Waldinger's Pharmacy has been a Bay Ridge fixture for sixty years--Sanaz Meshkinpour/NYCinFocus.

Bella Feinberg juggles life, work, family and a host of chronic illnesses. Asthma. Blood pressure. A heart condition. She heartily chuckles, trying to remember her list of daily medications.

“I think I have 13 prescriptions,” Feinberg, 69, said. “Maybe that’s without my asthma medicine. Maybe it’s more with my asthma.”

For the past thirty years, Feinberg has filled her prescriptions at Waldinger’s Pharmacy, a 5th Avenue mainstay in the heart of the Bay Ridge shopping district in Brooklyn. She depends on pharmacist Frank DeRosa to help keep her medications on track.

But beginning next month, Feinberg will no longer be able to rely on DeRosa. Her insurance company switched to mandatory mail order through CVS and won’t pay for medications dispensed at places like Waldinger’s.

Feinberg isn’t the only patient DeRosa has lost to mandatory mail order. Waldinger’s prescription drug business has dropped 60 percent over the past few years, said the pharmacist. Other pharmacies along Bay Ridge’s 3rd and 5th Avenues report declines in prescription drug sales from 20 to 60 percent. Such sales represent a large portion of a pharmacy’s income and are a main incentive driving customers into the store.

“We’re a pharmacy, [prescriptions] is where all of our business comes from,” said Igor Grabov of Bay Ridge Specialty Pharmacy. When it comes to mail order, “they take their share, but we have to compete with them.”

At a time when more employers are opting for savings through mandatory mail order prescriptions, DeRosa believes he still provides a vital community service—personalized care from a pharmacist who understands the individual needs of each patient.

Pharmacist Frank DeRosa answers customer questions behind the counter--Sanaz Meshkinpour/NYCinFocus

“Patients look to us to answer their questions, to explain to them things they don’t understand with their medication and their treatments,” DeRosa said.

But insurance companies and drug managers believe that mail order prescriptions are more efficient, cut costs and serve patients well. The increase of mandatory mail order prescriptions threatens not only the survival of those hard hit pharmacies, but the community service they provide to patients in need of constant guidance.

As President Barack Obama and lawmakers on Capitol Hill debate how to expand coverage and control spiraling health care costs, prescription drugs comprise one of many conundrums. In 2008, prescription drugs sales reached $291.5 billion, a 1.4 percent increase from the year before, according to Forbes magazine. According to the Centers for Disease Control, chronic conditions account for 96 percent of drug costs in the country.

Within the pharmaceutical industry, drug managers—also known as pharmacy benefit managers—advocate mail order prescriptions for patients with chronic illness. They say mail order is the best option to streamline the price, the sale and the distribution of prescription drugs. These managers take in large rebates and discounts by purchasing drugs in bulk and thus have considerable discretion over which drugs are used.

Although mail order prescriptions date back to the 1940s, the business boomed in the 90s and quickly became the fastest-growing distribution channel for the industry. It is estimated that today, one in three households nationwide use a mail order pharmacy to fill prescriptions. Thirty-six percent of those households are required to do so by their health plans, according to the 2007 Pharmacy Satisfaction Digest from WilsonRx and Boehringer Ingelheim, two health care research firms.

In New York City, health insurance plans for all city employees and several major unions require mandatory mail order for all maintenance drugs—prescriptions taken regularly over an extended period of time.

Mail order is convenient, saves money for employers and patients, and is designed specifically for people with chronic conditions, said Jennifer Leone Luddy, a spokesperson for Medco Health Solutions, one of the country’s largest pharmacy benefit managers and mail order pharmacy operators. Medco offers phone consultations with pharmacists 24 hours a day, and also with specialists in several common chronic conditions. Luddy said these services help patients manage chronic illnesses.

“These specialist pharmacists can tell if a patient is not refilling their prescription on time, and [is] therefore not compliant, or not getting testing for things,” Luddy said.

Many users swear by mail order’s convenience and savings. John Morlano, 75, a life-long Park Slope resident and diabetic had bypass surgery 12 years ago. Since then, he has taken a cocktail of 13 prescription pills a day.

“I take four pills a day for diabetes,” Morlano said. “And four water pills, four pills for blood pressure, one pill for my heart, plus vitamins.”

Morlano, a veteran of the Korean War, orders his medication through Veterans Affairs. He prefers mail order because “it’s good and cheap,” he said. “I pay $8 per prescription. You can’t beat that, and all I gotta do is call up.”

Pharmacist Frank DeRosa of Waldinger's Pharmacy--Sanaz Meshkinpour/NYCinFocus

But managing a complicated regimen isn’t so easy for everyone. Pharmacist DeRosa said some patients are confused and devastated when new conditions arise and need a great deal of personal attention to walk them through major life changes.

For instance, 12 years ago, an elderly man began seeking DeRosa’s help after he’d been diagnosed and prescribed medication for gout—a form of arthritis that causes pain and swelling of the joints, mainly on toes and fingers.

“In the beginning, we thought he was a cranky old man,” DeRosa said. “But it was because he didn’t feel good.”

The man, now 69, continued to develop new illnesses—following the gout was asthma, then vision problems, and most recently, diabetes. He now takes more than 30 medications a day, said DeRosa.

“He’s got a lot of questions,” DeRosa said. “He doesn’t understand what’s going on with his health, what his doctor’s trying to tell him. But he’ll come here, and we go over everything together.”

Despite a major language barrier—Arabic is the man’s native language—DeRosa said he and the patient have developed a common understanding based on gestures and simple phrases. DeRosa is skeptical that over-the-phone pharmacists would be able to serve this man’s needs—or develop relationships that serve patients in the long term.

“We are the front lines for people’s health,” DeRosa said. “We are the ones they come to help them when they don’t feel good. You need to be able to have that access to a pharmacist who can recognize if it is a simple cold or rash or sprain, or is it something more serious.”

A vast majority of Waldinger's business comes from prescription sales--Sanaz Meshkinpour/NYCinFocus

Devon Stone of the Washington, D.C.-based organization, National Community Pharmacists Association, says that despite industrywide financial stability in 2008, local pharmacies continue to face several pressures: mandatory mail order, big chain drug stores and lower reimbursement rates from insurance providers and Medicare.

“You can’t go head to head, mano y mano, against the mail orders and the big chains,” Stone said.

The solution, according to Stone, is for community pharmacists like DeRosa to continue what they have been doing for years: offering personalized care and a diverse set of services. DeRosa is hoping that industry decision makers will recognize the preventative role pharmacists play in health care: helping cut costs by preventing conditions from getting worse. That, said DeRosa, is often missing from policy talk.

Feinberg said she would continue coming to Waldinger’s with her questions and for the occasional cold medicine. But without constant communication, DeRosa cannot provide the same quality of care as he has for the past thirty years.

Each patient DeRosa loses to mail order only reminds him of a changing industry where employers, insurance providers, and drug managers decide which patients stay and go.

“Before, simply being here was enough,” DeRosa said. “People needed pharmacies, and they needed pharmacists. It’s not the case anymore. Still, I don’t think any of them are a good substitute for what we provide in the pharmacy, and I hope people realize that.”

On the train she sits quietly, leaning against the window and nodding to the private beat of her lime-green iPod. The hour-long commute is nothing new for this teenager, who has traveled this distance for the last five years to pursue her dream of becoming a professional ballet dancer.

“People constantly ask me, ‘how do you commute every day, don’t you get annoyed?’ I don’t see it like that,” said Medvinskaya. “For me, it is my hour to listen to music, sew my pointe shoes, and to just be with my own thoughts.”

A recent graduate of Fiorello H. LaGuardia High School in Manhattan, a prestigious performing arts school, Medvinskaya has been dancing for 15 years. As she narrates the story of how she has made it this far, as a pre-professional, it is with a mix of delight, sadness, and wonder—almost as if she can’t possibly be talking about someone she knows, let alone about herself.

“I have self-doubt every day,” said Medvinskaya. “Sometimes, I wonder, why am I doing this? Dance never came easy for me. There was always something that stood in my way, and I had to fight for it.”

Katia Shraga-Davidenko, an archivist at Columbia University, is Medvinskaya’s mother. Over the years, she has watched her daughter grow up on stage and mature as both her child and as a dancer.

“I remember when she was three or four years old, she said to me, ‘I can’t say it, but I’ll dance it for you,’ and she did. And I understood,” recalled Shraga-Davidenko. “She always had a love for it. But, I don’t wish anyone to go through what she went through. There was always something in her life telling her to stop and not to go on.”

Medvinskaya has been dancing since age four. She and her family moved from Kiev, Ukraine to Brooklyn when she was 11 months old. Three years later her parents enrolled her in a dance class. Fifteen years later, she continues to follow her passion.

But the pursuit has not been without cost. Throughout Medvinskaya’s training, she has had to sit on the sidelines a number of times. From injuries to emotional breakdowns, Medvinskaya says she has endured a lot for her age, and continues to do so as she undergoes physical therapy for her latest hip injury.

“I had a lot of set backs that made it a bit inconvenient to dance,” said Medvinskaya. “I’ve seen what it is like not to be able to do it, to have it taken away from me. But, it has given me a thick skin, which I think will help me out not only in dance, but in life.”

In high school, Medvinskaya’s life was consumed with ballet. She spent the first two summers training at the Kirov Academy, a boarding school for aspiring professional dancers. Upon completing her second intensive, the academy offered Medvinskaya an invitation to train year round.

“The invitation to the Kirov was a very big push into the direction that I wanted to be heading in,” said Medvinskaya who had trained at the school for two summers. “When I was invited to go to the Kirov Academy of Ballet year-round, I felt that I was accepted into the ‘real’ ballet world.”

Medvinskaya accepted the invitation, and spent a full semester training in Washington D.C. Her time at the Kirov confirmed her desire to become a professional dancer, but she left the academy after a semester to be closer to home. She eventually enrolled in LaGuardia and began training every day at Valentina Kozlova’s Dance Conservatory, a small window-lined studio in Manhattan.

Vladimir Lepisko, a former dancer of the Kiev State Choreographic School and the current coordinator of Brighton Ballet Theatre, has watched Medvinskaya train for the last 10 years. Lepisko says he has believed in Medvinskaya, despite the doubts she has had about her own dancing.

“There is passion in her,” said Lepisko. “We all helped her. She was always destined to be something big. She was the top student here. But she didn’t come here with natural talent, but with a love for dance and performing.”

As Medvinskaya works her way up the professional ladder, she says she tries to balance being a teenager with ballet. In addition to training six days a week, Medvinskaya also studies English at Hunter College.

“I love reading,” said Medvinskaya as she carefully opens her course book. “When I read, I feel like I am in my own bubble, just like with ballet.”

With company auditions around the corner, Medvinskaya is working on improving her technique. Although, she says she is not where she’d like to be ideally, Medvinskaya still projects an air of calm when speaking about her future. “The chances of me even making it in the dance world are slim,” she said. “But I can’t stop. I may not make it in this round, but that won’t stop me from trying again.”

Diana Markosian/NYCinFocus

To begin the journey, catch the B or Q line. Exit at the last stop and head down the never-ending staircase, where you will find the many-colored crowd and glittering shops of a world away from Manhattan. Welcome to Brighton Beach, a grungy Soviet enclave of Brooklyn, where life is seemingly frozen in time.

With roughly 35,000 people living here, the neighborhood once nicknamed “Little Odessa” because of its large Ukrainian population, has gained a new reputation as “a retired poor man’s Miami.” 

The area was once seen as a destination of opportunity, primarily by the first surge of Soviet citizens who arrived in the late 1970s, at the height of the Cold War.  A second wave of migrants moved to Brighton Beach in the 1990s after the collapse of the Soviet Union. 

Since then, the neighborhood has developed a more negative reputation. To the latest generation of former Soviets the area represents a Brezhnev-era closed world, a stark contrast to present-day Moscow. 

Alisa Fort, 21, is an aspiring model and student, who moved to the neighborhood two years ago from St. Petersburg. At first, Fort says, she had a hard time acclimating. But she is now slowly adjusting to the small-town feel of Brighton Beach.

“My family was lucky, very lucky,” she says. “But, it is also hard. Young people who come here are always sad when they see how hard it is. The truth is, there is no opportunity for them in Brighton.”

Nearly a decade after the break up of the Soviet Union, Russia’s new breed of capitalists are eager to find work and build careers for themselves in their own country. So it’s become even more disappointing for many who arrive in Brighton and discover it doesn’t offer greater opportunity than back home in Russia.

Nastya Glubskaya, like many new Russians immigrants, journeyed to New York from Moscow in search of work. She is a college student, and took on a summer job as a recruiter for a Russian firm in Brighton. With just a week left in her stay, Glubskaya’s once romanticized version of America has her clamoring to go home.

“At first, I couldn’t believe this was America,” says Glubaskaya in Russian. “It is like a big countryside. I came here from Moscow, where we have class and culture.”

“The streets in Brighton change every month,” says Alla Petrovskaya, who has lived in the same home on Brighton’s 1st Avenue for 35 years. From her modest kitchen window she has quietly watched her neighborhood transform over the years. “Some businesses open, but close the next month,” she says. “Now, it is the people. It seems like everything is always changing.”

Petrovskaya is referring to a new wave of immigrants, predominantly Hispanic and Chinese, who are settling in Brighton Beach. In many cases, this influx of ethnic migrants has deterred young capitalist Russians from settling permanently in the area. Often, these newcomers say they have a hard time identifying with neighbors who do not speak Russian.

That’s not the case, however, for Gleb Kutopov an early settler in the Brighton area. For the last two decades, Kutopov has owned a tiny, yet popular Russian bakery, tucked quietly on the corner of Brighton 11th Avenue. Unlike more recent émigrés, Kutopov is proud to be living in Brighton.

“This is my home, not Russia,” says Kutopov proudly. “I don’t care who is moving to the area. We are all people. I welcome every person to my restaurant, not just Russians and former Soviets.”

But, not all former Soviet émigrés share Kutopov’s fondness for Brighton. Just a few blocks south of Kutopov’s bakery, Albert Ivanov and his wife, Mila, live in what is considered to be a posh residential area of Brighton. The two fled Riga, Latvia in 1979. Thirty years later, the couple still feels leery of associating themselves with the Brighton community.

“I am not your typical immigrant who comes to Brighton Beach from Russia,” says Ivanov. “I don’t know what welfare or Medicare is, thank God. I also didn’t come here illegally. I came here to work.”

The often-grim portrayal of Brighton Beach as a classless, low-income neighborhood developed in the late 1990s when an influx of families moved to Brighton Beach with little or no money. It’s that image that leads newcomers from the former Soviet Union to overlook Brighton as a place to settle.

“If I come back, I will only visit, that is it,” says Glubskaya in broken English. “This place is not Russia. Just pretend.”

However, one Pentecostal pastor and a small group dedicated to his cause, hope to accomplish what city developers have failed to do – save the South Bronx.

Jenn Carmona has their story.

Music: “Awesome God” – Church of the Revelation Choir

On the list of advisable tourist activities in New York City, touching mysterious substances on the sides of subway cars ranks pretty low.  Nevertheless, Montana native Marina Dimitrov prods gingerly at a shapeless white lump with her left index finger.  “Something that looks like marshmallow,” she decides; now she just has to figure out how to clean it off.

Thirteen-year-old Marina is one of 10 middle-schoolers from across the country invited to Manhattan to participate in the Young Scientist Challenge, a competition held this morning at the Metropolitan Pavilion.  The Challenge consists of a series of tests in which students put scientific methods and theories to practical use.  In this round, Marina and the other finalists were finding the best way to remove a variety of stains from a subway car without damaging the metal underneath.

The competition is co-sponsored by Discovery Education and 3M, the chemical company that has provided the cleaning supplies the students are using.  To get here, contestants submitted a one- to two-minute video relating a science concept to everyday life; one used aluminum foil to improve a wood stove’s ability to heat a room.  Another crafted a homemade soundproofing panel out of paper bowls and newsprint.  There’s more than pride at stake for the competitors—the winner gets $50,000 worth of savings bonds.

Each finalist gets their own “lab” for the day—which is actually more of a stall, containing a work table and all the supplies to be used in a given round.   Green-shirted judges roam the space, making notes on how well each student is performing his or her tasks.   Blue-shirted coaches offer help with everything from the technical–“What’s the difference between regular alcohol and denatured alcohol?” asked one contestant–to the mundane–providing a second pair of hands to help separate a pile of beads into one dish of blue beads and one of white.  Both the judges and the coaches are 3M scientists.

While the adults (scientists and administrators alike) marvel at the kids’ scientific acumen, the finalists themselves are just as interested in each other as in their experiments.  During a lunch break, Utah seventh-grader Emily Grover says that the biggest surprise of the trip was how quickly everyone made friends since arriving in New York yesterday.  Marina seconds that sentiment; the finalists are friends “even though we’re supposed to be ‘enemies,’” she says, curling her fingers into quotation marks.

The students face four challenges over the course of the day.  In one they must purify water to remove a series of contaminants, and also separate nearly-microscopic diamonds from a mixture of dirt and rocks—all in just 60 minutes. Nico Seamons, a ninth-grader from New Mexico, peers into a stereo microscope that lets him examine particles in three dimensions.  He’s trying to determine how many different components the mixture has; he’ll get extra points for every one he can isolate.  He finds one crystal with a yellow tint, and learns from a coach that this is one of the industrial diamonds he’s searching for.

With less than ten minutes remaining in the round, Nico is trying to use a stack of sieves of different mesh sizes to sift out additional components from his diamond mixture.  He furrows his brow and bites his lip as he shakes the stack.  With the hand he isn’t using to cross his fingers, he lifts the top sieve.  “Ye-es, that’s what I’m talking about!”

More information about the competition and the name of this year’s winner can be found here.

Broadway Goes Green from nycinfocus.org on Vimeo.

Janelle Richards and Angelica Spanos/ NYCInFocus

Angelica Spanos /NYCinFocus

When early ancient Egyptians put fruitcakes in coffins for their loved ones and Roman fighters carted them along to battle, they probably didn’t think that tens of thousands of years later such a humble food would be so misunderstood.

Notorious for lasting (almost) forever, the traditional fruitcake just can’t seem to get any respect around December, until now.

In early December PayPal launched a holiday campaign that allows users to raise money for one of 25 charities by baking a virtual fruitcake on www.regiftthefruitcake.com.  Participants select a charity, pick a fruitcake, and solicit donations through Facebook Connect.  Participants can even set fundraising goals and pick a dare they’ll fulfill if their donation goal is reached.  Some options, “I will give a stranger a $100 bill” or “I will eat a whole fruitcake in one sitting.”

Call it the redemption of the fruitcake.  “We’re going to put its unpopularity to good use this season,” PayPal’s tagline on their website.

PayPal will award the charity that raises the most money with $20,000. The runner-up will receive $10,000, and the third place will get $5,000.  So far, more than $10,000 has been raised and the leading charity is for Operation Smile with 2,110 re-gifts.

Even if you are not cutting into a dense fruitcake this holiday season, at the least maybe you can make one to “send to all.”

For the few, or many that do like a fruitcake during the holidays, try my family’s recipe.

Merry Cherry Fruitcake
1 1/2 cups sifted flour
1 1/2 cups sugar
1 teaspoon baking powder
1 teaspoon salt
14 1/2 ounces pitted dates
1 pound diced canned pineapple
2 jars (16 ounces each) drained, pitted maraschino cherries
5 1/2 cups pecan halves
6 eggs
1/3 cup dark rum
1/2 cup light corn syrup

DIRECTIONS: Preheat oven to 300 degrees. Grease two 9 x 5 x 3 inch loaf pans, line with foil (allow a two-inch overhang); grease foil. Sift flour, sugar, baking powder and salt in a VERY large mixing bowl. Add fruit and pecans; toss to coat well. In a separate bowl, beat eggs and rum well; pour over fruit mixture. Mix until combined. Pour into prepared loaf pans. Press frequently with spoon to pack tightly. Bake at 300 degrees 1 hour and 45 minutes or until cake tests done. Remove from oven and cool in pan 15 minutes. Remove cakes from pans, tear off all the foil and brush loaves with corn syrup while they are still warm. Cool thoroughly before wrapping or storing.

To store: sprinkle cakes thoroughly with rum, wrap them in rum-soaked cheesecloth. Then wrap in foil or plastic wrap or store in a tightly covered tin. Age 2-4 weeks unwrapping and remoistening cakes every 2 weeks.

Leonard Schoenberger /NYCinFocus

Mar Cabra/NYCinFocus

In Motion For A Million from nycinfocus.org on Vimeo.

For more information on the cause please visit www.InMotionForAMillion.org
Angelica Spanos and Leonard Schoeoberger/ NYCinFocus