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Can Family Secrets Make You Sick?

NPR Health Blog - Mon, 03/02/2015 - 3:02pm
Can Family Secrets Make You Sick? March 02, 2015 3:02 PM ET Laura Starecheski Listen to the Story 8 min 16 sec   Maria Fabrizio for NPR

In the 1980s, Dr. Vincent Felitti, now director of the California Institute of Preventive Medicine in San Diego, discovered something potentially revolutionary about the ripple effects of child sexual abuse. He discovered it while trying to solve a very different health problem: helping severely obese people lose weight.

I remember thinking, 'Well, my God, this is the second incest case I've seen in 23 years of practice.' And so I started routinely inquiring about childhood sexual abuse. And I was really floored.

Felitti, a specialist in preventive medicine, was trying out a new liquid diet treatment among patients at a Kaiser Permanente clinic. And it worked really well. The severely obese patients who stuck to it lost as much as 300 pounds in a year.

"Oh yeah, this was really quite extraordinary," recalls Felitti.

But then, some of the patients who'd lost the most weight quit the treatment and gained back all the weight — faster than they'd lost it. Felitti couldn't figure out why. So he started asking questions.

First, one person told him she'd been sexually abused as a kid. Then another.

"You know, I remember thinking, 'Well, my God, this is the second incest case I've seen in [then] 23 years of practice,' " Felitti says. "And so I started routinely inquiring about childhood sexual abuse, and I was really floored."

More than half of the 300 or so patients said yes, they too had been abused.

Felitti wondered if he'd discovered one of the keys to some cases of obesity and all the health problems that go along with it.

Shots - Health News People With Low Incomes Say They Pay A Price In Poor Health Shots - Health News Poll Finds Factors Large And Small Shape People's Health

That possibility made him very curious: What if having a bad childhood could affect health in other ways?

The idea that childhood abuse and neglect could affect adult health was a revelation to Felitti. But a poll released Monday (from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health) finds that the public widely believes this to be the case today.

How To Measure The Troubles Of Childhood

As he continued to explore the idea in the 1990s, Felitti got together with an epidemiologist named Dr. Rob Anda, who at the time was on staff at the Centers for Disease Control and Prevention. They came up with a set of questions to trace, in a larger group, how tough childhood experiences might affect adult health.

They called their work the study of Adverse Childhood Experiences, or ACE.

Additional Information: NPR

First developed in the 1990s, the 10 questions of the Adverse Childhood Experiences test are designed to take a rough measure of a difficult childhood.

The 17,000 or so patients in this study were mostly middle-aged white people, upper- and middle-class, from San Diego. Felitti and Anda asked them to think back to their childhoods and list how many of 10 different types of adverse childhood experiences they'd had, including sexual, physical or emotional abuse; neglect; loss of a parent due to death, divorce or incarceration; mental illness in a parent; and drug or alcohol abuse by a parent.

The researchers wanted to get a sense of how being exposed to these different categories of adverse experience early in life might affect long-term health. So, on Felitti and Anda's score sheet, having undergone any one of those different categories of trauma or neglect before age 18 would add one point to a person's ACE score. Whether someone had been sexually abused one time, or dozens of times, the experience would count as one point in their study. Being habitually abused, and losing a parent to death, would add up to an ACE score of 2.

Even though Felitti and Anda were just getting a rough measure of the severity of the patients' experiences, when Anda's team at the CDC crunched the numbers, he was shocked.

One in 10 of the patients surveyed had grown up with domestic violence. Two in 10 had been sexually abused. Three in 10 had been physically abused.

"I thought that people would flock to this information, and be knocking on our doors, saying, 'Tell us more. We want to use it.' And the initial reaction was really — silence."

"Just the sheer scale of the suffering — it was really disturbing to me," Anda remembers. "I actually ... I remember being in my study and I wept."

And then came the part where he found out what happened to all those people when they grew up: "very dramatic increases in pretty much every one of the major public health problems that we'd included in the study," he says.

Cancer, addiction, diabetes and stroke (just to name a few) occurred more often among people with high ACE scores.

Now, not everyone who'd had a rough childhood developed a serious illness, of course.

But, according to the findings, adults who had four or more "yeses" to the ACE questions were, in general, twice as likely to have heart disease, compared to people whose ACE score was zero. Women with five or more "yeses" were at least four times as likely to have depression as those with no ACE points.

When ACEs Are Very High

Carol Redding, one of Felitti's patients, answered yes to every single ACE question, and she ended up with an ACE score of 10. Ten out of 10.

Today Redding lives in a tidy, peaceful house outside San Diego. The walls of her home office are lined with degrees and certificates — at age 58, she's working on a Ph.D. From the outside, she's a success.

"An association doesn't necessarily mean that one thing causes the other thing."

But inside — in her body as well as her mind, Redding says — she has been battling all her life.

She was diagnosed with post-traumatic stress disorder, as a result of those childhood experiences. "I had the flashbacks," she says, "the depression, the anxiety — Oh, my lord! Anxiety, like ... if it were a tangible thing living in the house with me, I'd need another room just to house that."

In childhood, she was diagnosed with high blood pressure. In adulthood, she had a thyroid condition and has survived three different types of cancer: leukemia, breast cancer and lymphoma.

Learning about the ACE study and her own results made Redding wonder if all of that — maybe even the cancer — might be partly connected to her troubled childhood. After so many years, all of a sudden, "all those very confused, very scattered puzzle pieces of my life just locked together in one big, amazingly clear picture," she says.

This revelation meant so much to Redding that she started a newsletter about the ACE study and later worked for the CDC, publicizing the study's results.

And she did all that because one big question kept nagging at her: Why didn't more people know about this research?

Medical Community Initially Skeptical

Anda says that when he and Felitti first published their results in the late 1990s, the response from the medical community was frustrating.

"I thought that people would flock to this information," Anda says, "and be knocking on our doors, saying, 'Tell us more. We want to use it.' And the initial reaction was really — silence."

In fact, it took a long time to even get the study published. A number of top medical journals rejected the article, Anda says, "because there was intense skepticism."

Sarah Floud, an epidemiologist at Oxford University in England, says she understands that skepticism and thinks it may still be warranted.

"An association doesn't necessarily mean that one thing causes the other thing," says Floud. She thinks doctors and patients should take care not to overinterpret an ACE score — it's not a crystal ball that predicts health or illness.

Rather, Floud says, this rough indicator of a difficult childhood is just one risk factor in the mix with lots of others, such as your genes, your diet, whether you drink heavily or smoke, for example — factors known to be strongly related to some illnesses, like heart disease, diabetes and cancer.

Shots - Health News Child Abuse And Neglect Laws Aren't Being Enforced, Report Finds

So if you're otherwise healthy, not a smoker or a drinker, and not obese, can childhood trauma alone increase the likelihood of diseases like cancer and heart disease?

Shots - Health News Childhood Maltreatment Can Leave Scars In The Brain

"I don't think there's quite so much evidence for that," Floud says. "But that's not to say that it might not be true. It's just that ... that seems to be harder to prove."

Now, 15 years after the ACE study came out, some scientists are trying to connect the dots — to get a clearer picture of what exactly adverse childhood experiences do to the body and why the study results came out the way they did.

"Well, you've reshaped the biology of the child," says Megan Gunnar, a developmental psychologist at the University of Minnesota who, for more than 30 years, has been studying the ways children respond to stressful experiences. "This is how nature protects us," Gunnar adds. We all become adapted to living in "the kinds of environments we're born into."

And if you have scary, traumatic experiences when you're small, Gunnar says, your stress response system may, in some cases, be programmed to overreact, influencing the way your mind and body work together. Research in animals and people suggests that the part of the mind that scientists call "executive function" — thought, judgment, self-control — seems to be most affected, she says.

"Over time, especially when you're young, experiences of neglect and abuse and stress impair those circuits," Gunnar says. "You're less able to tell yourself not to eat the ice cream, or smoke the cigarette, or have that additional drink. You're less capable of regulating your own behavior. And that seems to be terribly important for linking early experiences with later health outcomes."

This growing body of research indicates that, right now, the health of millions of children is being shaped by abuse and neglect. As they grow up, these children will be more likely than other children to use behaviors like smoking, drinking and overeating to cope with stress.

Preventing childhood trauma in the first place, Felitti, Anda and their proponents now believe, is one of the biggest opportunities to prevent disease — and save billions in health care costs. It's an opportunity, they say, that American medicine and the health care industry still seem to be missing.

This story is part of the NPR series, What Shapes Health? The series explores social and environmental factors that affect health throughout life. It is inspired, in part, by findings in a poll released Monday by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Take The ACE Quiz — And Learn What It Does And Doesn't Mean

NPR Health Blog - Mon, 03/02/2015 - 2:57pm
Take The ACE Quiz — And Learn What It Does And Doesn't Mean March 02, 2015 2:57 PM ET Laura Starecheski

An ACE score is a tally of different types of abuse, neglect, and other hallmarks of a rough childhood. According to the Adverse Childhood Experiences study, the rougher your childhood, the higher your score is likely to be and the higher your risk for later health problems. You can take the test below:

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

So, you've got your score. Now what?

First, remember that the ACE score isn't a crystal ball; it's just meant as guidance. It tells you about one type of risk factor among many. It doesn't directly take into account your diet or genes, or whether you smoke or drink excessively — to name just a few of the other major influences on health.

Shots - Health News Can Family Secrets Make You Sick? Shots - Health News Poll Explores Our Perception Of How Factors Large And Small Shape People's Health

To learn more, check the CDC's ACE Study website. You'll find, among other things, a list of studies that explore the ways adverse childhood experiences have been linked to a variety of adult conditions, ranging from increased headaches to depression to heart disease.

Remember this, too: ACE scores don't tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma. Having a grandparent who loves you, a teacher who understands and believes in you, or a trusted friend you can confide in may mitigate the long-term effects of early trauma, psychologists say.

"There are people with high ACE scores who do remarkably well," says Jack Shonkoff, a pediatrician and director of the Center on the Developing Child at Harvard University.

Resilience, he says, builds throughout life, and close relationships are key. Recent research also suggests that for adults, "trauma informed" therapy — which can center on art, yoga or mindfulness training — can help.

Three Types of ACEs

Source: Centers for Disease Control and Prevention

Credit: Robert Wood Johnson Foundation

How best to find and help kids who are experiencing abuse and neglect right now?

Child psychologist Hilit Kletter, of Stanford University's School of Medicine, says that to spot these children, she looks for visible signs of stress to understand what might have happened to them and how best to intervene. Some kids have nightmares or recurring thoughts of a stressful event, she says, or may re-enact the trauma through play. Or the child may seem distracted or withdrawn.

"This will come out at school," Kletter says. "Teachers will tell parents [their child] seems to be in a daze in the classroom, not paying attention."

ACEs Increase Health Risks

According to the Adverse Childhood Experiences study, the rougher your childhood, the higher your score is likely to be and the higher your risk for various health problems later.

Source: Centers for Disease Control and Prevention

Credit: Robert Wood Johnson Foundation

Kletter says reactions to trauma are sometimes misdiagnosed as symptoms of attention deficit hyperactivity disorder, because kids dealing with adverse experiences may be impulsive — acting out with anger or other strong emotions.

"It's something that's very common in trauma: difficulty in regulating emotions and behavior," she explains. "That's why a lot of these kids get in trouble with the classroom."

Shots - Health News People With Low Incomes Say They Pay A Price In Poor Health

Shonkoff's research center at Harvard tests interventions that can build resilience in kids who are growing up with adverse experiences — not just problems in the family, such as those the ACE study investigated, but also trauma stemming from poverty, for example, or from the chronic stress of racial or gender discrimination.

To bolster parents, the Harvard team is testing interventions right now that use video coaching to show moms and dads how to engage their babbling infants, using sounds and facial expressions in a style Shonkoff calls serve and return.

Shonkoff says these early interactions — a kind of conversation — have been shown to help children with later learning and literacy. Even more important, they boost kids' resilience, by helping them build secure attachments with caring adults. Research suggests that just one caring, safe relationship early in life gives any child a much better shot at growing up healthy.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

People With Low Incomes Say They Pay A Price In Poor Health

NPR Health Blog - Mon, 03/02/2015 - 4:05am
People With Low Incomes Say They Pay A Price In Poor Health March 02, 2015 4:05 AM ET Listen to the Story 6 min 58 sec   Hanna Barczyk for NPR

When you ask people what impacts health you'll get a lot of different answers: Access to good health care and preventative services, personal behavior, exposure to germs or pollution and stress. But if you dig a little deeper you'll find a clear dividing line, and it boils down to one word: money.

Shots - Health News Poll Finds Factors Large And Small Shape People's Health

People whose household income is more than $75,000 a year have very different perceptions of what affects health than those whose household income is less than $25,000. This is one key finding in a poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. One third of respondents who are low income say lack of money has a harmful effect on health.

This is the case for 29-year-old Anna Beer of Spokane, Wash. She lives with her husband in the basement of her father's house. Beer got laid off from her job as a nanny last summer. Now she is attending college in the hope that she will get a better than minimum-wage job when she graduates. Beer's husband earns $10 an hour working at a retail store. "This is probably the most poor we've been," Beer says.

My health is deteriorating and I know what the cause of it is, but I can't fix it.

When she was working, Beer could afford to buy fresh fruits and vegetables and chicken from the local farmer's markets. Now she buys canned and frozen vegetables, which are cheaper but not as healthy.

"They've had preservatives added to them, a lot of times salt that's just not good for you," she says. Poor diet and financial stress have had a huge impact on her health, Beer says. Her migraines are worse and her health has deteriorated. It's frustrating, she says. "I know what the cause of it is, but I can't fix it. It's hard."

Losing a job increased the odds of developing stress related health conditions by 83 percent.

One in 5 people in our poll say they are in a similar position — low paying jobs or unemployment harms their health. And there's research to back this up. Kate Strully, a sociologist at the University at Albany, State University of New York, studied what happened when healthy people were laid off following a plant closing. She found that losing a job increased the odds of developing stress-related health conditions by 83 percent — conditions like stroke, heart disease, diabetes and emotional or psychiatric conditions.

Another social fact that affects health is housing. Forty percent of the low-income people in our poll say bad housing causes bad health. Uzuri Pease-Greene says this is true for her family. She rents a small two-bedroom apartment with her husband, two daughters and a grandchild in a public housing complex in San Francisco. When something breaks, she says it takes years to get it fixed. Ovens don't work, there are holes in the walls, the water doesn't work or there's a sewage backup.

Uzuri Pease-Greene talks with two police officers in the public housing complex in San Francisco where she lives.

Talia Herman for NPR

Then there is the constant stress of the neighborhood. "You have shootings, stabbings and break-ins," Pease-Greene, 49, says. "People with their music up at all times of the night, people arguing, fighting, fussing, people using dope, being drunk." She worries about her 4-year-old granddaughter growing up in this environment.

The impact of childhood experiences on adult health is another surprising finding in our poll. More than any other factor in childhood, people say abuse and neglect contribute to poor health in adults. This is what happened to Daniel, who is 65 years old and lives in San Diego. We agreed not to use his full name because he worries about losing his job.

When he was about 8 years old and his sister was 4, "I walked in to the dining room and my mother was beating my sister with a big old wooden spoon," he says. "My mother's just wailing on her, telling her she's a dirty little girl and a pig."

It turned out Daniel's sister had gone across the street to the grocery store. A man touched her inappropriately and she told her mother. When he saw his sister being beaten, Daniel started crying. His stepfather said, "I'll give you something to cry about." And he started "beating the hell out of me too, so there we were — that's our Sunday — not untypical at all."

By the time he was 12 years old, Daniel says, he was smoking cigarettes and drinking alcohol. He started doing drugs after getting out of the military, all to nearly unbelievable extremes. On any given day, seven days a week, Daniel says he drank 12 to 18 beers, a half bottle of whiskey and smoked two to four packs of cigarettes a day.

Daniel traces his addictions to the abuse he suffered as a child. And by the time he reached his 50s, Daniel's health problems were severe. He was 60 pounds overweight; he had high blood pressure, high cholesterol, liver damage, lung damage and diabetes. But nothing was as overwhelming as the emotional burden. "Have you ever seen a dog that's been beaten and abused?" he says. "You raise your hand and the dog will cower."

Daniel was finally diagnosed with PTSD when he was in his mid-50s. It was a relief, he says. With the help of talk therapy he learned to manage his symptoms. He quit smoking, rarely drinks and has lost weight, exercising four times a week. And life is finally tolerable.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Poll Explores Our Perception Of How Factors Large And Small Shape People's Health

NPR Health Blog - Mon, 03/02/2015 - 4:03am
Poll Explores Our Perception Of How Factors Large And Small Shape People's Health March 02, 2015 4:03 AM ET

We often think of health as a trip to the doctor or a prescription to treat or prevent diseases. Or maybe it's an operation to fix something that's gone wrong.

But a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health reveals that Americans perceive health as being affected by a broad range of social and cultural factors.

Much of our series, What Shapes Health, explores how doctors and other health professionals pay little attention to early childhood experiences as a fundamental cause of health problems. We look at efforts to change this.

Our poll also found that Americans don't see just one factor as the most important cause of individuals' health problems.

When people rated the importance of 14 possible causes of ill health, five factors jumped to the top: lack of access to high-quality medical care; personal behavior; viruses or bacteria; high stress; and being exposed to pollution. It's a question never before asked in a poll like this.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-poll-health-causes-20150302', 'http://apps.npr.org/dailygraphics/graphics/poll-health-causes-20150302/child.html', {} ); });

It's worth noting that African-Americans, Latinos and low-income Americans have somewhat different perceptions than others. For example, African-Americans are much more likely to say factors such as eating a poor diet in childhood and not graduating from high school have an "extremely important" impact on a person's health later in life.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-poll-health-abuse-20150302', 'http://apps.npr.org/dailygraphics/graphics/poll-health-abuse-20150302/child.html', {} ); });

One of the most striking findings in the poll is that 54 percent of Americans believe that being abused or neglected in childhood is an extremely important cause of health problems later in life. And more than a third said it was "very important."

$(function() { var pymParent = new pym.Parent( 'responsive-embed-poll-health-childhood-20150302', 'http://apps.npr.org/dailygraphics/graphics/poll-health-childhood-20150302/child.html', {} ); });

Income figured prominently. One example: When we asked whether people were better off healthwise than their parents, those with higher household incomes ($75,000 a year or more) were more likely than those with household incomes of less than $25,000 a year to say they were better off, and less likely to say they were worse off.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-poll-health-parents-20150302', 'http://apps.npr.org/dailygraphics/graphics/poll-health-parents-20150302/child.html', {} ); });

Some of us were surprised that so many people feel they have a great deal or quite a bit of control over their own health. Diseases can seem so random.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-poll-health-control-20150302', 'http://apps.npr.org/dailygraphics/graphics/poll-health-control-20150302/child.html', {} ); });

Be sure to come back to Shots this week and next for more reporting in our series. You can find the complete poll results here.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

How A Group Of Lung Cancer Survivors Got Doctors To Listen

NPR Health Blog - Sun, 03/01/2015 - 7:03am
How A Group Of Lung Cancer Survivors Got Doctors To Listen March 01, 2015 7:03 AM ET Katherine Hobson

Chris Newman, seen at her home in Los Molinos, Calif., calls the change she helped get made to lung cancer treatment guidelines a "small, but very important victory."

Courtesy of Chris Newman

A group of lung cancer survivors was chatting online last May about what they thought was a big problem: Influential treatment guidelines published by a consortium of prominent cancer centers didn't reflect an option that several people thought had saved their lives. They wanted to change that.

The guidelines from the National Comprehensive Cancer Network are important because they're often a first stop for an oncologist trying to develop a treatment plan after a patient's diagnosis, Chris Newman, one of the patient group's members, told Shots. But the guidelines don't always reflect newer and less proven treatment options that may be offered only at big academic cancer centers, she said. Patients might miss out on treatments that could help them, if the guidelines aren't up to date.

That's what Newman and others thought was happening for some patients with a type of advanced non-small cell lung cancer. When cancer has spread, or metastasized, beyond the original site, it's diagnosed as stage IV. And it's historically been a pretty black and white diagnosis. With most forms of cancer, you have metastases or you don't, says Paul Okunieff, a radiation oncologist and director of the University of Florida Health Cancer Center. Patients whose cancer has spread are often offered chemotherapy or supportive care rather than surgery or radiation to remove the tumors, on the assumption that it's too late to prevent further spread.

Shots - Health News Cancer Patients And Doctors Struggle To Predict Survival

But some research suggests that patients with oligometastases, or a limited number of tumors (Okunieff says it's fewer than three or five, depending on whom you ask) may get significant benefit from more aggressive treatment. That possibility wasn't reflected in the NCCN guidelines.

On a whim, Newman looked on the NCCN website and realized the guidelines were up for their annual review. In fact, the deadline for submitting suggested revisions was a little more than a month away. She knew this was usually a task for professionals, but decided to go for it anyway. (The worst that could happen, she reasoned, was that they'd "round-file it.")

Newman called on the expertise of current and former online community members. (The site is run by the for-profit company Inspire.) Several of them credited their long-term survival — despite a stage IV diagnosis — to surgery for oligometastases.

For example, George Haughton, now 62, had surgery more than 15 years ago to remove an egg-size brain tumor as well as the small primary tumor in his left lung. "I didn't think the surgery was going to do anything," he said. "But I had to do everything possible because my twin sons were 6 years old." He had some chemo and later some targeted radiation for a recurrence of the brain tumor about a year later, but has had no treatment since 2000 and is cancer-free.

Shots - Health News Know Your Exposure: A Cancer Quiz

Some online community members helped Newman edit the proposal. Others recruited clinicians to support their efforts — one even went to the annual meeting of the American Society of Clinical Oncology to buttonhole potential allies. Another obtained the full-text copies of the scientific studies they'd need to buttress their argument. Some donated office supplies and even Twizzlers to Newman, who was the lead author of the proposal. Some of the 15 clinicians who officially supported their effort read early drafts and made some suggestions. (Okunieff was one of them.)

And when the updated guidelines were released, they included some of the group's suggestions. One key phrase from the revision, which took effect Jan. 1, was: "Aggressive local therapy may be appropriate for selected patients with limited-site oligometastatic disease."

Joan McClure, senior vice president of clinical information and publications for the NCCN, says most suggestions for guideline changes come from the major cancer centers that make up the network. A smaller number come from the drug industry or from established advocacy groups. A proposal from an ad hoc patient group like this one is "not so common, but still very welcome," she says. Brian Loew, CEO of Inspire, says he was "thrilled, but not surprised," to hear about the social network's activism. (Another example: A woman with a very rare heart condition used an Inspire-hosted community to find other patients with the problem, and then to jump-start research at the Mayo Clinic.)

Newman, who is 62 and a survivor of stage III lung cancer, calls her group's success a "small, but very important victory."

She's careful to say the group isn't advocating this treatment for just anyone. There are risks to surgery, and while there are observational studies to support aggressive treatment for oligometastases in a select group of patients, there's not been a randomized controlled trial to test it.

But for those with a limited number of metastases that can be safely removed, "our argument is that this may be the last decision these people ever get to make," says Newman. "It should be up to them, with the assistance of their clinician, to decide the boundaries of risk versus the benefit."

It's hard to say how many people might be affected by the change, because so much will depend on an individual's disease and preferences. David R. Jones, chief of thoracic surgery at Memorial Sloan Kettering Cancer Center, who wasn't involved in the proposal, says about half of non-small cell lung cancer patients have metastasis — so are stage IV — when they're diagnosed. (This is why lung cancer is so deadly.) A small subset of those might have oligometastases and be eligible for treatment, he says. At Memorial Sloan Kettering, patients who fit the bill are typically discussed at a meeting of the tumor board, where specialists from many disciplines weigh in on how best to manage an individual case. Like Newman, he thinks it should be part of the conversation for eligible patients. "We need more options," he says.

Newman says she's usually pretty cynical about the ability of an individual or small group of patients to make a difference, but that this victory has changed her thinking. "It's motivated all of us as far as being able to make a difference," she says. Now she and her fellow patients are each considering what other changes they might push for.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

One Man's Race To Outrun Alzheimer's

NPR Health Blog - Sat, 02/28/2015 - 4:56pm
One Man's Race To Outrun Alzheimer's February 28, 2015 4:56 PM ET Listen to the Story 4 min 28 sec  

Greg O'Brien gathers his thoughts before a run in 2013. "Running is essential," he says.

Michael Strong/Living With Alzheimers

This is the third in NPR's series "Inside Alzheimer's," about the experience of living with the illness. In parts one and two, Greg O'Brien talked about what it was like to get the diagnosis of Alzheimer's, and how he thinks about the future.

In this installment, he talks about the importance of exercise — and his struggle to get it.

Greg O'Brien has always been a runner. He used to run outside, on the country roads around his home on Cape Cod.

Then O'Brien was diagnosed with early-onset Alzheimer's — and a few years ago, he started to get lost.

"At least my wife knows where I am. After I had an accident a couple months ago, my wife found this computer thing — an app on your iPhone that can tell people where you are at all times."

So, he turned to the treadmill — six miles every evening, pushing himself hard to keep his body strong, even as his memory began to fail him.

But as his Alzheimer's disease has progressed, it's begun to take a physical toll as well. His balance sometimes gives way. Today, O'Brien still goes to the gym every day to clear his head and keep himself in shape, but he's had to change a lot about how he works out.

Click on the audio link above to hear him describe some of the challenges.

Interview Highlights

On the importance of running

Running, to me, is essential, and I do it at the end of the day when something called sundowning takes over. It's what light does to the brain when light changes, and it creates greater confusion. So that's when I go to run. ...

Three years after being diagnosed with early-onset Alzheimer's disease, Greg O'Brien got his mile time down below six minutes. He says regular exercise is crucial to keeping his mind clear.

Courtesy of Greg O'Brien

I used to run six miles a day on the treadmill. I would punish my body, and I'd be punishing my brain because it makes me angry.

On driving

Trying to get out of my driveway in this pure ice — I know I shouldn't be driving, but I just hate to give it up. At least my wife knows where I am. After I had an accident a couple months ago, she found this computer thing — an app on your iPhone that can tell people where you are at all times. So I gave it to my wife; I gave it to my kids. It's like piece by piece, stripping yourself away of identity.

I know I'm not supposed to be driving, but it's a country road and I'm going to the gym because that's just what I'm going to do. There's [going to be] a day when I can't do it. ...

But, just between us, what I do, just to piss [my family] off sometimes, is I turn the phone off; and then they don't know where I am.

Additional Information: Inside Alzheimer's Shots - Health News 'How Do You Tell Your Kids That You've Got Alzheimer's?' Shots - Health News After Alzheimer's Diagnosis, 'The Stripping Away Of My Identity'

Hear all the stories and subscribe to future entries on the series page.

Then I get yelled at.

On adapting his workout

Alzheimer's can break the body down after it starts to break the brain down, because brain signals get all whacked out. I haven't had feeling in parts of my hands and feet for several years, and [I] was diagnosed recently with acute scoliosis and degeneration of the spine. So [instead of running outside] I now go into the gym daily. And I put the treadmill on an incline of 15, which is the highest, and I crank the speed up ... and I do my miles that way.

It still hurts, but less pain because I'm not pounding. And it tells me that I'm still in this race.

I'm 64 now. When I was 62 I got my mile down to 5 minutes and 20 seconds — which is pretty darn good. But I did it in rage.

I was trying to outrun Alzheimer's.

Next week, on Weekend All Things Considered, O'Brien's wife Mary Catherine talks about caring for her husband, and how his diagnosis has changed their marriage of almost 40 years.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Parents Choose A Simple Device To Reshape A Baby's Ear

NPR Health Blog - Fri, 02/27/2015 - 1:07pm
Parents Choose A Simple Device To Reshape A Baby's Ear February 27, 2015 1:07 PM ET Poncie Rutsch

Before and after photos of an ear shaped with the EarWell device.

Courtesy of Becon Medical, Ltd.

Soon after giving birth to a baby girl, Jennifer McMullen noticed that one of her daughter's ears looked a little different.

"She had a condition called lidding, where the top part of the cartilage in the ear is basically folded over so the top ridge is kind of rounded over," McMullen tells Shots. Her daughter could hear just fine, but McMullen worried about bullying when she got older. "She's a beautiful baby girl," she says. "If she plays sports, I don't want her to be self-conscious pulling her hair back or anything like that."

Parents have three options when their child's ear looks a little misshapen. They can do nothing and embrace a unique ear. They can choose to surgically reshape the ear, but they have to wait until the child is at least 5 years old. Or, if their child is still a baby, they can use a plastic mold to shape the ear.

McMullen works as a clinical nutritionist, so she asked around and a few friends suggested a mold called an EarWell and a plastic surgeon named Dr. Melissa Doft in New York. She applied the mold, which adheres to the skin behind the ear and flattens or guides the ear closer to the head. McMullen's daughter started the process when she was just 6 weeks old. After six weeks of ear molding her ear looked like any other kid's.

The EarWell device attaches to a baby's head with adhesive tape and is worn for two to six weeks.

Courtesy of Weill Cornell Medical College

"It rounded out her ear and cartilage completely," says McMullen, who lives in Darien, Conn.. "And she never seemed to be uncomfortable or in pain." McMullen says her insurance company covered the majority of the cost.

Doft credits the ease of the process to her patients' youth. She started applying the EarWell devices to younger babies in 2010, after reading a study showing that the cartilage is most pliable when the baby is younger than six weeks. "From being in utero the baby has an elevated level of estrogen that peaks at day three and goes down after six weeks," Doft tells Shots. The estrogen interacts with an enzyme called hyaluronidase that keeps the cartilage flexible.

"The ear is supposed to be pliable during this short window," says Doft. "So why don't we take advantage of this spike in estrogen during this baby's first week of life?"

Doft found that by applying an ear mold to babies at two weeks old or younger, she could shorten the treatment time from six to eight weeks to just two weeks. She reports a 96 percent success rate in her study, published today in Plastic and Reconstructive Surgery, meaning that 96 percent of the parents in the study rated the outcomes as excellent or greatly improved. The 4 percent that were unsuccessful either had ears that responded minimally to the molding or reverted once the molds were removed.

Doft is careful to point out that parents have options. She says that surgery can cost upwards of $10,000 once you take the cost of anesthesia and operating room fees into consideration. EarWell costs about $3,500 for one ear. And there is another less expensive device called Ear Buddies that parents can order and use themselves.

Shots - Health News Guidelines Aim To Clear Confusion Over Ear Tubes For Kids

Still, she's the first to mention that there are plenty of people in popular culture who don't have the best ears, and they've still achieved a lot. There are studies reporting that people with ear deformities experience serious bullying and teasing. But the studies only ask people who have had their ears molded or surgically altered. They don't ask people who leave their ears unaltered. It's tough to find these people, Doft says, because the people who come into her office are the ones who are unhappy and want to change their ears.

"I've had adults come in and say, 'This has been bothering me my whole life,' " Doft says. As for the babies, some of their parents proceed without hesitation while others deliberate. "This is the first medical decision that they have to make," she says. But Doft mentions that some of the most hesitant parents become the most enthusiastic about the procedure.

"We have a lot of happy parents," she says.

McMullen's daughter and her molded ears will be 8 months old next week.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Parents Choose A Simple Device To Reshape A Baby's Ear

NPR Health Blog - Fri, 02/27/2015 - 1:07pm
Parents Choose A Simple Device To Reshape A Baby's Ear February 27, 2015 1:07 PM ET Poncie Rutsch

Before and after photos of an ear shaped with the EarWell device.

Courtesy of Becon Medical, Ltd.

Soon after giving birth to a baby girl, Jennifer McMullen noticed that one of her daughter's ears looked a little different.

"She had a condition called lidding, where the top part of the cartilage in the ear is basically folded over so the top ridge is kind of rounded over," McMullen tells Shots. Her daughter could hear just fine, but McMullen worried about bullying when she got older. "She's a beautiful baby girl," she says. "If she plays sports, I don't want her to be self-conscious pulling her hair back or anything like that."

Parents have three options when their child's ear looks a little misshapen. They can do nothing and embrace a unique ear. They can choose to surgically reshape the ear, but they have to wait until the child is at least 5 years old. Or, if their child is still a baby, they can use a plastic mold to shape the ear.

McMullen works as a clinical nutritionist, so she asked around and a few friends suggested a mold called an EarWell and a plastic surgeon named Dr. Melissa Doft in New York. She applied the mold, which adheres to the skin behind the ear and flattens or guides the ear closer to the head. McMullen's daughter started the process when she was just 6 weeks old. After six weeks of ear molding her ear looked like any other kid's.

The EarWell device attaches to a baby's head with adhesive tape and is worn for two to six weeks.

Courtesy of Weill Cornell Medical College

"It rounded out her ear and cartilage completely," says McMullen, who lives in Darien, Conn.. "And she never seemed to be uncomfortable or in pain." McMullen says her insurance company covered the majority of the cost.

Doft credits the ease of the process to her patients' youth. She started applying the EarWell devices to younger babies in 2010, after reading a study showing that the cartilage is most pliable when the baby is younger than six weeks. "From being in utero the baby has an elevated level of estrogen that peaks at day three and goes down after six weeks," Doft tells Shots. The estrogen interacts with an enzyme called hyaluronidase that keeps the cartilage flexible.

"The ear is supposed to be pliable during this short window," says Doft. "So why don't we take advantage of this spike in estrogen during this baby's first week of life?"

Doft found that by applying an ear mold to babies at two weeks old or younger, she could shorten the treatment time from six to eight weeks to just two weeks. She reports a 96 percent success rate in her study, published today in Plastic and Reconstructive Surgery, meaning that 96 percent of the parents in the study rated the outcomes as excellent or greatly improved. The 4 percent that were unsuccessful either had ears that responded minimally to the molding or reverted once the molds were removed.

Doft is careful to point out that parents have options. She says that surgery can cost upwards of $10,000 once you take the cost of anesthesia and operating room fees into consideration. EarWell costs about $3,500 for one ear. And there is another less expensive device called Ear Buddies that parents can order and use themselves.

Shots - Health News Guidelines Aim To Clear Confusion Over Ear Tubes For Kids

Still, she's the first to mention that there are plenty of people in popular culture who don't have the best ears, and they've still achieved a lot. There are studies reporting that people with ear deformities experience serious bullying and teasing. But the studies only ask people who have had their ears molded or surgically altered. They don't ask people who leave their ears unaltered. It's tough to find these people, Doft says, because the people who come into her office are the ones who are unhappy and want to change their ears.

"I've had adults come in and say, 'This has been bothering me my whole life,' " Doft says. As for the babies, some of their parents proceed without hesitation while others deliberate. "This is the first medical decision that they have to make," she says. But Doft mentions that some of the most hesitant parents become the most enthusiastic about the procedure.

"We have a lot of happy parents," she says.

McMullen's daughter and her molded ears will be 8 months old next week.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Fines Remain Rare Even As Health Data Breaches Multiply

NPR Health Blog - Fri, 02/27/2015 - 11:16am
Fines Remain Rare Even As Health Data Breaches Multiply February 27, 201511:16 AM ET

Partner content from

Charles Ornstein ProPublica

In a string of meetings and press releases, the federal government's health watchdogs have delivered a stern message: They are cracking down on insurers, hospitals and doctors offices that don't adequately protect the security and privacy of medical records.

"We've now moved into an area of more assertive enforcement," Leon Rodriguez, then-director of the U.S. Department of Health and Human Services' Office for Civil Rights, warned at a privacy and security forum in December 2012.

All Tech Considered Anthem Hack Renews Calls For Laws To Better Prevent Breaches

But as breaches of patient records proliferate — just this month, insurer Anthem revealed a hack that exposed information for nearly 80 million people — federal overseers have seldom penalized the health care organizations responsible for safeguarding this data, a ProPublica review shows.

Since October 2009, health care providers and organizations (including third parties that do business with them) have reported more than 1,140 large breaches to the Office for Civil Rights, affecting upward of 41 million people. They've also reported more than 120,000 smaller lapses, each affecting fewer than 500 people.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-propublica-data-privacy-20150226', 'http://apps.npr.org/dailygraphics/graphics/propublica-data-privacy-20150226/child.html', {} ); });

In some cases, records were on laptops stolen from homes or cars. In others, records were targeted by hackers. Sometimes, paper records were forgotten on trains or otherwise left unattended.

Yet, over that time span, the Office for Civil Rights has fined health care organizations just 22 times.

"It's disappointing and underwhelming," said Bob Chaput, founder and chief executive of Clearwater Compliance, which helps health care organizations create programs to protect sensitive information. "They're not doing as much as they could or should."

The Office for Civil Rights declined an interview request from ProPublica, but said in a statement that it "aggressively" identifies and investigates "high-impact cases that send strong enforcement messages about important compliance issues." The agency looks into all large data breaches, a spokeswoman wrote in an email, and the cases resulting in financial penalties "have involved systemic and/or long-standing" concerns.

The agency's stiffest sanction to date came last May, when it hit New York-Presbyterian Hospital and Columbia University with fines totaling $4.8 million for failing to secure the electronic health records of 6,800 people. A physician had tried to remove his personal computer server from a shared network, causing patient records, including patient status, vital signs, medications and lab results, to be found on Web search engines. The problem surfaced when a person found a deceased partner's personal health information online.

The federal government has played a growing role in health privacy and security since the passage of the Health Insurance Portability and Accountability Act, or HIPAA, in 1996. The law mandated standards for the use and dissemination of health care information and for how organizations protect electronic medical records.

GRAPHIC: See a timeline of major security breaches and search by state and organization Sisi Wei/ProPublica

In 2009, the Health Information Technology for Economic and Clinical Health Act, known as the HITECH Act, went a step further. It required that organizations publicly report breaches involving at least 500 patients, increased how much HHS could fine organizations that violate patient privacy and record security, mandated that HHS conduct audits, and extended the rules to third parties that work with health care organizations.

But since then, even HHS' inspector general has been critical of the way in which the Office for Civil Rights has used its authority. In November 2013, the inspector general faulted the agency for not performing audits mandated by the HITECH Act.

A first, pilot set of audits, conducted in 2011 and 2012, showed that 102 of the 115 organizations reviewed had at least some problems with security or weren't following rules to safeguard patient privacy. A larger follow-up round of audits is only now getting underway, experts say.

Some industry veterans say the Office for Civil Rights is trying to strike a balance between working with organizations to improve their security and punishing truly egregious lapses. Health providers often agree to make voluntary changes even if they're not fined, the agency has said.

"What you don't want [the Office of Civil Rights] to become is somebody like your parking enforcement where they're funding themselves by issuing tickets or fines to everybody who has the smallest infractions," said Joy Pritts, who until last year served as chief privacy officer for the federal Office of the National Coordinator for Health Information Technology.

Data security experts also say the Office for Civil Rights simply does not have the resources to handle its oversight responsibilities. While it can keep whatever fines it imposes to use for enforcement, it has fewer than 200 employees and a budget of just $39 million. Its duties, by comparison, are vast: Each year, it handles over 4,000 discrimination complaints, reviews 2,500 Medicare provider applicants to see if they are complying with federal civil rights requirements, and resolves more than 15,000 complaints of alleged HIPAA violations. The president is seeking a budget increase for the agency next year.

"They're swamped," said Dan Berger, chief executive of Redspin, an IT security company that issues an annual report on trends in large data breaches.

Some organizations currently under review by HHS say they don't know the status of their cases. In 2012, the state of Utah disclosed that hackers gained access to a server that stores data on Medicaid and children's health insurance claims. Social Security numbers of 280,000 people and less-sensitive information on 500,000 others were accessed.

Since then, the state health department has had three official interactions with the Office for Civil Rights, the last coming in May 2014. "It's hard to tell where we are in the process," said Tom Hudachko, an agency spokesman. "We thought there would have been resolution by this point."

Some security experts say that the government needs to use its authority to impose fines to send a message. Bruce Schneier, a computer security expert and blogger, compared the situation to environmental pollution.

"If the cost of polluting is zero, companies will pollute. How would a rational company not do that?" he said. "If your CEO said we're going to spend four times as much money not to pollute, he would be fired. What you need is to make security rational."

Help us investigate patient privacy by sharing your story. Also read our story about how a real-life medical show filmed a man's death without his permission.

ProPublica is a nonprofit investigative reporting newsroom based in New York.

Copyright 2015 ProPublica. To see more, visit http://www.propublica.org/.
Categories: NPR Blogs

Fines Remain Rare Even As Health Data Breaches Multiply

NPR Health Blog - Fri, 02/27/2015 - 11:16am
Fines Remain Rare Even As Health Data Breaches Multiply February 27, 201511:16 AM ET

Partner content from

Charles Ornstein ProPublica

In a string of meetings and press releases, the federal government's health watchdogs have delivered a stern message: They are cracking down on insurers, hospitals and doctors offices that don't adequately protect the security and privacy of medical records.

"We've now moved into an area of more assertive enforcement," Leon Rodriguez, then-director of the U.S. Department of Health and Human Services' Office for Civil Rights, warned at a privacy and security forum in December 2012.

All Tech Considered Anthem Hack Renews Calls For Laws To Better Prevent Breaches

But as breaches of patient records proliferate — just this month, insurer Anthem revealed a hack that exposed information for nearly 80 million people — federal overseers have seldom penalized the health care organizations responsible for safeguarding this data, a ProPublica review shows.

Since October 2009, health care providers and organizations (including third parties that do business with them) have reported more than 1,140 large breaches to the Office for Civil Rights, affecting upward of 41 million people. They've also reported more than 120,000 smaller lapses, each affecting fewer than 500 people.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-propublica-data-privacy-20150226', 'http://apps.npr.org/dailygraphics/graphics/propublica-data-privacy-20150226/child.html', {} ); });

In some cases, records were on laptops stolen from homes or cars. In others, records were targeted by hackers. Sometimes, paper records were forgotten on trains or otherwise left unattended.

Yet, over that time span, the Office for Civil Rights has fined health care organizations just 22 times.

"It's disappointing and underwhelming," said Bob Chaput, founder and chief executive of Clearwater Compliance, which helps health care organizations create programs to protect sensitive information. "They're not doing as much as they could or should."

The Office for Civil Rights declined an interview request from ProPublica, but said in a statement that it "aggressively" identifies and investigates "high-impact cases that send strong enforcement messages about important compliance issues." The agency looks into all large data breaches, a spokeswoman wrote in an email, and the cases resulting in financial penalties "have involved systemic and/or long-standing" concerns.

The agency's stiffest sanction to date came last May, when it hit New York-Presbyterian Hospital and Columbia University with fines totaling $4.8 million for failing to secure the electronic health records of 6,800 people. A physician had tried to remove his personal computer server from a shared network, causing patient records, including patient status, vital signs, medications and lab results, to be found on Web search engines. The problem surfaced when a person found a deceased partner's personal health information online.

The federal government has played a growing role in health privacy and security since the passage of the Health Insurance Portability and Accountability Act, or HIPAA, in 1996. The law mandated standards for the use and dissemination of health care information and for how organizations protect electronic medical records.

GRAPHIC: See a timeline of major security breaches and search by state and organization Sisi Wei/ProPublica

In 2009, the Health Information Technology for Economic and Clinical Health Act, known as the HITECH Act, went a step further. It required that organizations publicly report breaches involving at least 500 patients, increased how much HHS could fine organizations that violate patient privacy and record security, mandated that HHS conduct audits, and extended the rules to third parties that work with health care organizations.

But since then, even HHS' inspector general has been critical of the way in which the Office for Civil Rights has used its authority. In November 2013, the inspector general faulted the agency for not performing audits mandated by the HITECH Act.

A first, pilot set of audits, conducted in 2011 and 2012, showed that 102 of the 115 organizations reviewed had at least some problems with security or weren't following rules to safeguard patient privacy. A larger follow-up round of audits is only now getting underway, experts say.

Some industry veterans say the Office for Civil Rights is trying to strike a balance between working with organizations to improve their security and punishing truly egregious lapses. Health providers often agree to make voluntary changes even if they're not fined, the agency has said.

"What you don't want [the Office of Civil Rights] to become is somebody like your parking enforcement where they're funding themselves by issuing tickets or fines to everybody who has the smallest infractions," said Joy Pritts, who until last year served as chief privacy officer for the federal Office of the National Coordinator for Health Information Technology.

Data security experts also say the Office for Civil Rights simply does not have the resources to handle its oversight responsibilities. While it can keep whatever fines it imposes to use for enforcement, it has fewer than 200 employees and a budget of just $39 million. Its duties, by comparison, are vast: Each year, it handles over 4,000 discrimination complaints, reviews 2,500 Medicare provider applicants to see if they are complying with federal civil rights requirements, and resolves more than 15,000 complaints of alleged HIPAA violations. The president is seeking a budget increase for the agency next year.

"They're swamped," said Dan Berger, chief executive of Redspin, an IT security company that issues an annual report on trends in large data breaches.

Some organizations currently under review by HHS say they don't know the status of their cases. In 2012, the state of Utah disclosed that hackers gained access to a server that stores data on Medicaid and children's health insurance claims. Social Security numbers of 280,000 people and less-sensitive information on 500,000 others were accessed.

Since then, the state health department has had three official interactions with the Office for Civil Rights, the last coming in May 2014. "It's hard to tell where we are in the process," said Tom Hudachko, an agency spokesman. "We thought there would have been resolution by this point."

Some security experts say that the government needs to use its authority to impose fines to send a message. Bruce Schneier, a computer security expert and blogger, compared the situation to environmental pollution.

"If the cost of polluting is zero, companies will pollute. How would a rational company not do that?" he said. "If your CEO said we're going to spend four times as much money not to pollute, he would be fired. What you need is to make security rational."

Help us investigate patient privacy by sharing your story. Also read our story about how a real-life medical show filmed a man's death without his permission.

ProPublica is a nonprofit investigative reporting newsroom based in New York.

Copyright 2015 ProPublica. To see more, visit http://www.propublica.org/.
Categories: NPR Blogs

5 Things To Know About The Latest Supreme Court Challenge To Health Law

NPR Health Blog - Fri, 02/27/2015 - 9:09am
5 Things To Know About The Latest Supreme Court Challenge To Health Law February 27, 2015 9:09 AM ET

Partner content from

Julie Rovner

The Affordable Care Act will take center stage at the Supreme Court on March 4.

Drew Angerer/Getty Images

The Affordable Care Act is once again before the Supreme Court.

On March 4, the justices will hear oral arguments in King v. Burwell, a case challenging the validity of tax subsidies helping millions of Americans buy health insurance if they don't get coverage through an employer or the government. If the court rules against the Obama administration, those subsidies could be cut off for everyone in the three dozen states using HealthCare.gov, the federal exchange website. A decision is expected by the end of June.

Here are five things you should know about the case and its potential consequences:

1) This case doesn't challenge the constitutionality of the health law.

The Supreme Court has already found the Affordable Care Act is constitutional. That was settled in 2012's NFIB v. Sebelius.

At issue in this case is a line in the law stipulating that subsidies are available to those who sign up for coverage "through an exchange established by the state." In issuing regulations to implement the subsidies in 2012, however, the IRS said that subsidies would also be available to those enrolling through the federal health insurance exchange. The agency noted Congress had never discussed limiting the subsidies to state-run exchanges and that making subsidies available to all "is consistent with the language, purpose and structure" of the law as a whole.

Last summer, the U.S. Court of Appeals for the 4th Circuit in Richmond ruled that the regulations were a permissible interpretation of the law. While the three-judge panel agreed that the language in the law is "ambiguous," they relied on something called "Chevron deference," a legal principle that takes its name from a 1984 Supreme Court ruling that held courts must defer to a federal agency's interpretation as long as that interpretation isn't unreasonable.

Those challenging the law, however, insist that Congress intended to limit the subsidies to state exchanges. "As an inducement to state officials, the Act authorizes tax credits and subsidies for certain households that purchase health insurance through an Exchange, but restricts those entitlements to Exchanges created by states," wrote Michael Cannon and Jonathan Adler, two of the fiercest critics of the IRS interpretation, in Health Matrix: Journal of Law-Medicine.

In any case, a ruling in favor of the challengers would affect only the subsidies available in the states using the federal exchange. Those in the 13 states operating their own exchanges would be unaffected. The rest of the health law, including its expansion of Medicaid and requirements for coverage of those with pre-existing conditions, would remain in effect.

2) If the court rules against the Obama administration, millions of people could be forced to give up their insurance.

A study by the Urban Institute found that if subsidies in the federal health exchange are disallowed, 9.3 million people could lose $28.8 billion of federal help paying for their insurance in just the first year. Since many of those people would not be able to afford insurance without government help, the number of uninsured could rise by 8.2 million people.

A separate study from the Urban Institute looked at those in danger of losing their coverage and found that most are low and moderate-income white, working adults who live in the South.

3) A ruling against the Obama administration could have other effects.

Disallowing the subsidies in the federal exchange states could destabilize the entire individual insurance market, not just the exchanges in those states. Anticipating that only those most likely to need medical services will hold onto their plans, insurers would likely increase premiums for everyone in the state who buys their own insurance, no matter where they buy it from.

"If subsidies [in the federal exchange] are eliminated, premiums would increase by about 47 percent," said Christine Eibner of the RAND Corporation, who co-authored a study projecting a 70 percent drop in enrollment.

Eliminating tax subsidies for individuals would also impact the law's requirement that most larger employers provide health insurance. That's because the penalty for not providing coverage only kicks in if a worker goes to the state health exchange and receives a subsidy. If there are no subsidies, there are also no employer penalties.

4) Consumers could lose subsidies almost immediately.

Supreme Court decisions generally take effect 25 days after they are issued. That could mean that subsidies would stop flowing as soon as July or August, assuming a decision in late June. Insurers can't drop people for not paying their premiums for 90 days, although they have to continue to pay claims only for the first 30.

Although the law's requirement that individuals have health insurance would remain in effect, no one is required to purchase coverage if the lowest-priced plan in their area costs more than eight percent of their income. So without the subsidies, and with projected premium increases, many if not most people would become exempt.

5) Congress could make the entire issue go away by passing a one-page bill. But it won't.

All Congress would have to do to restore the subsidies is pass a bill striking the line about subsidies being available through exchanges "established by the state." But given how many Republicans oppose the law, leaders have already said they won't act to fix it. Republicans are still working to come up with a contingency plan should the ruling go against the subsidies. Even that will be difficult given their continuing ideological divides over health care.

States could solve the problem by setting up their own exchanges, but that is a lengthy and complicated process and in most cases requires the consent of state legislatures. And the Obama administration has no power to step in and fix things either, Health and Human Services Secretary Sylvia Burwell said in a letter to members of Congress.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

5 Things To Know About The Latest Supreme Court Challenge To Health Law

NPR Health Blog - Fri, 02/27/2015 - 9:09am
5 Things To Know About The Latest Supreme Court Challenge To Health Law February 27, 2015 9:09 AM ET

Partner content from

Julie Rovner

The Affordable Care Act will take center stage at the Supreme Court on March 4.

Drew Angerer/Getty Images

The Affordable Care Act is once again before the Supreme Court.

On March 4, the justices will hear oral arguments in King v. Burwell, a case challenging the validity of tax subsidies helping millions of Americans buy health insurance if they don't get coverage through an employer or the government. If the court rules against the Obama administration, those subsidies could be cut off for everyone in the three dozen states using HealthCare.gov, the federal exchange website. A decision is expected by the end of June.

Here are five things you should know about the case and its potential consequences:

1) This case doesn't challenge the constitutionality of the health law.

The Supreme Court has already found the Affordable Care Act is constitutional. That was settled in 2012's NFIB v. Sebelius.

At issue in this case is a line in the law stipulating that subsidies are available to those who sign up for coverage "through an exchange established by the state." In issuing regulations to implement the subsidies in 2012, however, the IRS said that subsidies would also be available to those enrolling through the federal health insurance exchange. The agency noted Congress had never discussed limiting the subsidies to state-run exchanges and that making subsidies available to all "is consistent with the language, purpose and structure" of the law as a whole.

Last summer, the U.S. Court of Appeals for the 4th Circuit in Richmond ruled that the regulations were a permissible interpretation of the law. While the three-judge panel agreed that the language in the law is "ambiguous," they relied on something called "Chevron deference," a legal principle that takes its name from a 1984 Supreme Court ruling that held courts must defer to a federal agency's interpretation as long as that interpretation isn't unreasonable.

Those challenging the law, however, insist that Congress intended to limit the subsidies to state exchanges. "As an inducement to state officials, the Act authorizes tax credits and subsidies for certain households that purchase health insurance through an Exchange, but restricts those entitlements to Exchanges created by states," wrote Michael Cannon and Jonathan Adler, two of the fiercest critics of the IRS interpretation, in Health Matrix: Journal of Law-Medicine.

In any case, a ruling in favor of the challengers would affect only the subsidies available in the states using the federal exchange. Those in the 13 states operating their own exchanges would be unaffected. The rest of the health law, including its expansion of Medicaid and requirements for coverage of those with pre-existing conditions, would remain in effect.

2) If the court rules against the Obama administration, millions of people could be forced to give up their insurance.

A study by the Urban Institute found that if subsidies in the federal health exchange are disallowed, 9.3 million people could lose $28.8 billion of federal help paying for their insurance in just the first year. Since many of those people would not be able to afford insurance without government help, the number of uninsured could rise by 8.2 million people.

A separate study from the Urban Institute looked at those in danger of losing their coverage and found that most are low and moderate-income white, working adults who live in the South.

3) A ruling against the Obama administration could have other effects.

Disallowing the subsidies in the federal exchange states could destabilize the entire individual insurance market, not just the exchanges in those states. Anticipating that only those most likely to need medical services will hold onto their plans, insurers would likely increase premiums for everyone in the state who buys their own insurance, no matter where they buy it from.

"If subsidies [in the federal exchange] are eliminated, premiums would increase by about 47 percent," said Christine Eibner of the RAND Corporation, who co-authored a study projecting a 70 percent drop in enrollment.

Eliminating tax subsidies for individuals would also impact the law's requirement that most larger employers provide health insurance. That's because the penalty for not providing coverage only kicks in if a worker goes to the state health exchange and receives a subsidy. If there are no subsidies, there are also no employer penalties.

4) Consumers could lose subsidies almost immediately.

Supreme Court decisions generally take effect 25 days after they are issued. That could mean that subsidies would stop flowing as soon as July or August, assuming a decision in late June. Insurers can't drop people for not paying their premiums for 90 days, although they have to continue to pay claims only for the first 30.

Although the law's requirement that individuals have health insurance would remain in effect, no one is required to purchase coverage if the lowest-priced plan in their area costs more than eight percent of their income. So without the subsidies, and with projected premium increases, many if not most people would become exempt.

5) Congress could make the entire issue go away by passing a one-page bill. But it won't.

All Congress would have to do to restore the subsidies is pass a bill striking the line about subsidies being available through exchanges "established by the state." But given how many Republicans oppose the law, leaders have already said they won't act to fix it. Republicans are still working to come up with a contingency plan should the ruling go against the subsidies. Even that will be difficult given their continuing ideological divides over health care.

States could solve the problem by setting up their own exchanges, but that is a lengthy and complicated process and in most cases requires the consent of state legislatures. And the Obama administration has no power to step in and fix things either, Health and Human Services Secretary Sylvia Burwell said in a letter to members of Congress.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

From Naked Mole Rats To Dog Testicles: A Writer Explores The Longevity Quest

NPR Health Blog - Thu, 02/26/2015 - 2:38pm
From Naked Mole Rats To Dog Testicles: A Writer Explores The Longevity Quest February 26, 2015 2:38 PM ET Listen to the Story 38 min 35 sec   Additional Information: Spring Chicken

Stay Young Forever (Or Die Trying)

by Bill Gifford

Hardcover, 366 pages | purchase

Purchase Featured Book
Title
Spring Chicken
Subtitle
Stay Young Forever (Or Die Trying)
Author
Bill Gifford

Your purchase helps support NPR Programming. How?

More on this book:

When journalist Bill Gifford turned 40, his friends gave him a cake shaped as a tombstone with the words, "R.I.P, My Youth." As he reflected on his creeping memory lapses and the weight he'd gained, Gifford got interested in the timeless quest to turn back the aging clock — or at least slow it down.

His latest book, Spring Chicken, explores everything from some wacky pseudo-cures for aging to fascinating research that point to causes of aging at the cellular level.

"In high school biology we pretty much learn that cells divide and divide forever and that's kind of what they thought up until about 1960," Gifford tells Fresh Air's Dave Davies. "Now they know that cells actually have a kind of lifespan — they have a limit to the number of times that they can divide."

Gifford says that after they're done dividing, the cells go into a state called "replicative senescence."

"So they go from being these lively dividing cells to basically retiring," he says. "And they're sitting there and they're kind of grumpy."

Scientists have learned that these cells are "basically toxic," he says.

"It's sort of like certain people bring everybody down," Gifford says. "Senescence cells are kind of the same way. Some people think that senescence cells actually drive much of what we recognize as aging."

Gifford's book not only explores the research at the cellular level, but he also looks at the history of anti-aging, how exercise, diet and stress affect growing old and interesting phenomena in the natural world — like the naked mole rat. It lives long, shows no increase in mortality with age, never gets cancer and never experiences menopause.

"They live underground; they're from Africa and they live in a colony," Gifford says. "I held one in my hand and she was the size of between a mouse and a rat — and she was 28 years old, whereas a mouse lives to about two years old. In human terms, it was like a 600-year-old person ... and she was pregnant."

These animals, Gifford says, have repair mechanisms in their cells that allow the cells to survive damage and live longer.

Scientists "recently sequenced the mole rat genome so they're looking pretty hard for what that might be," he says. "On the other hand, it might just be an anomaly ... we don't know. The point is that nature knows how to let animals live a very long time."

Interview Highlights

Bill Gifford is a contributing editor for Outside Magazine. His previous book was called Ledyard: In Search of the First American Explorer.

Darryl Patterson/Courtesy of Grand Central Publishing

On the late 19th century scientist Charles-Édouard Brown-Séquard

He was one of the great scientists of the 19th century; he's regarded as the founder of endocrinology, the study of glands. When he got to be about 70 years old he wasn't feeling so hot and he started to wonder why. He thought the answer had to do with something produced in the gonads, so he mixed up a little mixture of crushed up dog testicles, testicular blood and semen, mixed it all up and injected himself with it for a period of about three weeks. In 1889, he gave a triumphant address to the society of biology in Paris describing this experiment and how it had miraculously rejuvenated him, an old man, he could work through the night now, he could lift much more weight, he could urinate farther, all these fantastic things and people were horrified. ...

He was already 70 or 71 and he lived about another five years, so he did pretty well for the 19th century, but whether the treatment extended his lifespan, [it's] difficult to say. They now think it was pretty much a placebo effect.

It became a cultural sensation. ... It was called the Séquard Elixir and all kinds of quacks set up mail order businesses where you could get 10 syringes for $2.50. There were songs written about it; it was written up in all the papers. People went crazy. He never made a dime off it. ...

In a way, Séquard's elixir was kind of a precursor of the testosterone replacement and estrogen replacement therapies that are extremely popular right now. So he was onto something.

On the controversial pre-Depression era scientist John Brinkley

In between the elixir and the testosterone, there was an unfortunate intermediate step where a salesman named John Brinkley down in Texas began implanting goat testicles in worn out middle-aged men and he did similar surgeries in women. Obviously [this was] not a good idea and many people died on his operating table, but he became fabulously wealthy. He was one of the richest men in the pre-Depression era. He actually had a radio station down there. He was just across the border in Mexico because they kicked him out of the country, but he had this hugely powerful radio station that broadcast some of the early country music stars.

On the conference for anti-aging and human growth hormones

It was founded by these two doctors in Chicago who basically pioneered the use of human growth hormone as a treatment for aging back in the '90s. And a study had come out in about 1990 saying that older men gained muscle mass when they were on an exercise program and human growth hormone.

"The scientists I spoke to feel that human growth hormone, far from reversing aging, actually accelerates aging."

So they kind of took this and ran with it, and now, 20 years later, older Americans inject themselves with about $1.4 billion worth of human growth hormone per year and the system of injections costs about $10,000 to 12,000 a year. ...

[But] the scientists I spoke to feel that human growth hormone, far from reversing aging, actually accelerates aging. It turns on these pro-growth, pro-aging pathways. And there aren't clinical trials of this stuff because it's technically illegal for this use, but let's just say the longest [living] laboratory mice had zero growth hormone. Their cells had no growth hormone receptors. So human growth hormone might make you feel better for a short time, but it's very doubtful that it will lengthen your life and may do the opposite.

On anti-aging supplements

Additional Information: Related NPR Stories Shots - Health News Anti-Aging Hormone Could Make You Smarter Shots - Health News Like All Animals, We Need Stress. Just Not Too Much The Salt Eat Plants And Prosper: For Longevity, Go Easy On The Meat, Study Says

There's very little evidence for most of these supplements that you see marketed to older people. Supplements are very poorly regulated in this country and there just aren't the same evidentiary standards that you need for say, a drug. There was just a recent case where the attorney[s] general of several states found that supplements sold in places like Walmart had things like grass clippings in them.

On studying people who are over 100 years old

At [Albert] Einstein College of Medicine ... the theory is that that they have genes that protect them from the diseases of aging that the rest of us get. So they get to 100 and they don't have diabetes; they don't have heart disease; they don't have cancer; they've been protected somehow. So the question is: Do they have genes that protect them from these diseases and what are the genes and ... can we make a drug that can kind of imitate the action of those genes.

On how exercise affects aging

Anything really, is better than nothing. Basically, we evolved to move around, to run, to walk, to use our bodies and not to just sit around the way most of us do for most of the day. There's kind of an idea of use it or lose it and that's really programmed into our biology. The more you use your muscles, the more you're walking around, the more you're going to hang on to your muscle as you get older. That's really important because muscle wasting with age is the second leading cause of admission to nursing homes after Alzheimer's disease.

On the theory that short-term, controlled physical stress is good for longevity

[Blogger Todd Becker] believes in small amounts of stress as a way of life. It sounds completely crazy but there's actually a scientific basis to it. ... He wakes up in the morning every day and he takes a freezing cold shower, that's how he starts off. Then he'll skip lunch at work and then at the end of the day, without having eaten all day, he'll go for a trail run in Palo Alto, [Calif.], where he lives. ... I started looking into the science and cold water exposure actually has some pretty interesting affects. [There are] studies of cold water swimmers and they are healthier than people who don't go cold-water swimming. ...

"Organisms that are exposed to stress in certain ways respond to it and become stronger. ... On the cellular level ... it has an effect of almost like cleaning up or reorganizing your proteins so they're in better shape."

The idea is this concept of hormesis — that's the stress response. That's another thing we have hard-wired into our biology. Organisms that are exposed to stress in certain ways respond to it and become stronger. One obvious example is exercise. You stress out your muscles, you lift a weight or whatever, they're damaged, and then they come back stronger. On the cellular level it also works. It has an effect of almost like cleaning up or reorganizing your proteins so they're in better shape.

On the theory that eating less helps you live longer

[There is] something called the Caloric Restriction Society, and there are people who basically make a great effort to eat anywhere from 15 percent to 30 percent less than most of us eat. So obviously they're very skinny, but they're doing this because research for decades has shown feeding mice and other animals a lot less seems to make them live longer. ...

When we were hunter gatherers, we didn't get three meals a day, we might get three meals a week. So the people who survived — or the critters who survived — were the ones who could go for pretty decent periods without food and even then, not eat a whole lot of food. So our biology is kind of tuned to survive famines, to survive low-nutrient conditions. What that does [is it] puts our cells in a sort of stress-resistant state that ends up prolonging life.

Read an excerpt of Spring Chicken

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

From Naked Mole Rats To Dog Testicles: A Writer Explores The Longevity Quest

NPR Health Blog - Thu, 02/26/2015 - 2:38pm
From Naked Mole Rats To Dog Testicles: A Writer Explores The Longevity Quest February 26, 2015 2:38 PM ET Listen to the Story 38 min 35 sec   Additional Information: Spring Chicken

Stay Young Forever (Or Die Trying)

by Bill Gifford

Hardcover, 366 pages | purchase

Purchase Featured Book
Title
Spring Chicken
Subtitle
Stay Young Forever (Or Die Trying)
Author
Bill Gifford

Your purchase helps support NPR Programming. How?

More on this book:

When journalist Bill Gifford turned 40, his friends gave him a cake shaped as a tombstone with the words, "R.I.P, My Youth." As he reflected on his creeping memory lapses and the weight he'd gained, Gifford got interested in the timeless quest to turn back the aging clock — or at least slow it down.

His latest book, Spring Chicken, explores everything from some wacky pseudo-cures for aging to fascinating research that point to causes of aging at the cellular level.

"In high school biology we pretty much learn that cells divide and divide forever and that's kind of what they thought up until about 1960," Gifford tells Fresh Air's Dave Davies. "Now they know that cells actually have a kind of lifespan — they have a limit to the number of times that they can divide."

Gifford says that after they're done dividing, the cells go into a state called "replicative senescence."

"So they go from being these lively dividing cells to basically retiring," he says. "And they're sitting there and they're kind of grumpy."

Scientists have learned that these cells are "basically toxic," he says.

"It's sort of like certain people bring everybody down," Gifford says. "Senescence cells are kind of the same way. Some people think that senescence cells actually drive much of what we recognize as aging."

Gifford's book not only explores the research at the cellular level, but he also looks at the history of anti-aging, how exercise, diet and stress affect growing old and interesting phenomena in the natural world — like the naked mole rat. It lives long, shows no increase in mortality with age, never gets cancer and never experiences menopause.

"They live underground; they're from Africa and they live in a colony," Gifford says. "I held one in my hand and she was the size of between a mouse and a rat — and she was 28 years old, whereas a mouse lives to about two years old. In human terms, it was like a 600-year-old person ... and she was pregnant."

These animals, Gifford says, have repair mechanisms in their cells that allow the cells to survive damage and live longer.

Scientists "recently sequenced the mole rat genome so they're looking pretty hard for what that might be," he says. "On the other hand, it might just be an anomaly ... we don't know. The point is that nature knows how to let animals live a very long time."

Interview Highlights

Bill Gifford is a contributing editor for Outside Magazine. His previous book was called Ledyard: In Search of the First American Explorer.

Darryl Patterson/Courtesy of Grand Central Publishing

On the late 19th century scientist Charles-Édouard Brown-Séquard

He was one of the great scientists of the 19th century; he's regarded as the founder of endocrinology, the study of glands. When he got to be about 70 years old he wasn't feeling so hot and he started to wonder why. He thought the answer had to do with something produced in the gonads, so he mixed up a little mixture of crushed up dog testicles, testicular blood and semen, mixed it all up and injected himself with it for a period of about three weeks. In 1889, he gave a triumphant address to the society of biology in Paris describing this experiment and how it had miraculously rejuvenated him, an old man, he could work through the night now, he could lift much more weight, he could urinate farther, all these fantastic things and people were horrified. ...

He was already 70 or 71 and he lived about another five years, so he did pretty well for the 19th century, but whether the treatment extended his lifespan, [it's] difficult to say. They now think it was pretty much a placebo effect.

It became a cultural sensation. ... It was called the Séquard Elixir and all kinds of quacks set up mail order businesses where you could get 10 syringes for $2.50. There were songs written about it; it was written up in all the papers. People went crazy. He never made a dime off it. ...

In a way, Séquard's elixir was kind of a precursor of the testosterone replacement and estrogen replacement therapies that are extremely popular right now. So he was onto something.

On the controversial pre-Depression era scientist John Brinkley

In between the elixir and the testosterone, there was an unfortunate intermediate step where a salesman named John Brinkley down in Texas began implanting goat testicles in worn out middle-aged men and he did similar surgeries in women. Obviously [this was] not a good idea and many people died on his operating table, but he became fabulously wealthy. He was one of the richest men in the pre-Depression era. He actually had a radio station down there. He was just across the border in Mexico because they kicked him out of the country, but he had this hugely powerful radio station that broadcast some of the early country music stars.

On the conference for anti-aging and human growth hormones

It was founded by these two doctors in Chicago who basically pioneered the use of human growth hormone as a treatment for aging back in the '90s. And a study had come out in about 1990 saying that older men gained muscle mass when they were on an exercise program and human growth hormone.

"The scientists I spoke to feel that human growth hormone, far from reversing aging, actually accelerates aging."

So they kind of took this and ran with it, and now, 20 years later, older Americans inject themselves with about $1.4 billion worth of human growth hormone per year and the system of injections costs about $10,000 to 12,000 a year. ...

[But] the scientists I spoke to feel that human growth hormone, far from reversing aging, actually accelerates aging. It turns on these pro-growth, pro-aging pathways. And there aren't clinical trials of this stuff because it's technically illegal for this use, but let's just say the longest [living] laboratory mice had zero growth hormone. Their cells had no growth hormone receptors. So human growth hormone might make you feel better for a short time, but it's very doubtful that it will lengthen your life and may do the opposite.

On anti-aging supplements

Additional Information: Related NPR Stories Shots - Health News Anti-Aging Hormone Could Make You Smarter Shots - Health News Like All Animals, We Need Stress. Just Not Too Much The Salt Eat Plants And Prosper: For Longevity, Go Easy On The Meat, Study Says

There's very little evidence for most of these supplements that you see marketed to older people. Supplements are very poorly regulated in this country and there just aren't the same evidentiary standards that you need for say, a drug. There was just a recent case where the attorney[s] general of several states found that supplements sold in places like Walmart had things like grass clippings in them.

On studying people who are over 100 years old

At [Albert] Einstein College of Medicine ... the theory is that that they have genes that protect them from the diseases of aging that the rest of us get. So they get to 100 and they don't have diabetes; they don't have heart disease; they don't have cancer; they've been protected somehow. So the question is: Do they have genes that protect them from these diseases and what are the genes and ... can we make a drug that can kind of imitate the action of those genes.

On how exercise affects aging

Anything really, is better than nothing. Basically, we evolved to move around, to run, to walk, to use our bodies and not to just sit around the way most of us do for most of the day. There's kind of an idea of use it or lose it and that's really programmed into our biology. The more you use your muscles, the more you're walking around, the more you're going to hang on to your muscle as you get older. That's really important because muscle wasting with age is the second leading cause of admission to nursing homes after Alzheimer's disease.

On the theory that short-term, controlled physical stress is good for longevity

[Blogger Todd Becker] believes in small amounts of stress as a way of life. It sounds completely crazy but there's actually a scientific basis to it. ... He wakes up in the morning every day and he takes a freezing cold shower, that's how he starts off. Then he'll skip lunch at work and then at the end of the day, without having eaten all day, he'll go for a trail run in Palo Alto, [Calif.], where he lives. ... I started looking into the science and cold water exposure actually has some pretty interesting affects. [There are] studies of cold water swimmers and they are healthier than people who don't go cold-water swimming. ...

"Organisms that are exposed to stress in certain ways respond to it and become stronger. ... On the cellular level ... it has an effect of almost like cleaning up or reorganizing your proteins so they're in better shape."

The idea is this concept of hormesis — that's the stress response. That's another thing we have hard-wired into our biology. Organisms that are exposed to stress in certain ways respond to it and become stronger. One obvious example is exercise. You stress out your muscles, you lift a weight or whatever, they're damaged, and then they come back stronger. On the cellular level it also works. It has an effect of almost like cleaning up or reorganizing your proteins so they're in better shape.

On the theory that eating less helps you live longer

[There is] something called the Caloric Restriction Society, and there are people who basically make a great effort to eat anywhere from 15 percent to 30 percent less than most of us eat. So obviously they're very skinny, but they're doing this because research for decades has shown feeding mice and other animals a lot less seems to make them live longer. ...

When we were hunter gatherers, we didn't get three meals a day, we might get three meals a week. So the people who survived — or the critters who survived — were the ones who could go for pretty decent periods without food and even then, not eat a whole lot of food. So our biology is kind of tuned to survive famines, to survive low-nutrient conditions. What that does [is it] puts our cells in a sort of stress-resistant state that ends up prolonging life.

Read an excerpt of Spring Chicken

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Doctors Join Forces With Lawyers To Reduce Firearms Deaths

NPR Health Blog - Thu, 02/26/2015 - 11:51am
Doctors Join Forces With Lawyers To Reduce Firearms Deaths February 26, 201511:51 AM ET

Closing loopholes in background checks for gun purchases would reduce the risk of death and injury, doctors' and attorneys' groups say.

Alexa Miller/Getty Images

Each year more than 32,000 people die in the United States as a result of suicides, homicides and accidents with firearms.

For years doctors have tried to reduce the toll by addressing gun injuries and deaths as a public health issue; there's ample evidence that ease of access to is linked to the number of suicides and homicides. But those efforts haven't gained much traction.

Shots - Health News How A Patient's Suicide Changed A Doctor's Approach To Guns

On Monday, six medical organizations including the American College of Physicians and professional societies for surgeons, family doctors, obstetricians and gynecologists, pediatricians and emergency physicians joined with the American Public Health Association and the American Bar Association in a "call to action" aimed at reducing the health consequences of firearms. Shots talked with Dr. Steven Weinberger, executive vice president and CEO of the American College of Physicians and leader of the effort, on what the doctors hope to change. This is an edited version of the conversation.

Your top priority is expanding criminal background checks to cover all firearm purchases. Why is that so important?

Right now there are loopholes in the background checks and there are certainly quite a few people who end up purchasing firearms through those loopholes, whether through private sales from an individual or gun show sales. All of a sudden the background checks are no longer effective. We feel that should be a universal requirement.

But you're also worried about laws that require doctors to report people who have mental health or substance abuse problems; some states bar them from buying or owning firearms. Why is that?

U.S. Battling Suicide In A 'Gun State' Means Treading Carefully

This is the tricky one. There needs to be better access to mental health care in the United States, I think there's no question about that. People who get adequate treatment are less likely to commit acts of violence. But if reporting of all people with mental health and substance abuse disorders is made a requirement, then people have a disincentive to seek care. We feel this has to be done on a case-by-case basis, not merely based on the presence of a mental or substance abuse disorder, but whether that person is at risk of doing harm to himself or herself or to others.

The paper says that private ownership of assault weapons represents a "grave danger to the public" and you want tighter restrictions on their use. How did you decide on that?

The tricky thing was how to define these particular types of firearms. We chose "military" type. We know gun manufacturers have done all sorts of things to get around those requirements in the past. It's relatively easy for the general public to say this is a military-style assault weapon in terms of the appearance and the magazine capacity. We really don't see any need for civilian use for those types of weapons or ammunition. And they have been of major import in mass shootings. So we feel it's critical to eliminate private use of those.

The Two-Way Fatal Shooting At Firing Range Sparks Debate About Safety

Obviously the gun lobby has been against anything at all that has any sort of restrictions on firearms or the type of person who can use firearms. Our hope is that there may be some ability to move this forward since we have the American Bar Association on this with us. We can speak to the medical and public health issues on this, but we are not constitutional law scholars. They have confirmed that these recommendations are constitutionally sound.

Some states have attempted "gag laws" that bar doctors from talking with patients or parents about gun safety or asking them if they have firearms in the house. As doctors you think this is a very bad idea. Why?

Shots - Health News Doctors' Questions About Guns Spark A Constitutional Fight

This is something that unfortunately comes up all the time. The idea that a pediatrician can't be speaking with a patient about the issue of firearm safety and whether there's a firearm in the home is really problematic. It does violate First Amendment rights, but beyond that it interferes with the physician-patient relationship in a really inappropriate way. With the things we've seen with a child going into a mother's pocketbook and pulling out a gun and shooting someone, it's tragic and it's unconscionable.

Doctors have been fighting this battle for years and not making much progress, frankly. It's got to be frustrating.

It is frustrating. One of the other authors on the report said that the number of people who are killed with firearms is the equivalent of a 747 going down with all its passengers once a week throughout the year. If we saw that would there be public uproar.

And these are preventable deaths. Homicides and suicides are things we can control. Obviously we recognize that this is an uphill battle. But it's such an important public health issue, we can't give up on it.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Doctors Join Forces With Lawyers To Reduce Firearms Deaths

NPR Health Blog - Thu, 02/26/2015 - 11:51am
Doctors Join Forces With Lawyers To Reduce Firearms Deaths February 26, 201511:51 AM ET

Closing loopholes in background checks for gun purchases would reduce the risk of death and injury, doctors' and attorneys' groups say.

Alexa Miller/Getty Images

Each year more than 32,000 people die in the United States as a result of suicides, homicides and accidents with firearms.

For years doctors have tried to reduce the toll by addressing gun injuries and deaths as a public health issue; there's ample evidence that ease of access to is linked to the number of suicides and homicides. But those efforts haven't gained much traction.

Shots - Health News How A Patient's Suicide Changed A Doctor's Approach To Guns

On Monday, six medical organizations including the American College of Physicians and professional societies for surgeons, family doctors, obstetricians and gynecologists, pediatricians and emergency physicians joined with the American Public Health Association and the American Bar Association in a "call to action" aimed at reducing the health consequences of firearms. Shots talked with Dr. Steven Weinberger, executive vice president and CEO of the American College of Physicians and leader of the effort, on what the doctors hope to change. This is an edited version of the conversation.

Your top priority is expanding criminal background checks to cover all firearm purchases. Why is that so important?

Right now there are loopholes in the background checks and there are certainly quite a few people who end up purchasing firearms through those loopholes, whether through private sales from an individual or gun show sales. All of a sudden the background checks are no longer effective. We feel that should be a universal requirement.

But you're also worried about laws that require doctors to report people who have mental health or substance abuse problems; some states bar them from buying or owning firearms. Why is that?

U.S. Battling Suicide In A 'Gun State' Means Treading Carefully

This is the tricky one. There needs to be better access to mental health care in the United States, I think there's no question about that. People who get adequate treatment are less likely to commit acts of violence. But if reporting of all people with mental health and substance abuse disorders is made a requirement, then people have a disincentive to seek care. We feel this has to be done on a case-by-case basis, not merely based on the presence of a mental or substance abuse disorder, but whether that person is at risk of doing harm to himself or herself or to others.

The paper says that private ownership of assault weapons represents a "grave danger to the public" and you want tighter restrictions on their use. How did you decide on that?

The tricky thing was how to define these particular types of firearms. We chose "military" type. We know gun manufacturers have done all sorts of things to get around those requirements in the past. It's relatively easy for the general public to say this is a military-style assault weapon in terms of the appearance and the magazine capacity. We really don't see any need for civilian use for those types of weapons or ammunition. And they have been of major import in mass shootings. So we feel it's critical to eliminate private use of those.

The Two-Way Fatal Shooting At Firing Range Sparks Debate About Safety

Obviously the gun lobby has been against anything at all that has any sort of restrictions on firearms or the type of person who can use firearms. Our hope is that there may be some ability to move this forward since we have the American Bar Association on this with us. We can speak to the medical and public health issues on this, but we are not constitutional law scholars. They have confirmed that these recommendations are constitutionally sound.

Some states have attempted "gag laws" that bar doctors from talking with patients or parents about gun safety or asking them if they have firearms in the house. As doctors you think this is a very bad idea. Why?

Shots - Health News Doctors' Questions About Guns Spark A Constitutional Fight

This is something that unfortunately comes up all the time. The idea that a pediatrician can't be speaking with a patient about the issue of firearm safety and whether there's a firearm in the home is really problematic. It does violate First Amendment rights, but beyond that it interferes with the physician-patient relationship in a really inappropriate way. With the things we've seen with a child going into a mother's pocketbook and pulling out a gun and shooting someone, it's tragic and it's unconscionable.

Doctors have been fighting this battle for years and not making much progress, frankly. It's got to be frustrating.

It is frustrating. One of the other authors on the report said that the number of people who are killed with firearms is the equivalent of a 747 going down with all its passengers once a week throughout the year. If we saw that would there be public uproar.

And these are preventable deaths. Homicides and suicides are things we can control. Obviously we recognize that this is an uphill battle. But it's such an important public health issue, we can't give up on it.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Attention, Shoppers: Prices For 70 Health Care Procedures Now Online!

NPR Health Blog - Thu, 02/26/2015 - 9:10am
Attention, Shoppers: Prices For 70 Health Care Procedures Now Online! February 26, 2015 9:10 AM ET

Partner content from

Jay Hancock

Shopping for an MRI scan? Guroo.org, won't yet show you what your local hospital or radiologist charges, but it will reveal the average cost of the test in your area.

iStockphoto

Buying health care in America is like shopping blindfolded at Macy's and getting the bill months after you leave the store, Princeton economist Uwe Reinhardt likes to say.

Shots - Health News How Much Is That MRI, Really? Massachusetts Shines A Light

But an online tool that went live Wednesday is supposed to help change that, giving patients in most parts of the country a small peek at the prices of medical tests and procedures before they open their wallets.

Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?

A website called Guroo.com shows the average local cost for 70 common diagnoses and medical tests in most states. It's showing the real cost — not the published charges, which often get marked down — based on a giant database of what insurance companies actually pay.

OK, this isn't like Priceline.com for knee replacements. What Guroo hopes to do for consumers is still limited.

It won't reflect costs for particular hospitals or doctors, although officials say that's coming, in some cases. And it doesn't yet have much to say about the quality of care.

Still, consumer advocates say Guroo should shed new light on the nation's opaque, complex and maddening medical bazaar.

Shots - Health News 'America's Bitter Pill' Makes Case For Why Health Care Law 'Won't Work' Shots - Health News In California, That MRI Will Cost You $255 — Or Maybe $6,221

"This has the potential to be a game changer," said Katherine Hempstead, who analyzes health insurance for the Robert Wood Johnson Foundation. "It's good for uninsured people. It's good for people with high deductibles. It's good for any person [who is] kind of wondering: If I go to see the doctor for such-and-such, what might happen next?"

Guroo is produced by the nonprofit and nonpartisan Health Care Cost Institute, working with three big insurance companies: UnitedHealthcare, Aetna and Humana. (A fourth, insurance firm, Assurant, will soon join the consortium.) The idea is to eventually let members of these health plans use a companion website to see how differing prices set by each provider affect copayments.

Known for its cost and utilization reports, HCCI receives some industry funding, but is governed by an independent board. This is its first tool for consumers.

Consumer advocates praise Guroo, but caution that the movement toward "transparency" in medical prices is still in its very early stages. Data on insurer, employer or government websites are often limited or inaccurate. Consumer information from Fair Health, which manages another huge commercial insurance database, is organized by procedure code.

Even on Guroo.org, "the average user may not have a good sense of what they're looking at and what they're supposed to do with the resulting price," said Lynn Quincy, a health care specialist at Consumers Union.

BlueCross BlueShield of North Carolina recently set a high standard for disclosure by posting prices — doctor by doctor and hospital by hospital — based on its reimbursement rates, Quincy says. Guroo doesn't do that.

HCCI says, so far, its prices detail what insurers pay for about 70 common tests and "bundles" of services, all described in understandable terms so patients don't need a medical textbook to figure out what they are. Users get the average (as well as a range) for local and national prices.

Your Money When Nonprofit Hospitals Sue Their Poorest Patients

That's not the same as seeing provider-specific prices online, of course. But within a year, HCCI expects to let members of UnitedHealthcare, Aetna, Assurant and Humana use a companion site to track spending, and check how switching caregivers might lower their out-of-pocket costs.

Information about the quality of the care provided — essential to helping patients make smart choices — is still to come, as well, Newman says. And at this point Guroo still lacks information on prices in Alabama, Michigan and several other states.

But given its size, influence and openness, Guroo could become a dominant portal for health care prices, says Hempstead.

"Their stance as a neutral broker," she says, "and the amount of data that they have and the amount of data that they're going to have really puts them in a different place."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

Attention, Shoppers: Prices For 70 Health Care Procedures Now Online!

NPR Health Blog - Thu, 02/26/2015 - 9:10am
Attention, Shoppers: Prices For 70 Health Care Procedures Now Online! February 26, 2015 9:10 AM ET

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Jay Hancock

Shopping for an MRI scan? Guroo.org, won't yet show you what your local hospital or radiologist charges, but it will reveal the average cost of the test in your area.

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Buying health care in America is like shopping blindfolded at Macy's and getting the bill months after you leave the store, Princeton economist Uwe Reinhardt likes to say.

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But an online tool that went live Wednesday is supposed to help change that, giving patients in most parts of the country a small peek at the prices of medical tests and procedures before they open their wallets.

Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?

A website called Guroo.com shows the average local cost for 70 common diagnoses and medical tests in most states. It's showing the real cost — not the published charges, which often get marked down — based on a giant database of what insurance companies actually pay.

OK, this isn't like Priceline.com for knee replacements. What Guroo hopes to do for consumers is still limited.

It won't reflect costs for particular hospitals or doctors, although officials say that's coming, in some cases. And it doesn't yet have much to say about the quality of care.

Still, consumer advocates say Guroo should shed new light on the nation's opaque, complex and maddening medical bazaar.

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"This has the potential to be a game changer," said Katherine Hempstead, who analyzes health insurance for the Robert Wood Johnson Foundation. "It's good for uninsured people. It's good for people with high deductibles. It's good for any person [who is] kind of wondering: If I go to see the doctor for such-and-such, what might happen next?"

Guroo is produced by the nonprofit and nonpartisan Health Care Cost Institute, working with three big insurance companies: UnitedHealthcare, Aetna and Humana. (A fourth, insurance firm, Assurant, will soon join the consortium.) The idea is to eventually let members of these health plans use a companion website to see how differing prices set by each provider affect copayments.

Known for its cost and utilization reports, HCCI receives some industry funding, but is governed by an independent board. This is its first tool for consumers.

Consumer advocates praise Guroo, but caution that the movement toward "transparency" in medical prices is still in its very early stages. Data on insurer, employer or government websites are often limited or inaccurate. Consumer information from Fair Health, which manages another huge commercial insurance database, is organized by procedure code.

Even on Guroo.org, "the average user may not have a good sense of what they're looking at and what they're supposed to do with the resulting price," said Lynn Quincy, a health care specialist at Consumers Union.

BlueCross BlueShield of North Carolina recently set a high standard for disclosure by posting prices — doctor by doctor and hospital by hospital — based on its reimbursement rates, Quincy says. Guroo doesn't do that.

HCCI says, so far, its prices detail what insurers pay for about 70 common tests and "bundles" of services, all described in understandable terms so patients don't need a medical textbook to figure out what they are. Users get the average (as well as a range) for local and national prices.

Your Money When Nonprofit Hospitals Sue Their Poorest Patients

That's not the same as seeing provider-specific prices online, of course. But within a year, HCCI expects to let members of UnitedHealthcare, Aetna, Assurant and Humana use a companion site to track spending, and check how switching caregivers might lower their out-of-pocket costs.

Information about the quality of the care provided — essential to helping patients make smart choices — is still to come, as well, Newman says. And at this point Guroo still lacks information on prices in Alabama, Michigan and several other states.

But given its size, influence and openness, Guroo could become a dominant portal for health care prices, says Hempstead.

"Their stance as a neutral broker," she says, "and the amount of data that they have and the amount of data that they're going to have really puts them in a different place."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

Infections With Dangerous Gut Microbe Still On The Rise

NPR Health Blog - Wed, 02/25/2015 - 5:00pm
Infections With Dangerous Gut Microbe Still On The Rise February 25, 2015 5:00 PM ET

An overgrowth of Clostridium difficile bacteria can inflame the colon with a life-threatening infection.

Dr. David Phillips/Getty Images/Visuals Unlimited

A potentially life-threatening gastrointestinal infection is more common than previously estimated, federal health officials reported Wednesday.

The infection, caused by a bacterium known as Clostridium difficile, or C-diff, causes nearly 500,000 illnesses in the United States each year and kills about 29,000, according to the federal Centers for Disease Control and Prevention.

Shots - Health News Deaths From Dangerous Gut Bacteria Hit Historic Highs

The estimate, based on an analysis of data collected at 10 geographic areas in 2011, is higher than any previous year, say CDC officials who published the data Wednesday in The New England Journal of Medicine.

The new estimate underscores a growing concern among doctors and health officials about the infection. C-diff produces a powerful toxin that can cause terrible diarrhea and is very difficult to treat, in part because many such infections are caused by strains of the bacteria that have become resistant to standard antibiotics.

Some patients end up having to have part of the colon removed to finally eradicate a C-diff infection. And even in those cases the infections frequently recur repeatedly — which can be severely debilitating and eventually fatal.

"This is very severe illness that causes tremendous suffering and death," Michael Bell, deputy director of the CDC's Division of Healthcare Quality Promotion at the National Center for Emerging and Zoonotic Infectious Diseases, told reporters during a Wednesday briefing.

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Bell stressed that the new numbers underscore the need to use antibiotics more sparingly; use of the drugs can upset the normal balance of bacteria in a person's digestive system, allowing C-diff to proliferate in some cases. Research shows C-diff infections often occur after patients have received antibiotics for some other reason.

The findings, the CDC says, also underscore the need for hospitals, nursing homes and other health care facilities to do a better job of preventing the spread of C-diff spores from one patient to the next (paying careful attention to frequent hand-washing and other hygiene protocols, for example, and offering infected patients a private room where possible). Many of these difficult infections emerge in a patient who is being treated for some other condition.

Increasingly, some doctors are trying to treat C-diff infections with a procedure known as a fecal transplant, which uses feces from a healthy donor to restore a healthy bacterial balance in the ill recipient.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Infections With Dangerous Gut Microbe Still On The Rise

NPR Health Blog - Wed, 02/25/2015 - 5:00pm
Infections With Dangerous Gut Microbe Still On The Rise February 25, 2015 5:00 PM ET

An overgrowth of Clostridium difficile bacteria can inflame the colon with a life-threatening infection.

Dr. David Phillips/Getty Images/Visuals Unlimited

A potentially life-threatening gastrointestinal infection is more common than previously estimated, federal health officials reported Wednesday.

The infection, caused by a bacterium known as Clostridium difficile, or C-diff, causes nearly 500,000 illnesses in the United States each year and kills about 29,000, according to the federal Centers for Disease Control and Prevention.

Shots - Health News Deaths From Dangerous Gut Bacteria Hit Historic Highs

The estimate, based on an analysis of data collected at 10 geographic areas in 2011, is higher than any previous year, say CDC officials who published the data Wednesday in The New England Journal of Medicine.

The new estimate underscores a growing concern among doctors and health officials about the infection. C-diff produces a powerful toxin that can cause terrible diarrhea and is very difficult to treat, in part because many such infections are caused by strains of the bacteria that have become resistant to standard antibiotics.

Some patients end up having to have part of the colon removed to finally eradicate a C-diff infection. And even in those cases the infections frequently recur repeatedly — which can be severely debilitating and eventually fatal.

"This is very severe illness that causes tremendous suffering and death," Michael Bell, deputy director of the CDC's Division of Healthcare Quality Promotion at the National Center for Emerging and Zoonotic Infectious Diseases, told reporters during a Wednesday briefing.

Shots - Health News Hospitals Struggle To Beat Back Serious Infections Shots - Health News Frozen Poop Pills Fight Life-Threatening Infections

Bell stressed that the new numbers underscore the need to use antibiotics more sparingly; use of the drugs can upset the normal balance of bacteria in a person's digestive system, allowing C-diff to proliferate in some cases. Research shows C-diff infections often occur after patients have received antibiotics for some other reason.

The findings, the CDC says, also underscore the need for hospitals, nursing homes and other health care facilities to do a better job of preventing the spread of C-diff spores from one patient to the next (paying careful attention to frequent hand-washing and other hygiene protocols, for example, and offering infected patients a private room where possible). Many of these difficult infections emerge in a patient who is being treated for some other condition.

Increasingly, some doctors are trying to treat C-diff infections with a procedure known as a fecal transplant, which uses feces from a healthy donor to restore a healthy bacterial balance in the ill recipient.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs
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