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Germanwings Crash Highlights Workplace Approaches To Mental Health

Wed, 04/01/2015 - 6:03pm
Germanwings Crash Highlights Workplace Approaches To Mental Health April 01, 2015 6:03 PM ET Listen to the Story 3 min 47 sec  

When it comes to an employee's mental health status, what does an employer need to know, or have a right to know?


The horrifying crash last week of the Germanwings flight operated by Lufthansa has put a spotlight on what the airline knew — and what it should, or could have done — about its pilot's mental health.

Lufthansa could face unlimited liability, after the pilot allegedly brought the plane down deliberately. Here in the U.S., employment experts say monitoring employees' mental health status raises a thicket of complicated issues.

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According to the Air Line Pilots Association, most U.S. pilots undergo medical testing that includes mental and emotional assessment at least once a year by a doctor approved by the Federal Aviation Administration. The airline industry association says crew members' fitness for duty can also be tested, as warranted.

But it's not just airlines with this concern. And when it comes to an employee's mental health status, what does an employer need to know, or have a right to know?

"It's a very complicated issue," says employment attorney Jonathan Segal, of Duane Morris Institute in Philadelphia. He says employers must respect health privacy and discrimination laws in addressing their potential workplace or public safety concerns.

"We're balancing," he says, "and anytime you're balancing, you're playing in the gray."

Segal advises employers: When in doubt, evaluate it — even at the risk of facing a discrimination charge down the line.

"Is there a risk in having an evaluation? Yes," Segal says. "Is there risk in not having an evaluation? Yes. So, if you have objective facts and you say, 'We're not saying you are a risk; we're not saying you're not. We just want you to be evaluated,' I think you're in a prudent position."

But evaluating mental health problems is not clear-cut, says Alan King, chief operating officer of Workplace Options, a firm that manages workplace benefits for companies around the world. For instance, he says, there are drug tests for those with substance abuse, but, "that doesn't exist for mental health."

The Americans with Disabilities Act prohibits employer discrimination against people with disabilities, including mental health problems. The statute is written in a way that gives employers some flexibility to monitor for potential problems, says Christopher Kuczynski, assistant legal counsel for the Equal Employment Opportunity Commission.

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"Once somebody gets on the job, under the ADA, generally the rule is you can ask medical questions and you can require people to undergo medical examinations only in certain circumstances," says Kuczynski. "Only where it's what we call 'job-related and consistent with business necessity.' "

Kuczynski says that airlines and other organizations responsible for jobs that affect public safety — those in trucking or law enforcement, for example — can require such evaluations of their employees, so long as the evaluation is done for everyone in that particular job.

And in any industry, there are instances where security trumps workers' rights, says Deirdre Kamber Todd, an employment lawyer in Allentown, Pa.

"The employer does not have to keep somebody in their workplace [if] they reasonably believe that that person may constitute a danger," she says.

The vast majority of people with mental health problems pose no danger. But some fear last week's airline crash could make it more difficult to reach out to those with psychological problems.

"The concern is that there's too much of a backlash when a case like this occurs," says Ron Honberg, an attorney and director of public policy and legal affairs for the National Alliance on Mental Illness. "It may serve as a deterrent to people seeking help, and that would be counterproductive."

Especially, Honberg says, if these employees think they might lose their jobs. Also, he points out, assessing a co-worker who may be going from "depressed" to "dangerous to themselves or others" is highly subjective.


The crash last week of the Germanwings flight has put a spotlight on what the airline knew and what it should or could have done about its pilot's mental health. Parent company Lufthansa and its insurer could face unlimited liability because the pilot allegedly brought the plane down deliberately. In the U.S., employment experts say monitoring the mental health status of employees raises a number of complicated issues. NPR's Yuki Noguchi reports.

YUKI NOGUCHI, BYLINE: According to the Airline Pilots Association, most U.S. pilots undergo medical testing that includes mental and emotional assessment at least once a year by a Federal Aviation Administration approved doctor. The Airline Industry Association says crew members fitness for duty can also be tested as warranted. But it's not just airlines with this concern, and when it comes to employee's mental health status, what does an employer need to know or have a right to know?

JONATHAN SEGAL: It's a very complicated issue.

NOGUCHI: Employment attorney Jonathan Segal says employers must respect health privacy and discrimination laws in addressing their potential workplace or public safety concerns.

SEGAL: We're balancing, and anytime you balance, you're playing in the gray.

NOGUCHI: Segal tells employers, when in doubt, evaluate the person, even at the risk of facing a discrimination charge down the line.

SEGAL: If there a risk in an evaluation? Yes. Is there a risk in not having an evaluation? Yes. So if you have objective facts and you say, we're not saying you are a risk, we're not saying you're not, we just want you to be evaluated by someone, I think you're in a prudent position.

NOGUCHI: But evaluating mental health problems is not clear-cut says Alan King, CEO of Workplace Options, which manages workplace benefits for companies. For instance, he says there are drug tests for those with substance abuse, but...

ALAN KING: ...That doesn't exist for mental health.

NOGUCHI: The Americans With Disabilities Act prohibits employer discrimination against people with disabilities, including mental health problems. The statute is written in a way that gives employers some flexibility to monitor for potential problems, says Christopher Kuczynski, assistant legal counsel for the Equal Employment Opportunity Commission.

CHRISTOPHER KUCZYNSKI: Once somebody gets on the job under the ADA, generally the rule is you can ask medical questions and you can require people to undergo medical examinations only in certain circumstances - only where it's what we called job-related and consistent with business necessity.

NOGUCHI: Kuczynski says jobs besides airlines affecting public safety - trucking or law enforcement, for example - can require such evaluations so long as the evaluation is done for everyone in that job. And in any industry, there are instances where security trumps workers' rights, says Deirdre Kamber Todd, an employment lawyer.

DEIRDRE KAMBER TODD: The employer does not need to keep somebody in their workplace where they reasonably believe that that person may constitute a danger.

NOGUCHI: The vast majority of people with mental health problems pose no danger, but some fear last week's airline crash could make it more difficult to reach out to those with psychological problems. Ron Honberg is director of public policy for the National Alliance On Mental Illness.

RON HONBERG: The concern is if there's too much of a backlash when a case like this occurs, it may actually serve as a deterrent to people stepping up and seeking help when they need it. And that would be counterproductive.

NOGUCHI: Especially, he says, if they think they might lose their jobs. Yuki Noguchi, NPR News, Washington.

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Trading Walkathons For Ice Buckets, Charities Try To Hold On To Donors

Wed, 04/01/2015 - 4:32pm
Trading Walkathons For Ice Buckets, Charities Try To Hold On To Donors April 01, 2015 4:32 PM ET Listen to the Story 4 min 4 sec  

A big crowd turned out for the March of Dimes walkathon in Gainesville, Fla., in early March. But overall, the March of Dimes' March for Babies raised $3.5 million less in 2014 than it did the year before.

Elizabeth Hamilton/Gainesville Sun/Landov

Springtime means outdoor charity events, and there are plenty to choose from.

You can walk, run, bike, swim or even roll around in the mud to raise money for a cause. But some of the bigger, more established events aren't doing as well as they used to, and charities are trying to adjust.

Last year, the 30 largest walkathons and similar events raised $41 million less overall than they did the year before, according to a recent study by the Peer to Peer Professional Forum, a group for professionals who organize fundraising events.

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"These would be programs like the American Cancer Society's Relay for Life, which brought in $335 million, but they were down $45 million last year," says David Hessekiel, the forum's president. He also notes that the March of Dimes' March for Babies raised $3.5 million less than it did the year before and fell below $100 million in receipts for the first time in years.

Hessekiel says these events still raise large amounts of money, but they're facing competition from a growing number of fundraisers.

He says individual donors today are also looking for more control and flexibility than being required to show up on a particular Saturday morning for a walk.

"In the era we live in, everyone has the opportunity to do what they'd like to, on their own time pretty much," Hessekiel says, and link to it with the online tools that are available."

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There's no greater example of this fundraising trend than last year's ice bucket challenge, which raised cash for the ALS Association and other groups fighting amyotrophic lateral sclerosis, or Lou Gehrig's disease. Just about everyone on the planet seemed to throw cold water on his or her head — raising more than $220 million.

Hessekiel points to other increasingly popular fundraising events, like people shaving their heads for childhood cancer research, or growing a mustache for men's health.

The dramatic shift in styles of fundraising, and their relative effectiveness, aren't lost on Sandra Hijikata, a senior vice president at the Juvenile Diabetes Research Foundation, which saw a 12 percent drop last year in its receipts from walkathons.

"There's huge competition," Hijikata says. "So it's important for an organization like JDRF to make sure that people understand who we are — that they understand the important work that we do."

So her diabetes group is re-branding its walking events. Each event is now called One Walk, to make clear that participants are raising money for Type 1 diabetes. Hijikata says the charity is also doing more to engage families affected by the disease in the effort and offering do-it-yourself options for those who prefer not to walk or bike.

"We provide electronic support, websites, etc., and they can design what they want to," she says, noting one online campaign where donors are cracking eggs on their heads in memory of a friend who had diabetes.

This doesn't mean that walkathons are going away.

Christie Madsen, senior manager of national events and brand campaigns for Make-A-Wish America, says her group plans to hold even more of its Walk for Wishes events in the future. She says the walks not only raise money but generate enthusiasm for the cause, which is granting the wishes of children who have life-threatening illnesses.

"What we see is a huge opportunity for growth," she says.

Like other charities, her group is trying to do more to help local chapters get the most out of the walks, in part by turning participants into better fundraisers. They're providing them with more support, such as tips on the best way to ask family and friends for money.

Mimi Totten says that was the hardest part for her, when she decided to participate in a recent Make-A-Wish Foundation walk in Fairfax, Va.

"Oh, my goodness," Totten says. "I would rather lick the kitchen floor than ask for money. And for months, I agonized over it and I couldn't write the letter."

But she finally sent out a fundraising email to family and friends and was pleasantly surprised by the response. She and her friend Kathy Young were able to raise about $5,000 for the foundation.

They're now considering new things they can do — maybe a wine and cheese party for friends — to raise even more money next year.

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Diagnosing A Sinus Infection Can Be A DIY Project

Wed, 04/01/2015 - 3:11pm
Diagnosing A Sinus Infection Can Be A DIY Project April 01, 2015 3:11 PM ET

This is what the inflammation of sinus infection looks like in a false-color X-ray. It hurts even more in real life.

CNRI/Science Source

Sinus infections are miserable, and it's hard not to want to run to the doctor for relief. Rethink that, the nation's ear, nose and throat doctors say.

Most people who get sinusitis feel better in a week, the doctors say, and many of those infections are caused by viruses. Getting an antibiotic isn't going to help.

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So the ENTs want to get patients involved in figuring out what's causing the infection, partly to reduce needless use of antibiotics and also so that people who might benefit from medication will get it.

"For the first time we've really made it crystal clear how to self-diagnose your own bacterial sinus infections without going to the doctor, with a high degree of accuracy," says Dr. Richard Rosenfeld, lead author of the practice guidelines published Wednesday by the American Academy of Otolaryngology-Head and Neck Surgery Foundation.

OK, how can you tell if it's bacterial or viral?

  • If you've been sick for less than 10 days and you're not getting worse, it's almost certainly viral.
  • If you're not improving at all in 10 days or if you get worse in that 10 days after having improved a bit, bacteria are probably to blame.

Underlying this DIY approach is the notion that it's OK to wait and see what happens, rather than hastening to get antibiotics.

Even if it is bacterial, Rosefeld says, antibiotics help just a tiny bit. "Most of what's going on is your body fighting off the infection yourself with maybe a little boost from antibiotics."

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Sinusitis gets diagnosed 30 million times a year, and with the infections accounting for 20 percent of all antibiotic prescriptions, the ENTs see this as a chance to reduce overprescribing.

They're going further than their previous guidelines in saying that even if you're really sick, it's OK to wait on the meds. And they're breaking ranks with their fellow physicians in infectious disease and internal medicine, who say everyone with a bacterial infection should get an antibiotic.

"We're not saying you're wrong to do it," Rosenfeld says. "We're saying, you know, there's a good chance you're going to get better on your own."

So then what to do while you're feeling like your head is going to explode?

Saline nose washes get a big thumbs up from the ENTs, as do as over-the-counter pain medications. The saline washes out mucus and reduces stuffiness, and also improves the health of membranes, Rosenfeld says.

Steroid nose sprays may help with inflammation, the guidelines say, especially for people with chronic sinusitis, which lasts more than three months.

Chronic sinusitis shouldn't be diagnosed just on symptoms, the guidelines say; a doctor needs to document there's inflammation of the nose and sinuses, something that can be done by looking up the nose with various scopes.

"You can diagnose acute sinusitis from your armchair at home," Rosenfeld says. "But you can't diagnose chronic sinusitis." For that, at least, you need that doctor.

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To Avoid Surprise Insurance Bills, Tell Exchange Plan When You Move

Wed, 04/01/2015 - 10:09am
To Avoid Surprise Insurance Bills, Tell Exchange Plan When You Move April 01, 201510:09 AM ET

Partner content from

Michelle Andrews

If you thought more experience with the heath insurance marketplaces would cut down on confusion about them, you'd be wrong. The questions about how they work keep pouring in. Here are answers to some of the latest queries.

I purchased health insurance in Ohio through the marketplace in April. I then moved to Missouri and applied for marketplace coverage there that began in October. I had assumed that the Ohio marketplace would cancel my coverage there, but that didn't happen. What should I do?

When people relocate, it's up to them to inform the marketplace and their insurer, says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

If you don't inform the marketplace that you're cancelling your subsidized plan, a 90-day grace period will begin the first month that you don't pay your premium. The grace period is intended to protect consumers from losing coverage immediately because of a late payment. During the first 30 days, insurers are required to continue coverage and pay claims. For the next 60 days, if consumers still haven't paid up, insurers may delay paying claims. During this period, consumers can still pay their back premiums and continue their coverage if they wish. After 90 days, the insurer can cancel coverage.

You could be on the hook for the entire premium for the first month of the 90-day period, according to the Centers for Medicare & Medicaid Services. Although consumers wouldn't generally be responsible for repaying any premium tax credit for that first month, in some circumstances they might have to pay that back when they file their taxes, CMS says.

Solomon's advice: "Call the Ohio marketplace and ask them to retroactively cancel her coverage."

I help people apply for marketplace policies and I've noticed that some of the plans sold on the state marketplaces don't cover tobacco-cessation medication and other products for free as a preventive service. Isn't that required?

Under the health law, most health plans have to cover — without cost sharing by patients — preventive services that are recommended by the U.S. Preventive Services Task Force, a nonpartisan group of medical experts. The only exception is for plans that are grandfathered under the law.

The task force recommends that doctors ask patients whether they smoke and provide smokers with cessation interventions. Last May, the administration spelled out what would be covered: at least two stop-smoking attempts annually that include at least four counseling sessions and all tobacco-cessation medications (both prescription and over-the-counter options) that have been approved by the Food and Drug Administration.

Only 17 percent of insurers on the state marketplaces cover tobacco cessation medications without cost sharing, according to a report released Tuesday by the American Lung Association.

Stingy smoking cessation coverage is short-sighted, says Brian Hickey, director of federal government relations at The Campaign For Tobacco-Free Kids, an advocacy group.

"It's not overutilized and it's not particularly costly, especially when you consider its ability to reduce future medical costs," he says.

If a plan doesn't offer comprehensive coverage, Hickey recommends bringing it to the attention of the state insurance commissioner.

As a small employer, I believe that my employees may be better off if I dropped our group health plan and let them get coverage from the public exchanges. Is there any way for me to provide my employees pre-tax reimbursement for the premiums they pay on the exchanges?

No, that's not possible. As a small employer, you won't be fined if you don't offer health insurance on the job to your employees. In contrast, employers with 100 or more workers face penalties of up to $3,000 per worker for not offering good coverage and those with more than 50 employees will have the same penalties next year.

But no matter how many people you employ, you're not allowed to give workers cash for the purpose of buying their own policy on the exchange, according to published guidance from the Obama administration. That arrangement would count as a group health plan, and under the law those arrangements can't be integrated with individual exchange coverage.

However, as a small business owner, "you can always pay more in cash to the worker and the worker can take the cash and use it as he wants, whether to buy health insurance or for something else," says J.D. Piro, a senior vice president at Aon Hewitt, who leads the benefits consultant's health law group. As an employer, you just can't earmark that cash for health insurance.

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Tobacco Firm Seeks Softer Warning For Cigarette Alternative

Wed, 04/01/2015 - 3:53am
Tobacco Firm Seeks Softer Warning For Cigarette Alternative April 01, 2015 3:53 AM ET Listen to the Story 4 min 50 sec  

Will this maker of snus, an alternative to cigarettes, be allowed to claim it is less harmful?

Swedish Match

The Food and Drug Administration is weighing whether to allow a tobacco company to do something it's never done before — claim that one of its products is less risky than cigarettes.

The company, Swedish Match of Stockholm, has applied to the FDA to designate its General brand of snus (rhymes with "loose") as safer than other versions of tobacco.

"Although there's evidence that snus may have reduced harm, reduced harm products are not the same as safe products."

Snus are tiny cloth packages that look a little like tea bags. But instead of tea, each bag is filled with moist tobacco powder. It comes in a variety of flavors. Snus is designed to give users another way to get nicotine and the taste of tobacco when they can't or don't want to smoke a cigarette or cigar.

Swedish Match wants the FDA to let the company remove most of the health warnings on its tins of snus (including a warning that the product increases a user's risk for mouth cancer or other tooth and gum problems), and change the label to say that snus is safer than cigarettes.

"What we're asking the FDA about is to allow us to inform the public with more truthful information about the health effects, because we believe that the health effects are clearly different than for most other products that are out there," says Lars Erik Rutqvist, the company's senior vice president for scientific affairs.

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He says snus doesn't increase the risk for any of the big problems caused by smoking, such as lung cancer and lung disease, because there's no smoke involved.

"Snus is at least 90 percent safer than cigarettes," Rutqvist says, "and there are some who claim that it's more than 99 percent less risky than cigarettes."

It's important that people know that, he says, because snus can help smokers kick their much riskier habits.

"There are a lot of smokers out there who are looking for less risky alternatives to their cigarettes, but who find it difficult to give up tobacco altogether," he says, noting that cigarette smoking decreased in Sweden as snus use increased.

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The tobacco industry has a long history of making misleading claims about the safety of its products. But some public health watchers of the tobacco industry say they are keeping an open mind about Swedish Match's request.

"This product appears to be less harmful than cigarette smoking," says Michael Eriksen, the dean of the Georgia State University School of Public Health. "And if that's established by the evidence that's presented to the FDA, then I think they should be able to say that in their advertising and in warning statements."

But many experts are also being cautious. Dr. Michael Steinberg, who directs the Tobacco Dependence Program at Rutgers University, says snus may be safer than cigarettes, but it's not totally safe.

"Although there's evidence that snus may have reduced harm," he says, "reduced harm products are not the same as safe products."

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Steinberg notes that snus contains nicotine, "which has physiologic risks in terms of raising heart rate, blood pressure etc." That could increase the risk for health problems such as strokes. There's also evidence snus may increase the risk for other health problems, such as pancreatic cancer.

Swedish Match questions that possible association and argues there's no evidence the product increases the risk for heart attacks or strokes.

Steinberg says another worry is that snus may end up helping smokers keep smoking by giving them kind of a crutch to get them through those times when they can't have a cigarette. And, Steinberg says, a change in the label could contribute to hooking a new generation on nicotine.

"If you imagine a young person who sees on a label that this is a less harmful tobacco product, they may interpret that as, 'Oh, this is not harmful at all. I might as well try it and see what it's all about,' " Steinberg says. "And that person can still become addicted to the nicotine effects, which could either lead to them becoming a long-term smokeless tobacco user, or could escalate to them starting to smoke cigarettes."

The FDA plans a two-day hearing, beginning April 9, to get advice about whether snus should become the first tobacco product that can officially claim it's safer than cigarettes.

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Tweeners Trust Peers More Than Adults When Judging Risks

Tue, 03/31/2015 - 3:35pm
Tweeners Trust Peers More Than Adults When Judging Risks March 31, 2015 3:35 PM ET

Jump off a roof? Ride a bike while texting? Well, what do you think?


If you are the parent of a preteen, you are all too aware that they suddenly seem to value the opinions of their peers far more than yours.

The good news, if there is any, is that you're not alone. Young teenagers ages 12 to 14 are more influenced by their peers' opinions than they are by adults', a study finds. That's true only for that age group, not for older teens, children or adults.

Researchers asked 563 people visiting the London Science Museum to rate the riskiness of activities like crossing the street on a red light, biking without a helmet, or bungee jumping. The study was published last week in Psychological Science.

Then they were told how other groups rated the risk, and asked to rate them again. Everyone's ratings changed based on what they were told. That's no surprise; decades of study has shown that we're all swayed by social influences.

But what's fascinating here is that only one age group paid more attention what their peers thought than what adults thought — the tweeners.

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"Adolescents are always more risk-taking than other groups," Lisa Knoll, a post-doctorate researcher in cognitive neuroscience at University College London and lead author of the study, told Shots. And they tend to take more risks when they're with other teens.

It's not clear why the young teens would suddenly pay more attention to their peers, Knoll says. She's doing further experiments with brain scans to see if it might be linked to adolescent brain development.

But for now, she can say there's a clear difference in perception for that age group. And they know it.

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She usually calls study participants after the fact and explains what she found.

"I asked them whether they think that's the case and whether they are surprised. Usually they're not surprised. They know that older people have more experience in these kinds of situations, but they say, 'Well, I'm a teenager.' Even teenagers have this stereotypical idea of how to be a teenager. And that's why they tend maybe to follow their age group in their behavior."

OK, so they're not listening to the adults when evaluating risks. Should parents be even more worried than they are now?

"If I were you I would not worry that you somehow lose control of your child," Knoll says. "A lot of studies suggest that teenagers still really trust the judgement of their parents, and they ask them for advice in major decisionmaking."

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Hackers Teach Computers To Tell Healthy And Sick Brain Cells Apart

Tue, 03/31/2015 - 2:36pm
Hackers Teach Computers To Tell Healthy And Sick Brain Cells Apart March 31, 2015 2:36 PM ET Listen to the Story 2 min 41 sec  

The Allen Institute for Brain Science hosted its first BigNeuron Hackathon in Beijing earlier this month. Similar events are planned for the U.S. and U.K.

Courtesy of Allen Institute for Brain Science

Brain researchers are joining forces with computer hackers to tackle a big challenge in neuroscience: teaching computers how to tell a healthy neuron from a sick one.

"Sick neurons have a withered appearance, much like a sick plant has a withered appearance," says Jane Roskams, an executive director at the Allen Institute for Brain Science. But at the moment, she says, highly trained scientists are still better than computers at assessing a neuron just by looking at its shape, which resembles a tree that can have thousands of branches.

"We should be able to then look within an aging brain and go, 'Wow, that's why that person is so sharp and sprightly. Their neuron in this part of their brain looks exactly the same as a 20-year-old's.' "

Automating the analysis of single neurons could greatly speed up the process, allowing analysis of thousands of cells. A standardized, computer-based system also would make it easier for researchers to compare results and allow more labs to study how the shape of neurons is changed by everything from learning to Alzheimer's disease, Roskams says.

A 3-D reconstruction of a healthy auditory neuron from a chick.

Courtesy of Allen Institute for Brain Science

So the institute has launched BigNeuron, a collaborative effort to improve the computer algorithms that turn microscope images of a neuron into a three-dimensional digital model and then analyze its shape. The effort will include a series of hackathons in which programmers and brain scientists get together to test their algorithms.

"So we have 15 to 20 people in a room," Roskams says. "They each have their pet algorithm, and they're kind of racing each other." The first hackathon took place in Beijing in mid-March. Others are planned for the U.S. and the U.K.

At each event, participants are given access to supercomputers and high-quality images of many different kinds of neurons. The goal is to find the best algorithms. And those won't necessarily come from people who know a lot about the brain, Roskams says.

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"We have incredibly talented young people who can code and program and begin to give meaning to some of the pictures that we've been taking in a way that many neuroscientists can't imagine doing," she says.

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The algorithms that emerge will be shared with scientists and even students around the world. Giving more people the ability to study neurons could help answer fundamental questions, like how the shape of a neuron changes throughout a person's lifetime, Roskams says.

"We should be able to look within an aging brain and go, "Wow, that's why that person is so sharp and sprightly. Their neuron in this part of their brain looks exactly the same as a 20-year-old's," Roskams says.

Today, analyzing the complex shape of a neuron often requires a supercomputer. But one long-term goal of BigNeuron, Roskams says, is to create programs that a high school student could use on a laptop computer.

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Meet The Bacteria That Make A Stink In Your Pits

Tue, 03/31/2015 - 11:19am
Meet The Bacteria That Make A Stink In Your Pits March 31, 201511:19 AM ET Poncie Rutsch

While you're resting, your armpit bacteria are hard at work pumping out stinky thioalcohols.


The human armpit has a lot to offer bacteria. It's moist, it's warm, and it's usually dark.

But when the bacteria show up, they can make a stink. That's because when some kinds of bacteria encounter sweat they produce smelly compounds, transforming the armpit from a neutral oasis to the mothership of body odor. And one group of bacteria is to blame for the stink, researchers say.

The researchers took bacteria commonly found in the armpit and added an odorless molecule found in human sweat. "These odorless molecules come out from the underarm, they interact with the active microbiota, [and] they're broken down inside the bacteria," explains Dan Bawdon, a postdoctoral researcher at the University of York in England, who led the study.

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When the bacteria break down the sweat they form products called thioalcohols, which have scents comparable to sulfur, onions or meat. "They're very very pungent," says Bawdon. "We work with them at relatively low concentrations so they don't escape into the whole of the lab but ... yes, they do smell. So we're not that popular."

The thioalcohol molecules evaporate from the underarm, which is what makes the armpit smelly. So Bawdon and his advisor Gavin Thomas, a senior lecturer in microbiology at the University of York, measured how much thioalcohol each bacteria species produced. In the end, they could point to Staphylococcus hominis as one of the worst offenders. They announced their findings Monday at the Society for General Microbiology's annual conference in Birmingham, England.

The two researchers are hoping that their findings will change the way that we engineer deodorants fight body odor. Most deodorants block sweat glands or kill off underarm bacteria. Blocking the sweat glands sometimes leads to irritated or swollen skin. And given all the new research into the complexity of the human microbiome, the researchers are a little anxious that deodorants may kill good bacteria, too.

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It's hard to say whether the bacteria in the armpit are helping the human body the way that gut bacteria or skin bacteria do. "But it kind of makes sense to not kill everything," says Thomas. "As we know from antibiotics, if we can design something specific that's probably going to be a more sensible approach."

He and Bawdon envision a deodorant that would keep armpit bacteria from producing thioalcohols. They borrowed their bacteria from Unilever, a company in the Netherlands and the United Kingdom that produces personal care products. The company provided a small amount of funding so that it can use the research results to make next-generation deodorants.

But before such a deodorant shows up on the shelf, the researchers need to make sure that there aren't other smelly processes taking place in the armpit. There may be other molecules that make the armpit smelly, and the researchers haven't yet finished their quest to describe them all.

"It's an extremely exciting time to be a microbiologist," Thomas says. Of those many denizens of the armpit, he says, "We haven't yet really figured out why they're there and exactly what they're all doing."

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No Easy, Reliable Way To Screen For Suicide

Tue, 03/31/2015 - 4:58am
No Easy, Reliable Way To Screen For Suicide March 31, 2015 4:58 AM ET Listen to the Story 4 min 9 sec  

About twice a year, statistics suggest, a pilot somewhere in the world — usually flying alone — deliberately crashes a plane. The Germanwing flight downed last week may be one such case. But most people who fit the psychological profile of the pilots in these very rare events never have problems while flying.

Patrik Stollarz/AFP/Getty Images

Even a careful psychiatric examination of the co-pilot involved in last week's Germanwings jetliner crash probably would not have revealed whether he intended to kill himself, researchers say.

"People are often motivated to deny or conceal thoughts about suicide for fear of being intervened upon or locked in a psychiatric hospital against their will."

The Two-Way Germanwings Crash: 'Suicide' Doesn't Seem To Tell The Story

"As a field, we're not very good at accurately predicting who is at risk for suicidal behavior," says Matthew Nock, a psychology professor at Harvard. He says studies show that mental health professionals "perform no better than chance" when it comes to predicting which patients will attempt suicide.

Nock made the comments after German authorities said that the co-pilot, Andreas Lubitz, had once received treatment for suicidal tendencies. Lubitz is suspected of deliberately crashing the Germanwings plane into the French Alps, killing 150 people onboard.

Most of what scientists know about suicide comes from studies of the general population, not pilots, says Guohua Li, who directs the Center for Injury Epidemiology and Prevention at Columbia University. Only one or two pilots a year kill themselves by crashing an airplane, he says, and they are nearly always general aviation pilots flying alone.

Li was a coauthor of a study in 2005 that looked at several dozen pilot suicides. It found many of them fit a profile: young, male, with a history of mental health problems and relationship problems. That profile appears to fit the Germanwings pilot "very, very well," Li says.

But the profile also fits thousands of pilots who will never have any problems while flying, Li says. "There is no reliable way for any airline to predict which pilots are going to commit suicide by airplane," he says.

Airlines could improve safety by aggressively screening pilots for alcohol and illicit drug use, Li says. The U.S. does this, but most other countries do not, he says.

One reason mental health professionals often get it wrong when it comes to suicide is that they know only what people are willing to tell them, says Nock. "People are often motivated to deny or conceal thoughts about suicide for fear of being intervened upon or locked in a psychiatric hospital against their will," he says.

Other motivations include fear of being stigmatized or losing a job. But even people who are already in a psychiatric hospital rarely reveal their intentions, Nock says. About "78 percent of people who die by suicide in the hospital explicitly denied suicidal thoughts or intentions in their last interview before dying," he says, sometimes because they lack insight into their own state of mind.

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So Nock has been experimenting with tests that are harder to fool. One involves simply indicating the color of words as they appear on a computer screen. Participants push one button for red words and another for blue words, while the computer measures their reaction time.

"If you're thinking about suicide, seeing the word suicide or death interferes with your ability to respond and it takes you just a few milliseconds longer to respond," Nock says. That's probably because the person has an involuntary emotional reaction to the word that slows him down, he explains.

Tests like that can greatly improve predictions about what a person is going to do, Nock says. But they are still experimental and still don't reveal precisely when someone will act.

"To date we've followed people over a six-month period," he says. "What we need to get better at is who's at risk of suicidal behavior imminently, in the next hours or days or even week. And that's where we still have a lot of work to be done."

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Why Are More Baby Boys Born Than Girls?

Mon, 03/30/2015 - 3:08pm
Why Are More Baby Boys Born Than Girls? March 30, 2015 3:08 PM ET Listen to the Story 3 min 13 sec  

There's a widely held assumption that a slight imbalance in male births has its start at the very moment of conception. But researchers say factors later in pregnancy are more likely to explain the phenomenon.

CNRI/Science Source

Scientists have found some unexpected clues that could help explain why 51 percent of the babies born in the United States are male.

It's been a mystery why that ratio isn't 50:50, since that's what basic biology would predict. But scientists have noticed a tilted sex ratio at birth since the 17th century.

The widely held assumption is that this imbalance starts at the very moment of conception — that more males are conceived than females.

"There were a number of people who said, hold on, we don't have much business saying anything about the sex ratio at conception," says biologist Steven Orzack at the Fresh Pond Research Institute in Cambridge, Mass. "But for the most part people didn't listen to them."

Orzack, along with colleagues from Harvard, Oxford and Genzyme Genetics, decided to dig into this question. They collected information from more than 140,000 embryos that had been created in fertility clinics, along with almost 900,000 samples from fetal screening tests like amniocentesis and 30 million records from abortions, miscarriages and live births. Most of these data came from the U.S. and Canada, not countries like China, where parents more often abort female fetuses.

"It's the largest compilation of data for this kind of investigation that's ever been put together," Orzack says.

And they now report in the Proceedings of the National Academy of Sciences that they did not see the long-assumed difference between male and female embryos at the time of conception.

"The best estimate we have is that it's even-steven — 50 percent males [and] 50 percent females," Orzack says.

So that must mean the skewed sex ratio at birth happens during pregnancy. Looking deeper, the researchers found that in the very first week of pregnancy, more male embryos died, possibly as a result of serious chromosomal abnormalities, which they also documented.

"When that settles out, it looks like there starts to be an excess of female mortality," Orzack says. "And in the third trimester, as has been known for a long time, there is a slight excess of male mortality."

When you put this all together, it turns out more males are born because more female fetuses are lost during pregnancy.

"That's completely opposite to what had been believed for a long time," Orzack says.

Explaining why more boys are born than girls is, of course, a catchy result. "It's always sexy to talk about sex," says Dr. Eugene Pergament, an obstetrics researcher at Northwestern University.

But he says the research's greatest contribution is that it sheds light on what's going on during early pregnancy. That's a time when scientists have very little understanding of what's happening within a developing embryo, and what external influences may be affecting its development and survival.

"I think it will eventually have greater consequences and significance in our understanding normal and abnormal human development," Pergament says.

Orzack says he's hoping all sorts of researchers can now turn his observations into insight.

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Doctors With Cancer Push California To Allow Aid In Dying

Mon, 03/30/2015 - 12:23pm
Doctors With Cancer Push California To Allow Aid In Dying March 30, 201512:23 PM ET

Partner content from

Anna Gorman

Dan Swangard, a 48-year-old physician from San Francisco, was diagnosed in 2013 with a rare form of metastatic cancer.

Anna Gorman/KHN

Dan Swangard knows what death looks like.

As a physician, he has seen patients die in hospitals, hooked to morphine drips and overcome with anxiety. He has watched death drag on for weeks or months as terrified relatives stand by helplessly.

Recently, however, his thoughts about how seriously ill people die have become personal. Swangard was diagnosed in 2013 with a rare form of metastatic cancer.

To remove the cancer, surgeons took out parts of his pancreas and liver, as well as his entire spleen and gallbladder. The operation was successful, but Swangard, 48, knows there's a strong chance the disease will return. And if he gets to a point where there's nothing more medicine can do, he wants to be able to control when and how his life ends.

"It's very real for me. This could be my own issue a year from now."

"It's very real for me," said Swangard, who lives in Bolinas, Calif. "This could be my own issue a year from now."

That's one of the reasons Swangard joined a California lawsuit last month seeking to let doctors prescribe lethal medications to certain patients who want to hasten death. If he were given only months to live, Swangard says, he can't say for certain whether he would take them.

"But I want to be able to make that choice," he said.

The right-to-die movement has gained renewed momentum in California and around the nation following the highly publicized death of Brittany Maynard. The 29-year-old with brain cancer moved from California to Oregon to take advantage of its "Death with Dignity" law and died in November after taking a fatal dose of barbiturates prescribed by her doctor.

The California lawsuit asks the court to protect physicians from liability if they prescribe lethal medications to patients who are both terminally ill and mentally competent to decide their fate.

Shots - Health News Contemplating Brittany Maynard's Final Choice

The lawsuit argues that while it is against the law in California for anyone to assist in another's suicide, these cases are not suicides. Rather, the suit argues, they are choices by a dying person on how his or her life should end and decisions about one's own body protected under the state constitution.

Separately, two California state senators have proposed a bill that would allow doctors to prescribe lethal medication to certain terminally ill adults.

Three states — Oregon, Washington and Vermont — already have laws allowing physician-assisted deaths. Courts in New Mexico and Montana also have ruled that aid in dying is legal, and a suit was recently filed in New York.

Legislation is pending in several other states. Kathryn Tucker, an attorney on several of the court cases, is spearheading the California lawsuit. This time, she and her legal team decided to include among the plaintiffs two doctors with life-threatening illnesses, Swangard and a retired San Francisco obstetrician.

Physicians "have a very deep and broad understanding about what the journey to death can be like," said Tucker, executive director of the Disability Rights Legal Center. "The curtain is pulled back. For lay people, death is much more mysterious."

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Historically, doctors have been some of the most vocal critics of assisted suicide, also called aid in dying. The American Medical Association still says that "physician-assisted suicide is fundamentally incompatible with the physician's role as healer." Similarly, the California Medical Association takes the view that helping patients die conflicts with doctors' commitment to do no harm. "It is the physicians' job to take care of the patient and that is amplified when that patient is most sick," said spokeswoman Molly Weedn.

But a recent survey of 21,000 doctors in the U.S. and Europe shows views may be shifting. According to Medscape, the organization that did the survey, 54 percent of American doctors support assisted suicide, up from 46 percent four years earlier.

Swangard is among those who believe that taking care of patients means letting them choose how their lives should end. That's not the same as killing patients or facilitating suicide, he said.

Swangard completed his medical residency in San Francisco in the middle of the AIDS crisis; young men were dying all around him. Throughout his career as an internal medicine doctor, a hospice volunteer and now an anesthesiologist, he has become frustrated with the way the medical system handles death. Doctors spend so much time trying to extend life that few focus on what patients want in their last days, he said.

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"I don't think we know how to die," he said. "We fight tooth and nail to keep that from happening."

Swangard's own illness was discovered in early 2013 during a long overdue checkup. He hadn't been worried about his health — he was obsessed with fitness, swimming regularly and seeing a trainer twice a week. But when the doctor pressed on Swangard's stomach, he felt a mango-size mass.

He had a visceral feeling, he said, "something bad was happening."

Within a week, a surgeon found a neuroendocrine tumor in the pancreas and metastasis in the liver. It was the same cancer that took Steve Jobs' life — one that doesn't generally respond to chemotherapy or radiation. "My fears became real," Swangard said.

The doctors told him they believed they got all the cancerous cells. But Swangard was tormented by questions: Am I going to be alive in a year? Is my cancer going to come back?

"I wasn't sleeping, I wasn't exercising, I was marinating in my own sadness and fear of what this all meant," he said. "I thought, 'This is going to kill me.' "

"It is a little bit of a blessing to know how I might die. I don't think a lot of patients have insight into what to expect."

Since his diagnosis, Swangard said he has had a greater understanding of his patients' struggles. Occasionally, he holds their hands and tells them he has been where they are.

Earlier this year, a physician friend asked him if he'd be willing to join the California case. Swangard didn't hesitate. He didn't go into medicine to help dying people linger and wants to help change that approach — for his patients and for himself.

When he dies, Swangard said, he wants to be surrounded by people he loves. He doesn't want to be in a drug-induced haze, nor consumed by worry about what's next. He wants to be able to say goodbye.

"It is a little bit of a blessing to know how I might die," he said. "I don't think a lot of patients have insight into what to expect."

These days, he wears a Buddhist prayer bracelet, a reminder to focus on the present. He cut his work hours, swims as often as he can and meditates regularly. At home, he stares out at the ocean, often watching dolphins pass by. He makes every effort to stay calm and healthy.

He is in remission, but he knows that what happens with the cancer is largely outside his control. MRI last year showed a small lesion in his liver, which doctors are watching closely.

"It's this big unknown," he said.

Dr. Robert Liner, a fellow plaintiff who only recently met Swangard, lives with the same uncertainty.

Retired San Francisco obstetrician Robert Liner, 70, is a plaintiff in a California lawsuit seeking to let doctors prescribe lethal medications to certain patients who want to die.

Ana Gorman/KHN

On his 69th birthday in May 2013, the retired obstetrician had a bad cough. He felt tired and short of breath. His wife took him to the hospital, where doctors discovered malignant masses on his kidneys — advanced-stage lymphoma.

After radiation and chemotherapy, the tumors shrank. He also is in remission. But if the cancer comes back, he said, "The prospects are not going to be good."

He often thinks of a former patient, a 25-year-old woman with metastatic ovarian cancer. She wanted to die while she still was able to communicate. Liner wasn't able to help ease her death because the law wouldn't let him. "I felt like I'd failed her," he said.

Years before his diagnosis, Liner, now 70, became involved with Compassion & Choices, an organization that promotes aid in dying. He has a shelf of books in his San Francisco home devoted to the subject: Being Mortal, Dying Right, Knocking on Heaven's Door.

Liner keeps a stack of notecards with quotes about the end of life, which he often recites in speeches to church groups or senior centers. One reads, "The best preparation for death is a life well-lived."

He believes having medication to hasten death helps terminally ill people live fully in their last weeks or months without being immobilized by fear. "If you are riddled with anxiety, you are not free to concentrate on what's most meaningful to you," he said.

Like Swangard, Liner doesn't know if he would take the medication. He recently married the woman he calls his "beloved" and said he has lots of plans for his retirement years, including writing a screenplay and improving his piano playing.

"My wife says I'd be hanging on to life by my fingernails," he said.

But that decision should be his to make, with his family and his doctor, he said. "I want the comfort of knowing it's up to me when enough is enough," he said.

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Sure, Use A Treadmill Desk — But You Still Need To Exercise

Mon, 03/30/2015 - 3:40am
Sure, Use A Treadmill Desk — But You Still Need To Exercise March 30, 2015 3:40 AM ET Listen to the Story 3 min 25 sec  

NPR senior Washington editor Beth Donovan walks on a treadmill desk in her office in Washington, D.C.

Meredith Rizzo/NPR

First off, I need to be upfront: I have a treadmill desk. I got it about two years ago, prompted by all the studies showing the dangers of sitting all day. The idea is to get people more active and walking while working. The problem is, I don't use it. In fact, I probably only used it for a few months. I still stand all day, but I'm not walking.

It turns out I'm not alone. Treadmill desks may have seen their day, according to Dr. Tim Church of the Pennington Biomedical Research Center in Baton Rouge, La. Church specializes in preventive medicine and works with companies to promote healthy activities on the job. A few years ago the treadmill desk "had a cool toy element to it," he says. "Everybody wanted one, and then when a lot of people got them they just didn't use them that much."

Shots - Health News Can You Move It And Work It On A Treadmill Desk?

And there's not a lot of evidence showing the benefit — or not — of using a treadmill desk. A recent small study, just 41 people, looked at whether the desks helped overweight and obese people get more active. The participants worked at a large insurance company and pretty much sat all day. Half the employees were given treadmill desks and were asked to walk on them twice a day at a leisurely pace for about 45 minutes.

But the participants didn't use the treadmills as much as they were asked, according to John Schuna, an assistant professor of exercise and sports science at Oregon State University and one of the study's authors. They averaged just one 45-minute session a day instead of two. And when they did use the treadmill, they didn't burn enough calories to lose weight — their pace was too slow.

Maura Howard tries to log about 3 miles a day on a treadmill desk at Salo, a financial staffing company in Minneapolis. She says regular walking helps her avoid after-lunch drowsiness.

Richard Sennott/MCT/Landov

Federal guidelines recommend 150 minutes of moderate to vigorous physical activity every week. That's walking about 3 miles per hour. Schuna says that's difficult on a treadmill desk — while working. If you tried to maintain that pace, "you'd likely start to perspire; some people may even start to have more labored or heavy breathing," he says, and "it's questionable how productive you could be from a work perspective."

But don't be too quick to write off the treadmill desk, which costs about $1,000 to $1,500. Study participants did increase the average number of steps they took in a day by about 1,000, and Schuna says, "Something is better than nothing."

If they had done a second 45-minute session or if the study had gone on longer, say six months, there may have been some weight loss, he adds. And as long as you're accumulating some physical activity, "you're still potentially gaining more health benefit than if you're sedentary all day."

Shots - Health News Walk A Little Faster To Get The Most Out of Your Exercise Time

And there are a couple of small studies that do suggest some benefit. One study, headed by Dr. James Levine, an endocrinologist at the Mayo Clinic's campus in Scottsdale, Ariz., found that over a 12-month period participants using treadmill desks increased their daily activity and lost weight.

Levine conducted another small study in 2007 at Salo, a finance, accounting and human resources staffing company in Minneapolis. This also was a very small study, just 18 people. For six months they rotated on and off treadmill desks, walking on average about three hours a day. Everyone lost weight and there were other health benefits, including lower cholesterol and triglycerides.

All Tech Considered Weekly Innovation: Get Moving, While Seated At Your Desk

Salo's marketing director, Maureen Sullivan, says the desks are still going strong. "I will get on if I'm on a conference call for an hour at a time," she says. "There are people in our office who are on between one to four hours, either every day or every other day."

One reason the desks remain so popular, she says, is that the company was founded on principles of healthy well-being and works hard to keep that spirit throughout the day. "We have a culture of movement," Sullivan says. There's a game room, walking meetings and a "contagious" atmosphere of high energy.

But the positive benefits found in the Salo study have yet to be reproduced in larger, long-term studies elsewhere. Until then, the bottom line seems to be, if you have a treadmill desk — use it. But don't forget you still have to fit about 150 minutes of moderate to vigorous exercise into your weekly routine as well.

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Compression Clothing: Not The Magic Bullet For Performance

Mon, 03/30/2015 - 3:39am
Compression Clothing: Not The Magic Bullet For Performance March 30, 2015 3:39 AM ET


Lauren Silverman Listen to the Story 3 min 35 sec  

Olympic gold medalist Sanya Richards-Ross pulls on compression sleeves before a 400-meter race at the World Indoor Athletics Championships in Istanbul in 2012.

Martin Meissner/AP

Maybe you've seen them in the gym, or even squeezed into them yourself: super-tight T-shirts, leggings, knee and calf sleeves, even tube tops. More and more athletes are wearing compression garments, hoping they will improve their performance and recovery.

But do they work? This is a question Abigail Stickford, a postdoctoral researcher at UT Southwestern Medical Center in Dallas, wanted to answer.

She conducted a small study using compression calf sleeves. Decades ago these were marketed to people with circulatory problems, but today they're also aimed at athletes. Manufacturers claim these garments will help improve blood flow and oxygen delivery to your muscles. Stickford says, "Those things in theory would really benefit your performance."

To test the claims, Stickford gave 16 endurance runners a pair of calf compression sleeves. Then she strapped on masks and monitors to measure the runners' gait and oxygen intake. The same routine was done without the calf sleeves as well, and "we found nothing," Stickford says. No difference.

"When we looked at the averages of our group of runners, all the measures of running gait were exactly the same with and without compression," Stickford says. "And the measures of efficiency were exactly the same."

Here's where it gets interesting. Two men who did show improvements while wearing the compression sleeves were the ones who believed the garments aided in training, racing and recovery.

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"The placebo effect is a real effect. It affects performance," Stickford says. "So if you think these garments work, there's not really any harm in trying them out."

That is, if you want to shell out the cash. A long-sleeve T-shirt might go for $60, a "core band" that looks like a tube top for $40 and a full body suit for several hundred dollars.

Stickford's study, published in the International Journal of Sports Physiology and Performance, was small. But larger research reviews back up the idea that compression clothing has little effect on performance.

So what is it good for? Well, possibly recovery. Compression is effective as a post-exercise recovery measure, says Daniel Cipriani, an associate professor of physical therapy at Chapman University. "Because it helps to keep down some of the swelling that occurs with all the blood flow," he says.

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Cipriani co-authored a study in the Journal of Chiropractic Medicine on cyclists who used compression and posture shirts while riding.

"During the ride, most of them liked the shirt in terms of making their back feel less fatigued and keeping them in a good posture while riding," he says. "But the majority felt it was even more useful after the ride as a recovery shirt."

Cipriani cautions that his study looked at the perceived effects of compression shirts — they didn't measure results. So it is possible that putting on the new garment had more of an effect on psychology than physiology.

Still, he says, it's worth giving compression clothes a try. While there's no evidence the clothing improves performance, there's also no evidence it's harmful.

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Videos On End-Of-Life Choices Ease Tough Conversation

Sun, 03/29/2015 - 5:21pm
Videos On End-Of-Life Choices Ease Tough Conversation March 29, 2015 5:21 PM ET Listen to the Story 5 min 6 sec  

Hawaii ranks 49th in the nation for use of home health care services during the last six months of someone's life. Videos from ACP Decisions show patients what their options are at the end of life.

ACP Decisions

Lena Katakura's father is 81. He was recently diagnosed with esophageal cancer and doctors don't expect him to survive the illness. Katakura says a nurse at their Honolulu hospital gave them a form to fill out to indicate what kind of treatment he'd want at the end of life.

"And we're looking through that and going, 'Oh my, now how're we going to do this?' " says Katakura. Then the nurse offered to show them a short video and Katakura and her father said, "Great!"

While the majority of Americans say they'd rather die at home, in many cases, that's not what happens. Among people 65 years of age or more, 63 percent die in hospitals or nursing homes, federal statistics suggest, frequently receiving treatment that's painful, invasive and ultimately ineffective. And Hawaii is one of the states where people are most likely to die in the hospital.

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The video that Katakura and her father watched pulled no punches. It begins: "You're being shown this video because you have an illness that cannot be cured." Then, in an undramatic fashion, it shows what's involved in CPR, explains what it's like to be on a ventilator, and shows patients in an intensive care unit hooked up to multiple tubes. "You can see what's really going to be done to you," says Katakura.

And you can decide not to have it done. The video explains that you can choose life-prolonging care, limited medical care or comfort care.

The simple, short videos are being shown in medical offices, clinics and hospitals all over Hawaii now. And they're being shown in many of the languages that Hawaiians speak: Tagalog, Samoan and Japanese, among others. Katakura and her father watched the video both in English and in Japanese.

"Some patients have said, 'Wow, nobody's ever asked me what's important to me before,' " says Dr. Rae Seitz, a medical director with the nonprofit Hawaii Medical Service Association — the state's largest health insurer. She says there are a number of obstacles that keep patients from getting the treatment they want.

Some health care providers may talk about it, she says; some may not; and each doctor, clinic, hospital and nursing home may have different standards. But also "it takes a lot of time, and currently nobody has a good payment system for that," says Seitz.

Out of 50 states, Hawaii ranks 49th in the use of home health care services toward the end of life. Seitz wanted to change that. She had heard about these videos, produced by Dr. Angelo Volandes of Harvard Medical School. She thought maybe they could help. So she brought Volandes to Hawaii to give a little show-and-tell for some health care providers.

"I frankly was astounded," Seitz says, "at how excited people became when they saw these videos."

Additional Information: Watch A Sample Video

This excerpt from an ACP Decisions video was posted by NPR member station KPCC. You can view the full catalog on ACP Decision's website, which notes that the videos are not meant for individual use but are designed to be part of a conversation between providers and patients.

Volandes thinks they were excited and — maybe — a little bit relieved.

"Physicians and medical students aren't often trained to have these conversations," says Volandes. "I, too, had difficulty having this conversation, and sometimes words aren't enough."

Volandes is the author of a book called The Conversation, which tells the stories of some of the patients he encountered early in his career and their end-of-life experiences. He describes aggressive interventions performed on patients with advanced cases of cancer or dementia. In the book, they suffer one complication after another. There is never a happy ending.

But the videos are not designed to persuade patients to opt for less aggressive care, Volandes says. "I tell people the right choice is the one that you make — as long as you are fully informed of what the risks and benefits are."

Still, studies show that the vast majority of people who see these videos usually choose comfort care — the least aggressive treatment. That's compared with patients who just have a chat with a doctor.

Every health care provider in Hawaii currently has access to the videos, courtesy of the Hawaii Medical Service Association. The impact on patients will be studied for three years. But one thing that won't be examined is how patients' choices affect cost, Seitz says.

"When a person dies in hospice care at home," she says, "it's not as costly as dying in the ICU. But it's also more likely to be peaceful and dignified. So people can accuse insurance companies [of pushing down costs] all they want to, but what I would look at is: Are people getting the kind of care that they want?"

Katakura's father is. He's at home with her, and receiving hospice services. After seeing the videos, she says, he chose comfort care only.

If she were him, she'd want that too, Katakura says. "So I was satisfied with his decision."

Now, she says, she needs to make a decision for the kind of care she wants for herself at the end of life — while it's still, she hopes, a long way off.

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Indiana's HIV Spike Prompts New Calls For Needle Exchanges Statewide

Sat, 03/28/2015 - 7:38am
Indiana's HIV Spike Prompts New Calls For Needle Exchanges Statewide March 28, 2015 7:38 AM ET


Jake Harper Listen to the Story 3 min 22 sec  

Needle exchange programs, like this one in Portland, Maine, offer free, sterile syringes and needles to drug users. The programs save money and lives, health officials say, by curtailing the spread of bloodborne infections, such as hepatitis and HIV.

Robert F. Bukaty/AP

Shane Avery practices family medicine in Scott County, Ind. In December, a patient came to his office who was pregnant, and an injection drug user.

After running some routine tests, Avery found out that she was positive for HIV. She was the second case he had seen in just a few weeks.

Dr. Shane Avery (right) and Kevin Collins, Scott County's coroner, say the prescription opioid problem in their community has led to an HIV outbreak that's still expanding.

John Sommers II/Reuters/Landov

"Right then, I kind of realized, 'Wow, are we on the tip of something?' " Avery says. "But you just put it away. ... It's statistically an oddity when you're just one little doctor, you know?"

It wasn't just a blip. Health officials have identified dozens of new HIV cases in the area since December, and more are expected.

Scott County is one of the poorest and least healthy counties in Indiana. For years, it has struggled with injection drug abuse. Now the drug use in the area has spawned an epidemic of a different kind: HIV.

"I'm actually surprised there haven't been similar outbreaks in similar parts of the country that could be described in the same way as Scott County, Ind. It may be that this is the first of several."

More than 70 new infections with the AIDS virus have been confirmed in just the last few months, in a place that normally sees a handful of cases in a year. The crisis led Indiana's governor, Mike Pence, to declare a public health emergency Thursday.

It also reignited a debate in the state over the use of needle exchange programs to prevent HIV's spread among users of injected drugs. Such programs have been found to work elsewhere, but the strategy is illegal in Indiana — and in 22 other states.

Many of the outbreak's cases have been linked specifically to oxymorphone, a prescription painkiller commonly known by the brand name Opana. The opioid seems to have become a favorite among drug abusers, who grind up the pills to inject the medication. Sharing needles is common.

Health Needle Exchange Program Creates Black Market In Clean Syringes Shots - Health News Needle Exchanges Often Overlooked In AIDS Fight

"There is a social network that often goes along with this kind of drug use," says Dr. Andy Chambers, a psychiatrist and addiction specialist at the Indiana University School of Medicine. "So it's fairly usual for infectious diseases to spread through through the needles."

Chambers says the HIV outbreak calls attention to the national epidemic of opioid drug abuse.

"I'm actually ... surprised there haven't been other, similar outbreaks in other parts of the country that could be described in the same way as Scott County, Ind.," he says.

The fear of HIV spreading beyond Scott County has reignited debate about whether needle exchanges should be legalized throughout the state.

The strategy encourages drug users to trade their used needles and syringes for free clean ones in order to reduce the spread of infections that occur when the equipment is reused and shared.

Though still opposed to legalizing needle exchanges throughout the state, Indiana Gov. Mike Pence told reporters Thursday he will temporarily permit the strategy in Scott County.

Michael Conroy/AP

The Centers for Disease Control and Prevention convinced Gov. Mike Pence to allow a temporary needle exchange in Scott County as part of the emergency response. But Pence is still against legalizing such exchanges statewide.

"I don't believe that effective anti-drug policy involves handing out paraphernalia to drug users by government officials," he says. "I reject that."

Rep. Ed Clere, a Republican state legislator who represents a nearby county, says needle exchanges shouldn't just be used to manage a crisis — they should be put in place in time to prevent outbreaks from occurring.

"When we smell smoke, we shouldn't wait until the house is engulfed in flames to do something," Clere points out.

Clere has introduced a measure that would legalize needle exchanges across Indiana. When he introduced a similar measure last year, it failed.

"Many of the folks who have contracted HIV in Scott County are going to be receiving treatment at taxpayer expense," Clere says. "Even with the number of cases that have been confirmed so far ... we could be talking about tens of millions or hundreds of millions of dollars."

Lawmakers in neighboring Kentucky approved needle exchanges in that state this week. But Indiana's Pence is still threatening to veto a needle exchange bill if it reaches his desk.

Jake Harper reports from Indianapolis for WFYI and for a regional health journalism collaboration.

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Medical Bills Linger, Long After Cancer Treatment Ends

Fri, 03/27/2015 - 3:04pm
Medical Bills Linger, Long After Cancer Treatment Ends March 27, 2015 3:04 PM ET


Amanda Aronczyk Listen to the Story 8 min 16 sec  

Melinda Townsend-Breslin holds a photo showing her and her mother standing in the parking lot of a favorite thrift store in 2013.

William DeShazer for NPR

Melinda Townsend-Breslin keeps a photo of herself on her refrigerator standing with her mother, MaryLou Townsend, in the front of the Unique Thrift Store in Louisville, Ky. They're side by side in the parking lot, both wearing white shirts and sporting short, practical haircuts.

Mom is proudly showing her discount card. "For the thrift store!" said Townsend-Breslin, laughing. "The discount for the thrift store!"

For Townsend-Breslin, this photo captures her mother: a frugal woman with a cheeky sense of humor, not prone to indulgences. When she was diagnosed with metastatic pancreatic cancer at 58, she approached her grim prognosis with the same pragmatism. She wanted to pursue treatment, but only if it was working.

Shots - Health News How Much Does Cancer Cost Us?

The time between discovering a lesion on her pancreas and requiring surgery to remove it was just a few weeks, so when their family doctor recommended a noted surgeon, the family didn't hesitate to use his services. They knew he was out of their health plan's network of doctors, but at that stage, it was the least of their worries.

"Mom, don't worry about it," Townsend-Breslin recalled saying to her mother. "Worry about being sick, worry about the time that you that have left, don't worry about the darn bills."

Townsend had several complications after surgery and had to stay in the hospital for 30 days. Not long after, the family began receiving bills for that part of her care.

"There's not a lot of time to ask questions when they come and say we're going to do this surgery," Townsend-Breslin said. "We didn't have time to say, can you tell us how much the surgery is going to cost? How many surgeons are going to be involved? ... We had no clue of the bills that were on the other side."

According to the family, the bills ballooned to over $300,000 before their health insurance kicked in.

After MaryLou Townsend died, her husband, John, and their daughter were left with a large medical debt.

William DeShazer for NPR

Until then, Townsend and her husband, John, had always been healthy. They rarely used the health insurance coverage that they received through his work as an automotive technician at a local car dealership.

When the bills started coming in the mail, they weren't always sure what they were responsible for paying, and what would be covered. Townsend feared they would go bankrupt or lose the house.

"She knew she was dying," her husband said. "And she was worried about paying the bills — me paying the bills after she was gone, on top of that."

They soon realized that their insurance coverage was true to its policy. It covered many of the charges, but it didn't fully cover their out-of-network surgeon or the full cost of all of the procedures. The familiy owed over $100,000, even with insurance.

"I always say, yes, $100,000 in debt is horrible," said Maggie Woods, director of the health and life division of the Kentucky Department of Insurance. "But half a million is much worse."

John and MaryLou celebrating their 36th wedding anniversary in 2011, before she was diagnosed with cancer.

Courtesy of Melinda Townsend-Breslin

"Unfortunately," she said, "Everyone thinks if it's insurance it's going to make you 100 percent whole. It's not the case."

The family regretted not looking at the policy more carefully and takes responsibility for that mistake. The family faults the health insurance company for its refusal to pay for a blood thinner that Townsend required.

She was suffering from blood clots and didn't respond to the standard drugs. She was in pain and only a blood thinner called Lovenox seemed to help. The drug cost around $1,000 a month and had to be paid out of pocket. Almost every month, the Townsends would have the same argument with their insurance company: The doctor said Lovenox was medically necessary; the insurance company wouldn't pay.

The family doesn't believe it was told that under the Affordable Care Act every state is required to have a formal appeals process, where patients can ask an external arbitrator to review a denial of payment. It's possible the Townsends received written notification of this process, they concede, but they don't recall that happening.

"I kind of think that's part of the doctor's job," Woods of the Kentucky insurance department said to Townsend-Breslin. "If they're going to be writing a prescription that's $1,200 or something like that, they have a responsibility in my opinion to give you all of your options to help you finance this health care for your mother."

Townsend's oncologist, Shawn Glisson, said that he knew about the appeals process. He said several members of his team spend their days negotiating access to drugs with insurance companies. In this case, the insurance company repeatedly refused to pay for what he deemed a medically necessary treatment, he said.

But he also doesn't think it is a doctor's responsibility to be involved in all the financial issues that arise during treatment beyond helping patients gain access to drugs at a reasonable cost.

Melinda Townsend-Breslin lost her mother to pancreatic cancer in 2014. The family is still coping with the bills.

William DeShazer for NPR

"No one shares with me their 1040 and their economic balance sheet," he said, because his role as the oncologist is to treat cancer.

"People come see me because they want to live. And I don't have any control over the cost or what they signed up for or didn't sign up for or whether they have access to money or not."

Townsend-Breslin agreed. "No, that's not his job. His job was to treat Mom. His job was to focus on Mom and not focus on kind of the ancillary things that the family was focused on."

The prognosis for advanced pancreatic cancer is very poor, and Townsend's blood clotting persisted throughout treatment. When her initial response to chemotherapy showed limited improvement, she decided to stop treatment. She died on May 22, 2014.

Find other stories in the Living Cancer series at


Since then, Townsend-Breslin has made it her part-time job to resolve her father's lingering financial issues. She works in the same hospital where her mother was treated and received assistance from two foundations affiliated with the hospital. She also negotiated and disputed various bills as best she could.

By earlier this month, she had successfully managed to reduce her father's medical debt down from $100,000 to less than $10,000.

Now, she and her father are learning to live without their beloved mother and wife. It has been bittersweet. A few months after Townsend died, Townsend-Breslin gave birth to the family's first grandchild, a healthy baby boy.

"I think MaryLou would've been really smitten with him," said her widower, as he smiled at his new 4-month-old grandson. "I think she would've had you spoiled, boy."

Our series is produced with member station WNYC and with Ken Burns Presents: Cancer: The Emperor of All Maladies, which will air on PBS starting March 30. Check your local listings for broadcast times.

Copyright 2015 WNYC Radio. To see more, visit
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New York City To Teens: TXT ME With Mental Health Worries

Fri, 03/27/2015 - 12:42pm
New York City To Teens: TXT ME With Mental Health Worries March 27, 201512:42 PM ET

Most teenagers with mental health problems don't get any help.


The majority of teenagers with mental health issues don't get help. But maybe if help were just a text message away — they wouldn't be so hesitant to reach out.

That's the thinking behind NYC Teen Text, a pilot program at 10 New York public high schools that allows teens to get help with mental health issues by text.

Chiara de Blasio, the 20-year-old daughter of Mayor Bill de Blasio who has been vocal about her own struggles with depression and substance abuse, helped launched the program. "I know from personal experience that reaching out when you're in pain can be the turning point – the first step on the road to recovery," she said at a press conference on Tuesday.

The initiative is managed by the city's health department in collaboration with the Mental Health Association of New York City, which already runs a citywide crisis phone service.

"I know from personal experience that reaching out when you're in pain can be the turning point – the first step on the road to recovery."

"Teens can be more candid on text than even in a phone conversation or in person," says John Draper, director of the National Suicide Prevention Lifeline, which helped design the Teen Text program. "This generation of teens make and break up relationships by text. So you can get pretty strong levels of intimate conversation with text."

The program is inspired by similar initiatives, including the Teen Line service in Los Angeles and the Crisis Text Line — which is available 24/7 for teens all over the country.

The advantage of having a local service is that counselors can look up and recommend local counselors to teens who need extra help. "We have more than 2,000 providers in our databases," Draper says.

And when teens who text the helpline appear to be in imminent danger of harming themselves or others, counselors can work with the local police department to track them down make sure they're safe.

But the text-based approach poses a few challenges, as well, Draper says. "One of the tricky things is making sure we're communicating our empathy. You can't hear someone say 'Mhm, mhm' over text."

Counselors who operate the text line receive extra training, Draper says. "Over text, counselors go out of their way to make it clear that they're actively listening. We may say something like 'It sounds like this loss has been terribly devastating for you, I'm so sorry to hear that.' "

New York City Department of Health

And teens who reach out to such services may need extra validation, Draper says. "The whole world could be black today and it may feel like that's the way it will be forever. They don't have life experience telling them that this is going to end and get better," he says. "The counselor's job is to really be there in the moment so they learn that they can get through this."

Privacy is another concern. "We use encrypted messages and store all the information in secure databases," Draper says. "Still, on their end, we have no control over what they do with their information. The advantage of keeping the texts on their phone is that they can read and reread these messages that were useful or important to them. But we do warn them — if they're concerned about someone seeing, they should forward their texts to a more secure setting."

"I was very excited about this program," says Nadine Kaslow, the president of the American Psychological Association and vice-chair of Emory University's psychiatry department. "I think it has a great deal of potential."

In-person counseling is the best, most effective way to help teens with mental health trouble, says Kaslow, who isn't involved with the Teen Text program. "But there will be some subgroup of teens where this text service is the only way to connect with them."

There is a lack of research on the long-term efficacy of text and mobile app based services, she notes. "The issue is that everything is anonymous and there's no way to follow-up with them to see if they ended up seeing a counselor later, or if they're doing better."

The NYC Department of Health and Mental Hygiene will be tracking the number of students who use the new service, and they're planning on gathering feedback from students at the 10 pilot high schools, according to Gary Belkin, the executive deputy commissioner for mental hygiene.

If the program is successful, the health department hopes to expand it and promote it in high schools citywide.

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How Much Does Cancer Cost Us?

Thu, 03/26/2015 - 5:00pm
How Much Does Cancer Cost Us? March 26, 2015 5:00 PM ET


Kathryn Tam

Before we started our Living Cancer series, we went on NPR's Facebook page to ask people about their experiences in paying for cancer treatment. Over a hundred people from across the country responded.

We talked with some people by phone to learn about their stories.

Maureen Carrigg, who lives in Wayne, Neb., was diagnosed with multiple myeloma six years ago. Even though she says she was meticulous about staying within her insurer's network for care, she still ended up owing $80,000 in out-of-pocket costs.

Shots - Health News Medical Bills Linger, Long After Cancer Treatment Ends

"When you're in the hospital, you can't just put a notebook by your bed and write everything down," she said.

"I went into the cancer center's office with these bills and just started bawling because I couldn't figure out how I was going to pay it all back," she said. In then end, she had to tap her son's college savings account.

Tough financial decisions were common among those who shared their stories with us. For many, the threat of personal bankruptcy loomed large. Ginger Roethemeyer, a retired oncology nurse from Omaha, Neb., says she cashed out her 401(k) to pay off her medical bills quickly.

Find other stories in the Living Cancer series at


She was diagnosed with lymphoma in 2010. Chemotherapy drugs were the most expensive part of her care. As a nurse, and eventually a patient, Roethemeyer saw both sides of cancer treatment. Looking back, she said, "I think I could deal with the actual cancer far better than having to deal with the medical system and the cost of treatment."

Many people told us the financial cost of cancer treatment was something they preferred not to think about — at first. But paying for cancer care shaped the way they make daily decisions, and it also took an emotional toll.

Cindy Alsobrook, 42, was diagnosed with cervical cancer in 2013. During her second round of chemotherapy, she developed severe lymphedema, a painful swelling, and had to quit her job at a local shoe store. Her husband supports them by working three days a week as a shipping and receiving clerk.

"So now all the weight is on him to keep us afloat," Alsobrook said over the phone from her home in Seattle. "I think it's obvious that the financial hardship creates an emotional hardship, but it has a lot of layers."

Alsobrook would like to get back to work, to help with bills and for the emotional fulfillment. "It's easy to feel like you don't count," she says. "I know that I have a lot to offer the world, but I feel like I've been shelved because I've been sick."

How much do you know about what cancer costs our country and the people who are affected by the disease? Take our quiz and put your knowledge to the test.

var pymParent = new pym.Parent('pym-cancer-costs-quiz', '', { });

Our series is produced with member station WNYC, and with Ken Burns Presents: Cancer: The Emperor of All Maladies, which will air on PBS starting March 30. Check your local listings for broadcast times.

Copyright 2015 WNYC Radio. To see more, visit
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Critic Faults Alcoholics Anonymous For Lack Of Evidence

Thu, 03/26/2015 - 3:38pm
Critic Faults Alcoholics Anonymous For Lack Of Evidence March 26, 2015 3:38 PM ET NPR Staff Listen to the Story 5 min 40 sec  

Founded by two men in Akron, Ohio, in 1935, Alcoholics Anonymous has since spread around the world as a leading community-based method of overcoming alcohol dependence and abuse. Many people swear by the 12-step method, which has become the basis of programs to treat the abuse of drugs, gambling, eating disorders and other compulsive behaviors.

But not everyone's a fan. In a recent critique of AA, author Gabrielle Glaser writes in the April issue of The Atlantic that, "Nowhere in the field of medicine is treatment less grounded in modern science."

The Salt Moderate Drinker Or Alcoholic? Many Americans Fall In Between Shots - Health News Meds Can Help Problem Drinkers, But Many Doctors Don't Know That

Glaser, whose 2013 book, Her Best-Kept Secret, explores what she calls "the epidemic of female drinking" in the U.S., says recent research on the brain suggests that the abstinence advocated by AA isn't the only solution — or even the best for many people. Cognitive therapy combined with the medication naltrexone, Glaser says, can help ease cravings and has been shown in some studies to help some problem drinkers learn to drink moderately without quitting.

Glaser's magazine story has drawn fire from defenders of AA, including Huffington Post writer Tommy Rosen, who calls himself "a person in long-term recovery (23 years) who overcame severe drug addiction and alcoholism in great part due to the 12 Steps." Glaser's article, Rosen writes, is "painfully one-sided." Therapist and psychology reporter Robi Ludwig told Glaser and the host of MSNBC's program All in With Chris Hayes last week that she thinks it's "very dangerous to put out the idea that AA doesn't work. Does it work for everybody? No. There's not going to be one form of treatment that works for everybody."

In an interview with NPR's Audie Cornish for All Things Considered, Glaser discusses her story, the heat she's getting and why she believes people with a drinking problem should consider options beyond AA. NPR contacted Alcoholics Anonymous for comment, but the organization declined.

Interview Highlights

On why Glaser thinks Alcoholics Anonymous should be challenged and updated

We did a lot of things in 1935 that we don't do anymore. You know, when babies were delivered, we spanked them on the bottom and held them upside down and that's something that didn't necessarily hurt babies, but we don't do that anymore.

I'm not saying AA shouldn't exist. But what I am saying is that we can't prove its efficacy. And some of the studies that have been done just don't justify our immense reliance on a system that hasn't been found to be effective.

[In] the modern history of disease, from AIDS to breast cancer, patients have demanded better treatment. They've demanded better drugs; they've demanded less disfiguring surgeries. But because of our country's ambivalent history with alcohol and problem drinkers, our answer has been: "Stick with the 12 steps. It works if you work it." And what I'm saying is, it works for some people but not for everybody. And we should be demanding more options.

On the dominance of AA and the 12-step approach in the treatment of substance abuse in the United States

There was a book that came out in 2013 called Inside Rehab by Anne Fletcher, and that book found that up to 80 percent of all rehabs rely on AA and 12-step treatments as the foundation for their centers. It really has crowded out other voices.

On the idea that some key aspects of AA — peer support, spirituality, personal transformation — don't lend themselves to scientific metrics

Right. ... That's a benefit that people do get from being in a group such as AA, but there are also many other [programs] that are free and peer-led and they happen to be rooted in evidence-based treatment. Many of them use cognitive behavioral therapy as their backbone. One is Smart Recovery. Moderation Management is another one. Women for Sobriety is a third.

On the criticism she's received that questioning AA is irresponsible, when so many people say 12-step programs are the only thing that enabled them to quit drinking

I get those messages all the time. My response to that is that this treatment actually can be just as damaging and dangerous for the people for whom it's failing. AA doesn't refer anybody out. It doesn't tell anybody that AA is not for them. It's very unlike professional organizations, which refer people to second opinions. AA tells people that if they don't benefit, it's basically their fault. This has produced, really, a lot of tragedies. I hear about them weekly. Someone sent me an email this morning about a younger brother who committed suicide last night with the [AA] Big Book and a glass of scotch next to his bed.

On the risks of AA to some people

It causes people to blame themselves for failing and, consequently, spending more time in the program feeling worse about themselves. Families also blame their loved ones if they don't do well or if they drop out rather than realizing that AA might not be the best approach.

On naltrexone, and whether there's danger in using a drug to treat someone with a serious drinking problem

That is an idea that's kind of rooted in history. When doctors were trying to get people away from their alcohol addiction in the 1950s and '60s, they were also prescribing Valium. So many people would become addicted to both Valium and alcohol. This is a completely different drug. Naltrexone is an opioid antagonist. It's nonaddicting. It's been shown in dozens and dozens of studies to be very safe. And in Finland, it's been used [to help] drinkers ... learn to moderate. The drug is legal. It was approved by the FDA in 1994, and it's used here in only about 1 percent of cases.

So there's a whole kit of tools out there that have been ignored. And this is really the moment to have this conversation. ... The Affordable Care Act now covers treatment for people with alcohol use disorder. The question arises: What treatments are we going to cover? What are we going to invest in as we move forward?

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A Single Gene May Determine Why Some People Get So Sick With The Flu

Thu, 03/26/2015 - 2:06pm
A Single Gene May Determine Why Some People Get So Sick With The Flu March 26, 2015 2:06 PM ET Poncie Rutsch

The H1N1 swine flu virus kills some people, while others don't get very sick at all. A genetic variation offers one clue.

Centre For Infections/Health Pro/Science Photo Library/Getty Images

It's hard to predict who will get the flu in any given year. While some people may simply spend a few days in bed with aches and a stuffy nose, others may become so ill that they end up in the hospital.

Until now, researchers could only point generally at differences between flu patients' immune responses. Jean-Laurent Casanova, a professor at Rockefeller University and investigator at Howard Hughes Medical Institute, has been sifting through cases of children with severe flu. He and his colleagues have pinpointed one gene that keeps the immune system from fighting off the flu, and their results were published today in Science.

For this study, Casanova focused on one girl, who was two and a half years old when she was infected with H1N1, more commonly known as swine flu. The girl, whom the researchers call P, was admitted to a pediatric intensive care unit where she was intubated and kept on a ventilator while she was treated.

Shots - Health News Scientists Implicate More Than 100 Genes In Causing Autism

The girl had no risk factors that might predispose her to severe influenza. "The child did not have pulmonary disease or any congenital problems," Casanova tells Shots. Nor did she have a family history of lung problems or anything that would suggest she could not stage a full-throttle immune response. "It's just life-threatening influenza coming out of the blue," he explains.

So Casanova and his collaborators sequenced the girl's genome, and searched for genes that might keep P from building a strong immune response to fight off the flu. They pinpointed one gene that prevents P from making interferons, proteins that help stop an invading virus from replicating and further spreading through the body.

Interferons are an important part of the immune response because they're an early defense that the body employs to fight disease. "They're made by all cells in the body," says Casanova. "Some cells have weak interferons, and in that case even a seasonal flu virus can be dangerous."

Shots - Health News Is Your State Ready For The Next Infectious Outbreak? Probably Not

In addition to pinpointing the gene, Casanova and his colleagues used stems cells to grow P's pulmonary cells in vitro. Sure enough, her cells could not produce interferons.

The study helps explain genetic variation changes the way that people fight off viruses. "The response to influenza is genetically impaired," says Casanova. He's hoping that the study will catch the interest of other pediatricians and lead to more patients offering their genomes for further research.

Casanova is also intrigued by interferon therapy, which is sometimes used to help fight multiple sclerosis, hepatitis C and some forms of cancer. "It's a little like insulin to the diabetic; you give a person with diabetes insulin and they're good," he explains. Patients might be able to receive interferon injections to mount a faster immune response, he speculates, instead of waiting for later attacks from B and T cells.

Shots - Health News Debunking Vaccine Myths Can Have An Unintended Effect

As for P, she made a full recovery from H1N1. Four years later, she gets the flu vaccine each year and has remained healthy. "If she is exposed to influenza after vaccination she can respond to the virus," says Casanova. This is because other parts of P's immune system still effectively defend her body from infection. The flu vaccine, for example, uses an inactive form of influenza to build a response in the body's T cells and B cells.

"She makes T cells and B cells against the virus, so when the virus comes it is immediately killed by those cells even though the interferons aren't working," Casanova explains.

So while it doesn't make sense to sequence children's genomes looking for variants that affect the immune system, Casanova strongly advises that every child receive the flu vaccine. "If this patient had been vaccinated prior to her first infection she would probably have always remained healthy," he says.

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