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Appeals Court Strikes Down Subsidies In Federal Health Exchange

NPR Health Blog - Tue, 07/22/2014 - 12:31pm
Appeals Court Strikes Down Subsidies In Federal Health Exchange July 22, 201412:31 PM ET

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Hear Nina Totenberg and Julie Rovner explain the decision on Morning Edition.  

A three-judge panel at the U.S. Appeals Court for the D.C. Circuit threw the fate of an important part of the Affordable Care Act into doubt Tuesday.

In a 2-1 decision, the court ruled that the Internal Revenue Service lacked the authority to allow subsidies to be provided in exchanges not run by the states. The ruling could put at immediate risk the millions of people who bought insurance in the 36 states where these online insurance marketplaces are run by the federal government.

"Because we conclude that the ACA unambiguously restricts the section 36B subsidy to insurance purchased on the Exchanges 'established by the state,' we reverse the district court and vacate the IRS's regulation," said the decision by Judge Thomas Griffith.

The Obama administration said it will appeal. The Justice Department will ask the entire appeals court panel to review the decision, and that panel is dominated by judges appointed by Democrats (7-4).

"There's a lot of high-minded case law that's applied here," White House spokesman Josh Earnest said. "There's also an element of common sense that should be applied as well, which is that you don't need a fancy legal degree to understand that Congress intended for every eligible American to have access to tax credits that would lower their health care costs, regardless of whether it was state officials or federal officials who were running the marketplace."

"We believe that this decision is incorrect, inconsistent with Congressional intent, different from previous rulings, and at odds with the goal of the law: to make health care affordable no matter where people live. The government will therefore immediately seek further review of the court's decision," said a statement from the Justice Department.

Meanwhile, just an hour later, another three-judge panel on the 4th Circuit Court of Appeals in Richmond, Va., came to the opposite conclusion – upholding the federal subsidies. "It is therefore clear that widely available tax credits are essential to fulfilling the Act's primary goals and that Congress was aware of their importance when drafting the bill," said the decision written by Judge Roger Gregory.

In any event, Elizabeth Wydra, chief counsel for the Constitutional Accountability Center said the D.C. Circuit ruling wouldn't take effect right away. "The court's rules are that it doesn't happen for 45 days," to give the government time to ask for a full en banc hearing, "or 7 days after the en banc hearing has been denied."

Should the decision eventually stand, however, it could mean at least 5 million Americans would face an average premium increase of 76 percent, according to a projection done by the consulting firm Avalere Health.

The court said that the wording of the health law "plainly makes subsidies available only on Exchanges established by states," and that the legislative history of the bill "provides little indication one way or the other of congressional intent."

But Judge Harry T. Edwards offered a strong dissent: "It makes little sense to think that Congress would have imposed so substantial a condition in such an oblique and circuitous manner."

The case could wind up in the Supreme Court.

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

States Experiment With Health Savings Accounts For Medicaid

NPR Health Blog - Tue, 07/22/2014 - 9:43am
States Experiment With Health Savings Accounts For Medicaid July 22, 2014 9:43 AM ET

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i i Topp Yimgrimm/iStockphoto

If all goes according to plan, next year many Arkansas Medicaid beneficiaries will be required to make monthly contributions to so-called Health Independence Accounts. Those who don't may have to pay more of the cost of their medical services, and in some cases may be refused services.

Supporters say it will help nudge Medicaid beneficiaries toward becoming more cost-conscious health care consumers. Patient advocates are skeptical, pointing to studies showing that such financial "skin-in-the-game" requirements discourage low-income people from getting care that they need.

The states of Michigan and Indiana have already implemented health savings accounts for their Medicaid programs, modeled after the accounts that are increasingly popular in the private market.

In Michigan and Indiana, people can use the funds, which may be supplemented by the state, to pay for services subject to the plan deductible, for example, or to cover the cost of other medical services.

Shots - Health News Arkansas Medicaid Expansion Attracts Other States' Interest

The program particulars in each state differ. But both states – and the Arkansas proposal — require beneficiaries to make monthly contributions into the accounts in order to reap certain benefits, such as avoiding cost sharing for medical services. Funds in the accounts may roll over from one year to the next, and participants may be able to use them to cover their medical costs if they leave the Medicaid program.

"We believe in consumerism," says John Selig, director of the Arkansas Department of Human Services. By requiring Medicaid beneficiaries to make a monthly contribution to a Health Independence Account, "we think they'll use care more appropriately and get a sense of how insurance works."

Under the health law, states can expand Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level.

Arkansas is one of several states, including Iowa and Pennsylvania, that is experimenting with using Medicaid funds to enroll new Medicaid-eligible beneficiaries in private health insurance through the Affordable Care act marketplace.

For 2015, Arkansas wants to expand its experiment by introducing the Health Independence Accounts. Nearly all beneficiaries earning between 50 and 138 percent of the poverty level ($5,835 to $16,105 for an individual) would have to participate through monthly contributions of between $5 and $25, depending on their income, or face cost-sharing requirements capped at 5 percent of income by Medicaid rules.

Shots - Health News In Michigan, Businessmen And Politicians Agree On Medicaid

In addition, Medicaid enrollees with incomes over the poverty level could be refused services if they don't make their monthly contribution and don't make a copayment. (This year, those with incomes between 100 and 138 percent of poverty already have copays.)

Each month that a beneficiary would make a payment to his or her account, the state would contribute $15. Unused amounts would roll over from one year to the next up to a maximum of $200, which could be used by the beneficiary for health care costs if he or she leaves Medicaid for private coverage.

At least 40 states charge premiums or cost sharing for at least some beneficiaries. These beneficiaries already have skin in the game, advocates say, and they question the value of these special accounts that add a whole new layer of complexity for people who may not ever have had insurance before.

"We're creating these incredibly complicated administrative structures, and I don't think people will understand them," says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

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

Teens Say Looks Can Be Liberating Despite Fashion Police

NPR Health Blog - Tue, 07/22/2014 - 4:44am
Teens Say Looks Can Be Liberating Despite Fashion Police July 22, 2014 4:44 AM ET

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Listen to the Story 5 min 38 sec   Youth Radio

At Oakland Tech, like high schools all over, passing period is a time for passing judgments.

Aaliyah Douglass, a 17-year-old, gives me a taste of how harsh critiques can be at the school in Oakland, Calif. She starts by evaluating a male classmate who walks by wearing shorts, a T-shirt and Vans.

"It's the classic teenage boy look," she says. "I don't know, he could probably dress nicer. More hipster-like I guess."

Additional Information: Two Sides To Every Selfie

For every stunning selfie that young people share on social media, there are a few less-than-perfect versions that don't make the cut. The difference between what we consider a good photo of ourselves and a bad one may seem minimal, but our hang-ups can say a lot about the role appearance plays in how we view ourselves. Youth Radio asked a few Bay Area teens to look through their smartphones and share two photos — one they opted not to post and one they really liked, and to tell us why. Youth Radio/Teresa Chin

$(function() { var pymParent = new pym.Parent( 'responsive-embed-stress-body-image', 'http://apps.npr.org/dailygraphics/graphics/stress-body-image/child.html', {} ); });

Next, her gaze falls on a female classmate's hairstyle.

"Well, that's a weave, and I don't like weaves that much because they look fake on many people," she says.

No one likes being cited by the fashion police, whether you're a teenager or an adult.

According to a nationwide survey of adults conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health, appearance ranks as a cause of stress for about a quarter of those reporting a high level of stress in the past month. Twenty-eight percent said that particular unhappiness was a cause of stress for them.

Teenagers, of course, totally get what all the stress over appearance is about. "At school, if you don't wear a certain thing, people notice and you will get made fun of," said 16-year-old Raina Pelly. Her classmates, 16-year-old Kamari Keonez and 17-year-old Sophie Varon, agreed.

"On weekends maybe I'll stress about it more than maybe, like, let's say a weekday," Pelly said, "but yeah, I stress about it most when I'm going somewhere and seeing a lot of people."

"I've hated being short my entire life, and I guess wearing high shoes and wearing clothes that I feel make me stand out kind of makes up for that," said Varon. "But I always wished I was taller.

Girls aren't the only ones wishing they were taller, fitter or better dressed. According to the NPR poll, adult men worry about appearance just as much as women. And, for some guys, the worry starts young.

"I was a fat Jewish kid from Brooklyn," said Tufts University professor Richard Lerner, "and many times psychologists study themselves. So as a pudgy Jewish kid from Brooklyn — notice I went from being fat to now I was only pudgy — I wanted to know why I wasn't so popular."

For nearly 40 years, Lerner has been studying how attractiveness affects the lives of young people. Obviously beauty is in the eye of the beholder, and according to Lerner's research, if you find someone attractive, you're more likely to help them. "The advantages of looking well are making good impressions and getting positive social evaluations and social opportunities more so than people who look less attractive," he said, adding that it's likely society has always operated this way.

"I would venture to say the folks in Queen Elizabeth's court also wanted to look attractive by the standards of attractiveness of those days," he says. "I think wanting to look good to other people is part of the nature of what it means to be a human."

It might also be part of the nature of what it means to be a teen. I discovered that how to use your looks to get ahead in high school is one lesson some of us learn easily and some not so much. My classmate Isabella Lew understands it well. Our high school voted her Best Dressed Senior of 2014. She walks away with more than just the title; she's also gained an important life skill.

"If you don't dress well, people are not going to think you have your life together," she said. "I mean, that's the first impression they get. At least for me, if my grades aren't right, or if something's wrong with my life, this is a way of faking it and pretending to people that you have your life together."

For 16-year-old Dani Tarver, getting dressed is not about covering up her flaws, but showing her true self. Most teens spend their mornings sleeping in. But for Dani, this is a time for unleashing her inner artist, crafting the perfect outfit to match her mood. School is practically her fashion runway.

On a recent morning this June, she gets up at 5 o'clock in the morning — that's late by her standards — to pick out her outfit for the day. She lays out four or five different outfits and begins the two-hour process of mixing and matching.

On this particular day, she decides on a blouse with flowers, tank top with colored stripes, black jeans with brown stitching, red socks and a pair of blue Converse sneakers.

"Yes, it takes me long to get ready, but I have my reasons," Tarver said. "I have feelings, I have things to consider going throughout my day, like, I have to work today, so I look good for work, I look good for school. I don't look like I'm showing too much because I'm not showing anything. But, yup, this is me. And I'm cute!"

Youth Radio/YouTube

Teenagers reflect on the sources of stress and how they cope.

Tarver calls this particular style her "girly-girl-serious-don't-mess-with-me look." And it's just one of the many personas Dani is trying out. That's what high school is partly about — figuring out how we want to appear to others.

It makes a lot of sense to me. In the chaotic life of teenagers, we have very little control over the other things that stress us out: the curfew our parents set, the pop quizzes our teachers give and the shade our peers throw at us.

But one thing we can own is the way we look. And if you figure out how to do that, waking up at 5 a.m. could seem like a pleasure and not a stress nightmare.

This story was produced by Youth Radio.

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

What The Odds Fail To Capture When A Health Crisis Hits

NPR Health Blog - Mon, 07/21/2014 - 5:05pm
What The Odds Fail To Capture When A Health Crisis Hits July 21, 2014 5:05 PM ET Listen to the Story 5 min 53 sec   i i

Brian Zikmund-Fisher with his wife, Naomi, and daughter, Eve, in 1999, after he had a bone marrow transplant. He says he made the decision to have the treatment based on factors he couldn't quantify.

Courtesy of Brian Zikmund-Fisher

How well do we understand and act on probabilities that something will happen? A 30 percent chance of this or an 80 percent chance of that?

As it turns out, making decisions based on the odds can be an extremely difficult thing to do, even for people who study the science of how we make decisions.

Brian Zikmund-Fisher would know. He teaches about risk and probability at the University of Michigan School of Public Health. Back in 1998, when he was studying behavioral decision theory in graduate school, he was diagnosed with myelodysplastic syndrome. People with the disorder can't produce blood cells the way they should, making them much more susceptible to bleeding and infection.

Zikmund-Fisher was told that without treatment he'd have about 10 years to live. The other option was a bone marrow transplant that had a 70 percent chance of curing him and ensuring a normal life.

"But the transplant itself — because of the chemotherapy, because of the infection risks — had roughly a 25 to 30 percent chance of killing me within six months to a year," Zikmund-Fisher says.

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Brian Zikmund-Fisher now teaches about risk and probability at the University of Michigan School of Public Health.

Courtesy of Donaghue Foundation

At the time, Zikmund-Fisher was 28, married, and had a child on the way. Ultimately, he made his life-or-death decision based on factors even he couldn't quantify.

He concluded that with no transplant and 10 years of life, he would get to know his then-unborn daughter, but she would remember him as a father in and out of hospitals. Those were not the 10 years he wanted. So he chose to gamble on the transplant.

"My experience, my outcome has been very positive," Zikmund-Fisher says. "I was on a hospital floor with 20 other patients, going through very similar procedures. Four of them never left the floor. I was one of the lucky ones."

What became apparent to Zikmund-Fisher was that probabilities, while useful, are quite limited in their ability to predict what will happen to any one person.

"We're never 95 percent alive. We either live or die. We experience outcomes," he explains. "On a population level, I can have 100 people in a room, and some will have something happen to them and some will not. And that's the hard part because if you happen to be the unlucky one who has that rare event happen to you, you still have the bad thing happen to you in its full awfulness."

Still, Zikmund-Fisher says, when it comes to medical treatment, it's important that doctors think about the overall numbers — not individual cases.

"A doctor doesn't see one patient. They see hundreds of patients — thousands of patients — over their career. We want doctors to make choices that give all of their patents the best possible outcomes regardless of whether that particular choice turned out well in the last time they tried it, or turned out poorly," he says. "We want doctors to take the long view, to give us the best chances of success, knowing that sometimes it's going to work well, and sometimes it's not."

On a personal level, Zikmund-Fisher acknowledges there's a harder reality.

"I only have one hand in this poker game. I only get one life," he says. "I can play the odds. I can try to give myself the best opportunities. But risk is a part of our everyday life, and rare things do happen, and we have to accept that."

This is part one of an All Things Considered series on Risk and Reason.

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

High-Performing Charter Schools May Improve Students' Health

NPR Health Blog - Mon, 07/21/2014 - 4:43pm
High-Performing Charter Schools May Improve Students' Health July 21, 2014 4:43 PM ET i i

Researchers are just starting to look at how school choice affects health.

romester/iStockphoto

Many people are intensely interested in how publicly funded charter schools affect children, and that includes not just their academic achievement but their health.

Researchers from UCLA and the Rand Corp. wanted to know whether attending a high-performing charter school reduced the rates of risky health behaviors among low-income minority teenagers.

They surveyed 521 ninth through 12th-grade students in Los Angeles who attended charter schools, and 409 students who attended local neighborhood schools. They asked students about their health behaviors, focusing on "risky" behaviors like smoking cigarettes, using marijuana or drinking, and "very risky" behaviors like binge drinking or unprotected sex.

When it came to risky behaviors, there was not much difference between the charter students and the noncharter students.

Education The Charter School Vs. Public School Debate Continues

However, the teens at academically better schools were less likely to indulge in high-risk behaviors. They were significantly less likely to engage in sex without contraception, indulge in binge drinking or hard drugs, use drugs at school or participate in gang activity.

The results were published Monday in the journal Pediatrics.

"It's kind of a chicken-or-egg phenomenon," says Dr. Adiaha Spinks-Franklin, an assistant professor of pediatrics at Texas Children's Hospital in Houston who was not involved in the study. In other words, are the students doing better because they're in a high-achieving school, or because they are the kind of students who were doing well before they came to the school?

"What we've learned through previous studies that black and Hispanic students do better in school environments when teachers have higher expectations of them," Spinks-Franklin tells Shots.

That may carry over to health behaviors, too.

The researchers speculate that as children develop better cognitive skills, they may learn to make better health decisions or become more health literate. But it could also be that being in a higher-performing school reduces their exposure to "risky" peers.

And it may be as simple as having more homework and less time to get in trouble, the researchers note.

This wasn't a randomized controlled trial. Even though the students were admitted to the charter schools by lottery, parents and children chose which schools to apply for, whether or not to enroll.

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

Big Data Peeps At Your Medical Records To Find Drug Problems

NPR Health Blog - Mon, 07/21/2014 - 5:15am
Big Data Peeps At Your Medical Records To Find Drug Problems July 21, 2014 5:15 AM ET Listen to the Story 8 min 32 sec   Katherine Streeter for NPR

No one likes it when a new drug in people's medicine cabinets turns out to have problems — just remember the Vioxx debacle a decade ago, when the painkiller was removed from the market over concerns that it increased the risk of heart attack and stroke.

To do a better job of spotting unforeseen risks and side effects, the Food and Drug Administration is trying something new — and there's a decent chance that it involves your medical records.

Shots - Health News Power To The Health Data Geeks

It's called Mini-Sentinel, and it's a $116 million government project to actively go out and look for adverse events linked to marketed drugs. This pilot program is able to mine huge databases of medical records for signs that drugs may be linked to problems.

The usual system for monitoring the safety of marketed drugs has real shortcomings. It largely relies on voluntary reports from doctors, pharmacists, and just plain folks who took a drug and got a bad outcome.

"We get about a million reports a year that way," says Janet Woodcock, the director of the FDA's Center for Drug Evaluation and Research. "But those are random. They are whatever people choose to send us."

Figuring out from those reports if a drug is really to blame for the symptom isn't easy. And if the side effect is something common, such as a rash or a stroke, there might not even be any reports because doctors might not connect a patient's symptoms to the drug.

Health Care Timeline: The Rise and Fall of Vioxx

"We need a rapid way to find out what's happening with drugs, especially safety of drugs, after they're approved and on the market," says Woodcock.

Your Health Q&A: Post-Vioxx, Pain Relief Remains Complicated

That's why the FDA is turning to workers at the operations center of Mini-Sentinel, which is located in a brick office building near Fenway Park in Boston.

Here, people in cubicles can send out queries to 18 data partners that include health plans and insurance companies. Their health records include nearly 180 million Americans.

If you have insurance through a private health plan, the chances are "pretty good" that your data may have been used in one of these studies, says Dr. Richard Platt, the principal investigator for Mini-Sentinel and a professor at Harvard Medical School's Department of Population Medicine.

Almost all of that data comes from billing records — not what your doctor has scribbled in your chart, but rather the codes for any diagnostic tests and procedures you undergo. (These codes are on your medical bill.) Platt says the data partnership has been carefully set up to preserve patient privacy.

Shots - Health News Remember Vioxx? Merck Settles Marketing Charges From Way Back

His own records have probably been part of a study, says Platt, but he has no way of knowing that. "We've built the system so the analyst here would have no way to say, 'Let's see if Dr. Platt's data is in there,' " he says. "The system is built so that that is an impossible question to ask."

It's taken five years for Platt's team to build Mini-Sentinel from scratch and make it a routine part of FDA's work. "We're now doing hundreds of queries a year," he says.

For example, they ran a search when the FDA got some troubling reports tentatively linking intestinal problems to a blood pressure drug called olmesartan.

"They had noticed that patients who had received this drug were having these complications that they thought might be related to the drug," recalls Platt.

At first, Mini-Sentinel found no connection. Then the FDA asked for a second search, this time focusing on people who took the drug for long periods. They found a link, Platt says. As a result, the FDA added a warning to the drug's label.

"It was possible to provide an answer that otherwise would frankly just be unavailable to them," says Platt.

Mini-Sentinel has been an experiment to see what's possible, but its contract ends in September and the FDA will be deciding what to do next.

Almost everyone agrees that the ability to sift through huge amounts of patient data is the way of the future — but not everyone believes that we really know how to best do that sifting yet.

"I think it's a good and important step that the FDA is moving in this direction," says Thomas Moore, a senior scientist at the nonprofit Institute for Safe Medication Practices. "The problem is, I think, they have underestimated how far they have to go."

Billing data were never meant to be used this way, says Moore, who questions how well they can reveal side effects from drugs. He thinks "the biggest danger is that people will get a false reassurance about safety."

He points to a controversy over a new blood-thinning medicine called dabigatran. Reports had come in about serious bleeding episodes, says Moore, but "the FDA published an article in a leading medical journal, basically discounting all that — saying that, using Mini-Sentinel, they had seen no unusual risk for this drug."

The agency is now taking another, more nuanced look at dabigatran, after critics questioned how well the FDA had designed the original Mini-Sentinel study.

People at the FDA are aware that when doing this type of research with big data, the way you set up the question can affect the answer.

"Things may change depending on what claims data set you use, or how you run your definitions, how you set up your parameters and so forth," says Woodcock. "And there's no doubt these studies are vulnerable to all these changes."

She says that's why the FDA is also involved in another effort to explore all these potential effects. This effort is led by The Reagan-Udall Foundation for the FDA, a foundation set up by Congress. Right now its major project is research on how to use large databases to study the safety of medicines on the market.

"This is a new science, and much work needs to be done to develop and continue to improve the methods behind this," says Troy McCall, who is managing the project for the Reagan-Udall Foundation.

The foundation does get some money from the FDA, but supports its research with other funds. And so far, all the money for this particular project has come from pharmaceutical companies like Merck, Pfizer, Novartis, Johnson & Johnson, GlaxoSmithKline, AstraZeneca and Eli Lilly.

McCall says he doesn't think it's seen as an "'industry project," because the work is so important. "Clearly at the end of the day this is all to benefit patients and ensure that drugs that are on the market are safe," he says, adding that patients also benefit when safe drugs are not unnecessarily removed from the market.

Drug companies do have a big interest in what stays on or off the market. But Woodcock sees no problem with industry funding the development of the scientific methods that will then be used to help make regulatory decisions.

"It would be very difficult to develop a method that was going to favor your drug when you're developing a general method, I think," Woodcock says. "But what I would say is, OK, who is going to develop these methods? We need them developed."

Officials at the Reagan-Udall Foundation say it operates transparently and has different stakeholders represented on its governing boards. But one board member who represents consumers says she finds the lack of independent funding troubling.

"I think that creates an appearance of a conflict of interest and potentially a real conflict of interest," says Diana Zuckerman, president of the nonprofit National Center for Health Research. "If all the money is coming from the pharmaceutical companies whose livelihoods are going to be affected by what the project finds, I just think that's an untenable situation."

Zuckerman says she worries that industry funding might influence the methods that eventually get used for finding signals in big data that drugs are unsafe — and that could potentially limit what this new approach will reveal about the medicines Americans take every day.

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

A YouTube Video Is Doctor's Secret Weapon Against Back Pain

NPR Health Blog - Sun, 07/20/2014 - 5:05am
A YouTube Video Is Doctor's Secret Weapon Against Back Pain July 20, 2014 5:05 AM ET Katherine Streeter for NPR

A woman in her late 20s came to see me recently because her back hurt. She works at a child care center in town where she picks up babies and small children all day long.

She felt a twinge in her lower back when hoisting a fussy kid. The pain was bad enough that she went home from work early and was laid out on the couch until she came to see me the next day.

In my office she told me she had "done some damage" to her back. She was worried. She didn't want to end up like her father, who'd left his factory job in his mid-50s on disability after suffering what she called permanent damage to his back.

Back pain is common. I see someone with back pain almost every day. Nearly all of us have at least one episode in our lives, and two-thirds of us will have it repeatedly. If you've somehow lived into your 40s and never suffered low back pain, congratulations! You're what doctors like me call an outlier.

In my patient's case, I was confident that her back pain wasn't serious. A minor injury was the clear cause. And nearly all back pain like hers from a simple mechanical strain gets better on its own.

I wanted to reassure her. I told her to go about her daily life. Keep exercising, but try to take it just a little bit easy until she felt better. At a minimum, I said, she should be walking 30 minutes a day. Also, try some ibuprofen, which helps with inflammation and doesn't require a prescription.

But she wasn't buying it.

"Don't I need an MRI, or at least an X-ray?" she asked. "My father had three herniated discs and wound up with two back operations. He still never has a day without at least some pain."

I upped the ante. I told her I could refer her to physical therapy, one of the few things shown to be truly helpful for low back pain.

No dice. She insisted on an MRI just to be sure.

A test like that wasn't warranted, in my opinion, because it would neither change her treatment nor the course of this first-ever bout of back pain.

She would just get better.

Dr. Mike Evans/YouTube

To convince her of this, I had to resort to my secret weapon: I showed her an 11-minute educational video created by Dr. Mike Evans of Toronto.

You may be familiar with Evans' work, even if you've never heard of him. He's the man behind the famous "23 1/2 Hours" whiteboard video that says the single-best move for health is being active for a half-hour or so a day. The video became a viral Internet sensation, racking up millions of page views, and even a shoutout on the hit TV show Orange Is the New Black.

Evans is passionate about making complex medical ideas simple. He and his team have made more than a dozen whiteboard videos on health topics including how to deal with stress, acne, quitting smoking and even flatulence.

"I'm looking for topics that affect a wide range of people, and are generally ignored by the health care system," Evans told me. Themes common to Evans' work include the importance of good daily habits and having a resilient attitude. He touts the importance of basics: walking, healthful relationships, avoiding stress and sleeping well.

In Evans' video about lower back pain, he cites a study in which 98 healthy volunteers got MRI scans. Two-thirds of the MRIs revealed some funky looking discs, even though the people felt fine.

Just because a scan shows something doesn't mean there's a real problem. In fact, there's a surprising lack of correlation between back imaging and how someone feels and gets around. Evans also points out that the most common mistake with low back pain is to stop being active. The other common problem is worrying that the pain will never get better.

Evans, who is 50, teaches us that back pain is something we're all vulnerable to and for which it makes sense to have a coping strategy ready.

Has Evans, who still plays hockey, ever had back pain? "I'm a member of the 90 percent club," he affirmed, meaning that like the vast majority of us, he's both had back pain and that it has improved on its own.

Fortunately for my patient, she wound up in the same club. At her next visit, she smiled and reminded me of the video's punch line: "Movement is medicine."

All of which is to say that the longer I practice medicine, the more convinced I'm becoming that less is often more.

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

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

A YouTube Video Is Doctor's Secret Weapon Against Back Pain

NPR Health Blog - Sun, 07/20/2014 - 5:05am
A YouTube Video Is Doctor's Secret Weapon Against Back Pain July 20, 2014 5:05 AM ET Katherine Streeter for NPR

A woman in her late 20s came to see me recently because her back hurt. She works at a child care center in town where she picks up babies and small children all day long.

She felt a twinge in her lower back when hoisting a fussy kid. The pain was bad enough that she went home from work early and was laid out on the couch until she came to see me the next day.

In my office she told me she had "done some damage" to her back. She was worried. She didn't want to end up like her father, who'd left his factory job in his mid-50s on disability after suffering what she called permanent damage to his back.

Back pain is common. I see someone with back pain almost every day. Nearly all of us have at least one episode in our lives, and two-thirds of us will have it repeatedly. If you've somehow lived into your 40s and never suffered low back pain, congratulations! You're what doctors like me call an outlier.

In my patient's case, I was confident that her back pain wasn't serious. A minor injury was the clear cause. And nearly all back pain like hers from a simple mechanical strain gets better on its own.

I wanted to reassure her. I told her to go about her daily life. Keep exercising, but try to take it just a little bit easy until she felt better. At a minimum, I said, she should be walking 30 minutes a day. Also, try some ibuprofen, which helps with inflammation and doesn't require a prescription.

But she wasn't buying it.

"Don't I need an MRI, or at least an X-ray?" she asked. "My father had three herniated discs and wound up with two back operations. He still never has a day without at least some pain."

I upped the ante. I told her I could refer her to physical therapy, one of the few things shown to be truly helpful for low back pain.

No dice. She insisted on an MRI just to be sure.

A test like that wasn't warranted, in my opinion, because it would neither change her treatment nor the course of this first-ever bout of back pain.

She would just get better.

Dr. Mike Evans/YouTube

To convince her of this, I had to resort to my secret weapon: I showed her an 11-minute educational video created by Dr. Mike Evans of Toronto.

You may be familiar with Evans' work, even if you've never heard of him. He's the man behind the famous "23 1/2 Hours" whiteboard video that says the single-best move for health is being active for a half-hour or so a day. The video became a viral Internet sensation, racking up millions of page views, and even a shoutout on the hit TV show Orange Is the New Black.

Evans is passionate about making complex medical ideas simple. He and his team have made more than a dozen whiteboard videos on health topics including how to deal with stress, acne, quitting smoking and even flatulence.

"I'm looking for topics that affect a wide range of people, and are generally ignored by the health care system," Evans told me. Themes common to Evans' work include the importance of good daily habits and having a resilient attitude. He touts the importance of basics: walking, healthful relationships, avoiding stress and sleeping well.

In Evans' video about lower back pain, he cites a study in which 98 healthy volunteers got MRI scans. Two-thirds of the MRIs revealed some funky looking discs, even though the people felt fine.

Just because a scan shows something doesn't mean there's a real problem. In fact, there's a surprising lack of correlation between back imaging and how someone feels and gets around. Evans also points out that the most common mistake with low back pain is to stop being active. The other common problem is worrying that the pain will never get better.

Evans, who is 50, teaches us that back pain is something we're all vulnerable to and for which it makes sense to have a coping strategy ready.

Has Evans, who still plays hockey, ever had back pain? "I'm a member of the 90 percent club," he affirmed, meaning that like the vast majority of us, he's both had back pain and that it has improved on its own.

Fortunately for my patient, she wound up in the same club. At her next visit, she smiled and reminded me of the video's punch line: "Movement is medicine."

All of which is to say that the longer I practice medicine, the more convinced I'm becoming that less is often more.

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

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

As New York Embraces HIV-Preventing Pill, Some Voice Doubts

NPR Health Blog - Sat, 07/19/2014 - 10:29am
As New York Embraces HIV-Preventing Pill, Some Voice Doubts July 19, 201410:29 AM ET Listen to the Story 4 min 11 sec   i i

Truvada has been around for a decade as a treatment for people who are already HIV-positive. In the last few years, it has also been shown to prevent new infections, and New York officials are embracing the pill as a way to prevent the spread of AIDS.

Justin Sullivan/Getty Images

AIDS researchers and policymakers from around the globe are gathering in Melbourne, Australia, for a major international conference that starts this Monday. They'll be mourning dozens of colleagues who died in the crash of Malaysia Airlines Flight 17.

But the work of the conference will continue, and one of the major topics to be discussed is expanding the use of a pill that prevents HIV.

The drug, Truvada, has been shown to be highly effective at preventing new infections. Public officials in New York are ramping up efforts to distribute the pill widely — but not everyone thinks that's a good idea.

Truvada has been around for a decade as a treatment for people who are already HIV-positive. It's only in the last few years that it's also been approved to prevent transmission of HIV.

That's why Damon Jacobs, an HIV-negative therapist in New York City, is taking it: "I had been newly single after being in a relationship for seven years, and found that people were not using condoms in 2011 the way they had been in 2001," he says.

Jacobs started taking Truvada three years ago for pre-exposure prophylaxis — also known as PREP. Since then, Jacobs says, he no longer uses a condom every time he has sex, but he's not worried about getting HIV.

“ We're trying to do education and give options to people in terms of staying safe. For some people, condoms are that. For some people, monogamy is that. But for some people, the only answer that's going to work right now is PREP.

"I didn't fully understand what it meant to live in fear every time I had sex," Jacobs says. "And it wasn't until about a year after I was using PREP that I had the experience of pleasurable intimacy, and realized: I'm not afraid anymore."

Studies have shown that Truvada can be more than 90-percent effective against the transmission of HIV, as long as it's taken every day. The drug has been approved for PREP by the FDA and endorsed by the Centers for Disease Control and Prevention.

At New York's Gay Pride parade last month, Gov. Andrew Cuomo announced that his state will be the first to make Truvada part of its ambitious plan to cut new HIV infections.

"The state of New York ... in many ways was ground zero of the HIV and AIDS crisis when it first started," Cuomo said. "I think it's fitting that New York should then be the state that is the most aggressive in eradicating this disease, in actually ending this disease."

Michael Weinstein, president of the AIDS Healthcare Foundation and a prominent critic of Truvada, calls this "a very dangerous experiment."

“ If people are taking this medication, they're definitely not going to use condoms. And if they're not taking it regularly, they're not going to be protected when they think they are ... We can do harm by telling people that you can pop this pill.

Weinstein points out that Truvada only works when you take it almost every day. He's worried about what will happen to those who don't.

"If people are taking this medication, they're definitely not going to use condoms. And if they're not taking it regularly, they're not going to be protected when they think they are," Weinstein says. "We would have many, many more infections in this country — particularly among men who have sex with men — if no one was using condoms. And we can do harm by telling people that you can pop this pill."

But public health officials in New York say that pill could be key to cutting the number of new HIV infections — a number that has held roughly steady for the past decade. Daniel O'Connell, who directs the AIDS Institute at the New York State Department of Health, says it's time to consider new approaches.

"We're trying to do education and give options to people in terms of staying safe. So for some people, condoms are that. For some people, monogamy is that," O'Connell says. "But for some people, the only answer that's going to work right now is PREP."

Additional Information: More On Truvada Shots - Health News FDA Approves First Drug To Prevent HIV Infection Shots - Health News Deciding On Truvada: Who Should Take HIV Prevention Pill? Shots - Health News Guideline Is No Guarantee Insurers Will Pay For Pill To Prevent HIV

Truvada is not the cheapest option. The drug costs $1,300 a month, though it is covered by most insurance plans and Medicaid. But those who are most at risk of getting HIV often have limited access to health care.

Perry Halkitis, a professor at New York University, says, "I will believe that PREP is truly going to be effective in the gay community if it gets in the hands of those who need it most in the gay community: young, black, gay men. And I have no evidence to suggest that it's getting there right now."

So far, the number of people anywhere taking Truvada for PREP seems to be small: just a few thousand nationwide. Prominent AIDS activist Larry Kramer, a co-founder of the Gay Men's Health Crisis, has publicly questioned why anyone would want to put "poison" into their body when they could wear a condom instead.

But public health officials like O'Connell say the side effects are minor — especially compared to the potential benefits.

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

Health Safety Experts Call For Public Reporting Of Medical Harms

NPR Health Blog - Fri, 07/18/2014 - 12:20pm
Health Safety Experts Call For Public Reporting Of Medical Harms July 18, 201412:20 PM ET i i

"We can't continue to have unsafe medical care be a regular part of the way we do business in health care," said Harvard School of Public Health's Dr. Ashish Jha at a Senate hearing Thursday.

AP Shots - Health News Independent Grades For Hospitals Show Quality Could Be Better Shots - Health News Online Doctor Ratings About As Useful As Those For Restaurants

The health care community is not doing enough to track and prevent widespread harm to patients, and preventable deaths and injuries in hospitals and other settings will continue unless Congress takes action, medical experts said Thursday on Capitol Hill.

"Our collective action in patient safety pales in comparison to the magnitude of the problem," said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine. "We need to say that harm is preventable and not tolerable."

Dr. Ashish Jha, a professor at the Harvard School of Public Health, said patients are no better protected now than they were 15 years ago, when a landmark Institute of Medicine report set off alarms about deaths caused by medical errors and prompted calls for reform.

"We can't continue to have unsafe medical care be a regular part of the way we do business in health care," Jha said.

One of the biggest problems, the experts told the Senate Subcommittee on Primary Health and Aging, is that providers and public health agencies still are not accurately measuring the harm.

Sen. Bernie Sanders, I-Vt., the panel's chairman, said afterward that most patients probably don't know that preventable patient harm is the third-leading cause of death in America. He said the problem hasn't received the attention it deserves in the public arena or from lawmakers.

Jha said it is crucial to develop better metrics to produce credible data about harm that is valid and credible. Without data, providers don't know how they're doing or if quality improvement efforts are working, he said.

Pronovost and Jha called for requiring the Centers for Disease Control and Prevention, which already collects data about hospital-acquired infections, to begin tracking other patient harms.

Dr. Tejal Gandhi, president of the National Patient Safety Foundation, said studies show that medication errors, adverse drug events and injuries due to drugs occur in up to 25 percent of patients within 30 days of being prescribed a drug.

Missed and delayed diagnosis is also a problem, and a primary cause of malpractice lawsuits in the outpatient setting, she said. Systems need to be put in place to monitor patient care instead of simply relying on doctors to get it right, Gandhi said.

"We cannot just tell clinicians to try harder and think better," Gandhi said.

The title of the hearing, "More Than 1,000 Preventable Deaths a Day Is Too Many: The Need to Improve Patient Safety," was inspired by a study by John James, a scientist and patient advocate whose son died because of a string of medical errors.

James' recently published study estimated that preventable harm in hospitals contributes to as many as 400,000 deaths a year.

James suggested that lawmakers establish a National Patient Safety Board — similar to the National Transportation Safety Board — to investigate patient harm. He also proposed a national patients' bill of rights that would contain protections similar to those for workers and minority groups.

Lisa McGiffert, director of the Consumers Union Safe Patient Project, urged the legislators to ensure there is more meaningful public reporting of the harm to patients, so consumers can make informed choices and providers will be motivated to improve.

Like this story? ProPublica's ongoing investigation into patient safety has highlighted many of the issues. Check out ProPublica's Facebook group and online questionnaires for patients and providers.

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

Half Of Texas Abortion Clinics Close After Restrictions Enacted

NPR Health Blog - Fri, 07/18/2014 - 11:01am
Half Of Texas Abortion Clinics Close After Restrictions Enacted July 18, 201411:01 AM ET

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Texas gubernatorial hopeful and state Sen. Wendy Davis came to prominence when she opposed legislation restricting abortions. The bill eventually became law and is now blamed for the closure of abortion clinics across the state.

LM Otero/AP

In a little over a year, the number of clinics that provide abortions in Texas fell to 20 from 41, and watchdogs say that as few as six may be left by September.

Many clinics closed because of a requirement that doctors at those clinics obtain hospital admitting privileges within a certain radius of the clinic, and many doctors couldn't comply. The requirement took effect last November. This week marks the first anniversary of the state law that started it all.

Bitter fighting over the law last summer propelled state senator Wendy Davis into the national spotlight, and she is now running for Texas governor on the Democratic ticket.

"We're seeing delays," said Heather Busby, executive director of NARAL Pro-Choice Texas. "We're seeing people being pushed further into pregnancy, having to leave the state, having to drive and sleep in their cars in parking lots because of these barriers to access."

The last restriction under the law goes into effect Sept. 1. All clinics that provide abortions at that point must have upgraded their facilities to ambulatory surgery centers. Busby says many can't afford it and more will close.

"This would basically force all the clinics to become mini-hospitals," Busby said. "They have to have hallway widths a certain length, and a janitor's closet, male and female locker rooms, which is completely unnecessary — and a bunch of other regulations that are really not appropriate or do anything to increase the safety of one of the safest procedures in the country."

Supporters of the law said it would protect women by making abortion safer. At the time of the law's passage, The Texas Tribune quoted Republican state Sen. Donna Campbell saying, "There's nothing in this legislation that will close a clinic. ... That's up to the clinic. If they want to put profit over a person, that's up to them."

Busby said abortion is already one of the safest office-based medical procedures, with a complication rate of less than .05 percent.

Busby predicted that after September only six or eight places will be left in Texas to get an abortion, unless a lawsuit stops the new requirement from going into effect. Whole Woman's Health is part of that lawsuit. The group previously had six reproductive health clinics in Texas but had to close two of them over the past year, Busby said.

It may have to close an additional three clinics that don't meet the new surgical center specifications, in Fort Worth, Austin and San Antonio. It would be left with just one, in San Antonio, that meets the new requirements.

Busby noted there are now no clinics that provide abortions in all of East Texas or in the Rio Grande Valley. She said the one clinic left in El Paso could close soon.

In Houston, the newly built headquarters of Planned Parenthood Gulf Coast does fulfill the ambulatory surgical center requirements, so it will remain open. But the status of smaller clinics remains unclear.

A call and email to Texas Right to Life for comment was not returned.

This story is part of a reporting partnership including NPR, Houston Public Media and Kaiser Health News.

Copyright 2014 KUHF-FM. To see more, visit http://www.houstonpublicmedia.org.
Categories: NPR Blogs

Head Scientist At CDC Weighs Costs Of Recent Lab Safety Breaches

NPR Health Blog - Fri, 07/18/2014 - 3:36am
Head Scientist At CDC Weighs Costs Of Recent Lab Safety Breaches July 18, 2014 3:36 AM ET Listen to the Story 5 min 2 sec  

The CDC's director, Tom Frieden, testified before a congressional subcommittee Wednesday regarding a recent anthrax incident and lab safety improvements he is instituting.

AFP/Getty Images

The director of the Centers for Disease Control and Prevention is on the hot seat.

“ We need to take a hard look at the risks and the benefits of the different types of research that are being done and make sure in every case that the benefits justify ... potential risks.

It all started in mid-June, when the CDC announced that dozens of its scientists might have accidentally been exposed to anthrax.

Since then, a number of other security risks in and via national laboratories have come to light: Ordinary flu virus was unknowingly contaminated with the deadly bird flu virus (sent from a CDC lab); vials of smallpox virus were found forgotten in a National Institutes of Health storage room; and just this week the FDA revealed that forgotten vials of other potential bioterrorism agents were discovered in the same storage room where the smallpox samples turned up.

These lapses, occurring in some of the nation's top government-run facilities, left many to wonder whether the CDC, which is charged with protecting the public from natural and man-made health threats, is capable of shielding Americans from the risks posed by its own research.

Under questioning by lawmakers on Wednesday, the CDC's director, Dr. Tom Frieden, testified that these errors represent a larger pattern of unsafe practices in government laboratories that must change.

This week Frieden sat down with NPR's Morning Edition host David Greene to discuss these breaches and what new steps are being taken to ensure the safety of lab workers and the public. Following are highlights of the conversation.

On the CDC's response to the anthrax and bird flu incidents

I've imposed a moratorium on transfer of all infectious or potentially infectious material out of all of our high containment labs until we trust but verify that they're changing their protocols. ... I've closed the individual labs associated with the two incidents and they won't reopen until we are certain that they can reopen safely. I've appointed a senior scientist to be the single point of accountability and we're going to work at every level of CDC to increase the culture of safety here.

On how the CDC is working to improve the safety of its labs

One of the things that we want to ensure in the strengthening of the culture of safety is that people understand that anytime there might be a problem — or there is a problem — report it, rather than try to figure it out first and then report it. CDC scientists are rightly famous around the world for being the top in the world in their field, and that same rigor that we've been applying to finding and stopping outbreaks — that's the rigor we are now applying to improving safety at CDC.

On how the CDC currently regulates labs that work with dangerous pathogens

Scientists don't regulate themselves. We currently have a select agent program run by both a separate division of CDC and the Agriculture Department's Animal and Plant Health Inspection Service. These two agencies ... oversee all entities that work with select agents. We make unannounced site visits; we have detailed reviews. We'll look at whether these incidents suggest that we should do other things in addition at those.

On whether we should establish an independent oversight team to regulate CDC facilities

We're certainly open to anything that will improve lab safety. One of the things that I will be doing this week is inviting an external advisory group that has no prior employment with CDC to ... look at what we are doing on lab safety and biosecurity and suggest any ways that we can improve that process.

One thing that all three of these incidents suggest is that we need to take a hard look at the risks and the benefits of the different types of research that are being done and make sure in every case that the benefits justify ... potential risks.

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

Hey, Miss Idaho, Is That An Insulin Pump On Your Bikini?

NPR Health Blog - Thu, 07/17/2014 - 2:49pm
Hey, Miss Idaho, Is That An Insulin Pump On Your Bikini? July 17, 2014 2:49 PM ET i i

Miss Idaho Sierra Sandison, shown here in her home town of Twin Falls, Idaho, decided not to hide the insulin pump she wears to treat Type 1 diabetes during the pageant.

Photo illustration by Drew Nash/Courtesy of Times News i i

"Honestly, it is terrifying walking out on stage in a swimsuit, let alone attached to a medical device," Sandison wrote on Facebook.

Susan Hessing Photography

There she is, Miss Idaho. And there it is, the insulin pump attached to her bikini bottom during the swimsuit competition. Since posting the photo on social media on Monday, Sierra Sandison has become a new hero to the Type 1 diabetes community.

One mother wrote on Facebook, "You changed my 11-year-old daughter's summer! She's been so self-conscious, but since she read about you and saw this photo, she cannot wait to wear a bathing suit tomorrow and show off her insulin [pump] and have me post a photo here!"

And that woman is not alone. As of Thursday afternoon, the photo has received more than 4,000 "likes" and over 2,500 "shares" on Facebook. Twitter users are responding to the hashtag she created, #showmeyourpump, with their own pump photos.

Insulin pumps ease diabetes control in many ways, but wearing one is a personal choice. People with Type 1 diabetes can also use multiple daily injections to control the condition. In her blog, Sandison, 20, of Twin Falls, Idaho, says that she used injections when she began competing in pageants because "I didn't want people to see a weird-tubey-machine-thing attached to me all the time, and could not wrap my head around having a medical device on my body for the rest of my life."

What changed her mind for the Miss Idaho pageant on July 12th? Hearing about Miss America 1999, Nicole Johnson, who also wore an insulin pump during the competition, although not visibly. Sandison writes, "Miss America 1999 has an insulin pump, and it doesn't make her any less beautiful. In fact, in my mind, it enhances her beauty!"

Johnson, who has continued her diabetes advocacy since her reign, tells Shots, "I think diabetes technology has become more socially acceptable because of the dominance of social media and our 'selfie' culture." She adds: "Our culture seems to be more accepting today, as opposed to when I was diagnosed in 1993."

Indeed, medical device-wearing "pride" appears to be a trend. Amputees are increasingly using visible prostheses rather than covering them up. And the ostomy community has its own version of the "show me" campaign.

On Facebook, Ms. Sandison also received thanks from two parents of kids who wear other medical devices: hearing aids and a feeding tube.

As an insulin "pumper" myself, I can attest to the hesitancy to wear a visible medical device – I resisted for years before deciding to use the pump in 2007. But now I wear it proudly. It's really fun for me to randomly run into another "pumper" on the street and strike up a conversation as if we were old friends. And in fact, that happens fairly often.

Johnson agrees. "It seems that insulin pumps and diabetes devices are now a symbol of community," she told me. "It is becoming more and more common to see them widely displayed, because of the opportunity that brings for connection to others. In the diabetes community, we use the visibility of our devices as a badge of courage and a connector. There is a pride in successfully managing the condition and surviving. One hundred years ago there were no survivors of Type 1 diabetes."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Young Scientists Say They're Sexually Abused In The Field

NPR Health Blog - Thu, 07/17/2014 - 10:26am
Young Scientists Say They're Sexually Abused In The Field July 17, 201410:26 AM ET

Many young scientists dream of their first trip to a remote research site — who wouldn't want to hang out with chimps like Jane Goodall, or sail to the Galapagos like Charles Darwin, exploring the world and advancing science?

But for many scientists, field research can endanger their health and safety.

In a survey of scientists engaged in field research, the majority — 64 percent — said they had personally experienced sexual harassment while at a field site, and 22 percent reported being the victim of sexual assault.

Most of the people reporting harassment or assault were women, and the vast majority were still students or postdocs.

And for female victims, the perpetrator was more likely to be a superior, not a peer. "This is happening to them when they are trainees, when they are most vulnerable within the academic hierarchy," says evolutionary biologist Katie Hinde, an author on the study published Wednesday in PLOS ONE. Hinde and her colleagues say this could be a factor in the large number of women who enter scientific fields but don't continue.

The Two-Way Campus Sexual Assaults Are Targeted In New White House Report

A total of 666 scientists, primarily in the fields of anthropology and archaeology, completed the voluntary Internet survey. And while the results do not reflect the true prevalence of sexual abuse in field research — this type of survey is not designed to measure that — the numbers are still alarming.

While sexual violence can occur in all workplaces — roughly 50 percent of women report experiencing sexual harassment at some point in their careers — Hinde says the particular nature of field sites, where researchers are far from home, and the lines between work life and personal life are blurred, may make them more prone to this type of wrongdoing.

But in the survey, fewer than half of respondents recalled ever having encountered a code of conduct or sexual harassment policy at their field sites.

"People are being told 'what happens in the field stays in the field,' " says biological anthropologist Kathryn Clancy, who led the survey team.

NPR News Investigations Campus Rape Reports Are Up, And Assaults Aren't The Only Reason

Many academic sciences have a problem retaining women. Though they enter the disciplines in high numbers, many leave before they reach the postdoctorate or professor level. The lack of role models and mentors and professional demands that leave little time for family life have been cited as reasons.

"One of the things that is not discussed out loud very much is how sexual harassment and sexual assault play into this problem," says Hinde.

Psychologist Rebecca Campbell, who studies the effect of sexual harassment on communities, says that while all workplace harassment is harmful, it can be particularly damaging when coming from a superior.

Gender Imbalance in Academic Science

She also says these findings should be incorporated into the broader discussion about campus sexual harassment and violence.

"The cultural narrative is that this is two drunk college kids in a dorm room, and we are seeing now that sexual assault is occurring as part of the core curriculum," says Campbell.

While both Hinde and Clancy say that it was difficult to parse so many stories of wrongdoing perpetrated by and against their colleagues, they hope the results spur scientific communities to come together in search of a solution.

"As horrifying as this data is, I'm really excited to have it out there," says Clancy. "Every person who has had this experience will be validated and know there are others out there who have their back. If this keeps just one more woman in science, it is absolutely worth it."

Editor's note:

July 21, 2014 A previous version of this story was illustrated with a file picture of an archaeological site in the United Kingdom. NPR did not intend to suggest that there are links between the content of this story and this archaeological site or the institution that organizes it.

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

Skimping On Sleep Can Stress Body And Brain

NPR Health Blog - Thu, 07/17/2014 - 3:31am
Skimping On Sleep Can Stress Body And Brain July 17, 2014 3:31 AM ET Listen to the Story 4 min 48 sec   Maria Fabrizio for NPR

"The lion and calf shall lie down together," Woody Allen once wrote, "but the calf won't get much sleep."

That's pretty much the connection between stress and sleep, researchers say, and NPR's own numbers suggest the same thing. In our recent poll on stress in America, conducted in conjunction with the Robert Wood Johnson Foundation and the Harvard School of Public Health, about 70 percent of those who reported experiencing a great deal of stress in the previous month also said they had trouble sleeping.

"Under stressful circumstances, and when people are haunted by life, they cannot sleep very well," says the University of Pittsburgh's Martica Hall.

“ Sleep isn't a timeout. Everything — all the sadness, all the fears, all the angst that you have — follows you into sleep.

And no wonder. When you're feeling stressed, Hall says, your body marshals its famous fight-or-flight response. Stress hormones, such as cortisol and adrenalin, are pumped out, your heart rate goes up, sugar is released into the blood, and more blood is sent to your brain and muscles. Hall says it's really hard to stay asleep through all that biological activity. She has found, for example, that cortisol — which surges to deal with that deadline or cope with that car payment — stays elevated throughout the night. So, even if you're sound asleep, cortisol is constantly nudging your brain to wake up, deal with danger — real or perceived.

"Daytime stress follows you into the night," Hall says.

Mareba Mack, a 42-year-old Air Force veteran who is now an education specialist with the Department of the Navy, says she typically wakes up four to six times a night. She'll fall asleep quickly and soundly, but be wide awake and worried a couple of hours later.

"I'm typically consumed with a thought or an idea of what I need to do," she says. "They can be work-related, or personal or just a litany of things."

Often it's a litany of stressful events. Mack recently moved from her home in Florida up to Washington, D.C. She's also a single mother of a 7-year-old with cerebral palsy. Mack feels up-rooted, anxious about her daughter, worried about work.

Shots - Health News This Is Your Stressed-Out Brain On Scarcity

"I'll sleep for a couple of hours, and then I'll wake," she says, "then sleep a couple of hours, and then I wake."

Throughout the night. Night after night.

This kind of interrupted sleep prevents a stressed person from ever feeling well-rested.

"It's not like sleep is a timeout," Hall says. "It isn't a timeout. Everything — all the sadness, all the fears, all the angst that you have — follows you into sleep."

All adults, whether stressed or not stressed, typically wake up multiple times in a night, each time very briefly. Scientists call these moments "mini-arousals." Unstressed people go right back into deep sleep in a matter of two or three seconds. But people who report feeling lots of stress have mini-awakenings that last much longer, Hall has discovered — sometimes many minutes longer.

Most adults need between seven and eight hours of sleep every night, says Harvard Medical School's Charles Czeisler, who is chairman of the board of the National Sleep Foundation. Any less than that (if it happens regularly) is a "sleep deficiency," Czeisler says. And when we're not sleeping well, that deficiency follows us right into the next day, making it hard to handle the slings and arrows that come our way.

"The exhaustion associated with that places a physiologic burden on us," Czeisler says, "and we actually are much less resilient."

A woman I met named Amanda (she doesn't want us to use her last name because she's worried about her job) feels that burden every day. She's 34, the mother of a toddler and an infant, and gets up at 5 a.m. each day for a long commute to a full-time job as a social worker helping vets find housing in San Francisco.

"It's very rough," she says. "I've missed a lot of work because of lack of sleep." You can hear the distress in her voice. The lack of sleep, she says, makes her not only exhausted but forgetful, moody, overwhelmed.

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Some mornings, she says, after only two or three hours of sleep, "I'd wake up and my hands are shaking — and I know I can't do it."

Researchers do have some practical suggestions to help: Go to bed and get up at the same time every night, even on weekends. This will train your brain's biological clock to release the sleep hormone, melatonin — key to us getting that seven or eight hours we need.

And get all the gadgets — cellphones, computers, TV — out of the bedroom. The short-wave light that these screens emit suppresses melatonin.

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

Patients With Low-Cost Insurance Struggle To Find Specialists

NPR Health Blog - Wed, 07/16/2014 - 4:11pm
Patients With Low-Cost Insurance Struggle To Find Specialists July 16, 2014 4:11 PM ET

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Listen to the Story 4 min 53 sec   i i

Dr. Charu Sawhney examines patient Mang Caan. Sawhney supports the Affordable Care Act, but has been frustrated by how difficult it is to find specialists who accept some of the plans her patients bought.

Carrie Feibel for NPR Shots - Health News So You Found An Exchange Plan. But Can You Find A Provider?

The Hope Clinic in southwest Houston is in the very heart of Asia Town, a part of the city where bland strip malls hide culinary treasures — Vietnamese pho, Malaysian noodles, Sichuan rabbit and bubble tea.

Inside the clinic, internist Charu Sawhney sees patients from many countries and circumstances. She's a big believer in the Affordable Care Act since most of her patients have been uninsured. She actively pushed many of them to sign up for the new plans.

But now she's seeing something she didn't expect. When patients need treatment unavailable at the clinic, it's been hard to find specialists and hospitals that accept the insurance.

"I was so consumed with just getting people to sign up," she says, "I didn't take the next step to say 'Oh, by the way, when you sign up, make sure you sign up for the right plan.' "

Understandably, a lot of her patients picked lower-cost plans, she says, "and we're running into problems with coverage in the same way we were when they were uninsured."

One of her patients is a Chinese immigrant to Houston who purchased a Blue Cross Blue Shield HMO silver plan. Soon after, he was diagnosed with stomach cancer. Sawhney found an oncologist to coordinate his treatment, but she and the oncologist ran into trouble trying to schedule chemotherapy and radiation. "The process just isn't as easy as we thought it would be," she says.

That's because the two largest hospital chains in Houston, Houston Methodist and Memorial Hermann, are not in that plan's network. Neither is Houston's premier cancer hospital, MD Anderson Cancer Center.

Those are the hospitals that the patient's oncologist, Paul Zhang, calls on the most. He says coordinating surgery or radiation usually isn't a problem, because most of his patients have insurance plans with wide networks.

"I could not find a surgeon," says Zhang. Eventually Zhang found one who took the insurance, though they'd never worked together. After the surgery, Zhang tried to set up the patient's chemotherapy and radiation at Houston Methodist. But that hospital wasn't taking the plan.

Zhang says he cannot refer patients with these narrow plans to the specialists he thinks are best, and that's a problem if the cancer is particularly complicated.

"You have limited options. So you're like a second-class citizen, you know. That's my feeling, you have this insurance and you cannot see certain doctors," he says.

Sawhney was less surprised by the barriers. Medicaid patients have similar problems finding doctors, and her uninsured patients have always struggled to find care. But she thought the Affordable Care Act would be an improvement.

Her patient with stomach cancer thought so too. He asked not to be identified because he has not shared his diagnosis with close family members.

"The (insurance) agent said that a lot of doctors will accept that insurance but when I got sick I found out nobody wants that kind of insurance."

The biggest irony, she added, is that even Harris Health, the county-wide public hospital system in Houston, doesn't take all the new marketplace plans. Yet Sawhney can still send uninsured patients there for cancer treatment. As people learn that some doors are closed, she worries people will decide insurance isn't worth the money.

"I don't want patients to get discouraged," she says. "I don't want patients when they have a choice again to say, 'You know what? I'm just not going to sign up because it doesn't matter if I have insurance or I don't have insurance, I still have problems getting health care.' "

Narrow networks of doctors and hospitals aren't new, but they've attracted attention with the rollout of the Affordable Care Act. Analysts point out that narrow networks are a powerful tool for insurance companies seeking to control costs – especially since they can no longer control costs by excluding sick people or adjusting premiums by gender or age.

By restricting the choices in a plan, the insurer can promise more customers for the doctors and hospitals that are included. In exchange, the insurers can get a break on what they pay those doctors and hospitals.

The industry's position is that patients have choices. Plans with access to more hospitals and specialists are available, but usually at a higher price.

Louis Adams is a spokesperson for Blue Cross Blue Shield of Texas. "Our goal was to offer an array of plan choices," he says. "We created more focused networks as a way to offer a broad range of plans with lower premium prices."

Sawhney and Zhang eventually found a place for the patient to get chemotherapy and radiation.

Despite the delays and difficulties, Sawhney still believes it's better to have insurance, and she still believes in the law. But, she says, from now on she'll tell her patients to shop more carefully, taking into account price and whether they have a chronic illness. It won't be about the cheapest plan anymore, but rather the plan that best meets their medical needs.

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

Copyright 2014 KUHF-FM. To see more, visit http://www.houstonpublicmedia.org.
Categories: NPR Blogs

Dialing Back Stress With A Bubble Bath, Beach Trip And Bees

NPR Health Blog - Wed, 07/16/2014 - 10:57am
Dialing Back Stress With A Bubble Bath, Beach Trip And Bees July 16, 201410:57 AM ET NPR/YouTube

Standing in the middle of a swarm of bees might not be your idea of stress relief, but it works for Ray Von Culin. He's a beekeeper in Washington, D.C., and he says caring for bees is one of the most relaxing things in his life.

We ran into Von Culin as we were canvassing the National Mall, microphones in hand, asking people how they deal with stress. The responses ran the gamut: from bubble baths to recreational drug use, from "staring at candles" to "hiking the entire Appalachian Trail."

Everyone had some sort of answer for us. Everyone — regardless of age or origin — had a strategy for getting rid of stress.

Of course, scientists are quick to point out that banishing stress entirely would be a big problem. "Our bodies respond to stress in order to literally keep us alive," says Bruce McEwen, head of the neuroendocrinology laboratory at Rockefeller University.

Stress raises our heart rate and ramps our immune systems to prepare for injury and danger. "The problem is if we don't turn those responses off efficiently when the danger is over ... they can cause damage," McEwen says.

So how do people turn off their stress response? We heard from a few people out on the National Mall, but we also took a more rigorous scientific approach. NPR teamed up with the Robert Wood Johnson Foundation and the Harvard School of Public Health to ask more than 2,500 Americans about the ways they relieve stress.

Socializing topped the list of stress reducers for those dealing with a great deal of stress, with about 7 in 10 respondents saying they spend time with family and friends to deal with stress. Just under 6 in 10 said they regularly prayed or meditated. And about half of respondents also tried exercising, eating healthful food and playing with pets.

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According to the poll, spending time outdoors wasn't the most popular chill pill, but it was the most powerful for those with a high level of stress. Ninety-four percent of those who spent time outdoors said it was an effective way to reduce stress. That rang true for the people we met on the National Mall. They mentioned trips to the ocean, naps by a lake and watching the leaves change color in the fall.

Only 46 percent of those surveyed said they pursued a hobby to try to relieve stress, but 93 percent of those who did said it was effective. Many on the Mall endorsed the calming power of hobbies including beekeeper Von Culin.

We handed his answer (and a few of our other favorites) over to animator Avi Ofer. He brought their anecdotes to life in the video at the top of this page.

We hope it inspires you to find new ways to beat the stress in your life. And don't worry. Not all of the stress-relief strategies in the video involve stinging insects.

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

Coping With A Co-Worker's Body Odor Takes Tact

NPR Health Blog - Wed, 07/16/2014 - 3:27am
Coping With A Co-Worker's Body Odor Takes Tact July 16, 2014 3:27 AM ET Listen to the Story 3 min 52 sec   i i

We can all work up a stinky sweat — welders, ballerinas and number-crunchers alike. Would you want to know?

emreogan/iStockphoto

It's summer. It's sweaty. And sometimes that means people are trailing some pungent body odors that their colleagues can't help but smell. But how do you tactfully inform co-workers that they stink and need to address it? As Cath Ludeman-Hall will tell you, it isn't easy.

She was just out of college and a newbie at a staffing firm when she was asked to gently talk to an older worker in a retail warehouse after his colleagues complained that he stank.

“ As a man, his virility, his masculinity was associated with his smell. Are you asking him to redefine who he is to fit into an office environment where he's making $4.50 an hour?

"The company loved him and wanted to hire him permanently," she remembers. "However, he did have a pretty strong body odor issue."

The man was a recent immigrant, Ludeman-Hall remembers — hard-working and earnest. Twenty years later, she still remembers the details. She brought a kit of deodorant and soap to offer him. In addition to overcoming her own mortification, she says, she also had to bridge a difference in how his culture regarded sweat.

"As a man, his virility, his masculinity was associated with his smell," she says. "Are you asking him to redefine who he is to fit into an office environment where he's making $4.50 an hour?"

She figured out an acceptable way to frame the issue; the man apologized, complied and was eventually hired.

A global workforce just complicates matters, says Steve Fitzgerald, vice president of human resources for Avaya, a telecom software firm with offices worldwide.

"There are personal hygiene standards in all societies," Fitzgerald says, "and there are times when people deviate from those standards. And when those deviations occur, then I think you enter into that moment where, as an H.R. professional, you groan, and you go, 'Oh, God, I've to go have that conversation.' "

Be Direct, Compassionate And Discreet

That conversation can be triggered in any number of ways. Some people develop odors from eating spicy foods; some don't wash their hair often. "We have a lot of older workers in the workforce nowadays, and sometimes incontinence can be an issue," he says. "Bad breath."

Margaret Fiester, a director of the Knowledge Center at the Society for Human Resource Management, says her group fields a couple of calls every week from human resources professionals asking how to broach the body odor issue. She advises discussing it in private, being direct and showing compassion for the offender.

But really, Fiester says, the people calling in often need their own moral support. For them, she says, "This is sort of like a rite of passage, almost."

I asked her where this topic ranks in the pantheon of embarrassing talks, and she says she ranks it "probably No. 1 or No. 2."

Fiester speaks from experience. Years ago, she had the talk with a welder working in a hot manufacturing plant in Alabama, who was really embarrassed. "I thought he was going to cry," she says. "I think I was going to cry."

Several Showers A Day Couldn't Eliminate The Odor

But imagine what it's like to be on the receiving end of such a talk. Jennifer LaChance struggled with severe body odor brought on by anxiety since her teen years.

"I could take several showers a day and still have some degree of odor," she remembers.

Deodorants, soaps and medication didn't solve it. LaChance says she abandoned dreams of becoming a teacher, because she couldn't bear the thought of sidling up to parents at teacher conferences. Instead, she went to work at an insurance firm. She says she tried being open with co-workers and supervisors about her medical issue. Still, emails from HR started to circulate in the office, imploring colleagues to address their body odor.

"After that email circulates," LaChance says, "you've got a hundred eyeballs zeroed in on you. There's nothing that feels more hostile or more devastating than that."

LaChance felt deeply embarrassed, immediately left work and resigned days later.

"I just felt like, wow, there's no place for me," she says. "I never want to walk into an office again. I don't want to be an offensive person to anybody."

Now, she says, she's back in school studying medical data management — a job she says she can do largely from home, and avoid having body odor be an issue for her at work.

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

Want More Stress In Your Life? Try Parenting A Teenager

NPR Health Blog - Wed, 07/16/2014 - 3:27am
Want More Stress In Your Life? Try Parenting A Teenager July 16, 2014 3:27 AM ET Listen to the Story 5 min 18 sec   i i

Amy Myers talks with her son Kamron, 18, in the backyard of their home in Boise, Idaho. She has found raising a teenager to be extremely stressful.

Kyle Green for NPR

If anyone can handle the stress of parenting in the teen years, you'd think it would be a high school teacher.

That's how Amy Myers felt. She teaches high school English in a suburb of Boise, Idaho, where she says she has "pseudo parented" about 3,000 teenagers "who I have talked to, given advice to, guided, directed, even lectured about teenage issues," she says.

So Myers, 41, felt pretty prepared for her own children's teenage years. That is until her oldest son, Kamron, turned 15. Suddenly, their close relationship turned sour. "Everything I demanded, he fought back. Advice? He didn't need it. Conversation? He didn't want it. It was hands down the toughest journey of my life so far, and that is coming from someone who has raised two children alone from day one and has worked for and earned two degrees," she says.

Shots - Health News Stressed Out: Americans Tell Us About Stress In Their Lives

NPR recently conducted a poll with our partners at the Robert Wood Johnson Foundation and the Harvard School of Public Health looking at the extent of stress in America.

We found that about one-third (34 percent) of those who live with one or more teenagers said they'd had a great deal of stress in the past month. Once we saw these results, we wanted to know more about the stories behind these numbers. So we put out a call on NPR's Facebook page. Hundreds of parents wrote to us.

From Marion, Iowa, Ann Brendes, 48, who has two sons, 15 and 17, and a daughter, 11, writes that it's "mind-blowing how stressful having teenagers is."

JoAnn Zeise, who's raising a 14-year-old son and a 12-year-old daughter, says the stress she feels now is a lot different than what she felt when the kids were young. "Once, I controlled the big decisions in their life," says Zeise, 39, who lives in Columbia, S.C. "Now they make decisions that can have drastic consequences. I feel like I am running out of time to teach them the important lessons they need," she writes.

i i

Amy Myers and Kamron, then age 3, in Pocatello, Idaho.

Courtesy of the Myers family

And numerous parents wrote to us about the difficulties of teenage defiance.

When it comes to stress, parenting a teen is "inherently stressful even in the best scenarios," according to David Palmiter, a clinical psychologist, professor at Marywood University in Scranton, Pa., and creator of the blog Hectic Parents.com.

He says it essentially boils down to a teenager's quest for independence. And that is understandably stressful for parents who used to be "driving the bus," he says. Now, he says, there's someone in the back seat saying (or yelling) "No, don't put the blinker on here, take that exit, what are you thinking?"

This constant questioning and challenging can be stressful for parents, of course, but Palmiter says it's actually a healthy part of growing up, and it often means parents are doing everything right.

Amy Myers' son Kamron is 18 now, and headed off to college. But the past three years, she says, have been extremely stressful for a number of reasons. She worried about his driving, about parties, about alcohol and drugs. And there were many late nights for Myers because, like many parents, she just couldn't fall asleep until she knew Kamron was safely home.

And like JoAnn Zeise, her biggest worries even now continue to be about her child's future. She's scared that Kamron might make a mistake that just can't be repaired.

Shots - Health News This Is Your Stressed-Out Brain On Scarcity

"I love this child more than I love myself, and I know what's around the corner and I'm trying to tell him and he's just ignoring me, and I really can't say or do anything about it. I just have to let him experience it and hope and pray that it's not a life-changing mistake," Myers says. Many psychologists say the best parents can do is making sure they have instilled positive values in their children and then just hope for the best.

As for dealing with their own stress, Palmiter suggests parents seek support from other parents, not just about their concerns but also about decisions. He also promotes special "one on one" time with your teenager. This means "being there" completely, cellphone unplugged, talking with your teen or observing them do an activity they enjoy like drawing, shooting basketball or playing an instrument. Just one hour a week of this special time can repair major differences, Palmiter says, and bring much-needed calm to households with teens.

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