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Cosplayers Use Costume To Unleash Their Superpowers

NPR Health Blog - Sat, 07/23/2016 - 5:00am

Leland Coleman of Nashville, Tenn., says Captain America was an inspiration to him over the past year as he lost 45 pounds and went off insulin. So he designed this Renaissance version of the character. The costume, he says, "gave me the strength. I feel like I've grown into it and become it. He and Becki Turner were among the attendees at AwesomeCon in Washington, D.C., in June.

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"My name is Becki," says a young woman standing in a convention center turned comic book bazaar. Then she flips a mane of orange hair and launches into Scottish accent. "And today, I am Merida from Brave."

Becki Turner, a 28-year-old from Waldorf, Md., is at AwesomeCon in Washington, D.C., along with thousands of other attendees dressed in elaborate costumes. When she's not a fictional Scottish princess from a Disney movie, Turner says she's much more withdrawn. "I'm much less shy when I'm in cosplay. I don't have as much hangups as I do when I'm me, [like] a little bit of social anxiety."

She flares her green dress and brandishes a recurved bow with a grin on her face. "[Merida's] a strong, fierce, independent woman," Turner says. And today, so is she.

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Costuming as science fiction or fantasy characters began at science fiction conventions in the United States back in the 60s and 70s. The first cosplayers wore outfits from Star Trek and Star Wars. But the practice has really grown. People wear costumes from comic books, anime, video games, movies and TV series. Think of a character from even a modestly popular science fiction or fantasy universe, and there's probably been someone who's masqueraded as that character. And there large subgroups of specialty cosplay like the "bronies:" men who dress up as ponies from My Little Pony.

Now cosplayers, a portmanteau of costume role players, regularly pack conventions in Japan, Europe and the U.S. For geeks, the convention offers a sanctuary where they can nerd out and meet their science fiction and fantasy brethren. For the cosplayers, that means sharing the experience of transforming themselves into someone, or something, else.

But for many, it's not a mere game of dress-up. The costumes they choose bring out something in them that's not usually visible. Ni'esha Wongus from Glen Burnie, Md., carries a 6-foot foam gun and wears a tight pleather bodysuit. "I am Fortune from Metal Gear Solid 2," she says. "I still consider myself an introvert. But once I got all the buckles and straps on and the gun and stood in front of the mirror for the first time? I fell in love with it. I feel like there's some strength, some confidence in me now because of this."

And for Leland Coleman of Nashville, Tenn., his costume symbolizes a physical transformation. Captain America was an inspiration to him over the past year as he lost 45 pounds and went off insulin. So he designed a Renaissance version of the Marvel Comics character. The costume, he says, "gave me the strength. I feel like I've grown into it and become it."

Jayson Brown of Sterling, Va., portrays Predator from the 1987 film. Brown has spent the past two years working on his costume, which includes a Predator ring that he wears even when he's not cosplaying. Brown's daughter Skyla Brown is dressed as the Queen of Hearts from Alice in Wonderland.

Meredith Rizzo/NPR

These cosplayers are invoking clothing's subtle sway over us. People have used clothing to subdue, seduce and entertain for millennia. In some outfits, people not only look different, but they feel different. Psychologists are trying to figure out how clothes can change our cognition and by how much. Adam Galinsky, a psychologist at Columbia Business School, spoke with NPR's Hanna Rosin for the podcast and show Invisibilia. Galinksy did a study where he asked participants to put on a white coat. He told some of the participants they were wearing a painter's smock, and others that they were in a doctor's coat.

Additional Information: The Secret Life Of Clothes

Do clothes have the power to transform us? The latest episode of the NPR podcast Invisibilia explores seven stories about how the clothes we wear affect us more than we think (though perhaps less than we hope).

Then he tested their attention and focus. The people who thought they were in the doctor's coat were much more attentive and focused than the ones wearing the painter's smock. On a detail-oriented test, the doctor's coat-wearing participants made 50 percent fewer errors. Galinksy thinks this is happening because when people put on the doctor's coat, they begin feeling more doctor-like. "They see doctors as being very careful, very detailed," Galinksy says. "The mechanism is about symbolic association. By putting on the clothing, it becomes who you are."

Almost any attire carrying some kind of significance seems to have this effect, tailored to the article as a symbol. In one study, people wearing counterfeit sunglasses were more likely lie and cheat than those wearing authentic brands, as if the fakes gave the wearers a plus to cunning. "If the object has been imbued with some meaning, we pick it up, we activate it. We wear it, and we get it on us," says Abraham Rutchick, a psychologist at California State University Northridge.

In Rutchick's studies, he has found that people wearing more formal clothing like they would wear to a job interview thought more abstractly and were more big-picture oriented than people in casual wear. For example, those in formal clothing would say that locking the door was more like securing a house, an abstract concept, than turning a key, a mechanical detail.

The effect from clothing is probably twofold, Rutchick says. "When I gear up in those things, I will feel a certain way," Rutchick says. Then, he says, "I [also] feel how people are perceiving me, and that's going to change how I act and how I think about myself."

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The effect of that feedback is obvious in the cosplay convention atmosphere, where people rush to compliment one another on costumes and take photos.

Riki LeCotey, a well-known cosplayer from Atlanta who goes by the stage name Riddle, says that the power she finds in cosplay is both from the costume and from people's reactions. "Someone is like, you're a perfect Black Cat [a character from Spiderman]. So you're like, 'Oh they think I'm sexy. I feel sexy in the costume. Maybe I am sexy,' " she says.

And those feelings linger after the con, LeCotey says. "When you take the costume off, you kind of remember. Or you look at photos and it reminds you. If you keep doing it over and over again, it just stays with you. It's like a muscle memory – of sexiness." LeCotey says cosplaying has helped her become far more confident than the shy teenager she was 17 years ago when she started.

At a fundamental level, LeCotey says, "[cosplaying] is about embodying the characters you love." For her, that means choosing characters that she identifies with because of a similar history or an attribute that she admires. About a quarter of cosplayers would agree with her, saying they choose their characters because of psychological traits or their narratives, based on a survey done in The Journal of Cult Media.

The clothing is a conduit to those traits, but it doesn't always need to be elaborate. "Like today, I woke up, and I wanted to wear something like Black Widow," says Jennifer Breedon, an AwesomeCon attendee from Washington, D.C. She's dressed in a leather jacket, black tights and combat boots. It's not Natasha Romanova's leather catsuit, and there's no S.H.I.E.L.D. patch to identify the Marvel Comics hero. Still, it works for Breedon. "And today, I'm channeling that character, that person, that part of me that feels that affinity with them."

She calls it a subtler cosplay, choosing characters who tend to wear simpler or street casual outfits. "Even if it's under the radar, even if nobody notices it. I know what it is," she says.

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The costumes can be barely noticeable – say, the grey hoodie, jeans and boots of another Marvel Comics hero, Jessica Jones. But Breeden says that at a terrible moment, when she was alone and defeated, these clothes helped her draw the strength to move forward.

Breedon, now 32, says that a decade ago she felt like a failure. She struggled with an eating disorder, drug abuse and one serious suicide attempt. And along the way, "I hurt a lot of people." She says that in the years since rehab, her life and health has felt precarious. "Even today, there's an underlying shame, and I need to work through it every single day."

She worked her way through law school, graduated and got a job. It felt like a huge achievement; she told everybody. Then they canned her a few months later, saying it wasn't a good fit. She spiraled into a depression, thinking, "I'll never be good enough."

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For three days, Breedon says, she sat alone in her apartment, re-watching Jessica Jones. She made a point of dressing just like Jessica, in her grey hoodie. "I had to be Jessica," she says. "The hoodie gave me purpose. Jessica Jones is always like, 'I don't want to work for your law firm or S.H.I.E.L.D. or whatever.' She had to do her own thing. It made me think, 'Maybe I'm not meant to work for this organization.' I just felt at peace."

Breedon moved on. She got a job working as an attorney and human rights analyst that she loves. She says she gets to help people, just like her heroes. And when she finds herself in need of toughness, she has their talismans, the hoodie, the leather pants, the boots, waiting in her closet.

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Miami Steps Up Mosquito Control Efforts After Suspected Zika Cases

NPR Health Blog - Fri, 07/22/2016 - 6:35pm
Miami Steps Up Mosquito Control Efforts After Suspected Zika Cases Listen · 3:45 3:45 Toggle more options
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July 22, 20166:35 PM ET Heard on All Things Considered

Larry Smart, a Miami-Dade County mosquito control inspector, uses a fogger to spray pesticide to kill mosquitoes in an effort to stop a possible Zika outbreak in Miami.

Joe Raedle/Getty Images

In a well-kept neighborhood in Miami with lush gardens, Larry Smart, a county mosquito control inspector, holds a turkey baster up to the light. "If you look closely, you'll see some moving fast. They're wriggling around," he says. "That's actually mosquito larvae." Smart uses the turkey baster to sample standing water in hard-to-reach places.

Florida is home to dozens of mosquito species, but the one officials are most concerned about now is Aedes aegypti, the main species that carries the Zika virus. These mosquitoes typically live near people and can breed in as little as a teaspoonful of stagnant water.

Health officials are worried that Zika may have a foothold in South Florida. They're investigating two cases of Zika that may have been contracted from mosquitoes in Florida, not by people traveling abroad.

At this Miami home, Smart found mosquito larvae in water held in the leaves of a bromeliad, a flowering plant common in South Florida yards.

Mosquitoes like to breed in the pooled water in plants like this bromeliad.

Joe Raedle/Getty Images

"They'll breed in there and become adults," he says. "A lot of people don't realize that a plant like that is renowned for mosquitoes."

With a handheld fogging machine, Smart mists the foliage with an insecticide. He also drops pellets that kill mosquito larvae into the plant. Officials say going door-to-door and spraying by hand is the most efficient way to stop the Aedes aegypti mosquito and the spread of Zika.

Over the past week, Miami's mosquito control activity has been focused on one particular neighborhood. It's near the home of a person health officials say may have contracted Zika locally from a Florida mosquito. There are actually two cases of suspected local transmission now, one in Miami and one just north in Florida's Broward County. But Lilian Rivera, the head of Miami-Dade County's Health Department, says there are few details she can share.

"We are in an active investigation stage, not only in Miami but also in Broward," she says. Her message for the media and the public? "Just to have patience."

Florida's Department of Health is working with the Centers for Disease Control and Prevention to rule out other ways the two individuals could have contracted Zika, such as through travel or sexual transmission. The department is also trapping mosquitoes and testing them for the Zika virus. So far, none have come back positive. Miami took similar measures in 2010 when the city saw a number of dengue cases. Because it can cause birth defects including microcephaly, Zika is even more worrying.

Miami's head of mosquito control, Chalmers Vasquez, says he really wasn't surprised when health officials began investigating a possible locally acquired Zika case, because of the city's close contacts with the Caribbean and Latin America. He says: "The virus is flowing through Miami International Airport every day. There are thousands and thousands of people coming back into our area from those countries that may be affected, they may not be."

Vasquez says, "We're trying to be as aggressive as possible."

Officials in Florida are concerned about how much the Zika response will cost. This week, the White House announced it was sending $60 million in Zika funding to the states, including $5.6 million for Florida.

Much more will be needed, says Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine. He's concerned Zika may already be established in mosquitoes in Florida, Texas and other states along the Gulf Coast. But so far, funds haven't been made available for intensive testing and surveillance.

"You have to have teams of people going into affected communities, community health centers, asking about fever and rash, and then taking a blood sample and testing it," Hotez says. "That requires some resources and it's not being done. I'm worried that we could be seeing quite a bit of Zika happening now. It's just that no one's looking."

The Obama administration is asking Congress for $1.9 billion to fund the fight against Zika, so far without success. And, at the height of mosquito season on the Gulf Coast, Congress has adjourned until after Labor Day.

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Categories: NPR Blogs

A Cast With Down Syndrome Brings Fresh Reality To Reality TV

NPR Health Blog - Fri, 07/22/2016 - 4:32pm
A Cast With Down Syndrome Brings Fresh Reality To Reality TV Listen · 4:38 4:38 Toggle more options
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July 22, 20164:32 PM ET Heard on All Things Considered

Born This Way is produced by Jonathan Murray, the co-creator of MTV's Real World. Above, cast members Cristina Sanz (left), Rachel Osterbach, Steven Clark and Sean McElwee (top).

Adam Taylor/A&E

Born This Way is a reality show — not too different from The Real World, the groundbreaking show that helped define the genre and aired for more than 30 seasons on MTV. Both feature a cast of diverse young adults navigating the world around them. Both came from reality TV pioneer Jonathan Murray (who co-created The Real World with Mary-Ellis Bunim). The big difference: All the stars of Born This Way have Down syndrome.

"It was challenging to cast this show," Murray told me recently from Bunim/Murray Productions in Van Nuys, Calif., as he readied for the launch of the second season on July 26. "Sometimes our cast members — it takes them a little struggle to get their thoughts out."

Murray had no personal connection to the Down syndrome community when he first came up with the concept of the show. He says he's always been committed to bringing underrepresented communities to the screen, stretching back to when The Real World featured a gay, HIV-positive character in the 1990s.

"I always felt that we grew up in our own little segmented worlds," he said, adding that television provides a chance to break down those walls.

That said, reality TV relies on conventions, and Born This Way follows plenty of them. The cast includes a musician, a party girl, a self-styled player and a drama queen. Rachel Osterbach is the 33-year-old sweetheart. She wears her red hair in a 1960s-style flip and was recruited for Born This Way at a drama class for people with Down syndrome.

"I actually cried from happiness," she said about being cast, "because I always wanted to be on TV. Because I wanted to be like the regular people on TV."

The A&E docu-series Born This Way was recently nominated for three Emmys. Sean McElwee (left) Megan Bomgaars, Rachel Osterbach and John Tucker star in the second season which premieres July 26.

Adan Taylor/A&E

Osterbachs' parents, Laurie and Gary, said they never really believed their family would end up onscreen. The family lives in Orange County, Calif. When they got picked, they were concerned, because Bunim/Murray Productions also makes Keeping Up With the Kardashians.

"We knew they were experienced," Gary Osterbach said wryly. "But when you're experienced in shows like the Kardashians — that doesn't necessarily make you feel like your daughter is going to come off great."

But Rachel Osterbach does come off great. So does the rest of the cast. Born This Way has been an unexpected hit for A&E. Over its first season, the show enjoyed more than an 80 percent rise in viewership. Other reality stars could learn much from this cast about handling conflict.

There's lots of hugging and forgiving. And when alcohol appears, it's not hurled during catfights. It's sipped responsibly during family dinners or among parents discussing how to handle their adult childrens' transition to independent living. (Cast members during the first season were ages 22 to 32.)

I learned about Born This Way from a reality TV producer who told me it has a dedicated following in the reality television community. (Yes, that's a real thing.) Jonathan Murray thinks that might be because the show demands a delicate touch that's uncommon in the genre.

Generally in reality TV, Murray said, "you don't get to play the small moments as much as I would like to. It has to be big and loud, and someone needs to flip a table at the end of Act One."

On this show, you see Rachel Osterbach doing her best to find love, and getting repeatedly turned down.

"That was the toughest part," said Gary Osterbach. "To watch on TV and know that there's now approximately 1 million people also watching your daughter get rejected."

"Twice," interjected Rachel's mom, Laurie.

"I don't like being rejected on film," Rachel said firmly. "At first, I didn't want that in there because I hate being let down."

"But it was OK, you said, right?" Laurie asked.

"It was OK, but I don't like being rejected," Rachel replied.

In a way, this is progress, said disability advocate David Perry. He's not generally the biggest fan of reality shows, he said, but he appreciates how Born This Way holds people with Down syndrome to the same standards as other reality stars.

"I like seeing struggle," he said. "I like seeing young adults with Down syndrome struggling with questions that young adults struggle with."

Perry's 9-year-old son has Down syndrome. Too often, Perry said, people with Down Syndrome are represented on TV as childlike innocents.

"Or it can be kind of angelic," Perry added. "There's a whole tradition of people with Down syndrome being angels on earth, being specially chosen by God, living without sin."

But Born This Way features complex characters; they're among the less than 1 percent of TV characters with disabilities, according to a recent survey by GLAAD. They're also among the first generations of people with Down syndrome who have benefited from such broad social changes as mainstreaming and the Americans with Disabilities Act.

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Shots - Health News Only Human: A Birth That Launched The Search For A Down Syndrome Test StoryCorps A Mom, A Son With Down Syndrome — And The Love That Made A 'Curse' A Gift Children's Health A Daughter With Down Syndrome Is The Perfect Sister

"Everything started to change in the late '70s, early '80s," observed Gary Osterbach, of the progress his daughter has enjoyed. "She's been in early intervention [programs] since she was a month old. If she'd been born, probably five years before that, none of that would have existed. People paved the path for us before we were there."

And the Osterbachs take pride in continuing that path by showing their family to a wide audience.

"I didn't think we'd get the acceptance like we did," Laurie Osterbach said softly. "And that's what I hoped by doing this — besides them just seeing how sweet Rachel is."

"Thank you, Mom," Rachel Osterbach piped up.

The sweetness — and the real drama — of Born This Way is getting acclaim outside the disability and reality communities. The show was recently nominated for three Emmys.

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Invisibilia: The Unbearable Lightness Of Footwear

NPR Health Blog - Fri, 07/22/2016 - 1:57pm
Isabel Seliger for NPR

Editor's note: This is an excerpt from the latest episode of the Invisibilia podcast and program, which is broadcast on participating public radio stations.

Walking among the California redwoods, drifting blank-brained on a break from college, I got to thinking about shoes. I can't say why, exactly. Perhaps it was because they were touching my feet.

My own shoes were performing admirably, I must admit. I was trudging on mud and bugs and roots and who knows what without feeling much of anything.

Additional Information: The Secret Emotional Life Of Clothes

Do clothes have the power to transform us? The latest episode of the NPR podcast Invisibilia explores seven stories about how the clothes we wear affect us more than we think (though perhaps less than we hope).

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And that, I realized in a flash, was a problem. Not that I had been stepping on gross stuff and snuffing out the lives of little things that, frankly, may not have deserved it. The problem was that I really couldn't tell.

Life and death and dog poop — it all basically felt the same underfoot.

I began thinking about the festering evil behind pollution, behind climate change, callousness and all the other ways we forget to consider each other and the world around us. Maybe shoes are to blame.

I realize this idea is so simple it could be taken for stupid. Bear with me for a moment.

When we invented footwear — probably some 40,000 years ago, according to paleoanthropologists — we also slipped a surface between ourselves and the world. Where we once were touching the ground with skin, touching all the time like lovers, shoes changed all this. With shoes, we swapped intimacy for a well-regulated separation.

Perhaps the moment at which we began walking only on objects of our own construction was the same moment we convinced ourselves that the world is of our own making. With shoes came pride, forgetfulness. Maybe Adam never even had to eat the apple at all. Maybe all he had to do was slip into a fresh pair of loafers.

It's a discovery I didn't know what to do with. And I still don't, to be honest — despite the years since, which I thought would make me smarter. But at the time, it felt as if a grand symbolic gesture was in order.

Isabel Seliger for NPR

I unlaced that faithful shoe of mine. I wiggled out of it, wadded my sock inside, cocked my arm behind my head in a pose I was sure looked heroic. With the great weight of all the world's dashed dreams on my shoulders I threw that shoe, that sad proof of all we've lost, as hard as I could, as far as I could.

It might have flown for miles — if it hadn't hit the tree right in front of me. The shoe gave out a defeated plop. The tree's trunk tossed off a few splinters. I know, because when I put it back on a few minutes later, I could feel them, wedged deeply in the sole.

Copyright 2016 NPR. To see more, visit NPR.
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Invisibilia: Do His Sunglasses Keep Him From Seeing The Light?

NPR Health Blog - Fri, 07/22/2016 - 3:00am

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Editor's note: This story is part of the latest episode of NPR's show and podcast Invisibilia, exploring the power of clothes.

When he was in middle school, something happened to Casanova Frankenstein that happens to a lot of kids. On the bus home from school, another boy started making fun of him. As soon as they got off the bus, the kid sucker punched him right in the face. Frankenstein dragged himself home through the snow and crawled into bed. When his mom came into the room later that night, instead of comforting him, she said, "If you ever come into this house again and you lose a fight, I'm gonna get you. You hear me?"

Additional Information: Listen To The Episode

Winning those fights wasn't going to be easy. In the early '80s, Frankenstein was a kid trying to make it through school on the South Side of Chicago. He didn't play sports. And he had what he thought was as an incriminatingly dorky birth name: Albert Melvin Frank III. And he wore glasses — glasses that framed cartoonishly sweet puppy-dog eyes. So given his limited options, he decided he would turn to clothes to save himself.

We often think the shirts or shoes or accessories we put on every morning will make us cooler, or more confident or more professional. And sometimes we are right. But sometimes the clothes change us in ways we don't expect, or may not even want.

In Frankenstein's case, he desperately wanted the clothes to make him someone the other kids wouldn't pick on. He tried a pair of motorcycle boots, a pair of trendy Air Jordan sneakers, even a varsity letter jacket. After watching a movie about an Army-jacket-wearing kid whose classmates thought he was a psychopath, he dug up his dad's old Army jacket and wore that to school, too.

But none of these worked. "If you grow up in the South Side of Chicago, the last thing you're worried about is a Vietnam vet," he says. "You just look like you're broke."

And then one day while shopping for new glasses, Frankenstein noticed a pair of large tinted frames in the display case. They went from dark magenta at the top to warm pink at the bottom. And he wondered: Could these be the answer? "In the black community, guys that wore sunglasses, man, they were sharp! They were cool!" he recalls.

A few days later, he showed up at school wearing the glasses, and as he walked through the hallways, he heard something new. "Cool glasses!" "Cool glasses!" "Man those are cool glasses!" "How come they're letting you wear glasses at school?"

He told everyone they were tinted prescription glasses. And just like that, the bullying miraculously ended. Usually it doesn't work this way. Usually we discover a hard limit to the power of clothing. But for some reason in his case, all of the tripping, all of the textbook slapping, all of the hiding of clothes in the locker room and spitballing — it just stopped. With those tinted frames hiding his eyes, he says, "I was like a ghost almost. And I know that sounds strange, but it was like people did not really notice me."

Problem solved. But maybe problem solved too well?

Casanova Frankenstein started wearing dark glasses as a defense against bullies. That was decades ago. But he's still wearing them.

Courtesy of Casanova Frankenstein/Flickr

Frankenstein is 48 now, and a lot has changed since high school. He has tattoos. He's changed his name to Casanova Frankenstein, Cass for short. He's an artist who had a somewhat popular underground comic in the 1990s. And for many years, his day job was working as a custodian for the University of Texas in Austin. But what hasn't changed in all of these years is the sunglasses. He has an impressive collection hanging by his bed.

"I wear them when I'm lying down in bed — yeah, everywhere."

He wears them whether he's outdoors, whether he's indoors, whether at the grocery store or going on a date — at times even during sex. Frankenstein is that guy. He wears the sunglasses all day and all night.

But he doesn't care what people think because he genuinely believes that sunglasses have a kind of magical power. He's even tried to quantify just why they work so well, writing a paper on the effects of wearing sunglasses after dark where he tells his story and speculates on how sunglasses might help protect bullied kids.

It's a careful layman's parsing of how wearing sunglasses changes the emotional dynamics of a situation. He explains, for example, how "by avoiding pack placement, you tend to avoid male conflict and contests of aggression." Or how shielding the eyes can provide cover to people who need it. "You can't see a person cry if [they are] wearing dark glasses," he points out.

He says it's "like being able to look at the world through a telescope or from behind a wall."

But the sunglasses might also keep Frankenstein from seeing things he really might like to see. Two years into his second marriage, he didn't remember that his wife, Beth, had blue eyes, not brown. Which raises the question: Is there anything about wearing sunglasses that Frankenstein, in his conviction, can't really see?

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Beth Wiley, now his ex-wife, says that during her marriage to Frankenstein she had this saying: "The world is only as dark as the sunglasses you see it through." Constantly wearing sunglasses gave Frankenstein a darker view of the world, she thinks. The sunglasses made strangers and even her friends more standoffish toward Frankenstein, and that, in turn, made him see more of the negatives in others. "I just felt like I spent a lot of the relationship preparing for people to be assholes," says Wiley.

Kristen Bunyard, Frankenstein's close friend of 20 years, agrees that the sunglasses sometimes function as a wall. "It's hard to have a conversation with someone for several hours and you can never really see their eyes," she says.

So perhaps the sunglasses are imprisoning him in a brutal high school version of the world and obscuring the truth, which is that grownups are generally nicer than kids?

"I mean at the risk of sounding rude or insensitive, nobody's bullying a 50-year-old guy, especially not in Austin," Bunyard responded. "And I think that the majority of people he surrounds himself with are all people he loves and who love him. And he is safe with all of us. I wish he felt like he could take them off."

Back in his apartment, safe from the outside world, Frankenstein disagreed with these ideas. "The only reason why they want to see my eyes is to see if I'm lying to them," he says. "I'll take my glasses off and then I'll talk to you, and see if there's any difference."

Frankenstein placed the sunglasses carefully on the bed. Suddenly there was a transformation. His fluttering brown eyes were rimmed with curly eyelashes. The man who just a moment ago was so sure of himself now looked naked and vulnerable. Even his voice had changed. "As I said, I get kind of flustered when I'm not wearing sunglasses, don't know exactly what to say because my shield is down," he says. "So it's a matter of their comfort over my comfort."

He talked for 30 more minutes without the sunglasses on and then the interview ended. Frankenstein put the glasses back on and once again, everything changed. He was back to cracking jokes, dancing, even singing. "Heavens, I love the dark. I adore the darkness!"

With his glasses on, he stood outside his front door and he seemed prepared, excited even, to venture out.

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

Invisibilia: How A Shirt Collar Helped A Man Survive Auschwitz

NPR Health Blog - Thu, 07/21/2016 - 4:39pm
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July 21, 20164:39 PM ET Heard on All Things Considered

When you got up this morning, did you dress for the weather? Your wife? Throw on your lucky socks?

NPR's show and podcast Invisibilia has been taking a long look at what we wear — from sunglasses to artist's frocks and hoodies — and asking how much our clothes affect us, sometimes in ways we're not aware of, or might not even like.

There's the tale of tailor Martin Greenfield, who has dressed the last three presidents as well as NBA players and Hollywood stars. But his first realization of how clothes convey power came from a much darker place — the Auschwitz concentration camp. There, Greenfield started wearing a castoff Nazi shirt under his prison uniform. And that white collar somehow preserved his dignity. "I was different," Greenfield says. "I was different all the way through."

We'll also ask whether a man who started wearing sunglasses all the time to fend off high school bullies wound up unintentionally creating a wall between him and his loved ones by still wearing sunglasses decades later.

And we contemplate whether shoes keep us from properly considering the world around us, and each other.

This weekend in NPR's health blog, Shots, we'll explore how cosplayers use elaborate costumes to bring out their hidden strengths and find community. Join us on the air and online!

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

Psychotherapy Helps People Tune Out The Din Of Tinnitus

NPR Health Blog - Thu, 07/21/2016 - 12:36pm

About 2 million Americans experience unbearable tinnitus.

Meriel Jane Waissman/Getty Images

About three years ago, a high-pitched "eeeeeeeee" sound started ringing in Linda Gray's ears. Sometimes, the ring would suddenly turn into a roar, sending Gray into panic mode. Her heart would speed up. She'd try to find a quiet room. "You're trying to escape it. It's like, 'Turn this off!' " she says.

A lot of people experience ringing, roaring or buzzing, also known as tinnitus. It can be maddening.

"It consumed me, it really did," says Gray, a childbirth educator living in Ohio. "I avoided talking on the phone, I avoided any social situation because it was so bothersome," she says. She stopped working for months.

Doctors writing Thursday in the journal JAMA Otolaryngology-Head & Neck Surgery found that about 1 in 10 U.S. adults reported experiencing tinnitus within the past year. And, surprisingly, very few of them talked with their doctors about one of the few methods known to help with it.

"Tinnitus is intimately tied to hearing loss," says Harrison Lin, an ear surgeon at the University of California, Irvine Medical Center and an author on the report. When a person loses the ability to hear a certain range of sound, their brain might chime in with its own iteration, like a soldier who can still feel pain in a limb they've lost.

"You hear a sound — a buzzing, a hissing or a tone — and no one else hears it. It's generated by something in your brain," says Lin.

Looking at a national survey of more than 75,000 people, Lin and his colleagues found that about a quarter said they'd experienced symptoms for more than 15 years. Over a third said their symptoms were nearly constant. According to the U.S. Department of Veterans Affairs, more than a million veterans get disability payments for tinnitus.

Health Tinnitus: Why Won't My Ears Stop Ringing?

For a lot of people, tinnitus is minor enough that they don't consider it a problem. But in cases where the sensation is intolerable, it's connected with anxiety, depression and lower quality of life.

Lin says one way to counteract it is to get hearing aids, so that the brain stops trying to compensate for the silence. The other thing known to help with tinnitus sounds a little odd coming out of a surgeon's mouth — psychotherapy.

"Cognitive behavioral therapy is widely accepted and promoted by our national professional society, but very few people know about it," says Lin. "It's about converting the way in which you think about tinnitus from negative emotions and trains of thought to more positive trains of thought."

For example, Lin says, a patient might be limiting their activities because of negative thoughts around their tinnitus. The therapy would help them take the bad thought, like "My tinnitus is very bad today, and I won't enjoy going out to dinner with my spouse, so I won't go," and turn it into a good one, like "I have tinnitus, and it may be distracting at times, but I will likely enjoy spending time with my spouse, delight in the meal and have an otherwise great evening."

Participants also learn relaxation techniques, how to manage sleep better, and ways to reduce their fear about encountering unpleasant sounds.

Despite studies showing the effectiveness of behavioral therapy, doctors rarely bring it up with patients. According to the survey Lin studied, about 0.2 percent of respondents with tinnitus had talked about it with their doctors.

Jennifer Gans, a psychologist with a private practice in San Francisco, is pushing for another form of therapy for tinnitus patients, mindfulness. The evidence for its effectiveness is a lot harder to come by than for cognitive behavioral therapy, but it operates on the same assumption — that changing a person's attitude about their affliction can minimize its impact on their life.

After learning about how mindfulness could help people with chronic pain, Gans decided to apply the method to tinnitus. She now has an online course in stress reduction to help people cope with the infuriating sounds.

"There's this great quote that 'Pain in life is inevitable, but suffering is optional,' and it really stands true," she says.

Gans asks participants to meditate for half an hour every day, learning to live with the tinnitus rather than harping on it as a burden. In the first lesson, she asks participants to pick up a raisin and focus on each detail — the texture, the sound of it rolling between two fingers, the look, taste, smell. She even asks people to notice the feeling of being "one raisin heavier" after eating it.

The idea is to help people learn to control their focus and their stress so that when something out of their control happens, like a loud ringing in their head, they can keep calm and get on with their daily life.

She says some people initially say, "No way, I'm not into that mumbo-jumbo stuff." But when all else fails, they tend to come around.

Linda Gray, who eventually took Gans' course, was initially among the skeptical.

"I'd done hearing aids, acupuncture, massage, tinnitus retraining therapy, and there was nothing else left," she says. She doubted that an online course involving a yoga mat would do much to help. But, she says, "I had to get on with my life. I couldn't just sit in my bedroom listening to white noise for days or weeks at a time.

"I'd still prefer it to be gone. As we're talking now, I can hear it," she says. But, she says, "I have some tools now to cope with it, rather than panic."

Though few studies have shown the effectiveness of mindfulness for tinnitus patients, a few studies have shown that combining mindfulness with cognitive behavioral therapy can reduce the negative psychological impact of chronic tinnitus.

Lin and his colleagues at UC Irvine have created their own eight-week online course in cognitive behavioral therapy. They're now enrolling patients at the medical center in a trial to understand how much it helps improve their quality of life.

Copyright 2016 NPR. To see more, visit NPR.
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Turning Down The Background Noise Could Help Toddlers Learn

NPR Health Blog - Thu, 07/21/2016 - 12:19pm

Earlier studies have found that children who grow up in houses with a TV on many hours a day learn fewer words than children in households with less TV time.

Heleen Sitter/Getty Images

Toddlers make their fair share of noise. But they also have a lot of noise to contend with — a television blaring, siblings squabbling, a car radio blasting, grownups talking.

Amid all that clatter, toddlers must somehow piece together the meanings of individual words and start to form their own words and sentences.

Loud background noise may make it harder for toddlers to learn language, according to a study published Thursday in the journal Child Development. Many other studies have already found that background noise can limit children's abilities to learn. Television noise, in particular, is ubiquitous in American homes and may negatively affect a child's ability to concentrate.

But few researchers have looked at how background noise affects toddlers as they are just beginning to learn words.

Learning words early is important and can affect basic reading skills later on, says Brianna McMillan, a psychology graduate student at the University of Wisconsin-Madison and lead author on the study. "These initial word learning experiences are very foundational for how kids succeed later in life."

McMillan and her graduate adviser, professor of psychology Jenny Saffran, tested whether louder or quieter background speech affected whether toddlers at about 23 months could learn new words.

A group of 40 toddlers listened to recordings of new words in sentences. At the same time, they also heard background speech — recordings that sounded like two people speaking at once. The researchers say that this background recording could represent people chatting in the same room or on the television or radio.

Half of the toddlers heard louder background talk — "like having a conversation with a friend while someone else is standing a foot away talking," explains McMillan. The other half heard the same recording at a quieter decibel — "more akin to background coffeehouse chatter," she says.

With the background noise still playing, the researchers then taught the toddlers the meanings of the new words by showing them images on a screen of what each word represents.

Additional Information: Learning Above The Noise

The researchers tested two levels of background noise to see how they would affect toddlers' learning.
(Courtesy of Brianna McMillan, Jenny Saffran, Tina Grieco-Calub and Ruth Litovsky)

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The scientists then tested how well each group of toddlers had learned the new words.

It turned out that toddlers could only learn new words when the background chatter was quieter.

The researchers tried the same experiment on a group of 40 toddlers who were about six months older and found the same result.

In a final experiment, the scientists allowed 26 toddlers to hear new words in sentences in a quiet room and then taught them the meanings of the words under the louder background noise condition. This group of toddlers did successfully learn the new words.

This last experiment provides some hope that carving out a bit of quiet time for learning words can help children attach meaning to those words later in their more typical noisy environments.

"It's not practical to completely turn off the radio or TV all the time," says McMillan. "I don't think that's how we can or should live." But she says that parents might want to be more aware of what their kids are hearing and turn off the TV now and then.

It's unclear whether the Wisconsin team's findings would hold true for a broader group of toddlers from across the United States — this study focused on a fairly small group from an area with a large university community.

But the Wisconsin team's research covers an important under-studied area, says Rochelle Newman, chair of the Department of Hearing and Speech Sciences and associate director of the Maryland Language Science Center at the University of Maryland. "There's been a lot of work on noise and its impact on learning once children reach the age of schooling. A lot less has been done on younger children," she says.

Newman says there are still many unanswered questions, including whether some level of noise might be beneficial for toddlers in the long term.

"Children are going to go to school where there is a lot of noise," Newman says. "They're going to eventually have to learn to deal with that noise. We don't know if they'll need some exposure to learn to deal with it. We don't know how much is too much noise."

Copyright 2016 NPR. To see more, visit NPR.
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As Indiana Governor, Mike Pence's Health Policy Has Been Contentious

NPR Health Blog - Thu, 07/21/2016 - 6:41am

Indiana Gov. Mike Pence took questions from the media as he and his wife, Karen, left their New York hotel to meet with Republican presidential candidate Donald Trump on July 15. Pence has drawn criticism from the left and the right for various health care stances.

Andres Kudacki/AP

Indiana Gov. Mike Pence is in the spotlight this week as the man Donald Trump has picked to be his running mate. Pence's decisions about health and health care in Indiana have drawn attention from within and outside the state. His record could be important in November, because Trump doesn't have a legislative record at all.

Here's a quick look at the governor's history in terms of health policy in Indiana.

Medicaid Expansion

Pence has always been a vocal opponent of the Affordable Care Act, even after the federal law passed in 2010 and was upheld by the Supreme Court.

But when faced with the choice of whether to expand Medicaid to cover Indiana residents who earn incomes that are 138 percent of the federal poverty level or below, a key part of the ACA, Pence compromised. He debuted a conservative-friendly version of the expansion, one that requires Medicaid recipients to pay a monthly contribution, based on income, into a health savings account. Recipients who miss a payment can be bumped to a lower level of coverage, or lose it entirely, for six months.

Now, after a year and a half, the Healthy Indiana Plan, or HIP 2.0, has enrolled about 190,000 more people into health coverage.

Caitlin Priest, director of public policy at Covering Kids & Families of Indiana, says the plan has helped many people get health insurance for the first time in their lives.

"It's really been a wonderful way to move the needle both on healthcare access and ultimately on long-term health outcomes," Priest says.

Pence took criticism from the right for accepting a component of Obamacare, but his conservative tweaks to Medicaid have other Republican-led states looking at that model.

HIV Outbreak

Pence drew criticism from local and national infectious disease experts for his response to an urgent health crisis in Indiana. In February of 2015, the state reported an outbreak of HIV in Scott County, blamed on opioid addiction and needle sharing.

It got so bad — growing to more than 80 cases in the month after the announcement, and more than 190 to date — that the CDC went to Indiana to investigate, and public health experts began calling for a needle exchange. At the time, syringe exchanges were illegal in the state, and Pence was opposed to changing that, at first.

He later signed an emergency declaration allowing Scott County to start a needle exchange program. Rather than legalize such exchanges statewide, Pence signed a bill that forces counties to ask permission to start a needle exchange.

Only a few counties have done it, so far, because the process takes a lot of planning, local support and money, which the state doesn't provide, says Carrie Lawrence, a researcher with the Rural Center for AIDS/STD Prevention.

"If you're the health department with only two part-time staff, and a full-time health director, who's going to do this, and when is it going to happen?" Lawrence says.

Public Health Budgets

The HIV crisis also brought some attention to Indiana's lack of public health funding in general, Lawrence says.

"I think we are dealing with the consequences of the fact that that we don't have a strong infrastructure for public health in the state," she says.

Politics Meet Mike Pence, 'Midwestern Polite' With An Unrelenting Conservative Message

As governor, Pence signed legislation that cut Indiana's budget for public health programs, despite the state's many pressing public health problems. Indiana has a high smoking rate, high obesity rate, and high infant mortality rate. The state is ranked nearly last for both federal and state public health funding. According to Trust for America's Health, Indiana spends just $12.40 per resident on public health. West Virginia, in contrast, spends more than $220.

As a member of Congress from 2001 to 2013, Pence voted against funding for health programs such as the State Children's Health Insurance Program and the Prevention and Public Health Fund.

Abortion Access

As a congressman, Pence was an early advocate for defunding Planned Parenthood, and this year, women's health advocates have clashed with him again.

In March, the governor signed a bill that's been cited as one of the most restrictive in the U.S., barring abortion on the basis of disability, gender or race of the fetus. It also requires women to get an ultrasound at least 18 hours before the procedure, and requires that the fetal remains be buried or cremated.

NPR Ed What Did Mike Pence Do For Indiana Schools As Governor? Here's A Look

Some Indiana women responded by updating the governor's office with (sometimes graphic) news on their menstrual cycles by phone and on social media with the hashtag #periodsforpence. The social media backlash mirrors #periodsarenotaninsult, which took aim at Donald Trump last year.

The Indiana ACLU brought a lawsuit against the state's abortion restrictions — and a judge has since blocked portions of that law. "What the state of Indiana has attempted to do here ... grossly flies in the face of existing law," says ACLU attorney Ken Falk.

This story is part of NPR's reporting partnership with Side Effects Public Media and Kaiser Health News. For more on Pence, check out this profile by NPR's Nina Totenberg, and a review of his record on education.

Copyright 2016 WFYI-FM. To see more, visit WFYI-FM.
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Rehab Hospitals May Harm A Third Of Patients, Report Finds

NPR Health Blog - Thu, 07/21/2016 - 12:02am

The physical therapy workouts a rehabilitation facility offers can be a crucial part of healing, doctors say. But a government study finds preventable harm — including bedsores and medication errors — occurring in some of those facilities, too.

Andersen Ross/Blend Images/Getty Images

Patients may go to rehabilitation hospitals to recover from a stroke, injury or recent surgery. But sometimes the care makes things worse.

In a government report published Thursday, 29 percent of patients in rehab facilities suffered a medication error, bedsore, infection or some other type of harm as a result of the care they received.

Doctors who reviewed Medicare cases from a broad sampling of rehab facilities say that almost half of the 158 incidents they spotted among 417 patients were clearly or likely preventable.

"This is the latest study over a long time period now that says we still have high rates of harm," says Dr. David Classen, an infectious disease specialist at the University of Utah School of Medicine who developed the analytic tool used in the report to identify the harm to patients.

"We're fooling ourselves if we say we have made improvement," Classen says. "If the first rule of health care is 'Do no harm,' then we're failing."

The oversight study, from the office of the inspector general of the U.S. Department of Health and Human Services, focused on rehabilitation facilities that were not associated with hospitals. Rehab facilities generally require that patients be able to undergo at least three hours of physical and occupational therapy per day, five days a week. Patients at these facilities are presumed to be healthier than patients in a more typical hospital or a nursing home.

Still, the findings echoed those of previous studies that found that more than a quarter of patients in hospitals and a third in skilled nursing facilities suffered harm related to their care.

"It's important to acknowledge that harm can occur in any type of inpatient setting," says Amy Ashcraft, a team leader for the rehabilitation hospital study. "This is one of the settings that's most likely to be underestimated in terms of what type of harm can occur."

For the purposes of the study, doctors and nurses identified harm by reviewing the medical records of 417 randomly selected Medicare patients who stayed in U.S. rehabilitation facilities in March 2012. The events they identified varied in severity, ranging from a temporary injury to something that required a longer stay at the facility or that led to permanent disability or death.

Almost a quarter of the harmed patients had to be admitted to an acute care hospital, at a cost of about $7.7 million for the month analyzed, the study shows.

The physicians who reviewed the cases for the OIG say substandard treatment, inadequate monitoring, and failure to provide needed care caused most of the harm. Almost half the cases, 46 percent, were related to medication errors and included bleeding from gastric ulcers due to blood thinners and a loss of consciousness linked to narcotic painkillers.

That high number indicates there's lots of room for improvement, says Dr. Eric Thomas, director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety.

"We know a lot about preventing medication errors," Thomas says.

An additional 40 percent of the cases in which patients were harmed were traced to lapses in routine monitoring that led to bedsores, constipation or falls. These problems almost never contributed to a patient's death but could mean extra days or weeks of recovery, a loss of independence or permanent disability, says Lisa McGiffert, director of the Consumers Union Safe Patient Project.

"It is a domino effect for any person who has had an adverse event," says McGiffert, who was not involved in the study.

The inspector general is recommending that Medicare and the Agency for Healthcare Research and Quality work together to reduce harm to patients by creating a list of adverse events that occur in rehab hospitals. In their responses to the report, the agencies have pledged to follow that suggestion.

Officials from the American Medical Rehabilitation Providers Association, the trade group that represents rehab facilities, say they have not yet seen the report and decline to comment for now.

Updated July 25, 2016: The American Medical Rehabilitation Providers Association issued a statement late Friday, saying they welcome any study that shows opportunities to improve care. The rehab industry has made improvements to reduce medical errors since 2012 (the time frame studied by the inspector general's office), according to the statement, and remains dedicated to providing high quality care. But the facilities still face pressure to speed up the pace of care and "press patients into less expensive settings," which is counter to the "need to take time to do things right the first time," the trade group said.

ProPublica is interested in hearing from patients who have been harmed while undergoing medical care, through its Patient Harm Questionnaire and Patient Safety Facebook Group.

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

Montana's 'Pain Refugees' Leave State To Get Prescribed Opioids

NPR Health Blog - Wed, 07/20/2016 - 4:13pm

Kathy Snook, Terri Anderson and Gary Snook traveled from Montana to Dr. Forest Tennant's office in West Covina, Calif.

Corin Cates-Carney/Montana Public Radio

Federal authorities say about 78 Americans die every day from opioid overdose. In Montana, health care officials report that abuse there is worse than the national average. But the casualties of the opioid epidemic are not all drug abusers.

On a recent night, three Montana residents, who call themselves pain refugees, are boarding an airplane from Missoula to Los Angeles. They say that finding doctors willing to treat chronic pain in Montana is almost impossible, and the only way they can get relief is to fly out of state.

Before Gary Snook drops into his seat, he pauses in the aisle, pressing his fingertips into his upper thigh. He bends his knees slightly and moves his hips side to side. He's getting in one final stretch before takeoff.

"My pain, it's all from my waist down," he says. "It's like being boiled in oil 24 hours a day." Snook has been taking opioids since he had spine surgery for a ruptured disk 14 years ago. After the operation, he says he was in so much pain he couldn't work. He's tried all kinds of things to get better.

"I got a surgery, epidural steroid injections, acupuncture, anti-inflammatories, physical therapy, pool exercises," he says. "I've tried anything that anyone has ever suggested me to try. Unfortunately what I do right now is the only thing that works."

Snook says though he might seem desperate like someone who is addicted to pain killers, he's not. He's not craving a quick fix. He leaves his home for treatment because he has no confidence in the doctors in Montana and he wants to be healed.

"I believe pain control is a fundamental human right, or at least an attempt at pain control," he says. "To deny someone with a horrible disease like me access to pain medications is the worst form of cruelty."

It's dark outside when Snook, his wife and the two other pain patients get off the plane in Los Angeles. They wheel their suitcases to a rented SUV. When they get to the hotel, they smile and greet the lobby clerk by name.

The trip has become routine. Every 90 days, they come here to see a doctor who gives them the care and prescriptions they say they can't get at home.

Fear Among Montana Doctors

Montana is a tough state to find many options for any medical care. Because much of the state is rural, residents often travel long distances, including out of state, for specialty care.

In the past several years, the Montana Board of Medical Examiners has taken on several high-profile cases of doctors it suspects of overprescribing opioids. At least two Montana doctors have had their licenses suspended since 2014.

Executive Director Ian Marquand says his organization doesn't play favorites. "The board does not encourage particular kinds of doctors, it does not discourage particular kinds of doctors. The door is open in Montana for any qualified, competent physician to come in and practice."

But Marc Mentel acknowledges that there's fear around prescription painkillers in Montana's medical community. He chairs the Montana Medical Association's committee on prescription drug abuse, and he says he does hear of doctors being more wary.

Mentel, who started practicing medicine in the 1990s, says that when he was training, medical education didn't include treating long-term pain.

"The perfect tool, the perfect medicine that would take away a person's pain and allow them to function normally does not yet exist," he says. "So we are trying to use any tool, any means we can to help lessen the severity of their pain."

Mentel says opioids do help some patients, but he hopes his generation of doctors will learn more about pain and understand ways to treat it beyond opioids.

In March, the Centers for Disease Control and Prevention published long-awaited guidelines that said opioids should be the treatment of last resort for pain, and if used should be combined with other treatments such as exercise therapy.

"Patients are in pain," Mentel says. "We don't have great tools for them and we need to recognize that this is going to be a chronic-disease state. They may be in pain for the rest of their lives. So ... how do we treat them without actually harming them?" he says.

The California Solution

For Snook, relief is found at a small strip-mall clinic in suburban Los Angeles.

Tennant says that doctors need to specialize in pain management to reduce the risk of improperly prescribing opioids.

Corin Cates-Carney/Montana Public Radio

Dr. Forest Tennant is a former Army physician who says he has consulted for the National Institute on Drug Abuse, the National Football League and NASCAR.

He has about 150 patients, half of them from out-of-state.

Tennant says there are legitimate reasons to be concerned about opioids, and that's why doctors need to specialize in pain management.

To an untrained physician, Tennant says, addicts and pain patients can look similar. "Doctors can get conned," he says. "I think that it is true that we've had a lot of opioids that get out on the street, and people get them ... whether it is heroin or a prescription opioid."

But opioids can also help people, Tennant says. Because of that, he says, the drugs shouldn't be stigmatized, but used responsibly.

"They are the last resort, when there is no other option. You don't use them until everything else has failed," he says.

Tennant is lobbying for a Montana bill to guarantee more access to opioids for pain patients, so people like Snook don't need to travel so far for a prescription.

"Had I stayed in Montana, I would have killed myself," says Snook. "I just want humanitarian care, and I get that in California."

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

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

Taking The Battle Against Lyme Disease Ticks To The Backyard

NPR Health Blog - Wed, 07/20/2016 - 1:05pm

Scientists have tried all sorts of strategies for stopping the blacklegged tick, the carrier of Lyme disease, from biting us.

Lyme disease is a bacterial infection that affects an estimated 300,000 people in the United States each year, primarily in the Northeast and upper Midwest.

Stopping the tick bite in the first place is key to limiting Lyme disease.

"I spend a lot of time counseling people on tick bite avoidance," says Dr. Anne Norris, an infectious disease specialist at the University of Pennsylvania Perelman School of Medicine. "Right now prevention techniques are all we have. We don't have an effective vaccine."

You're probably familiar with tick-avoidance practices like wearing long pants, using bug sprays that contain DEET and treating clothing with permethrin, an insecticide.

But researchers have tested more strategies for keeping ticks away from us. Many more.

In a review paper published Wednesday in the Journal of Medical Entomology, scientists Lars Eisen and Marc Dolan of the Centers for Disease Control and Prevention analyze the past 30 years of evidence for techniques to prevent blacklegged tick bites. They focus on studies that looked at preventing nymph bites (as opposed to bites from ticks in the larva or adult stages) because nymphs, which are active from May through July, are the most likely to spread Lyme.

Many of the strategies are designed to limit exposure by reducing the number of ticks in backyards, or at least the part of backyards more likely to be used by humans. They include:

Create a barrier. Ticks love to hang out in the area where a lawn meets the woods. If you have a wooded edge on your property, you may want to consider removing this habitat by creating an artificial border about a yard wide between the woods and lawn. Scientists have tried making borders out of everything from crushed stone and wood chips to sand and sawdust. More research is needed — none of these materials stopped ticks in their tracks entirely — but sawdust from the Alaska yellow cedar seemed to be the most promising option.

Spray pyrethrin insecticides. Studies have shown that treating wooded areas with sprays made from pyrethrins, compounds found in chrysanthemum plants, can dramatically reduce the number of blacklegged ticks. But the effect wears off within a few weeks, so homeowners who want to try this strategy would have to reapply regularly. And the spray can kill beneficial insects like honeybees, too. Pyrethrins typically don't harm people or other mammals, but they can cause some irritation if touched or inhaled.

Put a robot on the job. OK, you can't actually hire a robot to remove ticks from your yard this summer, but you may be able to someday. Scientists have designed a robot to control tick populations. Dubbed the TickBot, this four-wheeled robot collects and kills ticks by dragging a permethrin-treated cloth. Early testing looks promising, but scientists haven't yet tested the robot on the blacklegged tick or looked at its long-lasting effects on tick abundance.

Help the mice help you. Rodents are one of the main carriers of Borrelia burgdorferi, the bacterium that causes Lyme disease. Ticks often pass the bacterium on to us after picking it up from rodent hosts, especially the white-footed mouse. If we could find a way to prevent mice from picking up ticks, we might be able to limit our own exposure to the disease. Enter the Damminix Tick Tubes. These are cardboard tubes filled with cotton balls treated with permethrin. Homeowners place the tubes in their yards and then mice use the cotton balls to build nests. The goal is for the permethrin to kill the ticks on the mice.

In some residential settings, tick tubes have proved to be highly effective at freeing white-footed mice from tick infestations. But in many cases, overall tick abundance in a treated area has remained high, possibly because the ticks survived on other vectors such as voles, shrews and squirrels.

Fence out the deer. Blacklegged ticks can't contract the bacterium that causes Lyme disease from deer, but the adult ticks do feed and reproduce on them. So reduce the number of deer in an area and you will likely reduce the number of ticks. Homeowners can consider using deer fencing to eliminate deer from their yards. Studies have shown that deer fencing can significantly reduce tick numbers, but this tactic typically only works for properties larger than 7 acres.

None of these methods is a "silver bullet," says review author Eisen. "It's looking more and more likely that there is no single method that will be sufficient to substantially reduce Lyme disease in the absence of a human vaccine."

Kirby Stafford, chief entomologist for the Connecticut Agricultural Experiment Station, agrees with Eisen's conclusion. "No one single tool other than waving a magic wand and making all the deer disappear will bring [tick] numbers down to a point where people aren't being infected," he says.

Eisen and Stafford both say that scientists now need to focus on testing combinations of tick-prevention techniques to find out which integrated approaches work best.

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

Florida Officials Probe Zika Case That May Not Be Related To Travel

NPR Health Blog - Wed, 07/20/2016 - 11:41am

A Broward County, Fla., employee takes water samples in a yard to test for mosquito larvae in June. It's part of the county's mosquito control program.

Lynne Sladky/AP

Health officials are investigating a Zika virus infection in Florida that could be the first case in which someone caught the virus by being bitten by a mosquito in the United States.

In a statement posted on its website Tuesday, the Florida Department of Health says the "possible non-travel related case of Zika" occurred in Miami-Dade County.

That means it's possible that the infected person did not catch the virus while traveling in another country where the virus is spreading. Rather, the infection might have been acquired from an infected mosquito.

But there's also the possibility that the Florida case may have occurred another way, such as sexual contact.

The statement does not mention sexual transmission, and officials did not provide any additional information in response to a request from Shots.

"We do not have additional information to share at this time," Brad Dalton, deputy press secretary in the department's office of communications, said in an email. He added that the investigation is ongoing.

The federal Centers for Disease Control and Prevention said in an email that the agency "has been informed" of the case and is "closely coordinating" with Florida officials in the investigation.

Health authorities have been expecting that Zika could eventually spread by mosquitoes in parts of the United States. But they have repeatedly said they are confident they could prevent any large outbreaks from occurring.

More than 1,300 cases of Zika have been reported in the continental United States and Hawaii. None of them, so far, has been linked to a mosquito bite in this country. Most have been among travelers returning from countries where the virus is spreading. At least 14 are believed to have arisen after sexual contact with someone who was infected outside the continental U.S.

Zika can cause serious birth defects when pregnant women get infected, and can cause neurological complications in adults in rare cases.

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

Anti-Abortion Groups Take New Aim With Diverse Strategies

NPR Health Blog - Wed, 07/20/2016 - 5:00am

An anti-abortion demonstrator outside the U.S. Supreme Court in Washington, D.C., in March. Last month the high court struck down a Texas law that imposed tight regulations on abortion providers.

Andrew Harrer/Bloomberg via Getty Images

Delegates at the Republican convention in Cleveland have approved the strongest anti-abortion platform in the party's history. But groups that oppose abortion — groups that lobbied for the strong language — are far from unified.

In fact, following last month's Supreme Court decision reaffirming a woman's right to abortion, leaders of a movement known for speaking largely with one voice are showing some surprising disagreement.

For the past several years, anti-abortion groups have pushed an agenda aimed at imposing much stricter regulation on abortion facilities. The groups said it was to promote the health and safety of women; abortion-rights supporters said it was an effort to regulate the clinics out of existence.

At least for now, the Supreme Court is siding with abortion-rights backers. Neither of the portions of Texas' omnibus abortion law that were up for review "offers medical benefits sufficient to justify the burdens upon access that each imposes," wrote Justice Stephen Breyer in the court's majority opinion.

The provisions that were struck down required abortion clinics in the state to meet the much higher safety standards for facilities that do much more advanced surgical procedures; the provisions also required doctors who perform abortions to have admitting privileges at a hospital within 30 miles of the clinic.

In hindsight, "maybe it was a mistake for us to champion safeguards for women," said Marjorie Dannenfelser, president of the Susan B. Anthony List, whose goal is to elect more anti-abortion candidates to public office. "Maybe we shouldn't have done that."

At a media briefing last week, Dannenfelser said her group will instead rally around legislation that has passed in more than a dozen states to ban abortion at roughly 20 weeks of pregnancy.

Similar legislation passed the U.S. House but not the Senate.

The 20-week ban is "our top priority," Dannenfelser said.

But Clarke Forsythe, acting president and senior counsel for Americans United for Life, said his group plans no fundamental change in strategy.

"It is more important than ever to focus on the risks to women and negative consequences," he said in an interview. "The justices can't sweep away the public health vacuum that they created with a few pen strokes."

Forsythe said that while the high court's ruling has "put some roadblocks in the way, and we will have to take those into consideration," there are still plenty of opportunities to regulate abortion providers that could pass constitutional muster, particularly if they are more narrowly targeted than the Texas law was.

The nation's oldest anti-abortion group, the National Right to Life Committee, has never embraced the push for health and safety regulations aimed at women.

"Our focus has always been on the humanity of the unborn," said its president, Carol Tobias, rather than potential risks to women seeking abortions.

Her group has instead been pushing state and federal bills to ban abortions after 20 weeks and also ban "dilation and evacuation" abortions, which are the most common procedure performed after the first trimester of pregnancy.

"I don't think the Texas decision is necessarily going to impact those types of legislation, and I know it's not going to affect us," she said.

But there is one thing all these anti-abortion groups seem to agree on: The future makeup of the Supreme Court — and the future of abortion rights — hang in the balance with the upcoming election.

Because of the vacancy left by the death of Justice Antonin Scalia last winter, "it is so obvious, so simple to make the case" about the importance of who controls the White House and Senate when it comes to Supreme Court appointments, said Dannenfelser.

"We say the court's always important," said Tobias. "But this time we have solid proof."

The groups also agree on something else — that despite the recent decision by the Supreme Court, abortion-rights forces are not winning the fight.

"The pro-life cause has never been stronger," said Dannenfelser. "And our opponents' position has never been weaker."

Immediately after the court's ruling, said Tobias, "Planned Parenthood came out and said they were going to pass pro-abortion legislation and repeal pro-life legislation."

That is true. "Today's victory means we can fight state by state, legislature by legislature, law by law, and restore women's access to reproductive health care," Dawn Laguens, executive vice president of the Planned Parenthood Action Fund, said in a written statement.

But in fact, Tobias said, "they haven't been able to do that in 40 years. The only way they make advances is through the courts. They don't have the people" on their side.

In an interview, Laguens agreed that her side has more work to do. "We've got to change hearts and minds," she said. But Laguens insists it is abortion opponents who are "out of sync with America and out of sync with the new generation."

With a more "social justice minded" generation of millennials now coming of age, she said, foes of abortion are the ones on the defensive. "They're in a last-gasp moment," she said. "They feel it slipping away."

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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

Maryland Switches Opioid Treatments, And Some Patients Cry Foul

NPR Health Blog - Tue, 07/19/2016 - 3:20pm
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July 19, 20163:20 PM ET Heard on All Things Considered

A demonstration dose of Suboxone film, which is placed under the tongue. It is used to treat opioid addiction.

M. Spencer Green/AP

Maryland Medicaid officials have made what appears to be a small change to the list of preferred medications to treat opioid addictions. The agency used to pay for the drug in a dissolvable film form. Now it's steering patients to tablets, which some doctors say are not as effective for their patients.

Those doctors say the change is having a profound effect on some people struggling to stay clean.

Starting on July 1, Maryland's Medicaid program removed Suboxone film — a drug that can be used by people addicted to opioids to keep their cravings at bay — from the state's list of preferred drugs and replaced it with a tablet form of the medication called Zubsolv.

State officials say the change was made to stop the illicit flow of the drug into jails and prisons.

"Those Suboxone strips were diverted and smuggled into jails and later were sold or traded in criminal activity that was happening in jails," says Shannon McMahon, deputy secretary of Maryland's Department of Health and Mental Hygiene. "The numbers were frankly staggering, the amount of diversion that was happening in the jails."

So far this year more than 2,300 hits of Suboxone have been seized in Maryland jails and prisons, according to Gerald Shields of the state's Department of Public Safety and Correctional Services. That's about 40 percent more than at this time last year, Shields says.

The drug helps people control their opioid habit. But it is also an opioid itself. It doesn't produce a high as strong as many opioid painkillers that have turned into popular street drugs, but it does stave off cravings and can create a mild sense of euphoria.

It comes as a tiny, dissolvable film — about the size of a Listerine breath mint strip — that's transparent and easy to hide.

"They have been cut up into multiple different pieces," McMahon tells Shots. A single strip can be worth as much as $50 on the street and they are often divided into several "hits" that are sold individually, she says.

"They were coming into prisons through letters — backs of stamps, corners of folks' eyeglasses," she says. McMahon says the strips were causing problems in prisons because of illegal sales and trade.

So at the recommendation of the Department of Corrections, along with a panel that advises the state's Medicaid program on medications, officials decided to replace the Suboxone strip with Zubsolv, made by a Swedish company called Orexo AB.

The choice is raising eyebrows because Maryland's health secretary Van Mitchell used to work for Manis Canning & Associates, the lobbying firm that represents Orexo. Mitchell's spokeswoman says he left the firm before Orexo became a client.

Mitchell and Steven T. Moyer, Maryland's secretary of Public Safety and Correctional Services, argued in an article in the Baltimore Sun that the change would save lives. They said Maryland's correctional system, since 2010, "has seen 13 fatal overdoses." However, a spokeswoman for the state's health department acknowledged that those were overdoses on opioids in general, and not specifically overdoses on Suboxone film.

Doctors say Suboxone film, as well as the Zubsolv pill that replaces it, actually protect against overdoses because they contain both the opioid Buprenorphine and a drug called naloxone that reverses the effects of an overdose. Naloxone is used by emergency responders to revive people who overdose.

The change has drawn broad opposition from doctors who treat people with substance abuse problems and from advocates for people who are recovering from addictions. Those include the Behavioral Health System of Baltimore, a nonprofit that oversees the city's behavioral health system, and the Maryland Association for the Treatment of Opioid Dependence.

The change has wreaked havoc on some people with substance abuse problems who, until a few days ago used Suboxone film, says Adrienne Breidenstine, vice president for policy and communications at the Behavioral Health System of Baltimore.

One of them is Nicole, a mother of two who has been in recovery for about eight years. Nicole became addicted to painkillers after she was injured in a car accident. She was stable on Suboxone strips but switched to Zubsolv 10 days ago. She asked NPR not to use her full name because her history of addiction is not common knowledge.

"When I got on Suboxone I didn't even have custody of my son," she says. "After I got clean, I got put on Suboxone. I've got both my kids now, we have our own house, I'm working, they're doing good in school, I finished school, and that's why it's so scary to me that they completely switched me over."

Since the change, she says, she's been feeling sick, having trouble sleeping, having cravings and symptoms of withdrawal.

"It hasn't been working for me," she says. "I don't know what I'm going to do if they don't cover it again. I just don't want to go back to that life and I don't want my kids to go there."

Nicole's doctor, Michael Fingerhood, has a primary care practice at Johns Hopkins Bayview Medical Center in Baltimore. His practice, which overlooks downtown Baltimore from across the water, welcomes people with substance abuse problems. The group treats about 450 patients who, until this month, were using Suboxone strips.

He says just two weeks into the change many of his patients, like Nicole, are struggling.

"This is taking patients who are stable, who are doing really well, and saying we're going to do something to disturb how well you're doing," he tells Shots.

Fingerhood says Zubsolv is supposed to be the equivalent of Suboxone. But not all patients react the same to different medications. Many, like Nicole, have been clean for years and for the first time, they're feeling sick again and some, he says, are in real danger.

Feeling even the slightest bit of withdrawal symptoms can be awful for someone in recovery, he says.

"In the midst of addiction people are searching for a high, they're having withdrawal, they're running the streets. Their lives were horrible," Fingerhood says. "Having withdrawal brings back all those memories of how terrible life had been and it's a terrible feeling to be in withdrawal."

Shaking up all the Suboxone patients across the state to keep a relatively safe drug away from a handful of inmates doesn't make sense, Fingerhood says. And the numbers are indeed pretty small.

If those 2,300 Suboxone hits seized in prison were whole strips — and prison officials say they weren't — that's still only the equivalent of about 10 prescriptions from January through last week.

Instead, Fingerhood says, "We should be providing treatment in the prison system."

He says if someone who was on Suboxone gets arrested, it makes sense that family members or friends would try to get them the drugs in prison.

The only place in Maryland that inmates can legally get any medication to help get or keep them off opioids is in the Baltimore City Jail, according to Shields, the Department of Corrections spokesman. He says the system provides methadone to some inmates to help wean them off opioids before moving them to another prison.

State officials say Medicaid patients can still get Suboxone if they really need it. Doctors just fill out a form requesting a waiver, known as a prior authorization, and get an answer the next day.

Fingerhood made that request for Nicole. Five days later, he still had no response.

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

Covered California's Health Plan Rates To Jump Sharply In 2017

NPR Health Blog - Tue, 07/19/2016 - 2:24pm

Peter Lee, executive director of Covered California, the state's health insurance exchange, said the projected rate increases for 2017 are linked to increases in the cost of health care in the state.

Rich Pedroncelli/AP

California's Obamacare premiums will jump 13.2 percent on average next year, a sharp increase that is likely to reverberate nationwide in an election year.

The increase, announced by the Covered California exchange Tuesday, ends the state's two-year respite from double-digit rate hikes.

The announcement comes as the presidential candidates clash over the future of President Obama's landmark health law and as major insurers around the country seek to announce even bigger rate increases during the open enrollment period this fall.

California won plaudits by negotiating rate increases for its 1.4 million enrollees that averaged 4 percent in the past two years. But that feat couldn't be repeated for 2017, as overall medical costs continue to climb and two federal programs that help insurers with expensive claims are set to expire.

Health policy experts said California is rejoining the pack after keeping rate increases lower than much of the country during the first years of Obamacare.

Critics of the health law, including Republican presidential candidate Donald Trump, have been quick to seize on these rising costs as further proof that the Affordable Care Act warrants repeal for failing the average consumer.

The Obama administration counters that federal subsidies spare most consumers from the full impact of the premium increases and says the health law enables people to shop around for a better deal.

Last week, consulting firm Avalere Health found that the average rate increase being sought for widely sold silver plans on the state and federal health insurance exchanges was 11 percent across 14 states. But consumers could limit the increase by choosing one of the lower-cost silver plans, which are set to go up only 8 percent.

These rate increases apply to people who purchase their own coverage in the individual market, not to the majority of Americans, who get their health insurance through work or government programs such as Medicare and Medicaid.

Peter Lee, executive director of Covered California, said prices for 2017 reflect the rising cost of care, not efforts by insurers to increase their profits.

"Under the new rules of the Affordable Care Act, insurers face strict limits on the amount of profit they can make selling health insurance," Lee said. "We can be confident their rate increases are directly linked to health care costs, not administration or profit, which averaged 1.5 percent across our contracted plans."

Two federal programs that have helped health insurers offset costly medical claims, and cover sick patients in general, are set to end this year. They were intended as a temporary cushion for insurers, who are now required to accept all applicants regardless of their medical histories.

Health insurers and Covered California said rate increases also reflect the ever-increasing cost of care, particularly for expensive specialty drugs.

"The rising trend of health-care costs remains a constant driving factor in health-care premiums," Lee said.

Insurers also have complained about lax rules for special enrollment outside the designated sign-up period. The loose rules have allowed some people to game the system by waiting until they need care to enroll, insurers say, and those people tend to generate more claims and higher costs. Federal and state officials say they have tightened the rules to address these complaints.

To press their case for higher rates, health insurers said they had the benefit of detailed data on exchange customers and their medical claims for the first time since these marketplaces opened in 2014.

Many consumer advocates in California had hoped that UnitedHealth Group Inc. would become another formidable competitor on the state-run insurance exchange. But the nation's largest health insurer is leaving Covered California after just one year of minimal participation — part of a broader pullback nationwide after the company posted heavy losses on individual plans.

The top four insurers in Covered California, led by Blue Shield of California and Anthem Inc., control more than 90 percent of enrollment.

The premium increases in California will vary widely by region and by insurance company and could pinch the pocketbooks of cost-conscious consumers like David Arnson.

Arnson, 57, of Los Angeles, qualifies for a federal subsidy and pays just $32 each month for a Molina Healthcare policy he purchased through Covered California. He said he relies on the coverage to help pay for treatment for ankle and knee problems.

Arnson, who works at a record store and plays in a band, said he worries about his monthly premium increasing next year.

"I make a marginal living," he said. "Like anything, you want to pay as little as possible. I need health care — it is at the top of my pyramid of necessities."

The higher rates in California may spur more consumers to switch health plans. Only 14 percent of Covered California enrollees who returned this year chose a different insurer. On the federal exchange, 43 percent of people switched plans for 2016.

However, the proliferation of narrow networks can make shopping complicated since certain doctors and hospitals may only be available through one or two insurers, and provider directories are often inaccurate.

Since 2014, California has benefited from having a healthier mix of enrollees compared with other states. One reason for that is that state officials defied the Obama administration by requiring insurers participating in Covered California to cancel existing individual policies at the end of 2013.

That unpopular decision quickly moved people into coverage that fully complied with the health law and created one giant risk pool for rating purposes. Those previously insured customers were generally thought to be healthier because, before the switch, insurers could deny coverage to people with pre-existing conditions.

But that positive effect may be wearing off as people get sick over time or leave the individual market for coverage elsewhere, health care analysts say.

The expansion of coverage under the Affordable Care Act has driven the percentage of uninsured Californians to a record low.

The share of Californians lacking health insurance was 8.1 percent at the end of 2015, down from 17 percent in 2013, federal data show.

The expansion of Medi-Cal, the state's Medicaid program for lower-income residents, accounts for a significant part of that reduction. Since January 2014, nearly 5 million people have joined the Medi-Cal rolls, bringing total enrollment to 13.4 million — about a third of the state's population.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. This story was produced by KHN, which publishes California Healthline, a service of the California Health Care Foundation. Anna Gorman of KHN contributed to this report.

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

Microhospitals May Help Deliver Care In Underserved Areas

NPR Health Blog - Tue, 07/19/2016 - 11:41am

The SCL Health Community Hospital — Southwest opened in Denver in May. The microhospital offers emergency medical care, two operating rooms, radiology services and a laboratory.

Courtesy of Emerus and SCL Health

Eyeing fast-growing urban and suburban markets where demand for health care services is outstripping supply, some health care systems are opening tiny, full-service hospitals with comprehensive emergency services but often fewer than a dozen inpatient beds.

These "microhospitals" provide residents quicker access to emergency care, and they may also offer outpatient surgery, primary care and other services. They are generally affiliated with larger health care systems, which can use the smaller facility to expand in an area without incurring the cost of a full-scale hospital. So far, they are being developed primarily in a few states — Texas, Colorado, Nevada and Arizona.

"The big opportunity for these is for health systems that want to establish a strong foothold in a really attractive market," says Fred Bentley, a vice president at the Center for Payment & Delivery Innovation at Avalere Health, a consulting firm. "If you're an affluent consumer and you need services, they can fill a need."

The Denver microhospital has just eight inpatient beds.

Courtesy of Emerus and SCL Health

SCL Health, a hospital system with headquarters in Broomfield, Colo., has opened two microhospitals in the Denver metropolitan area and has another two in the works.

Microhospitals "are helping us deliver hospital services closer to home, and in a way that is more appropriately sized for the population compared to larger, more complex facilities," says spokesman Brian Newsome.

The concept is appealing, and some people suggest they should be developed in rural or medically underserved areas where the need for services is great.

Small hospitals, even tiny ones, with robust outpatient services could be a real boon for people who live far from major metro areas.

"Right now they seem to be popping up in large urban and suburban metro areas," says Priya Bathija, senior associate director for policy development at the American Hospital Association. However, "We really think they have the potential to help in vulnerable communities that have a lack of access."

Analysts liken microhospitals to standalone emergency departments, which have been cropping up in recent years in fast-growing metropolitan areas where people are often well-insured and waits at regular hospital emergency departments may be long. Both can handle many emergencies and are equipped with lab, imaging and some diagnostic capabilities.

However, patients facing serious emergencies, such as severe chest pain or major medical trauma, should call 911 and let trained medical personnel decide where best to seek treatment, says Bret Nicks, an associate professor of emergency medicine at Wake Forest Baptist Health.

Unlike standalone EDs, microhospitals are fully licensed hospitals with inpatient beds to accommodate people admitted from the emergency room. They may have other capabilities as well, including surgical suites, a labor and delivery room, and primary care or specialist services on site or nearby.

Dignity Health, a health care system with facilities in Nevada, Arizona and California, opened its first microhospital in the Phoenix area more than a year ago and will open another one there this year, says Peggy Sanborn, vice president of strategic growth, mergers and acquisitions. It also plans to open four microhospitals in the Las Vegas area and is exploring the model for California.

One of the advantages of a microhospital is that it can help connect patients with specialty and primary care physician networks, says Sanborn. In Las Vegas, for example, the microhospital design includes a second floor with separate specialty and primary care physician offices to which patients could be referred.

The growing interest in microhospitals can be linked to the shift toward providing more care in outpatient settings, says Bathija. In addition to the emergency department, the facilities can include medical home services and other outpatient services.

Between 2010 and 2014, the annual number of inpatient hospital admissions declined by more than 2 million to 33.1 million, according to figures from the American Hospital Association. Meanwhile, the total number of outpatient hospital visits increased to 693.1 million in 2014 from 651.4 million four years earlier.

Microhospitals offer an opportunity to "really ramp up outpatient services," Bathija says.

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

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

Twin Sisters Try To Get Pregnant With Ovaries They Froze In 2009

NPR Health Blog - Tue, 07/19/2016 - 4:43am
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July 19, 20164:43 AM ET Heard on Morning Edition

Ovarian tissue after the thaw — ready for reimplantation.

Courtesy of The Infertility Center of St. Louis

When Sarah Gardner was 34, she started getting worried about whether she'd ever have a baby. So she took a test that aims to measure a woman's fertility.

The results terrified her. They indicated she had the fertility of a woman a decade older — a woman in her mid-40s.

"I was devastated," Gardner says. The news hit her especially hard because she was in the midst of breaking up with her longtime boyfriend.

"I knew that being a mom was something I wanted in my life," she says. "And I knew that it would be very difficult to achieve that, given that I was about to be single. So, yeah, I was devastated."

In her hunt for a solution, Gardner eventually found Dr. Sherman Silber, a surgeon who runs the Infertility Center of St. Louis. As Shots reported in 2012, when we first met Gardner and her doctor, Silber does something controversial among infertility specialists — he removes and freezes the ovaries of healthy women to put their biological clocks on hold.

The idea is that the ovaries can then be thawed and returned to the women via surgery when they're ready to try to have children.

Joanne Gardner (left) and Sarah Gardner each had an ovary removed and frozen when they were in their 30s. Now 44, the women had the ovaries reimplanted in June.

Courtesy of Joanne Gardner; Courtesy of Sarah Gardner

Gardner, who lives in Australia, discussed that option with her twin sister, Joanne, who lives in London. Joanne was also worried about running out of time to have kids. So both sisters decided to undergo the procedure, as a hedge against their dwindling fertility odds.

"What it gave us was huge amounts of relief," Sarah Gardner says. "It really just took a huge weight off us."

Today the Gardner twins are 44; Sarah just got engaged and wants to finally try to have a baby. She and Joanne both returned to St. Louis in June to get their ovaries reimplanted.

"It's weird," Sarah Gardner says. "It's like we went in a time machine — a fertility time machine. It's amazing."

Not only do the sisters hope their reimplanted ovaries will help them get pregnant, they are also hoping the procedure will reverse their menopause.

"I'm really excited," Sarah says. "It will be really nice to not have another hot flash."

The approach was originally developed for women who are being treated for cancer and hope to preserve their fertility but don't have time to freeze their eggs. Some cancer treatments can destroy fertility.

Although removing ovarian tissue (or an entire ovary) and preserving it, then reimplanting it years later has produced promising results for such women, it remains far from clear how often the multistep procedure works. It's still considered experimental. The Gardner sisters may be the first women without a history of cancer to have undergone it, according to Silber.

Egg freezing, on the other hand, has been studied more extensively. And many experts say egg freezing, with its far from certain success, is much safer than going through two surgical procedures to have an ovary removed and later reimplanted.

Dr. Glenn Schattman, an associate professor of reproductive medicine at the Weill Medical College of Cornell University, says recommending ovarian freezing for women who don't have cancer is "irresponsible."

But Silber says freezing, thawing and reimplanting an ovary is easier, more reliable and safer than egg freezing; typically, harvesting the ovary and reimplanting it can both be done on an outpatient basis, he says.

Moreover, when an entire ovary is frozen, women don't have to undergo the weeks of hormonal injections required to ripen the multiple eggs that are extracted when the eggs are to be frozen, Silber says. And the total cost of the procedure to remove, freeze, thaw and and reimplant and reattach an ovary — less than $3,000 — is much lower, he says, than the cost of going through several attempts to collect eggs for freezing.

"There are huge advantages to this," Silber says.

Meanwhile, the Gardner sisters are once again home in Australia and England. They're both waiting for their periods to start again and hope to be pregnant by the end of the year.

"Wouldn't that be nice?" Sarah Gardner says, adding that she and her sister realize that the doctors can't guarantee success.

"We're going to leave it up to the gods or the universe," she says, "and see what happens."

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

Twin Sisters Try To Get Pregnant With Ovaries They Froze In 2012

NPR Health Blog - Tue, 07/19/2016 - 4:43am
Twin Sisters Try To Get Pregnant With Ovaries They Froze In 2012 Listen · 3:51 3:51 Toggle more options
  • Download
  • Embed Embed "> <iframe src="https://www.npr.org/player/embed/485838529/486571640" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
July 19, 20164:43 AM ET Heard on Morning Edition

Ovarian tissue after the thaw — ready for reimplantation.

Courtesy of The Infertility Center of St. Louis

When Sarah Gardner was 34, she started getting worried about whether she'd ever have a baby. So she took a test that aims to measure a woman's fertility.

The results terrified her. They indicated she had the fertility of a woman a decade older — a woman in her mid-40s.

"I was devastated," Gardner says. The news hit her especially hard because she was in the midst of breaking up with her longtime boyfriend.

"I knew that being a mom was something I wanted in my life," she says. "And I knew that it would be very difficult to achieve that, given that I was about to be single. So, yeah, I was devastated."

In her hunt for a solution, Gardner eventually found Dr. Sherman Silber, a surgeon who runs the Infertility Center of St. Louis. As Shots reported in 2012, when we first met Gardner and her doctor, Silber does something controversial among infertility specialists — he removes and freezes the ovaries of healthy women to put their biological clocks on hold.

The idea is that the ovaries can then be thawed and returned to the women via surgery when they're ready to try to have children.

Joanne Gardner (left) and Sarah Gardner each had an ovary removed and frozen in 2012, when they were in their 30s. Now 44, the women had the ovaries reimplanted in June.

Courtesy of Joanne Gardner; Courtesy of Sarah Gardner

Gardner, who lives in Australia, discussed that option with her twin sister, Joanne, who lives in London. Joanne was also worried about running out of time to have kids. So both sisters decided to undergo the procedure, as a hedge against their dwindling fertility odds.

"What it gave us was huge amounts of relief," Sarah Gardner says. "It really just took a huge weight off us."

Today the Gardner twins are 44; Sarah just got engaged and wants to finally try to have a baby. She and Joanne both returned to St. Louis in June to get their ovaries reimplanted.

"It's weird," Sarah Gardner says. "It's like we went in a time machine — a fertility time machine. It's amazing."

Not only do the sisters hope their reimplanted ovaries will help them get pregnant, they are also hoping the procedure will reverse their menopause.

"I'm really excited," Sarah says. "It will be really nice to not have another hot flash."

The approach was originally developed for women who are being treated for cancer and hope to preserve their fertility but don't have time to freeze their eggs. Some cancer treatments can destroy fertility.

Although removing ovarian tissue (or an entire ovary) and preserving it, then reimplanting it years later has produced promising results for such women, it remains far from clear how often the multistep procedure works. It's still considered experimental. The Gardner sisters may be the first women without a history of cancer to have undergone it, according to Silber.

Egg freezing, on the other hand, has been studied more extensively. And many experts say egg freezing, with its far from certain success, is much safer than going through two surgical procedures to have an ovary removed and later reimplanted.

Dr. Glenn Schattman, an associate professor of reproductive medicine at the Weill Medical College of Cornell University, says recommending ovarian freezing for women who don't have cancer is "irresponsible."

But Silber says freezing, thawing and reimplanting an ovary is easier, more reliable and safer than egg freezing; typically, harvesting the ovary and reimplanting it can both be done on an outpatient basis, he says.

Moreover, when an entire ovary is frozen, women don't have to undergo the weeks of hormonal injections required to ripen the multiple eggs that are extracted when the eggs are to be frozen, Silber says. And the total cost of the procedure to remove, freeze, thaw and and reimplant and reattach an ovary — less than $3,000 — is much lower, he says, than the cost of going through several attempts to collect eggs for freezing.

"There are huge advantages to this," Silber says.

Meanwhile, the Gardner sisters are once again home in Australia and England. They're both waiting for their periods to start again and hope to be pregnant by the end of the year.

"Wouldn't that be nice?" Sarah Gardner says, adding that she and her sister realize that the doctors can't guarantee success.

"We're going to leave it up to the gods or the universe," she says, "and see what happens."

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

Got Dense Breasts? That Can Depend On Who Is Reading The Mammogram

NPR Health Blog - Mon, 07/18/2016 - 5:01pm

Breasts deemed "dense" in a mammogram tend to have less fatty tissue and more connective tissue, breast ducts and glands, doctors say. About 40 percent of women between the ages of 40 and 74 have dense breasts.

Lester Lefkowitz/Getty Images

If you're a woman who gets screening mammograms, you may have received a letter telling you that your scan was clear, but that you have dense breasts, a risk factor for breast cancer. About half of U.S. states require providers to notify women if they fall into that category.

But what you may not know is that gauging breast density isn't a clear-cut process. Researchers reporting in Annals of Internal Medicine Monday found that density assessments varied widely from one radiologist to another. That means you shouldn't let one finding freak you out too much, nor should you assume something's wrong if your reported density changes from year to year.

"Women and providers should keep in mind that density is a subjective measure," says Brian Sprague, a cancer epidemiologist at the University of Vermont and an author of the study. And, he says, breast density is only one factor contributing to a woman's individual risk of getting breast cancer.

Shots - Health News Letters Telling Women About Breast Density Are Often Too Darn Dense

About 40 percent of women between 40 and 74 years old have dense breasts — meaning they have more breast tissue (that is, ducts and glands) and connective tissue and less fatty tissue than women whose breasts aren't dense. You can't know your status by how the breasts feel; it only shows up on a mammogram.

Dense breasts make it harder for radiologists to detect possible abnormalities on a mammogram, and the presence of the tissue itself is an independent risk factor for breast cancer.

The researchers looked at 216,783 mammograms from more than 145,000 women, interpreted by 83 radiologists in Pennsylvania, Vermont, New Hampshire and Massachusetts. The average proportion of mammograms that fell into the "extremely dense" or "heterogeneously dense" categories was 38.7 percent. But the proportion of mammograms assigned to those two categories by individual radiologists ranged from 6.3 percent to 84.5 percent.

Even when adjusting for each patient's age, race and body mass index — since, after all, the patient population in Philadelphia isn't same as in rural Vermont — the variation continued, the authors say.

And among women who had consecutive mammograms read by different radiologists, 17.2 percent got different assessments of whether they fell into the dense or nondense category.

The findings aren't too surprising, says Dr. Priscilla Slanetz, a radiologist at Beth Israel Deaconess Medical Center. "There's agreement usually in the extremes, but a lot of variation in the middle," she says.

Shots - Health News Letters About Dense Breasts Can Lead To More Questions Than Answers

The guidelines for assessing density have also changed since the study was conducted, Slanetz points out, though it's not yet clear how that will affect the percentage of women assessed as having dense breasts.

At a policy level, the researchers say, the results mean that authors of state legislation requiring that women be notified of breast density — and in some cases, offered extra screening using other methods — need to be aware that this variation exists. If all women classified as having dense breasts are referred for an ultrasound based on that factor alone (as they are in some states), that could make for a lot of unnecessary tests and false positive results without an offsetting benefit.

Slanetz's advice for women is to use the density report as a jumping-off point for a broader discussion about their individual breast cancer risk. Authors of a large study published last year said that density alone shouldn't be the only criterion for getting extra screening. Nor should women whose breasts aren't dense assume that they have a low risk of breast cancer.

That personal discussion with a doctor or other health care provider should cover risk factors such as personal history of breast abnormalities and family history of breast cancer, as well as density, Slanetz says.

She also recommends that women with dense breasts seek out digital mammography, which improves detection of cancers.

Ultrasound, digital breast tomosynthesis and MRI have all been suggested as additional screening options for women with dense breasts. But the U.S. Preventive Services Task Force says there's not yet enough evidence to know whether they should be used for screening.

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

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