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To Die At Home, It Helps To Have Someone Who Can Take Time Off Work

NPR Health Blog - Fri, 10/09/2015 - 9:22am

Having a loved one take at least two weeks off work increased the likelihood that terminally ill cancer patients could die at home.


When a family member of mine was dying of cancer, her husband's boss told him to take all the time he needed to care for her. She was granted her wish of being at home when she left this earth, surrounded by those she loved most.

But a wide base of support is needed in order for a patient's wish to die at home to be made real — including, in some cases, whether someone can take time off work to be with their loved one in their final days, a study finds.

Terminally ill cancer patients whose relatives took at least two weeks off work in the three months preceding their death had a greater likelihood of dying at home, compared with patients whose relatives took no more than three days off.

The study, which was published in BMC Medicine on Thursday, looked at the deaths of more than 350 cancer patients in London. Using feedback from those patients' loved ones, researchers found that four factors could explain 91 percent of deaths that occurred at home: patient's preference, relative's preference, home palliative care or district/community nursing.

Having a comprehensive home-care plan in place is crucial, says lead author Barbara Gomes, a research fellow at the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation at King's College London. That should include specialist palliative care services and the availability of around-the-clock nursing. The number of home doctor visits also increased a patient's chances of dying at home.

But researchers also identified three factors that had been previously overlooked yet still weighed into whether a patient died at home: the length of time in which the family knew the patient's illness was incurable; discussion of the patient's preference with family; and the number of days family members took off work in the three months before the patient's death.

There are a variety of possible explanations for the connection between relatives' days off work and a loved one's at-home death, but Gomes is careful to point out that this retrospective, observational study can't draw a cause and effect on this point.

Some governments have recognized the importance of being with a loved one who is dying and have set up support programs to better facilitate family caregiving. Gomes points to a compassionate care benefit in Canada, which offers employees a paid employment insurance program if they need to care for a gravely ill loved one.

Only three states have paid family leave policies: California, New Jersey and Rhode Island. Both Washington, D.C., and the state of New York are considering paid family leave legislation, and the FAMILY Act was introduced in Congress this year with the goal of providing a national paid family and medical leave insurance program.

David Bolotsky, founder and CEO of the online marketplace and retailer UncommonGoods, provides his employees at the Brooklyn-based company with paid leave. Not all American workers are so lucky: Every company has a different policy and different leave benefits. Although many workers are eligible for the federal Family and Medical Leave Act to care for a child, parent or spouse with a serious health condition, that leave is unpaid, which can make it financially impossible.

Bolotsky argues for providing paid family leave to all employees, as he did recently in an op-ed in support of the New York bill. "For most of us, nothing is more important than our families," he says. "The folks who raised us ought to be able to have a dignified passing, and being able to be there with your loved ones is really important."

The British study also found that dying at home was more peaceful for the patient and led to less grief among their loved ones. And the people who died at home didn't experience more pain than those who were in a hospital.

Though health care should ideally be patient-centered, Gomes says remembering the crucial role that relatives play in the decision-making process and in the actual caregiving is important.

She recommends that health care providers encourage the patient and loved ones to discuss preferences for where the terminally ill patient will die, as well as acknowledge that preferences may change as time goes on.

Providers should also help the patient and relatives become aware of the medical supports and services available to them, along with explaining that staying at home to die may not be medically feasible.

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California Approves Laws To Cut Use Of Antipsychotics In Foster Care

NPR Health Blog - Thu, 10/08/2015 - 4:23pm

Children and teens in foster care are much more likely to be prescribed antipsychotic drugs.


Efforts to protect children in foster care from being inappropriately medicated with powerful antipsychotic drugs got a big boost forward on Tuesday, when California Gov. Jerry Brown signed three bills into law designed to reform prescribing.

Overprescribing of psychiatric meds for foster youth is a persistent problem nationwide, with children given the drugs at double or triple the rate of those not in foster care.

In 2011, the federal Government Accounting Office found nearly 1 in 4 children in foster care was taking psychotropic medications, which include antipsychotics, antidepressants, mood stabilizers and stimulants.

Hundreds of children were found to be taking five or more psychotropic medications at a time, and thousands were prescribed doses that exceeded FDA-approved guidelines. According to the report, monitoring programs fell short of guidelines established by the American Academy of Child and Adolescent Psychiatry. Many of the medications have side effects that include lethargy, weight gain, diabetes and tremors.

The California legislation, which covers 63,000 children and teens in foster care, will allow public health nurses access to medical records to monitor the foster children who are prescribed psychotropic drugs; identify the group homes that rely most on these medications and potentially require them to take corrective action; and provide child welfare workers with better training and oversight tools to spot dangerous prescribing practices.

Shots - Health News California Moves To Stop Misuse Of Psychiatric Meds In Foster Care

"I hope the approval of this legislation tells our foster care youth that we love them, that their lives matter to all of us and that we care deeply about their future," said state Sen. Jim Beall, a San Jose Democrat, author of two of the bills.

The Oakland-based National Center for Youth Law, which was among the legislation's sponsors, called it the most comprehensive effort in the U.S. to date to curb the misuse of psychotropics in foster care. However, a bill that would have required a prior medical examination and ongoing monitoring before a juvenile court could authorize psychotropic drugs was pulled from the legislative package following intensive lobbying by associations representing physicians and group homes.

The bill's author said he would reintroduce the measure in January.

Elaine Korry writes about health care and social policy from the San Francisco Bay Area. She recently wrote about antipsychotic medications and foster care for NPR and Youth Today.

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Firstborns May Be More Nearsighted, And Parents May Be Why

NPR Health Blog - Thu, 10/08/2015 - 1:37pm

If you are the firstborn, you probably got a lot more Mom time. Does that mean you're also going to need glasses?


There's a lot of worry about nearsightedness in children, with rates soaring in Southeast Asia as populations become more urban and educated. But maybe it also has something to do with how much Mom and Dad make you hit the books.

Firstborn children are 10 percent more likely to be nearsighted than latter-borns, according to a study published Thursday in JAMA Ophthalmology. And they're 20 percent more likely to be severely myopic.

When the researchers adjusted the data to account for people's level of education, the correlation between birth order and myopia shrank. That's how they came up with the idea that "reduced parental investment in education of children with later birth order may be partly responsible."

OK, helicopter parents, how do you feel now?

Other studies, in Israel and the United Kingdom, also have found that firstborns are more likely to be nearsighted. This study, conducted by researchers at Cardiff University in Wales, looked at data on almost 90,000 adult participants in the UK Biobank study who had had an eye exam.

The researchers had earlier looked at whether firstborns were more likely to be myopic because they're often a little smaller at birth. That turned out not to be true.

"In the current study we set out to test whether the link between birth order and myopia might have arisen because first-born individuals tend to spend slightly longer in full-time education than later-born individuals," Jeremy Guggenheim, the lead author, wrote in an email.

To make sure that there wasn't something about having lots of kids that could affect eyesight, Guggenheim and his colleagues compared families with two children to the entire database, and found the relationship between myopia, firstborns and later siblings to be pretty much the same.

Still, the effect here is pretty small, and the researchers point out that the increase in nearsightedness among children in Asia over the past few decades has been much bigger, suggesting that there are other environmental influences at work.

Higher income, education and less time spent outdoors also increase the risk of myopia, other studies have found. And nearsighted parents are more likely to have nearsighted kids.

Though undiagnosed nearsightedness can cause problems in school, once it's corrected it usually isn't a health issue, unless a person is severely myopic.

Myopia rates in the United States have been reported from 20 to 50 percent, while in some parts of Asia they're up to 90 percent.

Guggenheim is now looking into why outdoor play may reduce the risk of nearsightedness, and just how it's affected by heredity.

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Bill Would Add Nurses, Physician Assistants To Pharma Disclosure Database

NPR Health Blog - Thu, 10/08/2015 - 11:02am

Sen. Charles Grassley, R-Iowa, and a Democratic colleague have introduced a bill that would require drugmakers and medical device companies to disclose payments made to physician assistants and nurses who can prescribe their products.

Brendan Smialowski/AFP/Getty Images

A bill proposed Wednesday by two U.S. senators would require drugmakers and medical device manufacturers to publicly disclose their payments to nurse practitioners and physician assistants for promotional talks, consulting, meals and other interactions.

The legislation would close a loophole in the Physician Payment Sunshine Act, which requires companies to report such payments to doctors, dentists, chiropractors, optometrists and podiatrists. Companies have so far released more than 15 million payment records, covering August 2013 to December 2014.

As ProPublica and NPR reported in July, the 2010 law doesn't include nurses with advanced degrees or physician assistants, even though they, too, can prescribe medications. Some have gotten in trouble for accepting kickbacks.

The bill, introduced by Sen. Charles Grassley, R-Iowa, and Sen. Richard Blumenthal, D-Conn., would expand the disclosure requirement beginning in 2017 to include physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives.

"We think that the void should be filled in order to have a complete record," Grassley said in an interview. "Transparency isn't an end to itself. Transparency is meant to bring accountability."

Because the data aren't publicly reported, it's unknown how much money these professionals receive from makers of drugs and medical devices, or whether that figure has increased since disclosure of payments to doctors was required. But in recent years, a few nondoctors have been criminally charged with taking kickbacks from industry.

A nurse practitioner in Connecticut pleaded guilty in June to taking $83,000 from Insys Therapeutics in exchange for prescribing its high-priced medication Subsys to treat cancer pain. In some cases, she delivered promotional talks attended only by herself and a company sales representative.

And in 2012, a physician assistant in Rhode Island was sentenced to six months in prison and six months of home confinement after pleading guilty to taking kickbacks from a medical device company. The company paid him $50 to $300 for each bone growth stimulator ordered by the surgeon he worked for — all told, some $120,000 between 2004 and 2011. The company, Orthofix, and several of its officials also pleaded guilty to charges including fraud, obstruction, kickbacks or perjury.

Blumenthal, the new bill's co-sponsor, said the Connecticut case was "a clear, loud alarm bell."

"Doctors need to be held accountable, but so do all the other providers," he said. "Requiring these companies to disclose gifts and payments made to other health care providers, not just doctors, is absolutely necessary in today's world."

Allan Coukell, senior director for health programs at the Pew Charitable Trusts, said that when the initial Sunshine Act was drafted, nurse practitioners weren't part of the discussion.

"It's an important step," Coukell said of the new legislation, called the Provider Payment Sunshine Act. "Nurse practitioners and physician assistants write a lot of prescriptions, and this creates a level playing field with the same kind of transparency as the original Sunshine Act created for physician payments."

A ProPublica analysis of prescribing patterns in Medicare's prescription drug program, known as Part D, found that nurse practitioners and physician assistants wrote about 10 percent of the nearly 1.4 billion prescriptions in the program in 2013. They wrote 15 percent of all prescriptions nationwide (not only Medicare) in the first five months of this year, according to IMS Health, a health information company.

For some drugs, including narcotic controlled substances, nurse practitioners and physician assistants were among the top prescribers.

Supporters of the new bill declined to handicap its chances of passage.

Separately, a bill called the 21st Century Cures Act, which passed the House of Representatives in July, includes provisions that would water down disclosure requirements in the Sunshine Act. Intended to speed the development of new treatments, the Cures Act would exempt companies from having to disclose the value of medical journal reprints and textbooks they give to physicians (they currently have to disclose them), as well as payments for continuing medical education and speaking engagements that do not promote a particular product.

The Centers for Medicare and Medicaid Services, which aggregates the industry disclosures and releases them once a year, said it does not comment on pending legislation. The American Association of Nurse Practitioners, a trade group, said it doesn't yet have an opinion on the issue.

Look up your doctor in our Dollars for Docs interactive database to see if he or she has received payments from drug or device companies in 2013–2014. Also read our story about doctors who had the most interactions with the industry.

Copyright 2015 ProPublica. To see more, visit .
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Despite Sweeping Aid-In-Dying Law, Few Will Have That Option

NPR Health Blog - Wed, 10/07/2015 - 5:48pm

The "death-with-dignity" movement took a giant step forward this week, with 38 million people coming under its umbrella in a single swoop when California Gov. Jerry Brown signed the End of Life Option Act on Monday.

But the law still leaves out a wide range of people who might want to be covered: people with progressive debilitating diseases that don't have an obvious six-months-to-live prognosis and people with dementia, the fastest-growing health threat in the U.S. That's also true of similar laws in Oregon, Washington, Montana and Vermont.

And there might be no good way around this.

These restrictions might be necessary at this point in the history of aid in dying in this country, according to Judith Schwarz of the advocacy group End of Life Choices New York. "Opponents have many fears that such laws will be misapplied to the disenfranchised," she wrote in an email, and it's important to guarantee that for these groups — the poor, the elderly, the isolated — the "right to die" doesn't somehow morph into the duty to die "for the sake of others."

Still, there's a problem with limiting the death-with-dignity option only to those with a prognosis of fewer than six months. For one thing, prognosis is difficult, and studies show that doctors are actually overoptimistic in their assessment of how long their patients have to live. "Some doctors may wish to be more compassionate and not be as specific," Janis Landis, president of the Final Exit Network, wrote in an email, "and ironically thus deny the patient the certification that is required."

And then there are the conditions that are completely unpredictable, not only in terms of life expectancy but in terms of how, when and in what order functions will be lost. This includes progressive neurological diseases like multiple sclerosis and ALS, where those who want to avoid the most debilitating final stages might end their lives prematurely, afraid that their ability to swallow a pill might disappear without warning.

"Fear of this actually drives some individuals to act early, while they can still procure the equipment they need," Landis wrote. To her, it seems especially harsh "to force such a cruel choice on an individual already suffering so greatly."

As fraught as it is, though, the requirement that a person be able to swallow lethal medication on his own is an important safeguard, according to Mickey MacIntyre, the chief strategic officer of Compassion & Choices. "This self-administration requirement is a critical distinction between medical aid in dying and euthanasia," he wrote in an email.

"Unlike medical aid in dying, euthanasia requires a healthcare professional or someone else, not the individual, to administer the medication," he added, "So the individual loses control of the decision."

MacIntyre pointed out that people often change their minds at the last minute, and have every right to do so. In Oregon, he noted, about one-third of the people who obtained lethal drugs through the state's death-with-dignity program since 1998 ultimately decided not to take them.

This seems to be a distinctly American quandary, though. In other countries, such as Belgium and the Netherlands, there are also safeguards written into their right-to-die laws, but they are broader and more inclusive.

"The European safeguard is 'intolerable suffering,' " said Margaret Pabst Battin, a bioethicist at the University of Utah. "It's not defined in terms of the time until death, and it does include people with ALS or other conditions that wouldn't fall under our laws, which don't say anything about suffering."

Peggy Battin is a bioethicist whose husband faced the question after he was paralyzed in a bike accident.

Dese'Rae L. Stage/Courtesy of University of Utah

Battin experienced the complexities of deciding when suffering becomes unbearable in caring for her husband, Brooke Hopkins, who was paralyzed from the shoulders down in a 2008 bicycle crash and lived for five more years, until he finally decided in 2013 to withdraw the machinery keeping him alive.

Earlier this year, the Supreme Court of Canada used European-style language upholding the right to die for anyone with "a grievous and irremediable medical condition ... that causes enduring suffering that is intolerable."

Shots - Health News If You Have Dementia, Can You Hasten Death As You Wished?

A death-with-dignity bill introduced in Battin's own state tried to broaden the safeguards to include people with a wider range of illnesses. On the phone with me, Battin read aloud from the Utah Death with Dignity Act, introduced by Rep. Rebecca Chavez-Houk, which could apply to someone with an "intractable and unbearable illness," defined as "bodily disorder that cannot be cured or successfully palliated, and that causes such severe suffering that a patient prefers death." She said such broad language would no doubt be changed if the bill works its way through the state Legislature, as has happened elsewhere.

But people with Alzheimer's disease and other forms of dementia are beyond the scope of almost all these laws.

Schwarz said that maybe, very far in the future, there might be some way to cover dementia, but it's "so complicated" that she doesn't see it happening anytime soon. How, for instance, do you write legislation to deal with the question of personhood, which alters as the disease progresses? Is the demented individual — perhaps someone relatively content in her diminishment — "the same as the individual who so FIRMLY REQUESTED/DEMANDED lethal meds at a certain point in their future demented state?" Schwarz wondered. "And who are you going to get to administer lethal meds under such circumstances?"

Schwarz spends a lot of time these days with Alzheimer's patients who want to choose the timing of their deaths. She said all she can offer them is guidance about stopping eating and drinking as a way to hasten the end.

"It's a very, very hard choice to make when life still has pleasure & purpose," she wrote. But "the window can close" on a person with dementia, affecting the ability to refuse food and water once that person can no longer feed herself and caregivers enter into the decision.

This means that a self-directed death for someone with dementia might always have to mean saying farewell to life a bit sooner than she might have otherwise chosen.

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Scientists Grow Primitive Human Kidneys In A Dish

NPR Health Blog - Wed, 10/07/2015 - 1:45pm
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Image of a mini-kidney formed in a dish from human induced pluripotent stem cells.

Minoru Takasato/Nature

For the first time, primitive human kidneys have been created in a laboratory dish, by using stem cells.

Although the kidneys cannot perform the functions of a fully formed adult kidney, the researchers hope the achievement will someday lead to new ways to treat people suffering from kidney failure.

"It's really exciting," says Melissa Little, who heads the Kidney Research Laboratory at the Murdoch Children's Research Institute in Australia. She led the research, which was published Wednesday in the journal Nature. "I think this is a really big advance."

Kidneys are essential for life. They perform a host of crucial bodily functions, including filtering toxins from the blood and regulating blood pressure and bone density. But kidneys can fail for a variety of reasons, including poisonings, infections and other diseases.

"The problem is that if something goes wrong with your kidneys, there are only two options and these have been the same for 50 years: You either have a transplant or go onto dialysis," Little says. "So we really need alternative options."

To find alternatives, Little and others have been trying for years to grow kidneys in the lab using cells known as induced pluripotent stem (iPS) cells.

This 11-second clip shows the specialized, functioning structures of a kidney, including ducts, that was grown in the laboratory using stem cells.

NPG Press/ YouTube

"Almost 10 years ago now it was shown that you could take any cell from anybody — like you or me — and actually convince it to go back into the state that's essentially like the fertilized egg, so it is able to turn into any tissue type," Little says.

While scientists have been able to use iPS cells to create many types of human cells, using them to create a kidney has proved difficult. The problem has been finding just the right combination of chemical signals to trigger iPS cells into making the various tissues in a kidney.

"It's like a recipe," Little says. "We put different concentrations and types of growth factors in a certain order into the dish. And then when it gets to a certain size we take all the cells and make it into a ball."

After that, the cells talk to each other, she says. One type of cell will signal to its neighbor, and its neighbor will signal back, and that actually makes them form the appropriate shape.

They were able to create some – but not all — of the key structures of a kidney, including nephrons, which are involved in filtering toxins from the blood and producing urine.

"It's an incredible process," she says.

In the new study, Little and her colleagues report they finally found the right recipe to create kidney "organoids" — very small, primitive kidneys that are more like the kidney in a fetus.

They are only able to do some of the functions that a kidney performs, such as filtering toxins from blood, Little says. The organoid is not advanced enough to do all the very complicated balancing that a completely formed kidney does.

Little's group is hoping the organoids may eventually continue developing into more fully functioning kidneys.

In the meantime, the primitive organs could possibly be used to help save failing kidneys by transplanting parts of them into patients, she says. Whether that will work remains to be seen.

Another use may be in pharmaceutical research. Companies could use the tissues to test new drugs.

"The pharmaceutical industry is really interested in having organoids made from human cells that will be good proxies for human kidneys so they can do their safety testing on those," says Jamie Davies, a professor of experimental anatomy at the University of Edinburgh who was not involved in the research. He wrote a commentary that accompanies the paper in Nature.

"The really long-term application and the thing we're all trying to do is to produce from a patient's own cells to produce new kidneys for them," he says.

"This is taking quite a big step forward," Davies says, toward that goal.

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Reversing Opioid Overdoses Saves Lives But Isn't A Cure-All

NPR Health Blog - Wed, 10/07/2015 - 1:17pm
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In Boston, Edmund Hassan, a deputy superintendent of emergency medical services, and his colleagues regularly revive people who have overdosed on opioids.

Jesse Costa/WBUR

With his ambulance sirens blaring, Edmund Hassan speeds to a home in South Boston after getting a call that someone there is unconscious. He's deputy superintendent of Boston Emergency Medical Services, and he suspects an opioid overdose. These days, he says, his workers administer Narcan, the drug that reverses that kind of overdose, roughly three times in every eight-hour shift.

With overdoses from heroin and opioid painkillers a leading cause of accidental deaths in the U.S., people on the front lines of the opioid battle are increasingly turning to Narcan (also known as naloxone) to save lives. In many cities, police, school nurses, and family and friends of drug users, as well as drug users themselves, commonly carry Narcan now. The Centers for Disease Control and Prevention reports that the use of naloxone kits by laypeople reversed at least 26,463 overdoses between 1996 and June 2014.

But being saved in the short run from an overdose is no guarantee that someone will stop using drugs. Narcan is one tool to improve the odds of survival, many health providers say, but more long-term solutions to addiction are needed, as well.

Hassan's radio crackles in Boston, and his hunch about the case he's about to face is confirmed: an overdose. Additional workers are dispatched to the scene.

When Hassan arrives at the single-family home, a team of emergency workers and firefighters is already there. Several people are running to the back of the house and down some steps into the basement. In the far corner, a middle-aged man is on the ground; two people are sobbing nearby. The crew rushes to administer naloxone, squirting it into the man's nose.

"OK, he's getting some Narcan now," Hassan explains to a woman standing nearby.

"You just found him here?" he asks her.

"Yes," she says, arms clenched around her body, tears in her eyes. "He's my husband."

"Has he ever used heroin before?" Hassan asks her.

"A long time ago," the man's wife says. "I thought he stopped." His son had discovered him unconscious in the basement.

We are not identifying the man because of medical privacy concerns. Hassan tries to reassure the family, as he and his team continue to work.

The emergency workers massage the man's chest, clap their hands in front of his face, yell his name and adjust a plastic ventilator over his mouth and nose to try to get him breathing again. Hassan explains that an overdose slowly shuts down a patient's respiratory system so the man needs help breathing until the Narcan kicks in.

After more than five minutes, the man's eyes open, and he groans.

"Come on, you want to try to get up?" a member of the team asks, as they walk him to the ambulance. Hassan says the emergency room will take over from here.

"As EMS providers, this call is a success," Hassan says. "In the big picture of health care, is it a success? Well, no, it's incomplete right now. For it to be a total success he'd get into a rehab program and never do heroin again."

After A Narcan Revival, Most Don't Get More Treatment

But, that's not what usually happens Hassan says. "At some point, we probably took care of him before."

Another 31-year-old Boston man named Joseph, who didn't want his last name used because of the stigma associated with his past substance abuse, had just the sort of experience Hassan is talking about.

Joseph says he's been revived by Narcan "about four to five times in my life" — and it was a terrible experience each time.

Naloxone nasal spray, also known as Narcan, is used by emergency squads in Boston about three times a night to revive people who have overdosed while using heroin or opioid painkillers.

Jesse Costa/WBUR

"It's horrible," he says of the experience of waking up after getting Narcan. "The worst withdrawals you ever felt in your life. You feel like you want your high back, almost. You just wanna die, you know. It's that bad."

The problem, he says, is that the lure of heroin's high can be so great that the risk of facing Narcan's nasty side effects — even the risk of dying from an overdose — isn't strong enough to beat back the addiction.

Joseph says that most of the time he has been brought to an ER because of an overdose, he has been discharged after only about three hours, without any recommendations about getting further treatment.

"They let you kinda sleep it off," he says. "They just discharge you and they tell you you need to get help — you need to do something."

Many ER doctors say that after a Narcan revival, if a patient appears to be breathing fine and walking, they are indeed discharged within a few hours. Many are so sick and uncomfortable they just want to leave. And even if they do want further counseling and extended treatment for their addiction, access is limited by availability and insurance.

"For myself, basically, they'd have to be able to walk safely, be able to have a conversation, be able to take fluids before they're released," says Dr. Edward Bernstein, a professor at Boston University, and an emergency physician at Boston Medical Center. Before the patients leave after a Narcan revival, most are given their own Narcan kit and information about further treatment.

But less than half the overdose patients revived with Narcan at the medical center actually do go on to get follow-up help with their addiction. That's often because there are no beds available, he says.

"You do feel helpless," Bernstein says. "Especially since we're trying our best, and we have all these different tools now."

About A Third Of Patients Revived By Narcan More Than Once

Repeatedly having to use Narcan on the same patient can make a health provider feel helpless, Bernstein says. About 30 percent of those revived with Narcan at Boston Medical Center have been revived there more than once, he says, and about 10 percent of patients more than three times. Those statistics are in line with what's seen in ERs elsewhere, public health officials say.

That doesn't mean Narcan isn't working, Bernstein says. He believes the repeated revival rate often seen in ERs reflects the fact that addiction, though still often stigmatized as a failure in character, is a chronic health problem. And like asthma, hypertension, heart failure and other chronic health problems, it's hard to control and requires multifaceted treatment.

"Asthma, hypertension, heart failure — we see these folks back numerous times," he says. "So I'm not surprised people with opiate addiction and other addictions come back to the emergency room more than one time."

The broad distribution of Narcan kits is a useful part of the solution, he says — though just one part. "We have to work on, basically, one day at a time, one step at a time, one life at a time. I think it would've been a lot worse if we hadn't had all these things in place."

Sometimes, after a Narcan treatment, Joseph says he felt so bad he just went home and shot up more heroin. "It's a vicious, vicious cycle," he says.

It's a cycle he's hoping to break. After struggling with opioid use for 15 years, he's been in treatment for more than a year. Narcan, he says, has been just one step on his journey to recovery.

Hassan says the bottom line is that Narcan saves lives so Joseph and others addicted to opioids can one day save themselves.

"Our job, as EMTs and paramedics, is dealing with the immediate crisis," Hassan says the day he revives the man in a South Boston basement. "We got him breathing again. That's a victory for us, but it is a very small victory. I guess it's one small battle in a very big war."

Hassan may never know whether the man in South Boston will win his battle. Though the emergency crew did give him a referral for further addiction treatment, we were prevented by medical privacy laws from learning whether he followed up and got it.

We left him at the doors of the ER, where his son walked up to the stretcher, took his father's hand and said, "I'm glad you're alive, Dad."

A longer version of this story ran on WBUR's blog CommonHealth, where you can find more coverage of the opioid addiction crisis in Massachusetts.

Copyright 2015 WBUR. To see more, visit
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Unhappy With Your Company's Health Savings Account? Move It

NPR Health Blog - Wed, 10/07/2015 - 9:35am

When it comes to health savings accounts and the so-called Cadillac tax on expensive health plans, the questions just keep coming. And what do you do about adding grandchildren to a health plan? Let's tackle that one, too.

Last year, my wife and I opened a health savings account. Since then, my account has been moved twice, and we have no choice as to who manages it. We can't shop around for someone with lower fees. I think that is a big flaw in the system. Why can't I choose to have my HSA with the same company I have my brokerage account?

You may be able to do just that. Any contributions you make or your employer makes to a health savings account belong to you, and you can transfer the funds to a different HSA with another HSA provider that offers lower fees or better services if you wish, say Treasury Department officials. If you want to move the money to the company where you have your brokerage account, you can, provided that company offers health savings accounts.

Health savings accounts, which were first offered in 2004, must be linked to a health plan that meets certain standards, including having a deductible of at least $1,300 for individual coverage and $2,600 for a family plan in 2015.

The accounts offer people a way to save money tax free to use for medical expenses. Depending on the account, contributions may earn interest, or account holders may invest the money in the market.

Many HSA account providers charge a monthly maintenance fee that may range from a few dollars to $7 or $8, says Eric Remjeske, president of Devenir, an HSA research and consulting company.

"Some just charge a fee but don't offer a lot of services," Remjeske says, "while others say it's $2 a month, but here are all the services you get," which may include a debit card and online tools or calculators.

The individual platinum plan that I purchased on the marketplace costs $12,000 a year. In 2018, I believe I'll owe 40 percent of $1,800 in excise tax because my plan will qualify as a "Cadillac plan." Is my calculation correct?

No, you won't be subject to the tax. Although your figures are correct, only group plans — not individual plans like yours purchased on the health insurance marketplace — are subject to the health law's so-called Cadillac tax. Group health plans are those usually offered by an employer or union.

Starting in 2018, group health plans whose premiums exceed $10,200 for single coverage or $27,500 for family coverage will be subject to an excise tax of 40 percent on the amount over those thresholds. The tax, which will be paid by insurers and employers, is intended to dissuade them from offering plans with very generous benefits. Such gold-plated plans may encourage people to get unnecessary tests and other care they may not need, which drives up spending overall. Some advocates have pointed out, however, that plans may be expensive for other reasons, for example, because they're offered in high-cost areas or cover disproportionate numbers of old or sick people.

You're correct that the excise tax would be 40 percent of $1,800, the amount over the $10,200 cutoff. But you won't owe that $720 because you have an individual plan.

The tax grew out of the congressional debate over the health law. Some people wanted to begin taxing workers on the value of their employer-sponsored health insurance. The excise tax on expensive plans was seen as a more palatable alternative that could accomplish some of the same goals. But it remains unpopular, and efforts to repeal it continue.

Many self-employed individuals can also reduce their taxable income by deducting the premiums they pay for health insurance from their income taxes, similar to the perk that workers with employer-sponsored coverage enjoy. However, applying the excise tax to people with individual coverage wasn't considered during the health law debate, says Timothy Jost, a law professor at Washington and Lee University who is an expert on the health law.

Can I add my newborn grandchild to my health insurance, if my son is not married and is covered under my plan?

It's unlikely you'll be able to do so. The health law requires insurers and employers that cover dependents to make coverage available until children reach age 26. But coverage isn't required to be offered to grandchildren.

However, it's still worth asking your employer if you can add your grandchild to your plan, says Cheryl Fish-Parcham, private insurance program director at Families USA, an advocacy group.

In addition, your grandchild may be eligible for Medicaid, the federal-state program for low-income people, or CHIP, which has slightly higher income limits. There are special eligibility rules for children who are tax dependents of someone who is not their parent or a spouse, says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. You can also purchase a "child-only" policy on the health marketplace in your state.

Copyright 2015 Kaiser Health News. To see more, visit
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Hospitals Still Don't Give Moms Enough Support For Breast-Feeding

NPR Health Blog - Tue, 10/06/2015 - 8:53pm

Most hospitals around the country aren't doing a good job of helping new moms who want to breast-feed, researchers report Tuesday in the journal Morbidity and Mortality Weekly Report.

Several common practices at the institutions may actually prevent moms from sticking with breast-feeding for six months — the duration thought to be most healthful for babies.

Epidemiologists at the CDC surveyed more than 80 percent of the birthing centers across the country about the support they give new moms trying to breast-feed. About half of those surveyed said they implement five of the 10 practices recommended by the World Health Organization. By comparison, only a third of hospitals were hitting that mark in 2007.

"We've seen significant progress in recent years," Dr. Tom Frieden, the director of the Centers for Disease Control and Prevention, told reporters at a press conference. "But there's still more to be done. ... Hospitals really need to support women before, during and after their hospital stay."

Shots - Health News I'm An Obstetrician And I Failed At Breast-Feeding

And, too often, that's not happening. For example, about 75 percent of hospitals still give healthy babies some formula in the first days of life, even when moms say they want to breast-feed.

"Even a little bit of formula may undermine a strong start to breastfeeding," Frieden says.

Only about a third of hospitals offer women breast-feeding help after they leave the hospital — by referring women to support groups, for example, or checking in with them after they go home, or connecting them with lactation consultants.

Such support can be crucial for helping moms push through the early challenges of breast-feeding, says epidemiologist Cria Perrine, who led the study.

Many mothers say they quit breast-feeding because of pain, or because of concerns that they aren't producing enough milk, or because the baby is having trouble latching on correctly.

"These problems can be overcome with early professional support," Perrine says, especially in the first few days after moms go home from the hospital.

On the flip side, many birthing centers — about 90 percent — are teaching women how to breast-feed, Perrine and her colleagues found. And 65 percent are encouraging moms to breast-feed within the first hour after birth. "A mother needs every opportunity to express her milk in the beginning to establish her supply," Perrine says.

Pediatrician Valerie Flaherman at the University of California, San Francisco, tells Shots she agrees that getting moms to breast-feed right away in the hospital is important. But she thinks some of the 10 best practices recommended by the WHO could use some updating.

The list hasn't changed since it was first drafted more than 20 years ago, she says. "Practices like that should be periodically re-evaluated, perhaps every decade, looking at fresh evidence in the area."

For example, WHO recommends limiting an infant's use of a pacifier. But there's little scientific evidence to back up the claim that pacifiers inhibit breast-feeding, Flaherman says.

"Maybe there are other practices that have become more important — or we've discovered are more important — and we're not capturing them in the list," she says. "I mean, did we really get them perfectly right 20 years ago?"

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Freezing Ovaries Before Cancer Treatment May Preserve Fertility

NPR Health Blog - Tue, 10/06/2015 - 7:03pm
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Ovarian tissue containing hundreds of small resting eggs is prepared to be transplanted back after cancer treatment.

Courtesy of Claus Yding Andersen

Women with cancer often lose their fertility after chemotherapy and radiation. But fertility can be restored in some women by removing all or part the ovary, freezing the tissue before cancer treatment and then transplanting it back afterward.

Danish researchers looked at 41 women who underwent the procedure between 2003 and 2014. They found that about one-third who tried to have a baby actually succeeded.

It's the largest number of transplants evaluated since doctors started doing the procedures in the early 2000s.

"This is a valid method and this does provide fertility to patients," says Claus Yding Andersen, a reproductive physiologist at Copenhagen University who helped conduct the study, which was published Tuesday in the journal Human Reproduction.

"Obviously, the thing that interests them the most is to survive the cancer," Anderson says. "But immediately after that they would say they are really interested in maintaining their fertility."

Women undergoing cancer treatment typically would have less than a 5 percent chance of getting pregnant later, says Glenn Schattman, an associate professor of reproductive medicine at the Weill Medical College of Cornell University.

"The take-home message is that it's a promising technique that offers the chance of preserving someone's fertility in the future," says Schattman, who was not involved in the study.

The success is renewing a debate about whether ovarian transplants should be offered to women without cancer, including those who are worried they're running out of time to have a baby.

Tubes with ovarian tissue are frozen in liquid nitrogen.

Courtesy of Claus Yding Andersen

"So many women are coming into our clinics at age 42 wanting to have a baby and it's kind of too late for the vast majority of them," says Sherman Silber, who performs the procedure at the Infertility Center of St. Louis, a private clinic he runs.

"Either for cancer patients or even for women that wish to delay childbearing, this is a very effective technique," Silber says.

Andersen says that may be true some day. But he argues that much more research needs to be done first.

And Schattman and other fertility experts argue that egg and embryo freezing are much simpler and safer options for women without cancer who wish to preserve their fertility.

"I think for regular fertility preservation in young girls I think it is not appropriate medical care," Schattman says.

The ovarian transplant procedure involves surgically removing all or part of one ovary and then another surgery to transplant it back after cancer treatment. Both surgeries are low-risk, but all surgeries do carry some risk.

About a decade ago, doctors like Andersen started trying the transplants, which at the time were considered highly experimental.

Births to women who have undergone this procedure have been reported sporadically over the years, but no one really knew how effective the approach is.

That led Andersen and his colleagues to look at women in Denmark, which has done more of the procedures than any other country.

The new study focused on 32 women who had undergone cancer treatment and who wanted to get pregnant after ovarian transplant.

Ten succeeded, producing 14 babies, the researchers reported. More women were pregnant when the research paper was being written.

Six of the children were conceived through in vitro fertilization, while the others were were conceived through intercourse, the researchers reported.

The transplanted tissue can continue functioning for years — in some cases even five or 10 years, Andersen says.

"They have a chance to conceive every month," he says.

The researchers also found no evidence that the women who underwent the procedures are at increased risk for a recurrence of their cancer, which has been a concern, he says.

Since the procedure seems safe and seems to be working so well, all women who still want to have children should consider freezing ovarian tissue when they are facing cancer treatment, Andersen says.

"This is now slowly getting to the point where we can start to consider this as something which should be offered to young women with cancer," he says.

Copyright 2015 NPR. To see more, visit
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Can You Really Roll Those Aches And Knots Away?

NPR Health Blog - Tue, 10/06/2015 - 2:01pm

You don't have to get this fancy with a foam roller to gain benefits, researchers say.


When my husband has a particularly tough workout (or workday), he comes home and says, "I have to roll."

He's talking about using a foam roller on body parts including the hips, quads and calves, using his own body weight to supply the force. You've probably seen people rolling in your gym; some facilities even offer classes. The rollers are available in various sizes and can cost as little as $10 — more for fancier ones with grooves intended for more targeted pressure.

But do rollers actually work?

According to a review of research published in the spring, yes — but there are still plenty of questions about exactly what they can do and how to best use them.

The rollers — and related tools like plastic handheld roller massagers — are meant to mimic some of the effects of massage therapy by targeting tight, stiff muscles, says Thomas Best, a sports medicine physician and professor at Ohio State University and author of the review. He and his coauthor identified nine randomized controlled studies that used foam or handheld rollers for self-massage.

Their review of those studies found that using the devices can help increase range of motion and promote quicker recovery after a bout of exercise. What is less certain is whether they can also improve direct measures of performance such as power and speed, says Best.

Another big question, he says: "What's the optimal use of this?" In other words, when should you roll, for how long, and with how much force, to get the best results? It's hard to glean answers from the published studies, which use different methods, target different muscles and measure different things.

For example, one recent study not included in the review looked at the effects of using a special deep tissue roller on NCAA Division I linebackers; it's not clear whether weekend warriors could gain the same hip flexibility as the elites did.

While the rollers can never replace a skilled massage therapist, they can maintain the benefits of massage and provide some interim relief to exercisers, according to Kyle Stull, a master instructor with the National Academy of Sports Medicine and also a senior master trainer and education manager with TriggerPoint Performance of Durham, N.C., one manufacturer of foam rollers and other therapeutic products.

To best mimic a massage, Stull suggests doing a slow roll across a muscle — about an inch per second — until you find a tender spot. Hold it for 20 to 30 seconds until some of the tension abates. And then he suggests doing some movement to activate the area you just worked on, like knee bends after rolling a quad muscle or ankle rolls after working on a calf muscle. In his experience, rolling daily — once before a workout and then again afterward — is best.

But Stull has a few caveats. Runners and cyclists sometimes get pain in their knee due to a tight iliotibial band, the band of tissue that runs along the outside of the thigh between the pelvis and the tibia. "If you have to roll your IT band before and after every run, you're using it as a Band-Aid," says Stull. With that sort of chronic pain or irritation, it's important to investigate the root causes with a physical therapist or other exercise pro.

He also says certain areas are best left unrolled. Pain in the lower back is likely to be caused by tight muscles elsewhere, so rolling the back directly isn't going to do much to address the problem, he says. (He also worries about hurting a kidney or liver if you roll too aggressively.) Tight hamstrings are likely better treated by rolling the quads, he says. And neck pain may be more effectively treated by rolling muscles in the chest, upper back and lats, he says. People with osteoporosis or arthritis should also consult a physician before starting a foam rolling program to find out if there are any areas to avoid.

And how much is this supposed to hurt? "A little bit of discomfort is good," he says. "Excruciating pain, not so good."

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: @katherinehobson

Copyright 2015 NPR. To see more, visit
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Your Chair Is Killing You. Here's What You Need To Do To Stop It

NPR Health Blog - Tue, 10/06/2015 - 11:31am

Instead of sit-down meetings at the office, doctors say we should keep moving.


You've heard it a million times: The hours we spend sitting in front of our computers, sitting in front of the TV and sitting just about everywhere else are adding up. We are sitting ourselves to death.

So it came as welcome news when we read last week that just 10 minutes — 10 minutes! — of walking after sitting for a long period of time can restore the damage to our vascular system.

But what about all those other studies that said we're doomed? Those that say that exercise probably can't save us, and that even if we go to the gym every night, it's still not enough?

But then there's the study telling us we can fidget our way out of the harmful effects of sitting. Should we demand a standing desk or just lean back in our office chairs and throw up our hands?

We here at Shots decided to call up the guy who's arguably the godfather of the sitting-ourselves-to-death concept to get the bottom line: Can we be saved?

James Levine is the inventor of the treadmill desk and co-director of Obesity Solutions at the Mayo Clinic and Arizona State University. He's also a professor of medicine at the Mayo Clinic and author of the book Get Up! Why Your Chair Is Killing You and What You Can Do About It.

Naturally, Levine spoke to us via speakerphone while walking around his office.

Cut to the chase. Is going to the gym a waste of time because we're all doomed anyway?

The vast majority of people — more than three-quarters of the population — do not go to the gym. They simply don't go. People feel stigmatized, it's too expensive and people are simply too busy. So for them, spin classes, Pilates and the amount of it one does is completely irrelevant.

How about your readers who do go to the gym — what's in it for them? This is, I think, where the confusion comes from. But it isn't actually that confusing. What is very, very clear is the following: If you actually go to the gym and exercise, that is a really, really good thing for you. And the data suggests that the more of it you do, the more benefit you will reap.

However, something you do at the end of the day for one hour, three evenings a week, doesn't actually offset the harm for what you do 15 hours a day, seven days a week: sit. These are independent variables — excess sitting and the presence or absence of exercise. Doing exercise is great if you do it. But that doesn't offset the harm, even in the few people who do it, from excess sitting.

Yikes. What is the solution?

When you have the annual staff meeting, [put] up your hand and [say] look, it's obvious that sitting is really harmful. What are we going to do as a company to give us better productivity and better health?

I met with a client at one of our corporate programs. She literally ran up and hugged me. She said, "Dr. Levine, I've lost 35 pounds." I said, "How?" She said, "I decided to take this on as a mission. Instead of watching TV with the kids, we go walking. I take the bus to work instead of my car. At work, I have many of my meetings [be] walk and talk. I sort of built this into my life. And guess what? The weight came off me."

We recommend people drawing up a careful plan about what they're going to do about excess sitting. How about I conduct this telephone call, instead of sitting at my desk, but on a speakerphone pacing around while I'm talking to you. It requires planning.

So there's no quick fix?

Often people want tips and tricks. You know, get a phone with a long cord, get a treadmill desk, get a bouncy ball, get a standing desk, get this, get that. Like anything that's important in our lives, the solution is not tips and tricks. The solution is a proper, sustained assault on the problem.

There's a lot more to be gained by engaging your intellect and coming up with a proper plan than going shopping. And if you're really into this and you feel that [a treadmill desk] will help you, [it] probably will help you. But a treadmill desk isn't the solution in and of itself. The solution is you, the individual.

When you look at the research, do you see questions that remain unanswered?

There are 150,000 unanswered questions, and I think what we could do is delay action for 15 more centuries and do absolutely nothing. But that would be the greatest tragedy of all.

At this point in time, today, we have enough information to share with individuals, companies, schools and cities that we need to get people up off their bottoms, on their legs and off their chairs. That information is sure. And I think there's a lot more research to be done, but we do not need to wait a second longer.

Can you leave us with a few words of inspiration to get us up and going?

In 20 years of building programs for companies and working with patients, I've never had a single person contact me to say this hasn't made their life better. Every person thus far I've interacted with [tells] me that their lives are better in some way. The surprising thing is that this advice comes with a money-back guarantee. I guarantee that if you get up and move more than you do, if you escape the chair sentence, you will be happier for it in some way.

Copyright 2015 NPR. To see more, visit
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Seniors Tend To Quit Medicare Advantage When Health Declines

NPR Health Blog - Tue, 10/06/2015 - 11:02am

Bars show the proportion of people who left one type of Medicare coverage for the other after receiving either long-term or short-term nursing home care.

Credit: NPR; Source: High-Cost Patients Had Substantial Rates of Leaving Medicare Advantage And Joining Traditional Medicare, October 2015

Senior citizens are switching from privately run insurance plans to traditional Medicare when they face serious, long-term health conditions, a study shows.

Researchers at Brown University found that 17 percent of Medicare Advantage patients who entered nursing homes for long-term care chose to switch to traditional Medicare the following year. Only 3 percent of similar patients in Medicare made the decision to go to a private Medicare Advantage plan.

The story is the same for patients who required short-term nursing care or home health care. A larger number switched out of Medicare Advantage plans than chose to move into them from traditional Medicare.

The results suggest that the private Medicare Advantage health plans are managing to get rid of patients once their care becomes too costly, says economist Momotazur Rahman, the study's lead author. "When the plan finds out this patient is very costly, there are incentives for the plan to get rid of the patient," he says.

The findings were published in the October issue of Health Affairs.

The shift of patients who were insured by private companies back to traditional Medicare rolls can cost taxpayers more.

The government pays a set monthly fee for each patient in Medicare Advantage plans. The amount varies according to a risk score for each person. But since the ultimate cost for patient care is borne by the private plans, insurers' profits can suffer if patients are more expensive to care for than expected.

The private plans don't kick people out. But they can provide reasons to leave, Rahman said. Those measures include imposing steep cost-sharing as patients need more expensive care, which is common for nursing or home care patients. They can also limit care for expensive treatments, such as cutting benefits for rehab after a hip replacement. And they can restrict their networks in some areas so physicians who care for particularly ill patients are hard to find or get to.

The Center for Medicare and Medicaid Services has been looking to minimize this so-called adverse selection — when sicker patients move back onto the government's health care rolls. The steps include paying more to private plans for sicker patients, and giving them incentives to manage costs.

These incentives aren't enough, according to Rahman. The agency should consider imposing penalties on the plans, he says, when patients "disenroll."

Medicare Advantage plans "definitely should not be telling people to leave in any kind of way," says Jack Hoadley, an analyst at Georgetown University's Health Policy Research Institute. "There's no evidence in this study that they are."

But limits on care in Medicare Advantage plans that are designed to cut costs can make those plans less appealing to sicker patients, Hoadley says. The Brown study, he says, suggests the incentives in the program aren't working properly.

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California Governor Signs Landmark Right-To-Die Law

NPR Health Blog - Mon, 10/05/2015 - 5:06pm

Debbie Ziegler holds a photo of her late daughter, Brittany Maynard, after the California State Assembly approved a right-to-die measure on Sept. 9. Maynard died on Nov. 1, 2014.

Rich Pedroncelli/AP

Updated at 9:15 p.m. ET.

California Gov. Jerry Brown signed landmark legislation Monday, allowing terminally ill patients to obtain lethal medication to end their lives when and where they choose.

In a deeply personal note, Brown said he read opposition materials carefully, but in the end was left to reflect on what he would want in the face of his own death.

Shots - Health News Contemplating Brittany Maynard's Final Choice

"I do not know what I would do if I were dying in prolonged and excruciating pain," he wrote. "I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn't deny that right to others."

One of the key co-authors of the legislation, state Sen. Bill Monning, a Democrat from Carmel, Calif., said the signing "marks a historic day in California" and called the governor's thoughts "a powerful statement."

Shots - Health News 'No One Should Have The Right To Prolong My Death'

Brown's signature concludes a hotly contested, 10-month debate that elicited impassioned testimony from lawmakers, cancer patients who fear deaths marked by uncontrollable pain and suffering, and religious and disability advocates who fear coercion and abuse.

Marg Hall, an advocate with the Bay Area disability rights group Communities United in Defense of Olmstead, said she was "disappointed" and "worried."

"Given the level of dysfunction and injustice that exists currently in our health care system — with many people without insurance still, with the very underfunded ability of people to have choices for treatment and care — adding this very potentially dangerous tool to the mix is of great concern to people with disabilities," Hall said.

Marilyn Golden, a policy analyst with the Disability Rights Education and Defense Fund, also strongly opposes the new law. It lacks safeguards, she said, adding that she fears abusive heirs or caregivers could "steer" patients toward assisted suicide.

But U.S. Sen. Dianne Feinstein, a Democrat from California, said Brown made the "absolutely correct" decision.

"I've seen firsthand the agony that accompanies prolonged illness, for both patients and loved ones, and this bill provides a compassionate, kind option," Feinstein said in a prepared statement that emphasized the law's safeguards.

Dr. Robert Liner, a retired obstetrician who is in remission from lymphoma, said he was thrilled with the governor's action, having fought for this change for many years.

"It has been a long road," Liner said. "I'm really glad Gov. Brown stepped up to the plate and signed it."

Liner is part of a lawsuit seeking the right of doctors to avoid liability for prescribing lethal medication to terminally ill patients. Liner said he doesn't know what he will do when he reaches the time to make a decision about his own life.

"But I really think it is important to have an option," he said. "I am delighted."

The new law requires two doctors to determine that a patient has six months or less to live before the lethal drugs can be prescribed. Patients also must be physically able to swallow the medication themselves and must have the mental capacity to make medical decisions.

One of the meetings must be private, with only the patient and the physician present. That requirement is aimed at ensuring the patient is acting independently, Monning said. Patients must also reaffirm in writing that they intend to take the medication within 48 hours.

Golden called these safeguards "hollow." She said none of the states — including California — that have legalized this option require a witness at the death. When asked if opponents would be monitoring implementation of the law to ensure there is no abuse, she said her group "is not taking any options off the table right now."

The law will take effect sometime in 2016 — 91 days after the special legislative session, which is still ongoing, concludes. At that time, California will become the fifth state to allow physician-assisted suicide. Oregon, Washington, Montana and Vermont permit the practice. It was permitted in New Mexico until August, when an appeals court in the state reversed a lower court ruling that had established physician-assisted suicide as a right. The New Mexico Supreme Court is now hearing that case.

Perhaps the most visible face of this law is Brittany Maynard, the 29-year-old California woman who suffered from terminal brain cancer and moved to Oregon explicitly because it permits aid in dying. Maynard used the law to end her life last November.

In an interview Monday, her widower, Dan Diaz, said he felt "an enormous sense of gratitude" that the bill has been signed into law. He said his wife would have felt "relief ... for all terminally ill Californians — that they have that bit of control."

Elizabeth Wallner, who lives in Sacramento and has stage 4 colon cancer, said she felt a "a great sense of relief. ... I don't want to die," she said, but "having the option is really powerful."

The legislation started out as SB 128, a bill introduced in January. That bill cleared the California Senate, but ultimately stalled in the state Assembly in July. The authors then introduced a similar bill in August, during a special legislative session called by Brown this summer.

The California law is set to expire in 10 years, unless the Legislature passes another law to extend it.

This story was produced by member station KQED's blog State of Health, with reporting contributions from Anna Gorman, a senior correspondent with the NPR partner Kaiser Health News.

Copyright 2015 KQED Public Media. To see more, visit
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Laws To Stop Bullying Can Protect Teens If They're Done Right

NPR Health Blog - Mon, 10/05/2015 - 3:02pm

In the past 15 years, states have passed laws intended to reduce the toll of bullying.


There's good news from the front lines in the fight against bullying: anti-bullying laws can help reduce aggression, both online and in real life.

Bullying affects one out of every five U.S. high school students. But anti-bullying laws do make a difference, researchers reported Monday in JAMA Pediatrics – especially when those laws comply with guidelines from the U.S. Department of Education.

"It's kind of hard to believe, but about 15 years ago, we didn't have any anti-bullying laws," says Mark Hatzenbuehler, lead author of the study and an associate professor of sociomedical sciences at Columbia University's Mailman School of Public Health. "Now, all 50 states have some form of anti-bullying legislation. Even though there's been a lot of legislative activity around bullying, surprisingly there's been really little research on whether these laws are actually effective in reducing bullying."

Hatzenbuehler and his colleagues wanted to address that gap.

Looking at data from more than 60,000 high school students in 25 states, the researchers found that when a state's anti-bullying laws included at least one of 16 key components from the Department of Education, students in that state were 24 percent less likely to report being bullied and 20 percent less likely to report being cyberbullied.

In particular, three components of anti-bullying laws were tied to decreased bullying and cyberbullying: having a description of where and when the school has the authority to take action against bullying; having a clear definition of what constitutes bullying; and having a requirement that schools develop and implement their own local policies, possibly on a timeline.

Understanding which elements of anti-bullying legislation make the laws more effective or less effective paves the way for future studies into how to create effective laws. "One of the things we really need to understand is which specific components and in which combination are most effective," Hatzenbuehler says.

There was substantial variation in the reported rates of bullying and cyberbullying across states, ranging from 14.1 percent in Alabama to 26.7 percent in South Dakota.

Researchers controlled for state-level violent crime rates and historical bullying rates. But they couldn't control for the variation in how the laws were implemented in each school district, Hatzenbuehler says.

While the study was an important first step to show that the laws are working, Hatzenbuehler says that more research remains to be done, especially concerning how schools implement the laws. "[Laws] can be more or less effective depending on how strong implementation is," he says. "And so we need a lot more research to understand both facilitators but also barriers to the implementation of anti-bullying laws."

Going forward, Hatzenbuehler is hoping also to look at whether these laws protect the most vulnerable, including students in a sexual minority, those who are overweight or obese, and those with disabilities.

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Overtesting Of Employees Can Be A Side Effect Of Workplace Wellness

NPR Health Blog - Mon, 10/05/2015 - 12:45pm

When is the right time to get a cholesterol test at work?


As health insurance open season heats up for businesses, many employees will discover that participating in their company's wellness program includes rolling up their sleeves for blood tests.

Across the country, half of large employers offering health benefits have wellness programs that ask workers to submit to medical tests, often dubbed "biometrics," that can involve a trip to a doctor's office, lab or workplace health fair.

While aimed at uncovering potential health risks early to head off serious and costly problems, the programs that involve those biometrics are also controversial. Will the screening exams actually improve health, or merely add to a culture of overtesting that is helping drive up the cost of health care?

So far, research is mixed on whether workplace wellness offerings truly save employers money. The Rand Corp. says most don't, with the exception of programs targeted at managing specific diseases, such as diabetes. Still, Rand found that programs can help spur employees to quit smoking, get more exercise and lose a bit of weight.

The debate hasn't slowed growth in workplace wellness, now estimated by Rand as a $6 billion a year industry, with most employers offering some kind of program, which must be voluntary. Many link financial incentives to employee participation, with a small percentage actually tying the rewards or penalties to meeting specific health targets.

Wellness In The Workplace

More Kaiser Health News stories in this series:

"Biometrics are growing," as a way to help workers know if they face health challenges "they may not even know they have," said Paul Coppola, head of wellness programs offered by insurer Aetna, which says participants are often able to reduce their risk factors by joining.

But Al Lewis, whose company offers alternatives to traditional wellness programs, said they are overselling their benefits and underplaying their risks.

Workplace programs that test everyone every year "are massively overscreening people," which could lead to false positives, unneeded medications or higher expenses for them and their employers, said Lewis, author of Why Nobody Believes the Numbers, a critique of workplace wellness programs.

What Are They Testing?

Asking employees about smoking or checking their blood pressure isn't controversial, but there is less agreement about some of the other tests included in many wellness programs.

That's mainly because most require a package that is one size fits all, not stratified based on whether a worker is 25 with no risk factors or 35 with parents who died of heart attacks in their 40s. Testing a broad cross section of adults every year with a range of screening exams poses some risks, medical and policy experts say.

All screening tests carry the potential to give a false positive result, meaning they suggest people have a problem that they don't; or a false negative, which could incorrectly reassure people that everything is OK.

Accurate results can help spur people to take needed medications, but drugs also come with risks.

Still, proponents say workplace programs provide valuable information. Once employees are screened, the programs often make individual recommendations and most provide resources, such as nutrition counseling, health coaching, online classes or stop-smoking programs.

"We can set individual goals for each person," said Jim Pshock, president and CEO of Bravo Wellness, which runs wellness programs for employers. "The hope is that the program will get people to proactively see their physicians to manage their health risks. Yes, this will, hopefully, mean more prescription drug utilization and office visits, but fewer heart attacks and cancers and strokes."

Is Screening Always Helpful?

Among the tests commonly included in workplace programs, cholesterol screening, which measures the levels of particular types of fats in the blood, is probably the most contentious.

That's because medical groups differ on the best age to start testing and the frequency.

And, as researchers learn more about cholesterol's role in heart attack and stroke, recommendations have changed on optimal levels, as have ideas on which levels should prompt patients to take medications, called statins. Those drugs are widely used and credited with helping lower heart attack risk, but they can also cause serious side effects in some patients.

The American Heart Association recommends testing every four to six years for people with normal levels, starting at age 20. But other groups, including the influential U.S. Preventive Services Task Force, generally recommend starting tests at older ages, unless a person has other risk factors for heart disease.

"Asking every 23-year-old to get lipid [cholesterol] screening is not consistent with national recommendations ... and furthermore adds to the costs," said David Grossman, medical director of Group Health Cooperative in Seattle. Group Health's own wellness program doesn't include cholesterol testing but asks whether participants use tobacco, assesses their body mass index — a ratio of height and weight — and checks their blood pressure.

Some workplace programs check only the so-called bad cholesterol, low-density lipoprotein, also known as LDL, while others measure the protective or good type, called high-density lipoprotein, or HDL. Some programs also test for triglycerides, another type of fat in the blood.

Wellness programs that simply measure LDL cholesterol are a waste of time, said Barbara Roberts, director of the women's cardiac center at Miriam Hospital in Rhode Island and author of The Truth about Statins: Risks and Alternatives to Cholesterol Lowering Drugs.

That's because studies have shown that HDL levels are a better predictor of heart disease risk, she said.

But what's the harm in knowing your numbers?

"The harm is you would be put on medication needlessly," if they are basing it on the wrong standards, said Roberts.

Instead of just a cholesterol screen, more employer programs are testing for what is called metabolic syndrome, which is evidenced by a cluster of five risk factors — large waist size, high triglycerides, low HDL cholesterol levels, and elevated blood pressure and blood sugar — and thought to increase the odds for heart disease, stroke and diabetes.

By organizing health test information in that way, it can be easier for the worker to understand, said Coppola at Aetna, whose own in-house program has seen scores improve as a result of the focus.

"We see someone with five risk factors, for example, reduce to just four, which helps," he said.

Still, many programs simply test for blood glucose levels, which is a measure of sugar in the blood. Elevated levels could indicate diabetes or a risk of developing the condition. And, as with cholesterol screening, broad-brush testing, particularly for younger people or those without risk factors, is not recommended by medical societies.

The U.S. Preventive Services Task force recommends glucose screening for adults without symptoms only if they have high blood pressure or other risk factors for diabetes, which include being overweight, having high blood pressure or having a family history of diabetes. Slightly different recommendations come from the American Diabetes Association, which says all adults older than 45 should be screened, as well as anyone of any age with risk factors.

Even with the differing recommendations on widespread screening, workers who take advantage of programs offered to help improve their health — and discuss the test results with their doctors — will get the most out of the programs, proponents say.

"I would love it when a patient brought one in," said Wayne Riley, president of the American College of Physicians and a professor of medicine at Vanderbilt University School of Medicine in Nashville. "It's a patient empowerment tool and also helpful to help me guide the care of my patients."

Copyright 2015 Kaiser Health News. To see more, visit
Categories: NPR Blogs

Women Find A Fertility Test Isn't As Reliable As They'd Like

NPR Health Blog - Mon, 10/05/2015 - 4:28am
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Women concerned about their fertility can use a test to help decide whether they should freeze their eggs now or whether they still have time to have a baby.

But this test, called an ovarian reserve test, is often ambiguous and can be misinterpreted. Some fertility specialists worry that many women will be misled by their results, leading some to feel pressured to freeze their eggs when they don't need to and others to miss their best window to do so.

A few months ago, I was in Samantha Margolis' kitchen in Washington, D.C., where she was getting ready to give herself an injection. In front of her were several small vials filled with hormones. Margolis was mixing the hormones with saline solution and then injecting them just below her belly button.

Margolis did these injections every day for 10 days to stimulate her ovaries to make several eggs grow at once. In a normal monthly cycle, just one egg grows and is released at ovulation, but flooding the ovaries with these hormones coaxes them to make more mature eggs.

At the end of the 10 days, Margolis had a medical procedure to retrieve the mature eggs so they could be frozen at Shady Grove Fertility Center. The idea behind egg freezing is that since the number of eggs and the quality of them decline in women over time, women can preserve eggs when they're younger to increase their chances of having a baby if they have a fertility issue in the future.

Margolis, who's 36, decided to freeze her eggs early this year after getting two key pieces of information about her fertility. First, she learned that her mother had gone through menopause at age 40, and her grandmother had gone through it at 38. (Studies show there is a genetic component to the age at which a woman goes through menopause.)

She also got the results of an ovarian reserve test.

Different fertility centers have different versions of this test, but every woman exploring the option of egg freezing has to take one so that doctors can figure out whether she is a good candidate for the procedure. At many fertility centers, the test involves measuring three different hormones in the blood that typically change dramatically in women between age 35 and menopause. There's also an ultrasound to count follicles, which is where eggs mature in the ovaries.

Doctors put all this information together, to get a rough picture of a woman's egg supply. Margolis' results didn't look good. When she asked her doctor whether she should freeze her eggs, "She said to me 'Samantha, I'm not an alarmist, but I would do this, and I would do it as soon as you can. I wouldn't wait.' "

All Tech Considered Silicon Valley Companies Add New Benefit For Women: Egg-Freezing Shots - Health News Women Can Freeze Their Eggs For The Future, But At A Cost

Two cycles of hormones and $22,000 later, Margolis got just eight eggs to freeze. Doctors recommend having 15 to 20 eggs for the best chance of making a baby with them later through in vitro fertilization.

Margolis says she's glad she froze her eggs when she did. But, she says, "I wish that [this test] was at a certain age was part of your annual [gynecologic] exam. There is no question that if I would have had this test earlier and known what my count was that I would have done this years ago." Had she done the procedure earlier, she also might have gotten closer to the goal of 15 to 20 eggs for freezing.

Reproductive medicine specialists say ovarian reserve testing can be useful for women like Margolis who discover when they take it that their egg supply may be running low. "The ability to both test for your egg supply and at the same time do something about it is really amazing," says Dr. Benjamin Leader, a fertility diagnostics researcher and CEO of ReproSource, a fertility testing company in Woburn, Mass.

Shots - Health News Freezing Eggs May Reduce A Woman's Odds Of Success With IVF

But fertility experts also worry that many women will be misled by their test results. "There are issues with the test, the reliability of the test," says Dr. Samantha Pfeifer, an associate professor at Weill Cornell Medical College and chairwoman of a committee at the American Society for Reproductive Medicine that guides doctors in her field.

Women are born with all of their eggs (some 1 million to 2 million total). One mature egg is typically released each month in the menstrual cycle. Meanwhile, other eggs are slowly dying.

Beginning around age 25, the number of eggs starts to decline a bit more swiftly, and then accelerates after 35 until menopause, when eggs are essentially gone. As the quantity of eggs declines, the quality of the remaining eggs is also deteriorating, which can also affect a woman's ability to conceive. (Egg quantity and quality are just a few of many different factors that can make it difficult for a couple to conceive.)

The ovarian reserve test was originally developed to measure egg supply in women who were struggling to get pregnant — not in women who wanted to freeze their eggs. Doctors realized that some of these women could benefit from ovarian stimulation to produce eggs to use in in vitro fertilization because they still had a lot of eggs left. Those women responded well to hormones — the same ones Samantha Margolis took in her own egg freezing process. (Women undergoing egg freezing and women doing IVF undergo the same ovarian stimulation process to make eggs — the difference is that the IVF patients usually use their eggs right away.)

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In particular, researchers realized that measuring one hormone, called anti-Mullerian hormone, or AMH, in the blood seemed to help predict whether a woman's ovaries would respond well to the drugs. Higher AMH meant that a woman was likely to produce more eggs under stimulation, while lower levels usually yielded fewer eggs.

In March, the ASRM practice committee that Pfeifer chairs published a paper in the journal of Fertility and Sterility noting that "there is mounting evidence to support the use of AMH as a screening test for poor ovarian response." The paper also noted that the three other hormones fertility centers often check — FSH, estradiol and inhibin B — are only poor to fair measures of how a woman's ovaries will respond to stimulation or her ability to conceive.

Even though the AMH level may be one of the strongest tools doctors have to assess egg supply, it still can be difficult to interpret what it means, since the range of AMH levels in women of the same age can be huge. Age still is a very important predictor of fertility, but one recent study of about 17,000 women in the U.S. found that AMH levels are very unevenly distributed by age. And AMH may decline faster in some women than others.

Pfeifer says that overall, the ovarian reserve test is not that precise, and is just a snapshot of one moment in time. "These tests do not tell me how many eggs are left; they can generally give you a sense of are there a lot of eggs there, or fewer eggs remaining," she says. "But they're not really predictive of when someone is going to go through menopause or be able to achieve a pregnancy."

Studies have also shown that there can be a lot of variability in test results, even for the same samples from the same woman. Leader says that's because different labs have different methods and don't calibrate their results to the same clinical outcomes.

For example, Leader says, "When results from one lab are compared to another, a 'concerning' result may not be 'concerning' for a given condition, and, vice versa, a 'reassuring' result may not actually be 'reassuring.' " Leader says that the best way to interpret test results is to calibrate the numbers to the "gold standard definition for egg supply," which is the number of eggs retrieved after the ovaries have been stimulated with hormones. This is how his company ReproSource calibrates egg supply for its patients and clinicians.

The worst case scenario of using an inaccurate test is that a woman might feel pressured to freeze her eggs because of ominous results when she actually has plenty of eggs left, while another woman might perceive a rosy outlook when she actually may be nearing the end of her egg supply.

Because of all the uncertainty in measuring egg supply in individual patients, Pfeifer says it's way too soon to be offering this test as part of regular gynecologic exams.

"I think that for some people this test is very helpful in guiding them in decision making, but for other people, it may not in and of itself direct them that accurately," she says.

People in the egg freezing business see it differently. Many of them say all women should get the test to be better informed about their fertility.

"There's no reason why we shouldn't be doing this test on an annual basis," says Jay Palumbo, a vice president at Eggbanxx in New York. It's a company that markets egg freezing with parties branded Let's Chill. Palumbo calls herself a "fertility matchmaker" because she helps women who want to freeze their eggs find doctors who will do it.

She says many of the women who call her looking for a doctor have gotten bad news from the test. "The egg freezing population — about 20 percent of them find out they have a fertility issue," she says. "And it's interesting to hopefully catch people early on in the process so hopefully that maybe, possibly they're able to avoid some of the heartache later on."

The heartache, as the fertility industry sees it, is having no eggs, or no good quality eggs, left when the time comes to try and get pregnant.

Many women, though, just won't get clear information from the test. That can make a major life decision like egg freezing more agonizing. You already have to weigh the cost — $8,000 to $30,000, depending how many rounds of hormones you have to do — and the possible side effects of the hormones, which include ovarian hyperstimulation syndrome. And then there's the fact that success rates for a live birth from frozen eggs are lower than for fresh eggs.

The test can be dangerous in other ways, according to Joann Galst, a psychologist in New York City who specializes in women's fertility issues. Measuring your fertility can be like a Pandora's box. "This is a really personal field in terms of how people feel about themselves as beings and their future life goals and parenting, Galst says. "It hits them in a very profound deep way to get any information that there may be a problem in this area."

That's why every woman getting the test should ensure they use a lab that gives meaningful results and find a doctor or nurse trained to interpret these results or women may get an inaccurate picture of their fertility, according to Leader of ReproSource.

Pfeifer of Weill Cornell says that as testing improves, doctors will be able to better guide patients to the right decision.

"Ideally we'd love to know how can we predict who should freeze their eggs, for example, or who should try and get pregnant sooner; who should do something sooner because their fertility decline faster than expected," says Pfeifer. "And if we can say these people don't have to freeze their eggs because they should have no difficulty getting pregnant well into their late 30s — well, that'd be great to know that."

But for now, Pfeifer says, this test isn't there.

Copyright 2015 NPR. To see more, visit
Categories: NPR Blogs

7 Questions To Ask Your Boss About Wellness Privacy

NPR Health Blog - Sun, 10/04/2015 - 6:11am

Employers are gathering detailed health and wellness information about their workers. Are confidentiality safeguards up to the task?

Andy Baker/Getty Images/Ikon Images

If your company hasn't launched a wellness program, this might be the year.

As benefits enrollment for 2016 approaches, more employers than ever are expected to nudge workers toward plans that screen them for risks, monitor their activity and encourage them to take the right pills, food and exercise.

This involves a huge collection of health data outside the established medical system, not only by wellness vendors such as Redbrick, Audax and Vitality but also by companies offering gym services, smartphone apps and devices that track steps and heartbeats. Such partners pass worker results to the wellness providers.

Standards to keep such information confidential have developed more slowly than the industry. That raises risks it could be abused for workplace discrimination, credit screening or marketing, consumer advocates say.

Here's what to ask about your company's plan.

What information will my employer see?

Wellness In The Workplace

Check out more stories in Kaiser Health News' ongoing series:

Many employers get only anonymous, group data. The vendor reports how many workers are overweight or have high blood pressure, for example.

But sometimes employers can see individual results, setting the stage for potential discrimination against those with disabilities or chronic illness. Or they can guess them. Discrimination based on disability and illness is illegal but hard to prove.

Workers should ask exactly what information will get back to their company and whether it will identify them.

Is the program covered under the HIPAA privacy law?

The Health Insurance Portability and Accountability Act restricts sharing of certain medical information to doctors, health insurers and other authorized users. Asking whether a wellness plan is covered by HIPAA is a good, first attempt at judging confidentiality.

Workplace wellness programs offered separately from an employer's group health insurance plan are not protected by HIPAA. Other privacy laws might apply. But often it's often impossible for employees to tell without asking.

Even in HIPAA-covered programs, a few, designated managers at your workplace can see health reports including identities, although they're supposed to keep them confidential.

I don't understand the privacy policy. Did I give up my HIPAA rights when I filled out my health assessment on the wellness site?

Use of a wellness portal often gives the vendor permission to share personal data with unidentified "third parties." Those would be insurers, data-storage firms and other partners necessary to the program, vendors say. They'll protect the information as well as anybody, they say.

But the open-ended nature of the permission gives consumer advocates the creeps. Read the privacy and terms-of-use disclosures. Ask questions if you're uncomfortable.

My employer says it sees only group results. Does that guarantee privacy?

At smaller firms it's sometimes easy for managers to match worker identities with results from group reports. The same goes for large companies when wellness data is disclosed by team or division.

Ask how far the results will be broken down.

How many other companies see my wellness data?

Workplace wellness often involves multiple firms gathering or sharing your information. The main wellness provider might work with labs, app publishers, fitness device makers, gyms, rewards fulfillment companies and others — each with its own confusing privacy policy.

Employees deserve a clear explanation of which companies get their data, what form it takes, how recipients will use it and how it is protected, privacy advocates say.

What privacy policies do subcontractors and other third parties have to follow?

One privacy standard for wellness contractors, set by the National Committee for Quality Assurance, requires the primary wellness vendor as well as third-party partners to conform to HIPAA.

But that kind of policy is not universal. NCQA recognizes only a few dozen out of hundreds of wellness companies. And NCQA standards are voluntary and don't confer consumer rights.

Could somebody try to identify individuals in the group results shared by my wellness plan?

Wellness privacy policies often give vendors broad room to share data stripped of names, addresses and other identifying features. Such information is not protected under HIPAA.

Experts have shown that such results can be re-identified by combining them with public databases. As an extra protection, wellness vendor Limeade and wearable device maker Fitbit prohibit third-party partners from attempting to re-identify the information they share.

But not all vendors do the same.

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.

Copyright 2015 Kaiser Health News. To see more, visit
Categories: NPR Blogs

As A Father's Alzheimer's Progresses, Family Learns To Love Him As He Is

NPR Health Blog - Sat, 10/03/2015 - 8:03pm

"My brain used to be my best friend," says Greg O'Brien, a journalist with early onset Alzheimer's. But he can't trust it anymore, he says. Alzheimer's is, in some ways, changing who he is.

Amanda Kowalski and Samantha Broun for NPR

In this installment of NPR's series Inside Alzheimer's, we're sharing a recent video of Greg O'Brien at home on Cape Cod, Mass. A longtime journalist, O'Brien was diagnosed with early-onset Alzheimer's disease in 2009.

The first time I interviewed Greg O'Brien, back in January, I asked him what he was most afraid of.

"I'm afraid of the in-between," he said.

He loves living and he's not afraid to die. It's everything in the middle — the long decline, the loss of identity and independence, his family's pain — that terrifies him.

In the video above, "Crest of the Hill," Greg O'Brien talks about losing his memories, his balance — and his home. He previously spoke to NPR about the family's decision to move.

Beyond Greg's memory loss, he and his family are dealing with an unsettling reality. Alzheimer's is, in some ways, changing who Greg is. And as soon as they get to know each new version of his personality, it changes again.

His wife Mary Catherine tells him she's proud of him for fighting through the losses to write about his experience the last few years.

"He's more open," she tells me. "We just talk about hard stuff that we used to maybe put off or avoid."

Additional Information: More From Inside Alzheimer's Shots - Health News 'How Do You Tell Your Kids That You've Got Alzheimer's?' Shots - Health News After Diagnosis, 'The Stripping Away Of My Identity' Shots - Health News As Alzheimer's Symptoms Worsen, Hard Conversations About How To Die

Hear more stories and subscribe to future entries on the series page.

But she's also afraid of some of the changes she sees.

"You get so angry," she told Greg a few weeks ago. "You never used to get so angry."

And he's always been outgoing — the guy at the head of the biggest, loudest table at any gathering. These days, Greg is quieter and more solitary, disappearing into a back room or retreating into a corner when a crowd of family or friends overwhelms him.

Some changes are hard, but the family is learning to love Greg as he is — not as he was yesterday, or as he might have been if he'd never gotten Alzheimer's.

"You're still funny," his son Conor told him recently. "You're slightly different, but you're still funny."

Greg is learning to love himself, too, and to be at peace with the changes, even if he doesn't trust his brain anymore. He's learning to value the past — and to let it go.

"I know I can't go back to who I was before," he says in this short video by Amanda Kowalski and Samantha Broun. "I've got to learn to live with the new me."

Photographer Amanda Kowalski and radio producer Samantha Broun of SoundLight Media produced this video in association with Atlantic Public Media. Greg O'Brien and his family hope to share more of their experiences with Alzheimer's in future installments of Inside Alzheimer's here on Shots.

Copyright 2015 NPR. To see more, visit
Categories: NPR Blogs

Ladies, New York City Wants You To Consider An IUD

NPR Health Blog - Fri, 10/02/2015 - 2:02pm

New York City's health department launched the "Maybe the IUD" campaign this week, aimed at increasing awareness about the IUD as a highly effective and low-maintenance option for birth control.


The New York City Health Department is at it again, this time with ads in the subway and on bus shelters chatting up the glories of IUDs.

"You spent the night in Brooklyn," one brightly colored poster reads. "But you left your birth control in Staten Island. Maybe the IUD is right for you."

The cheeky ad campaign isn't a huge surprise, seeing as these are the same folks who brought New York an app that helps to locate a free condom on a big night out and the program allowing New York City teens to get mental health help via text.

But how did they decide that intrauterine devices, a long-acting form of birth control, should be a conversation starter on the morning commute?

Courtesy of New York City Health Department

"Sex is part of life. Talking about birth control is part of life," says Deborah Kaplan, the assistant commissioner for the Bureau of Maternal, Infant and Reproductive Health for the New York City Health Department. "And if we can make this more open, we think more women will be comfortable going to their providers, asking about this and thinking about the different options they have."

There's good reason to think that not enough women know their options when it comes to birth control. Of every 10 pregnancies in New York City, Kaplan says, six are unintended.

The health department launched the "Maybe the IUD" campaign this week, aimed at increasing awareness about the IUD as a highly effective and low-maintenance option for birth control. Studies have found that it's more effective than the pill at preventing pregnancy, and the models currently in use are considered quite safe. "This is a method that a lot of people don't know about [and] there's a lot of misinformation or lack of information," Kaplan says.

While the IUD — a small, T-shaped device that is inserted into a woman's uterus — might not be for everyone, Kaplan wants women to have accurate information about it. Such as how it's safe for women with a history of sexually transmitted infections. And how it can last for three to 10 years and can be removed at any time without affecting a woman's future fertility.

And although the IUD is the star of this show, the conversation they want to start is about more than one particular form of birth control. Kaplan and her colleagues want women to understand their choices and know where in the city they can get those birth control options for a low cost or free.

In order to get the message out, the health department is partnering with the City University of New York (CUNY). Many of CUNY's students lack access to information and services related to reproductive health care, Kaplan says. And a majority of CUNY students are in their 20s, she says, the age at which half of all unplanned pregnancies occur. "Being able to plan your pregnancies is a critical piece of moving forward with your goals around education."

IUDs and other birth control methods are covered as a primary care benefit with no cost to those with health plans under the Affordable Care Act, Kaplan says. Women who do not qualify for insurance plans under the Affordable Care Act can search for providers who offer birth control for low or no cost, and anyone can find more information on IUDs by visiting the health department's website.

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