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Campuses Play Host To Tanning Beds, Despite Skin Cancer Risk

NPR Health Blog - Wed, 10/29/2014 - 4:06pm
Campuses Play Host To Tanning Beds, Despite Skin Cancer Risk October 29, 2014 4:06 PM ET Alison Bruzek

This may seems like a great campus amenity, until you get melanoma.

iStockphoto

The frigid winters left everyone hungry for sun at the college I attended in Chicago. I still remember a friend longing for a tanning studio, preferably just down the hill from the student center. And as it turns out, in a surprising number of college campuses now, that's just the case.

Half of the top 125 U.S. colleges and universities listed in US News and World Report have indoor tanning facilities either on campus or in nearby student-focused housing, according to a study published Tuesday in JAMA Dermatology, a journal of the American Medical Association.

Shots - Health News Teen Girls' Yen For Indoor Tans Sparks Battle Over Risks

In addition, 14 percent of those colleges allowed students to use campus cash to pay for exposure to the ultraviolet rays of tanning beds. This despite abundant evidence that using tanning beds raises the risk of skin cancer, including deadly melanoma. And teenagers and young adults are especially at risk.

"I think this is one health issue that is not on the map when it comes to college-aged kids," says Sherry Pagoto, an associate professor of medicine at the University of Massachusetts Medical School and first author of the study. "It's something that we don't always think of as dangerous as tobacco, but it really is."

Shots - Health News Use Of Tanning Beds Common, Despite Cancer Risks

Melanoma is the number one cancer in adults 25 to 29 years old, according to the American Academy of Dermatology.

"In contrast to most other cancers where the incidence rate has stabilized or declined, the incidence of melanoma continues to increase," Dr. Craig Elmets, chairman of the department of dermatology at the University of Alabama at Birmingham, tells Shots. Indoor tanning can increase a person's melanoma risk by 75 percent, and research shows almost one-quarter of non-Hispanic white women ages 18 to 35 use a tanning salon.

Shots - Health News Tanning Beds Substantially Raise Skin Cancer Risks

Researchers completed the survey by searching for "tanning" on college and university websites and calling tanning parlors to ask if they would take campus cash. The callers acted as though they were interested in the college and wanted to know what amenities it had, or as if they were a potential patron of the campus salon.

Colleges in the Midwest and Northeast were much more likely to have indoor tanning on campus and in off-campus housing, not surprisingly. By contrast, schools in the sun-drenched West had no on-campus tanning.

Worrying to Pagoto was the fact that 36 percent of colleges that had off-campus housing with tanning facilities referred students to that housing on their website.

"Tobacco and alcohol are not allowable purchases on many campuses," Pagoto says, "We would encourage colleges to take that one step further and add tanning to that list."

Parents should also add access to tanning beds to their checklist and investigate whether or not money they put on their children's cash card could be used to tan.

Unlike some of the other crazy things you do in college, your risk for skin cancer doesn't go away, says Pagoto. The damage done to your skin in your teenage and college years will stick with you for the rest of your life.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Scientists Implicate More Than 100 Genes In Causing Autism

NPR Health Blog - Wed, 10/29/2014 - 3:35pm
Scientists Implicate More Than 100 Genes In Causing Autism October 29, 2014 3:35 PM ET Nancy Shute iStockphoto

The hunt to find genes that cause autism has been a long slog, one hampered by a lack of technology and families willing to be tested.

But those efforts are starting to pay off. On Tuesday, researchers at more than 50 laboratories said they had identified more than 100 genes that are mutated in children with autism, dozens more than were known before.

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These are mutations that crop up spontaneously, not ones that parents pass down to their children. At least 30 percent of autism cases are caused by these spontaneous mutations, according to researchers at Cold Spring Harbor Laboratory.

One group of mutations contributes to autism in high-IQ, high-functioning boys, one study found, while another group influences autism in girls and boys with low IQ.

"There's somewhat of a mechanism difference in the genes that are being hit, and the way that gene function is being changed, "says Michael Ronemus, a researcher Cold Spring Harbor Laboratory and an author of one of the studies, which were published Tuesday in Nature.

Girls are less likely to get autism than boys, and this study found that the mutations in girls affected genes that play crucial roles during an embryo's early days in the womb. Scientists think that girls are somehow protected against autism, and that it takes a heavy hit like this to cause the disorder in girls.

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"What is the amazing thing about autism genetics is that in many cases you disrupt just one copy of the gene, you cause some sort of dysfunction," Ronemus says. That's very different from other genetic disorders, which require mutations on both copies of a gene to cause trouble.

Ronemus and his colleges tested the genes of more than 3,000 people — the parents of children with autism, as well as the affected child and an unaffected sibling. Comparing within families helped figure out what mutations weren't inherited.

Then the mutations were compared among all the participants, to see which mutations were shared in people with autism.

They looked at less than 2 percent of the human genomes, just the part involved in making proteins.

The scientists are now starting to use faster, cheaper gene-scanning technology to look for shared mutations in people's entire genomes. As they do, they'll come up with hundreds more suspect mutations.

That may sound daunting, but it's good, Ronemus tells Shots. "What we're really discovering is where to look."

Because many of the mutations affect the same biological functions, it's not like hundreds of different treatments would be needed. "If we have better genetic screening when a child is diagnosed with autism we might be able to say, here is the behavioral intervention they need," Ronemus says. "We already know that if you intervene early on you can produce a more optimal outcome."

More people are needed to take part in research on the genetics of autism, because the bigger the pool of people, the easier it is to identify harmful mutations. The Interactive Autism Network, or IAN, lets families share their information with researchers around the world.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Patients Do Better After Surgery If They Do 'Prehab' First

NPR Health Blog - Wed, 10/29/2014 - 9:10am
Patients Do Better After Surgery If They Do 'Prehab' First October 29, 2014 9:10 AM ET Katherine Hobson

Getting stronger before surgery has been shown to help cancer patients do better long term.

iStockphoto

People are often told to follow a rehabilitation program following surgery to speed recovery. But starting weeks before going under the knife might help them regain function even faster.

So-called "prehabilitation" to prepare someone for an upcoming stressful event has been used quite a bit in orthopedic surgery, Dr. Julie Silver, a physiatrist at Spaulding Rehabilitation Hospital in Boston, tells Shots. And there's increasing interest in using it before cancer treatment, especially to help frail or elderly patients better tolerate what lies ahead, she says.

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Researchers from McGill University in Montreal studied 77 patients scheduled for colorectal cancer surgery. A kinesiologist gave the patients aerobic exercises and strength training to do at home. A registered dietitian gave them nutritional counseling and prescribed a whey supplement to make up any protein deficits, and a psychologist provided anxiety-reducing relaxation exercises.

Half of the patients were told to start the program before surgery – an average of about 25 days before – and to continue afterward for eight weeks. The other group was told to start right after surgery.

Not surprisingly, the group assigned to prehabilitation did better on a presurgery test that measured how far they could walk in 6 minutes. And it paid off.

Two months after surgery, the prehabilitation group walked an average of 23.7 meters farther than when they started the study. Rehab-only patients walked an average of 21.8 meters less than when they started. (A change of 20 meters is considered clinically significant.) And a greater proportion of the prehabilitation group was back to baseline exercise capacity by then.

The study appears in the journal Anesthesiology.

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It's not clear which elements of the program caused the improvements, Dr. Liane Feldman, a surgeon at McGill and an author of the study, tells Shots. "There have been questions whether exercise alone was enough," she says.

A previous study by the group used exercise only, and the patients assigned to a structured aerobic exercise and strength-training program did worse than the group assigned to a simple walking and breathing routine. So the nutrition and stress-reduction elements used in this study might have helped, too.

Both groups recovered fairly well, likely thanks to the widespread use of minimally-invasive surgery and other measures taken in the hospital, and there were no differences in complication rates, says Feldman. She says this study is proof that the concept of prehabilitation can work. A larger study targeting people at higher risk of complications, such as those whose function is deteriorating before surgery, is a next logical step.

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Silver, who developed a model of cancer prehabilitation, says other components can include specific exercises aimed at the area being operated on, such as movements increasing the range of shoulder motion for breast-cancer patients.

Getting people to quit smoking beforehand helps, too. (Smoking increases the risk of surgical complications.)

And while prehabilitation looks promising, nobody should delay cancer surgery or treatment in an effort to squeeze it in. "Use whatever window of time is available," Silver says.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Emory Hospital Shares Lessons Learned On Ebola Care

NPR Health Blog - Wed, 10/29/2014 - 5:00am
Emory Hospital Shares Lessons Learned On Ebola Care October 29, 2014 5:00 AM ET

from

Jim Burress Listen to the Story 3 min 55 sec  

Ebola patient Amber Vinson arrived by ambulance at Emory University Hospital on Oct. 15. Now healthy, Vinson was discharged from the hospital Tuesday.

Kevin C. Cox/Getty Images

Atlanta's Emory University Hospital got the first call at the end of July. An American doctor who'd been treating Ebola patients in Liberia was now terribly sick with the virus himself. In just 72 hours, Dr. Kent Brantly would be coming through Emory's doors. Then, almost immediately, the staff learned that a second Ebola patient was also on the way. Dr. Jay Varkey's first thought was, "What do we need today, in order to care for these patients tomorrow?"

“ The true cure for Ebola virus is keeping the patient alive long enough to develop the antibodies that will cause them to get over the infection.

In the three months since, Emory has treated four Ebola patients; all survived. Most recently, Dallas nurse Amber Vinson spent more than a week in a special treatment unit at Emory before being discharged in restored health and good spirits Tuesday.

"The general dogma in our industry in July was that if patients got so ill they required dialysis or ventilator support, there was no purpose in doing those interventions because they would invariably die," Dr. Bruce Ribner, who heads Emory's Ebola team, told reporters at a news conference Tuesday. Emory, he said, proved instead that aggressively treating the illness can be effective.

Emory's plan to treat patients who have diseases like Ebola actually began 12 years ago. That's when the Atlanta-based Centers for Disease Control and Prevention started working with the hospital to create a special isolation unit.

Since then, Varkey says, a core team of health workers has trained yearly and held practice drills every six months to stay sharp — ready for whatever infectious disease comes their way. Once, in 2005, the unit was used for a suspected SARS case that turned out to be negative.

But in July, with two Ebola patients on the way, it quickly became clear that Emory's specially trained team was too small, says Nancye Feistritzer, the hospital's chief of nursing.

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Critical care nurses volunteered to help fill in the gaps but weren't part of the core group that had long practiced for this day. The expanded team had to quickly train — and not everybody made the cut.

Once all the team members were in place, they focused on supportive care of these patients — administering IV fluids and preventing infections.

"The true cure for Ebola virus is keeping the patient alive long enough to develop the antibodies that will cause them to get over the infection," Varkey says.

Emory learned lessons, big and small, from each case, he says.

For example, just increasing the amount of working space around patients sick with Ebola helped a lot, he says. So did "having a hand sanitizer dispenser available that wouldn't require us to actually touch it with a gloved hand."

In Emory's experience, nurses on the Ebola unit, who started out on eight-hour shifts, preferred 12-hour rotations instead. And caring for the emotional health of patients in isolation is as important as promoting physical well-being, the staff learned.

Team members worked hard to coordinate their efforts. From top administrators to waste management crews, to pharmacists and lab technicians — every department played a role.

"Every morning the team meets to discuss what worked well, what might be refined," Feistritzer says, looking for lessons that might be put into practice the next shift, or the next day.

The Emory team doesn't claim to have all the right answers, Varkey says. But what they do know, they're sharing.

"Our entire 84-page document, in terms of our protocols," he says, "is now available to any person who wants to access that on the Web."

Those protocols went live a week ago. So far, more than 11,300 people have registered to get access to them.

This story is part of a reporting partnership between NPR, WABE and Kaiser Health News.

Copyright 2014 WABE-FM. To see more, visit http://www.wabe.org/.
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Home Health Workers Struggle For Better Pay And Health Insurance

NPR Health Blog - Tue, 10/28/2014 - 4:38pm
Home Health Workers Struggle For Better Pay And Health Insurance October 28, 2014 4:38 PM ET

fromWCPN

Sarah Jane Tribble Listen to the Story 4 min 3 sec  

Home health care workers Jasmine Almodovar (far right) and Artheta Peters (center) take part in a Cleveland rally for higher pay on Sept. 4.

Sarah Jane Tribble/WCPN, Ideastream

Holly Dawson believes her job is a calling.

She is one of about 2 million home care workers in the country. The jobs come with long hours and low pay.

Each workday, Dawson drives through the Cleveland suburbs to help people take their medicines, bathe and do the dishes. She also takes time to lend a sympathetic ear.

George Grellinger, a former client of hers, has dementia. He recently fell down the back steps of his home. Dawson remains friends and regularly stops in to check on him. To remain living at home, Grellinger had to switch to an aide who is covered by his veterans' benefits.

When Dawson worked for him, Grellinger paid an agency $37 for two hours of her time each day. Dawson received $13 an hour, higher than the national average for home health aides. She had to pay her own taxes and health care benefits. Dawson says she can't remember the last time she could afford health insurance

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Dawson says she has been a home health aide for 31 years. She has never done it for the money, rather to help people like Grellinger, she says.

But the conditions of home health work are leading many aides to seek better pay and benefits.

On an early September morning, home health workers held a rally in Cleveland. Jasmine Almodovar, 35, chants with the crowd: "We want change and we don't mean pennies!"

She says she earns $9.50 an hour, which is actually just above average for a home health worker in Ohio.

"We work really long hours, really hard work," she says. "A lot of us are barely home because if we don't go to work, we don't get time off. We don't get paid vacations. And some of us haven't had raises in years."

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Almodovar says her last raise was four years ago. She makes about $21,000 a year so she makes too much to qualify for Medicaid, but paying for a plan on Ohio's federal exchange doesn't fit in her monthly budget.

"I don't have a retirement plan, I don't have life insurance, I don't have medical," she says. "Because by a government basis, I'm 90 percent above the poverty level — but I'm in poverty."

Home care workers are mostly women. More than half are women of color, and 1 in 5 are single mothers. A recent analysis by the Brookings Institution found that while the ranks of home health workers grew exponentially over the past decade, their earnings dropped when accounting for inflation, says Martha Ross a researcher at Brookings.

"People aren't shocked about a fast food worker not having health insurance," she says, "But someone who is in the health care sector providing necessary health care who does not have health insurance? Just on the face of it, it's wrong."

Under the Affordable Care Act, there are financial incentives for hospitals and doctors to keep patients healthy. Ross says home care workers should be considered – and compensated – as vital front-line personnel in reaching the new goals.

And the U.S. Labor Department says more than a million new home care workers will be needed in the next decade.

"They can contribute to better care," Ross says. "Down the line that can contribute to reduced costs through reduced hospitalizations or going back into a nursing home and over time you can take those savings and put them into increased earnings for that home care worker."

Home care workers are often trusted advisors for the patients, says Lisa Kristosik with the Visiting Nurses Association of Ohio.

"People get real confused about how to navigate the health care system," she says. "And they know because they've seen it. Because they're in the homes. And they are in the homes for hours on end."

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

Copyright 2014 Cleveland Public Radio. To see more, visit http://www.wcpn.org.
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Blood Test For Ebola Doesn't Catch Infection Early

NPR Health Blog - Tue, 10/28/2014 - 4:20pm
Blood Test For Ebola Doesn't Catch Infection Early October 28, 2014 4:20 PM ET Listen to the Story 2 min 2 sec  

Magnified 25,000 times, this digitally colorized scanning electron micrograph shows Ebola virus particles (green) budding from an infected cell (blue).

CDC/NIAD

In an ideal world, health care workers returning from West Africa would get a quick blood test to prove they aren't carrying the Ebola virus. A test like that would likely put to rest some of the anxiety surrounding these doctors, nurses and scientists.

Unfortunately, even the best blood test in the world can't do that.

The test uses a technology called PCR, for polymerase chain reaction. It can detect extraordinarily small traces of genetic material from the Ebola virus.

But the catch is, the test is usually used on blood samples. And in the beginning, that's not where the Ebola virus hides.

"The initial sites of replication actually are not in the blood itself — they're mostly in tissues like spleen or liver," says Thomas Geisbert, a microbiologist at the University of Texas Medical Branch in Galveston.

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It's not practical to sample these organs to look for Ebola. But the virus doesn't stay there forever, Geisbert explains. As the infection grows, virus particles are gradually released into the blood, as well.

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And as soon as a small amount of virus ends up in the blood, PCR will detect it. It can find one or two virus particles in a drop of blood. That concentration is so low, Geisbert says, that an infected person's body fluids pose a minuscule risk to others at that stage. The problem is, that can change pretty quickly.

"As the disease progresses, and people start to get sick," he says, "in that same small drop of blood [there can be] 100 particles — or a thousand particles."

That's the point when body fluids do pose a risk. It's also the moment when the infected person starts to feel sick.

"You're going to start to detect the virus at about the same time you're going to have clinical signs of disease," Geisbert says.

So — sensitive as the PCR test is — it doesn't reliably give you much advance warning that a person is infected.

On the plus side, this pattern of infection also explains why people infected with Ebola aren't a risk to others until they actually fall ill with symptoms.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Insurers May Cover Costly Hepatitis C Drugs Only For The Very Ill

NPR Health Blog - Tue, 10/28/2014 - 11:20am
Insurers May Cover Costly Hepatitis C Drugs Only For The Very Ill October 28, 201411:20 AM ET

Partner content from

Michelle Andrews

Gilead's once-a-day pill for hepatitis C is the latest expensive and effective treatment that insurers say is a business challenge.

Courtesy of Business Wire

In the past year, hepatitis C drugs that promise higher cure rates and fewer side effects have given fresh hope to millions who are living with the chronic liver disease.

But many patients whose livers haven't been significantly scarred by the virus face a vexing reality: They're not sick enough to qualify for the drugs that could prevent them from getting sicker.

An estimated 3.2 million people are infected with hepatitis C virus. Many public and private insurers are restricting access to treatment to those who already have serious liver damage. The treatment cost per patient is roughly $95,000 or more for a 12-week course of treatment.

Other strategies that limit access include restricting who can prescribe the drugs or requiring early proof the drug is working before continuing with treatment. In addition, many state Medicaid programs require that patients be free of drugs and alcohol for a period of months before they can get the hepatitis C drugs.

"Everybody is trying to figure out how best to deliver needed treatments without blowing out resources because of the cost," says Brendan Buck, a spokesman for America's Health Insurance Plans, a trade group. AHIP has been an outspoken critic of high prices for specialty drugs, including those for hepatitis.

Gilead Sciences, maker of hepatitis C drugs Sovaldi and Harvoni, said no one was available to comment by deadline. But the company provided information about pricing and a policy brief that states, "The price of Gilead's hepatitis C treatments reflects the significant clinical, economic and public health value of these drugs, and is comparable to, or in many cases less than, the cost of older, less effective regimens."

Insurers base their coverage decisions in part on practice guidelines issued by clinical groups such as the American Association for the Study of Liver Disease,. which recommends giving patients with advanced liver disease priority in treatment. "Limitations of workforce and societal resources may limit the feasibility of treating all patients within a short period of time," the organization said in a statement when the recommendations were announced.

Paul Walker is one of the healthy ones. Diagnosed with hepatitis C in 1998, the 53-year-old Tyler, Texas, resident had a biopsy this year that showed only slight evidence of scar tissue that can cripple the liver, eventually resulting in cirrhosis or liver cancer.

Walker's doctor prescribed Sovaldi, a pill approved by the Food and Drug Administration in December that can cure the chronic infection in 12 weeks, significantly faster than the nearly year-long course of treatment often required under older drug regimens.

Sovaldi is taken with another hepatitis C drug such as interferon, which can cause flu-like symptoms, nausea and depression and which adds to the cost. Instead of interferon, Walker's physician prescribed Olysio, another recently approved hepatitis C drug that is popular among physicians. But its use in combination with Sovaldi for cases like Walker's hasn't been approved by the Food and Drug Administration.

Walker's insurer, Blue Cross Blue Shield of Texas, denied his physician's request for the drug. The insurer cited the off-label use of Olysio in its denial.

"We are committed to providing our members access to quality, cost-effective medications," Dan McCoy, chief medical officer for Blue Cross Blue Shield of Texas, said in a statement. "Our coverage criteria is based on clinical trial data, published literature and recommendations from a wide variety of medical specialty societies." The insurer didn't respond to a request for specific coverage criteria.

In October, the FDA approved Gilead's Harvoni, a daily pill that doesn't have to be taken with another drug. A typical 12-week course of treatment will generally cost about the same as for Sovaldi used with another drug (unless it's Olysio, which can push the total treatment cost to $150,000 or more). Patients like Walker might be cured in as little as eight weeks using Harvoni, however, slashing the cost by a third.

Walker says he hopes he'll be approved for Harvoni.

"Until I actually get the medication and am cured there's going to be a lot of anxiety," says Walker.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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With Obamacare, More Millennials Are Going To The Doctor, Sort Of

NPR Health Blog - Tue, 10/28/2014 - 9:55am
With Obamacare, More Millennials Are Going To The Doctor, Sort Of October 28, 2014 9:55 AM ET

I write about health and health care, but even I'm not immune to the "young and invincible" mentality. My annual dental checkup is more than six months overdue.

A provision of the Affordable Care Act that took effect in 2010 aimed to make it easier for young adults to access preventive care by allowing them to stay on their parents' insurance until they turn 26. As of 2011, some 3 million young adults gained coverage through this provision.

So does this mean more young people are getting their annual checkups and cholesterol screenings?

Sort of, suggests a study published Monday in JAMA Pediatrics.

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Researchers from the University of California, San Francisco found that after the provision took effect, the number of young adults using preventive care services went up slightly.

Between 2009 and 2011, there was a 3 percent increase in the number of young people getting routine checkups, and a 5 percent increase in annual dental visits.

But the 18- to 25-year-old group is still avoiding annual flu shots.

Though the improvement is modest, it is encouraging, says Dr. Josephine Lau, an assistant professor of pediatrics at UCSF who led the study. "This study shows us, basically, if we remove the financial barrier, young adults will actually take us up on getting the care that they need."

The results are based on data from the annual Medical Expenditure Panel Survey, conducted by the Department of Health and Human Services. The researchers only looked at the numbers through 2011, before young adults had the option to get insurance through state and federal exchanges.

"As we start analyzing data from 2012, 2013 and 2014, we will likely see a further uptick in the number of young people getting preventive care," Lau says.

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Sara Collins of the Commonwealth Fund, a health care research and advocacy group, agrees. Collins wasn't involved in the JAMA Pediatrics study, but she says early results from other surveys suggest that health coverage and preventive care access among young adults are continuing to go up, a result of the insurance exchanges and Medicaid expansion.

"These are early data," Collins says, "but it looks promising."

Still, coaxing young adults to get all the recommended screenings and immunizations may take a little extra effort, Lau says.

Lau treats young adults at UCSF's Adolescent and Young Adult Clinic, and sometimes "this group needs a bit more guidance," she says. "They may not have refilled a medication before, so you may have to explain."

Broader educational campaigns wouldn't hurt, either, she adds. "This is an age group in transition. A lot of them are living independently for the first time. We need to educate them, tell them why it's important to get preventative care."

At least her study has guilted me into finally calling my dentist.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Is 'Leaning In' The Only Formula For Women's Success In Science?

NPR Health Blog - Mon, 10/27/2014 - 5:15pm
Is 'Leaning In' The Only Formula For Women's Success In Science? October 27, 2014 5:15 PM ET Listen to the Story 5 min 8 sec  

Caltech biochemical engineer Frances Arnold was awarded a National Medal of Technology and Innovation by President Obama in 2013.

Jason Reed/Reuters/Landov

Don't wait to be invited or encouraged to make a career in science, engineering or technology, Frances Arnold advises the young women she teaches at the California Institute of Technology. If you're a scientist, she says, you should know how to solve a problem.

"Bemoaning your fate is not going to solve the problem," she says. "One has to move forward."

An award-winning biochemical engineer, and professor and researcher at Caltech for 28 years, Arnold grew up in Pittsburgh and studied engineering at Princeton University only a few years after the college began admitting women. Her father helped build one of the world's first commercial nuclear reactors; when Arnold got her Ph.D. in chemical engineering at the University of California, Berkeley she, too, had big ambitions from the start.

Additional Information: Changing Lives Of Women

This story is part of NPR's series The Changing Lives of Women.

"I wanted to rewrite the code of life, to make new molecular machines that would solve human problems," she says. So she moved to Caltech, a small, but well-funded research institute, where she now heads the biotechnology center and says anything is possible.

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Sure, she faced roadblocks along the way.

"I'm sure that there are people who are skeptical that a woman can do this job as well as a man," Arnold says, adding, "I am blissfully unaware of such people — and have been gifted with the ability to ignore them completely." She advises other women in fields dominated by men to do the same.

Arnold's female students at Caltech say she's a god. But they don't all agree with her "lean-in" philosophy.

Nikki Peck is getting a Ph.D. in bioengineering. Her parents are both science teachers. She spent her weekends growing up going to science museums and went on to Harvey Mudd College, which emphasizes science, engineering and math as well as liberal arts.

But at Caltech there was one guy she worked with who acted like women were inferior, Peck says, and her self-esteem took a hit. Still, the whole lean-in response that Arnold advises is not her style.

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"I consider myself an introvert," Peck says. "I have a hard time just, like, talking to people. It's hard for me to get up the initiative to just ... 'Lean in!' or to 'Just do it!' "

"I don't know," Peck says. "That attitude — I think it works really well for a certain type of woman. But I don't think it works for every woman."

So Peck figures she might not be the next big-shot academic. Instead, she's taking a year off from her graduate work to go work for Calico, Google's new life-extension company. She says she's a little worried about working near a city with the nickname Man Jose, where women get good tech jobs but don't stay in them.

Peck's story isn't that unusual. The pipeline of young people heading into jobs in science, technology, engineering and math is starting to widen, to diversify — more women than in decades past are getting into STEM and staying there through college, grad school and even that first job.

These days, there are about 70 male students for every 30 female students on the Caltech campus in Pasadena, Calif.

Patrick T. Fallon/Bloomberg via Getty Images

But then they opt out.

“ I'm sure that there are people who are skeptical that a woman can do this job as well as a man. I am blissfully unaware of such people and have been gifted with the ability to ignore them completely.

Peck says she thinks it's because we still haven't figured out how women can work these high-power jobs and have families. It's a conversation she hoped to have at a recent cupcake social for Women in Chemistry at Caltech.

Peck and her friends showed up at the event with their male colleagues, "but [other attendees] were sort of like, 'What are you doing here?' And then, of course, our male co-workers felt like they weren't allowed there, so they left," she says. "And so, I don't know, on the one hand, that's how we feel sometimes. But still, I don't think the way you help out women is by pushing down men."

These days Caltech is about 70 percent men to 30 percent women, with the number of women on the upswing.

But even with the push for more diversity, some students still feel singled out — and not in a good way.

Earlier this month, Caltech hosted a fly-in for high school seniors from groups that admissions officers say have been historically underrepresented in STEM fields.

You can imagine the scene, says Moraa Marwanga, a student in the International Baccalaureate program at her high school in Rockville, Md., who attended the event.

"I am one of maybe three black girls there," Marwanga recalls, "and one of maybe 10 black people in general. ... The college application process people are, like, 'Oh you're just going to get in everywhere. You're black and you're female and you like math.' ... It's frustrating," she says.

So don't let it get to you, her friend Angela Umeh from Dallas advises her. It'll be harder if you let it get to you.

Maybe that's the best advice for women now, they say: Instead of "Lean In," you might call that approach to obstacles, whatever they are, "Lean To The Side, And Let It Pass By."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

New York's Disease Detectives Hit The Street In Search Of Ebola

NPR Health Blog - Mon, 10/27/2014 - 4:22pm
New York's Disease Detectives Hit The Street In Search Of Ebola October 27, 2014 4:22 PM ET

fromWNYC

Fred Mogul Listen to the Story 3 min 28 sec  

A woman on the L train in New York City last week covers her face, fearful because a doctor with Ebola rode the train days earlier. Epidemiologists say people on the subway were not at risk.

Stephen Nessen /WNYC

A little-seen force has fanned out across New York City intent on stopping the spread of Ebola virus – disease detectives go looking for contacts who might be infected.

"They're just really good at finding people," says Denis Nash. He worked for the Centers for Disease Control and Prevention and the New York City Health Department, tracing the spread of HIV and West Nile virus. He says these trained applied epidemiologists are experts at finding almost anybody, with only a vague description.

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"A person can say, 'You know, he's a light-skinned guy who hangs out on this corner with a freckle,'" Nash said, "and these disease intervention specialists will go and find them and let them know they may be exposed and they need to be tested."

Nash is now at the City University of New York School of Public Health with Dr. Lorna Thorpe, a tuberculosis specialist who also worked for the CDC and was the city Health Department's deputy commissioner of epidemiology. Neither of them has any inside knowledge of the current investigations of Ebola. But Thorpe says you can bet there's one strategy that trumps almost all others: "You need to prioritize," she says.

In TB investigations, Thorpe began by focusing on households, work and other contacts. She and her colleagues would start with the first person infected, or "index patient," and work their way out.

"We would literally draw concentric circles and then prioritize accordingly, because you can't expend all your human resources chasing everybody," she explains.

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The searchers don't swing into action only when a headline-grabbing disease emerges. Every day they're investigating the spread of sexually transmitted diseases, tuberculosis, measles and other contagious illnesses.

"They can't stop doing TB surveillance and TB contact tracing because there's an Ebola outbreak going on," Nash says. "So it's all about trying to manage the whole big picture, which is really hard."

That being said, this Ebola outbreak has some things going for it that make it easier to deal with than other outbreaks. First of all, Ebola is transmitted only by direct contact with bodily fluids. Nash says that's different than a lot of illnesses, like the measles.

"There have been cases of people not even being in the same room as a measles case contracting the infection, because it's so infectious and airborne," he says. "This is so worlds away from that."

Second, the index case is known in this instance. That's often very difficult to figure out. And thirdly, Thorpe says, Dr. Craig Spencer is the ideal index patient: an emergency physician knowledgeable about the disease he's contracted, who's been closely monitoring his own health.

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"He came in early," she says. "The channel of communication between him, his employers, the Health Department and the medical facility seemed to be very efficient. By evening time, we had people in quarantine and the public had a deep knowledge of where he has been."

City officials say their focus is Spencer and the three other close contacts, but it's not clear how many other people they're reaching out to – if only to gather phone numbers and emails. Thorpe says that would depend on available manpower, but, typically, it would be useful to know the people in the next concentric circle or two out from the index patient, just to be safe.

This story is part of a reporting partnership between NPR, WNYC and Kaiser Health News.

Copyright 2014 WNYC Radio. To see more, visit http://www.wnyc.org/.
Categories: NPR Blogs

Ancient Viruses Lurk In Frozen Caribou Poo

NPR Health Blog - Mon, 10/27/2014 - 4:00pm
Ancient Viruses Lurk In Frozen Caribou Poo October 27, 2014 4:00 PM ET Listen to the Story 2 min 33 sec  

Caribous doing their business in mountain ice have left a viral record hundreds of years old.

Courtesy of Brian Moorman

A careful examination of frozen caribou poop has turned up two never-before-seen viruses.

The viruses are hundreds of years old: One of them probably infected plants the caribous ate. The other may have infected insects that buzzed around the animals.

The findings prove viruses can survive for surprisingly long periods of time in a cold environment, according to Eric Delwart, a researcher at Blood Systems Research Institute in San Francisco.

"The DNA of viruses is preserved extremely well under cold conditions," he says.

Delwart's day job at Blood Systems is to find new viruses that could contaminate the blood supply. But he enjoys looking in odd places too. He got interested in ice cores from high mountain regions, after reading about all the interesting old things the ice contained.

"Things like old shoes and arrowheads," he says, "and then I realized this is nature's freezer, which should also contain organic remains."

Delwart had one particular type of organic remains in mind: caribou poop. Just about everything an animal eats can be infected with a virus. And that makes animals, including humans, virus vacuums that suck up every virus in their path.

"I mean we're constantly shoving viruses down our throat and if you look at poo samples from humans and from animals you will find a lot of viruses," he says.

Caribous hang out on ice, so these pristine ice cores are actually full of poo. And as scientists go through layer after layer of ice, the poo gets older and older.

Delwart examined poop from northern Canada that was 700 years old. The result, published Monday in the Proceedings of the National Academy of Sciences, is the discovery of these two viruses.

The DNA was so well-preserved that Delwart's collaborators could even reconstitute one virus and use it to infect a plant in the lab.

As far as Delwart can tell, these viruses aren't dangerous, which is good. As the North warms and ice melts, more caribou poo infected with ancient viruses will be finding its way into the modern ecosystem.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Disabled Vermont Woman Who Led Class-Action Suit Sues Medicare Again

NPR Health Blog - Mon, 10/27/2014 - 12:56pm
Disabled Vermont Woman Who Led Class-Action Suit Sues Medicare Again October 27, 201412:56 PM ET Susan Jaffe iStockphoto

A 78-year-old Vermont mother of four who helped change Medicare coverage for millions of other seniors is still fighting to persuade the government to pay for her own care.

Glenda Jimmo, who is legally blind and has a partially amputated leg due to complications from diabetes, was the lead plaintiff in a 2011 class-action lawsuit seeking to broaden Medicare's criteria for covering physical therapy and other care delivered by skilled professionals. In 2012, the government agreed to settle the case, saying that people cannot be denied coverage solely because they have reached a plateau and are not getting better.

The landmark settlement was a victory for Medicare beneficiaries with chronic conditions and disabilities who had been denied coverage under what is known as "the improvement standard" — a judgment about whether they are likely to improve if they get additional treatment. It also gave seniors a second chance to appeal for coverage if their claims had been denied because they were not improving.

Jimmo was one of the first seniors to appeal her original claim for home health care under the settlement that bears her name. But in April, the Medicare Appeals Council, the highest appeals level, upheld the denial. The judges said they agreed with the original ruling that her condition was not improving — criteria the settlement was supposed to eliminate.

After running out of options appealing to Medicare, her lawyers filed a second federal lawsuit in June to compel the government to keep its promise not to use the improvement standard as a criterion for coverage. They are asking Medicare to pay for the home health care that Jimmo received for about a year beginning in January 2007.

"There was really no expectation that she would improve — she was getting skilled nursing and home health care to maintain her condition and reduce complications," said Michael Benvenuto, director of Vermont Legal Aid's Medicare Advocacy Project, who has filed review requests for 13 other seniors. "It shows there may be real problems with implementing the settlement at the very highest level."

In the settlement, officials had agreed to rewrite Medicare's policy manuals to clarify that as long as patients otherwise qualify for coverage — for instance, they have a doctor's order for skilled care to preserve their health or to prevent or slow deterioration —Medicare must pay for therapy and other care at home, in a nursing home or office. They also agreed to educate providers, billing contractors and appeals judges about the change.

The council's decision on Jimmo makes no sense to Judith Stein, executive director of the Center for Medicare Advocacy, which filed the original class action lawsuit with Vermont Legal Aid, and helped negotiate the Jimmo settlement.

"People shouldn't have to decline in order to get the care they need," Stein said.

She recommended that seniors or their families get the center's self-help packet and contact her if they still have problems at improvement@medicareadvocacy.org.

The Parkinson's Action Network, one of the seven advocacy groups that had joined the original Jimmo lawsuit, still receives several calls a week from patients who are told Medicare won't cover their care because they aren't improving. But Parkinson's disease is an incurable chronic degenerative neurological condition.

"Just maintaining function is a victory," said Ted Thompson, chief executive of the Parkinson's group.

Gabe Quintanilla, a lawyer for the city of San Antonio, refused to sign the noncoverage forms when he was told at least seven times this year that his 92-year-old mother's physical and speech therapy would end because she wasn't improving following her hospitalization for a stroke. One doctor suggested hospice care.

"The only reason I was able to keep my mother's therapy going is because I sent a copy of [the] Jimmo [settlement] to her doctor, her insurance company and the home care agency," he said. His mother has a Medicare Advantage plan, a private health insurance program that must also comply with the settlement. He discovered it "by accident," he said, while researching legal options on the Internet.

His mother eventually left the hospital and received follow-up care at a nursing home before returning home. Despite the dire predictions, what began as maintenance therapy has led to unexpected, if slight, improvements.

In a video he posted on YouTube, he leans in close to share his prediction that the Spurs are going to beat Portland. And she smiles, pleased that her favorite basketball team won't let her down.

"The Jimmo settlement saved my mother's life," he said.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Corneal Implants Might Make Reading Glasses Obsolete

NPR Health Blog - Mon, 10/27/2014 - 4:36am
Corneal Implants Might Make Reading Glasses Obsolete October 27, 2014 4:36 AM ET Listen to the Story 3 min 41 sec  

A corneal inlay next to a contact lens.

Courtesy of John Vukich

For Lori Bandt, who works as a medical technician and an EMT in a suburb of Madison, Wis., the print on vials of medication has become so difficult to read that if she forgets her reading glasses she has to resort to having a younger EMT worker read the directions. The 45-year-old says: "I'm just stuck."

And she's hardly alone: 1 in 5 Americans needs reading glasses or bifocals because of presbyopia. With age, the formerly pliable lens of the eye starts to harden. That makes it harder for muscles to squeeze the lens to focus on nearby objects.

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But eye doctors are trying to come up with options for people like Bandt. Her doctor, Dr. John Vukich, is one of them. The corneal inlay, called KAMRA, is a flexible doughnut-shaped ring that is surgically inserted into the eye and creates a sort of artificial pupil. He is working as a consultant to the company marketing the implant.

The surgical procedure uses a laser to make a small incision in the very front of the cornea, where the ring is placed. The results with a corneal inlay are "immediate," says Vukich, restoring near vision right away. And there isn't much down time for patients. He says the procedure is far less complicated and invasive than LASIK.

The KAMRA corneal inlay has been used in Europe since 2011, and is also being used in South America and Asia.

Science Bionic Eye Opens New World Of Sight For Blind

But members of an FDA advisory panel have raised concerns about the safety of the device. At the committee's meeting in June, the company presented data from a 36-month trial that found that 83 percent of the 478 patients enrolled achieved visual acuity of at least 20/40 or better.

However, that did not include 44 patients who dropped out of the study and had the corneal inlays removed. Most of those patients, 86.4 percent, said the device didn't improve their vision like they expected.

Had the patients been included, the device's efficacy rate would have dropped to 75.8 percent. Officials also noted that even after removal of the inlay, some patients still had hazy vision or fluid buildup in the cornea.

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The FDA advisory panel determined that the device was effective, voting 7 to 1 in favor. But when it came to safety, it voted 4 to 5 against the inlay. The FDA hasn't decided whether it will approve KAMRA, but it often follows the advice of its advisory committees.

The fact that some patients had vision problems after the inlays were removed is a problem, says Dr. Anne Sumers, an ophthalmologist and spokesperson for the American Academy of Ophthalmology. "This is the windshield of the eye, and the windshield of the eye needs to be crystal clear like your car windshield," she says. "If there's haze or fluid in it, it's not crystal clear."

Even so, the technology has great potential, says Sumers, and might prove a reasonable option for aging boomers in the near future.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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In The Hospital, A Bad Translation Can Destroy A Life

NPR Health Blog - Mon, 10/27/2014 - 4:36am
In The Hospital, A Bad Translation Can Destroy A Life October 27, 2014 4:36 AM ET

fromOPB

Kristian Foden-Vencil Listen to the Story 4 min 40 sec  

Dr. Angela Alday talks with Isidro Hernandes, via a Spanish-speaking interpreter, Armando Jimenez. Both patient and doctor say they much prefer an in-person interpreter to one on the phone.

Jeff Schilling/Courtesy of Tuality Healthcare

Translating from one language to another is a tricky business, and when it comes to interpreting between a doctor and patient, the stakes are even higher.

Consider the story of 18-year-old baseball player Willie Ramirez.

In 1980, Ramirez was taken to a South Florida hospital in a coma, says Helen Eby, a certified medical interpreter in Oregon. "His family apparently used the word 'intoxicado' to talk about this person," she says. "Well, 'intoxicado' in Spanish just means that you ingested something. It could be food; it could be a drug; it could be anything that has made you sick."

The family thought something Ramirez had eaten might have caused his symptoms. But the interpreter translated their Spanish as "intoxicated."

“ One problem that I run into with the translator phone is a lot of our elderly patients seem to be kind of confused by it. You know, some of them don't hear very well.

"So the doctor immediately made a diagnosis of drug overdose," Eby says. A couple of days later, the health team figured out that Ramirez's problem was actually bleeding in his brain. But by then he'd suffered lasting damage. "The guy ended up quadriplegic," Eby says.

In medical situations, doctors and hospitals often turn to family members for help with interpreting, but that can be problematic, she says.

"You know, you've got a 10-year-old in a gynecology appointment," she says. "Is this where you would normally take a 10-year-old? Not likely. Or [you'll] have a child — an adult child even — interpret a parent's cancer diagnosis. That's got to be highly traumatic." And the chance that important medical details will be misunderstood increases significantly.

Thirteen years ago, the state of Oregon recognized the problem and required doctors and hospitals to start using professional interpreters. The Affordable Care Act also has expanded the kinds of materials that hospitals and insurers are required to translate for people who don't speak English.

But more than a decade after its state law passed, Oregon still has trouble getting all patients the medical interpretation help they need.

For example, many hospitals and doctors turned to a phone service, where they can quickly get help in several languages. But the people who work for those language services often aren't certified medical interpreters — so aren't necessarily conversant in medical terminology — and are working at a distance, which can lead to other problems.

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Dr. Angela Alday, an internist at Tuality Healthcare, a community hospital in Hillsboro, Ore., says that up to 20 percent of her patients require an interpreter.

"One problem that I run into with the translator phone is a lot of our elderly patients seem to be kind of confused by it," Alday says. "You know, some of them don't hear very well, so that can be a problem with the phone translator. And then, particularly if the patient has dementia, sometimes using the telephone translator is confusing. They don't know what's going on."

Isidro Hernandes, a 48-year-old landscaper in Oregon's fertile Willamette Valley, says (via medical interpreter Armando Jimenez) that he, too, prefers an in-person interpreter to one on the phone. Hernandes, who speaks primarily Spanish, landed in Tuality hospital for treatment of heart problems after feeling tightness in his chest at work.

"A lot of times the over-the-phone interpreter can't see what you're doing, can't describe or relay that message," Hernandes says via Jimenez. "And sometimes they might have errors or mistakes in communications."

Gerry Ewing, the director of corporate communications at Tuality, says the hospital has largely been relying on qualified phone interpreters, but it plans to use more in-person interpreters.

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"We're trying to reflect the demographics of our community, which is changing rapidly," Ewing says. "Washington County is around 25 percent Hispanic, so we need to reflect that in the services we provide our patients."

Alday says she's pleased that the hospital is planning to use more in-person interpreters. In the meantime, she says, she often relies on phone interpreters, but also sometimes will turn to a family member for particularly touchy issues. "I feel like if there's a family member standing there beside them, then they understand more what's happening," she says.

Oregon has about 3,500 medical interpreters. But Eby says only about 100 of those have the right qualifications. "So, you have a 3 percent chance of getting a qualified or certified interpreter in Oregon right now," she says. "That's pretty low, in my opinion."

She says it takes a long time and costs a lot of money to become certified. And after going through all that training, a person may find that he or she can make more money and have a more stable lifestyle in another career — like being a translator for court reporting. That's because medical interpreters tend to be consultants and don't get paid to travel. The hours can also be sparse and sporadic.

But Eby remains hopeful. Now that the Affordable Care Act is penalizing hospitals for readmissions, reducing medical errors should be more of a priority than ever, she says — it's better for patients and it can save hospitals money.

A study by the American College of Emergency Physicians in 2012 analyzed interpreter errors that had clinical consequences, and found that the error rate was significantly lower for professional interpreters than for ad hoc interpreters — 12 percent as opposed to 22 percent. And for professionals with more than 100 hours of training, errors dropped to 2 percent.

To help ease the shortage of interpreters in Oregon, the state's Office of Equity and Inclusion reports that it is trying to increase training and add 150 new interpreters over the next couple of years.

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

Copyright 2014 Oregon Public Broadcasting. To see more, visit http://www.opb.org.
Categories: NPR Blogs

Fresh From Appalachia: Chinese Medicinal Herbs

NPR Health Blog - Sun, 10/26/2014 - 12:13pm
Fresh From Appalachia: Chinese Medicinal Herbs October 26, 201412:13 PM ET

fromWVTF

Robbie Harris Listen to the Story 3 min 52 sec  

The Appalachian Medicinal Herb Growers Consortium's goal is to raise plants that meet the quality standards demanded by clinical practitioners.

Blue Ridge Center for Chinese Medicine

Traditional Chinese medicine is gaining acceptance in the U.S., though still largely as a complementary treatment.

Mainstream doctors are mixed on its effectiveness. Still, as alternative treatments gain traction and the demand for Chinese herbs grows, farmers in Appalachia are responding.

The Blue Ridge Center for Chinese Medicine in Pilot, Va., is surrounded by miles of mountains, forests and farmland.

Outside the building, small plots of Chinese medicinal herbs grow on terraced slopes.

Jars of dried roots, leaves and flowers line the shelves of the Blue Ridge Center for Chinese Medicine.

Blue Ridge Center for Chinese Medicine

"A lot of these herbs we are going to let flower and be pollinated and grow for the seed because there is such a need for the seed," says David Grimsley, co-director of the Appalachian Medicinal Herb Growers Consortium, a new project based at the center that teaches others how to grow native Chinese herbs in Appalachia.

At the Appalachian Medicinal Herb Growers Consortium, the goal is to raise plants that meet the quality standards demanded by clinical practitioners.

In what looks like a well-organized kitchen, rows of shelves stack to the ceiling lined with neatly labeled glass canisters filled with dried roots, leaves and flowers. Grimsley pulls one down and opens the lid.

"This is Trichosanthes," he says. "We go by their Latin name as opposed to their Chinese Pinyin medicinal name, because we're farmers working with the herbs themselves and not the medicine. This is a perennial melon. And one wonderful thing about it is the skin is used, the seeds are used, the fruit is used and the root is used and they're all for something different."

Practitioners must be certified by the state, and not all states allow it. But growers see an increase in demand.

The renowned Cleveland Clinic opened the Chinese Herbal Therapy Clinic in January, one of the first herbal clinics inside a hospital in the country. Director Jamie Starkey, like most practitioners, buys her herbs from China, but she says she'd like to see high-quality medicinal herbs grown in the U.S.

"If the United States farmers can tap into growing Chinese herbs, but do it in a way where there's proper testing by third parties, they're able to identify the herbs properly, there's no contamination, no pesticides, you know, I think it's such a great opportunity," Starkey says.

Jean Giblette, a longtime grower who has studied the market, says 27,000 licensed practitioners work in the U.S. She estimates the market to be $200 million to $300 million a year.

"That's a conservative estimate, because once they're presented with fresh, domestically grown herbs I think it's actually going to change practitioner behavior," Giblette says. "It's going to encourage people who may be relying on manufactured products ... to go back to the traditional agricultural products."

Many herbalists say the most effective way to use medicinal herbs is to boil them twice, then discard them and drink the "tea" — a process known as decoction. It's exactly the way people in Appalachia have taken wild indigenous herbs for decades.

"This area of the Appalachians corresponds very nicely to the medicine belt in China, where a lot of the Chinese herbs are endemic — they grow naturally in the wild — so we're very excited to become a medicinal hub for Chinese herbs," Giblette says.

Since the project began in the spring, the Appalachian Medicinal Herb Growers Consortium has helped plant nine farms in the area. Grimsley says 20 more are on the way.

Copyright 2014 WVTF Public Radio. To see more, visit http://www.wvtf.org.
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A Diary Of Deaths Reminds Doctor Of Life

NPR Health Blog - Sat, 10/25/2014 - 7:50am
A Diary Of Deaths Reminds Doctor Of Life October 25, 2014 7:50 AM ET Listen to the Story 2 min 58 sec   Maria Fabrizio for NPR

Doctors rarely talk about death.

Mostly it's because we're in the business of trying to help people prolong their lives, which almost always makes death an unwelcome topic of discussion.

Too often, death is seen as failure, though it shouldn't be. Death is a natural part of the cycle of our lives.

After all the time I've spent working in hospitals I'm less afraid of death than I used to be. It can be scary to see death up close. But the end can seem a blessing after you've watched patients suffer and witnessed medical treatments that were dehumanizing and fruitless.

Even though my medical practice is mostly confined to the office now, I still confront death regularly. As a part of my practice, I decided to be more mindful about it by keeping a list of the patients I've cared for who have died. I call it my necrology.

I started by keeping names in a small notebook. Later, I moved it to a computer file so that I wouldn't lose it. I add names to the list about four or five times a year. Whenever I pull up my necrology, I look it over and remember the names of those already there. For most of them, I was their doctor for years and stayed involved until their dying breath. Others rocketed into and out of my medical practice like meteors, where I was but one witness among many.

Ray was a patient of mine diagnosed in his mid-60s with metastatic prostate cancer, the kind that spread beyond the gland and into his bones. Amazingly, through the use of hormonal treatment that starved his cancer, he lived more than a decade past his diagnosis. Eventually his cancer became resistant to the treatment, and he died. For Ray, his family, and his doctors, his extra time was a medical victory.

Tricia was a young and unfortunate patient I met only twice. During her first appointment, she revealed that her boyfriend had beaten her. I counseled that nothing could justify such treatment, and that help was available if she had the courage to leave. I gave her the number of a women's shelter where I knew she could get support and legal aid to protect herself.

The next time I saw her, she told me things were better. She never called the shelter. I last heard about Tricia when a police officer called me for information about her. She'd been found dead at age 34.

I started my necrology because early in my career I'd seen a colleague keep a file of his deceased patients. I never asked him about it, because it seemed too personal. But I liked his idea, and started my own list.

In everyday medical care, the practice of reflection is too often overlooked. Remembrance is what makes us human. Somehow, keeping tabs on who has died over the years keeps me humble. It also reminds me that in spite of all of medicine's marvels, and whatever I might be able to do, our patients all eventually die.

When a patient of mine died recently amid complicated medical circumstances, I sought counsel from colleagues about what, if anything, I could have done differently. The conversations led me to ask about their remembrance practices. I learned that all doctors have memories of patients now deceased, but besides lamenting them when they died, very few colleagues have a formal habit of remembrance, such as keeping a list. The prevailing sentiment is that as doctors, we are trained to acknowledge death, and then to quickly move on, lest we become too emotionally involved.

To try to better understand my own necrological compulsion, I circled back to my inspiration: a former colleague, Dr. Adam Cifu, an internist like me, at the University of Chicago.

Cifu told me that he started his list the first time one of his patients died — in 1995, from complications of HIV. Beside each name, he adds a sentence on the cause of death and interesting points about the illnesses — what he artfully terms "a medical epitaph."

"The process lets me remember the people, get a sense of what people die from in my practice ... and potentially teaches me something," he wrote.

I wondered if Cifu sought solace and advice from the doctors he works with after a patient dies, as I have over the years. Yes, he told me. "A little bit of it is mourning and a little bit of it is clearing my conscience if I feel there were things I could have done better," he wrote.

What will become of our necrologies? "They'll just keep getting longer," Cifu told me, "until our names are added to the list."

John Henning Schumann is a primary care doctor in Tulsa, Okla., where he teaches at the University of Oklahoma School of Community Medicine. He also hosts Public Radio Tulsa's Medical Matters. He's on Twitter: @GlassHospital

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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For Hospitals, Doing More On Ebola May Mean Less Elsewhere

NPR Health Blog - Fri, 10/24/2014 - 5:20pm
For Hospitals, Doing More On Ebola May Mean Less Elsewhere October 24, 2014 5:20 PM ET

As Bellevue Hospital in New York City treats its first patient with Ebola, other hospitals around the country are pouring resources into getting ready in case they're next.

Eighty-one percent of hospitals have started training their staff in caring for an Ebola patient, according to a survey of 1,039 members of the Association for Professionals in Infection Control and Epidemiology. They're the folks who manage infection control in hospitals.

In the survey, 78 percent said their hospital is moderately to well prepared to care for a patient with Ebola virus.

But more time spent on Ebola can mean less time to handle day-to-day demands, particularly the Enterovirus D-68 outbreak and the approaching flu season.

"We have to drop so many other things to take this on," says Jennie Mayfield, president of APIC.

Infection prevention and control at hospitals can range from ensuring that nurses and doctors are washing their hands and wearing face masks to coordinating whether or not a certain patient really needs an antibiotic, in order to reduce the prevalence of drug-resistant bugs.

For infection preventionists, a normal routine includes "Looking at the lab results, we're looking at what new patients maybe came onto a unit, we're taking calls from the unit, 'What do you think I should do about this particular thing?'" says Linda Greene, an infection prevention manager and member of APIC's regulatory review panel.

But now, Green says, if the infection preventionist is working on training with personal protective equipment for Ebola, their other tasks aren't getting done as promptly or efficiently as they could be.

As a result, Greene tell Shots the fear is that they'll "miss red flags" for patients with the flu or antibiotic-resistant bacteria. And while patients needn't necessarily be worried about making a visit to their local clinic, she says hospitals could be doing a better job. Greene says hospitals need to think about their worst-case scenario, whether that be an Ebola patient or a larger flu pandemic, and equip themselves with the people and technology to handle it.

"We learned this from the SARS outbreak," Greene says. "People burn out."

The Ebola outbreak has helped highlight the gaps in hospitals' response to highly infectious agents, Greene says, but if hospitals take the time to address those gaps, it won't be so hard when the next big health problem comes our way.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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In Minnesota, Abandoned Wheelchairs Are Just Part Of The Landscape

NPR Health Blog - Fri, 10/24/2014 - 12:09pm
In Minnesota, Abandoned Wheelchairs Are Just Part Of The Landscape October 24, 201412:09 PM ET

fromMPR

A lone Mayo Clinic wheelchair sits on the Cascade Creek walking trail near Kutzky Park in Rochester, Minn.

Elizabeth Baier/MPR News

Anyone who has spent much time in Minnesota's "Med City" can't help but notice that wheelchairs are everywhere.

From city parking ramps and downtown sidewalks to park trails and the local mall, the chairs have an inescapable presence.

More than likely that has do to with the fact that Rochester is home to Mayo Clinic, visited by thousands of patients every day. Many of them use wheelchairs to get around. So it's not surprising that they exist in big numbers.

The big curiosity is how they end up all over the city with their users nowhere in sight — a fact that some local residents can be oblivious to.

Denny and Carol Scanlan say empty wheelchairs are just part of the Rochester landscape.

"I never even thought of it until just now," Denny Scanlan says over a drink at American Legion Post 92, where he is a member. "Well, I see them kind of everywhere we go, I guess — where you least expect them."

"Yes," says his wife, with a laugh. "At the mall. In a restaurant. " She adds, "We're so used to it that I don't even notice it."

But some people do notice the big blue chairs.

At the Blue Water Salon on the skyway level of the Doubletree Hotel, owner Shelly Joseph often sees them just outside her door, in a public stairwell largely used by hotel staff.

Mayo Clinic employee Kevin Acker collects wheelchairs from a hallway at the Kahler Grand Hotel in Rochester. He retrieves abandoned chairs around the city every weekend.

Alex Kolyer for MPR News

"I don't know why they're in here, but randomly they're in this stairwell," she says. "It's a fire exit, basically."

At the Starbucks across the hall, manager Dawn Lee-Britt sees wheelchairs outside the employee entrance at the back of the coffee shop at least a couple of times a week.

"Sometimes we can't get out," she says. "I'm getting used to it because we see them so often." She adds: "It's like they don't need it anymore or it's time to go.

Mayo Clinic has 1,180 wheelchairs in its Rochester fleet, largely for patient transport. It loses up to 150 chairs each year, says general services manager Ralph Marquez, who oversees patient equipment.

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At $550 each, that could be as much as $82,500 a year.

"Yes, it's a financial burden to us from that standpoint, but it's also a service we provide," Marquez says. "And if the patient, you know, truly comes first, sometimes that's the expense of the business."

Because the clinic does not want to keep patients from leaving the campus, the clinic's courier service rounds up wheelchairs weekly, mostly from hotels and other places that alert them.

But the chairs can travel much farther than that.

"We've gotten calls from Orlando Airport. Goodwill up in Duluth had one of our chairs and luckily we were able to retrieve that one. We've had them in Denver, out east in a few airports," Marquez says. "They get back to us dirty and needing to be cleaned. People may take them home for a while. They wind up everywhere."

Mayo Clinic employee Merle Paxton returns wheelchairs to a building on campus.

Alex Kolyer for MPR News

That includes the Rochester Public Library, where communications manager John Hunziker considers wheelchairs normal.

"I'm sure if you aren't used to Rochester, seeing somebody going down the skyway, you know, pushing an IV on a rolling stand looks kind of weird," he says. "But it's just part of living in Rochester."

And on some days, part of Hunziker's job is to let the Mayo Clinic know there's a blue chair to pick up in the lobby.

Copyright 2014 Minnesota Public Radio. To see more, visit http://www.mpr.org/.
Categories: NPR Blogs

VIDEO: Talking While Female

NPR Health Blog - Fri, 10/24/2014 - 9:03am
VIDEO: Talking While Female October 24, 2014 9:03 AM ET Animation by Kelli Anderson for NPR/YouTube

Ask a woman if anybody has ever complained about her voice and, chances are, you'll get a story. Watch the above animated video, and you'll see what we mean.

Your voice is too squeaky, it's too loud, it lacks authority, it sounds childish, it's grating or obnoxious or unprofessional.

We put together a list of six top complaints. Rindy Anderson, a biology professor at Florida Atlantic University, provides some context. Anderson used to study birdsong but has since done a number of studies with her political scientist husband, Casey Klofstad of the University of Miami, on the perception of women's voices.

1. Your Voice Is Too High

Women's voices tend to be higher than men's, at least partly because their vocal cords are thinner and shorter than men's. That's related to hormones (having a lot less testosterone than men) and genetics and a bunch of other factors. This can be a liability for women whose voices are naturally high, since Anderson's research suggests lower voices are perceived as more "competent." You can pull a Margaret Thatcher and get coaching to speak lower, but that'll only get you so far.

2. You Sound Like A Child

This is related to No. 1. Children have high voices, so I guess women with high voices sound childlike — even when they're fully grown professionals — like a 5-foot-tall, high-voiced New York City litigator who sometimes gets mistaken for a teenager (she took lessons to sound more commanding, just like Thatcher).

3. You Don't Sound Authoritative

Lower voices are associated with being powerful and authoritative. When NPR's Susan Stamberg became the first woman to anchor a national nightly news broadcast, there was opposition. People said a woman's voice wouldn't carry, Stamberg recalls: " 'A woman's voice is not authoritative. People will not believe her; she will not be taken seriously.' " That was the '70s, and now it's well understood that women — even if their voices are not low and booming — are believable and can have authority. ... Psych! Women still get this all the time.

4. You've Got Vocal Fry

Vocal fry happens when you drop your voice to its lowest register and it fries, or crackles or creaks. Lots of people go nuts about vocal fry and how it's terrible. Anderson's research suggests that people who use vocal fry are less hirable and perceived as less trustworthy. It's not actually clear that women use it more than men, but they certainly get the lion's share of flak for it.

5. Is That A Question?

Ah, uptalk. It's when you go up at the end of your sentence? Even when it's not a question? Every once in a while there's pandemonium about uptalk invading our speech. "Uptalk is a really old vocal affectation," Anderson says. "It dates back to the 19th century — some people believe — in Britain." So much for a new fad. Anderson also has some interesting ideas about why it's used. "There's some evidence that women who find themselves in a socially dominant position will use uptalk in order to soften that dominance." Another theory? It's a way of indicating to your listener that you're not done yet — a kind of "Are you with me?" asked through inflection.

6. Your Voice Is Too Low

Now this is just unfair: If women's voices aren't too high, they are sometimes perceived as too low. "Humans like average," Anderson says. "We don't want a high, squeaky voice on a woman, but we also don't want a really low, booming voice on a woman." Because, she says, that's sex atypical — it sounds too manly. That is, unless you're Lauren Bacall.

And so, today, many women in positions of power are advised to modulate their voice pitch and speech patterns to match their male counterparts. Maybe when more women achieve positions of power, what we perceive as a powerful, competent voice will start to broaden and change.

This story is part of NPR's periodic series, The Changing Lives of Women.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

FDA Cracks Down On Fake Ebola Cures Sold Online

NPR Health Blog - Thu, 10/23/2014 - 4:22pm
FDA Cracks Down On Fake Ebola Cures Sold Online October 23, 2014 4:22 PM ET

fromKERA

Listen to the Story 3 min 20 sec  

The problem isn't just that fake cures are worthless, doctors say. Fraudulent claims also give some people the false sense that the product can protect them from getting sick.

iStockphoto

Snake venom, vitamin C, Nano Silver and herbs have all been pitched online as a treatment or cure for Ebola. None has the backing of the FDA.

"Unfortunately during public health threats such as Ebola, fraudulent products that claim to prevent, treat, cure disease often appear on the market almost overnight," says Gary Coody, the FDA's national health fraud coordinator. In particular, the FDA wants consumers to beware Ebola "cures" peddled online.

“ It's like storm-chasing roofers, who go and try to defraud people after a big storm. Some of them may be making an honest mistake; other companies are trying to rip people off.

The problem isn't just that such products are worthless. "Consumers who are misled by false claims may delay seeking the medical care they need, such as proper diagnosis and supportive care," Coody says. Or they may have a false sense that the product will protect them from the virus.

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The FDA has sent warning letters to three companies it says are making fraudulent claims about Ebola cures. The letters threaten property seizure and even criminal prosecution if the firms don't respond appropriately.

The strategy amounts to "public shaming," says Nathan Cortez, who teaches law at Southern Methodist University in Dallas. "It's one mechanism that the FDA uses to lean on companies in a very public way. It's also meant as a warning to other firms, he says, "to say we know companies are trying to defraud the public with fake Ebola tests and treatments and we're on the case."

Two of the firms that got the FDA warning letters didn't respond to my emailed messages. But Ralph Fucetola of the New Jersey-based company Natural Solutions Foundation says he heard the FDA's message loud and clear. Natural Solutions received the warning for its claims that a product known as Nano Silver can effectively kill Ebola.

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"We understand that there is no approved treatment for Ebola," Fucetola says. "Since we are in the middle of negotiating with the government with regard to how we can best describe what we believe is a very important health breakthrough, we are not using the legal term of art 'treatment of disease.' "

Even if the company doesn't explicitly say that Nano Silver "treats" Ebola, it has claimed on its website, Twitter and Facebook that Ebola has a cure — a statement not borne out by the evidence so far, according to the FDA, CDC and other health officials.

While there are experimental drugs and vaccines being tested in the current Ebola outbreak, nothing yet has been proved to work.

Online, other companies tout clove oil, oregano and homeopathic treatments to prevent the virus. There's even a tutorial that was up on YouTube for a do-it-yourself vaccine.

Some businesses, Cortez says, take advantage of fear.

"It's like storm-chasing roofers, who go and try to defraud people after a big storm," he says. "Some of them may be making an honest mistake; other companies are trying to rip people off."

Mistake or not, the FDA says Ebola cures advertised on the Internet are misleading and dangerous. The agency encourages consumers who have seen such claims to report them.

Copyright 2014 KERA Unlimited. To see more, visit http://www.kera.org/.
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