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Hidden Heart Disease Is The Top Health Threat For U.S. Women

NPR Health Blog - 6 hours 34 min ago
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May 30, 20165:12 AM ET Heard on Morning Edition

Tracy Solomon Clark didn't realize that the shortness of breath and dizziness she felt at age 44 was actually serious heart disease.

Benjamin Brian Morris for NPR

Tracy Solomon Clark is outgoing and energetic — a former fundraiser for big companies and big causes. As she charged through her 40s she had "no clue," she says, that there might be a problem with her heart.

It was about six years ago — when she was 44 — that she first suffered severe shortness of breath, along with dizziness. She figured she was overweight and overworked, but never considered heart disease.

"That was the furthest thing from my mind," Solomon Clark says. "I was young!"

But it was her heart. Her doctor sent her to the hospital emergency room, where physicians diagnosed a blockage in a key artery. They inserted a stent to open it up and ease blood flow to her heart.

Ultimately Solomon Clark, who lives in Gardena, Calif., got several more stents to treat what turned out to be serious cardiovascular disease. Last year she had double-bypass surgery to replace the left main artery of her heart.

She's not alone, according to Dr. Noel Bairey Merz, who directs the Barbra Streisand Women's Heart Center at Cedars-Sinai Medical Center in Los Angeles, says she's not surprised by Solomon Clark's experience. Bairey Merz often meets young and middle-aged women who have no idea they are at risk for heart disease and a heart attack.

She and colleagues recently surveyed 1,011 women ages 25 to 60, a random sampling from across the U.S. Only about half of those interviewed knew that heart disease is the leading threat to women's lives, the scientists found. Many thought breast cancer poses a bigger risk. They were wrong.

Every year in the U.S. about 40,000 women die from breast cancer, according to statistics from the Centers for Disease Control and Prevention. Meanwhile, roughly 10 times that number die from heart disease.

Greater awareness and advances in detection and treatment have dramatically decreased breast cancer deaths over the past few decades, Bairey Merz explains. But heart disease now claims the life of 1 in every 4 women.

Many women with heart disease could benefit from effective treatment, including aspirin, statins, beta blockers and the like, says Dr. Laxmi Mehta, a cardiologist at the Ohio State Wexler Medical Center. But they can be helped only if they are diagnosed.

After the stent was placed, Solomon Clark continued to have periodic bouts of dizziness, shortness of breath and even a little pain. The symptoms were eventually traced back to continuing heart trouble.

But not right away. When she returned to an ER to have the symptoms checked out, tests suggested no new blockages, and the emergency room doctors told her she might just be suffering an anxiety attack.

Last year Solomon Clark had double-bypass surgery to replace the left main artery of her heart.

Benjamin Brian Morris for NPR

Mehta chaired a committee of the American Heart Association that this year released the organization's first scientific statement on the problem of heart attacks among women.

Even after a heart attack, Mehta says, women are less likely than men to be referred to cardiac rehabilitation programs, though these programs significantly reduce the chances of a second heart attack.

Part of the reason women are misdiagnosed or not diagnosed at all is because heart disease looks a lot different in women than it does in men, she says. And men have been the focus of most heart disease research.

For example, men are more prone to blockages in major arteries — these are relatively easy to spot on an angiogram, and are more likely to prompt timely diagnosis, Mehta says.

Women, on the other hand, are more likely to have problems with tiny arteries embedded in the heart, she says. These smaller blood vessels often are not visible on angiograms, and also don't fill up with plaque.

"They don't have enough of a wall to build up plaque," says Bairy Merz. "That's how tiny they are." But these small arteries can lose flexibility and run into problems — constricting too much and cutting off blood flow to the heart.

In her survey, Bairey Merz found that 74 percent of the women had at least one heart disease risk factor, such as high blood pressure, high cholesterol, diabetes, irregular menstrual periods, early menopause or a family history of heart disease. Yet only 16 percent reported having been told by a doctor that they had an elevated risk.

Instead, Bairey Merz says, the doctors, who also were surveyed by the researchers, were more concerned about their patients' weight and breast health than heart disease.

All primary care doctors should routinely assess a woman's risk for heart disease, Mehta says. And if they don't, women should take the lead and bring up the subject of heart disease and their individual risk. (You can start by using this online risk calculator.)

Pay attention to your body, Mehta tells her patients. "If something seems out of the ordinary, it's best to seek medical attention, especially if something is occurring only with exertion — or worsening with exertion.

"I'd rather be wrong and go to the ER," Mehta says, "than die at home."

Copyright 2016 NPR. To see more, visit NPR.
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Death Talk Is Cool At This Festival

NPR Health Blog - Sun, 05/29/2016 - 6:13am
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May 29, 20166:13 AM ET Heard on Weekend Edition Sunday


A chalkboard "bucket list" stirred imaginations and got people talking at an Indianapolis festival designed to help make conversations about death easier.

Jake Harper/WFYI

In a sunny patch of grass in the middle of Indianapolis' Crown Hill Cemetery, 45 people recently gathered around a large blackboard. The words "Before I Die, I Want To ..." were stenciled on the board in bold white letters.

Sixty-two-year-old Tom Davis led us through the thousands of gravestones scattered across the cemetery. He'd been thinking about his life and death a lot in the previous few weeks, he told us. On March 22, he'd had a heart attack.

Davis said he originally planned to jot, "I want to believe people care about me." But after his heart attack, he found he had something new to write: "I want to see my grandkids grow up."

Others at the event grabbed a piece of chalk to write down their dreams, too, including some whimsical ones: Hold a sloth. Visit an active volcano. Finally see Star Wars.

The cemetery tour was part of the city's Before I Die Festival, held in mid-April — the first festival of its kind in the U.S. The original one was held in Cardiff, Wales, in 2013, and the idea has since spread to the U.K., and now to Indianapolis.

The purpose of each gathering is to get people thinking ahead — about topics like what they want to accomplish in their remaining days, end-of-life care, funeral arrangements, wills, organ donation, good deaths and bad — and to spark conversations.

"This is an opportunity to begin to change the culture, to make it possible for people to think about and talk about death so it's not a mystery," said the festival's organizer Lucia Wocial, a nurse ethicist at the Fairbanks Center for Medical Ethics in Indianapolis.

The festival included films, book discussions and death-related art. One exhibit at the Kurt Vonnegut Memorial Library had on display 61 pairs of boots, representing the fallen soldiers from Indiana who died at age 21 or younger.

These festivals grew out of a larger movement that includes Death Cafes, salon-like discussions of death that are held in dozens of cities around the country, and Before I Die walls — chalked lists of aspirational reflections that have now gone up in more than 1,000 neighborhoods around the world.

"Death has changed," Wocial said. "Years ago people just died. Now death, in many cases, is an orchestrated event."

Medicine has brought new ways to extend life, she says, forcing patients and families to make a lot of end-of-life decisions about things people may not have thought of in advance.

"You're probably not just going to drop dead one day," she said. "You or a family member will be faced with a decision: 'I could have that surgery or this treatment.' Who knew dying was so complicated?"

With that in mind, the festival organizers held a workshop on advance care planning, including how to write an advance directive, the document that tells physicians and hospitals what interventions, if any, you want them to make on your behalf if you're terminally ill and can't communicate your wishes. The document might also list a family member or friend you've designated to make decisions for you if you become incapacitated.

"If you have thought about it when you're not in the midst of a crisis, the crisis will be better," Wocial said. "Guaranteed."

About a quarter of Medicare spending in the U.S. goes to end-of-life care. Bills that insurance doesn't cover are usually left to the patients and their families to pay.

Jason Eberl, a medical ethicist from Marian University who spoke at the festival, said advance directives can address these financial issues, too. "People themselves, in their advance directive will say, 'Look, I don't want to drain my kids college savings or my wife's retirement account, to go through one round of chemo when there's only a 15 percent chance of remission. I'm not going to do that to them.' "

The festival also included tour of a cremation facility in downtown Indianapolis. There are a lot of options for disposing of human ashes, it turns out. You can place them in a biodegradable urn, for example, have them blown into glass — even, for a price, turn them into a diamond.

"It's not inexpensive," Eddie Beagles, vice president of Flanner and Buchanan, a chain of funeral homes in the Indianapolis area, told our tour group. "The last time I looked into it for a family, "it was about $10,000."

A crematorium tour was part of the festival, too. Metal balls, pins, sockets and screws survive the fire of cremation.

Jake Harper/WFYI

"Really, when it comes to cremation, there's always somebody coming up with a million dollar idea," Beagles added. "If you can think of it, they can do it."

Beagles showed us a pile of detritus from cremated human remains. He picked up a hip replacement — a hollow metal ball — then dropped it back into the ashes.

I'm a health reporter, so I know a fair amount about the things that could kill me, or are already killing me. But watching this piece of metal that used to be inside a human be tossed back onto the heap gave me pause. I'm thinking about what I might write on a "Before I Die" wall. I still don't know — there are many things to do before I go. But I'm thinking about it a lot harder now.

This story is part of NPR's reporting partnership with Side Effects Public Media and Kaiser Health News.

Copyright 2016 WFYI-FM. To see more, visit WFYI-FM.
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Could Thinking Positively About Aging Be The Secret Of Health?

NPR Health Blog - Sat, 05/28/2016 - 7:27am
Could Thinking Positively About Aging Be The Secret Of Health? Listen· 4:28 4:28
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May 28, 20167:27 AM ET Heard on Weekend Edition Saturday Daniel Haskett/Ikon Images/Getty Images

The dictionary defines ageism as the "tendency to regard older persons as debilitated, unworthy of attention, or unsuitable for employment." But research indicates that ageism may not just be ill-informed or hurtful. It may also be a matter of life and death.

Not that it's literally killing people. Researcher Becca Levy, a professor of epidemiology and psychology at the Yale School of Public Health, says it depends on how much a given individual takes those negative ideas to heart.

In one study, Levy looked at people's attitudes about aging when they were in late middle age and then followed them over time. Some of these people thought of older people as weak or dependent. Others thought of them as experienced or wise. What she found was that the people who had a positive view of aging lived about 7 and half years longer than the people who saw aging in a negative light.

Now that doesn't mean that if you think positive thoughts about aging, it's OK to sit on the couch in front of the TV and eat a pound of bacon.

But according to Levy's other studies, this mind/body connection counts for a lot. For example, one showed that middle-aged people who had no cognitive impairment but did have negative views of aging were more likely to later develop the brain changes associated with Alzheimer's disease. And the more negative their views, the worse those brain changes were. On the other hand, another study found that people with positive views of older adults were much more likely to recover from major health setbacks.

A living, breathing example of how an older person can thrive if they're not weighed down by negative stereotypes is 95-year-old Jim Shute of Medford, Ore. (He's the father of SHOTS editor Nancy Shute, who's written about him here.)

His typical day? Up at 6:30 or 7, go out to get The Wall Street Journal or the local paper, read the papers over breakfast, check his rose beds and the irrigation system in the garden, trim the bushes. He also likes to fish, plays bridge once a week, hikes nearly every day, refinishes furniture and hunts for morel mushrooms in season.

Jim Shute at age 94, out for his morning walk.

Nancy Shute/NPR

Maybe it's not necessary to do all of those things, but having something that gives one's life a sense of purpose can pay amazing health dividends, according to researcher Patricia Boyle, a neuropsychologist and behavioral scientist at Rush Alzheimer's Disease Center in Chicago.

Purpose, says Boyle, doesn't have to be something complicated and lofty, just something that's goal oriented and gives you a sense of accomplishment.

"People who have the sense that their life is meaningful are much less likely to suffer early mortality, they're less like to develop disability, that is, trouble taking care of themselves," says Boyle.

What's more, "they're less likely to suffer strokes. They're also substantially less likely to develop Alzheimer's disease, and they have much less cognitive decline."

Boyle says having a purpose in life is a robust predictor of how well someone will live and thrive as they age.

It's not something a doctor can prescribe as easily as a change in diet. But whether it's doctor's orders or society at large, attitudes do change. And Levy's and Boyles' research suggests that if people don't assume that they'll be useless when they're older, the payoff could be huge.


Copyright 2016 NPR. To see more, visit NPR.
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Long-Acting Opioid Treatment Could Be Available In A Month

NPR Health Blog - Fri, 05/27/2016 - 5:00pm
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May 27, 20165:00 PM ET Heard on All Things Considered


The Probuphine implant delivers medication for six months. It helps reduce cravings for people with opioid use disorder.

Courtesy of Braeburn Pharmaceuticals

Labels for the first long-acting opioid addiction treatment device are rolling off printing machines Friday. Trainings begin Saturday for doctors who want to learn to insert four matchstick-size rods under the skin. They contain the drug buprenorphine, which staves off opioid cravings.

The implant, called Probuphine, was approved by the Food and Drug Administration on Thursday, and is expected to be available to patients by the end of June.

"This is just the starting point for us to continue to fight for the cause of patients with opioid addiction," said Behshad Sheldon, CEO of Braeburn Pharmaceuticals, which manufactures Probuphine.

But debate continues about how effective the implant will be and whether insurers will cover it.

Nora Volkow, head of the National Institute on Drug Abuse, calls Probuphine a game changer, saying it will help addiction patients stay on their meds while their brain circuits recover from the ravages of drug use.

And addiction experts say it will be much harder for patients prescribed the implant to sell their medication on the street, which can be a problem with addiction patients prescribed pills.

"I think it's fantastic news," said Dr. Sarah Wakeman, medical director of the Substance Use Disorder Initiative at Massachusetts General Hospital. "We need as many tools in the toolbox as possible to deal with the opioid epidemic."

Still, Wakeman is concerned that the implant only delivers one dose of 8mg of buprenorphine daily. She prescribes between 4 and 24mg, depending on how much a patient needs to fight opioid cravings.

"This is wonderful tool for someone who doesn't want to take a daily medication" or someone who can't manage doing so, Wakeman said. "If you need to add daily medication on top of Probuphine, you lose the added benefit that would come without needing that daily pill."

Sheldon says Braeburn is testing weekly and monthly injections of buprenorphine that would be available in many doses.

Wakeman plans to sign up for a four-hour Probuphine training session, which includes a lecture, a demonstration and practice inserting the implant. The company does not know yet if it will be safe to insert implants repeatedly into the same spot in the upper arm. A study is underway.

In the meantime, some doctors say they will hold off on using the implant. Dr. Indra Cidami, who treats addiction patients in New Jersey, says she's worried patients will assume it's enough, that they don't need the check-ups or the counseling that are part of most recovery programs.

"Probuphine is set up for failure in that way," said Cidami, "because the patient will be seen after six months and in the meantime, they're not going to be following up with therapy. And that means it's not going to be medication assisted therapy — it is medication maintenance only."

Braeburn Pharmaceuticals and the FDA say they expect patients to be in counseling while prescribed the implant.

In Massachusetts, the state's largest health insurer says it will cover the device, which will cost $4,950, or about $825 a month. But some other insurers say they aren't sure yet if the implant is worth the price compared to pills, which cost $130 to $190 a month.

Braeburn CEO Sheldon says that Probuphine will be cheaper than Vivitrol, a form of naltrexone that is injected once a month and costs about $1,000 a month.

"Certainly the drug holds great promise for individuals struggling with opioid addiction. However, there's still a lot we don't know about its effectiveness," said Eric Linzer, senior vice president for the Massachusetts Association of Health plans.

Braeburn says it may refund money to insurers if the Probuphine implant doesn't work to keep patients from relapsing and offer rebates for patients who have to buy it on their own.

Copyright 2016 WBUR. To see more, visit WBUR.
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Ship That Breast Milk For You? Companies Add Parent-Friendly Perks

NPR Health Blog - Fri, 05/27/2016 - 4:54pm
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May 27, 20164:54 PM ET Heard on All Things Considered Gary Waters/Ikon Images/Getty Images

A handful of companies are offering parental benefits that go way beyond just paid leave, to include things like surrogacy reimbursement, egg freezing or breast milk shipping for traveling mothers.

As competition for talent heats up, companies see it as a relatively cheap way to recruit, retain and motivate their employee base.

This month, Johnson & Johnson extended fertility treatment benefits to same-sex couples and increased coverage to $35,000 for full- and part-time U.S. employees. It upped reimbursements for surrogacy and adoption to $20,000 — and it also ships breast milk.

"We wanted to be a leader in this space," says Peter Fasolo, Johnson & Johnson chief human resources officer. Taking care of employees in this way costs far less than, say, health insurance, in part because the benefits are used by a minority of workers, and generally on a one-time or short-term basis. "They're really not that expensive, to be frank with you."

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It may not be a lot of money for the company, but it can be for an individual employee.

Bruce Elliott, manager of benefits for the Society for Human Resource Management, says the amount Johnson & Johnson offers is unusually high. "We don't see a lot of that. You know, we will see adoption support typically capped at about $5,000," he says.

Elliott says rich benefits are more common in tech and finance. Ernst & Young has offered breast milk shipping for years, and last year, IBM, Accenture and Twitter added it. Apple and Facebook started covering egg freezing two years ago.

Clif Bar, the energy food company, instituted a breast milk shipping benefit recently that has made a huge difference for Marin Vaughn, a customer manager. Instead of schlepping pumped milk home in suitcases packed with ice when she came home from work travel, she now just requests supplies that allow her to refrigerate and ship the milk back home.

"So it just goes FedEx overnight; it's super easy. I wish it had been around earlier," when she had her first child three years ago, she says.

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But the companies bolstering their family friendly benefits are largely ones where talent is in short supply. Outside of those rarefied places, it's still uncommon.

According to SHRM, fewer than a third of employers, 27 percent, cover in vitro fertilization treatment. Adoption and surrogacy benefits are rarer still, and usually take the form of paid leave, not reimbursement. Seventeen percent offer adoption leave; 5 percent offer paid leave for parents having a child through a surrogate, SHRM says.

Ellen Bravo, executive director of advocacy group Family Values@Work, says 60 percent of women work in places without lactation rooms.

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"For them it means squeezing into a bathroom stall, the most unsanitary place to pump milk," Bravo says. And some employers won't even allow pumping in bathrooms. She cites a discrimination suit filed with the Equal Employment Opportunity Commission this month by four female Frontier Airlines pilots alleging, in part, insufficient support for breast-feeding moms.

A Frontier Airlines spokesman says accommodations are made where possible, but allowing pilots to pump in flight could disrupt service, embarrass crew members or pose a security risk.

Though there are exceptions, most employment experts say there's a big generational and cultural shift toward parent-friendly policies.

Kate Torgersen founded Milk Stork, a company that handles the logistics of breast milk shipping, and says she thinks young parents are demanding more of employers.

"They're ambitious about their parenting," she says. "They know about the value of breast-feeding, they're incredibly informed and they're vocal about what their needs are."

Milk Stork launched less than a year ago. Since then, Torgersen says, the company has signed on a dozen corporate clients and is talking to many more.

Copyright 2016 NPR. To see more, visit NPR.
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Is Virginia Health Insurer's Decision To Drop Bronze Plans An Omen?

NPR Health Blog - Fri, 05/27/2016 - 10:57am

A subsidiary of CareFirst BlueCross BlueShield in Virginia won't offer an insurance plan on the lowest tier of the marketplace next year.

Morgan McCloy/NPR

News that a subsidiary of CareFirst BlueCross BlueShield will stop selling bronze-level health plans on the Virginia marketplace next year prompted speculation that it could signal a movement by insurers to drop that coverage level altogether.

The reality may be more complicated and interesting, some analysts said, based on a look at plan data.

Bronze plans provide the least generous coverage of the four metal tiers offered on the insurance marketplaces, paying 60 percent of benefits on average, compared with 70 percent for silver plans, which are far more popular.

During the 2016 open enrollment period, 23 percent of marketplace customers signed up for a bronze plan, compared with 68 percent who chose silver, 6 percent who picked gold and 2 percent who chose a platinum plan.

Next year, the CareFirst BCBS subsidiary Group Hospitalization and Medical Services will no longer offer bronze plans on the Virginia marketplace, and bronze plan members will be moved into silver plans, said a spokesperson for the insurer. The company will continue to offer bronze plans on other exchanges, however.

The decision spurred some health policy analysts and health law critics to question whether other insurers would follow suit. Part of that reasoning had to do with the health law's risk adjustment provisions. In the program, individual and small group insurers that enroll sicker, generally costlier members receive payments from insurers that enroll healthier, less costly members. Since bronze plans may attract healthier people, insurers may stop selling them to avoid risk adjustment program payments, some argue.

Between 2015 and 2016, the number of bronze plans offered on the marketplaces increased less than 1 percent, while the number of silver plans grew by 2.9 percent, according to data from the Robert Wood Johnson Foundation.

It's too soon to say whether CareFirst's shift signals a trend in insurers pulling back from the bronze metal tier, said Katherine Hempstead, who leads RWJF's work on health insurance coverage. But even if that happens, it's unclear that the effect on consumers would be negative.

Bronze and silver plans may become more similar as time passes, Hempstead said.

Insurers have some wiggle room in designing plans. Although bronze plans must pay 60 percent of costs on average, they can range from 58 to 62 percent. Likewise, every silver plan doesn't have to pay exactly 70 percent of costs on average; a plan can pay from 68 to 72 percent. Issuers can design plans that pay at the low or high end of these ranges and still meet the criteria for a bronze or silver plan.

An analysis of the premiums for bronze and silver plans in census regions across the country reveals that average prices for the two types of plans moved toward each other slightly between 2015 and 2016, Hempstead said. In addition, looking across all regions the highest-priced bronze plan was significantly more expensive than the cheapest silver plan in each region in 2016.

A recent analysis by the actuarial firm Milliman found that while people who purchased silver plans tended to get those with lower premiums, those turning to bronze plans chose the more expensive options. "Many issuers found it difficult to develop [bronze] plans that were palatable to consumers and in the bottom portion of the metallic level range," the report concluded.

"It's interesting if the industry standardizes itself," Hempstead said, "and what if the most common plan becomes a sort of bronzy silver?"

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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Germ Resistant To Antibiotic Of Last Resort Appears In U.S.

NPR Health Blog - Thu, 05/26/2016 - 5:53pm

A Pennsylvania woman developed a urinary tract infection cased by Escherichia coli bacteria that were found to be resistant to colistin, an antibiotic that is seen as the last line of defense.

Nature's Geometry/Science Source

A germ that can't be treated with an antibiotic that is often used as the last resort has shown up for the first time in the United States.

Government scientists say the case is cause for serious concern but doesn't pose any immediate public health threat.

The germ was discovered in a 49-year-old woman in Pennsylvania with a urinary tract infection. The infection was caused by E. coli bacteria that had a gene that made them resistant to an antibiotic known as colistin.

The findings were published online Thursday in Antimicrobial Agents and Chemotherapy.

Colistin, a medicine that dates to the 1950s, is now used on infections that have become resistant to every other antibiotic. In this case, the woman's infection could still be treated with another antibiotic. She recovered.

But the case is still causing concern among public health officials. Now that this resistance gene has shown up in the U.S., it could spread to other germs, creating infections that doctors will have no way to treat.

That's already happened in other parts of the world, including China.

Copyright 2016 NPR. To see more, visit NPR.
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To Kill Mosquitoes That Spread Zika, Strike Before They Fly

NPR Health Blog - Thu, 05/26/2016 - 3:10pm
To Kill Mosquitoes That Spread Zika, Strike Before They Fly Listen· 4:10 4:10
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May 26, 20163:10 PM ET Heard on All Things Considered

Maureen LoCascio, with the mosquito control team in Hudson County, N.J., uses a backpack sprayer to spread insecticide against mosquito larvae.

Hansi Lo Wang/NPR

In the marshy woods of Secaucus, N.J., a mosquito can make a happy home.

With water and shade under a canopy of maple trees, you could barely ask for more to start your own bloodsucking family.

For Gary Cardini, though, this is a battleground.

"You want to get them in the water before they're flying," explains Cardini, who supervises the field team for Hudson County Mosquito Control. "In the water, they're captive. You know where they are."

Mike Iverson, an inspector for Hudson County Mosquito Control, looks for mosquito larvae in a water sample from a marsh in Secaucus, N.J.

Hansi Lo Wang/NPR

Every spring, his team of inspectors checks for mosquito larvae in pools of water and then spreads larvicide that kills the larvae after they eat it.

"You need a very small amount to effect a very large decimation of the population," says one of Cardini's inspectors, Maureen LoCascio.

Killing bloodsuckers is also a priority across the Hudson River in New York City, as the health department there prepares for the possible spread of the Zika virus during mosquito season.

States like New York and New Jersey have used pesticides for years to deal with the West Nile virus. But now they're facing Zika — a virus carried by a different kind of mosquito. That's forcing public health officials to rethink how to reduce mosquito populations.

"One of the most important strategies is to never fall behind when trying to control the Aedes mosquitoes," says Jay Varma, New York City's deputy commissioner for disease control.

He cautions that the chances of the Aedes mosquitoes spreading Zika around New York are low. Still, the health department is doubling the number of pesticide treatments for larvae in wetlands this year from three to six times.

But it may not do much to prevent Zika.

Aedes mosquitoes are more likely to grow in "pet food dishes, children's toys, tarps in people's backyards, clogged gutters, boats, rain buckets," according to Greg Williams, superintendent of mosquito control for Hudson County, N.J., where the Aedes mosquito has not been a main target until this year.

"Luckily, it doesn't fly very far," Williams says. "If you and your neighbors can keep your yards free of standing water, then you probably wouldn't need any pesticides to get rid of that mosquito."

That's why he's advising people to "dump and drain" through a public education campaign — while keeping pesticides as an option.

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"Sometimes the mosquitoes are still just there for one reason or another, so the spraying is just a little extra added insurance," he says.

But Laura Harrington, an entomologist at Cornell University who specializes in Aedes mosquitoes, says that may be a waste of money and time. She gets frustrated whenever she hears about aerial spraying of pesticides over wetlands or large bodies of water to try to stop Zika.

"We know a lot about the biology of these mosquitoes, and we know that they do not breed in those types of habitats," she says.

All the Aedes mosquitoes need is a container of water that can be as small as a bottle cap, which makes it difficult for mosquito control teams to find and treat their breeding sites.

While there's a relatively low risk of Zika spreading in the U.S., Harrington says she does support using pesticides in infected areas if there is an outbreak.

Studies have shown that pesticides can lower the number of mosquitoes that can spread the West Nile virus. A study published in 2008 found that in Sacramento, Calif., pesticides reduced the mosquito population by as much as 75 percent, thus lowering the risk of human infection.

William Reisen, who co-authored the study, also warns that there's a critical difference between the mosquitoes carrying West Nile and the ones that can carry Zika.

"The problem with the Aedes mosquitoes is that these are mostly day-active mosquitoes," says Reisen, a retired entomologist from the University of California, Davis. These mosquitoes aren't necessarily flying around when the insecticide is sprayed, usually at dusk or nighttime.

It's another complication as cities watch out for Zika and adjust their mosquito strategies.

Copyright 2016 NPR. To see more, visit NPR.
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Women Who Have To Delay Pumping Risk Painful Breast Engorgement

NPR Health Blog - Thu, 05/26/2016 - 1:53pm
Maria Fabrizio for NPR

When we covered the story about four Frontier Airlines pilots who said their employer did not provide adequate accommodations for pumping breast milk, more than a few readers seemed to feel like the women just wanted an extra work break. "Bathroom breaks are necessary to ensure the pilot can still perform," a commenter said. "Breast pumping is not."

Au contraire, say women, lactation consultants and health care providers. The painful swelling of engorgement can lead to medical problems and reduce milk supply. And it can make it extremely hard to focus on the job. But many people don't know about it; even new mothers.

"When I had my first and started breast-feeding, I was completely unprepared for any of it. I knew nothing, not even what was normal," says Alissa Parker, now an international board certified lactation consultant in Ashland, Ky. She had her child after earning a master's in nursing as a pediatric nurse practitioner and working in primary care pediatrics for five years. "Breast-feeding education for health care providers is that weak."

She figures that most healthy breast-feeding women have experienced engorgement at least once outside of the immediate postpartum period. That could be because they were unable to pump at work, felt uncomfortable about breast-feeding in public or miscalculated the time they would be separated from their baby or a pump.

Engorgement immediately becomes stressful because it's like a "ticking time bomb," Parker says. "The main thought in your head is, 'How can I get this to stop; when can I pump or feed my baby?' "

And if a woman can't pump, breasts swell and become firm and painful. For Parker, engorgement felt like having two hot, sweaty bowling balls strapped to her chest. That's not unlike my description: like two boulders had been grafted to my chest tissue and magically hooked up to my nerves so that they radiated pain from the inside out. One light touch elicited a scream of pain — definitely more distracting than needing to pee.

"It felt like a toothache that was so bad I would have been headed for a root canal — with a second-degree sunburn to boot," Stephanie Palmieri of Fremont, Calif., told me on social media. And Meribeth Densmore in Santa Fe, N.M., said it was "like my boobs were about to explode."

The pain is often coupled with heat, leading some women to compare it to an actual burn.

"The pain is hard to describe. [My breasts] were sensitive to touch, like sunburn is, and a fairly permanent kind of burning ache set up on my chest, waxing and waning as they filled and emptied," said Madeleine Ware of Wellington, New Zealand. "I wouldn't want my pilot distracted by a burning feeling in her breasts, or hesitant to lean over to perform certain actions because of the risk of pain."

Melina Kolb of Alexandria, Va., described it as "hard lumps that burn and hurt" when she lifted her arms.

"When you are engorged, that is the only thing on your mind," Kolb said. "I could not think about anything else except my breasts and the fear of developing mastitis."

Mastitis is a bacterial infection that can result from engorgement. If a woman can't pump, engorgement can lead to plugged ducts, mastitis and even abscesses, sometimes requiring hospitalization and intravenous antibiotics. One study found that approximately 1 in 10 breast-feeding mothers experienced mastitis in the first month of breast-feeding — and that was in Nepal where far fewer women had to navigate work schedules or similar barriers.

An earlier study in Australia found 27 percent of breast-feeding mothers developed mastitis. Severe mastitis can develop into sepsis — blood poisoning — and require intensive care. Abscesses can require surgery and extra time for wounds to heal. These medical costs can mount up for the woman and her employer if she has employer-provided health insurance, and reduce work productivity.

Even if women don't develop these problems, trying to pump while already engorged can cause nipple trauma and bruising. Further, as few as four consecutive days of inadequate pumping breaks can reduce a mother's milk supply, Parker says, but it takes much longer to bring supply back up — if it ever comes back up.

Breast-feeding or pumping reduces the pressure, but unlike the relief of emptying a bladder, breasts remain tender, bruised and sore even after engorgement has passed.

The only way to reduce the likelihood of engorgement is to breast-feed or pump regularly — which gets us back to the story about the four Frontier pilots. They weren't just seeking a bathroom break. They were trying to maintain milk supply while not risking a potentially serious medical complication.

[View the story "What Does Engorgement Feel Like? Breastfeeding Mothers Share..." on Storify] Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

It's Still Hard To Get Birth Control Pills In California Without A Prescription

NPR Health Blog - Thu, 05/26/2016 - 5:00am

Pharmacists in California will have to give women a short health consultation before providing contraceptives without a prescription.

Media for Medical/UIG via Getty Images

It has been more than 18 months since California's governor signed a law that allows pharmacists to distribute most types of hormonal birth control methods without a prescription.

That means that while women in the state still have to see a doctor to get an IUD, or a contraceptive implant, they should be able to simply walk into their local pharmacy and easily buy contraceptive pills, the patch or the vaginal ring — much like getting a flu shot, or buying over-the-counter medicine to fight a cold.

But good luck finding a pharmacy that will actually dispense birth control that way.

Calls to eight pharmacies around the San Francisco Bay Area — including large corporate locations and smaller, independent stores — yielded no pharmacies delivering these services. Most pharmacists said they still needed to undergo the state-mandated training and that their stores were in the process of figuring out what the service would look like.

There's confusion, too. One person told me that the law hadn't yet passed; another told me prescription-free birth control was only an option in Oregon, where a similar bill went into effect on Jan. 1.

Pharmacy giants Walgreens and Rite Aid both confirmed that they are not yet providing birth control pills or a contraceptive patch without a prescription.

Jim Graham, a spokesperson for Walgreens, which operates 629 pharmacies in California, said the company is "currently assessing" the law's requirements. "We plan to test the service in a small number of pharmacies," he said.

CVS said it is testing the service at a few select locations in the Los Angeles area to determine customer demand.

It's hard to pin down exactly how many — or how few — pharmacies have implemented the new law, because there is no database of pharmacists trained to distribute these birth control methods without a prescription.

Sally Rafie, a pharmacist and medication safety specialist for the University of California, San Diego Health System, specializes in birth control training and access. She estimated that of the approximately 7,000 pharmacies in California, fewer than 100 are actually distributing these types of nonprescription birth control to customers.

Rafie has been involved in training pharmacists to comply with the new law. Under a protocol developed by the state Board of Pharmacy, pharmacists first have to be trained to do a short consultation with the customer and help her select the appropriate birth control option, as well as identify potential red flags in terms of her underlying health, such as a history of blood clots or uncontrolled high blood pressure.

Online classes are also available for practicing pharmacists, and students in pharmacy programs in California now get this training as part of their graduate school curriculum.

At the California Pharmacists Association's annual meeting two weeks ago, 150 people took the birth control training workshop, according to Rafie. There are 29,000 registered pharmacists in the state.

Big players, like Rite Aid, Walgreens and CVS, have companywide processes that have to be standardized across all the stores, said Lisa Kroon, a professor at University of California, San Francisco's school of pharmacy, who has been involved in the implementation of the law.

"There are just a lot of hoops that a large corporation has to implement," she said.

Kroon spoke from experience. The Walgreens where she oversees pharmacy students on the UCSF campus has yet to implement the law.

Kroon said she is "really pushing" Walgreens to move the process along.

Stumbling blocks include: Who will answer incoming doctors' phone calls while the pharmacist provides the consultation, and where will the consultation happen? Rafie said that in the community pharmacy where she works in San Diego, a private consultation room has to be designed and remodeled.

All of this takes time. But there are other factors in play, pharmacists say.

Although the law finally went into effect on April 8, the state spent the previous 18 months developing regulations. Those were finalized earlier this year. Pharmacies had all that time to prepare to hit the ground running last month.

"I think that they're being cautious," said Virginia Herold, head of California's Board of Pharmacy. "They don't know what demand is going to be, and they're a little hesitant to ramp up."

Offering the new service is optional, according to the law, not mandatory, and there's no reason for pharmacies to opt in if there isn't an incentive for them to do so. And right now, there's actually a financial incentive for them not to comply.

"They have the authority to furnish birth control, but it didn't come with the requirement that they get paid for these services," said Kroon.

If you go to a gynecologist for a regular appointment or consultation, your insurance pays for the service (in addition to paying for the medication itself). But, right now, most insurance providers won't pay your pharmacist for the consultation. Customers either have to pay out of their own pocket, or the pharmacist has to work for free. In Oregon, in contrast, that state's Medicaid program reimburses a pharmacist $35 for the service. Kroon says there are efforts toward a similar law in California.

The bill to make these types of hormonal birth control available without a prescription was put forward by Sen. Ed Hernandez, a Democrat from West Covina, and sponsored by the California Pharmacists Association as part of a larger effort to put more primary care in the hands of pharmacists and other nonphysician providers.

"Pharmacists are accessible, and they're underutilized," said Herold.

Early on, some physicians' groups voiced concern that a woman who bypasses a visit to her doctor for birth control will also be less likely to get screened for cervical cancer or STDs.

Indeed, studies of U.S. residents living near the Texas border with Mexico found that women who obtained their birth control over the counter in Mexican pharmacies were somewhat less likely to go to the doctor for other preventive care, compared to women who got contraception at medical clinics. But women who had to go to a clinic were also more likely to stop using birth control, in part because of having to schedule a doctor's visit to get it.

The potential for controversy may be part of what has slowed some pharmacies from offering hormonal contraception to women directly. And, certainly, said Rafie, it requires a different marketing approach than flu vaccines or other services offered by pharmacists. Once it's clear that women want the service, though, she, Kroon and Herold all say they believe that pharmacies will get on board.

"By the end of the year, this will be very commonplace in California," Herold predicts.

This story was produced by KQED's State of Health blog.

Copyright 2016 KQED Public Media. To see more, visit KQED Public Media.
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For Female Fruit Flies, Mr. Right Has The Biggest Sperm

NPR Health Blog - Wed, 05/25/2016 - 1:04pm
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May 25, 20161:04 PM ET Heard on All Things Considered

Female Drosophila bifurca flies have an organ to store sperm (right) that male flies compete to fill, crowding out rivals.

Scott Pitnick/Nature

You can't help but notice that Scott Pitnick has a big tattoo. It's a sperm with a long tail that winds down his right arm.

People sometimes stare. "And when I tell them what it is, they either are very interested or they pivot on their heel and walk away," says Pitnick, an evolutionary biologist at Syracuse University. "All eye contact ceases."

Some people just don't like talking about sperm. But not him. He's spent his career trying to unravel the mystery of giant sperm.

The sperm are made by some fruit fly species, and they can be more than 2 inches long — or 20 times the length of the fly's body. The massive sperm get rolled up like a ball of yarn, and they're so costly to make that males produce very few of them.

"I mean, every decent scientist I know has this dogma-busting streak," says Pitnick. "And so you always have your eyes out for something that doesn't make any sense, that doesn't jive with prevailing theory."

And these bizarre sperm defied easy explanation. After all, males in most species typically produce tons of sperm. An adult man, for example, makes millions of new sperm each day. It's generally the females that produce relatively few eggs.

"So for me, discovering species where males have this very female-like reproductive strategy of producing very few high-investment gametes, or sperm, was a thrilling moment," says Pitnick.

The question was, why do the flies do this?

"Discovering species where males have this very female-like reproductive strategy of producing very few high-investment gametes, or sperm, was a thrilling moment," says Scott Pitnick.

Nathan Dappen

It's not unusual for males to try to impress females with big body parts. Consider antlers on deer, or elaborate tails on peacocks. Females check these out to decide who is good enough to mate with. "A crappy male in poor condition isn't able to afford to grow really huge antlers and carry them around on his head," Pitnick points out.

But the size of a fly's sperm isn't as obvious or flashy. Nonetheless, Pitnick and his colleagues have results from a study published Wednesday in the journal Nature comparing the evolution of long sperm in fruit flies, or Drosophila, with other male ornaments in the animal kingdom that are used to woo females — everything from deer antlers to stag beetle mandibles to lizard horns.

"Sperm length in Drosophila has been subject to incredibly strong sexual selection, more so than any other ornament that's ever been studied before," Pitnick says.

It turns out that as female flies flit around mating with different males, the females store the sperm inside a special organ before the eggs get fertilized, and the sperm jostle around in there.

"The advantage to having relatively long sperm is that they are better competitors for this limited storage space inside of the female reproductive tract," says Pitnick. Any increase in the size of the female's storage space seems to drive the evolution of longer sperm, and vice versa.

But that's not the only thing that's been working to make sperm longer and longer, he says.

"In the species with long sperm, males transfer very few sperm — a few to dozens of sperm per copulation," he says. "Females have to mate multiple times a day just to get an adequate supply of sperm."

Only the guys with the best genes can make enough long sperm to take advantage of all these mating opportunities. That's because making giant sperm isn't easy — it takes a lot out of the poor guys.

"As sperm get longer, the number of sperm males produce becomes more and more reliant on the health, the condition the male is in," says Pitnick.

That's a plus for females, who only want to make babies with the most hardy, manly flies.

"There's this whole world that we've barely scratched the surface of, of complex interactions between sperm and females," says Pitnick. "You have to understand that it's not just a simple game of numbers where males are competing through a lottery and the female reproductive tract doesn't matter. A lot of people, I think, still subscribe to the idea that females are passive vessels in which this competition plays out, and nothing can be further from the truth."

Biologist and sperm researcher Tim Karr, who is currently a visiting scholar at Kyoto Institute of Technology in Japan, says the new work is impressive and that these huge sperm have long been an enigma.

"The biology is so very different and there has been no good explanation or even attempt to explain it," says Karr. "I think it will spark an awful lot of conversation and hopefully additional research."

It's often the weird outliers that can reveal nature's secrets, says Karr, and this study shows how female choice and male competition can be linked together in surprisingly complex ways.

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

Asking Mom: 'Did You Know I Was Depressed In High School?'

NPR Health Blog - Wed, 05/25/2016 - 11:25am
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Louise Ma for Only Human/WNYC

Rose has dealt with depression since high school. She'd put her head down, focus on school and get through. But during her senior year of college, Rose couldn't even concentrate on school anymore.

"I was struggling. I was feeling depressed. I was feeling isolated," Rose, now 24, says. "I was crying at Cheerios commercials, which is not normal."

Rose started seeing a therapist and feels like she has everything under control. She's even on her way to becoming a therapist herself, in her third year of a Ph.D. program in clinical psychology. (We're using first names only in this story to protect her patient-therapist relationships.)

She has never told her parents anything about her own depression. She worried about disappointing them. She also worried that her mental health issues were frivolous compared with the struggles that her parents, who grew up in Pakistan and emigrated to the United States, have endured.

And she was particularly worried about what her mom would say.

"So I had moved out for college, and that's not really the norm for my cultural background," Rose says. "I was afraid that I was going to share this with her and the response would be: 'I told you it wasn't good for you to move out. You should have stayed home.' "

A few weeks ago, Rose decided to take a huge step. In talking about this story, she realized this could be a good opportunity to tell her mother for the very first time about her struggles with depression. She got her mother's permission to record the conversation:

Rose: I don't think I've ever asked you how do you feel about my decision to be a psychologist?

Mama: Mmmm.

Rose: (Laughs.) Complicated feelings.

Mama: Yeah.

One of the reasons Rose was interested in sitting down with her mom for this story was because she plans to do her thesis on this very kind of thing. In general, children have trouble talking to their parents about mental health issues. But in Rose's case, and for a lot of first-generation Americans, there's not just the generation gap — there's also a culture clash.

Rose: I know you've seen family that's depressed. You've seen the symptoms like being cranky, sleeping a lot, not eating much. Those kind of things. Did you ever notice any of that in me when I was living here or even now?

Mama: No.

Rose: You never noticed any of that?

Mama: I don't think you have any of this problem.

Rose: Well, it actually has been a problem for me.

Mama: I know, but I think this is no big problem.

Rose: OK. So, you've noticed those things but it's not a big problem.

Mama: Yeah.

After that, Rose goes on for a while, explaining to her mom that she sort of hid her depression and maybe that's why it didn't look like a big problem.

Mama: You have depression, I understand. You live alone and nobody talk to you. And I know this is depression.

Rose: But you know I don't think it's because I live alone. Because I felt this way in high school when I lived here. This isn't brand new.

Then Rose told her mother that she was worried that her mother would judge her.

Rose: I didn't want you to think that I'm weak or ... broken or anything like that. Do you think of me any differently?

Mama: No. I am proud of you, and you are the angel of our life.

Rose: So after this conversation, what, if anything, do you think is going to change?

Mama: You move here.

Rose: (Laughs.) I'm not moving here. I think you know that.

That conversation ended on what seemed like a pretty nice note. But then Rose shut the recorder off. At that point, she says, her mom got mad about Rose going public, and told her that she would have a harder time getting married because of it. Rose says now:

I tried to be like, that's the point. That's why we're doing this. Because both in our American culture and in our Pakistani culture there's a stigma, and she knows it. Because now she's afraid that people are going to know this about me and judge me for it, and it's going to make it harder to have a future the way she wants me to have a future.

She regretted having shared all this with her mom. But then, the next day, Rose's mom started asking these little questions like, "Where did this start?" or "What could I have done differently?" Even, "Is this because I wouldn't let you wear makeup to school?" Rose started to feel like her mom was coming from a place of wanting to understand better, rather than judging.

And with a little time, Rose found herself doing the same thing — trying to understand her mom's reaction instead of judging it:

I've had years to come to terms with this knowledge about myself and I gave her, what, maybe an hour-long conversation and then expected her to, at the end of it, be totally understanding and calm and collected about it, which wasn't fair on my part.

Rose thinks that sharing and being open about mental illness may ultimately bridge these kinds of generational and culture gaps.

But people have to be prepared for a process, she says, not a hit-and-run conversation.

Laying everything out has made her and her mom more reflective. So maybe it wasn't such a bad idea after all.

For more on WNYC's Only Human podcast series on mental health, check here. You can stay in touch with @OnlyHuman on Twitter and @Only Human on Facebook.

Additional Information: Sharing Your Story

WNYC and NPR recently asked listeners: Have you ever had a hard time talking openly about your mental health? We'll be posting some of these responses on Facebook throughout the series.

Copyright 2016 WNYC Radio. To see more, visit WNYC Radio.
Categories: NPR Blogs

Baby Boomers Will Become Sicker Seniors Than Earlier Generations

NPR Health Blog - Wed, 05/25/2016 - 12:01am

There will be about 55 percent more people with diabetes as baby boomers become senior citizens, a report finds.

Rolf Bruderer/Blend Images/Getty Images

The next generation of senior citizens will be sicker and costlier to the health care system over the next 14 years than previous generations, according to a new report from the United Health Foundation. We're talking about you, baby boomers.

The report looks at the current health status of people ages 50 to 64 and compares them to the same ages in 1999.

The upshot? There will be about 55 percent more senior citizens who have diabetes than there are today, and about 25 percent more who are obese. Overall, the report says that the next generation of seniors will be 9 percent less likely to say they have good or excellent overall health.

That's bad news for baby boomers. Health care costs for people with diabetes are about 2.5 times higher than for those without, according to the study.

It's also bad news for taxpayers.

The Health Of Baby Boomers As They Age, For Better And Worse

  • GOOD: 50 percent fewer smokers
  • BAD: 55 percent more people with diabetes
  • BAD: 25 percent more people who are obese
  • BAD: 9 percent less likely to say they have "very good" or "excellent" health

Source: United Health Foundation

"The dramatic increase has serious implications for the long-term health of those individuals and for the finances of our nation," says Rhonda Randall, a senior adviser to the United Health Foundation and chief medical officer at UnitedHealthcare Retiree Solutions, which sells Medicare Advantage plans.

Most of the costs will be borne by Medicare, the government-run health care system for seniors, and by extension, taxpayers.

Some states will be harder hit than others. Colorado, for example, can expect the numbers of older people with diabetes to increase by 138 percent by 2030, while Arizona will see its population of obese people over 65 grow by 90 percent.

There is some good news in the report, too.

People who are now between 65 and 80 years old have seen their overall health improve compared to three years ago. And people who are aging into the senior community are far less likely to smoke than earlier generations.

"Some of these trends are very good and in the right direction," Randall tells Shots.

She says the decrease in smoking shows that it's possible to change health behaviors, noting that doctors, public health professionals and policymakers used a variety of strategies simultaneously to reduce smoking.

"That's a good model for what we need to look at to tackle the epidemic of diabetes and the big concern we have around obesity," she says.

The study also ranked states on the health of their current senior populations. Massachusetts topped the list, jumping to No. 1 from the No. 6 ranking it had the last time the rankings were calculated. Vermont slipped to No. 2.

Louisiana is the least healthy state for older adults.

Copyright 2016 NPR. To see more, visit NPR.
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To Cut Wait Times, VA Tries MinuteClinics In Northern California

NPR Health Blog - Tue, 05/24/2016 - 11:55am

For simple care and prescriptions, veterans in Northern California can go to 14 CVS MinuteClinics.

Tom Starkweather/Bloomberg via Getty Images

Struggling with long wait times, the Veterans Affairs Health Care System is trying something new: a partnership with the CVS Pharmacy chain to offer urgent care services to more than 65,000 veterans.

The experiment began Tuesday at the VA's operations in Palo Alto, Calif.

Veterans can visit 14 CVS MinuteClinics in the San Francisco Bay Area and Sacramento, where the staff will treat them for conditions such as respiratory infections, order lab tests and prescribe medications that can be filled at CVS pharmacies.

The care will be free for veterans, and the VA will reimburse CVS for the treatment and medications. Whether the partnership will spread to other VA locales isn't yet clear.

The collaboration comes amid renewed scrutiny of the nation's troubled VA health system, which has tried without much success to improve long wait times for veterans needing health care.

Despite a $10 billion program called Veterans Choice that allows veterans to receive care outside the closed VA system, vets nationwide wait for an appointment even longer than they did before the program started in 2014, according to a federal audit.

The MinuteClinic partnership isn't part of the Veterans Choice program.

"The concern has always been, how do we make sure veterans get the care they need in a timely way and in a way that works for the veteran?" said Dr. Stephen Ezeji-Okoye, the Palo Alto VA's deputy chief of staff. The deal indicates that the VA is willing to try outside partnerships to meet veterans' needs, he said. "We want to have not just timely access but geographic access to care."

Shots - Health News Despite $10B 'Fix,' Veterans Are Waiting Even Longer To See Doctors

Sarah Russell, the Palo Alto VA's chief medical informatics officer, came up with the idea, said Ezeji-Okoye.

The VA will integrate MinuteClinics' patient records with its own electronic health records to provide consistency of care, Ezeji-Okoye said.

The Palo Alto VA fares better than some other facilities nationwide in providing timely care to veterans, according to VA data, and Ezeji-Okoye said most patients with urgent care needs are seen quickly.

But the system was so busy in the past year that about 11 percent of appointments at its network of hospitals and clinics — which stretch south from Sonora to Monterey — couldn't be scheduled within 30 or fewer days, which is considered an acceptable time frame, VA data show. That includes appointments that would require urgent care.

More than 5,000 appointments systemwide were scheduled more than 30 days out, but each hospital and clinic's performance varied widely. At a Fremont clinic, less than 2 percent of appointment requests couldn't be scheduled within 30 days. At the VA's rural Modesto clinic, by contrast, more than 17 percent of requests weren't scheduled within 30 days.

Once the MinuteClinic operation is well underway, Ezeji-Okoye anticipates that between 10 and 15 veterans — from among the estimated 150 who call the Palo Alto VA's advice nurse hotline daily — will be treated at the retail clinics on any given day.

About 95,000 veterans are eligible to use the Palo Alto system, one of the VA's largest in the Western United States. About 65,000 use it every year.

The $330,000 pilot project will be evaluated after one year. CVS' MinuteClinic president, Dr. Andrew Sussman, hopes it can be rolled out nationally if it succeeds. CVS is by far the biggest player in retail pharmacy clinics, operating 1,135 of them in 35 states.

"We'd love to have that opportunity to expand after we go through this phase," Sussman said. "We're well-suited to help because of our large footprint and ability to see people on a quick basis."

It is unclear, however, what the VA's nationwide plans are. The Veterans Health Administration office didn't respond to Kaiser Health News' request for comment.

Blake Schindler, a retired Army major who lives in Santa Clara near one of the participating MinuteClinics, was intrigued, but cautious about the idea. He counts himself lucky, because unlike some other veterans, he has access to the U.S. military's TRICARE health insurance program for active and some retired service members.

"It could make a big difference, but how much access are the veterans going to have? That was the big problem with the Veterans Choice program; it didn't end up the way it was supposed to," said Schindler, 58.

"I'm always hopeful when I hear about these things; I keep an open mind until I have experience with it," he added.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. You can follow Barbara Feder Ostrov on Twitter: @barbfederostrov.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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Doctor Yearns For Return To Time When Physicians Were 'Artisans'

NPR Health Blog - Tue, 05/24/2016 - 9:38am

Dr. Abraham Nussbaum argues for medicine to reconnect with its past: Caring for patients should be a calling, not a job, he says.

PhotoAlto/Michele Constantini/Getty Images

In his recent book, The Finest Traditions of My Calling, Dr. Abraham Nussbaum, 41, makes the case that doctors and patients alike are being shortchanged by current medical practices that emphasize population-based standards of care rather than individual patient needs and experiences.

Nussbaum, a psychiatrist, is the chief education officer at Denver Health Medical Center and works on the adult inpatient psychiatric unit there. I recently spoke with him, and this is an edited transcript of our conversation.

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Your book is in some ways a lament for times gone by, when physicians were "artisans" who had more time for their patients and professional independence. But you're a young doctor and you must have known at the outset that wasn't the way medicine worked anymore. Why do you stick with it?

The first thing I'd say was that I didn't know right away that medicine is no longer universally understood as a calling instead of a job. We are describing health as if it is just another consumer good, and physicians and other health practitioners as the providers of those goods. That is the language of a job. When you remember that being with the ill is a calling, then you remember that it is a tremendous privilege to be a physician. People trust you with their secrets, their fears and their hopes. They allow you to ask about their lives and to assess their bodies. So my lament is not for the loss of physician privilege — goodbye to that — but to the understanding of medicine as a calling.

You don't like checklists and quality improvement measures that dictate how physicians care for patients because you say it turns doctors into technicians and is an obstacle to "moral reasoning." But those tools, which generally take a systems approach to providing care and rely on evidence-based guidelines, aren't going away anytime soon. How do you do the kind of doctoring you want to do in this environment?

Quality improvement seems to be here to stay. Regulators at all levels require it. But I believe that evidence of its success is not as clear as they suggest. Just last week, The BMJ, formerly the British Medical Journal, published a study that found no evidence that introducing quality metrics has resulted in a significant reduction in patient mortality. The leaders of the quality movement's version of quality improvement developed out of industrial engineering, so they are always comparing the care of patients to things like the production of cars or the flying of airplanes. People are far more varied than cars on an assembly line or planes on the runway. So quality metrics always feel forced to me, especially for the more interactive medical encounters.

In my own specialty, the current quality metrics all encourage me to perform standardized screens on patients or to document carefully. None of them require me to develop a relationship with a patient so that I can, say, foster hope after a suicide attempt, or knit a psychotic person back into the life of their family. Yet that is was my patients want, those human relationships. It is also what physicians want, and the most recent studies suggest that most physicians are dispirited by quality metrics.

But not all physicians are equally skilled or conscientious. As a patient, I feel more comfortable knowing there are rules and standards that doctors have to meet.

I don't think physicians should be free to do whatever they want. Their thinking and decision-making should be held up to scrutiny. A physician's standard of quality should be evidence-based, but even more, it should be patient-centered. The standard should be what the patient defines as what matters. So if you are suffering chronic pain, it is not just a reduction of your score on a standardized pain scale, but your ability to resume the activities you identify as constitutive of your life.

You talk about wanting to be able to sit with patients and talk with them, to really "see" them. All that takes time that physicians don't generally have. I understand your book isn't a how-to manual. But, really, how can physicians do this, even if they want to?

It's a real challenge. It's important to use the time you have in service of the patient's needs. I don't review records while I'm in the room with a patient. I try to make every question be about the patient. I have to ask standard questions, but I try to do that as way to get to know the patient. For example, if I have to ask questions about what they can remember, I'd ask about a book they have with them. Part of my concern about checklists is that they train you to follow a script instead of following your patients.

Only 55 percent of psychiatrists take insurance compared with nearly 90 percent of physicians in other specialties. That puts their services out of financial reach for many people who could use their help. How does that square with your vision of doctors as healers and teachers?

It's deeply concerning to me. I've made a conscious choice to work at a safety net hospital, so I can see people regardless of their ability to pay. I hope that through things like the Medicaid expansion and mental health parity, more psychiatrists will work with people who have mental illness.

You talk about the virtues of "slow" medicine, similar to the slow food movement, where physicians reject providing care in a standardized, mass-produced fashion. One path that some physicians have chosen is to establish boutique practices that accept a limited number of patients who pay extra fees for more personal attention and better access. What's your perspective on that?

It sounds appealing to me. In most descriptions of boutique medicine, they talk about it like a lovely restaurant, one that I couldn't afford to go to every night. I think it's an interesting model but not a solution to the large problems facing medicine, in particular the ability to provide care to the most needy among us and the indigent.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter: @mandrews110

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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Mosquito Hunters Set Traps Across Houston, Search for Signs of Zika

NPR Health Blog - Tue, 05/24/2016 - 5:05am
Mosquito Hunters Set Traps Across Houston, Search for Signs of Zika Listen· 4:02 4:02
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May 24, 20165:05 AM ET Heard on Morning Edition


Christy Roberts, an entomologist in Harris County, Texas, sorts mosquitoes with tweezers. They will be tested for viruses such as West Nile and Zika.

Carrie Feibel/Houston Public Media

Mosquito control is serious business in Harris County, Texas.

The county, which includes Houston, stretches across 1,777 square miles and is the third most populous county in the U.S. The area's warm, muggy climate and snaking system of bayous provide an ideal habitat for mosquitoes — and the diseases they carry.

The county began battling mosquitoes in earnest in 1965, after an outbreak of St. Louis encephalitis. Hundreds of people contracted the virus and 32 died.

These days, mosquito control efforts include chemical spraying on foot, by truck and occasionally from airplanes. But spraying happens strategically, after careful research reveals the geographic distribution of infected mosquitoes and sometimes birds, which can carry West Nile.

To that end, the county employs 50 scientists and technicians year-round. In the summer, the county hires two dozen more workers. They set traps, sort mosquitoes by species and conduct lab tests for five viruses: St. Louis encephalitis, West Nile, dengue and chikungunya. This year they've added Zika.

The county's tab for mosquito control runs $4 million or more a year.

The surveillance cycle begins outdoors. Technicians set and retrieve three kinds of traps every weekday, hiding them beneath manhole covers, in roadway medians and in yards (with homeowners' permission). The county is divided into 268 sectors, and researchers collect mosquitoes from each sector at least every other week.

Entomologist Christy Roberts makes her rounds in a white, county-issued pickup truck. At each stop she sets out orange traffic cones before retrieving traps that have typically been outside for about 12 hours.

One type, called a gravid trap, sits on top of a plastic tub of water. The stagnant, smelly water lures female mosquitoes. Alongside a house in one yard, Roberts pulls the tub out from underneath some bushes. She peers inside the trap's cylindrical net, spotting individual insects in the blur of flickering wings.

Mosquitoes in traps are transported back to the county's laboratory for analysis.

Carrie Feibel/Houston Public Media

"Lots of females, some of them are blood-fed, and we have males in there, too," she says. "The female will fly over the water and then land on top of the water to lay their eggs," Roberts explains. "And as they're floating on top of the water, the fan will suck them up into the net." The focus of surveillance is females: They need at least one blood meal in order to reproduce.

Roberts makes a circuit around southwest Harris County. The empty traps go in her truck bed, and she hangs the nets full of trapped mosquitoes inside from the roof of the cab. "We hang the nets so that the mosquitoes will be able to continue to fly," she says. "And they won't rub their scales off, which is what we need to identify them. And it also helps keep them alive until we can freeze them."

At the lab, the mosquitoes are killed by flash freezing, which helps preserve any viruses they might harbor. A technician puts the cold mosquitoes in a box, labels them by location, then sorts them by sex and species.

Roberts sits down at a lab bench and uses green tweezers to pick through the fragile, feathery bodies. To the untrained eye, they just look gray. But Roberts is searching for banding, wing color and variations in the shape and size of the insect's proboscis and other organs.

"I am sorting for Culex quinquefasciatus, which is our primary vector for West Nile. And I'm just placing them directly into the vial," she says. (As the Latin name indicates, that mosquito has five bands across its abdomen.)

Vials then go to Harris County's virology unit, where they are tested for West Nile, St. Louis encephalitis, dengue and chikungunya viruses.

For Zika testing, samples are currently sent to the University of Texas Medical Branch in Galveston. But soon, the lab will also be able to test for Zika on site. The county will spend $300,000 to renovate lab space and buy a PCR-assay testing machine.

Harris County is home to 56 different species of mosquitoes, says Dr. Mustapha Debboun, director of mosquito control. But only three species are relevant, because they carry viruses harmful to humans.

"We have the Aedes aegypti, which is the yellow fever mosquito. And also the Aedes albopictus, also known as the Asian tiger mosquito, and the Culex mosquito," Debboun explains. "These are the three that we are after. And thank God, we're only dealing with three."

Debbun says they mostly find West Nile — 1,286 cases in 2014, 406 in 2015, none so far this year. He says in the past five years, they've had four positive tests for St. Louis encephalitis (also carried by Culex), and none for dengue or chikungunya. Zika — as well as dengue and chikungunya — is transmitted by the Aedes mosquitoes and has not been found in Harris County mosquitoes.

In many municipalities, mosquito control simply means spraying chemicals, Debboun says. But in Harris County, spraying is done strategically. "We go hit the area where we know the mosquitoes have the disease in them," Debboun explains. "We don't just go randomly and just spray, and not only waste the pesticide, but also put a pesticide in the environment when you don't need to."

Selective spraying also keeps the insects from developing resistance, he says. Occasionally, the county will conduct aerial spraying, but that has happened only twice recently — after Hurricane Ike in 2008 and during a West Nile outbreak in 2014.

Debboun says his team is prepared for Zika. In 2013, he diversified the traps, purchasing models that are especially attractive to Aedes species, so his employees have had a few years to learn to use those traps. He's planning to ask the county commissioners for 74 more of the traps, at a cost of $300 each.

This story is part of a reporting partnership with NPR, Houston Public Media and Kaiser Health News.

Copyright 2016 KUHF-FM. To see more, visit KUHF-FM.
Categories: NPR Blogs

Building An Antibiotic To Kill Bad Microbes While Sparing Good Ones

NPR Health Blog - Mon, 05/23/2016 - 3:36pm

What if a drug could knock out Staphylococcus aureus bacteria like these without disturbing the bacteria that help make you healthy?


Antibiotics can save lives, but sometimes they can work too well.

Most antibiotics can't tell the difference between good and bad bacteria. That means the medicines kill helpful bacteria in your gut while they're obliterating the bacteria making you sick.

The helpful bacteria make up what's known as your microbiome. Damaging the microbiome can cause a number of health problems, including making people more vulnerable to infections from other bacteria such as Clostridium difficile, which can cause debilitating diarrhea and be difficult to treat.

Researchers are working on an antibiotic that targets specific, harmful bacteria while sparing the microbiome.

A group from St. Jude Children's Research Hospital in Memphis, Tenn., is testing an experimental drug, Debio 1452, that targets the bacteria that cause staph infections. Staph bacteria include dangerous strains of methicillin-resistant Staphylococcus aureus, or MRSA, common causes of skin infections that can spread in hospitals. The study was published online by Antimicrobial Agents and Chemotherapy in early May.

Historically, antibiotics were designed to kill as many bacteria as possible. But not this one. "The idea was to develop a drug against staph, not against anything else," said the leader of the study, who works in the infectious disease department at St. Jude's. "This type of approach to antibiotic discovery and development is not very common."

The antibiotic targets a protein that is common to all staph bacteria. This protein, called FabI, isn't found in many other types of bacteria. When FabI is disrupted by Debio 1452, the structure of the bacterial cell is compromised.

The scientists working on the drug compared the microbiomes of mice treated with Debio 1452 or commonly used antibiotics, such as clindamycin and amoxicillin. The microbiomes in mice that received Debio 1452 didn't change much. In contrast, the microbiomes of mice treated with the other antibiotics were significantly depleted.

Once the mice were taken off antibiotics, their microbiomes began to return to normal. After two days, the microbiomes of the mice that were treated with Debio 1452 bounced back almost completely. The populations of good bacteria in the mice on the other antibiotics took up to a week to recover. It took even longer, up to 20 days, for the diversity of bacteria to return to normal.

The quick return in the variety of gut bacteria after Debio 1452 is important, the scientists say, because their diversity could be as important or more than their total number.

"All in all I am very enthusiastic about this," says Michael Gilmore, the Sir William Osler professor of ophthalmology, and microbiology and immunobiology at Harvard Medical School. "Staph is a good target because it is so common and the treatment will usually be right."

But, Gilmore says, better ways are needed to diagnose patients to make sure a targeted antibiotic is the right choice.

The latest results, of course, apply only to mice. Although Debio 1452, being developed by Swiss drugmaker Debiopharm Group, has completed preliminary safety and effectiveness testing in human, the drug would have to successfully pass larger clinical trials in humans and be approved by the Food and Drug Administration before doctors could prescribe it. Even if all the studies go perfectly, a drug wouldn't reach the market for years.

Copyright 2016 NPR. To see more, visit NPR.
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Inventing A Machine That Spits Out Drugs In A Whole New Way

NPR Health Blog - Mon, 05/23/2016 - 3:12pm
Inventing A Machine That Spits Out Drugs In A Whole New Way Listen· 3:58 3:58
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May 23, 20163:12 PM ET Heard on All Things Considered


In a lab at the Massachusetts Institute of Technology, all the work that happens in a vast pharmaceutical manufacturing plant happens in a device the size of your kitchen refrigerator.

And it's fast. This prototype machine produces 1,000 pills in 24 hours, faster than it can take to produce some batches in a factory. Allan Myerson, a professor of chemical engineering at MIT and a leader of the effort, says it could become eventually an option for anyone who makes medications, which typically require a lengthy and complex process of crystallization.

"We're giving them an alternative to traditional plants and we're reducing the time it takes to manufacturer a drug," he says.

The Defense Department is funding this project because the devices could go to field hospitals for troops, hard-to-reach areas to help combat a disease outbreak, or be dropped at strategic spots across the U.S.

"If there was an emergency you could have these little plants located all over. You just turn them on and you start turning out different pharmaceuticals that are needed," Myerson says.

Sounds simple? It's not. This mini drug plant represents a sea change in how medications have been made for a long time.

"For roughly two centuries, to be honest," says Tim Jamison, a professor of chemistry at MIT and one of Myerson's partners, along with Klavs Jensen, a professor of chemical engineering at MIT. "The way that we tend to do chemistry is in flasks and beakers and that sort of thing, and we call that batch chemistry — one batch at a time," he says.

That's the way virtually all pharmaceuticals are made. Big batches of chemicals are synthesized, then they have to cool down, then are synthesized again to create new compounds. Then those compounds have to crystallize, filter and dry. Powders are added to make a tablet or capsule. These steps that can take months. This new device, says Jamison, produces medicine in one fast continuous process.

"We had to figure out new ways to make molecules, new ways to think about making molecules but from my perspective that has also provided us with a lot of opportunities that are very powerful," says Jamison. His lab and Myerson's also are collaborating with the Novartis- MIT Center for Continuous Manufacturing, which is funded by the pharmaceutical company Novartis.

The prototype raises the possibility that hospitals and pharmacies could make their own pills as needed, says James McQuivey, an analyst at Forrester Research.

"If it can done at lower cost, here's one way at least that we could reduce the exorbitant cost of medications and that could a social good as well as an economic good," McQuivey says.

Most of the cost of an expensive drug is not the materials or manufacturing or transportation says McQuivey; it's in the drug makers' monopoly control. So, he says, "If we can distribute the manufacturing of anything, pharmaceuticals included, so that more people have the opportunity to manufacture it, now there will be competition among those manufacturers."

Drug makers have at least two big concerns about the widespread use of this device, says Dr. Paul Beninger, who oversees pharmaceutical safety at manufacturer Genzyme Sanofi. He said first and foremost, the drug industry worries about intellectual property rights.

Drug manufacturers own exclusive rights to produce the drugs they develop for a period of time, typically three to five years depending on how much is new in the drug. His other worry is safety, including monitoring of machines to ensure quality and safety.

"There are some really significant issues that this MIT project has to deal with if they're going to try and make this a successful venture," he says.

MIT researchers say continuous monitoring would be built into the continuous production process. The Food and Drug Administration is working on how to oversee this type of process.

On the patent concern, MIT developers say the device is being tested to make generic drugs for now, but that pharmacies or hospitals might someday license the right to produce drugs that have just been approved, not existing ones.

For now, their focus is on making an even smaller more portable unit, producing more and more complex drugs and seeking FDA approval for the device.

This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.

Copyright 2016 WBUR. To see more, visit WBUR.
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Penicillin Shortage Could Be A Problem For People With Syphilis

NPR Health Blog - Mon, 05/23/2016 - 4:29am
Penicillin Shortage Could Be A Problem For People With Syphilis Listen· 2:40 2:40
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May 23, 20164:29 AM ET Heard on Morning Edition

Syphilis can be wiped out with one to three shots of penicillin.

PhotoAlto/Eric Audras/Getty Images

Since it came onto the scene in 1943, penicillin has made syphilis a thing of the past — almost. Now, the sexually transmitted disease is making a comeback in the U.S. and there's a shortage of the medication used to treat it.

Pfizer, the company that supplies it, says it's experiencing "an unanticipated manufacturing delay," and in a letter to consumers wrote that it would be providing just one-third of the usual monthly demand until July.

The medication, called Bicillin L-A, is the recommended treatment for people with syphilis. It's also the only one available for pregnant women who are infected with or exposed to syphilis, which is caused by the bacterium Treponema pallidum. But the antibiotic can be used against other bacteria, like the one that causes strep throat.

The Centers for Disease Control and Prevention has asked that health care providers save the drug for people with syphilis, especially pregnant women. Even if a woman does not show symptoms, the infection can pass to a fetus during pregnancy and can cause miscarriage, stillbirth and complications including deformed bones, seizures and blindness.

"And the real tragedy is that it is a treatable infection," says Dr. Sarah Kidd, a medical epidemiologist with the CDC's Division of STD Prevention.

She's on a surveillance team that tracks syphilis transmission in the U.S. There were 20,000 cases in 2014. The vast majority of those patients would be treated with one to three injections of Bicillin L-A, also called penicillin G benzathine. Kidd says according to preliminary data, the climb continued in 2015, a trend that started in 2000.

"It is becoming a more common infection," says Kidd. "And because this is the preferred regimen for treatment for syphilis, it really is a critical problem for syphilis control."

Shots - Health News More Babies In The U.S. Are Dying Because Of Congenital Syphilis

It's routine for pregnant women to be tested for syphilis during their first prenatal visit and, if infected, to receive a course of Bicillin L-A. But after declining in the U.S. for four years, the incidence of babies born with syphilis rose sharply after 2012, likely due to a lack of prenatal care. In 2014, about 500 babies were born in the U.S. with syphilis.

Kidd says the CDC is working with state health departments to identify where there are shortages and send supplies of the medication there.

"If [patients] have to go to a different clinic or place to get their Bicillin shot, it just increases the odds of transmission further before they're cured. So it's another potential barrier in the prevention and control of syphilis."

This particular shortage is no rare event, says Erin Fox, director of the Drug Information Service at University of Utah Health Care, which tracks drugs across the country.

"Unfortunately there are constantly drug shortages. Right now we are following just over 200 active shortages," she says. That's a lot better than the 300 she was tracking before, she says, "But it's still something that hospitals are facing on a daily basis."

Most shortages are due to manufacturing problems, Fox says, like rusting machinery, moldy walls or particles getting into vials that are supposed to be sterile. Some of those events can take months or even years to clear up.

Generic drugs that come in the form of a shot, like Bicillin L-A, are particularly prone to shortages. They're cheap and hard to make, so only a few companies produce them. And when it comes to Bicillin L-A, Pfizer is the only supplier.

"The supply chain is really fragile because we really only have just a small number of companies that make these products," says Fox. "And so when you have a small number of factories and one has a problem, there just isn't additional capacity to make up that difference."

And the market is consolidating. Last year, Pfizer bought Hospira, one of the few U.S. companies manufacturing injectable generic drugs.

Fox says that patients usually get the medications they need because hospitals and pharmacies scramble to get the stocks to the right place, or to prescribe an alternative. But it's hard to plan for drug shortages. Fox says it's a little like preparing for natural disasters.

"Almost every hospital has a set plan for how they deal with drug shortages. The surprise that happens on a daily basis is 'What product is going to be short?'" she says. Often, the first time hospitals and pharmacies find out about a shortage is when a shipment of medications never arrives.

Luckily, says Fox, this situation appears to be short-term. Pfizer says the supply should be back to normal in July.

Copyright 2016 NPR. To see more, visit NPR.
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Do Women Need Periods?

NPR Health Blog - Mon, 05/23/2016 - 4:29am
Do Women Need Periods? Listen· 3:52 3:52
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May 23, 20164:29 AM ET Heard on Morning Edition Hanna Barczyk for NPR

Six years of your life. Or 2,190 days. That's about how long the average woman will spend having her periods.

For some women, that's too many days, too many periods.

More women in their 20s and 30s are choosing contraception that may suppress their menstrual cycles, says Dr. Elizabeth Micks, who runs an OB-GYN clinic at the University of Washington in Seattle. "In general, I think views are changing really rapidly," Micks says. "That need to have regular periods is not just in our society anymore."

With traditional birth control, a woman takes a hormone pill for 21 days to stop her cycle. Then she takes a sugar pill for a week, so she can have what looks like a period.

But Micks says, physiologically this isn't a real period at all. And it isn't necessary. "There's absolutely no medical need to have a period when you're on contraception," she says.

So why have women been having all these "fake" periods for decades? "It's actually a historical thing," she says.

One of the doctors who helped invent the pill was Catholic. He thought the pope might accept the pill if it looked like women were having periods.

But the Catholic church never came around to the pill. And when doctors actually asked women if they wanted to have these fake periods, many said they didn't.

Today women have many options if they want to try to suppress their cycles. There's the hormonal IUD, an arm implant and a hormone shot. They can also take some types of birth control pills continuously.

Use of the IUD and implant has risen nearly fivefold in the past decade, a report from the Centers for Disease Control and Prevention found.

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And two top medical organizations — the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics — recommend these forms of contraception as the top choice for young women who want birth control. One study found the IUD and implant were nearly 20 times more effective at preventing pregnancies than birth control pills.

But none of these methods are a guarantee for getting rid of periods altogether. "It's not an on and off switch for menstruation," says Paula Hillard, an OB-GYN at Stanford University Medical Center.

Instead, most women have spotting or unscheduled bleeding when they first start these methods. "It can happen without a rhyme or reason, but it tends to improve over time."

For example, with the hormonal IUD, about 50 percent of women don't have periods after a year. But nearly all women will have lighter, shorter and less painful periods after about six months, Hillard says.

Even if a woman hasn't had a cycle in five to 10 years, there's no evidence that suppressing menstruation hurts future fertility, Hillard says. Most women can get pregnant right after they stop using the contraception, except for the hormonal shot — which can decrease fertility for months after it's discontinued, or even a year.

As with all forms of hormonal contraception, there are risks and side effects with these devices, such as an increased risk of blood clots. And some doctors think there isn't enough known about the long-term effects of menstruation suppression, especially with teenagers.

"Important studies, like what are the effects on the breast? What are the effects on bone — haven't been done," says Jerilynn Prior, an endocrinologist at the University of British Columbia.

She says women should think carefully before trying to suppress their cycle. Having a period does serve a purpose, she says: It tells you your reproductive system is working well and that you're not pregnant. It isn't a "disease" that needs to be treated away, she says.

"I think there is value in understanding and appreciating our own intrinsic hormonal cycles," Prior says. "It's our identity."

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