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Women Who Eat Fish Twice Weekly Cut Their Risk Of Hearing Loss

NPR Health Blog - Wed, 09/10/2014 - 3:48pm
Women Who Eat Fish Twice Weekly Cut Their Risk Of Hearing Loss September 10, 2014 3:48 PM ET

Researchers speculate that the Omega-3 fatty acids in fish may help maintain good blood flow to the inner ear.

iStockphoto

Are you finding it tougher to follow conversations in a noisy restaurant? Or does it seem like people are mumbling when you speak with them?

These are two questions commonly used to screen for hearing loss, which affects more than one-third of people over age 65, according to the National Institutes of Health.

So, what to do to cut the risk?

Women who eat fish regularly have a lower risk of developing hearing loss compared to women who rarely or never eat fish, according to a study published Wednesday in the American Journal of Clinical Nutrition.

Shots - Health News Here's Fish Oil In Your Eye

Women who ate two or more servings of fish per week had a 20 percent lower risk of hearing loss, according to Dr. Sharon Curhan, a researcher at Brigham and Women's Hospital and co-author of the study.

And though she and her colleagues had a hunch that certain types of fish may be more protective than others, it didn't turn out that way. "Eating any type of fish — whether it's tuna, dark fish [like salmon] or light fish was a associated with a lower risk," Curhan told Shots.

The omega-3 fatty acids found in fatty fish are linked to a range of health benefits, including cutting the risk of heart disease, depression and possibly, memory loss.

The Salt Eat Fish And Prosper?

"Omega-3 antioxidants, polyunsaturated fatty acids, and vitamin C have been the focus of a growing body of evidence showing potential hearing benefits," says Dr. Gordon Hughes, program director of clinical trials for the National Institute on Deafness and Other Communication Disorders, which funded the study.

The findings come by way of the Nurses' Health Study — yes, that huge, long-term research study that includes more than 100,000 nurses.

The nurses were aged 27 to 42 when they started completing detailed surveys about what they ate and drank. And they were also asked whether they had a hearing problem and, if so, at what age they first noticed it.

The blood flow to the inner ear needs to be very well-regulated and "higher fish consumption may help maintain adequate cochlear blood flow," Curhan says. This could help protect against hearing damage.

Curhan and her colleagues are not the only researchers to document a connection between fish consumption and hearing. In an Australian study of about 800 men and women, those who ate fish had a lower incidence of hearing loss

And it looks like lots of people have an opportunity for improvement. Curhan points out that only one-third of Americans eat fish once a week, and almost half eat fish only occasionally or not at all.

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

Heavier Teen Pot Smoking Linked To Problems In Young Adults

NPR Health Blog - Wed, 09/10/2014 - 12:00pm
Heavier Teen Pot Smoking Linked To Problems In Young Adults September 10, 201412:00 PM ET

Does smoking pot make it less likely that you'll go to college?

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There's a lot of argument over how teenage marijuana use might affect people through life, but distressingly little data to help figure it out. That leaves parents, policymakers and young people pretty much in the dark when it comes to making decisions about use and legalization.

Three long-running studies of teenagers and young adults in Australia and New Zealand might help. An analysis of the studies found a dose-response relationship: The more someone smoked pot as a teenager, the more likely that person would struggle as a young adult.

People who were daily marijuana smokers before age 17 were much more likely to have not completed high school or graduated from college than were those who never smoked; their odds were 63 percent and 62 percent lower. They were also much more likely to be dependent on marijuana and to be using other illegal drugs in adulthood. The risk of a suicide attempt also increased, though more modestly than the other factors.

13.7: Cosmos And Culture When Science Becomes News, The Facts Can Go Up In Smoke

Earlier studies also have found that marijuana use makes it less likely that students will succeed in school. But those findings, and all of these studies, look at correlation, not causation. And they are muddied by confounding factors, like the fact that adolescents living in low-income communities are more likely to use marijuana.

There will almost certainly never be a randomized controlled trial on teenage marijuana use, so observational studies, confounders and all, are what we've got. The studies used in this analysis are among the best: long-term studies with lots of participants that tracked their behavior and health in real time, rather than retrospectively. Altogether the studies followed 3,765 teenagers starting at age 13 until they reached age 30.

The researchers looked at two milestones in making the transition to adulthood: graduating from high school or college. They also looked at whether the young adults were dependent on marijuana; used other illicit drugs; had attempted suicide; were diagnosed with depression; or were dependent on welfare.

Shots - Health News Evidence On Marijuana's Health Effects Is Hazy At Best

Once the researchers used statistical analyses to adjust for confounding factors, they found that depression and welfare dependence were not associated with adolescent pot use. But the associations with completing school, drug use and suicide attempts remained strong. The likelihood of problems increased as smoking frequency increased, on a scale that ranged from less than monthly to daily.

The results were reported Wednesday in the journal The Lancet Psychiatry.

Earlier studies have found that heavy marijuana use in adolescence affects learning and memory, and that teenagers' thinking skills are more impaired than those of adults. But they didn't look at long-term effects.

"Youth is a very vulnerable period in life," Merete Nordentoft, a suicide prevention researcher at the University of Copenhagen, wrote in a commentary accompanying the study. It's a time when people are developing skills to meet the demands of adult life, she notes. "Cannabis use, especially frequent uses, impairs this development and reduces the likelihood that a young person will be able to establish a satisfactory adult life."

Shots - Health News Poll: Yes To Medical Marijuana, Not So Much For Recreational Pot

Surveys in the United States, including one poll conducted earlier this year by NPR, find that although almost half of people support legalization of marijuana, they overwhelmingly oppose legalization for teenagers. And half of our respondents also thought that there should be age restrictions on use of medical marijuana.

"The reason that people are concerned is that they recognize that this is an addictive substance, and some portion of the population that uses it will become addicted to it and have very bad outcomes," Dr. Sharon Levy, director of the adolescent substance abuse program at Boston Children's Hospital, told Shots in May. "As with all addictive products, the risk is greatest in adolescence."

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

Love And Sex In The Time Of Viagra — 16 Years On

NPR Health Blog - Tue, 09/09/2014 - 6:00pm
Love And Sex In The Time Of Viagra — 16 Years On September 09, 2014 6:00 PM ET Listen to the Story 4 min 45 sec  

Mountains of "little blue pills" and their chemical kin have transformed the way many people think about sex and aging.

Raphael Gaillarde/Gamma-Rapho/Getty Images

The lives of older men have changed in a significant way since 1998, or at least their sex lives have changed. That's the year Viagra was introduced. Cialis and Levitra followed a few years later.

The once taboo subject of erectile dysfunction is now inescapable for anyone who watches TV. Late-night comedians continually mine the topic. By 2002, Jay Leno had told 944 Viagra jokes, according to the Wall Street Journal. We couldn't independently verify that number. Actually, we didn't try.

The drugs have been pitched by former Sen. Bob Dole, Chicago Bears coach Mike Ditka and dozens of attractive, anonymous actors canoodling on sofas and lounging in bathtubs.

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A retired Marine Corps pilot named Mike — he asked us just to use his first name — says his own experience wasn't much different from the scenes on TV.

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"It was fantastic," he says.

Mike's been married for 47 years. He's been using either Viagra or Cialis for the past 10.

Movies In Quest For A Female Viagra, Many An Odd Twist

"I was having some 'issues,' " Mike explains. So he discussed the problem with his son, who's a doctor and suggested Mike try the drugs.

Mike's wife was all for it, too, and he says they've lived happily ever after. "I believe my wife and I became closer," he says, because a source of anxiety vanished from their relationship.

Before Viagra, relieving that anxiety required measures that could cause plenty of anxiety themselves, says Dr. Edward Schneider, a professor of gerontology, medicine and biology at the University of Southern California. They're "just medieval, these things," he says.

For example, there's the vacuum pump, "where you essentially cause an erection by creating a partial vacuum around the penis, drawing blood into the penis," Schneider explains. He's never tried it himself, he says, but "I imagine it's awful."

Schneider says other remedies on the market include a surgically implantable pump; a Viagra-like drug you can inject directly into the penis; and a little pill that can be inserted directly into the tip of the penis.

All these methods are still in use, explains Schneider, because some men can't take the oral medications. But the men who can take them have made Viagra, Cialis and Levitra wildly successful: The three drugs took in more than $2.5 billion last year.

Dr. Jacob Rajfer, a urologist at UCLA Medical School, says there's another reason the drugs are so profitable: Erectile dysfunction "happens to all men."

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Not all at once, but gradually over time, "such that men in their 40s have a 40 percent chance of having this problem," Rajfer says. "For every decade after 40, there's a 10 percent increase." That means that a man in his 70s would have a 70 percent chance of having a problem, at least once in a while.

Rajfer says this happens because after a man's prime reproductive years, smooth muscle — the type found within the walls of blood vessels and in the penis — starts to deteriorate. In fact years before Viagra hit the market, Rajfer helped identify nitric oxide as the chemical in the body that acts on smooth muscle and makes erections possible. Viagra-type drugs work by keeping nitric oxide from breaking down too quickly.

The drug is much more than the sum of its chemical parts — and its physiological effects, says a man named David, who also asked that we not use his last name. "It's something that gives that sense that intimacy can continue," he says. "You can feel less alone as a result."

David is 66 years old, a recently retired community college professor, and a widower. He's now in a new relationship.

"I was simply concerned at my age that I wasn't as capable as I wanted to be," he says. "And after I got the prescription I told her I had done that so that she would know.

And he says she was fine with it.

"Women have their own concerns as they age," says David. "She was also concerned about how we were going to be as older people making love."

With people living longer, David notes that he and the new woman in his life could spend 25 years together.

"I wanted to keep that intimacy as long as possible because I love this person and I expect to be with her for a long time," he says.

And now because of a little pill, being physically intimate with the woman he loves isn't something that will be lost to old age.

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

When Scientists Give Up

NPR Health Blog - Tue, 09/09/2014 - 4:27pm
When Scientists Give Up September 09, 2014 4:27 PM ET Listen to the Story 7 min 41 sec  

Randen Patterson left a research career in physiology at U.C. Davis when funding got too tight. He now owns a grocery store in Guinda, Calif.

Max Whittaker/Prime for NPR

Ian Glomski thought he was going to make a difference in the fight to protect people from deadly anthrax germs. He had done everything right — attended one top university, landed an assistant professorship at another.

But Glomski ran head-on into an unpleasant reality: These days, the scramble for money to conduct research has become stultifying.

So, he's giving up on science.

Ian Glomski outside his home in Charlottesville, Va. He quit an academic career in microbiology to start a liquor distillery.

Richard Harris/NPR

And he's not alone. Federal funding for biomedical research has declined by more than 20 percent in the past decade. There are far more scientists competing for grants than there is money to support them.

That crunch is forcing some people out of science altogether, either because they can't get research funding at all or, in Glomski's case, because the rat race has simply become too unpleasant.

"My lab was well-funded until, basically, the moment I decided I wasn't going to work there anymore," he says during an interview on the porch swing of his home in Charlottesville, Va. "And I probably could have scraped through there for the rest of my career, as I had been doing, but I would have had regrets."

Glomski's problem was that he could only get funding to do very predictable, unexciting research. When money gets tight, often only the most risk-averse ideas get funded, he and others say.

"You're focusing basically on one idea you already have and making it as presentable as possible," he says. "You're not spending time making new ideas. And it's making new ideas, for me personally, that I found rewarding. That's what my passion was about."

At his lab at the University of Virginia, Glomski had a new idea about how to study an anthrax infection as it spread through an animal — and doing this with scans, rather than having to cut the animal open.

Shots - Health News U.S. Science Suffering From Booms And Busts In Funding

"I think if it did what I hoped it would, it would have revolutionized a lot of the research that I was focusing on," Glomski says. It would have given him important new insights, he thinks, into how this bacterium does its deadly damage.

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But it was not a surefire idea. Like a lot of science, it might not have worked at all. Glomski never found out. His repeated grant applications to the National Institutes of Health never made the cut. Funding is so competitive that reviewers shy away from ideas that might not pan out.

"You actually have to be much more conservative these days than you used to," Glomski says, "and being that conservative I think ultimately hurts the scientific enterprise." Society, he says, is "losing out on the cutting-edge research that really is what pushes science forward."

Historically, payoffs in science come from out of the blue — oddball ideas or unexpected byways. Glomski says that's what research was like for him as he was getting his Ph.D. at the University of California, Berkeley. His lab leader there got funding to probe the frontiers. But Glomski sees that farsighted approach disappearing today.

"That ultimately squashed my passion for what I was doing," he says. So two years ago, at the age of 41, he quit.

Instead of helping society improve its defenses against deadly anthrax, he's starting a liquor distillery, Vitae Spirits. He's actually excited about that. It's a big challenge, and it allows him to pursue an idea with passion, rather than with resignation.

Meanwhile, Randen Patterson is not passionate about his post-science career as a grocery store proprietor. He recently bought the Corner Store in the tiny town of Guinda, Calif.

Randen Patterson (right) mans the register at the Corner Store in Guinda.

Max Whittaker/Prime for NPR

Patterson, 43, once worked for Dr. Solomon Snyder at Johns Hopkins University in one of the top neuroscience laboratories in the world. His research is published in some of the most prestigious journals.

And Patterson got there against the odds. He was raised in a trailer park in Pennsylvania by a single parent, he says, and stumbled into science quite by accident. Mentors realized his potential and encouraged him to make a career of it.

“ I shouldn't be a grocer right now. I should be training students. I should be doing deeper research. And I can't. I don't have an outlet for it.

He landed a tenure-track assistant professorship at Penn State University, and then moved on to a similar job at University of California, Davis (a 45-minute drive from his new "hometown" of Guinda).

But Patterson struggled his entire career to get grants to fund his research, which uses computer simulations to probe the complex chemistry that goes on inside living cells. And he chose an arcane corner of this field to focus his intellectual energy.

"When I was a very young scientist, I told myself I would only work on the hardest questions because those were the ones that were worth working on," he says. "And it has been to my advantage and my detriment."

Over the years, he has written a blizzard of grant proposals, but he couldn't convince his peers that his edgy ideas were worth taking a risk on. So, as the last of his funding dried up, he quit his academic job.

"I shouldn't be a grocer right now," he says with a note of anger in his voice. "I should be training students. I should be doing deeper research. And I can't. I don't have an outlet for it."

When the writing was on the wall a few years ago, Patterson says he bought his own souped-up computer so he could continue dabbling in research on the side. But those ideas aren't adding to the world's body of knowledge about biology.

"The country has invested, in me alone, $5 million or $6 million, easily," Patterson says, thinking back on the funding he received for his education and his research. And he's just one of many feeling the brunt of the funding crunch.

There are no national statistics about how many people are giving up on academic science, but an NPR analysis of NIH data found that 3,400 scientists lost their sustaining grants between 2012 and 2013. Some will eventually get new funding, others will retire; but others, like Glomski and Patterson, will just give up.

"We're taking all this money as a country we've invested ... and we're saying we don't care about it," Patterson says.

He watches with some trepidation as his daughter, a fresh college graduate, hopes to launch her own career in science.

The funding squeeze could persist for his daughter's generation as well. So Patterson is hoping she will settle on a field other than biomedical research — one where money isn't quite so tight.

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

Get The Measles, Get Ready To Be Out For Two Weeks

NPR Health Blog - Tue, 09/09/2014 - 2:52pm
Get The Measles, Get Ready To Be Out For Two Weeks September 09, 2014 2:52 PM ET

Helen Down holds her 14-month-old daughter, Amelia, for an MMR shot in Swansea, Wales, April 2013. The vaccination was in response to a measles outbreak.

Geoff Caddick/AFP/Getty Images

Measles is often lumped in with flu and chickenpox as mild childhood illnesses. But people who got measles during outbreaks in the United Kingdom say they were pretty darned sick, missing two weeks of school or work on average.

A bout of the measles lasted 14 days on average, according to a study by the London School of Hygiene & Tropical Medicine and Public Health England. That added up to having to take 10 days off work or school. More than a third of people needed someone to stay home to take care of them, too.

And they felt crummy. This study is one of the few that actually asks people how they feel when they're sick. They said they felt high levels of pain and anxiety, and weren't able to do their usual activities.

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"People with the measles report that they're far more sick than if they have flu or chickenpox," Dominic Thorrington, a graduate student in epidemiology and lead author of the study, told Shots. The study was published Tuesday in the journal PLoS ONE.

The researchers asked people who had become infected during the 2012 and 2013 measles epidemics in the United Kingdom how they felt and how they coped.

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Being unable to manage school, work and other usual activities was the biggest complaint, with 97 percent of people saying they had severe problems or some problems with that. Another 90 percent said they suffered pain or discomfort. About half said measles severely compromised their mobility, and 40 percent said they couldn't care for themselves.

The vast majority of 203 people in the study had never been vaccinated for measles.

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Earlier research has shown that the measles outbreaks in the United Kingdom followed a vaccine scare prompted by a 1998 paper that implicated the measles, mumps and rubella vaccine in autism. The study was later proven to be fraudulent, but the number of children who did not get vaccinated spiked in the following decade.

The virus spreads easily in unvaccinated communities. Researchers say the higher numbers of unvaccinated people in the U.K. led to the outbreaks.

"I just hope that when people read this, they realize that measles is not a disease that has gone away and it is a disease that has quite severe implications when there's an outbreak," Thorrington says. "The best way to protect yourself is through vaccination."

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

Can I Buy Insurance After Being Injured In An Accident?

NPR Health Blog - Tue, 09/09/2014 - 10:36am
Can I Buy Insurance After Being Injured In An Accident? September 09, 201410:36 AM ET

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Now that the federal health law forbids denial of insurance for pre-existing condition, some people have wondered if they can wait until they get sick to buy health coverage.

Let's say an uninsured person is in a car accident, has emergency surgery and is hospitalized, and after awaking from surgery asks to purchase insurance right away. Under the health law, would his medical costs be covered since he can't be denied insurance because of a pre-existing medical condition? An article I saw said the hospital would even enroll people and pay their premiums. Is that correct?

It's unlikely that this hypothetical person would be able to sign up for coverage after being injured, says Judith Solomon, a vice president for health policy at the Center on Budget and Policy Priorities.

"It's true that you can't be denied because you have a pre-existing medical condition, but you generally have to sign up during an open enrollment period," says Solomon. Employers generally offer insurance through an enrollment period in the fall. People buying coverage individually on or off the online marketplaces set up under the health law can sign up during open enrollment starting Nov. 15. But there's a lag between when a person signs up and when coverage begins.

The reason for open enrollment is clear: If people could sign up anytime, chances are they would wait until they got sick to do so, wreaking havoc on the health insurance market that relies on spreading the insurance risk among sicker and healthier people.

Hospitals may sometimes pay premiums for patients' existing policies or enroll people before they get sick. But in general it's not possible to purchase coverage after you've already been injured and admitted to the hospital, says Solomon.

There is one important exception, however. Enrollment in a state's Medicaid program for low-income people is open year-round. If someone lives in a state that has expanded Medicaid coverage to people with incomes up to 138 percent of the poverty level (currently $16,105 for an individual), enrollment would generally be retroactive to the first day of the month that the person applied for coverage. In addition, if someone was eligible for Medicaid during the three months preceding the application, medical care received during that time could be covered as well.

My work offers health insurance, but I opted to go into the marketplace last winter and buy it individually instead. Was this not allowed? Should I terminate my coverage and get on my boss's plan even though I don't want that coverage?

The answer depends on your circumstances. Most people can opt to buy a marketplace plan during open enrollment rather than sign up for employer coverage if they want; there's nothing in the health law that prohibits it.

The real question is whether you're eligible for subsidies to make coverage more affordable if you do so. If you have good, affordable employer coverage available — meaning it costs less than 9.5 percent of your income and covers at least 60 percent of your medical costs — you won't be eligible for subsidies. Nor will you qualify for subsidies if your income is more than 400 percent of the federal poverty level ($46,680 for an individual next year).

If you take subsidies out of the equation, however, there's no reason not to buy a plan on the state marketplace if you prefer it over your on-the-job coverage, says Solomon.

My employer is telling me that an excise tax will be assessed if our company pays more than 80 percent of the cost of our health insurance premium. I thought it was based on the value of the plans, that if individual coverage exceeds $10,250 and family coverage $27,500 our company would be taxed. Can you tell me when the excise tax will be assessed and who pays the tax?

The excise tax that will be assessed on so-called Cadillac health plans with very generous benefits starts in 2018. It isn't related to how much the employer or employee pay in premiums. The tax will be charged based on the total value of a plan, including both employer and employee premium contributions.

Under the health law, if the total value is more than $10,200 for individual coverage or $27,500 for family coverage, the employer or insurer will be responsible for paying a 40 percent tax on amounts over those thresholds.

"There's nothing to preclude an employer from passing along some or all of that tax to an employee," says Amy Bergner, managing director at tax and human resources consultant PwC.

By the time the tax takes effect in 2018, expect the thresholds to be higher, says Bergner, because of consumer price index adjustments, among other things.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

U.S. Science Suffering From Booms And Busts In Funding

NPR Health Blog - Tue, 09/09/2014 - 3:03am
U.S. Science Suffering From Booms And Busts In Funding September 09, 2014 3:03 AM ET Listen to the Story 7 min 51 sec   Leif Parsons for NPR

Ten years ago, Robert Waterland got an associate professorship at Baylor College of Medicine and set off to study one of the nation's most pressing health problems: obesity. In particular, he's been trying to figure out the biology behind why children born to obese women are more likely to develop the condition themselves.

Waterland got sustaining funding from the National Institutes of Health and used it to get the project going.

But after years of success in this line of research, he's suddenly in limbo. His NIH grant ran out in 2012 and he hasn't been able to get it renewed.

"We're in survival mode right now," he says.

His research can't move forward without funding. And he has plenty of company. Nationwide, about 16 percent of scientists with sustaining (known as "R01") grants in 2012 lost them the following year, according to an NPR analysis. That left about 3,500 scientists nationwide scrambling to find money to keep their labs alive — including 35 at the Baylor College of Medicine.

The root cause is plain, and it's not just about a current shortage in funding: The NIH budget shot steadily upward from 1998 to 2003. That spawned great jubilation in biomedicine and a gold-rush mentality. But it didn't last. Since 2004, the NIH budget has decreased by more than 20 percent. (That's not counting the hefty two-year bump the budget got from stimulus funds via the American Recovery and Reinvestment Act of 2009.)

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Grants are the lifeblood of university research. Scientists rely on that steady stream of cash to hire staff, buy equipment and run the experiments. Their results help propel innovation, medical advances and local economies. Academic research is a major reason the United States remains a leader in medicine and biotechnology; but the future is uncertain.

"If I don't get another NIH grant, say, within the next year, then I will have to let some people go in my lab. And that's a fact," Waterland says. "And there could be a point at which I'm not able to keep a lab."

He notes that the hallway in his laboratory's building is starting to feel like a ghost town as funding for his colleagues dries up. He misses the energy of that lost camaraderie.

"The only people who can survive in this environment are people who are absolutely passionate about what they're doing and have the self-confidence and competitiveness to just go back again and again and just persistently apply for funding," Waterland says.

Dan Burke, a biochemist at University of Virginia, will likely have to close his lab. Research institutions overspent on infrastructure in boom times, he says.

Richard Harris /NPR

He has applied for eight grants and has been rejected time and again. He's still hoping that his grant for the obesity research will get renewed — next year.

Baylor College of Medicine is suffering more than most. Its NIH funding dropped from a peak of $252 million in 2002 to $184 million in 2013. But many other schools are in the same fix. The University of Virginia, for example, regarded as one of the top public universities in the nation, watched its NIH funding shrink from a peak of $159 million in 2005 to $110 million in 2013.

Take Dan Burke, a professor of biochemistry and molecular genetics, who is one of about 30 scientists at University of Virginia who lost their sustaining grants between 2012 and 2013. Until that point, he'd had continuous funding since 1987 to conduct studies about the basic mechanics of DNA. He has had to fire his lab staff and is planning to close his lab.

It seemed like great fortune when the NIH budget soared more than a decade ago.

"Unfortunately, a lot of research institutions and medical schools were hogs to the trough," Burke says. "They hired a lot of people and built a lot of buildings with the expectation that that would continue. And when that flattened off, and started losing money to inflation, the institutions were essentially bloated."

Additional Information: Search NIH Grant Data By Institution Tyrone Turner/Getty Images/National Geographic

Use NPR's interactive search box to create year-by-year charts of NIH grant funding given to individual biomedical institutions and laboratories.

His institution sought to cash in on those boom times. University of Virginia doubled the amount of biomedical laboratory space on campus between 2007 and 2013 — from 233,000 square feet to 416,000 square feet. Funding for some of that expansion was supposed to come from the grants that its scientists garnered.

The university touted plans to add 700 new scientists and support staff to fill these labs. Instead, last year it eliminated more than 300 jobs — many held by highly skilled workers — as funding for biomedical research sank. New labs built to handle dangerous germs and small animals are now lightly used.

"The U.Va. swings in overbuilding or unused space for specialized facilities really have been extremely moderate, compared to the scaling that occurred either at larger institutions or at some of the large private medical centers," Tom Skalak, vice president for research at the university, told NPR.

To help close the budget gap, the university has raised tuition. (The commonwealth of Virginia now provides only 10 percent of its flagship university's funding.) Skalak defends using tuition to help pay for new laboratories, saying undergraduates can enhance their education by working in a lab.

The University of Virginia's building boom was twice the national average. Nationwide, National Science Foundation data show that universities have expanded laboratory space by 50 percent in the past decade, expecting a funding boom that turned out to be a bust.

In absolute terms, there is still a lot of money for biomedical research — the NIH budget is about $30 billion a year. But with the doubling and subsequent decline in funding, supply and demand are completely out of whack.

"It's an unstable system," says Paula Stephan, a labor economist at Georgia State University. "It really depended on funding growing and growing and growing. And so we need to find some way for it to reach equilibrium."

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Many scientists hold out hope for a simple solution: more money. But the current U.S. Congress has no appetite to spend more — even on health research that has broad, bipartisan public support.

So a group of leading scientists is trying to figure out how to repair the hobbled biomedical enterprise without a cash infusion.

"We have to remember that this is a fragile system, says Dr. Harold Varmus, who was head of the NIH when the funding doubled; he now runs the National Cancer Institute. " 'Do no harm,' the doctor's mantra, is very applicable here," he says.

Varmus is helping to organize a major summit meeting on this funding crisis, to be held later this year.

"We have a system that has worked well in the past, that has made the U.S. the leader in biomedical research worldwide," Varmus says. "And while I don't think we've lost that yet, we do see a rising tide in lots of places."

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

Researcher Urges Wider Genetic Screening For Breast Cancer

NPR Health Blog - Mon, 09/08/2014 - 4:24pm
Researcher Urges Wider Genetic Screening For Breast Cancer September 08, 2014 4:24 PM ET Listen to the Story 3 min 58 sec  

Lisa Schlager of Chevy Chase, Md., demonstrates outside of the Supreme Court as arguments were made in a case seeking to determine whether the BRCA breast cancer genes can be patented. The court ruled in 2013 that individual genes can't be patented.

Tom Williams/CQ Roll Call/Getty

A prominent scientist has started a big new debate about breast cancer. Geneticist Mary-Claire King of the University of Washington, who identified the first breast cancer gene, is recommending that all women get tested for genetic mutations that can cause breast cancer.

"My colleagues and I are are taking a really bold step," King said. "We're recommending that all adult women in America, regardless of their personal history and regardless of their family history, be offered genetic testing for the breast cancer genes."

But others say that one study is far from enough evidence to know if these women face a higher risk of getting cancer, and that universal testing could lead women to undergo unnecessary surgery, doing more harm than good.

The breast cancer genes are called BRCA1 and BRCA2. Women who have mutations in these genes are much likely to get breast cancer and ovarian cancer. From 5 to 10 percent of breast cancer is caused by BRCA mutations, according to the National Cancer Institute.

Doctors usually recommend women get tested only if one of those cancers runs in their families.

"The difficulty with that approach is that it misses identifying some women who have mutations in these genes," says King, who laid out her arguments in an article published Monday in JAMA, the journal of the American Medical Association. King was awarded a Lasker-Koshland prize Monday for her work on BRCA.

Shots - Health News Supreme Court Gene Ruling Splits Hairs Over What's 'Natural'

In fact, about half of the women who carry mutations in BRCA1 or BRCA2 have no family history of breast or ovarian cancer, she says.

Shots - Health News How Being Ignored Helped A Woman Discover The Breast Cancer Gene

But no one has recommended screening all women for a very good reason: No one knew how dangerous the mutations were for the average woman.

"There was a big piece of the puzzle missing," King says.

So King and her colleagues decided to try to find that missing piece. They identified more than 400 women who were carrying the mutations even though they had no family history.

"The women turned out to have the same high risks of developing either breast or ovarian cancer that we see among those who are identified by virtue of their family history," says King, who reported the findings in a paper published last week in the Proceedings of the National Academy of Science.

King thinks that's the tipping point — it's time to recommend all women get screened.

"People who are positive can do something about it. Some women, for instance Angelina Jolie, wrote elegantly about her decision to have a double mastectomy," she says. They could also have their ovaries removed to make sure they never get ovarian cancer.

But that's exactly what has a lot of breast cancer advocates worried.

"We are far, far from being ready to recommend that all women be screened for genetic predisposition to breast cancer," says Fran Visco, president of the National Breast Cancer Coalition.

Visco and others aren't convinced the new data are strong enough to know anything for sure. Just because a woman has one of these mutations doesn't mean she'll definitely get cancer. Thus a woman could undergo radical surgery for no good reason.

"These are very serious surgeries that women have to undergo. Removing their breasts. Removing their ovaries. We're talking about surgery to remove healthy body parts. If we give women this message, we may very well end up doing more harm than good," Visco says.

In addition, screening tests can cost hundreds to thousands of dollars depending on insurance coverage.

"Having the genetic mutation doesn't mean you're definitely going to get cancer," says Dr. Olufunmilayo Olopade, a geneticist at the University of Chicago.

Women who find out they are carrying the mutations could get regular MRIs to try to catch any cancer early, when it's most treatable, Olopade says. They could also do things to try to minimize their chances of getting cancer in the first place. "If you have children, breast-feed children, don't gain weight and eat right — exercise. All those things modify the risk for mutation carriers."

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

CDC Warns Of Fast-Spreading Enterovirus Afflicting Children

NPR Health Blog - Mon, 09/08/2014 - 4:02pm
CDC Warns Of Fast-Spreading Enterovirus Afflicting Children September 08, 2014 4:02 PM ET

13-year-old Will Cornejo of Lone Tree, Colo., recovers at Rocky Mountain Hospital for Children in Denver from what doctors suspect is enterovirus 68. His parents found him unconscious on the couch and called 911. He was flown to Denver for treatment.

Cyrus McCrimmon/Denver Post/Getty Images

A rarely seen virus is sending children to the hospital with severe respiratory infections, and the federal Centers for Disease Control and Prevention is warning doctors and parents to be on the alert.

"Hospitalizations are higher than would be expected at this time of year," Dr. Anne Schuchat, head of infectious diseases for the CDC, said Monday at a press briefing on enterovirus 68. "The situation is evolving quickly."

In August, health officials in Illinois and Missouri reported a surge in emergency room visits for severe respiratory illnesses in Chicago and Kansas City. That surge is continuing. Enterovirus 68 has been identified in 19 of 22 people tested in Kansas City, and 11 of 14 cases in Chicago. The sick patients have all been children and teenagers, and 68 percent have a history of asthma or wheezing, according to a report published Monday in Morbidity and Mortality Weekly Report. No one is known to have died.

So far about a dozen states have reported higher-than-usual numbers of severe respiratory infections, and the CDC is working with them to figure out if EV-68 is to blame, Schuchat says. "This is a very dynamic situation, an unusual virus, and we're just beginning to understand it."

Some patients have become sick enough to end up in the intensive care unit on oxygen. Many have wheezing, even those who don't have asthma.

Enteroviruses are very common, with 10 to 15 million infections in the United States a year. They usually cause mild illness, if they make people sick at all.

But EV-68 is a rarer critter. It was first identified in California in 1962, but then was almost never seen until 2009 to 2012, when there were outbreaks in Japan, the Philippines and the Netherlands, and small clusters of cases in the United States.

Shots - Health News Overlooked Virus May Be Cause Of Paralyzing Disease In California

The strain of the virus in these current cases is not new, Schuchat says, and is the same as earlier EV-68 cases in the United States and in other countries. It's unclear why it's making people sicker and how it's spreading, but respiratory viruses spread very easily. Cold season typically peaks in September when children return to school, and the enterovirus cases may be following a similar pattern.

Parents shouldn't worry about runny noses and sniffles, Schuchat says, but should act quickly if a child has difficulty breathing. "This can be a scary thing to hear about for parents," Schuchat says. "If your child is having difficulty breathing, you want to get medical attention."

And parents of children with asthma should make extra-sure that the children are taking medications and the asthma is well controlled, she adds.

There is no vaccine or specific treatment for EV-68.

In 2014, five children in California suffered a polio-like illness that left an arm or leg paralyzed. Two of those children tested positive for EV-68. There have been no reports of paralysis or other neurological issues in the current cases, Schuchat said Monday.

"I can't say if we'll be seeing this in many more states or not," Schuchat concluded. "It's just too soon to say."

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

New Option For Getting Rid Of Old Drugs: The Pharmacy

NPR Health Blog - Mon, 09/08/2014 - 3:52pm
New Option For Getting Rid Of Old Drugs: The Pharmacy September 08, 2014 3:52 PM ET

Soon there will be disposal choices beyond the take-back drives for old medicines.

DEA

If you have old or unused narcotic painkillers in the medicine cabinet, your main choices for getting rid of them have been to toss them in the trash, flush them down the toilet or drop them off at the police station.

But soon it will be possible to take them to the local drugstore or even mail them back.

The Drug Enforcement Administration is loosening up its rules so that people will have more ways of disposing of drugs that can be risky to keep around after they're no longer needed. New disposal options could also alleviate environmental concerns that crop up when people put their old drugs in the toilet or the garbage.

Narcotics are tightly controlled because they can be abused. By regulation, narcotics couldn't be taken back to drugstores before. It's why the usual take-back sites have been police stations.

Under a regulation that takes effect in a month, drugstores, hospitals with pharmacies, drugmakers and even drug-treatment centers can serve as collection points for unused narcotics.

The change is "long overdue," said Dr. G. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health, according to The New York Times.

Shots - Health News Trash Can May Be Greenest Option For Unused Drugs

In 2013, there were 230 million prescriptions written for opioid painkillers, such as Vicodin and Percocet, dispensed in the U.S. More Americans now die from drug overdoses than auto accidents.

Shots - Health News The DEA Wants Your Old Meds, No Questions Asked

"It's baffling that it's so easy to get a prescription for opioids and yet so difficult to dispose of these drugs safely," Alexander said.

The new regulation focuses on controlled substances, but a DEA spokesman confirmed that a collection box that's OK for narcotics would also be OK for the return of other prescription drugs.

Now, there's no requirement that drugstores have to add collection boxes or return-by-mail options. A spokeswoman for the National Association of Chain Drugstores, a trade group, said it "is reviewing the final DEA rule with our members."

Walgreen didn't immediately respond to calls about their plans once the regulation takes effect.

The DEA suggested in the official notice of the change that participation could have advantages. Drugstores and hospitals that take part may garner goodwill by "providing a valuable community service," the DEA wrote. The companies and organizations that use a mail-back option could benefit from the chance to "distribute to consumers promotional, educational, or other informational materials with the mail-back packages."

Updated 4:23 p.m.: After the initial version of this post was published, a CVS spokesman emailed that the company "is committed to combating prescription drug abuse in multiple ways" and is "reviewing the new federal regulation announced today as part of our on-going commitment to measures that can help prevent prescription drug abuse."

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

The Start Of School Is Not The Only Risky Time For Campus Rape

NPR Health Blog - Mon, 09/08/2014 - 3:24am
The Start Of School Is Not The Only Risky Time For Campus Rape September 08, 2014 3:24 AM ET Listen to the Story 2 min 47 sec   iStockphoto

It's sometimes called "the red zone" — from the first day on campus to Thanksgiving break — when female students are thought to be at higher risk of sexual assault.

Students away from home for the first time with no parental supervision are trying to make friends and fit in. Add parties and alcohol, and it can be a dangerous mix.

"It's assumed the highest-risk period is at the beginning of the first semester," says Bill Flack, an associate professor of psychology at Bucknell University in Pennsylvania.

13.7: Cosmos And Culture To Fight Campus Rape, Culture Must Change

Flack remembers seeing posters on campus warning female freshmen to be wary of the "red zone," but he couldn't find much evidence to back it up. So Flack conducted two studies on two different college campuses. What he found was surprising.

One study did find higher reports of sexual assault at the beginning of the first year, but there was also an increased risk during the winter term. Students at this small liberal arts college only take one class during the winter term and describe it as a time of less work, more socializing and heavier drinking.

The second study, at another liberal arts college, didn't find any higher risk at the beginning of the first semester. In fact, the reports of sexual assault were higher at the start of the second year, when students were taking part in sorority and fraternity rush. The higher-risk periods on the two different campuses were at different times, but both coincided with periods of more partying.

"Alcohol consumption tends to go hand in hand with sexual assault," Flack says.

Shots - Health News The Power Of The Peer Group In Preventing Campus Rape

It's the combination of alcohol consumption and students who are on their own for the first time that can make the first few weeks of school particularly dangerous.

Research shows that a small percentage of male college students are responsible for most of the campus rapes. These predators are looking for people who are vulnerable, says Melissa Osmond, the associate director for health promotion at Lewis and Clark College in Portland, Ore.

"A lot of times those are young women who may be under the influence of alcohol, and these perpetrators will sometimes help that along," Osmond says.

She says it's a mistake to think the first few weeks are the only dangerous time.

"I truly believe it can happen anytime, and it doesn't have to be in the first six weeks or 15 weeks, and it's not always freshmen women," Osmond says. "It can happen at any time in your college career."

A White House Task Force to Protect Students from Sexual Assault has asked each college to do a climate survey to find out the extent of the problem on campus and develop strategies to stop it. One of the problems is that so few sexual assaults are actually reported. A government website called NotAlone.gov provides a host of information, including enforcement data on different campuses and advice on how to file a federal complaint.

And as students head back to college, many are being required to undergo sexual assault prevention training.

"Consent is hot, assault is not," is one of the marketing slogans for the state of Indiana prevention program, which also cautions students to "ask for my sober consent."

Good advice, considering alcohol is involved in the majority of sexual assaults.

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

Cheap Drinks And Risk-Taking Fuel College Drinking Culture

NPR Health Blog - Mon, 09/08/2014 - 3:22am
Cheap Drinks And Risk-Taking Fuel College Drinking Culture September 08, 2014 3:22 AM ET Listen to the Story 5 min 21 sec   Rob Donnelly for NPR

There's no question that alcohol is a factor in the majority of sexual assaults on campus. And alcohol is abundant and very present at most colleges today.

In fact, federal health officials say more than 80 percent of college students drink. And about half say they binge drink. This means more than four drinks for women and more than five drinks for men, within a two-hour time frame.

"Everybody's drinking to get drunk," says Dr. Sharon Levy, a pediatrician and director of the Adolescent Substance Abuse Program at Boston Children's Hospital. "Kids tell me this is how they socialize with friends."

Levy says that what's happening on college campuses is an unfortunate collusion of the brain's biology with a hard-to-resist environment.

Though 18-year-olds are legally considered adults, their brains are sort of stuck in adolescence, Levy says, not fully developed till the mid-20s. So at 18, the when students typically enter college, the part of their brain in charge of seeking reward and stimulation is in full gear.

But here's the tricky part: The part of the brain that could put the brakes on impulsive behavior is still immature and not fully functioning. When people in this age group drink, Levy says, "they're more likely to do risky things even though their judgment is impaired and some of those things may be dangerous. They're more likely to drive a car, more likely to go for a swim and, frankly, more likely to have sexual contact."

Shots - Health News Legal Drinking Age Of 21 Saves Lives, Even Though It's Flouted

And college students drink a lot more than their peers who are not in college, Levy says. "We've created a situation in which there is an expectation that drinking — heavy drinking — is just part of the college experience."

It's an experience many teenagers just aren't prepared for. Last year, Alexa was a freshman at a West Coast college. She agreed to discuss her drinking experiences with us, but because drinking alcohol isn't legal for her or for her classmates under 21, we agreed not to use her full name.

Alexa didn't drink or party in high school. So it was a real shocker, she says, when she got to college and alcohol was everywhere. "You just step out your door and there's a whole community right there, it's easy, there's no challenge to it," she says. And parties where drinking games abound? No problem there, either. "In college I'd say there's probably a party five days out of the week," she says.

And even if it's not a party, Alexa says, kids drink in their dorm rooms while playing board games or cards.

At first she just wasn't interested. But then she felt other students viewed her as unapproachable, even judgmental. And that's not how she wanted to come across.

So, she started going to parties, started drinking and got drunk a number of times. "My decision to 'fit in' backfired on me in the sense that when I did become inebriated, I didn't act how I usually act, present myself in a way which I'm proud of. I was just loud, obnoxious and probably a bit too honest with people I was just meeting and, yeah, I'm not proud of that."

Even so, Alexa says she was on the "luckier" side. She didn't pass out, go to the hospital or get alcohol poisoning. But plenty of students do.

More than a half-million people between the ages of 18 and 24 get injured while under the influence each year, according to the National Institute on Alcohol Abuse and Alcoholism. Federal health officials say more than 1,800 die every year from alcohol-related unintentional injuries, including motor vehicle crashes.

Studies consistently find a link between alcohol and sexual assault on campus. Drinking by men increases the odds that they will perpetrate a sexual assault, and drinking by women increases their vulnerability. One study found a woman was 19 times more likely to be assaulted if she had had four or more drinks.

Shots - Health News Can We Predict Which Teens Are Likely To Binge Drink? Maybe

Harvard epidemiologist Elissa Weitzman wanted to know why some teenagers become binge drinkers in college, while others don't. She conducted a national survey of college freshmen. "The largest single factor that predicted the uptick of binge drinking for freshmen coming to college was the price they paid for a drink; it enormously increased their risk."

And, in most college towns, Weitzman says, the price is right: It's cheap.

"The way the bars compete is through volume discounts; they make alcohol very cheap at the per-drink level. The bar makes money through volume," she says. And that bargain price had a lot more to do with whether kids drank than public-health information about the dangers of alcohol.

Hence ladies night. Two-for-one night. "Specials" that appeal to young kids with fake IDs or who may not be carded to prove they're 21 and legally able to drink.

Shots - Health News College Students Can Learn To Drink Less, If Schools Help

But those effects aren't inevitable, Weitzman says. When colleges partner with local communities to put rules in place and enforce them, college drinking decreases.

In one study, Weitzman looked at 10 universities with high binge drinking rates. When the schools and communities asked bars to reduce marketing and promotions that appealed to young people, worked with police to close down wild parties and prohibited alcohol ads in student newspapers, things changed.

Students actually drank less and reported fewer hangovers, missed classes or academic problems.

Vandalism went down. So did drunken driving and injuries. It's not clear whether sexual assault was reduced because so many cases weren't reported. Weitzman says the findings suggest that "communities absolutely have the power to change the environment around them."

And following the lead of designated drivers, with slogans like "friends don't let friends drive drunk," she suggests strategies like "friends don't let friends get out of control."

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

Cosmic Rays Sound Scary, But Radiation Risk On A Flight Is Small

NPR Health Blog - Sat, 09/06/2014 - 5:30am
Cosmic Rays Sound Scary, But Radiation Risk On A Flight Is Small September 06, 2014 5:30 AM ET

Credit: Katherine Streeter for NPR

If you take a Geiger counter with you on your next flight, you'll notice the dial ratchet up as the plane approaches cruising altitude. Every time you fly, you get zapped by a little extra radiation from space. It goes right through you, in teensy amounts. It's usually nothing to worry about, even if you're pregnant.

But for people who fly a lot — like the plane's crew — that sort of exposure might, in rare instances, amount to something.

Research published Wednesday in JAMA Dermatology shows that pilots and other air crew members have "approximately twice the incidence of melanoma compared to the general population." The study's authors say that difference might be partially due to in-flight exposure to UV and cosmic radiation.

The National Institute for Occupational Safety and Health is using computer models to look into how working as a flight attendant might affect reproductive health. A recent study in the journal Aviation, Space, and Environmental Medicine looked at data from 2 million flights and found that some flight attendants may exceed recommended radiation limits.

The sun regularly shoots charged particles at the Earth, especially during solar temperature tantrums. Earth's atmosphere and magnetic field deflect most of these particles before they reach us.

NASA

"This would be uncommon, but it does happen," says Barbara Grajewski, an epidemiologist with NIOSH and an author of the study. "It could be at a level that could be of concern, and in excess of the national recommended dose for a pregnant woman."

In some countries, including the United States, members of a flight crew are considered "radiation workers." According to NASA researchers, a pilot who routinely works long-haul flights may be exposed to about twice the radiation of the average landlubber and more than a fuel-cycle worker in a nuclear power plant.

"Galactic cosmic rays" may sound like beams from an alien weapon, but they're actually the charged particles emitted by stars, including our sun. In an instrument called a cloud chamber, they look like gentle wisps. When accompanied by violinists, they sound like buzzing flies.

The rays pass through us all, "whizzing through you every day of your life," delivering a smidgen of radiation, says radiation physicist Robert Barish, who wrote a book about in-flight radiation. On a long-haul flight, particularly at high latitudes, that smidgen can become a dollop.

There are a few reasons for that. At a passenger jet's cruising altitude — 30,000 feet or more above the ground — the protective layer of atmosphere that surrounds the Earth and deflects cosmic rays isn't as dense. The Earth's magnetic shielding is also weaker over the poles, which means that more radiation enters at high latitudes. And the sun sometimes lets loose with space weather, delivering 100 times more radiation than usual.

Data from the National Council on Radiation Protection and Measurements show the average annual effective dose for workers in various fields. Aviation doses are estimated based on flight routes and altitudes.

NCRP Report 160

Airlines in European Union countries train and monitor their employees as if they were working directly with radioactive materials. Elsewhere, Canada and Japan have issued similar recommendations. U.S. airlines tend to be less prescriptive, though the Federal Aviation Administration has published guidelines to advise them.

The possible health ramifications for flight crews are still under study. NASA is developing a space weather monitoring system that might be used to give airlines a heads up when rays are likely to be particularly intense. The International Commission on Radiological Protection is working on a report on the subject. And an upcoming NIOSH study will look at the possible impact of flight on the risk of miscarriage.

Evidence that solar radiation has any effect on fetuses is scanty, researchers say. "The science says that the fetus is particularly sensitive between the eighth and 15th week," says Jacques Lochard, leader on the upcoming ICRP report. "This is the sensitive period [for] IQ loss."

But most of that information is based on cases of extreme exposure, he says, such as the children of atomic bomb survivors, who would have received a different kind of radiation, and in doses much higher than those experienced on a plane flight.

Radiation is only one part of why European airlines encourage female staff to declare their pregnancy as soon as possible. Jet lag, for example, which entails a disruption of circadian rhythms, might also affect reproductive health.

Even if the risk from occupational exposure to cosmic radiation is small, airlines should routinely provide information that would enable flight crew members to figure out their lifetime exposure, as "a matter of respect," Lochard says.

Additional Information: Related Stories 13.7: Cosmos And Culture Cosmic Rays: 100 Years Of Mystery Shots - Health News Headed To Mars? Watch Out For Cosmic Rays

Judith Murawski, an industrial hygienist with the Association of Flight Attendants, agrees. "Would it be justified to not mention to nuclear workers that they're being exposed to radiation?" she asks. "It's the same."

There isn't much crews or passengers can do about their exposure, short of avoiding polar flights, or taking a boat instead. Flying airlines at low altitudes would burn more fuel, and it wouldn't make sense to encase jets in heavy protective material.

NIOSH's Grajewski and her co-authors suggest that commercial airlines heed warnings about unusual space weather so they can change flight paths. They also recommend that pregnant members of any air crew choose flight routes that travel at lower altitude and latitude, if they can.

Anyone can estimate their own exposure with various online calculators, or check out space weather conditions, as Murawski did when she was pregnant. "Had there been a solar storm of S2 or higher, then I would not have flown," she says.

Of course, many travelers don't have that level of flexibility or concern. At the end of the day, Grajewski says, it's about probability. "The more you're exposed, the higher the probability" that you've somewhat increased your risk of something like cancer or prenatal defects.

That may sound scary. But this chart, from the blog Information is Beautiful, helps put things in perspective. As the diagram makes clear, walking through an airport security scanner exposes a person to about the same ionizing radiation dose as eating a banana. Flying from New York to Los Angeles exposes you to roughly the same amount of radiation you'd get from eight dental X-rays — and less than you'd get living in a stone house for a year. And those peanuts that airlines hand out? They're a little radioactive, too.

"Radiation is one example of where people have such a wrong idea about what is dangerous, and are also unaware of its ubiquitous nature," says Barish. "Radiation is all around us. It is in us."

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

Cosmic Rays Sound Scary, But Radiation Risk On A Flight Is Small

NPR Health Blog - Sat, 09/06/2014 - 5:30am
Cosmic Rays Sound Scary, But Radiation Risk On A Flight Is Small September 06, 2014 5:30 AM ET

Credit: Katherine Streeter for NPR

If you take a Geiger counter with you on your next flight, you'll notice the dial ratchet up as the plane approaches cruising altitude. Every time you fly, you get zapped by a little extra radiation from space. It goes right through you, in teensy amounts. It's usually nothing to worry about, even if you're pregnant.

But for people who fly a lot — like the plane's crew — that sort of exposure might, in rare instances, amount to something.

Research published Wednesday in JAMA Dermatology shows that pilots and other air crew members have "approximately twice the incidence of melanoma compared to the general population." The study's authors say that difference might be partially due to in-flight exposure to UV and cosmic radiation.

The National Institute for Occupational Safety and Health is using computer models to look into how working as a flight attendant might affect reproductive health. A recent study in the journal Aviation, Space, and Environmental Medicine looked at data from 2 million flights and found that some flight attendants may exceed recommended radiation limits.

The sun regularly shoots charged particles at the Earth, especially during solar temperature tantrums. Earth's atmosphere and magnetic field deflect most of these particles before they reach us.

NASA

"This would be uncommon, but it does happen," says Barbara Grajewski, an epidemiologist with NIOSH and an author of the study. "It could be at a level that could be of concern, and in excess of the national recommended dose for a pregnant woman."

In some countries, including the United States, members of a flight crew are considered "radiation workers." According to NASA researchers, a pilot who routinely works long-haul flights may be exposed to about twice the radiation of the average landlubber and more than a fuel-cycle worker in a nuclear power plant.

"Galactic cosmic rays" may sound like beams from an alien weapon, but they're actually the charged particles emitted by stars, including our sun. In an instrument called a cloud chamber, they look like gentle wisps. When accompanied by violinists, they sound like buzzing flies.

The rays pass through us all, "whizzing through you every day of your life," delivering a smidgen of radiation, says radiation physicist Robert Barish, who wrote a book about in-flight radiation. On a long-haul flight, particularly at high latitudes, that smidgen can become a dollop.

There are a few reasons for that. At a passenger jet's cruising altitude — 30,000 feet or more above the ground — the protective layer of atmosphere that surrounds the Earth and deflects cosmic rays isn't as dense. The Earth's magnetic shielding is also weaker over the poles, which means that more radiation enters at high latitudes. And the sun sometimes lets loose with space weather, delivering 100 times more radiation than usual.

Data from the National Council on Radiation Protection and Measurements show the average annual effective dose for workers in various fields. Aviation doses are estimated based on flight routes and altitudes.

NCRP Report 160

Airlines in European Union countries train and monitor their employees as if they were working directly with radioactive materials. Elsewhere, Canada and Japan have issued similar recommendations. U.S. airlines tend to be less prescriptive, though the Federal Aviation Administration has published guidelines to advise them.

The possible health ramifications for flight crews are still under study. NASA is developing a space weather monitoring system that might be used to give airlines a heads up when rays are likely to be particularly intense. The International Commission on Radiological Protection is working on a report on the subject. And an upcoming NIOSH study will look at the possible impact of flight on the risk of miscarriage.

Evidence that solar radiation has any effect on fetuses is scanty, researchers say. "The science says that the fetus is particularly sensitive between the eighth and 15th week," says Jacques Lochard, leader on the upcoming ICRP report. "This is the sensitive period [for] IQ loss."

But most of that information is based on cases of extreme exposure, he says, such as the children of atomic bomb survivors, who would have received a different kind of radiation, and in doses much higher than those experienced on a plane flight.

Radiation is only one part of why European airlines encourage female staff to declare their pregnancy as soon as possible. Jet lag, for example, which entails a disruption of circadian rhythms, might also affect reproductive health.

Even if the risk from occupational exposure to cosmic radiation is small, airlines should routinely provide information that would enable flight crew members to figure out their lifetime exposure, as "a matter of respect," Lochard says.

Additional Information: Related Stories 13.7: Cosmos And Culture Cosmic Rays: 100 Years Of Mystery Shots - Health News Headed To Mars? Watch Out For Cosmic Rays

Judith Murawski, an industrial hygienist with the Association of Flight Attendants, agrees. "Would it be justified to not mention to nuclear workers that they're being exposed to radiation?" she asks. "It's the same."

There isn't much crews or passengers can do about their exposure, short of avoiding polar flights, or taking a boat instead. Flying airlines at low altitudes would burn more fuel, and it wouldn't make sense to encase jets in heavy protective material.

NIOSH's Grajewski and her co-authors suggest that commercial airlines heed warnings about unusual space weather so they can change flight paths. They also recommend that pregnant members of any air crew choose flight routes that travel at lower altitude and latitude, if they can.

Anyone can estimate their own exposure with various online calculators, or check out space weather conditions, as Murawski did when she was pregnant. "Had there been a solar storm of S2 or higher, then I would not have flown," she says.

Of course, many travelers don't have that level of flexibility or concern. At the end of the day, Grajewski says, it's about probability. "The more you're exposed, the higher the probability" that you've somewhat increased your risk of something like cancer or prenatal defects.

That may sound scary. But this chart, from the blog Information is Beautiful, helps put things in perspective. As the diagram makes clear, walking through an airport security scanner exposes a person to about the same ionizing radiation dose as eating a banana. Flying from New York to Los Angeles exposes you to roughly the same amount of radiation you'd get from eight dental X-rays — and less than you'd get living in a stone house for a year. And those peanuts that airlines hand out? They're a little radioactive, too.

"Radiation is one example of where people have such a wrong idea about what is dangerous, and are also unaware of its ubiquitous nature," says Barish. "Radiation is all around us. It is in us."

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

Feds Hope Hitting Nursing Homes In The Wallet Will Cut Overmedication

NPR Health Blog - Fri, 09/05/2014 - 5:45pm
Feds Hope Hitting Nursing Homes In The Wallet Will Cut Overmedication September 05, 2014 5:45 PM ET Listen to the Story 3 min 34 sec  

Federal prosecutors allege two nursing homes in California have "persistently and severely overmedicated elderly and vulnerable residents." Antipsychotic drugs like risperidone, also known as Risperdal, can be dangerous for elderly people, but are frequently prescribed to nursing home patients.

JB Reed/Bloomberg via Getty Images

A federal lawsuit against two Watsonville, Calif., nursing homes may offer a new approach to dealing with the persistent problem of such facilities overmedicating their residents.

The lawsuit details multiple cases when the government says these drugs were inappropriately administered to patients.

For instance when an 86-year-old man identified in the lawsuit as Patient 1 was admitted to Country Villa Watsonville West, he could speak clearly and walked in under his own power. Within days the facility began giving him Haldol and Risperdal, drugs used to treat schizophrenia and bipolar disorder, and he became bedridden, stopped eating and developed bedsores and infections.

"Within days he declined precipitously, to the point where he was read his last rites in the hospital," says Tony Chicotel, a staff attorney with California Advocates for Nursing Home Reform who represented the man and his family in a private suit that was settled out of court.

"He subsequently recovered," says Chicotel, "but all this had been done without his family's knowledge, without his informed consent, without real good clinical indications for the use of the drug."

Antipsychotics like Risperdal and Haldol come with so-called black box warnings that say they could hasten death in elderly patients or people with dementia. Nevertheless, about a fifth of nursing home patients nationwide are prescribed antipsychotic drugs.

Shots - Health News A Third Of Nursing Home Patients Harmed By Their Treatment Shots - Health News Audit Finds Widespread Use Of Antipsychotic Drugs In Nursing Homes

The U.S. attorney for Northern California declined to comment on the lawsuit, but it claims that the two nursing homes provided "grossly inadequate, materially substandard and/or worthless services." Meanwhile, they received about $20 million from Medicare and Medicaid for those services. So now the government wants its money back, and then some.

"Under the False Claims Act, the government can ask for triple damages," explains Kelly Bagby, a senior attorney with the AARP Foundation. The nursing homes also could be fined, she says, for each incidence of filing a false report.

"So every time they submitted a form that said, 'Here is Mrs. Jones' needs' and Mrs. Jones' needs were different than that, each one of those forms is a violation," says Bagby.

In a statement, the companies that own the two nursing homes called the charges "untrue and without merit." They also filed their own lawsuit blaming the company they hired to manage the two facilities.

Deborah Pacyna, public affairs director for the California Association of Health Facilities, says that in the past couple years the federal government, in partnership with organizations like hers, has succeeded in reducing the use of antipsychotic drugs in nursing homes.

"But a lot of the regulators, a lot of our critics seem to be ignoring the fact that antipsychotics are being widely prescribed to patients who have dementia who are living at home, who are in the hospital or who are in assisted living settings," Pacyna says. "Skilled nursing (homes) represents a fraction of those that have been impacted by this practice, yet we remain the focus."

Bagby would like to maintain that focus, and thinks this lawsuit can help do that. "If you're going to hit their bottom line, that's really where you change behavior."

Bagby adds that with antipsychotic drugs still so widely prescribed for nursing home residents, there's the potential for more cases like this one across the country.

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Stinky T-Shirt? Bacteria Love Polyester In A Special Way

NPR Health Blog - Fri, 09/05/2014 - 4:23pm
Stinky T-Shirt? Bacteria Love Polyester In A Special Way September 05, 2014 4:23 PM ET

The bacteria that stink up polyester shirts are different from the bacteria that stink up armpits.

Getty Images/Stock4B Creative

Sure, exercising can make you stronger, happier and healthier. But it can also make you stink. And that polyester workout wear isn't helping.

Anyone with a drawerful of T-shirts knows that the synthetic ones can get sour after just a brief jog, while old-school cotton T-shirts remain relatively stink-free all day. And now science explains why.

The bacteria that flourish on a sweaty polyester T-shirt are different from those that grow on cotton, researchers at the University of Ghent in Belgium found.

Polyester makes a happy home for Micrococcus bacteria, while Staphylococcus, a common armpit denizen, was found on both poly and cotton.

Polyester workout wear is light, comfortable and dries quickly. But it's notorious for getting rank and staying that way. Internet message boards are awash with advice on how to de-stink gym clothes, but the perennial nature of the questions suggests that none of the answers — vinegar, baking soda, avoiding fabric softeners, rinsing your clothes in the shower — works 100 percent of the time.

Microbes love the cozy warmth of the human armpit; it's like a trip to the tropics without ever having to leave home. And it's crowded in there. Those microbes eat compounds in sweat and generate odors, which support a flourishing deodorant industry. One of the authors of this study, Chris Callewaert, is trying to figure out the causes of smelly pits, a quest he details on his website, Dr. Armpit.

Shots - Health News Exploring The Invisible Universe That Lives On Us — And In Us

The scientists asked 26 volunteers to take a spinning class while wearing shirts made of cotton, poly or blends. The shirts were then incubated for a day, and the microbes extracted and DNA fingerprinted. Volunteers also had their armpits swabbed. The study was published in the journal Applied and Environmental Microbiology.

It turns out the bugs on the shirts are different from the bugs in the pits. While Corynebacterium is thought to be the main cause of armpit body odor, there was no Corynebacterium on the clothes. Instead, Staphylococcus flourished on cotton and poly, and Micrococcus, bacteria also known for making malodor, loved polyester.

It's unclear how Micrococcus gets on polyester clothing when it's not a dominant species in the armpits, Callewaert says. He's wondering if the bacteria might spread in the washing machine and is doing research to figure that out.

He's also trying to help people with excessive body odor by giving them armpit bacteria transplants. "We have done transplants with about 15 people, and most of them have been successful," Callewaert, a Ph.D. student in applied biological sciences at the University of Ghent, tells Shots. "All have had an effect short term, but the bad odor comes back after a few months for some people."

Manufacturers have tried to make polyester fabric less hospitable to bacteria by impregnating it with antimicrobials like silver nanoparticles or triclosan. Both products have been criticized as having potentially negative impacts on the environment, and there are few data on how they might affect the wearer.

Callewaert thinks the ultimate solution will be something more organic — supplant bad bugs with good ones. "The bacteria has to do a war on its own," he says. "If you have the good bacteria present, eventually you have no bad odor."

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Science On Diets Is Low In Essential Information

NPR Health Blog - Fri, 09/05/2014 - 9:44am
Science On Diets Is Low In Essential Information September 05, 2014 9:44 AM ET

Americans crave information about diets, even as our national weight keeps rising. New studies are highlighting that there is still a lot that we don't know.

A study published Monday in the Annals of Internal Medicine is contributing to water cooler chatter about the benefits of a low-carbohydrate diet compared with one low in fat. The study was a clinical trial in which scientists randomly assigned participants to a low-carbohydrate diet or a low-fat diet and determined the diet's effect on weight and cardiovascular risk factors. They enrolled 148 middle-aged, obese participants.

People assigned to the low-carbohydrate group were told to maintain a diet of total carbohydrate (minus total fiber) of less than 40 grams a day, which is quite restrictive. For comparison, the recommended daily intake of carbohydrates for someone on a 2,000-calorie diet is 300 grams. A single slice of white bread, for example, has about 35 grams of carbohydrates.

The Salt Cutting Back On Carbs, Not Fat, May Lead To More Weight Loss

The other group was instructed to keep calories from total fat below 30 percent of daily intake. The subjects were also told to keep calories from saturated fat below 7 percent.

Shots - Health News Blood Pressure Ruckus Reveals Big Secret In Medicine

The findings produced a win for the low-carbohydrate diet, which resulted in about 7 more pounds of weight loss at one year. Participants in the low-carbohydrate group also had more favorable changes in their blood lipid levels, such as cholesterol.

Meanwhile another study, published in JAMA, the journal of the American Medical Association, surveyed prior studies of popular diets and found that the differences between diets like Atkins, Ornish, Zone and Weight Watchers were quite small and not enough to distinguish one from another.

Perhaps the most amazing thing in all this is that there is such scant scientific information available about the actual effects of diets. That's why the randomized trial involving 148 people became big news this week.

The JAMA survey of studies went back as far as 1966 and found fewer than 50 blinded trials. All told, they included fewer than 8,000 people. The studies were generally small (most had fewer than 100 people), and they typically lasted for only 24 weeks. Finally, these trials weren't able to determine whether a particular diet actually lowered the risk of disease.

Our diets may be exerting powerful effects on our health, but we lack studies that assess health events. We commonly expect this kind of study for drugs and other health care interventions. And yet, dietary recommendations are made all the time, and different diets may have different effects on health risk.

We have mostly built recommendations based on observational studies, the kind that watch what happens to people who eat different diets. But these studies are limited because people who eat different diets often have different lifestyles. Vegans and burger-lovers may vary when it comes to other habits that may also influence health, making it difficult to isolate the effects of the diet.

The diet industry generates billions of dollars annually, but it is built on razor-thin evidence about what is best for any individual. And it is likely that one size doesn't fit all. A diet that is best for one person may not be so for another. Ultimately, our recommendations need to be personalized.

Which diet reduces the risk of heart attacks and cancer? The risk factors alone don't tell you. They provide an indication, but there are many instances where an intervention that decreased cardiovascular risk factors didn't lower the likelihood of heart disease. To determine which diets reduce risk for which people, we need larger studies with longer follow-up.

For many people, it will be enough to know whether a low-carbohydrate diet is better for weight loss. Even then, we need additional confirmatory studies that are larger and more definitive.

But for other people, the issue is health and the desire to lower risk along with weight loss. People will have to wait for the answer to the question about which diet is better for their health: low-carbohydrate or low-fat? Truth is, we need answers about the health effects of all the different types of diets that are being promoted. It's time to do the studies.

Harlan Krumholz is a cardiologist and the Harold H. Hines Jr. Professor of Medicine at Yale University School of Medicine. He directs the Yale-New Haven Hospital Center for Outcomes Research and Evaluation and is a director of the Robert Wood Johnson Clinical Scholars Program at Yale.

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Replacing An Ambulance With A Station Wagon

NPR Health Blog - Fri, 09/05/2014 - 3:30am
Replacing An Ambulance With A Station Wagon September 05, 2014 3:30 AM ET Listen to the Story 3 min 54 sec  

Eric Bleeker and a partner respond to 911 calls in this vehicle. The medical team can run simple lab tests and prescribe some drugs, which may spare a patient a trip to the ER.

Eric Whitney

When a fire department gets a call for medical help, most of them scramble both an ambulance and a fully staffed fire truck. But that's way more than most people need, according to Rick Lewis, chief of emergency medical services at South Metro Fire Rescue Authority in the Denver suburbs.

"It's not the prairie and the Old West anymore, where you have to be missing a limb to go to the hospital," Lewis says, "Now it's a sore throat or one day of cold or flu season sometimes, and that can be frustrating for people, I know it is."

South Metro receives more than 12,000 emergency medical calls a year, and takes about 7,000 patients to area hospitals. Somebody who's been running a fever for a couple of days may need help — just not necessarily a ride to the ER. That disconnect can be frustrating for both ambulance crews and patients.

Crews aren't required to transport everyone who calls, but Lewis says they fear lawsuits if they were to leave and a patient got worse. Also, ambulance companies typically don't get paid unless they take somebody to the hospital. So Lewis teamed up with Mark Prather, an emergency room doctor, to try and come up with a better way.

"We created a mobile care unit that can go to a given patient, if we think they're safe to treat on scene, and provide definitive on-scene treatment," says Prather.

The mobile care unit is, basically, a station wagon. Advance practice paramedic Eric Bleeker shows off some of the gear. "This one is a suture set, so it has everything for wound closure, from staples to regular sutures," he says.

Ambulances don't have that kind of equipment, so even someone who just needs a few stitches gets a ride to the emergency department.

Several cities across the country are using paramedics as physician extenders, sending ambulance crews to do routine things like hospital follow-up visits in places where basic health care is hard to get. South Metro's model focuses on responding to calls. The team always includes at least one nurse practitioner, who can prescribe basic medicines that they stock in the mobile unit.

"A lot of what we do is sort of that mid-level between the acute care you receive in an emergency department and what the paramedics can currently do," says Bleeker.

It's kind of like an urgent care clinic on wheels.

There's also a miniature medical lab. "We can run full blood chemistry, we can do complete blood counts, we can check for strep throat, we can check for influenza," he says. Those are capabilities that even many doctors' offices don't have on site.

South Metro Fire also relies heavily on Colorado's new electronic medical records network. The nurse or EMT can call up patient records on the scene to provide care that's more like an office visit, and dispatchers can check recent medical histories to make sure they send ambulances to people who might really need one.

That person who called 911 because they were running a fever could end up being diagnosed and treated in their living room by South Metro's station wagon for about $500, instead of spending a lot more for similar care at an emergency room.

Insurance companies don't yet pay for this, though, says Prather.

"That's maybe why nobody has done it yet," he says, laughing.

For the last nine months South Metro has been running the service basically for free, to prove that it saves money. But Prather thinks that's about to change because of Obamacare. The law aims to get insurance companies, Medicare and Medicaid to stop paying for too much medical care. And it can penalize health care providers who contribute to overuse of emergency rooms.

"It allowed us to think about payment differently, and basically switch from a volume situation to a quality situation," he says.

But it's not like the law just flips a switch and starts paying for appropriate care instead of rewarding providers who see a high number of patients and do lots of procedures. The change to reward efficient, appropriate health care is just starting to happen. Slowly. But Prather is now in talks with insurers and hopes to be getting paid soon.

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

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Johnson & Johnson Pushes Ahead With Ebola Vaccine

NPR Health Blog - Thu, 09/04/2014 - 3:31pm
Johnson & Johnson Pushes Ahead With Ebola Vaccine September 04, 2014 3:31 PM ET

Ebola virus particles cling to a cell from an African green monkey.

NIAID

All of a sudden there's some movement in the development of vaccines against Ebola.

Johnson & Johnson said Thursday that the company is speeding up work on its part of an experimental two-shot vaccine being developed in collaboration with the National Institute of Allergy and Infectious Disease. J&J's Crucell unit would make a vaccine that would prime the immune system. A second shot from a company called Bavarian Nordic would be given later to boost the immune response.

The vaccine combination would target the Zaire species of Ebola that's now spreading through West Africa. The J&J vaccine worked well in tests on macaque monkeys, the company said. If all goes as planned, the vaccine could be tested in humans starting in the first half of 2015.

The J&J vaccine has been a long time coming. The scientific work involving Crucell, now a J&J subsidiary, and NIAID, part of the National Institutes of Health, dates back to 2002.

The initial goal was a vaccine that would simultaneously protect against two Ebola species and Marburg, a related hemorrhagic fever. But a multipronged vaccine like that would take more time to refine and test, so J&J has pared down the vaccine goal to move up the start of human tests by a year.

"We will only focus on the Zaire strain as a target," Dr. Paul Stoffels, J&J's chief scientific officer, told Shots. "That allows us to accelerate the vaccine development."

Shots - Health News Experimental Ebola Vaccine Will Be Put To Human Test

The J&J approach has some particulars that set it apart. The Crucell shot makes use of a modified human cold virus to get bits of Ebola's genetic material into cells inside the human body. Once there, the noninfective bits of Ebola trigger an immune response. Similarly, the Bavarian Nordic shot uses a weakened relative of the smallpox virus to carry Ebola genetic material into human cells.

While Ebola versions of these vaccines are new, the viral carriers being used have been tested previously for safety in human, Stoffels said. "Of course, we still need to build in the Ebola piece. We haven't tested that in the clinic yet," he said. "But the vector, which is the carrier for the vaccine, is safe. And, therefore, we think and we hope that the vaccine will be safe as well."

This week, as planned, NIAID began human testing of a different Ebola vaccine being developed in collaboration with GlaxoSmithKline. An NIAID spokeswoman said the first doses have been given to two volunteers.

Also, an experimental Ebola vaccine licensed to NewLink Genetics Corp. by the Public Health Agency of Canada is expected to begin human testing soon. The Defense Department funded that work.

The World Health Organization convened a two-day meeting in Geneva Thursday to talk about how to evaluate and when to use the experimental treatments and vaccines now in the works.

"We will do our part," J&J's Stoffels said. "But we can't do this without significant collaboration. We believe many options are needed."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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More Homes Go Smoke-Free, But Exposure Remains A Health Threat

NPR Health Blog - Thu, 09/04/2014 - 1:22pm
More Homes Go Smoke-Free, But Exposure Remains A Health Threat September 04, 2014 1:22 PM ET

Hey toots, can you please take it outside?

Vojkan Milenkovik/iStockphoto

These days you're pretty much guaranteed a smoke-free experience in stores, restaurants and on the job. But those laws usually don't reach inside the home. Though more than three-quarters of homes are now smoke-free, millions of children and other relatives of smokers are still exposed to secondhand smoke, a study finds.

The number of smoke-free homes rose from 43 percent in 1992-1993 to 83 percent in 2010-2011, according to a study of Census Bureau data published Thursday in Morbidity and Mortality Weekly Report.

That's a result both of people who don't smoke telling their smoking friends to take it outside, and smokers doing the same at home. The national prevalence of smoke-free homes rose from 57 percent to 91 percent in families without an adult smoker, and from 9.6 percent to 46 percent in families with a smoker.

That's progress, but the federal Centers for Disease Control and Prevention, which sponsored the study, is worried about those remaining smoky homes.

In 2006, the surgeon general declared that there's no level of secondhand smoke that's safe. Homes are the main source of exposure for children, and for adults who don't smoke.

"Because 100 percent smoke-free indoor environments are the only effective way to fully eliminate secondhand smoke exposure, efforts are warranted to educate the public about the dangers of secondhand smoke and to promote the adoption of smoke-free home rules, particularly among subpopulations at greatest risk for exposure, such as those living in households with smokers, in states with lower prevalence of smoke-free home rules, and in multiunit housing," this most recent CDC report concludes.

And some states are doing a lot better than others. Western states generally had the highest rate of smoke-free homes, while Kentucky and West Virginia trailed, with just 69 percent of all homes reported as smoke-free. You can check out specifics on your state in the chart below.

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