NPR Health Blog - Thu, 12/05/2013 - 2:11pm
Medical Journal Goes To The Dogs
by Scott HensleyDecember 05, 2013 2:11 PM Enlarge image i
That's Dr. Fido to you, pal.JAMA
For a half-century, JAMA, the journal of the American Medical Association, adorned its cover with works of fine art. You could have easily mistaken an issue of the august medical journal on your doctor's desk for a stray copy of ARTnews.
But a JAMA redesign this summer put the table of contents on the front cover and moved the art inside.
Why? "Many readers let us know that while they appreciated [the art], there was no indication on the cover of what was in the journal, the content of the journal," says Dr. Phil Fontanarosa, JAMA's executive editor.
Sometimes for a theme issue, though, the editors will push the article listings down a bit to make room for a picture.
And this week for an issue devoted to medical education, JAMA created what may be a new kitsch masterpiece. A group of seven canine healers, some apparently in training, hover around a sick mutt sucking on a thermometer in a hospital bed.
If you've spent any time in knotty-pine-paneled rec rooms or playing pool in dive bars, you'll recognize the style instantly.
Just in case you don't, the JAMA editors write that the cover is "an homage to the early 20th-century artist Cassius Marcellus Coolidge." His body of work includes paintings such as A Friend in Need and A Bold Bluff. The JAMA editors point out that Coolidge's "oeuvre is most commonly referred to as Dogs Playing Poker."
The JAMA editors say they were unaware of any Coolidge paintings that depicted medical education and decided to commission a cover to fill the gap. The Dogs Playing Doctor cover was a collaboration between editor Dr. Robert Golub and JAMA medical illustrator Cassio Lynm.
"While the cover is certainly whimsical, we think it's an homage of sorts to medicine," Fontanarosa tells Shots. "We fully expect that our readers are going to react to the cover." In fact, he says, one doctor who admired it has asked about getting a poster-size print suitable for framing. That's not something JAMA is able to do just yet.
But don't get fixated on the doctor dogs. Fontanarosa says the issue has lots of excellent research on hot topics in medical education, ranging from substance abuse by anesthesiology residents to reduction of errors when residents hand off patients at the end of shifts.
So just like another magazine that used to be headquartered in Chicago, you might pick up JAMA to look at the eye-popping cover and stick around for the thought-provoking articles.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Thu, 12/05/2013 - 5:00am
White House Cites Pre-Existing Condition Case From Its Own Ranks
by Ari ShapiroDecember 05, 2013 5:00 AM Enlarge image i
Michael Robertson, then chief of staff of the Government Services Administration, testifies on Capitol Hill on April 16, 2012. Now chief of staff of the Cabinet Affairs Office in the Obama administration, Robertson has undergone treatment for stage IV colorectal cancer.Chip Somodevilla/Getty Images
It's Day 4 of the White House's new messaging push for the Affordable Care Act. Today the goal is to tell the stories of people with pre-existing conditions who are now entitled to coverage under the new health care law.
One such story comes from within the White House.
Michael Robertson, deputy assistant to the president and deputy cabinet secretary, was diagnosed with stage IV colorectal cancer 16 months ago. He was 35.
"I went overnight from being completely healthy and exercising and all that to having this catastrophic disease," he said in an interview at the White House on Wednesday. Robertson described the shock of realizing "these things can happen in an instant. They don't just happen to older people."
Doctors told him the disease had spread to three organs. He immediately went into treatment. "I had a total of eight months of chemotherapy, a month and a half of radiation — every day — which was a real rough part of it. You go every morning for the radiation. And then I had a total of five surgeries with various stints in the hospital for that, plus the recovery time," said Robertson.
For insurance purposes, Robertson had just become someone with a pre-existing condition. And that made him vulnerable to losing his coverage should he change jobs.
"I'd always imagined pre-existing condition to be something you were born with, something you've had for years," he said. "Not something you can go to bed one night and wake up the next morning and be told you have. That was a real eye-opening thing."
As Republicans have fastidiously catalogued the many hiccups and stumbles with the health law, the Obama administration is eager to shift the focus away from the troubled website and President Obama's false promise that "if you like your insurance, you can keep it."
In Robertson's case, roughly $900,000 of treatment left him with no detectable cancer in his body. He was fortunate to have insurance that covered almost all of the cost.
A White House official says in the coming days, the administration will call attention to stories like Robertson's. While many parts of the Affordable Care Act are unpopular, this provision has broad support. The law prohibits insurance companies from denying or charging higher premiums to people with health problems that may recur, such as cancer, asthma or diabetes.
The administration also hopes that stories like this one persuade so-called young invincibles to sign up for health coverage. The participation of young, healthy people in the system is essential to balance out the cost of older, sicker people who depend more on expensive medical services.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Thu, 12/05/2013 - 4:00am
FDA Expected To Approve New, Gentler Cure For Hepatitis C
by Richard KnoxDecember 05, 2013 4:00 AM Listen to the Story
A colorized closeup of the hepatitis C virus.James Cavallini/Science Source
The Food and Drug Administration is expected any day now to approve the first in a new class of drugs that can cure the leading cause of liver failure and liver cancer.
The disease is hepatitis C, a slow-moving but deadly virus that infects more than 3 million Americans. The new treatment is a once-a-day pill that can cure at least 85 percent of victims without the need for injections of interferon, an immune stimulant that causes severe side effects.
The advent of interferon-free treatments for hepatitis C is an advance that's "about as hot as I've ever seen," says Dr. David Thomas, a liver specialist at Johns Hopkins University.
He says the new drugs are almost like curing lung cancer with only three months of once-a-day pills.
"That's kind of an exaggeration because lung cancer treatment is worse than what we used to do (to treat hepatitis C)," Thomas says. "But it's that kind of thing — where we did something that didn't work that much and hurt people a lot. And then we go from that to something that's ... really an amazing transformation."
The first of the new hepatitis C drugs is Gilead Science's sofosbuvir. It interferes with the virus' replication without much affecting cell metabolism. The drug won a unanimous recommendation for approval from of an FDA advisory committee last October for interferon-free treatment of two strains of the virus, in combination with the oral drug ribavirin. Agency approval is expected by Dec. 8.
The advisory panel also recommended approval of sofosbuvir for treatment of the most common and difficult-to-treat strain of hepatitis C, called genotype-1. But in that case, it needs to be used with interferon.
But other new hep-C drugs are in the pipeline, with approvals expected in late 2014 or early 2015. Some regimens may enable treatment of genotype-1 without interferon too.
"This is really a landmark shift in the treatment of hepatitis C," says Dr. Eric Lawitz of the Texas Liver Institute. "It's going to lead to a new generation of all-oral pills for all patients without the use of interferon, which is very tough for patients to take."
One of Lawitz's patients illustrates the potential. Over the past eight years, Henry Alameda, a 54-year-old carpenter who lives in San Antonio, endured two grueling six-month treatment regimens that failed to clear the virus from his blood. He thinks he was infected 20 years ago from the contaminated needle of an amateur tattoo artist.
The interferon side effects were hard to take. It's "like waking up with a bad cold," he says. "You would have to get under the blanket and you would start shaking. You would get real bad chills." Interferon, which is intended to get patients' immune systems to attack the virus, also commonly causes fatigue, nausea, diarrhea, anemia and depression.
Two years ago Alameda got into a study of sofosbuvir in combination with ribavirin. "It was like a miracle pill," he says. "It was just like taking an aspirin. I had no side effects at all." Some study patients have had headaches, fatigue, nausea, itching and weakness, but few have had to stop taking the pills because of side effects.
The new regimen worked for Alameda. Fifteen months after he finished taking the pills, there's no trace of the virus in his blood. Doctors have pronounced him cured.
The safety, effectiveness and low rate of side effects from the new regimens are expected to increase the number of hepatitis C patients who get treatment, although many doctors may hold off until other drugs are approved and combinations are tested in different types of patients.
The potential impact is huge. Hepatitis C infects up to five times as many people as HIV – another insidious virus that takes years to cause life-threatening disease. The U.S. Preventive Services Task Force says all Americans born between 1945 and 1965 should get tested for the infection – a population that includes 79 million baby boomers.
Thomas says the new treatments are coming at just the right time. Many baby boomers got infected decades ago – by experimenting with drug use, from blood transfusions or medical treatments that exposed them to contaminated blood, from things like tattoos and piercings. The virus can be transmitted sexually as well, although the evidence is controversial.
Now an increasing number of infected people are beginning to show signs of liver damage. Untreated, the virus causes progressive liver scarring and eventually cirrhosis that can require liver transplants. It's also the reason that liver cancer rates are increasing. Alcohol use greatly accelerates the damage.
But the new drugs won't come cheap. The price of sofosbuvir hasn't been set, but it's expected to cost around $90,000 for a course of treatment.
That's going to spark a lot of debate about who should be treated at what stage of infection.
But Johns Hopkins' Thomas says society should consider the cost of forgoing treatment. "If we fail to provide treatment to an expanding population of persons at risk of cirrhosis and liver cancer, then we'll have even greater costs," he says. "And they won't all be economic."Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Thu, 12/05/2013 - 3:16am
HealthCare.gov Now Allows Window Shopping, And A Do-Over
by Julie RovnerDecember 05, 2013 3:16 AM Listen to the Story
One thing that's clear about the relaunch of the troubled HealthCare.gov website is that it can accommodate more people.
Federal officials said more than 1 million users logged in on Monday, and nearly that many on Tuesday.
But less attention has been paid to some other upgrades that are also making the site easier for people to use. That's too bad, says Nancy Metcalf, senior editor of Consumer Reports, who has been chronicling the rollout of the health exchanges. She says some of them are pretty impressive.
Of course, the most noticeable improvement to the site is that "the thing actually works," Metcalf says. "I've heard from consumers who couldn't get through before and they have now."
It's not yet clear whether everyone can get from the beginning to the end of the process without any glitches, she adds, "but I think we're on the right track. And it's certainly time for people to shop anyway, because they only have until the 23rd to get a plan."
That is, if they want insurance to begin Jan. 1.
One of the biggest improvements is in what's known as the website's window shopping function. That's where you can look at plans available in your area without having to create an account first. It had one before, but it wasn't very helpful. Among other things, it provided prices only for people who were 27 or 50 years old; no one else.
"It would be like being able to browse for cars and just being able to look at a picture of a car," Metcalf says.Shots - Health News Administration Says You Can Now Escape HealthCare.Gov 'Prison'
The new shopping function is, well, functional. There's a button on the home page where you provide your age and ZIP code, and it gives you a list of plans and actual prices. Those are not the prices you'll pay if you're eligible for a government subsidy. Those might be lower. And, as they say, there's more.
"You can click through to the plan's website to see their provider directory and their list of preferred drugs; really useful for consumers, and something even some of the better state exchanges don't even have yet," she said. "So it's night and day."
The website also has another new function that will come as a relief to a lot of people who have suffered through repeated problems until now — an actual reset button. Although on the website it's called "remove."
"That could be an option for some individuals who would simply prefer to start over in the process now that it is running much more smoothly," Julie Bataille, spokeswoman for the Centers for Medicare and Medicaid Services, told reporters in a conference call Tuesday. "Essentially they can click a 'remove' button in order to get rid of their old application and something they may have been having a problem with, and then they would be able to go and create a new application."All Tech Considered The Key Test For HealthCare.gov Is The Part You Can't See
Individuals, perhaps, like Meredith Portman of Daphne, Ala. She's a freelance writer who has been trying to get signed up since October. After several false starts she managed to create an account and fill out an application, but she got a letter back that stopped her cold.
It told her to "send the marketplace proof of your yearly income for 2014," she says.
But as a freelance writer, Portman says, she barely knows what she's going to make this year, much less next year. And documenting it? She says she can't begin to imagine how she'd do that.
"So I called them up, and they said, 'Well, we'll have somebody get back in touch with you.' And I think that was Nov. 1."
Portman eventually got a call back over Thanksgiving, but didn't hear her cellphone ring, and the person didn't leave a direct number to return the call. Now she's worried about running out of time to get things straightened out.
"On Jan. 1, my current insurance doubles. And it took them a month to get back to me," Portman says. "I'm hoping it will not take another month or I will be in a bad situation."
Whether or not Portman decides to exercise the reset option, Metcalf says she should definitely take advantage of one other new feature on the home page of the HealthCare.gov website — a "find local help" button. It's designed to help people find a live person who can help them sort through problems.
"Make use of those people," Metcalf says. "They've had a lot of experience by now with the vagaries of this website."
Because while HealthCare.gov is clearly better, it's also clearly not all fixed yet.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Thu, 12/05/2013 - 3:14am
Teens Who Feel Supported At Home And School Sleep Better Listen to the Story
Solid friendships can help buffer life's stress.iStockphoto
A teen's relationship — or lack of good relationship — with parents, pals or teachers may have a lot to do with why most kids aren't getting the nine to 10 hours of sleep that doctors recommend. The hormonal disruptions of puberty likely also play a role.
That's the word from David Maume, a sociologist and sleep researcher at the University of Cincinnati. Maume recently analyzed federal health data from a survey of 974 teenagers who were questioned first when they were 12 years old, and then again at age 15. His findings appear in the December issue of the Journal of Health and Social Behavior.
Teens who had very warm relationships with their parents — who said they felt supported, for example, and could talk to their folks — tended to sleep better, Maume found. "Whereas, families going through distressful times — divorce or remarriage — that tended to disrupt teen sleep," he says.
Having problems or feeling unsafe at school also disturbed sleep, though students who said they had good relationships with teachers tended to sleep better.
Teens who reported having strong friendships with peers who shared similar academic goals, or who were involved in sports or other school activities also got a better night's sleep.
Kids, it turns out, aren't so different from adults in this way. "If we're happy and content," Maume says, "we're much more likely to sleep better than if we're distressed and anxious and worried."Shots - Health News School Stress Takes A Toll On Health, Teens And Parents Say
Of course, teens are often more drawn to their computers and social networking than adults are. But Maume found that when parents were strict not only about bedtime, but also about limiting technology, the kids slept better.Shots - Health News Parents Of Sleep-Deprived Teens Push For Later School Start Times
"It's a finding that seems obvious," Maume says. "But perhaps we need reminding that parents really do matter when it comes to health habits of their teenagers."
The national data suggest that, on average, kids lose about an hour and a half of sleep a night between ages 12 and 15 — dropping from about nine hours per night to a little less than eight.
Nudging that number back up to the recommended nine or 10 nightly hours seems impossible to Stacy Simera, an Ohio mental health therapist who is also mother to 14-year-old Graig.
"As a mom, my role is to set the right environment for my son," Simera says. "He does not have caffeine. He does not have TV in the bedroom, [and] no cellphone or iPad in his room when he's supposed to be asleep."
Graig's good about all of that, Simera says. But even if he hits the sack at 9 p.m., she'll often hear him tossing and turning until after 11.
Dr. Shalini Paruthi, who heads the pediatric sleep and research center at St. Louis University, blames the shifting hormones of puberty for throwing a wrench into the internal clock of many teens.
"They're not as sleepy as early as they used to be," Paruthi says. "So, in grade school they were easily going to sleep and getting sleepy at 8:30, [but] now they're getting sleepy at 9:30 — and for some kids it goes much further."
As with many hormonal changes, some people are more affected than others. But whatever the cause, statistics suggest that kids who don't get the ideal nine or 10 hours total of shut-eye each night are at higher risk for things like poor academic performance, colds, flu, depression and — among teens old enough to drive — accidents on the road.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Wed, 12/04/2013 - 5:01pm
Fertility Drugs, Not IVF, Are Top Cause Of Multiple Births
by Nancy ShuteDecember 04, 2013 5:01 PM Enlarge image i
An education campaign has reduced the number of high-order multiple births due to in vitro fertilization, but more are now due to fertility drugs alone.CDC and Brown University
Drugs that help women become pregnant have replaced in vitro fertilization as the main culprit behind high-risk multiple births, according to a study looking at births of triplets and higher-order multiples.
"IVF, which is usually the one we tend to point fingers at, was not the leading culprit," says Eli Adashi, a professor of obstetrics and gynecology at Brown University who was senior author of the study, published Wednesday in the New England Journal of Medicine.
The number of multiple births of triplets or more due to fertility drugs like clomiphene citrate and injectable hormones rose from 36 percent to 45 percent from 1998 to 2011. At the same time, the births of multiples because of IVF dropped from 48 percent to 32 percent.
Having more than one baby at a time increases the risk for both mother and children, including premature birth, cerebral palsy and developmental delays. Between 1971 and 2011, the proportion of multiple births doubled in the United States, the study finds, from 1.8 percent to 3.5 percent. Almost all of that was due to fertility treatments.Shots - Health News Number Of Twins Soars As Older Moms Turn To Fertility Treatments
Back in the 1990s, it became increasingly clear that transferring multiple embryos for IVF was boosting the number of high-risk multiple pregnancies.
Since 1998, doctors have discouraged women from transferring more than two embryos at a time for IVF. More recently, improved IVF techniques have made it more likely to achieve a successful single birth by choosing to transfer just one embryo. That is credited with lowering the numbers of high-order multiples by 29 percent from 1998 to 2011.
That's good news for babies and moms. But based on this new information, it looks like the education campaign needs to expand to include non-IVF fertility treatments, too.Shots - Health News Researchers Say 3 Embryos Is Too Many For IVF
Fertility drugs are cheaper and easier to use than IVF, and are often covered by insurance. Clomiphene citrate is a pill, and hormones called gonadotropins can be injected at home. The drugs stimulate the ovaries to produce more than one egg in a cycle.
"You certainly have less control" over the potential number of eggs with fertility drugs compared to IVF, Adashi tells Shots. But fertility specialists already have guidelines that help reduce that risk. Clearly not all doctors who prescribe the drugs are following the advice, Adashi says. "Using lower doses of drugs will go a long way toward reducing the number of multiples."
IVF births are tracked in a national registry, but there's no registry for births from fertility drugs alone. So the researchers did some math, taking the number of multiple births, subtracting IVF births, and then adjusting for the fact that women are having babies when they're older.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Wed, 12/04/2013 - 4:25pm
Second Meningitis Outbreak Erupts In Southern California
by Maanvi SinghDecember 04, 2013 4:25 PM Enlarge image i
Administrators at University of California, Santa Barbara are encouraging fraternities and sororities to hold off on parties.Damian Gadal/Flickr
The University of California, Santa Barbara is experiencing a meningitis outbreak a lot like the one that hit Princeton earlier this year. The California university confirmed a fourth case of meningococcal disease on Monday.
Like the outbreak at Princeton, this outbreak involves type B meningitis, a form of the disease that isn't covered by the vaccine approved for use in the U.S.
A vaccine that works against this type of meningitis is approved in Europe. And last month, the Food and Drug Administration gave Princeton special permission to administer the European vaccine on campus starting on Dec. 9.
Dr. Amanda Cohn, an epidemiologist with the Centers for Disease Control and Prevention, says it might consider asking the FDA for a similar waiver in Santa Barbara. She says CDC is also conducting tests to make sure the European vaccine will work against the Santa Barbara strain.
But for now, Cohn tells Shots, the CDC is just closely monitoring the outbreak. "Our hope is that there are no additional cases," she says.
Since UCSB's student body is much bigger than Princeton's, she says it's unclear how far the disease might spread. "We can't tell at this point if there's a certain group within the university that's more at risk," Cohn says.
She says it's also worth noting that this outbreak isn't related to the one in Princeton. "These are two outbreaks that are caused by the same type of meningococcal disease, but they're different strains."
As we reported last month, meningitis is transmitted through fairly intimate, close contact like kissing. It can also spread among roommates who spend a lot of time around each other.
UCSB spokesman George Fulsham tells Shots that just to be safe, the university's student health service has administered preventive antibiotics to over 700 students who could be at risk. And, he says, they'll be giving even more students the antibiotics Wednesday. Administrators are also encouraging fraternities and sororities to cancel social events.
Bacterial meningitis is an infection of the brain and spinal cord that can be fatal. One of the infected students in Santa Barbara had to have both feet amputated after contracting the disease. Fulsham says two of the others have already returned to class.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Wed, 12/04/2013 - 3:33pm
Administration Says You Can Now Escape HealthCare.Gov 'Prison' Enlarge image i
The HealthCare.gov jailbreak is on.iStockphoto
The Obama administration says it has patched hundreds of software bugs infecting the government's health insurance website. That includes the notorious "prison glitch."
Martha Freeman of Pennsylvania encountered the bug when she tried to sign up for coverage for herself and her adult children. The website wanted documentation of the children's incarceration status.
Never mind they'd never been in prison. The website was soon locked up.
Freeman figured she was stuck in solitary, until she called the toll-free help line and discovered she wasn't alone.With November Ending, Taking Stock Of HealthCare.gov's Progress 4 min 58 sec
"I was talking to a lovely woman with a Southern accent," Freeman recalled last week. "And she said, 'Oh, yeah. The prison glitch. I've heard that before.' "
Delia Igo of Indiana was also snared when the website became convinced — incorrectly — that she was in prison.
According to the agency that oversees HealthCare.gov, Igo and the other victims of the prison glitch have now been liberated.
"That has been fixed," said spokeswoman Julie Bataille of the Centers for Medicare and Medicaid Services.
During a call with reporters Wednesday, Bataille suggested that insurance customers who've been wrongly incarcerated by the prison glitch hit the reset button and start their applications again.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Wed, 12/04/2013 - 10:43am
Rule Spells Out How Insurers Must Cover Mental Health Care
by Michelle AndrewsDecember 04, 201310:43 AM Enlarge image i
Insurance plans that offer mental health benefits have to keep them in line with the coverage for medical care.iStockphoto
The Mental Health Parity and Addiction Equity Act of 2008 requires health plans that offer benefits for mental health and substance use to cover them to the same extent that they cover medical and surgical care.
Among other things, the law prohibits treatment limits and copayments or deductibles that are more restrictive than a plan's medical coverage.
The government issued interim regulations back in 2010 that clarified some aspects of the law. The final rules, issued in November, spell out more specifics.
To find out more, I talked with Jennifer Mathis, director of programs at the Judge David L. Bazelon Center for Mental Health Law in Washington, about the parity law and the new regulations. These interview highlights were condensed and edited for clarity.
What issues does this final mental health parity rule address that will be important to consumers?
The rule offers a number of clarifications about the parity law. Some of these clarifications concern how parity requirements relate to the Affordable Care Act, and others relate to issues that were not addressed in the interim rule.
Plans don't have to cover mental health benefits, but if they do, they generally have to cover inpatient and outpatient services, emergency care and prescription drugs. This final rule says that within a category, such as outpatient care, plans can treat preferred providers differently than nonpreferred providers. So it might mean a consumer could have higher copays for nonpreferred providers in their insurer's network for mental health outpatient services than for preferred providers, for example.
The regulation also said that services some would label as intermediate-level mental health services, including residential treatment and intensive outpatient services, are within the scope of the parity law. The regulations say they should be covered at parity. That hadn't been clear in the interim rules.
The parity law doesn't allow quantitative differences in coverage, such as fewer office visits or higher copayments for mental health services. But what about other limits that may be harder to measure?
The rule provides some clarification on that. These are things like requiring plan members to get prior authorization before receiving services and setting up protocols to determine whether treatment is medically necessary. What the final rules say is that plans must use the same type of processes to determine what is medically necessary or to require prior authorization for both mental health and medical services. If they have a rigorous process for justifying prior authorization for medical services they must have a similarly rigorous process for mental health services prior authorization as well.
What does it clarify about mental health coverage and the Affordable Care Act?
The ACA says plans can't have annual or lifetime dollar limits on the 10 essential health benefits, one of which is mental health and substance use disorder treatment. Normally, under parity, you can have those dollar limits as long as they're at parity with medical service limits. This rule clarifies that the ACA trumps parity in this regard.
Who's affected by this rule, and by parity more broadly?
People who get counseling, psychotherapy, prescription drugs are likely to see the biggest benefit from these rules because those are the services that commercial health plans usually cover. And they already have benefited since the law passed in 2008. This is not a brand new set of rules, this is an update of the rules that already apply. They have benefited and will continue to benefit.
And people on the exchanges who previously had no insurance or bad insurance not only will be able to get insurance now but also insurance with mental health parity.
The Affordable Care Act also applies parity requirements to insurance plans in the states that adopt the new Medicaid expansion for adults with incomes up to 138 percent of the federal poverty level ($15,856 for an individual in 2013). These regulations do not apply to those plans, but the government says that it will be issuing further guidance about how parity applies to those plans. Parity is likely to be a very important requirement in those plans, which in many cases will cover more mental health services than are typically covered by commercial insurance plans, including services that are used by people with significant psychiatric disabilities. Thus a wider variety of services, used by a wider group of people with mental health needs, will be subject to parity requirements.
What types of health plans are covered by the rule?
It generally applies to both fully insured and self-funded large group plans as well as individual and small group plans sold on and off the health insurance exchanges.
What if states have mandated mental health benefits of their own?
State parity laws that are more stringent than federal parity laws are not pre-empted. For example, some states' parity laws require coverage of particular services or benefits on top of the federal requirements. Some states require autism coverage, for example.
What about providers that don't accept insurance. Does the parity law or this rule affect them?
No. That is an issue, certainly for psychiatric services. That's becoming an increasing concern.
Since the mental health parity law passed, is there any evidence that companies have dropped mental health benefits from their plans so as not to have to comply?
A study sponsored by the Department of Health and Human Services found that since the 2010 parity regulations came out, only a small percentage of plans have dropped mental health or substance use coverage.Copyright 2013 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
NPR Health Blog - Tue, 12/03/2013 - 5:58pm
Mammograms In 3-D May Be Better, But Hard Proof Is Missing
by Nancy ShuteDecember 03, 2013 5:58 PM Enlarge image i
A woman is positioned for a traditional mammogram at Tufts Medical Center in Boston.Bizuayehu Tesfaye/AP
A newer form of mammogram may do a better job of finding cancer, a study finds. But the technology is still too untested to know if it's going to be useful for most women or even to know for sure who might benefit.
It's called breast tomosynthesis, or 3-D mammography. Since being approved by the Food and Drug Administration in 2011, the new type of scan has been touted by radiologists.
"I strongly encourage you to take advantage of this technology for your mammogram today," says the website of a radiology practice in Washington, D.C. "3-D mammography is helping us every day to find more early curable breast cancers."
But so far there has not a lot of evidence to back up the claim of superiority. As a result, many insurers aren't paying for it. If a woman wants a 3-D mammogram, she'll probably have to pay $50 or $100 out of pocket to have the extra scan added to a conventional mammogram. And she'll get an extra dose of radiation in the process.
Adding the 3-D technique increased the cancer detection rate from 4.28 to 5.24 per 1,000 patients, according to data presented Tuesday at the Radiological Society of North America meeting in Chicago. And it reduced false positives from 10.40 percent to 8.78 percent, according to Dr. Emily Conant, a professor of radiology at the University of Pennsylvania Medical Center who led the study.Shots - Health News Sorting Out The Mammogram Debate: Who Should Get Screened When?
"It really addresses a lot of the criticism of screening mammography by the U.S. Preventive Services Task Force and others," Conant tells Shots. In 2009, that panel recommended that women under age 50 not get mammograms because of the high rate of false alarms. The decision was denounced by many in the cancer and women's health communities.
Conventional mammograms are far from perfect, missing about 20 percent of breast cancers, according to the National Cancer Institute. Mammograms also deliver a false positive result about 10 percent of the time, which means women have to undergo more testing and the anxiety that goes with it.
Conant's team looked at results from 15,633 women who had 3-D scans at Penn in 2011. That year, the hospital started using the technology on every woman who walked in the door for a mammogram. They then compared the findings with results for 10,752 women who'd had standard digital mammograms at the hospital the year before.
It wasn't a randomized trial. And the results could be better because the first time a new test is used it typically picks up cancers that were missed by the old technology. After that, the success rate often drops.
Still, Conant is enthusiastic. "It's an exciting platform," she says. "I would highly recommend seeking out tomosynthesis."Shots - Health News Why Younger Women Could Benefit From Mammograms After All
Other breast imaging experts aren't so sure. "The gains seem to be modest in both directions," says Dr. Carol Lee, a diagnostic radiologist at Memorial Sloan-Kettering Cancer Center. "Is this something that will prove to be worth the additional time, expense and radiation exposure? I think that Dr. Conant's study is encouraging, but it's not the definitive study."
"We need to wait and see if the next round shows the same benefit, and whether we can figure out if it's for everybody, every year," says Dr. Barbara Monsees, a professor of radiology at the Washington University School of Medicine in St. Louis.
There's been speculation that women with dense breasts may benefit more from 3-D mammograms because the usual mammogram isn't good at seeing through dense tissue.
Standard mammograms take two images of each breast, one vertical and one horizontal. In a 3-D mammogram, the X-ray machine swings in an arc to take about 60 1-millimeter-thick images. The radiologist then views them like a digital flipbook. That should up the odds of spotting tiny tumors.
But there are as yet no data showing 3-D really is better for dense breasts or whether some other subgroup of women might benefit more from this technology. "I think it will get worked out eventually," Monsees tells Shots.
Right now, women have to get both a regular mammogram and the 3-D version, which means they get a double dose of radiation. That's still within safe limits, Conant says, though not ideal.
Update 11:58 a.m.: The FDA approved an application from Hologic, Inc., manufacturer of a 3-D scanner, for a software module to make 2-D images from a 3-D scan. This would reduce women's radiation exposure.
Tomosynthesis "is not the be-all and end-all," Conant agrees. Instead, she hopes it's the beginning of an evolution toward more precise, personalized breast cancer screening.
In November, the Centers for Medicare and Medicaid Services posted an FAQ stating that breast tomosynthesis should be included in the cost of regular mammography for Medicare patients, which may pressure private insurers to start paying for it. But that won't necessarily make women's decisions any easier.
"I can't give you a, 'Yes, you should, no, you shouldn't,' " Lee says of whether women should go 3-D at this point.
When she started doing mammography 30 years ago, Lee says, there were no other choices. Now women can choose sonograms, MRIs and various flavors of X-ray screens. "Unfortunately, the more tools we get, the harder it is to know which ones to use."Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Tue, 12/03/2013 - 1:34pm
Nonprofits Challenge Missouri Licensing Law For Insurance Guides
by Julie RovnerDecember 03, 2013 1:34 PM Enlarge image i
Nonprofits that are supposed to be helping people figure out their health insurance options are challenging an allegedly restrictive state law.iStockphoto
In the first lawsuit of its kind, several nonprofit groups that received federal grants to help people sign up for insurance under the Affordable Care Act are suing the state of Missouri.
The Missouri law requires health insurance helpers called navigators to be licensed by the state, which involves passing an exam and paying a fee.
Plaintiffs in the lawsuit include the St. Louis Effort for AIDS, Planned Parenthood of the St. Louis Region and Southwest Missouri, the Consumer Council of Missouri and Missouri Jobs with Justice.
They claim that various provisions of the state law "prohibit some plaintiffs from performing the duties required of them by the Affordable Care Act (ACA), prohibit other plaintiffs from providing information about health insurance altogether, and prevent plaintiffs and the Missouri public from receiving information about health insurance from the person or source of their choosing."
The plaintiffs say the Missouri law has made their work pretty much impossible. You can read the complaint here.
"Missouri has placed groups like St. Louis Effort for AIDS in an untenable situation: If they comply with Missouri statutes, they can't perform the duties the Affordable Care Act requires them to perform, but if they comply with the ACA and do perform those duties, they violate the Missouri law and are subject to thousands of dollars in penalties for doing so," says Jay Angoff of Mehri and Skalet, who is representing the plaintiffs. Angoff is a former Missouri insurance commissioner and also the former head of the federal office implementing the ACA at the Department of Health and Human Services.Shots - Health News Strange Bedfellows Among Groups Helping Insurance Buyers
Missouri is one of more than a dozen states where Republican-led governments have passed laws or otherwise taken steps to restrict insurance navigators and other in-person counselors from attempting to help people sign up for health insurance on the new exchanges.Shots - Health News First Step In Health Exchange Enrollment: Train The Helpers
Florida, for example, barred navigators from state offices, while Texas Gov. Rick Perry ordered strict new regulations, on top of the ones imposed by the federal government. Those include additional training and testing, and reporting the names of people enrolled to the state.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Tue, 12/03/2013 - 10:36am
Overweight And Healthy: A Combo That Looks Too Good To Be True
by Nancy ShuteDecember 03, 201310:36 AM Enlarge image i
Gym members warm up on treadmills at Downsize Fitness in Addison, Texas. Membership at the gym is limited to people who have a high body mass index.LM Otero/AP
Overweight or obese people are indeed more likely to die prematurely than people of normal weight, say researchers who've analyzed the data. Their conclusion throws cold water on recent studies that have found some excess weight isn't so bad.
Earlier this year, researchers at the Centers for Disease Control and Prevention reported that overweight people actually live a bit longer than their skinnier peers.Shots - Health News Research: A Little Extra Fat May Help You Live Longer
But the new analysis says that overweight people who already have high blood pressure, high cholesterol or insulin resistance don't live longer and are at increased risk of cardiovascular disease. Same goes for overweight people without those issues, it turns out.
The CDC study didn't look at those factors, which are considered major health risks and when lumped together are called metabolic syndrome.
"Sometimes the message changes when you look closer," says Dr. Caroline Kramer, an endocrinologist at Mount Sinai Hospital in Toronto who led the study. "It's not OK to be overweight. It's not OK to be obese, even though you might not have metabolic abnormalities."
The notion of healthy obesity is appealing to patients and doctors.
If both states could really coexist, it would mean that some of the 38 percent of Americans who are obese might not have to lose lots of pounds to get or stay healthy. Doctors wouldn't have to badger patients to lose weight. And the health care system wouldn't have to invest lots of time and money in weight-loss programs and bariatric surgery.
But figuring out who those healthy obese people are, or even if they exist, has turned out to be a challenge. The CDC study compared people's body mass index, or BMI, to their longevity. It found that obese people died earlier, but that overweight people had a slightly lower risk of death than normal-weight people — about 6 percent.Calling Obesity A Disease May Make It Easier To Get Help
But that study, which was published in February, was heavily criticized because it didn't look at the health of the people studied. You can be thin because you're dying of cancer.
The new study tried to make up for some of those shortcomings by looking not just at people's BMI and age at death, but at their metabolic status and whether or not they had cardiovascular disease. The findings were published Monday in Annals of Internal Medicine.
The researchers conducted what's called a meta-analysis that evaluated eight previously published studies of 61,386 people. They found that people of any weight who had metabolic abnormalities were more likely to die earlier from all causes. They also were more likely to have cardiovascular disease. And the risk increased as the amount of excess weight increased. And the more risk factors someone had, the higher the likelihood of early death and disease.
People who were obese without having metabolic syndrome also had a higher risk of death, so they weren't protected by being healthier. That's because being obese affects many other things including hormones and growth factors, Kramer says, and not just commonly used measures like blood pressure.
But when the meta-analysis looked at overweight people, it found that those who had normal metabolic profiles had no increased risk of death. Still, Kramer says they're not off the hook.
The overweight people also had slightly elevated metabolic markers. In other words, their blood pressure was on the high end of normal. Over time, Kramer says, their risks will increase, especially if they keep gaining weight. Increased death risks didn't show up until people had been observed for 10 years or more. About one-third of Americans are overweight.
This study has its shortcomings too, of course. The data used didn't reveal people's health behaviors, and didn't track weight changes over time. Clearly this isn't the last word on this contentious topic.
But it is further ammunition for the argument that, as an accompanying editorial wrote, "No level of obesity is healthy."Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 12/02/2013 - 6:40pm
As Polio Spreads In Syria, Politics Thwarts Vaccination Efforts
by Deborah AmosDecember 02, 2013 6:40 PM Listen to the Story Enlarge image i
Syrian boys line up to get the polio vaccine at a refugee camp in Sidon, Lebanon, on Nov. 7. The Lebanese government plans to vaccinate all kids under age 5 for the virus, including Syrian refugees.Mohammad Zaatari/AP
The World Health Organization has declared a polio emergency in Syria.
After being free of the crippling disease for more than a decade, Syria recorded 10 confirmed cases of polio in October. Now the outbreak has grown to 17 confirmed cases, the WHO said last week. And the virus has spread to four cities, including a war-torn suburb near the capital of Damascus.
The Syrian government has pledged to immunize all Syrian children under age 5. But wartime politics is getting in the way. And the outbreak is expected to grow.Additional Information: Middle East A Conquered Foe Returns To War-Torn Syria: Polio Shots - Health News First Polio Cases Since 1999 Suspected In Syria
"Actually, it is spreading quickly," says Dr. Mohammed Al Saad in Gaziantep, Turkey, near the northern border of Syria. There are now more than 60 suspected cases, he says, with new ones reported each day.
Most cases have occurred in children less than 2 years old, who were born in Syria after the war started and missed their routine vaccinations, he says.
Saad is part of an early-warning medical team with the Syrian opposition that monitors rebel-held areas. The group, called the EWARN team, is working with the U.S. Centers for Disease Control and Prevention in Atlanta. It was the team that first raised the alarm after discovering polio cases in the province of Dier ez-Zor.
Now the medical group is gearing up for a mass vaccination campaign in northern Syria — a short drive across the Turkish border.
The goal of this polio task force is to immunize children in rebel areas. The communities there have been decimated by shelling and bombs. They have no electricity, clean water or functioning sewage treatment.
These are places where children are at greatest risk, says the leader of the task force, Dr. Bashir. (He asked us not to use his last name for security reasons.) "Our target is to train about 8,000 people for the door-to-door polio campaign," he says.
Mass immunization is the only way to contain the outbreak. The fastest way to reach kids is to cross the border from Turkey. But that raises a political problem for United Nations agencies in charge of the vaccinations.Enlarge image i
Syrian children at a refugee camp in Sidon, Lebanon, wait for the polio vaccine on Nov. 7.Mohammad Zaatari/AP
Requests to the U.N. for vaccines have been in vain, Bashir says. "Until now they didn't promise they could provide us with vaccine for our children."
Delivery from any U.N. agency is not likely. That's because the U.N. is only authorized to operate through sovereign states, meaning it delivers all humanitarian aid through the central government in Damascus. And last month, the Syrian regime said no to a U.N. Security Council statement urging cross-border aid.
UNICEF's vaccination program is based in Damascus. Reaching children in rebel areas is a challenge, says UNICEF spokeswoman Juliette Touma. "In the past couple of years, we were not able to reach more than half a million children because of access restrictions," she says. "And this could explain why we have polio inside Syria."
Only after the outbreak was confirmed did the Syrian regime pledge to vaccinate all Syrian children. Now some vaccines are getting to rebel areas. After negotiations with the regime and the rebels, about 180,000 doses arrived in Dier ez-Zor, where the first cases were reported, Touma says.
There is no other way to deliver humanitarian assistance than to deal with all parties of the conflict. Touma says that UNICEF has been able to do that.
But doctors on the opposition's Polio Task Force charge that the Damascus based program is not reaching all the vulnerable children in rebel areas. Dr. Khaled Almilaji says the virus is spreading faster in rebel areas, where millions of people are displaced and living in dire conditions, he says. Families are drinking directly from the rivers, dependent on contaminated water, which can carry the virus.
"We are sure that the people in Dier ez-Zor [and] some villages don't know about the polio, actually," Almilaji says. "Do they know they have to take the vaccines?"
A door-to-door campaign is now key to families with children at risk, he says. "This is a disease. This is not politics."
International aid workers are calling for great pressure on the Syrian regime to allow a route from Turkey to northern Syria for vaccinators.
The polio cases are alarming, says Mary Ana McGlasson, a registered nurse who is now working on humanitarian efforts in Syria. "Humanitarian aid, in general, throughout large parts of Syria is not functioning," she says. "And I think that the polio epidemic and the vaccination campaign is one symptom of many."
The return of this crippling disease and the response, she says, are a sign that the international aid system is failing Syria's children. "My anger is directed at all parties to the conflict that are slowing down humanitarian aid even by a fraction," McGlasson says. "It's children caught in the middle of that who are suffering, and that's tragic to me."
Polio does not stop at borders or military checkpoints. Without a comprehensive response to stop the virus, aid workers fear that the outbreak could become a public health catastrophe.
Update at 10:32 p.m. ET. Vaccine Airlifted Into Syria:
The U.N. said Monday that it had airlifted polio vaccines for 538,000 children in hard-to-reach areas of northern Syria, including Dier ez-Zor. The airlift also brought blankets and other winter supplies to families.
Cross-border aid from Turkey — the easier way to reach these children — is still not an option.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 12/02/2013 - 4:55pm
Obama Launches HIV Cure Initiative, Ups Pledge For Global Health
by Richard KnoxDecember 02, 2013 4:55 PM Enlarge image i
President Obama walks into an auditorium in the Eisenhower Executive Office Building Monday for a speech about World AIDS Day.Carolyn Kaster/AP
Commemorating the 25th World AIDS Day a day late, President Obama announced an initiative Monday to find a cure for HIV infections that would be funded by $100 million shifted from existing spending.
"The United States should be at the forefront of new discoveries into how to put people into long-term remission without requiring lifelong therapies — or better yet, eliminate it completely," Obama said at a meeting in the Eisenhower Executive Office Building next to the White House.
The initiative reflects a growing optimism among scientists that it may be possible to get patients' immune systems to control HIV without drugs, or even to eliminate the virus from their systems. A feat like that seemed impossible not so long ago. The moneywill come from expiring AIDS research grants over the next three years, the administration said in a statement.
The president also pledged $5 billion over the next three years to the Global Fund to Fight AIDS, TB and Malaria if other countries contribute twice that amount. The Global Fund is holding its fourth replenishment meeting this week in Washington, with a goal of topping the $9.3 billion pledged three years ago.
Obama boasted that PEPFAR has exceeded the goal — thought to be ambitious when he set it on World AIDS Day two years ago – of getting anti-HIV treatment to 6 million people in developing countries. "Today I'm proud to announce that we've not only reached our goal, we've exceeded our treatment goal," he said. "We've helped 6.7 million people receive life-saving treatment, and we're going to keep at it."
Obama also noted that the waiting list for treatment under the federal-state AIDS Drug Assistance Program last week fell to zero, from a peak of 9,310 in the fall of 2011.
Apart from that domestic bright spot, however, a report card on how America is doing with its own HIV epidemic reveals only slow progress.
In a panel discussion following Obama's remarks, Dr. Chris Beyrer of Johns Hopkins University pointed out that when PEPFAR and the Global Fund began, AIDS experts were betting it would be easier to combat HIV in targeted populations in America than to get millions of HIV-infected people in sub-Saharan Africa into treatment.
But the opposite has happened. "African-American men are about half as likely" to have their HIV infection under control as non-Hispanic white men, Beyrer says. "And two-thirds of new infections are among men who have sex with men."
The White House report is thin on promising results, as one section puts it, and heavy on challenges.
For instance, a 2010 National AIDS Strategy set a goal of reducing new HIV infections in this country by 25 percent. But the incidence "remains unacceptably high," the latest report says. And, in fact, new HIV infections increased 12 percent among men who have sex with men in the most recent figures – 22 percent among the youngest males, from 13 to 24 years old.
The strategy aimed to increase the percent of HIV-infected who know their status to 90 percent. But the most recent figures indicate undiagnosed HIV decreased by only 9 percent between 2006 and 2010. And fewer than half of those between ages 13 and 24 years are aware of their infection.
When it comes to effective anti-HIV treatment, fewer than half of Americans at highest risk – men who have sex with men, blacks and Latinos – get sufficient antivirals drugs to keep their HIV under control.
Still, there's evidence that concerted efforts to combat HIV can pay off in the most heavily affected places. The report cites impressive gains in New York City, the District of Columbia and San Francisco.
"All three have made care and treatment very available, have ramped up testing and needle exchanges," says Chris Collins, policy director of amfAR, the American Foundation for AIDS Research. "When you do that, you see infection rates fall."
For instance, when Washington, D.C., increased publicly funded HIV testing from 400 tests in 2007 to 120,000 in 2011, newly diagnosed cases went down by almost half. Newly diagnosed cases have also fallen by half in New York City and San Francisco.
The proportion of HIV-treated people whose virus was suppressed has gone steadily up in New York City, especially after the health department recommended that all newly diagnosed patients should be offered anti-retroviral treatment. By the end of last year, nearly 8 in 10 were virally suppressed.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 12/02/2013 - 4:42pm
ACLU Sues, Claiming Catholic Hospitals Put Women At Risk
by Julie RovnerDecember 02, 2013 4:42 PM Listen to the Story
Archbishop Joseph William Tobin of Indianapolis prays at the United States Conference of Catholic Bishops' annual fall meeting in Baltimore on Nov. 12.Patrick Semansky/AP
The American Civil Liberties Union has decided to go directly to the source of its unhappiness with the way women are treated in Catholic hospitals. It's suing the nation's Catholic bishops.
The ACLU and the ACLU of Michigan have filed suit in federal court in Michigan charging that the United States Conference of Catholic Bishops forces hospitals to deliver what amounts to substandard medical care.
Directly at issue are the bishops' "Ethical and Religious Directives for Catholic Health Care Services," which among other things forbid Catholic hospitals to perform abortions, even if the pregnant woman's life or health is at risk.
"It's about rules that tie the hands of doctors at Catholic facilities," says ACLU Deputy National Legal Director Louise Melling.
The case involves a mother of three from Muskego, Mich., named Tamesha Means. In December 2010, when she was 18 weeks pregnant, her water broke. A friend drove her to the nearest hospital, Mercy Health Partners, where she was told she was likely to lose the baby. But she was not told that the hospital would not do the therapeutic abortion she would get in a non-Catholic facility. She was given medication to stop contractions and sent home. She returned to the hospital later, bleeding, running a fever and in pain, and begged them to help her.Religion Nun Excommunicated For Allowing Abortion
"And they proceeded on with, 'Well, you know, Tamesha, there's nothing that we can do to help you,' " she says. Means said she was unaware that it was a Catholic facility.
Eventually, as the hospital was preparing to discharge her again, she delivered the very premature infant, who died after a few hours.
Dr. Douglas Laube, a professor of obstetrics and gynecology at the University of Wisconsin, says the care she got did not meet basic medical standards.
"A woman who is 18 weeks pregnant and who presents with these symptoms, the same that Ms. Means had, should be told that there's virtually no chance that her fetus will survive and that continuing the pregnancy puts her at risk, and that the safest course of treatment would be to terminate the pregnancy," Laube says. "From the outset, Ms. Means should have been given this information at the very least."
This is hardly the first time a pregnant woman in a life- or health-threatening situation has run afoul of Catholic ethical and religious directives. In 2010, a nun who was the administrator of a Catholic hospital in Phoenix was excommunicated after she allowed an abortion to save a woman's life. And as more and more hospitals merge with or get taken over by Catholic facilities, the tensions continue to grow.
"It's clear to me that Mercy Health Partners neglected to treat Ms. Means according to basic medical standards, and as such prolonged her suffering and jeopardized her health," says Laube. "While we're all entitled to our religious beliefs, hospitals should not be entitled to impose their religious beliefs on patients and medical staff who do not share them."
The Conference of Catholic bishops declined to comment on the lawsuit. But others wonder about the idea of suing the bishops themselves for neglect.
"Yeah, this is a novel case," says Richard Garnett, a law professor at the University of Notre Dame.
While there's nothing new about suing doctors or hospitals, Catholic or not, Garnett says, "to sort of claim that it is negligence for the bishops to be issuing directives reminding Catholic hospitals what the church's teachings are with respect to things like abortion and sterilization are, that is a stretch."
And he wonders what future if any such lawsuits against the church may have.
"That seems to me to be adopting a strange notion of tort responsibility — that religious teachings become legal negligence," he said.
But Garnett wonders if the ACLU's real motive is less to win the case than to find a new way to bring attention to the continuing dispute between the church and advocates for women's health. And clearly it has won that round, at least for now.Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 12/02/2013 - 3:17pm
Alleged Perils Of Left-Handedness Don't Always Hold Up
by Emily SinerDecember 02, 2013 3:17 PM Enlarge image i
Lefties don't necessarily do everything with their left hand, and the ones who do might not use the right side of their brain for language.iStockphoto
I recently stumbled upon a description of research out of Yale that suggested there was a link between left-handedness and psychotic disorders like schizophrenia.
Forty percent of those with psychotic disorders are lefties, one of the researchers said. That startled me. Only about 10 percent of people in the general population are left-handed. I'm one of them.
I've often read that I'm going to die earlier. Also, I'm bad with scissors. And now, it seemed, I'm at high risk for mental illness. Was my hand preference a lifelong curse?
The short answer: No.
After getting both my hands on the full study, I found that the work, while intriguing, falls far short of being conclusive.
The study, published in the journal SAGE Open, looked at the prevalence of left-handedness among people with mood disorders, like depression, and those with psychotic disorders.
Researchers collected data from 107 psychiatric patients in an outpatient mental health clinic for people with low incomes. Only a third of the people, or 35, had a psychotic disorder. All in all, that's not necessarily representative of the general psychiatric population — and it's a pretty small sample from which to draw a potentially big conclusion.
“ One of the issues ... is the following notion: Everyone should be right-handed, and if not, there's something wrong with the brain.
- Clare Porac, Penn State Erie
The researchers on this study acknowledge that its 40 percent finding is high compared to other research. Previous estimates on left-handedness in those with schizophrenia range from a low 7 percent — less than the prevalence in the general population — to 31 percent, the study says.
And there's one other thing. To determine if patients were left-handed, the researchers asked just one question: Which hand did people prefer to write with?
Psychiatrist Jadon Webb, the lead author and a clinical fellow at Yale School of Medicine, tells Shots that this simplicity helped the researchers get a higher participation rate. But other researchers say handedness is too ambiguous to determine reliably with that question alone.
Finding links between left-handedness and mental disorders is nothing new. In fact, lefties have gotten bad press for centuries.
"The words 'left' and 'left-hand' in almost all the world's languages have negative connotations — from 'sinister' in Latin and Italian to 'dishonest' in Mandarin," wrote Howard Kushner, a public health professor at Emory University who studies the medical and cultural implications of handedness.
In the early 20th century, an Italian criminologist connected left-handedness to feeble-mindedness and criminality. Since then, Kushner wrote, researchers have proposed links between left-handedness and learning disabilities, autoimmune disorders, autism and dyslexia, among other ailments.
"There's a 150-year history of trying to connect left-handedness to every pathology they can think of," Clare Porac, a psychology professor at Penn State Erie, tells Shots. "One of the issues ... is the following notion: Everyone should be right-handed, and if not, there's something wrong with the brain."
One claim that keeps popping up is that lefties die earlier, which two researchers in Canada posited in 1991. Forget that one. "That's a theory that has been discredited for 15 years in the scientific community," Porac says.
Other health claims, like the link between left-handedness and schizophrenia, continue to be debated in scientific research. One study finds a link, another doesn't — and when you look at it all, Porac says, it kind of evens out.
Why is it so difficult to come up with a scientific consensus?
First, lefties are remarkably inconsistent when it comes to hand use. Some write with their left and throw with their right, some use their right hand for everything but writing and some don't write with their left hand because they were trained not to. Definitions of what it means to be left-handed can vary among studies, making it hard to draw broad conclusions.
Second, handedness is often used as a proxy for brain lateralization, or which side of the brain does what. People often assume that left-handers are predominantly right-brained and right-handers are the opposite.
But that's not always true, Emory University's Kushner tells Shots. In fact, he says, language and speech are localized to the right side of the brain in only 18 percent of lefties. The more accurate way to tell where language functions reside is to do a brain scan.
And, finally, Kushner says many studies on schizophrenia link the disease to weak brain lateralization (or mixed-handedness, as some researchers call it), not even to left-handedness specifically.
In Porac's opinion, at least, there's no reason for lefties to worry. "I've interviewed hundreds of left-handers," she says, "and they're all pretty much OK."Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 12/02/2013 - 10:00am
Uninsured Fret About Getting Health Coverage By New Year's Day
by Jordan RauDecember 02, 201310:00 AM
For Tambra Momi, who has Dercum's disease, health coverage can't come soon enough.Courtesy of Tambra Momi
Tambra Momi has been eagerly awaiting the promise of guaranteed health insurance.
Since 2011, she has battled Dercum's disease, a rare and painful condition in which noncancerous tumors sprout throughout her body, pressing against nerves.
Jobless and in a wheelchair, Momi needs nine different drugs, including one costing $380 a month, to control the pain and side effects. No insurer has been willing to cover her, she says, except a few that have taken her money and then refused to pay for her medications.
Yet her effort to sign up for the health law's coverage has been painful in its own way. Momi, who lives in Fort Mohave, Ariz., hasn't been able to complete an application on the federal HealthCare.gov website. Three attempts to submit an application over the phone haven't panned out. Once when she called back, she says she was told they had no record of the application. Another time, officials told her they could see the application but couldn't open it.
"I was so elated with this whole thing," Momi, 46, says about the health insurance marketplace., "Now I'm praying to God that I'll be able to get something."
Enrollment has been open since Oct. 1, but hitches such as those that Momi encountered have put many people behind schedule. The next three weeks are critical for consumers keen on getting health coverage as soon as the health law allows it on Jan. 1. People who want coverage by then need to sign up no later than Dec. 23. Consumers can still enroll up to the end of March, but their coverage will begin later.
For people in the states with well-functioning insurance websites, such as California, New York and Kentucky, this appears to leave plenty of time. But making the deadline could be dicier for people in Arizona and the 35 other states where HealthCare.gov is the path to coverage. Same goes in Oregon and Hawaii, which have struggled to get their sites working.
On Sunday, the government reported progress in improving HealthCare.gov, saying the site now allows more than 800,000 visits a day with the rate of timeouts or crashes reduced to below 1 percent. Officials said repairs continue.
The technological trials for these websites have turned an enrollment period that was supposed to be a leisurely three-month stroll into a last-minute sprint for millions of Americans. "The challenge ahead is you have a lot of people who need to get into the system," says Sarah Lueck, an analyst with the Center on Budget and Policy Priorities, a Washington think tank that focuses on issues related to low- and moderate-income people.
Prompt Enrollment Threatened
Within the Obama administration, concern is great enough about accommodating everyone who wants coverage by the first of the year that officials pushed back the deadline from its original date of Dec. 15.
Prompt enrollment is critical for people in several circumstances. Some have no coverage, either because they haven't been able to afford it or, like Momi, because they have pre-existing medical issues that led insurers to reject them in the past. Some have insurance that is going to expire. That group includes people whose health plans have been canceled and those in a high-risk pool that is closing. For people with serious medical issues, such as cancer patients in the middle of treatment, the loss of coverage could be medically and financially devastating.
Sara Collins, a vice president at the Commonwealth Fund, a New York health care foundation, predicts two waves of people will try to sign up for plans in the first half of December: those who had tried to shop on the websites but were stymied by technological glitches and those who were able to look at plans but didn't settle on one.
For people who wait until the Dec. 23 deadline — either by choice or because they encountered difficulties—insurers will have just a week to process the applications before people can start filing claims. Robert Laszewski, an industry consultant, says insurers generally need two weeks to add newly covered people to their computer systems. "The chances are we're going to see lots of customer service problems," he says.
'Nobody Knows What Accident They Can Be In'
Sandra Fox, a psychiatric social worker in Pittsburgh, has been trying to buy insurance through the marketplace since the day it opened at the beginning of October. After many failed attempts, she succeeded.
But HealthCare.gov said she and her husband, an artist, aren't eligible for a government subsidy while she believes they are. (Based on information she provided, KHN calculated they are eligible for a $292 monthly subsidy.) She was told to mail a written appeal. Despite sending it off Nov. 1, her case remains unresolved.
Fox's husband goes to a pain clinic and uses medication for his spinal stenosis. She fears if they aren't enrolled in new insurance when their current policy lapses at the end of the year, they will have to pay out of their own pockets. "It would be extremely expensive," she says. "And nobody knows what accident they can be in tomorrow. I don't think it's wise to be without insurance for one day, frankly."
Early mix-ups occurred in the launch of the last major federal health expansion, the Medicare Part D prescription drug benefit. People were supposed to sign up by Dec. 31, 2005, to start using the benefit when coverage began on Jan. 1, 2006. But that turned out to not leave enough time for Medicare to process all the enrollments. "There were all these stories about people showing up to pharmacies and the pharmacies not having the seniors in the systems," said Sabrina Corlette, who directs the Health Policy Institute at Georgetown University. "And the seniors walked away empty handed because Medicare hadn't transferred the information."
Momi's pain is so intense from her disease that any delay would be agonizing. "I have lipomas, fatty tumors that grow throughout my body," she says. "They're attacking through my spine, my internal organs. My nervous system is actually growing through them. You can see them."
She drives monthly to Las Vegas, more than 100 miles north of Fort Mohave, to see her doctor. He wants to install a pain pump for a new medicine from sea snail venom, but it's so expensive she has had to delay the surgery. "My doctor is helping me so much I can't even begin to tell you," she says, crying. "I pay him what I can pay him."
No one knows how many people might still be clamoring for coverage at the cusp of Christmas. When Massachusetts launched its health insurance exchanges, the big spike in enrollment didn't occur when the program began in 2007. Instead, it hit when the financial penalty for not signing up kicked in that December, according to a study by Harvard professor Amitabh Chandra and other researchers.
For the federal law, the comparable time is the close of the enrollment period at the end of March. After that, people without health coverage face tax penalties of $95 or 1 percent of income, whichever is greater, unless they meet the criteria for exemptions.
Chandra, however, notes that there are differences from Massachusetts' experience that make it less than a perfect comparison. For one, the Massachusetts penalty was higher than the federal health law's penalty in the first year. On the other side, he noted that more people in the United States are aware of the health law's penalty "because we've had a four-year fight about [the law]; nothing like this had happened in Massachusetts."
Laszewski says the political controversy over the rules may have left consumers confused. "Is my policy really canceled? What do all these objections from insurance commissioners really mean?" he says. "The consumer is left in the lurch trying to figure out what is going on."Copyright 2013 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
NPR Health Blog - Mon, 12/02/2013 - 2:54am
Parents Of Sleep-Deprived Teens Push For Later School Start Times
by Allison AubreyDecember 02, 2013 2:54 AM Listen to the Story
Starting at 6:05 a.m., Cristina Sevin wakes up 15-year-old Isaac (left) and 16-year-old Lily for high school.Maggie Starbard/NPR
Cristina Sevin knows the drill. Her 15-year-old son Isaac's first alarm goes off at 6:05 a.m.
When he sleeps right through it, Mom starts the nudging. But she also has to wake up 16-year-old Lily. She flips on the bedroom lights. "Lily, you gotta get up!"
They have to be out the door before 6:35 a.m. in their Annapolis, Md., neighborhood in order to catch the bus for a 7:17 school start. "I wish I didn't have to be awake right now," says Lily.Enlarge image i
Cristina Sevin packs lunches for her two teenagers in Annapolis, Md., on Nov. 22.Maggie Starbard/NPR
She barely has time to brush her teeth and grab a go-mug of hot tea before she and Isaac head out into the predawn darkness.
Cristina Sevin is convinced there's a better way to raise teenagers: Push back the start of school one hour. Instead of a 7:17 morning bell, how about 8:18?
Sevin's family is part of a growing grass-roots campaign advocating for later high school start times. A national petition to promote legislation that would prevent public schools from starting before 8 a.m., started by the group Start School Later, has thousands of signatures from all 50 states.
There have been years of debate on this issue. Sleep scientists argue that early high school start times conflict with teens' shifting circadian rhythms. Beginning in puberty, "adolescents are programmed to fall asleep later," says Dr. Judith Owens, who directs the Sleep Medicine Clinic at Children's National Medical Center in Washington, D.C. And she says many teenagers can't fall asleep before 11 p.m.
Because teenagers need eight to nine hours of sleep, waking up at 6 a.m. can lead to a pattern of sleep deprivation. And that puts them at higher risk of a whole range of potential problems, from depression to automobile accidents.Enlarge image i
Lily and Isaac walk to catch the bus at 6:35 in the morning.Maggie Starbard/NPR
So Owens says it makes sense to move school start times later. As it is now, "we are asking [teens] to be awake and alert at the time in their 24-hour clock when their alertness level is at its very lowest."
A new poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health finds that 50 percent of parents of students in high school report a start time before 8 a.m. And almost 1 in 5 parents report school starting even earlier, before 7:30 a.m. (See the full results here.)
Proponents of later start times say that they're gaining traction.
"Momentum has picked up considerably in the past few years," says Terra Ziporyn Snider, executive director of Start School Later. Her group maintains a list of schools in 29 states that have made changes.Tuck That Teen Into Bed
Sleep expert Amy Wolfson of College of the Holy Cross in Worcester, Mass., says these five strategies will help teenagers sleep longer and better.
- Try to get 8 1/2 to 9 1/2 hours of sleep a night.
- Keep a regular sleep-wake schedule throughout the week. Varying bedtimes by more than 60 to 90 minutes, even on weekends, can affect academics, mood and health.
- Keep a regular study schedule. Studying late at night makes falling asleep harder.
- Ban texting, videos and working or gaming on a computer in the hour before bedtime. Keep cellphones out of the bedroom, too.
- Eliminate caffeine, especially three to five hours before bedtime.
And she points to two very large school districts in the Washington, D.C., area — Fairfax County, Va., and Montgomery County, Md. — that are both considering later starts. A petition in Montgomery County started by activist Mandy Mader to push high school start times to 8:15 or later has garnered more than 11,000 signatures.
But there are logistical obstacles. Transportation is one. How do schools rearrange bus schedules to pick up high school students later, without alarming the parents of elementary school kids who might be picked up earlier to accommodate the changes?
Parents opposed to later school start times point to issues such as day-care schedules and after-school jobs. Coaches say later dismissal times would interfere with team practices.
But given the fact that many schools have already overcome these obstacles and moved to later school start times, Ziporyn Snider says, "the real problem isn't sports or jobs or day care; the real problem is fear of change and failure of imagination."
And failure to act, advocates say, is putting high school students at greater risk.
There's a gathering body of evidence to suggest that pushing back school start times can cut the risk of car crashes. In Fayette County, Ky., the number of car accidents caused by teenage drivers dropped almost 17 percent in the two years after the county pushed start times back an hour to 8:30 a.m. That compares with an 8 percent increase in crashes among 17- and 18-year-old drivers statewide over the same time.
Despite the biological and societal nudging that keeps many teenagers awake well past midnight, it does help when parents set a bedtime, experts say — even if that bedtime is 11:30 p.m.
Teens whose parents set a bedtime are more likely to get enough sleep and function better at school, a recent study found. Owens says: "If a parent sets a bedtime, it at least gets the message across that [they] feel it's important."Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Mon, 12/02/2013 - 2:53am
School Stress Takes A Toll On Health, Teens And Parents Say Listen to the Story Enlarge image i
Colleen Frainey, 16, of Tualatin, Ore., cut back on advanced placement classes in her junior year because the stress was making her physically ill.Toni Greaves for NPR
When high school junior Nora Huynh got her report card, she was devastated to see that she didn't get a perfect 4.0.
Nora "had a total meltdown, cried for hours," her mother, Jennie Huynh of Alameda, Calif., says. "I couldn't believe her reaction."
Nora is doing college-level work, her mother says, but many of her friends are taking enough advanced classes to boost their grade-point averages above 4.0. "It breaks my heart to see her upset when she's doing so awesome and going above and beyond."
And the pressure is taking a physical toll, too. At age 16, Nora is tired, is increasingly irritated with her siblings and often suffers headaches, her mother says.Teens Talk Stress
When NPR asked on Facebook if stress is an issue for teenagers, they spoke loud and clear:
- "Academic stress has been a part of my life ever since I can remember," wrote Bretta McCall, 16, of Seattle. "This year I spend about 12 hours a day on schoolwork. I'm home right now because I was feeling so sick from stress I couldn't be at school. So as you can tell, it's a big part of my life!"
- "At the time of writing this, my weekend assignments include two papers, a PowerPoint to go with a 10-minute presentation, studying for a test and two quizzes, and an entire chapter (approximately 40 pages) of notes in a college textbook," wrote Connor West of New Jersey.
- "It's a problem that's basically brushed off by most people," wrote Kelly Farrell in Delaware. "There's this mentality of, 'You're doing well, so why are you complaining?' " She says she started experiencing symptoms of stress in middle school, and was diagnosed with panic disorder and generalized anxiety disorder in high school.
- "Parents are the worst about all of this," writes Colin Hughes of Illinois. "All I hear is, 'Work harder, you're a smart kid, I know you have it in you, and if you want to go to college you need to work harder.' It's a pain."
Parents are right to be worried about stress and their children's health, says Mary Alvord, a clinical psychologist in Maryland and public education coordinator for the American Psychological Association.
"A little stress is a good thing," Alvord says. "It can motivate students to be organized. But too much stress can backfire."
Almost 40 percent of parents say their high-schooler is experiencing a lot of stress from school, according to a new NPR poll conducted with the Robert Wood Johnson Foundation and the Harvard School of Public Health. In most cases, that stress is from academics, not social issues or bullying, the poll found. (See the full results here.)
Homework was a leading cause of stress, with 24 percent of parents saying it's an issue.
Teenagers say they're suffering, too. A survey by the American Psychological Association found that nearly half of all teens — 45 percent — said they were stressed by school pressures.
Chronic stress can cause a sense of panic and paralysis, Alvord says. The child feels stuck, which only adds to the feeling of stress.
Parents can help put the child's distress in perspective, particularly when they get into what Alvord calls catastrophic "what if" thinking: "What if I get a bad grade, then what if that means I fail the course, then I'll never get into college."
Then move beyond talking and do something about it.Enlarge image i
Colleen pets her horse, Bishop. They had been missing out on rides together because of homework.Toni Greaves for NPR
That's what 16-year-old Colleen Frainey of Tualatin, Ore., did. As a sophomore last year, she was taking all advanced courses. The pressure was making her sick. "I didn't feel good, and when I didn't feel good I felt like I couldn't do my work, which would stress me out more," she says.
Mom Abigail Frainey says, "It was more than we could handle as a family."
With encouragement from her parents, Colleen dropped one of her advanced courses. The family's decision generated disbelief from other parents. "Why would I let her take the easy way out?" Abigail Frainey heard.
But she says dialing down on academics was absolutely the right decision for her child. Colleen no longer suffers headaches or stomachaches. She's still in honors courses, but the workload this year is manageable.
Even better, Colleen now has time to do things she never would have considered last year, like going out to dinner with the family on a weeknight, or going to the barn to ride her horse, Bishop.
Psychologist Alvord says a balanced life should be the goal for all families. If a child is having trouble getting things done, parents can help plan the week, deciding what's important and what's optional. "Just basic time management — that will help reduce the stress."Copyright 2013 NPR. To see more, visit http://www.npr.org/.
NPR Health Blog - Fri, 11/29/2013 - 6:06pm
Popping A Baby Out Like A Cork, And Other Birth Innovations
by Dana Farrington and Rae Ellen BichellNovember 29, 2013 6:06 PM Enlarge image i
The Odon Device was inspired by a YouTube video about how to remove a cork from the inside of a wine bottle.The Odon Device
An invention to help with obstructed labor has turned some heads — and not just because the idea came from a party trick on YouTube.
The Odon Device, created by Argentine car mechanic Jorge Odon, guides a folded plastic sleeve around the baby's head. A little bit of air is then pumped between the two plastic layers, cushioning the baby's head and allowing it to be sucked out. This trick for removing a cork from an empty wine bottle works the same way.
The device has been embraced by the World Health Organization and is being developed by the global medical technology company BD. Once clinical trials are done, the WHO and individual countries will have to approve it before it's sold. BD hasn't said how much it will charge, but each one is expected to cost less than $50 to make.A Curious Dilemma
Hominin brains have gotten bigger and female pelvises have narrowed since the advent of walking on two feet. This unfortunate geometric problem, termed the "obstetric dilemma," means that over time it has become harder for babies to fit through where they're supposed to come out. The cause is still under debate.
"If proven safe and effective," a 2011 presentation on Odon's invention said, "the Odon Device will be the first innovation in operative vaginal delivery since the development of forceps centuries ago and vacuum extractor decades ago."
The Odon device shows that "good ideas can come from anyone and anywhere," says Wendy Taylor, director of USAID's Center for Accelerating Innovation and Impact.
If you're in the business of innovating, she says, there's no need to strive for mechanical complexity. Some of the biggest breakthroughs are cheap and simple. And, she says, the strategy for scaling something up for worldwide use "is just as important as the innovation itself."
One of the crowning innovations in preventing death during childbirth was convincing doctors to wash their hands in between handling corpses and delivering babies. And many argue that fancier tools are just part of a tradition of unnecessary interference that circumvented the best tool in the box: gravity.
With that in mind, here are five ideas that struck us as innovative and surprising (some more likely to succeed than others):
1. Ready Yet?
A team at the University of California, San Francisco created a "cervical cap" to check whether a woman is about to go into labor. The device can detect changes in the collagen of the cervix. The softening of collagen as the cervix opens is a telltale sign a baby's on its way. Information from the cap's sensors can be transmitted to a nearby cellphone, which can send the data to a doctor. The device can be inserted briefly once a day, without a professional's help.Additional Information: Shots - Health News Babies Take Longer To Come Out Than They Did In Grandma's Day Author Interviews 'Get Me Out': Making Babies Through The Ages Global Health Drug Given To Moms After Childbirth Sparks Controversy
2. Back To Basics
A team at Massachusetts General Hospital developed a uterine balloon kit to stop postpartum hemorrhage. It consists of a condom tied to a catheter. Water from the catheter fills the condom in the uterus, creating pressure that can stop the bleeding. The kit has been tested successfully in South Sudan and Kenya. A similar tool in the U.S. can cost more than $300 each, Mass General says, compared with less than $5 each for the simple balloon kit.
3. Like Stretching Before A Race
Athletes stretch their muscles before a race; why not do the same before birth? That's the thinking behind a device by Materna Medical currently being evaluated in clinical trials in Australia. Over the course of one to three hours during early labor, it mechanically dilates the vaginal canal from the usual diameter of 2.6 centimeters to the fully expanded size required to pass a baby, about 8 to 10 centimeters. Though the product description includes bracing terms like "force-controlled" and "semi-automatic," it's supposed to make birth gentler on Mom.
4. From Gourds To Balloons
This silicone balloon can inflate to the size of a football. In practice, it doesn't get wider than a standard grapefruit. In the weeks leading up to delivery, the German-made pelvic floor muscle exerciser is intended to stretch vaginal muscles so that they don't tear during birth. The invention was supposedly inspired by the traditional use of gourds in some African countries for the same purpose.YouTube
5. Centrifugal Birth
Patented in 1965 by George and Charlotte Blonsky, the Blonsky Device is an "apparatus for facilitating the birth of a child by centrifugal force." It looks medieval and works like a centrifuge. The soon-to-be-mother is strapped to a table, which rotates at high speed until the baby shoots out into a carefully placed net — about as close as birth gets to a slam dunk. The inventors posthumously won an Ig Nobel Prize for their, um, ingenuity, and were honored with a mini-opera about the patent.Copyright 2013 NPR. To see more, visit http://www.npr.org/.