NPR Health Blog - 7 hours 5 min ago
Seeking Solutions For Sexual Aggression Against Women In Bars
by Maanvi SinghMarch 07, 201412:04 PM i i
What is it about bars that brings out bad behavior?iStockphoto
Our post on sexual harassment in bars sure struck a nerve.
Earlier this week we covered a study from the University of Toronto that found that men who were sexually aggressive in bars weren't necessarily drunk, and that their actions usually weren't the result of miscommunication.
The researchers hired and trained young adults to go into bars in the Toronto area and observe people's behavior. They found that 90 percent of the victims of sexual aggression were women being harassed by men — and that the perpetrators' aggressiveness didn't correlate with their level of intoxication.
Bystanders and bar staff rarely intervened, according to the study, which was published in Alcoholism: Clinical & Experimental Research. Two-thirds of the incidents involved nonconsensual touch; in other cases the aggressors threatened contact or verbally harassed their targets.
Hundreds of you weighed in, and the debate was passionate. Several people felt that the study merely confirmed the obvious.
Yep, you don't have to be drunk to be a creep, and just because you are drunk doesn't automatically make you a creep. No surprise there.
But many readers said the focus should be on the aggressors' behavior, not that of victims.
Shifting the focus to the women's behavior suggests that women are able to stop these predators. That is how it becomes victim blaming. Society needs to spend as much time scrutinizing the predatory behavior of men as it does focusing on the behavior of women who encounter them. Without the presence of predatory men the incidents just would not happen.
Mae Flexer, a representative in the Connecticut General Assembly and chair of the Assembly's Task Force on Domestic Violence, called in to point out that we should avoid putting undue blame on both men and women.
"Yes, women being intoxicated makes it easier for predators to act out their aggression against women, but these predators are going to do this anyway, whether women are drunk or sober, and I think that's a very important point to get across," she tells Shots.
"It's also important when we talk about these issues that we're not talking about men in the collective," she says. "We need to show that we recognize that the men who commit these crimes are a very small portion of the population."
Yet other readers pointed out that bad behavior isn't limited to Saturday night.
It should also be noted ... the reason for the men targeting these women in this study was because they were "less able to rebuff them." Think of how often these same men are aggressive and predatory in other situations where women are less able to seek justice! For example, when they are alone with women, when they are supervisors or in positions of power over women, when the woman has a physical or mental handicaps, etc. This kind of harassment isn't limited to bars!
But bars aren't a bad place to start trying to figure out a solution.
We called Lauren Taylor, one of the organizers behind Washington, D.C.'s Safe Bars initiative, and asked her what her group is trying to do.
The initiative's goal, Taylor told Shots, is to educate bystanders on what to do when they see sexual aggression. Taylor says the organization hopes to work with bars in D.C. and train staff to intervene and help victims of aggression.Shots - Health News If He's Sexually Aggressive In Bars, It's Not Because He's Drunk
Bystanders can help in many ways, Taylor says. "For example, you might go up to somebody who is being targeted and say, 'Your friend is calling over there.' " A bystander could also address perpetrators directly and ask them to cut it out, she says.
Her group tries to educate bystanders and staff on how to safely intervene. But she realizes that this goes beyond just how people behave on Saturday night. "Really what we're talking about is changing rape culture," Taylor says. "[Rape culture] is the overall messaging throughout our culture that says this kind of behavior is allowed."
That includes the idea that "boys will be boys," or that women at bars should expect bad behavior at bars, she says. And though most men aren't perpetrators of sexual aggression, the majority of perpetrators are men, Taylor says.
"Men can go out and get drunk, and run a whole bunch of risks including getting in a car accident, blacking out or getting alcohol poisoning," Taylor says. "Women run those same risks. But men never have to think 'I shouldn't get drunk because someone is going to rape me.' "Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - 7 hours 35 min ago
Actuaries In Denver Will Get First Peek At Obamacare's Full Cost
by Jay HancockMarch 07, 201411:34 AM i i
Health insurers are banding together to share information about how much new customers are costing health plans. A group of actuaries in Denver will be the first to see the figures, which could be used in calculating future rates.iStockphoto
Now that medical insurers must accept all applicants no matter how sick, what will these new customers cost health plans? And how will their coverage costs affect insurance prices for 2015 and beyond?
Few questions about the Affordable Care Act are more important. How it all plays out will affect consumer pocketbooks, insurance company profits and perhaps the political fortunes of those backing the health law.
A few Denver actuaries, bound to confidentiality, will be the first to glimpse the answers.
Quite a few companies have agreed to give Wakely Consulting Group early information about enrollment and member health in plans for individuals and small businesses sold through the online marketplaces that opened last fall.
The firm will use the data to give insurers the earliest possible estimates of how much they'll pay or receive through a government program designed to distribute risk more evenly among plans. The information will also help insurers set rates for 2015, which are due to regulators relatively soon.
"It's really about, how healthy or sick are these people?" said Ross Winkelman, a Wakely actuary who's running the analysis along with colleague Syed Mehmud. "That's probably the biggest uncertainty in each plan's rate filing."
Wakely is getting information on enrollees' health and demographics far beyond what the Department of Health and Human Services has published. (The data are totaled. Wakely doesn't see member information.) Since the ACA bars insurers from asking about people's health until after they sign up, each carrier is quickly trying to assess its new membership.
But plans aren't affected just by the health of their own members. The new enrollees their competitors sign up can also influence bottom lines. That's because the health law's risk adjustment provisions are designed to shift money from insurers that potentially signed up much healthier members than average to those that enrolled sicker members than average. The program, similar to one for Medicare managed care plans, is supposed to remove incentives for insurers to enroll only the healthy.
Properly accounting for risk adjustment could mean as much as 10 percentage points in costs or revenue for plans accustomed to making 3 percent profit — a huge swing, said Winkelman. But to know what they're getting, insurers need to know how their experience compares to that of their competitors in a given state and what the average risk is for the total market.
That information won't come through normal regulatory channels for many months — long after carriers have to set rates for 2015 and start reporting profits to shareholders.
Instead, and perhaps improbably, Wakely has persuaded insurers in more than 30 states to let it act as a clearinghouse, gathering detailed information from each company, figuring how it fits together and sharing only what's necessary.
Winkelman declined to identify the insurers or which states they're in. But in some states every health plan in the individual and small-group markets agreed to participate, he said. A Wakely website lists companies that said they intended to participate. They include most major insurers.
In October, UnitedHealth Group, which owns the nation's biggest health insurer, said it had signed up for such a study, without identifying Wakely.
"We have absolutely participated with a third party to gather industry information and get some feedback on where we sit," Dan Schumacher, chief financial officer for United's insurer, told stock analysts last fall. "And based on that information, as well as our past experience, we feel very comfortable with our ability to estimate the results [on the risk adjustment program] as we get into 2014."
Some Blue Cross and Blue Shield plans are also participating. Wakely is still recruiting clients — especially community-run co-op health plans created by the federal health law and others new to the individual and small-group business.
"The health plans that are probably least likely to be participating right now are the ones that are new, and they are the ones that could really benefit from it," Winkelman said.
Because of insurers' concerns about confidentiality, Wakely won't be sharing what it learns with the federal government, he said.
Thanks to the health law's new requirements, insurers knew they might get a line of sicker-than-usual customers. They priced this year's plans accordingly. But it was still largely a guess.
Whether they have recruited enough healthy members to balance out costs for the sick and keep premiums from rising substantially for 2015 will be something many people in Washington and CEO suites across the country will want to know.
The folks at Wakely will have a better, earlier idea than anybody else. But don't expect them to put out any announcements.Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
NPR Health Blog - Thu, 03/06/2014 - 4:00pm
Second Baby Cleared Of HIV. Rare Event, Or Hope For Others?
by Linda PoonMarch 06, 2014 4:00 PM Listen to the Story
In only the second documented case of its kind, an infant born with the AIDS virus may have been cured of the infection, thanks to an intensive drug treatment begun just hours after her birth. The baby girl — now 9 months old — from Long Beach, Calif., is still on that regimen of antiretroviral drugs. But researchers who described her case at an AIDS meeting in Boston this week say advanced testing suggests that she is HIV-negative.
While not conclusive, the two cases are "quite promising," says Anthony Fauci, a longtime AIDS researcher who directs the National Institute of Allergy and Infectious Diseases.Alex Wong/Getty Images
The California child's case comes three years after doctors apparently cleared an infant in Mississippi of her HIV infection shortly after she was born. That child is now a healthy 3-year-old who seems to be free of HIV, doctors say, despite having been off the AIDS drugs for almost two years now.
Researchers are eager to determine if the two remarkable cases are rare experiences or a broader sign of hope for the hundreds of HIV-infected babies born each day. To find out, clinical trials involving roughly 60 newborns will begin as early as this April or May, says Dr. Anthony Fauci, who directs the National Institute of Allergy and Infectious Diseases.
Fauci, whose institute funded the research in both cases, sat down on Thursday with NPR's Audie Cornish, for All Things Considered, to talk about the two children, and what their promising experience might mean for the future. Here's an edited excerpt of their conversation:
How is this course of treatment different from what's usually given to babies infected with HIV?
In the usual situation when a baby is born to an infected mother, you don't know at birth, for sure, if the baby is infected. So what you do is you give the baby what's called a preventive type of drug [regimen] — lower dose and [fewer drugs]. When you find out that the baby is ultimately infected, you switch over to the full component of three drugs at the right dose, to start treating them. ... The original Mississippi baby and the baby from California were treated within hours of birth as if they were infected. So instead of giving them the prevention type of drug over a period of a few weeks, they were immediately given the full-blown course of the treatment drugs.
But how did doctors know when to stop treatment in the first case — the little girl born in Mississippi?Shots - Health News Scientists Report First Cure Of HIV In A Child, Say It's A Game-Changer
The doctors would never have just ... stopped drug [treatment] in the baby after several months. The mother was lost to follow up and [she apparently] stopped giving the drug to the baby. And then when [the mother and child] came back, the physician noticed that [the little girl] had been several months off therapy and the virus did not rebound. So a quirk — of the mother's decision, or accident, in not following up with the baby — has actually led to a situation that turned out to be beneficial.Shots - Health News A Toddler Remains HIV-Free, Raising Hope For Babies Worldwide
So that case was accidental. How will doctors know in the future when to stop drug treatment, and is that even ethical?
To just ... stop would not be ethical, and that's the reason why we're sponsoring a clinical trial that will begin sometime at the end of April [or] at the beginning of May, where we're taking a large number of babies ... born of mothers who are infected, [women] who have not received any [anti-HIV] treatment [during pregnancy] at all, and we're going to be treating those babies literally within 48 hours of birth with the full component of the treatment regimen. [We will be] assuming that they are infected, even though they might not be. And then we'll wait for a considerable period of time, and very carefully, in individual babies, stop therapy to see if the virus rebounds.Global Health In Mozambique, A Fight To Keep Babies HIV-Free
Give us some context. Just how big a problem is it — babies born HIV-positive?
In the United States, it's really not a big problem at all only because we have the [prenatal and postnatal] care for the mothers, and almost all mothers who are infected will be started on [antiretroviral drug] therapy. It will be extremely unlikely that the baby will be infected – not impossible but very, very unlikely. However, the situation in the developing world is somewhat different. [There] it's not uncommon that a mother will come into a clinic, in labor, ready to deliver, never having seen a health care provider, and not being on antiviral therapy. Those are the babies that are at the highest risk.
How promising are these findings?
Well, it's quite promising because if it's the second one that we have documented now — and there probably will be others coming along — it really brings up a broader concept. If you have the possibility of truly curing babies at the time of birth, then the risk/benefit ratio of waiting until you document that they're infected ... that really changes the equation.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Thu, 03/06/2014 - 2:41pm
Strange But True: Music Doesn't Make Some People Happy
by Nancy ShuteMarch 06, 2014 2:41 PM i i
Is there anyone who can resist dancing when Pharrell Williams sings "Happy"? Yes, if you're one of the rare few with specific musical anhedonia.Kevin Winter/Getty Images
Surely listening to Pharrell Williams' Oscar nominee "Happy" makes you bounce with joy. Nirvana still makes you want to wail. And old Beatles songs make you feel like everything's going to be all right. But maybe you don't feel anything at all.
Some people lack the ability to get pleasure from music, researchers say, even though they enjoy food, sex and other great joys in life.
Psychologists at the University of Barcelona stumbled upon this while they were screening participants for a study by using responses to music to gauge emotion. They were surprised to find that music wasn't important at all to about 5 percent of the people — they said they didn't bob up and down to tunes they liked, didn't get weepy, didn't get chills. It was like they couldn't feel the music at all.i i
Love, love me do? I will if the Beatles sing to me. Here the Fab Four rehearse for a performance in November 1963.Central Press/Getty Images
People with a disorder called amusia can't hear musical tones. So the Barcelona team tested to see if these people could identify the emotions in different types of music. They could do that; they could hear the music.
Then they asked the participants, who were Spanish university students, to bring in music they liked.i i
"I woke up in my mother's arms." Kurt Cobain of Nirvana sings for MTV Unplugged in 1993.Frank Micelotta/Getty Images
"The first surprise is that some of the participants had trouble bringing music from home," says Josep Marco-Pallares, an associate professor of psychology at the University of Barcelona and senior author of the study. These people didn't have any music — no MP3s, no CDs. No Spotify or Pandora.
Then the 30 volunteers were asked to listen to tunes judged pleasurable by other college students, ranging from Puccini's "Nessun dorma" to Simon & Garfunkel's "Bridge over Troubled Water." The scientists measured participants' heart rate and skin conductance, which are considered physiological measures of emotion.
The people who had said they got no pleasure from music showed no physical response, while the music lovers did. "The other participants reported chills when listening to music," Marco-Pallares told Shots. "With our anhedonic group, they had no chills. They had no real response to music."Deceptive Cadence Who Needs Drugs When You've Got Music?
Well, maybe they're just insensitive boors. But the scientists thought of that, too. They then gave participants a common psychological test with which people can earn monetary rewards. The people who were indifferent to music did just fine, showing faster heart rates and skin response at the prospect of winning.Shots - Health News Turns Out Your Kids Really Did Love That Music You Played
"This suggests that they don't have a global impairment of the reward system," Marco-Pallares says. "This is specific to music." The results were published Thursday in Cell Biology.
So here you have healthy, happy people who just don't get music. Maybe those people who don't dance at weddings aren't wallflowers after all. And maybe if we figure out why a small number of humans have missed out on the thrill of music — Marco-Pallares calls it "specific musical anhedonia" — it will reveal something about why music matters so much to the rest of us.
Marco-Pallares is hoping to find that out. He's continuing the experiment by scanning people in an MRI to see if the brains of people who say "meh" to music respond differently.http://www.npr.org/.
NPR Health Blog - Thu, 03/06/2014 - 11:46am
Teens Who Try E-Cigarettes Are More Likely To Try Tobacco, Too i i
They're both legal. Either, both or none?iStockphoto
While electronic cigarettes may be marketed as alternatives that will keep teenagers away from tobacco, a study suggests that may not be the case.
Trying e-cigarettes increased the odds that a teenager would also try tobacco cigarettes and become regular smokers, the study found. Those who said they had ever used an e-cigarette were six times more likely to try tobacco than ones who had never tried the e-cig.
Researchers from the Center for Tobacco Research and Education at the University of California, San Francisco, analyzed data from the 2011 and 2012 National Youth Tobacco Survey, a federal questionnaire administered to students in grades 6 through 12 in middle and high schools nationwide. It asked teenagers whether they smoked electronic or tobacco cigarettes or both.Shots - Health News Cities Take The Lead In Regulating Electronic Cigarettes
The survey found that students' use of electronic cigarettes doubled from 3.3 percent to 6.8 percent in 2011 and 2012. But the number of smokers declined only slightly, from 5 percent to 2011 to 4 percent in 2012.
Teenagers who smoked were more likely to use e-cigarettes, and vice versa. In 2012, 57 percent of those who had tried cigarettes had also tried e-cigarettes. And 26 percent of current smokers used e-cigs as well. By contrast, 4 percent of teens who had never smoked had tried e-cigs, and 1 percent said they use them currently.
E-cigarettes don't burn tobacco. Instead, a battery heats up liquid nicotine and turns it into a vapor that's inhaled into the lungs.
Director Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, has called the rise of e-cigarette use among teenagers "alarming," because nicotine is still an addictive drug. Frieden also has expressed concern that electronic cigarettes may be a gateway to tobacco cigarettes.Shots - Health News Kids' Use Of Electronic Cigarettes Doubles
"The adolescent human brain may be particularly vulnerable to the effects of nicotine because it is still developing," the authors write. Their study was published Thursday in the journal JAMA Pediatrics.
The study is one of the first to try to get a grip on how e-cigarettes affect tobacco use. It couldn't look at whether e-cig use caused tobacco use, or vice versa, or why teenagers decided to use the products. And it doesn't answer the question of whether teenagers used e-cigarettes in order to avoid tobacco.
Although cigarette makers deny they target teenage customers, researchers say the companies aggressively market glamorous and sexy images that appeal to a teenager's sense of rebellion and tendency toward risky behavior. Those same tactics are now being used for e-cigarette ads, tobacco control advocates say.
The electronic versions also come in a variety of flavors like strawberry, watermelon and licorice. There are far more restrictions on tobacco cigarettes including a ban on offering sweet or fruity flavors, as well as restrictions on advertising and sales to minors. The Food and Drug Administraiton is currently considering whether and how much to regulate electronic cigarettes.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Thu, 03/06/2014 - 5:00am
Florida's Insurers Push To Sell Health Coverage To Latinos
by Sammy MackMarch 06, 2014 5:00 AM
fromWLRNListen to the Story
Yolanda Madrid of Miami (left) talks with navigator Daniela Campos while signing up for health insurance under the Affordable Care Act in January.Lynne Sladky/AP
For all of California's troubles advertising health care to Latinos, that state has embraced the Affordable Care Act and is spending millions of dollars to get people to sign up. Florida is a different story.
Florida has a high rate of uninsured Latinos - almost 10 percent of all the country's uninsured Hispanics who are eligible for health insurance under the Affordable Care Act live in the state.
But Florida lawmakers rejected the Affordable Care Act from the beginning, even being party to a lawsuit to stop its implementation. When the ACA did become law, the state decided not to run its own exchange, and it has not expanded Medicaid. Governor Rick Scott has come out in favor of Medicaid expansion, but it's unlikely the legislature will go along with it this session.
Florida is not marketing the law to anybody. In the absence of state outreach efforts, it's up to the insurers and other groups to get the word out about Obamacare.
And Florida's Hispanics are a group they really want to reach. They tend to be younger and healthier than the rest of the population, so insurers want them because they may pay into the system more than they use in services. Having healthy young people on their rolls helps insurers balance the books.Shots - Health News Selling Health Care To California's Latinos Got Lost In Translation
Florida Blue, a large insurer, is trying to reach the population with a mix of old and new media. The company has developed a mobile phone app, because research shows that's how many Latinos access the Internet. Florida Blue is also partnering with Spanish-language bloggers and forming a partnership with Navarro, a Hispanic drug store. And they've been working with community health centers where Latinos go to the doctor, since face-to-face interaction is critical to reaching this demographic.Shots - Health News Despite Big Market In Florida, Obamacare Is A Hard Sell
Churches, health centers and advocacy groups from within the Latino community have also been working on a grassroots level.
Spanish-language television is also playing a key role in Florida. Univision is partnering with rival Telemundo for Thursday's town hall with President Obama.
Univision's Stephen Keppel says his network is embedding messages about health care into their variety programming, such as Sábado Gigante and Despierta America.
This story is part of a partnership with NPR, WLRN and Kaiser Health News.Copyright 2014 WLRN Public Radio. To see more, visit http://www.wlrn.org/.
NPR Health Blog - Thu, 03/06/2014 - 3:03am
Selling Health Care To California's Latinos Got Lost In Translation
by April DemboskyMarch 06, 2014 3:03 AM
fromKQEDListen to the Story i i Covered California
It's been decades since the advertising industry recognized the need to woo Hispanic consumers. Big companies saw the market potential and sank millions of dollars into ads. The most basic dos and don'ts of marketing to Latinos in the United States have been understood for years.
So when officials started thinking about how to persuade the state's Spanish speakers, who make up nearly 30 percent of California's population, to enroll in health care plans, they should have had a blueprint of what to do. Instead, they made a series of mistakes.
For example, one thing health policy experts love about Obamacare is that no one can be denied coverage for a pre-existing health condition. Covered California, the state's health insurance exchange, made this a selling point in almost all its Spanish ads. But that doesn't resonate with Latinos. Many have never had insurance, never considered it.
Bessie Ramirez is with the Los Angeles-based Santiago Solutions Group, a Hispanic market research firm that has consulted for large health care clients like HealthNet, Cigna and Blue Cross.
She says another problem is that all the early TV ads end with a web address for Covered California in Spanish — no phone number or physical address. She says that completely misses how Hispanics like to shop, especially for a complicated product like health insurance.KQED/YouTube
Grammatically correct, but lacking nuance?
"Hispanics are heavily on the Internet, and they're growing very fast on the Internet, however they're not transacting on the Internet," Ramirez notes. "They transact on a personal basis. Hispanics will wait to go to a 7-Eleven until 11 o'clock [if] at 11 o'clock they know that [their friend] Juan is on duty."
Covered California's biggest mistake was perhaps simply translating ads developed in English into Spanish. Think of Got Milk?, the long-running English-language campaign. At worst, a literal translation into Spanish could be a rude reference to breast milk. At best, it just falls flat. That's what happened with Covered California's first Spanish-language ad.
The ad features a series of people looking directly into the camera saying, in Spanish, "Welcome to a new state of health. Welcome to Covered California."
Ad experts say that was an obvious misstep.
"To say we're in a new state of health for California, it's grammatically correct to translate it literally, but it doesn't have the same nuance or cuteness that it does in English," says Roberto Orci, CEO of Acento Advertising in Santa Monica, Calif.
He found one of the state's follow-up ads just boring — the music, the message and the man in the ad.
"This guy was stiff as a board and ... seco, which in English means dry," he says.
If the product is chicken nuggets or milk, it might not matter to anyone but the company if Latinos buy it. But if Latinos don't buy health insurance, it matters to everyone.
On average, Latinos are younger and healthier than the general population. The premiums they will pay if they sign up help cover the health care costs of older, sicker Californians. That keeps premium costs down for everyone else.
That's why Covered California is sweating the numbers. Just 6 percent of people who enrolled in Covered California health plans last year speak Spanish as their first language. The state is worried how far that number is from the number of Spanish speakers.Shots - Health News Mix Of Young And Old Signing Up For Health Care In California
"We don't think we've done a good enough job yet," says Peter Lee, executive director of Covered California. "Relative to our ambitions and our aspirations we don't stack up well enough yet, and so we're going to be doubling down."
The state spent almost $5 million on its Spanish-language ad campaign last year. It plans to spend more than $8 million in the first three months of this year. Covered California has upped its market research efforts and has vowed to adjust its creative messaging. This time around, it will put a lot of emphasis on ads where people can go to get help in person.
"Even from day one, we thought Spanish speakers would need in-person help," Lee says. "How important that is has really crystallized over the last three months."
The final deadline to sign up for coverage this year is March 31. It's not clear if Covered California can come up with a more effective marketing campaign before then.
This story is part of a reporting partnership among NPR, KQED and Kaiser Health News.Copyright 2014 KQED Public Media. To see more, visit http://www.kqed.org.
NPR Health Blog - Wed, 03/05/2014 - 4:30pm
To Clean Drinking Water, All You Need Is A Stick
by Joe PalcaMarch 05, 2014 4:30 PM Listen to the Story i i
Current water-filtering technology is costly, but MIT scientists are testing a simpler and cheaper method that uses wood from white pine trees.Wikimedia Commons
Removing all the dangerous bacteria from drinking water would have enormous health benefits for people around the world.
The technologies exist for doing that, but there's a problem: cost.
Now a scientist at the Massachusetts Institute of Technology thinks he's on to a much less expensive way to clean up water.
MIT's Rohit Karnik is a mechanical engineer who works on water technologies. He says it's relatively easy to make membranes that can filter the bacteria out of water. But making membranes cheaply, he says, is not so easy.Additional Information: Related NPR Stories Water-Filtration Plant Sparks Concern About Impact on Ecology Jan. 30, 2003
One day a few years ago, he was at a meeting on plants and water flow when a light bulb went off in his head. Why not, he thought, use the xylem tissue in plants for water filtration?
Now if you remember your high school biology, you'll know that xylem is the stuff in plants that transports water in the form of sap from the roots to the leaves.
"And the way the water is moved is by evaporation from the leaves," says Karnik.
It's somewhat like what happens when you put a straw into a glass of liquid. Evaporation from the leaves has the same effect as sucking on the straw.
Pulling water up to the leaves this way creates a problem for the plant, but also an opportunity for an inventor.
The plant's problem is something called cavitation, or the growth of air bubbles, which makes it harder for water to reach the leaves. But Karnik says xylem has a way of getting rid of these bubbles.
"The xylem has membranes with pores and other mechanisms by which bubbles are prevented from easily spreading and flowing in the xylem tissue," he says.
And it turns out these same pores that are so good at filtering out air bubbles are just the right size for filtering out nasty bacteria.
To prove it worked, he created a simple setup in his lab. He peeled the bark off a pine branch and took the sapwood underneath containing the xylem into a tube. He then sent a stream of water containing tiny particles through the tube and showed that the wood filter removed them.
"We also flowed in bacteria and showed we could filter out bacteria using the xylem," he says. Karnik estimates the xylem removed 99.9 percent of the bacteria.Around the Nation Here, Drink A Nice Glass Of Sparkling Clear Wastewater
The results were published Wednesday in the journal PLOS ONE.The Salt Recipe For Safer Drinking Water? Add Sun, Salt And Lime
Karnik says what makes wood such an attractive material for water filtration is that it's cheap. So he thinks it's worth trying to work out the technical hurdles to scaling up his system.
But Robert Jackson, an environmental expert at Stanford University, points out that at least as it stands now, the system doesn't do a good enough job at filtering out bacteria. He wrote in an email that filtering out almost all of the nasty bacteria is certainly helpful, "but when you can have hundreds of thousands, even millions, of them in a drop of water, you don't want to rely on something with 99 percent efficiency."
"In a survival or short-term situation this could work," he wrote. "As a longer-term or global solution to the billion people on Earth without access to clean water, call me skeptical."Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Wed, 03/05/2014 - 4:00pm
A Third Of Nursing Home Patients Harmed By Their Treatment
by Ina JaffeMarch 05, 2014 4:00 PM Listen to the Story
Failures in ordinary care are causing widespread harm that's sometimes serious, inspectors say.iStockphoto
On the last day of his life, Charles Caldwell was surrounded by seven members of his family, but no one thought he was dying. He was in a Dallas-area nursing home, recuperating from surgery to insert a feeding tube. Caldwell had Parkinson's disease. He'd "lost his ability to swallow," explains Caldwell's son-in-law, Bill Putnam.
Charles Caldwell died in a nursing home in 2008, his family says, after a nurse there mistakenly forced medicine from his feeding tube into his lungs.Courtesy of the Putnam family
Things began to go wrong, Putnam says, when a licensed practical nurse gave Caldwell some medication through his feeding tube. The medicine wouldn't stay down. So, as Putnam describes it, the nurse came back with the medication in three large syringes and forced the liquid into Caldwell's stomach.
Within a few minutes, he was choking.
"This medication is traveling up his esophagus and then into his lungs," Putnam says, "and he can't expel it like you and I could. So, within minutes, Dad's thrashing his arms and legs for his last breath. He has no pulse. His eyes are fixed. He's not breathing."
Putnam says that the family could do nothing but watch Caldwell drown.
The case is similar to the many reviewed in a national report on nursing homes. The report was released this week by the Office of the Inspector General of the U.S. Department of Health and Human Services. In a large sampling of Medicare patients discharged from hospitals to skilled nursing facilities in one year, roughly a third of the patients were harmed by their treatment in the nursing homes, the study found. Most of that harm could have been prevented.
Although Caldwell died three years before the department's review team began its study, the officials say his case fits with the misjudgments and ignorance they found repeatedly in their analysis.
"We were surprised at the seriousness of many cases," says Ruth Ann Dorrill, a deputy regional inspector general in the Department of Health and Human Services, the office that conducted the study.Home Or Nursing Home Shots - Health News Why A Young Man Died In A Nursing Home, A State Away From His Mom
Dorrill says that many of the problems they observed were failures in ordinary, everyday care. Lack of monitoring and paying attention was definitely a factor, along with "what clinicians would call substandard medical care." She sites the example of a patient already on 15 different medications — not that rare among nursing home patients — who was then given an additional anticoagulant, such as an aspirin, or something similar.The Two-Way Smoker May Have Caused Retirement Home Fire; Dozens Still Missing
"And then they would have a bleed," Dorrill says, "a fatal bleed."
About 60 percent of nursing home residents harmed by their treatment wound up back in the hospital as a result; such injuries likely cost Medicare about $2.8 billion a year, officials say. That's just the hospitalization cost. It doesn't account for extra doctor visits and longer nursing home stays that also result from patients' injuries.
Nursing homes are inspected by state officials, not by the federal government. But the HHS investigators hope their report will provide guidance for state inspections and will improve patient safety. That's especially crucial because today's nursing home patients are sicker and more fragile than they used to be.
"It's been a gradual thing," Dorrill says.
Twenty years ago, the typical patient might be found in the game room playing cards. But now, Dorrill says, "the average resident might be on a ventilator."
The nursing home industry doesn't dispute the findings of the report, but representatives say it doesn't take into account more recent initiatives to improve care.
Dr. David Gifford is head of quality and regulatory affairs for the American Health Care Association, which represents about 60 percent of nursing homes.
"The report reflected care from 2011 and 2012," Gifford says, while it wasn't until 2012 that his organization started a quality improvement initiative. "So we've been seeing progress since 2012, but we still have a ways to go."
A very long way to go, according to Toby Edelman, an attorney with the Center for Medicare Advocacy. She says she thinks the inspector general's report suggests a simple remedy.
"The inspector general found that staff didn't monitor residents and delayed in providing necessary care. Those are staffing issues," Edelman says. "We don't have enough nurses in nursing homes providing care to residents."
But for Caldwell's family, it wasn't just the size of the nursing home staff, but what they were trained — or not trained — to do, that meant the difference between life and death.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Wed, 03/05/2014 - 2:59pm
Edgy Washington State Ads Urge Young People To Buy Insurance
by Scott HensleyMarch 05, 2014 2:59 PM YouTube
Rian, 26, tells the rappers about the low-cost health plan she bought on the exchange in this TV ad.
They drink. They dance. And they love the Sasquatch Music Festival, an annual phenomenon in Washington state. But will young people sign up for insurance on the state's health exchange?
The folks who run the exchange were sponsors of the music festival's launch party last month, reminding people they have until the end of March to pick health insurance and see if they qualify for help paying for it.
And the exchange has put together some ads that feature a pair of fictitious rappers — one thin and white and the other overweight and black — to help make the insurance sale to young people, sometimes referred to as young invincibles.
One ad focuses on the pair talking with Rian, a fit, 26-year-old woman who no longer qualifies for insurance on her parents' plan. "Low Cost Plans. Check It," the ad's tagline says.YouTube
"The Captain and Patricia" talk about their medical debts.
The other one, called "Hospital Billz," focuses on a middle-aged couple, the rappers call "The Captain and Patricia." They had been turned down for insurance because of pre-existing conditions and racked up $200,000 in medical debt. But now the couple can get insurance on the exchange.
The ads at least have the potential to work. Washington's exchange has performed well from the start, unlike neighboring Oregon's, and more than 100,000 people in the state have signed up for private health coverage.
But the insurance-hawking rap duo has drawn fire. "People are really offended," said Bill Hinkle, a board member of the Washington Health Benefit Exchange, at a recent meeting. He and other board members asked that the ads be yanked, according to a report by a partnership of The Seattle Times and Kaiser Health News.
Michael Marchand, communications director for the exchange, said the only thing that really matters is people remembering the site's Web address. Enrollment rose by 10 percent in the week after the ads started running, The Times and Kaiser reported.
A commenter on Kaiser's site found the criticism laughable:
"LOL. I'm 26 and Black and don't find the ad offensive at all. It made me laugh ... yeah the way they present the 'rappers' visually is an exaggerated stereotype, but its not like they are perpetuating any behavioral stereotypes, which is usually what most ppl will find offensive. Who cares what a bunch of old (probably White) men think? They aren't the target deomgraphic."Shots - Health News Colorado Ads Use Sex And Alcohol To Sell Health Insurance
In the quest to appeal to young people, many ads touting states' exchanges have pushed the bounds of propriety. None, more so, probably than some provocative spots designed to appeal to young Coloradans. Keg stands and the promise of free birth control pills were highlighted in two spots prepared by an outside group.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Wed, 03/05/2014 - 12:33pm
Cities Take The Lead In Regulating Electronic Cigarettes
by Nancy ShuteMarch 05, 201412:33 PM
Electronic cigarettes for sale in Vapeology LA, a store in Los Angeles, are tended by owner John Hartigan.Reed Saxon/AP
Count Los Angeles as the latest big city to say no to electronic cigarettes.
The City Council there voted unanimously on Tuesday to ban use of the devices, which release vaporized nicotine, in almost all public places, including bars, workplaces and beaches.
If the mayor signs the ordinance, L.A. will follow New York and Chicago in restricting use of e-cigs, much as they do old-fashioned, smoke-producing cigarettes. San Francisco is considering a ban, too.Business E-Cigarette Critics Worry New Ads Will Make 'Vaping' Cool For Kids
The Food and Drug Administration is working on proposed regulations on e-cigarettes, but is hampered by the fact that there's very little data on whether inhaling nicotine vapor is hazardous to health, to the vaper or to people nearby. As the FDA's website notes:
Additionally, it is not known if e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death.
That lack of data is fueling efforts by proponents of vaping, including cigarette manufacturers, to push back against restrictions on advertising, sale and use of e-cigarettes.Shots - Health News Candy Flavors Put E-Cigarettes On Kids' Menu
But tobacco control advocates say they've seen it all before.
"I feel like I'm in a time machine," Dr. Stanton Glantz, director of the University of California, San Francisco's Center for Tobacco Control Research and Education, told the San Francisco Chronicle Monday, when that city's proposed ban was unveiled.The Two-Way New York City Extends Smoking Ban To E-Cigarettes
"I was here and participating in 1983 when San Francisco passed a smoking law," Glantz says, "and it was the same arguments - that it would destroy freedom, that it would destroy America, that it would ruin everything. That there was no evidence secondhand smoke is dangerous. It was not true when we were talking about secondhand smoke in 1983, and it's not true when we are talking about e-cigarettes now."Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Tue, 03/04/2014 - 3:32pm
Palliative Chemo Can Make It More Likely You'll Die In The ICU
by Nancy ShuteMarch 04, 2014 3:32 PM i i
Chemotherapy is administered to a patient at Duke Cancer Center in Durham, N.C.Gerry Broome/AP
Cancer patients who get chemotherapy in the last months of their lives are more likely to die in the intensive care unit, rather than where they wish, a study finds.
And with more than half of all people with incurable cancer getting palliative chemotherapy in the months before they die, many people could be suffering more than needed.Shots - Health News Another Side Effect Of Chemotherapy: 'Chemo Brain'
Palliative chemotherapy is used to control symptoms and, perhaps, buy a patient a bit more time, once it's clear the person will likely die from the cancer.
But this study, which involved 386 patients at eight academic medical centers, found that chemotherapy may be interfering with other important aspects of care in those final weeks.
People getting palliative chemo were more likely to be given CPR or be put on a ventilator in the last week of life. And 11 percent died in an ICU, compared to 2 percent of patients who didn't get the chemo.Shots - Health News Mammogram Uncertainty Gives Patients, Doctors More Reason To Talk
Chemo patients were less likely to die at home, with only 65 percent dying in their preferred place, compared to 80 percent of other patients.
"I didn't expect to see such a powerful association," says Dr. Alexi Wright, the lead author of the study, "because we give chemotherapy so frequently. I honestly, as an oncologist, was somewhat skeptical."
But the study's percentages came out the same even when Wright and her colleagues accounted for things like how active the patients were and whether they'd discussed their end-of-life wishes with their doctors.Shots - Health News A Busy ER Doctor Slows Down To Help Patients Cope With Adversity
"The findings I took from this are not that it's wrong to give palliative chemotherapy," says Wright, an oncologist at Dana-Farber Cancer Institute in Boston. "It's not. It does help patients."
Instead, she says, the findings should send a message to doctors that they need to talk with patients about what they want the end of life to be like.
Earlier studies have found that 12 percent of patients get chemotherapy in their last two weeks of life — when it's almost certainly doing them no good.
In 2012, the American Society for Clinical Oncology listed chemotherapy at life's end as one of the top five treatments to avoid:
For patients with advanced solid-tumor cancers who are unlikely to benefit, do not provide unnecessary anticancer therapy, such as chemotherapy, but instead focus on symptom relief and [other types of] palliative care.
But oncologists have been reluctant to make that shift, Wright tells Shots.
"A decade ago, oncologists argued vehemently that you can do people harm by telling them that they are dying," Wright says. "I don't think that's where we are now. But realizing that and making that happen are two different things."
And patients may be reluctant, too. In this study, patients said they would continue chemo if it enabled them to live just one more week.
Still, patients are usually relieved when doctors bring up end-of-life choices, Wright says.
"The take-home message is not that palliative chemotherapy is futile, but that it has the potential to be ineffective and potentially harmful, especially if we don't understand what patients want."Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Tue, 03/04/2014 - 1:00pm
Health Law Provides No Guarantees Of Access To Birthing Centers
by Michelle AndrewsMarch 04, 2014 1:00 PM i i
Nurse midwife Danielle Kraessig seen meeting with Yakini Branch at the PCC South Family Health Center in Berwyn, Ill., in early 2013. While the federal law requires insurers to cover maternity services, birthing centers and midwifery services aren't always included.M. Spencer Green/AP
Insurance coverage for maternity care is required in most individual and small group plans under the federal health law, extending such coverage to plans where it used to be rare. But for women who prefer services provided by midwives and birthing centers, there are no coverage guarantees, despite the law's provisions that prohibit insurers from discriminating against licensed medical providers.The Baby Project The Definition Of Perfection: A Baby's Birth Goes According To Plan
Most women give birth in hospitals and are attended by obstetricians, but a growing number choose to deliver their babies at birthing centers. The centers, typically staffed by midwives, offer women who are at low risk for complications an alternative to traditional hospital labor and delivery, eschewing common medical interventions such as drugs to induce labor and electronic fetal monitors, among other things.
In 2012, 53,635 births in the United States took place outside the hospital, or 1.36 percent of all births, according to a study released Tuesday by the Centers for Disease Control and Prevention. Twenty-nine percent — 15,577 births — occurred at freestanding birthing centers. (The rest were primarily home births.) Although still a tiny percentage of the nation's total, the proportion of births at these centers increased 70 percent between 2004 and 2012, the CDC report found.
"Birth centers and certified nurse-midwives have a good record of safety and patient satisfaction and birth outcomes," says Cynthia Pellegrini, senior vice president for public policy and government affairs at the March of Dimes.
Birth centers are also significantly less expensive than hospitals. The average hospital charge for a vaginal birth without complications was $10,166 in 2010, compared to $2,277 for a birth center, according to data from the Agency for Healthcare Research and Quality and the American Association of Birth Centers.Additional Information: Related NPR Stories For Midwife, 71, Delivering Babies Never Gets Old March 6, 2013
Some advocates predict that coverage of birth centers in private insurance plans will become routine now that Medicaid, which pays for roughly 50 percent of all births in the United States, has embraced their use. But at this time, coverage for birth centers and for midwives, who work in a variety of settings, including hospitals, is less predictable in private insurance plans.
When Sean and Stephanie Taylor learned she was pregnant last July, Stephanie, 30, initially planned to use an OB-GYN and deliver in a hospital near the couple's home in Rancho Santa Margarita, Calif. But after visiting her doctor a few times she began to have misgivings about the practice's routine use of ultrasounds, among other things, during her visits.
"I wondered, is this really necessary?" says Stephanie. "I'm a really healthy person, and I'm not high risk. I started to question all of this."
The couple's Blue Shield of California HMO plan, which they have through her job as an executive assistant at a credit union, doesn't have midwives or birth centers available in the couple's network. When Stephanie asked her OB-GYN to approve a request for her to use a nurse midwife out of the insurer's network, he declined, as did Blue Shield.
In its denial letter, Blue Shield said her plan allows for the coverage of midwife services. But it noted that since there are none available in her medical group, she was limited to using any participating obstetrician.
"If someone can get better, less expensive care, why are their hands tied?" says Stephanie. "People should have the right to choose what's best for them." She and her husband decided to pay the $5,500 charge for the midwife and birth center on their own. Their baby is due in April.
Blue Shield of California declined to discuss the details of Stephanie Taylor's case. In an email response, the company said that generally people insured through an employer-provided HMO "must access medical services from providers within the plan network in order to be covered. While some exceptions exist, going outside the plan network is rarely authorized when providers within the network are able to offer maternity care."
Under the health law, maternity and newborn care is one of the 10 essential health benefits that must be covered in individual and small group plans unless they have grandfathered status. But the law doesn't require that specific types of providers be covered, says Dania Palanker, senior counsel at the National Women's Law Center.
Starting this year health plans are prohibited from discriminating against licensed or certified health care providers who want to participate in their networks. However, the law says, insurers aren't required to contract with any particular provider.
Midwifery and birth center advocates say they're uncertain how the nondiscrimination provisions will be applied or enforced, and the Department of Labor says it's not issuing any further guidance.
"It leaves us in the dark," says Jesse Bushman, director of advocacy and government affairs at the American College of Nurse-Midwives.
For consumers, if having access to a midwife or birth center is important, the best and perhaps only remedy is to call the plan directly and ask about coverage.Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
NPR Health Blog - Tue, 03/04/2014 - 3:52am
Drugmakers Slash Spending On Doctors' Sales Talks
by Charles Ornstein, Eric Sagara and Ryann Grochowski JonesMarch 04, 2014 3:52 AM Listen to the Story i i
Now that Eli Lilly & Co.'s antidepressant Cymbalta and some other blockbusters have gone generic, the company is spending less on promotional activities by doctors.Darron Cummings/AP
Some of the nation's largest pharmaceutical companies have dramatically reduced payments to health professionals for promotional speeches amid heightened public scrutiny of such spending, a ProPublica analysis shows.
Eli Lilly & Co.'s payments to speakers dropped by 55 percent, from $47.9 million in 2011 to $21.6 million in 2012.
Pfizer's speaking payments fell 62 percent over the same period, from nearly $22 million to $8.3 million.
And Novartis, the largest drugmaker in the U.S. as measured by 2012 sales, spent 40 percent less on speakers that year than it did between October 2010 and September 2011, reducing payments from $24.8 million to $14.8 million.
The sharp declines coincide with increased attention from regulators, academic institutions and the public to pharmaceutical company marketing practices. A number of companies have settled federal whistleblower lawsuits in recent years that accused them of improperly marketing their drugs.
In addition, the Physician Payment Sunshine Act, a part of the 2010 health reform law, will soon require all pharmaceutical and medical device companies to publicly report payments to physicians. The first disclosures required under the act are expected in September and will cover the period of August to December 2013.
Within the industry, some companies are re-evaluating the role of physician speakers in their marketing repertoire. GlaxoSmithKline announced in December that it would stop paying doctors to speak on behalf of its drugs. Its speaking tab plummeted from $24 million in 2011 to $9.3 million in 2012.
Data compiled by ProPublica show decines in spending in 2012 compared with 2011.ProPublica
Not all companies have cut speaker payments: Johnson & Johnson increased such spending by 17 percent from 2011 to 2012; AstraZeneca's payments stayed about flat in 2012 after a steep decline the previous year.
ProPublica has been tracking publicly reported payments by drug companies since 2010 as part of its Dollars for Docs project. Users can search for their doctors to see if they have received compensation from the 15 companies that make such information available online. (We've just updated our application to include payments made through the end of 2012, totaling $2.5 billion. Forest Labs, which only began reporting in 2012, reported speaking payments of $40 million, more than any other company in Dollars for Docs.)
Some companies in the database said their declines have less to do with the Sunshine Act and more to do with the loss of patent protection for key products. Lilly, for example, began facing generic competition to its blockbuster antipsychotic Zyprexa in late 2011. Its antidepressant Cymbalta lost its patent at the end of 2013.
"The value of educational programs tends to be higher when we're launching a new medicine or we have new clinical data/new indication," Lilly spokesman J. Scott MacGregor said in an email, adding that the drop in speaking payments also reflects the increased use of Web conferencing.
Pfizer's patent on Lipitor, its top-selling cholesterol drug, expired in 2011.
"Like any other company, our business practices must adapt to the changing nature of our product portfolio, based in part on products going off patent and new products being introduced into the market," company spokesman Dean Mastrojohn said in an email.
Novartis' patent for its breast cancer drug Femara expired in 2011, its hypertension drug Diovan in 2012 and its cancer drug Zometa in 2013. In a statement, Novartis said speaking payments dropped in 2012 in part because of a shift from big blockbuster drugs that many doctors prescribe toward specialty products prescribed by fewer physicians. Resources were also shifted "to support potential future product launches," a spokeswoman said in an email.
One of the first drugmakers to disclose its payments to doctors has pulled the data offline.
Cephalon, now a subsidiary of Teva Pharmaceutical Industries, had reported its ties to doctors since 2009 under the terms of a Corporate Integrity Agreement with the inspector general of the Department of Health and Human Services. The pact was put in place after the company agreed to pay a $425 million settlement in 2008 for marketing Actiq, Gabitril and Provigil for uses not approved by the Food and Drug Administration.
But that requirement expired last September, and Teva pulled the data offline earlier this year when it updated its website.
Cephalon's payments from 2009 to 2012 continue to be available on ProPublica's Dollars for Docs website, which aggregates payments made by 15 pharmaceutical companies since 2009. During that time, the company reported nearly $90 million in payments to doctors.
The gap in the company's disclosures will be short. Teva will have to resume publicly reporting its payments to doctors later this year under the Physician Payment Sunshine Act, which requires that all pharmaceutical and medical device companies disclose payments over $10 to doctors. The first report, covering the period of August to December 2013, is expected to be released in September of this year.
The industry's increased emphasis on expensive specialty medications for such conditions as multiple sclerosis or hepatitis C has been striking, said Aaron Kesselheim, an assistant professor of medicine at Harvard Medical School. A piece in the New England Journal of Medicine last week noted that half of the 139 drugs approved by the Food and Drug Administration since 2009 were for rare diseases and cancers.
"It's possible the number of physicians they need to support sales of these items is less, leading to lower payments overall," Kesselheim said.
In some cases, companies maintained or made smaller cuts to other forms of physician compensation while pulling back dramatically on speaking payments. Pfizer's spending on consultants dropped 9 percent from 2011 to 2012, far less than its payments to speakers. The company's spending on research stayed essentially the same.
Lilly increased spending on physician researchers by more than 20 percent, while reducing payments to consultants by more than two-thirds.
Many bioethicists and leaders of major academic medical centers frown upon physicians delivering promotional talks for drug companies, saying they turn doctors into sales representatives rather than leaders in research and patient care.
Officials with Pharmaceutical Research and Manufacturers of America, an industry trade group, dispute this characterization. They said they are working with their member companies to prepare for the Sunshine Act and have created a campaign to promote the value of drug company-doctor collaborations.
"Companies will make their own independent decisions about how to engage professionals," said Kendra Martello, PhRMA's deputy vice president of strategic operations.
Scott Liebman, an attorney who advises pharmaceutical companies on the Sunshine Act, said it's too early to know how much the law's requirements are affecting company practices, in part because it's so new. The fact that some companies are cutting back on speaking while preserving their spending on research and consulting suggests that other business forces could be at play, he added.
"It's very hard to pinpoint exactly why that's happening," Liebman said. "I think there's a lot of potential answers to that. I just don't know which is the right one."Copyright 2014 ProPublica. To see more, visit http://www.propublica.org/.
NPR Health Blog - Tue, 03/04/2014 - 3:49am
Flagging Down Taxi Drivers To Sign Up For Obamacare Listen to the Story
Yuvania Maldonado, a counselor for President Obama's health care law, speaks with Chicago taxi driver Mohammad Chaudri at a city office where taxi drivers go to renew their license.M. Spencer Green/AP
Dan Ware has been driving a taxicab in Chicago for more than a decade, but he still doesn't have what many jobs offer: health insurance.
"I'm without health coverage," he says.
And that's not unusual, says Chicago Public Health Commissioner Bechara Choucair. "What we know in Chicago is that around 70 percent of taxi drivers are uninsured," Choucair says.
That means about 8,000 cabbies could be eligible for coverage under the Affordable Care Act. Nationwide, there are more than 200,000 taxicab drivers, and so in a few big cities — including Chicago — supporters of the Affordable Care Act are working to recruit them to sign up before this month's open enrollment deadline.
Choucair says a couple of years ago, a study showed taxi drivers in Chicago had plenty of health problems, largely due to the long hours they spend behind the wheel.
"They don't eat as healthy, they don't exercise as much and those are definitely risk factors for diabetes, for heart disease, for strokes," Choucair says.
Add to that chronic back issues that can come from sitting and health problems caused by traffic accidents.Additional Information: Shots - Health News Connecticut Looks To Sell Its Obamacare Exchange To Other States Shots - Health News Doctors' Offices Get Put On Hold Trying to Find Out Who's Insured Shots - Health News In Rural Iowa, Distance Makes Health Care Sign-Ups A Challenge
Enrollment workers in Chicago are signing up taxicab drivers for Obamacare at the facility where cabbies obtain or renew their city chauffeur's license.
"We've been enrolling an average of between 5 to 9 people on site," says Salvador Cerna, an outreach manager for the state. He says others make appointments to get help enrolling, and there are plenty here who want assistance.
Ejaz Waheed has gone without health insurance for nearly a decade. "Back until 2005, I was with a regular job, so I had it. Then I became self-employed and I lost insurance," he says.
Ghulam Memon began driving in 1994 and shares a similar story. "My wife has Medicare and Medicaid both because she's 65-plus. I'm like 60 years, and I don't have anything," Memon says.
So he's exploring his options, as is Orkhan Askarov, 24. Askarov was applying for his first taxicab license, and he says he'll also apply for health insurance "and guarantee that if anything [happens] to me I'm going to be [in] good hands."
The nonprofit Enroll America is running similar cabbie programs in Austin and in Philadelphia. The group's president Anne Filipic says it's trying different ways to reach out to the uninsured as the March 31 deadline nears.
“ Drivers were finding plans as cheap as $35 to $60 per month, and that's something they can afford and these are really good health plans.
- Ronald Blount, head of the Taxi Workers Alliance of Pennsylvania
"Our focus right now is an all-hands-on-deck effort to get the word out. We know that a lot of people still don't have all the facts and don't know, for example, that financial assistance is available, so we want to meet them where they are and get them the information that they need," Filipic says.
In Philadelphia, where there are about 5,000 taxi drivers, many cabbies are getting their information at the headquarters of the Taxi Workers Alliance of Pennsylvania. President Ronald Blount says until now many simply couldn't afford health insurance at all.
"Most drivers in Philadelphia are earning less than $5 per hour. They are working 12 to 16 hours per day, 6 to 7 days per week," Blount says.
He calls the Affordable Care Act a godsend and says about 700 taxi drivers have already signed up there. "Drivers were finding plans as cheap as $35 to $60 per month, and that's something they can afford and these are really good health plans," Blount says.
And that's a boon for many cabbies who may take an easier route and seek out medical help early for any of the ailments that come from driving a taxi.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 03/03/2014 - 5:47pm
If He's Sexually Aggressive In Bars, It's Not Because He's Drunk
by Maanvi SinghMarch 03, 2014 5:47 PM
We used to think they behaved badly because they were drunk. Now we know they were just behaving badly.iStockphoto
Young women are often the targets of aggression when they're out in bars, but the problem isn't that guys are too drunk to know better.
Instead, men are preying on women who have had too much to drink.
When researchers at the University of Toronto and the University of Washington observed young people's behavior in bars, they found that the man's aggressiveness didn't match his level of intoxication. There was no relationship.
Instead, men targeted women who were intoxicated.
The researchers hired and trained 140 young adults to go into bars in the Toronto area and note every incident of aggression they saw. They found that 25 percent of all incidents involved sexual aggression. And 90 percent of the victims of sexual aggression were women being harassed by men.
Almost all of the aggression was physical, with about two-thirds of the aggressors physically touching women without consent. About 17 percent threatened contact. And 9 percent verbally harassed their targets.Author Interviews Drinking To 'Numb,' Women Gain On Men In Alcohol Abuse
Men may perceive intoxicated women either as more amenable to advances or as easier targets who are less able to rebuff them because they don't have their wits about them, the researchers say.
"There's no reason that women should be touched against their will," says Kate Graham, the study's lead researcher and a senior scientist at the Centre for Addiction and Mental Health at the University of Toronto. Women wouldn't accept that kind of behavior at school or on the street, she notes, but it seems to get a pass in bars, she tells Shots.
The study was published online Monday in Alcoholism: Clinical & Experimental Research.
The researchers also wanted to look into whether unwanted sexual advances were intentional or just a matter of misperception. This study points to the former, Graham says.
"If you walk through a bar and grab a woman's breasts and then disappear into the crowd, that's probably not a misunderstanding," she says. "You don't actually think that she wants you to do that."
The fact that men were more likely to take advantage of intoxicated women shows that most of these incidents aren't well-intentioned, Graham says.Shots - Health News Drinking Too Much? Don't Count On Your Doctor To Ask
And the bar staff rarely stepped in to stop the sexual aggression. "There should be training for staff on how to intervene," Graham says. "If [a bar] wants to have female patrons, they ought to make it more female friendly."
The observers rated people's level of intoxication based on the number of drinks they consumed and their behavior. Observers worked in pairs with one man and one woman to reduce potential bias.
Since the observations were made in public places in or around bars, the study doesn't tell us much about sexual assault or rape that might occur out of public view or after women leave a bar.
But the takeaway, Graham says, is that "people should stop believing that [Robin Thicke] song. The lines really aren't that blurred."Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 03/03/2014 - 2:49pm
Dunk Now, Pay Later: Elite College Players May Suffer In Middle Age
by Nancy ShuteMarch 03, 2014 2:49 PM
Duke's Jabari Parker weaves his way through UCLA players during a December game in New York.Jason DeCrow/AP
College athletes astound us with their power and speed, but they can pay a price years later. Division I players are more likely to be disabled, depressed and in pain in middle age, a study finds. And they may end up worse off because they fail to make the switch from high-level competition to the low-level activity of the rest of us.
"A lot of athletes don't want to work out on a treadmill," says Janet Simon, a graduate student in public health at Indiana University who led the study. "Division I players are used to playing at such a high level. If they can't play at that level, they sometimes don't want to do anything."
Simon asked 457 Indiana alumni ages 40 to 65 about their health. Half had played varsity sports in college, including football, basketball and baseball. The other half were recreational athletes at best.
By the time they reached middle age, the former elite athletes were twice as likely to have health problems that limited their daily activity. Two-thirds of the athletes said they had suffered a major injury while playing. They also were more likely to have arthritis, with 40 percent of athletes being diagnosed, compared to 24 percent of the nonathletes.
Half of the athletes had chronic injuries, compared to 28 percent of non-athletes. And they were more likely to be in pain and depressed.
"If someone is unhappy with how they're working out, they made feel depressed, or they may have poorer quality of life," Simon told Shots.Additional Information: Playing Hard Shots - Health News Young Athletes Risk Back Injury By Playing Too Much Sports Back At School, Injured Player Fights On After Fateful Tackle Shots - Health News Doctors To Vote On Whether Cheerleading Is A Sport
Overall, the nonathletes who had been active in college had better health in middle age than the athletes. They also were healthier than people of the same age in the general population who were not involved in the study.
"We have a lot of resources for our athletes," Simon says. She's an athletic trainer herself, so she should know. "But most of them are geared toward making them the best athlete they can be when they're at the university. There's not a lot of talk about what you're going to do when you leave. Football is not a lifetime sport."
Obviously not all former athletes are having problems. But college athletes are starting to realize that their intense training and competition can make for health problems later. Student athletes at Northwestern University are pushing to unionize, and their demands include health care after college.
The study was published in the February American Journal of Sports Medicine.
This study has a number of limitations. It is skewed toward football players, who made up 40 percent of the athletes. And there are more men: 167 men compared with 65 women. And the results were self-reported.
Simon is now working on expanding the study to measure participants' present-day health in the laboratory, including what people are doing compared to what they wish they could. She'll also compare how athletes in different sports fared. "Football is such a different sport," she says.
She hopes that present-day Division I athletes will fare better, because training and sports medicine has improved in the past 40 years. "Maybe they won't be as limited."Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 03/03/2014 - 3:33am
Evidence On Marijuana's Health Effects Is Hazy At Best
by Richard KnoxMarch 03, 2014 3:33 AM Listen to the Story
C. Nash smokes after possession of marijuana became legal in Washington state on Dec. 6, 2012.Ted S. Warren/AP
Colorado opened its first pot stores in January, and adults in Washington state will be able to walk into a store and buy marijuana this summer. But this legalization of recreational marijuana is taking place without much information on the possible health effects.
"We should have been doing a lot more research to find out just how useful it is, how it affects the brain, et cetera, et cetera," according to Dr. Herbert Kleber, a Columbia University psychiatrist and drug abuse researcher.
But he says it's been hard to study the effects of Cannabis sativa, the plant that produces marijuana.Around the Nation No Easy Answers For DUI Concerns As Marijuana Gains Support
A large part of the reason marijuana research has lagged is that it's been very hard to get federal approval for such projects, as well as access to federally sanctioned supplies of the drug.Shots - Health News Marijuana May Hurt The Developing Teen Brain
Kleber hopes that the push to legalize the drug will stimulate long-delayed research. Meanwhile, he thinks it's "a bad idea. I don't think we know what we're getting into."
He's not the only person who would like to see more science on marijuana and health. But not all think the drug poses big health risks, or at least not big enough risks to keep it illegal.
"Most cannabis users are moderate users," says Mark Kleiman, a professor of public policy at the University of California, Los Angeles, who studies drug policy. "They use a joint a week or less."i i
Jacquelene Cohen enjoys an occasional joint as a way to unwind after work.Jonathan Steinberg for NPR
Jacquelene Cohen, the 29-year-old director of publicity for a Seattle publisher, is a typical user — indulging once or twice a month, she says. "It's just like a small pleasure," she says, like "pouring a nice bourbon for a friend or passing a pipe with marijuana in it. It's just something nice to do when you're sitting around conversationally."
While Kleiman doesn't see enough health risks from marijuana to override the push toward legalization, he does worry about users who get hooked on the stuff. He says if the price of marijuana falls too much, it could result in more dependence, especially among adolescents and low-income users.
"The main risk of cannabis," he says, "is becoming habituated to cannabis and spending your whole life stoned."
About 11 percent of marijuana users fit the definition of dependence — that is, their habit interferes with their life and they've been unable to cut back. That's lower than the dependence number for heroin and other opioids (23 percent), cocaine (17 percent), cigarettes or alcohol (15 percent) or nicotine (32 percent).
Heavy users aren't hard to find. "I have friends that I've never seen not stoned," Cohen says. "It doesn't seem that it's that harmful. My friends that smoke a lot of marijuana are productive and creative and sociable, and they form strong relationships and they make good life choices."
The National Institute on Drug Abuse says that while marijuana dependence is similar to that for other drugs, "the long-term clinical outcomes may be less severe."
Cohen passes a joint to her friend Mika Loudon at her home in Seattle, Wash.Jonathan Steinberg for NPR
Surveys show that 16 million Americans use marijuana at least once a month, and 2 million of those meet the criteria for dependence. Kleiman says that's not alarmingly high.
"It's not a very high risk," he says, "but it's a high risk if it's you or your child or your parent or your sibling. So people who say, 'Oh, cannabis isn't abusable, cannabis isn't addictive,' it seems to me just aren't looking at the data."
The addiction potential is higher among those who start using marijuana at younger ages. And the higher potency of marijuana these days may increase the risk of dependency, although data are lacking on that point.
Psychological treatment to wean marijuana users from dependency works about 70 percent of the time, according to Kleber, the Columbia University researcher. There's promising research indicating treatment can be improved with medication — in particular a combination of synthetic THC (the main psychoactive ingredient in marijuana) plus a long-acting drug for high blood pressure only available in Europe.
When it comes to other adverse health effects, the evidence is unclear.
Marijuana smoke contains many of the same toxic chemicals as cigarette smoke. But even heavy marijuana smokers don't seem to have more lung cancer or emphysema.Shots - Health News Florida Bill Would Allow Medical Marijuana For Child Seizures
"Oddly enough," Kleiman says, "the epidemiology has not come in to support the microbiology. The obvious speculation is that there's something else in cannabis that's actually a tumor-suppressing agent, and people are looking hard at that now."The Salt Marijuana-Laced Treats Leave Colorado Jonesing For Food-Safety Rules
Many worry that marijuana might increase the risk of schizophrenia. Authorities say there's enough evidence to warn against marijuana use for anybody who's had a psychotic episode or a family history of schizophrenia. Still, as millions of people have used marijuana in recent years, the incidence of schizophrenia has remained static, at around 1 percent of the population.
And then there's driving under the influence.
Kleiman says one study allowed heavy marijuana users to smoke as much as they wanted before testing them on a driving simulator.
Even when the subjects were "as stoned as they want to be," he says, they were about as impaired as people who just meet the drunken-driving threshold.
That's not entirely reassuring. But it suggests that marijuana might not be as dangerous as alcohol when it comes to driving.
But here's an important point: Kleiman says there's some evidence that marijuana users may be driving-impaired for hours after they think their high has worn off.
"That's where a real public health campaign could make a difference," Kleiman says, "saying if you smoke cannabis, do not drive for something like six hours after — we'd have to do the research. That's a lot longer than the subjective high lasts. But it's probably what you need to get people actually safe."
Kleiman adds one more key point: "Cannabis is much more dangerous when it accompanies even a little bit of alcohol." So he thinks the blood-alcohol limit for drivers with any level of cannabis in their blood should be zero.
Of the states considering legalization, most are considering legalizing recreational marijuana (17 states) or decriminalizing possession of small amounts (12 states and the District of Columbia). Twenty states plus Washington, D.C., allow marijuana sale for medical use, although in some places the medical pretext is slim.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 03/03/2014 - 3:32am
Marijuana May Hurt The Developing Teen Brain Listen to the Story
The teenager's brain has a lot of developing to do: It must transform from the brain of a child into the brain of an adult. Some researchers worry how marijuana might affect that crucial process.Shots - Health News Evidence On Marijuana's Health Effects Is Hazy At Best
"Actually, in childhood our brain is larger," says Krista Lisdahl, director of the brain imaging and neuropsychology lab at University of Wisconsin, Milwaukee. "Then, during the teenage years, our brain is getting rid of those connections that weren't really used, and it prunes back.
"It actually makes the brain faster and more efficient."
The streamlining process ultimately helps the brain make judgments, think critically and remember what it has learned.
Lisdahl says it's a mistake for teenagers to use cannabis.
"It's the absolute worst time," she says, because the mind-altering drug can disrupt development. Think of the teen years, she says, as the "last golden opportunity to make the brain as healthy and smart as possible."
Lisdahl points to a growing number of studies that show regular marijuana use — once a week or more — actually changes the structure of the teenage brain, specifically in areas dealing with memory and problem solving.
That can affect cognition and academic performance, she says.
"And, indeed, we see, if we look at actual grades, that chronic marijuana-using teens do have, on average, one grade point lower than their matched peers that don't smoke pot," Lisdahl says.
In one study, researchers from Duke University analyzed data gathered over many years from people living in New Zealand. They compared IQs in childhood through age 38 among marijuana users and nonusers.
"We found that people who began using marijuana in their teenage years and then continued to use marijuana for many years lost about eight IQ points from childhood to adulthood," says study author Madeline Meier, now a professor at Arizona State University, "whereas those who never used marijuana did not lose any IQ points."
The amount people smoked also made a difference. Those who smoked the most — at least every day — saw the greatest drop in IQ, the full 8 points. And the younger they were when they started using cannabis, the greater the IQ decline.
It wasn't just IQ. Adults who smoked marijuana as teenagers did worse in tests of memory and decision-making than adults who hadn't smoked pot.
But there's an important caveat here: Those who used the most marijuana in the Meier study had lower IQs to begin with. Dr. Gregory Tau, a psychiatrist and drug abuse researcher at Columbia University, says there's a chicken-and-egg dilemma with many marijuana studies, including this one.
"It's very possible that there's something very different to begin with among teenagers who tend to get into trouble with marijuana or who become heavy users," Tau says. "They could have subtle emotional differences, perhaps some cognitive functioning differences.
"It may be hard for them to 'fit in' with a peer group that's more achievement-oriented."
These differences could predispose them to use pot.
Tau says more funding is needed for better-designed long-term studies. Current research is inadequate to answer all of the questions about marijuana risk. But he says some things are common sense.
"It's not rocket science to think if you smoke weed when your brain is developing, that it can't be 'good' for you, just like any 'toxic' substance isn't good for you," he says.
Such concern seems to be lost among teenagers themselves. In a recent federally sponsored survey, 60 percent of high school seniors say they think marijuana is safe, and 23 percent say they've used marijuana in the past month — more than those who used alcohol or smoked cigarettes.
Six percent of high school seniors say they use pot every day, which is triple the rate over the past decade. And, the marijuana they smoke is much more potent than it was in the 1970s, with far higher levels of THC, the main mind-altering ingredient.
"The higher the THC levels, the more brain changes there are and the more there is the risk for addiction," the University of Wisconsin's Lisdahl says.
She says more teens and young adults are smoking marijuana in states that have made the drug available for medical use. She says that's worrisome because it might be a harbinger of things to come if pot is fully legalized.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 03/03/2014 - 12:02am
Noise Machines To Help Babies Sleep Can Raise Quite A Din
by Katherine HobsonMarch 03, 201412:02 AM i i
Noise machines to help infants fall asleep can be so loud that they pose a hazard, researchers say.iStockphoto
About a year ago, pediatric otolaryngologist Blake Papsin went into a patient's room at The Hospital for Sick Children in Toronto. He was surprised by the roar of a sleep machine the parents had brought to help their child conk out amid the beeps and buzzes of the hospital.
"I can't even talk to you. It's too loud,' Papsin remembers telling the parents. That chance encounter sparked his interest in measuring exactly how loud the infant sleep machines, designed to mask environmental sounds, can get.
The answer: pretty loud. In research published online Monday in Pediatrics, Papsin and his colleagues report that at maximum volume, all 14 machines tested exceeded 50 A-weighted decibels, or dBA, measured at a distance of about a yard or closer. (A dBA is a unit of sound pressure adjusted to account for how the human ear actually perceives the sound.) All but one machine were capable of exceeding 50 dBA even from a distance of about 2.2 yards.Shots - Health News Simple Test For Babies Could Help Spot A Virus That Damages Hearing Shots - Health News Shhh, The Kids Can Hear You Arguing (Even When They're Asleep)
At 50 dBA, more than an hour of noise exposure would exceed the recommended maximum noise level for babies in hospital nurseries and NICUs.
Measured at a distance of about a foot, or about the distance from a baby to a crib rail, three of the machines produced sound exceeding 85dBA at maximum volume. That happens to be the recommended workplace noise limit for adults over an 8-hour period, which the researchers said may not be conservative enough given infants' developing senses.
Exposure to loud noises can damage infant hearing and physiology, and background noise can disturb sleep, the researchers said. The study didn't look at how parents actually use the machines, so the volume and distance from the baby in the real world aren't known. And it's not known if babies exposed to the machines are actually experiencing damage, since no such large studies of those kids have been done.
"The conversation we want to start isn't, 'Don't use these, they're dumb,' " says Papsin. But he wants parents to be aware of the potential risk.
The researchers have advice for parents. If you use one of these machines, place it far away from the baby, never in the crib or on the rail. Keep the volume low and only use one of the machines for a little while, not all night.
Papsin says parents can do other things to help their young kids get to sleep, such as installing carpet or double-glazed windows to cut down on noise. It wouldn't hurt to lower the TV volume either.
The researchers recommended manufacturers limit the maximum volume of the devices, include noise warnings on packages and build a timer into devices that shuts them off after a set period.
The trade group representing the companies that make the machines, the Juvenile Products Manufacturers Association, says in a statement that its members "welcome any and all information that will advance the safety and wellbeing of children. And the members apply that information, when applicable, in the safety and design of products."Copyright 2014 NPR. To see more, visit http://www.npr.org/.