King said, "You are an abuser of the 1st Amendment. You cheapen the 1st Amendment."

King said that because Isaacs continued selling the films, even plugging his website on a radio show two days after his conviction, incarceration was a necessary "deterrent." Isaacs must also pay more than $10,000 in fines, as well as submit to community supervision for three years after his release from prison.

Isaacs was asked to report to federal authorities by Feb. 19, but he plans to file an appeal. Clad in a fedora and a baggy gray suit after the sentencing, he appeared unfazed by the prospect of prison time.

He has been waiting for federal authorities to arrest him since the day he started his business, Isaacs said. He signed many of his films as "Josef K," the name of a protagonist in a Franz Kafka novel who is prosecuted by a distant authority for an unknown crime.

"That's the Academy Award I just won in there," Isaacs said. "That's an artist's dream."

frank.shyong@latimes.com

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Syrian Opposition Finds Hearts and Minds Are Elusive

Goran Tomasevic/Reuters

Rebel fighters in a neighborhood of Damascus on Tuesday. Many Syrians remain wary of the opposition and its assurances of how it would govern the country.

BEIRUT, Lebanon — As the Syrian civil war nears the two-year mark, the opponents of President Bashar al-Assad and their international backers have failed to win the backing of many government supporters, including minorities, a slice of the population whose help is essential not only to resolve the conflict, but also to keep Syria from becoming a failed state, analysts say.

Syrian opposition leaders in exile have repeatedly offered promises that a future Syria will guarantee equal rights to all citizens regardless of religion and ethnicity, including members of President Assad’s minority Alawite sect, and that government officials without “blood on their hands” will be safe. But that has done little to win the allegiance of a significant bloc of Syrians who are wary of the uprising.

“The opposition is in fact helping to hold the regime together,” said Peter Harling, an analyst with the International Crisis Group who meets in Syria with people on all sides of the conflict. “It seems to have no strategy to speak of when it comes to preserving what’s left of the state, wooing the Alawites within the regime or reaching out to those who don’t know who to hate most, the regime or the opposition.”

Analysts with contacts in Syria said that the opposition had failed to spell out how it would handle challenging political issues like the fate of the Baath Party, the army rank and file, and the public sector — which employs at least 1.2 million Syrians — or how it would curb sectarian violence and revenge killings. The opposition, critics say, has missed opportunities to split government support from within and has allowed Mr. Assad to portray himself to fence-sitters as the best bet to keep the Syrian state intact.

That vacuum, some analysts say, was the backdrop for Mr. Assad’s confident tone in a speech he gave on Jan. 6, when he offered to engage in political dialogue with opponents he considers acceptable.

Mr. Harling said the speech allowed Mr. Assad to try to persuade the undecided that he is still a plausible choice, and reflected a belief in the president’s circle — perhaps mistaken — that “people will ultimately come back to them, because they offer more of the prospect of a state.”

On Sunday, Russia’s foreign minister pointedly called on the opposition to offer specific counterproposals for a political solution rather than complain about Mr. Assad’s refusal to negotiate. And on Monday, Kofi Annan, the former United Nations secretary general, chided the United States and Russia for not working harder to bring the sides together, warning that the opposition’s insistence that Mr. Assad step down before any negotiations begin is perpetuating a stalemate and risking a descent into chaos.

The concerns come not only from Russia, Mr. Assad’s strongest ally, and Mr. Annan, who resigned as international envoy to Syria when his mediation efforts went nowhere. They are shared by a growing chorus of Middle East analysts, Syrian intellectuals and a former Syria adviser to the Obama administration, which has recognized the opposition as the country’s legitimate representative.

The former Syria adviser, Frederic C. Hof, wrote last month that although the opposition has offered general assurances to the one-third of Syrians who belong to minority groups, “probably no more than a handful” believe it, especially as jihadist groups grow more prominent on the battlefield and issue videotaped calls for the restoration of the Islamic caliphate.

“And why should they?” he wrote in an article published by the Atlantic Council, a research institute in Washington. “What would weigh heavier on the brain of a non-Sunni Arab (or a Sunni Arab committed to secular governance): the occasional word about the primacy of citizenship, or the televised chanting of hirsute warriors?”

Part of the problem is that the opposition, unlike the government, does not speak with one voice. It is divided among secular and religious members, exiles and those fighting inside Syria, and supporters and opponents of armed struggle. Even after reorganizing under pressure from the West, the coalition has yet to agree on a government in exile.

Yet, the coalition understands the danger, Samir Nachar, a member, said in an interview from Turkey.

“Everyone feels and knows that there is a real dilemma and danger when it comes to the morale of the Syrian citizen,” he said. “Unfortunately, we don’t have anything on the ground that can truly relieve the fears and the anxieties that are plaguing minorities at this time. Sadly, the Alawite sect has been taken hostage by this regime.”

Hania Mourtada and Kareem Fahim contributed reporting.

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Tablet shipments in 2013 could be lower than previously expected

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The Bachelor Celebrates 25 Seasons

TV Watch

The Bachelor

By Monica Rizzo

01/15/2013 at 07:50 PM EST

Sean Lowe and past stars and contestants of The Bachelor

Warner Bros.

Happy anniversary!

The Bachelor's current star, Sean Lowe, was joined by past franchise favorites on Jan. 11 to celebrate 25 seasons of the hit ABC reality dating show.

The Texas hunk clinked glasses at the famed Agoura Hills, Calif., Bachelor mansion with series creator Mike Fleiss and past Bachelorettes Ali Fedotowsky, Trista Sutter, Jillian Harris, DeAnna Pappas and the show's most recent star, Emily Maynard.

Also on hand were former Bachelor Jason Mesnick and his wife, Molly, who is expecting the couple's first child in March, as well as former contestants Courtney Robertson, Michael and Stephen Stagliano, Erica Rose and Casey Shteamer.

Jake Pavelka was also there, though he didn't appear in a group photo (above).

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Risk to all ages: 100 kids die of flu each year

NEW YORK (AP) — How bad is this flu season, exactly? Look to the children.

Twenty flu-related deaths have been reported in kids so far this winter, one of the worst tolls this early in the year since the government started keeping track in 2004.

But while such a tally is tragic, that does not mean this year will turn out to be unusually bad. Roughly 100 children die in an average flu season, and it's not yet clear the nation will reach that total.

The deaths this year have included a 6-year-old girl in Maine, a 15-year Michigan student who loved robotics, and 6-foot-4 Texas high school senior Max Schwolert, who grew sick in Wisconsin while visiting his grandparents for the holidays.

"He was kind of a gentle giant" whose death has had a huge impact on his hometown of Flower Mound, said Phil Schwolert, the Texas boy's uncle.

Health officials only started tracking pediatric flu deaths nine years ago, after media reports called attention to children's deaths. That was in 2003-04 when the primary flu germ was the same dangerous flu bug as the one dominating this year. It also was an earlier than normal flu season.

The government ultimately received reports of 153 flu-related deaths in children, from 40 states, and most of them had occurred by the beginning of January. But the reporting was scattershot. So in October 2004, the government started requiring all states to report flu-related deaths in kids.

Other things changed, most notably a broad expansion of who should get flu shots. During the terrible 2003-04 season, flu shots were only advised for children ages 6 months to 2 years.

That didn't help 4-year-old Amanda Kanowitz, who one day in late February 2004 came home from preschool with a cough and died less than three days later. Amanda was found dead in her bed that terrible Monday morning, by her mother.

"The worst day of our lives," said her father, Richard Kanowitz, a Manhattan attorney who went on to found a vaccine-promoting group called Families Fighting Flu.

The Centers for Disease Control and Prevention gradually expanded its flu shot guidance, and by 2008 all kids 6 months and older were urged to get the vaccine. As a result, the vaccination rate for kids grew from under 10 percent back then to around 40 percent today.

Flu vaccine is also much more plentiful. Roughly 130 million doses have been distributed this season, compared to 83 million back then. Public education seems to be better, too, Kanowitz observed.

The last unusually bad flu season for children, was 2009-10 — the year of the new swine flu, which hit young people especially hard. As of early January 2010, 236 flu-related deaths of kids had been reported since the previous August.

It's been difficult to compare the current flu season to those of other winters because this one started about a month earlier than usual.

Look at it this way: The nation is currently about five weeks into flu season, as measured by the first time flu case reports cross above a certain threshold. Two years ago, the nation wasn't five weeks into its flu season until early February, and at that point there were 30 pediatric flu deaths — or 10 more than have been reported at about the same point this year. That suggests that when the dust settles, this season may not be as bad as the one only two years ago.

But for some families, it will be remembered as the worst ever.

In Maine, 6-year-old Avery Lane — a first-grader in Benton who had recently received student-of-the-week honors — died in December following a case of the flu, according to press reports. She was Maine's first pediatric flu death in about two years, a Maine health official said.

In Michigan, 15-year-old Joshua Polehna died two weeks ago after suffering flu-like symptoms. The Lake Fenton High School student was the state's fourth pediatric flu death this year, according to published reports.

And in Texas, the town of Flower Mound mourned Schwolert, a healthy, lanky 17-year-old who loved to golf and taught Sunday school at the church where his father was a youth pastor.

Late last month, he and his family drove 16 hours to spend the holidays with his grandparents in Amery, Wis., a small town near the Minnesota state line. Max felt fluish on Christmas Eve, seemed better the next morning but grew worse that night. The family decided to postpone the drive home and took him to a local hospital. He was transferred to a medical center in St. Paul, Minn., where he died on Dec. 29.

He'd been accepted to Oklahoma State University before the Christmas trip. And an acceptance letter from the University of Minnesota arrived in Texas while Max was sick in Minnesota, his uncle said.

Nearly 1,400 people attended a memorial service for Max two weeks ago in Texas.

"He exuded care and love for other people," Phil Schwolert said.

"The bottom line is take care of your kids, be close to your kids," he said.

On average, an estimated 24,000 Americans die each flu season, according to the Centers for Disease Control and Prevention. People who are elderly and with certain chronic health conditions are generally at greatest risk from flu and its complications.

The current vaccine is about 60 percent effective, and is considered the best protection available. Max Schwolert had not been vaccinated, nor had the majority of the other pediatric deaths.

Even if kids are vaccinated, parents should be watchful for unusually severe symptoms, said Lyn Finelli of the CDC.

"If they have influenza-like illness and are lethargic, or not eating, or look punky — or if a parent's intuition is the kid doesn't look right and they're alarmed — they need to call the doctor and take them to the doctor," she advised.

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CDC advice on kids: http://www.cdc.gov/flu/protect/children.htm

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