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In California, Less Water Means More West Nile Virus

Mon, 09/22/2014 - 1:54pm
In California, Less Water Means More West Nile Virus September 22, 2014 1:54 PM ET

fromKQED

Low water levels, like at this reservoir near Gustine, Calif., bring birds and mosquitoes together and help transmit West Nile virus to humans.

Rich Pedroncelli/AP

California's historic drought is partly to blame for the recent rise in West Nile virus infections, public health officials say. There have been 311 cases reported so far, double the number of the same time last year, and the most of any state in the country.

West Nile virus is spread by mosquitoes. They contract the virus when they feed on infected birds, then spread it to the birds they bite next. A shortage of water can accelerate this cycle.

"When we have less water, birds and mosquitoes are seeking out the same water sources, and therefore are more likely to come in to closer proximity to one another, thus amplifying the virus," says Vicki Kramer, chief of vector-borne diseases at the state Department of Public Health.

Also, the water sources that do exist are more likely to stagnate. Stagnant water creates an excellent habitat for mosquitoes to breed.

Around the Nation Despite California's Drought, Taps Still Flowing In LA County

"It makes more mosquitoes, and it makes them faster," says Roger Nasci, chief of the arboviral diseases branch at the Centers for Disease Control and Prevention.

High temperatures contribute as well, and can be especially bad when it doesn't cool down at night. That's been the case in Orange County this year. It has logged the highest number of West Nile cases in humans in the state: 116.

Local officials have been waiting for the right weather conditions to spray pesticides to kill mosquitoes and have been surveying the region by plane for backyard pools and birdbaths that have stagnated. High foreclosure rates in the region led to an increase in abandoned pools in recent years, and continue to be a factor in the current elevated rates of West Nile, Kramer says.

The Salt California Drought Has Wild Salmon Competing With Almonds For Water

While case numbers are high in Orange and Los Angeles counties, some counties in Northern California have a higher concentration of cases. Glenn County north of Sacramento has the highest incidence of West Nile at 35 cases per 100,000 people. Orange County's incidence is just 4 per 100,000.

"There's a broader type of habitat available for mosquitoes in the Sacramento Valley compared to Bay Area counties, for instance," Kramer says.

As a result, the area draws two types of mosquitoes to the region: rural mosquitoes that breed in the rice fields, and urban mosquitoes in surrounding towns.

"So those two mosquitoes working together will further amplify the virus," she says.

Shots - Health News The High Cost Of Treating People Hospitalized With West Nile Virus

The majority of people infected with West Nile virus show no symptoms. Twenty percent get flu-like aches and fever, and only 1.5 percent develop the most severe neuroinvasive form of the disease. Ten percent of those who get very sick, die.

So far this year, 12 people in California have died, mainly the elderly and people with underlying conditions like diabetes or high blood pressure. In total, California has the most reported cases of West Nile in the country — 311 cases as of last Friday. Texas is second with 98 cases, and Louisiana is third with 78, according to CDC data.

Nasci warned that the season for West Nile has yet to peak. Temperatures and infection rates are still rising.

"There's still a substantial period of the year left," he says. "How long that risk persists will depend on how many more mosquitoes are produced, how much longer they're going to live, how many birds are susceptible."

Public health officials recommend that people protect themselves from infection by wearing long sleeves and long pants, and using insect repellent.

This story was produced by State of Health, KQED's health blog.

Copyright 2014 KQED Public Media. To see more, visit http://www.kqed.org.
Categories: NPR Blogs

NFL Looks To Training To Prevent Domestic Violence By Players

Mon, 09/22/2014 - 3:33am
NFL Looks To Training To Prevent Domestic Violence By Players September 22, 2014 3:33 AM ET Listen to the Story 5 min 10 sec  

No amount of training can undo the violence someone experienced at home as a child, but it can help break the cycle.

Pamela Albin Moore/iStockphoto The Two-Way NFL Commissioner: 'We Will Get Our House In Order'

On Friday, NFL Commissioner Roger Goodell broke a week of silence following the release of a video that showed former Baltimore Ravens running back Ray Rice assaulting his then-fiancee.

Goodell apologized for his role in the NFL's handling of the matter.

He also vowed that the NFL will mandate trainings on preventing abuse for all players and staff. What the trainings will entail remains to be seen. But researchers say that to truly cut back on violence among players, the NFL should address at least one major risk factor: a culture of acceptance in professional sports.

Of course, the type of people who engage in domestic violence is disturbingly diverse — some accountants, judges, even clergymen hit their partners.

But lately the question has been: Why the NFL? Especially when the vast majority of NFL players will never abuse their wives or beat their children.

“ The most startling finding was that the highest rate of domestic violence in the Unites States Army was not in the combat infantry or special forces. It was those people who worked in supply.

"Football is not even the most violent sport," says Richard Gelles, a professor of social policy at the University of Pennsylvania. "Why aren't we hearing about wrestlers or boxers? You know the old joke: 'I went to a fight and a hockey game broke out.' "

Gelles has been studying domestic violence since the 1970s. He has done a lot of research on sports, but he also has looked into family violence among members of the military: combat infantry soldiers, trained to kill an enemy.

The U.S. Army brought in Gelles to conduct an internal study in the 1990s. It wanted to find out if men trained to kill were more likely to beat their wives or hit their kids. Gelles found that rates of domestic violence in the Army were slightly higher than in the general population. "But the most startling finding was that the highest rate of domestic violence in the Unites States Army was not [in] combat infantry or Special Forces," he says. "It was those people who worked in supply."

"Supply" — as in ordering things and receiving them. Restocking for missions.

"So the training of people to be violent, and violence as part of your work culture, is not a sufficient explanation for what's going on in the NFL," Gelles says.

It's challenging to measure rates of domestic violence, because most incidents are not reported to the police, or anyone else; but Gelles is not convinced that rates in the NFL are significantly higher than in the general population.

He also notes that, even when aggression is the goal, it's quite difficult to train people to be violent: "In World War II, only about 30 percent of combat infantry actually fired their weapons."

So where do people who abuse their partners and children learn the behavior? How far-reaching should these NFL trainings be?

Rowell Huesmann, a psychologist at the University of Michigan, has spent his career trying to figure out what makes some people violent. Much of his research points to childhood experiences.

The Two-Way Hannah Storm, A Pro, Fan And Mother, Gives NFL An Earful

"Children are great imitators," Huesmann says. Children who grow up with physical abuse and domestic violence are learning that "this is a way you deal with other people when you want to make them bend to your will," he says. "You hit them."

Adrian Peterson, the Minnesota Vikings running back recently indicted by a grand jury on a child abuse charge for his method of disciplining his son, says his own father whipped him as a child. Peterson even chose the same instrument his father used to discipline him: a switch cut from a tree.

No NFL training can change what players experienced as children. But that sort of education can address the biggest risk factor for committing acts of violence: having committed such an act before. Researchers say it's much easier to be violent if you're getting a message that violence is acceptable. The NFL has, at least indirectly, and until very recently, been sending that message for decades.

It doesn't just reach players, says Jackson Katz, a violence prevention educator. It trickles down to fans — even the youngest ones.

"Millions of boys across the United States have big posters of football players on their wall," says Katz. "You can bet that they know what's going on here."

Katz works with NFL players in a program called MVP, Mentors in Violence Prevention — a training program that's just the sort Goodell promised Friday to mandate for all NFL players. (In August, NPR reported on MVP and how it's used with high school boys to prevent sexual assault.)

Katz has trained players in the NFL for almost 15 years. But, except for consistent work with one team, the New England Patriots, he's been brought in only occasionally, he says.

"It's never been systematic in the NFL," Katz says. "We've argued for years that we could do so much more if they wanted us, and wanted to make it happen."

He hasn't gotten a call from the NFL about the new mandate. But in order to make a difference in players' behavior, he says, the trainings will have to go beyond a one-shot presentation.

"What we're talking about here is culture change," Katz says. "We're talking about setting a tone where abusive behavior is seen as completely unacceptable."

In the meantime, Richard Gelles says that even the delayed reaction to Ray Rice's abusive behavior is progress.

This year, Gelles says, "is the first time that I have seen a professional athlete really rung up and sanctioned for domestic violence."

Gelles can rattle off a long list of baseball players, basketball players and football players who were not arrested, and who were allowed to keep playing, even after particularly brutal assaults of their wives and girlfriends.

But he suspects those days in professional sports might be coming to an end, because "what has been private is now becoming public," he says, in the form of YouTube videos and the cascade of public opinion that follows.

That's something institutions like the NFL can no longer ignore.

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

The Biology Of Altruism: Good Deeds May Be Rooted In The Brain

Mon, 09/22/2014 - 3:32am
The Biology Of Altruism: Good Deeds May Be Rooted In The Brain September 22, 2014 3:32 AM ET Listen to the Story 3 min 36 sec   Rob Donnelly for NPR

Four years ago, Angela Stimpson agreed to donate a kidney to a complete stranger.

"The only thing I knew about my recipient was that she was a female and she lived in Bakersfield, Calif.," Stimpson says.

It was a true act of altruism — Stimpson risked pain and suffering to help another. So why did she do it? It involved major surgery, her donation was anonymous, and she wasn't paid.

"At that time in my life, I was 42 years old. I was single, I had no children," Stimpson says. "I loved my life, but I would often question what my purpose is."

Angela Stimpson smiles before surgery to donate a kidney on Sept. 22, 2010, at Weill-Cornell Hospital in New York.

Courtesy of Angela Stimpson

When she read about the desperate need for kidneys, Stimpson, a graphic artist who lives in Albany, N.Y., says she found her purpose. She now blogs about her experience and encourages others to become donors.

People like Stimpson are "extraordinary altruists," according to Abigail Marsh. She's an associate professor of psychology at Georgetown University and one of the country's leading researchers into altruism.

Marsh herself was the beneficiary of extraordinary altruism when she was 20. She got into a freak highway accident and ended up stalled in the fast lane facing oncoming traffic. A man dodged traffic to come to her aid and help get her car started. He saved her life, she says, then disappeared before she could ask his name.

Marsh wanted to know more about this type of extraordinary altruism, so she decided to study the brains of people who had donated a kidney to a stranger. Of the 39 people who took part in the study, 19 of them, including Angela Stimpson, were kidney donors.

Marsh took structural images to measure the size of different parts of their brains and then asked the participants to run through a series of computer tests while their brains were being scanned using functional MRI. In one test, they were asked to look at pictures of different facial expressions, including happiness, fear, anger, sadness and surprise.

Most of the tests didn't find any differences between the brains of the altruistic donors and the people who had not been donors. Except, Marsh says, for a significant difference in a part of the brain called the amygdala, an almond-shaped cluster of nerves that is important in processing emotion.

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The amygdala was significantly larger in the altruists compared to those who had never donated an organ. Additionally, the amygdala in the altruists was extremely sensitive to the pictures of people displaying fear or distress.

These findings are the polar opposite to research Marsh conducted on a group of psychopaths. Using the same tests as with the altruists, Marsh found that psychopaths have significantly smaller, less active amygdalas. More evidence that the amygdala may be the brain's emotional compass, super-sensitive in altruists and blunted in psychopaths, who seem unresponsive to someone else's distress or fear.

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

Best To Not Sweat The Small Stuff, Because It Could Kill You

Mon, 09/22/2014 - 3:30am
Best To Not Sweat The Small Stuff, Because It Could Kill You September 22, 2014 3:30 AM ET Listen to the Story 4 min 33 sec   Keith Negley for NPR

Chronic stress is hazardous to health and can lead to early death from heart disease, cancer and of other health problems. But it turns out it doesn't matter whether the stress comes from major events in life or from minor problems. Both can be deadly.

And it may be that it's not the stress from major life events like divorce, illness and job loss trickled down to everyday life that gets you; it's how you react to the smaller, everyday stress.

The most stressed-out people have the highest risk of premature death, according to one study that followed 1,293 men for years.

"People who always perceived their daily life to be over-the-top stressful were three times more likely to die over the period of study than people who rolled with the punches and didn't find daily life very stressful," according to Carolyn Aldwin. She directs the Center for Healthy Aging Research at Oregon State University and led the study, which is scheduled for publication in the journal Experimental Gerontology.

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Some people get frantic sitting in bumper-to-bumper traffic, worried about being late or not being able to do what they hoped in a timely manner. Others simply take the time to sit back, listen to music and appreciate the break as some quiet time.

Now, getting upset in traffic once is no big deal. But if things like that happen all the time and the response is always getting really upset, then the harmful effects of stress can become toxic.

"There are a number of ways chronic stress can kill you," says Aldwin. That includes increased levels of cortisol, often referred to as the stress hormone. Elevated cortisol levels interfere with learning and memory, lower immune function and bone density, and increase blood pressure, cholesterol and heart disease.

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If you are one of those chronically upset worriers, Dr. Robert Waldinger, a psychiatrist at Massachusetts General Hospital and Harvard University, has a prescription for you: exercise.

"If you could give one magic pill that would improve physical health, mood, reduce weight," this would be it, Waldinger says. Federal health officials recommend 30 minutes of moderate aerobic activity every day.

When it comes to fighting stress, Waldinger says, that's enough. "When they do studies particularly of the mood benefit, they find that more than 30 minutes a day is not necessary — you don't get any boost. So if you think just in terms of stress relief and antidepressant effect, 30 minutes is enough."

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Another option would be to add meditation to your daily routine. For many people, that can make a big difference, Waldinger says, "because what you do is watch your mind spin out anxiously over trivia, and eventually it settles down and you begin to have more perspective."

Breathing may be the simplest and most immediate fix, Aldwin says. "Take a step back when you feel yourself getting upset, step back psychologically and even physically," she recommends. "And then watch your breathing; people who get upset a lot breathe very rapidly and shallowly, and it creates more anxiety." Breathing slowly from the abdomen helps slow the stress response, she says.

And finally, Waldinger says here's something not to do: Don't overdo alcohol. "It feels in the moment like having that extra drink at night eliminates stress because it relaxes you, but it turns out that alcohol disturbs sleep." And it also acts as a depressant.

Some stress is inevitable for everyone, Waldinger says. But stress-related disease doesn't have to be.

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

Terminally Ill, But Constantly Hospitalized

Sun, 09/21/2014 - 5:38am
Terminally Ill, But Constantly Hospitalized September 21, 2014 5:38 AM ET

fromWNYC

The place: Beth Israel Hospital in Manhattan.

The diagnosis: fast-growing, small-cell lung cancer.

The patient: Paula Faber, unrepentant, life-long smoker.

The choice: treat it aggressively to extend life, but probably not cure the disease, or manage the pain and focus on the quality of life.

It was September 2012 and it was Paula Faber's third cancer in a decade, but she did not hesitate.

"She was going to fight it every inch of the way," says her husband Ron Faber.

By August 2013 after much fighting, Paula Faber died at age 72. Ron Faber now regrets the intervening 11 months of chemotherapy, radiation, painkillers and side effects that reduced his wife to 67 pounds of frayed nerves.

"I would have rather have had a really OK four-and-a half months than this endless set of treatments," the stage actor said.

As they confronted Paula's terminal diagnosis, the decision the Fabers made is among the most difficult anyone can make. But it turns out that in the New York metropolitan region, patients opt for aggressive treatment much more often than other Americans.

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

"New York City continues to lag in serious ways with regards to providing patients with the environment that they want at the end of life," says Dr. David Goodman, who studies end-of-life care at Dartmouth College's Geisel School of Medicine.

The reasons they do this are many, but most experts agree that it has less to do with the unique characteristics and desires of people in New York and New Jersey than the health care system and culture that has evolved here.

At the end of life, all this translates to more people dying in the hospital, often in an intensive care unit on a ventilator or feeding tube; more doctor visits leading to tests, treatments and drug prescriptions; and more money being spent by the government, private insurers and patients themselves.

Specialists at the Dartmouth Healthcare Atlas maintain that one of the main drivers of this phenomenon is quantity: People end up in hospitals here so often, they say, because this region simply has a lot of hospital beds.

"One of the truisms of health care is that whatever resources are available, or whatever beds are built, they tend to get filled," Goodman says.

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

A second driver is that every region has its own medical "culture," and the one in New York is built around highly trained specialists and sub-specialists who see it as their job to cure illness. Dr. Diane Meier says that means, "that if there's a cancer it needs chemotherapy, that if there's heart failure, it needs a procedure."

Meier is a geriatric specialist at Mount Sinai and the director of the Center to Advance Palliative Care

She says also driving the culture of heavy treatment is the high proportion of specialists and sub-specialists who constantly refer patients to each other — both because that is how they were trained and because it is good for business.

"If I'm an endocrinologist, if I refer to the cardiologist, the cardiologist will refer back to me for endocrine problems," says Meier. "It's like a cottage industry."

At Mt. Sinai, the chair of surgery now demands his staff discuss hospice alternatives with terminally ill patients — and make an electronic note of the conversation that can be tracked. If it does not happen, he demands to know why. Meier said every hospital doctor should follow this example.

"All of medicine needs to be willing to say, 'Why did this person with end-stage dementia have three or four hospitalizations in the last three months of life and die in the intensive care unit? This was a terrible experience for the patient and family. A lot of unnecessary suffering. Over a million dollars cost to the taxpayer. How did that happen?' " she says.

Ron Faber is still asking that question.

A year after his wife Paula died, he still believes her oncologist at Beth Israel Hospital was strangely optimistic about her prospects. Faber acknowledges it was Paula's decision to fight the cancer "every inch of the way," but he thinks she might not have, if her doctors had told her more about the upsides of palliative care and the downsides of aggressive treatment.

"I think they sold her on it," he says. "She was so afraid of death that she was ready to buy, and they knew it. And I think it happens a lot."

Hospice had come up before as an option, but the Fabers thought of that only as a place to go and die, and no one had told them otherwise. Then a social worker explained that hospice is something that can happen at home, too. Belatedly, Faber said, the couple chose that option, and hospice workers from the Visiting Nurse Service of New York came to their apartment in Greenwich Village.

"Once they arrived, it was like putting everything together," he said. "And from that moment on, everything was right."

It turned out to be the Fabers' final five days together, after almost 50 years.

This story is part of a reporting partnership with NPR, WNYC and Kaiser Health News. Special thanks to WNYC's Data Team.

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

Terminally Ill, But Constantly Hospitalized

Sun, 09/21/2014 - 5:38am
Terminally Ill, But Constantly Hospitalized September 21, 2014 5:38 AM ET

fromWNYC

Listen to the Story 6 min 7 sec  

Paula and Ron Faber walk their dog Millie in 2009, between cancer diagnoses.

Shelley Seccombe/Shelley Seccombe

The place: Beth Israel Hospital in Manhattan.

The diagnosis: fast-growing, small-cell lung cancer.

The patient: Paula Faber, unrepentant, life-long smoker.

The choice: treat it aggressively to extend life, but probably not cure the disease, or manage the pain and focus on the quality of life.

It was September 2012 and it was Paula Faber's third cancer in a decade, but she did not hesitate.

"She was going to fight it every inch of the way," says her husband Ron Faber.

By August 2013 after much fighting, Paula Faber died at age 72. Ron Faber now regrets the intervening 11 months of chemotherapy, radiation, painkillers and side effects that reduced his wife to 67 pounds of frayed nerves.

"I would have rather have had a really OK four-and-a half months than this endless set of treatments," the stage actor said.

As they confronted Paula's terminal diagnosis, the decision the Fabers made is among the most difficult anyone can make. But it turns out that in the New York metropolitan region, patients opt for aggressive treatment much more often than other Americans.

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

"New York City continues to lag in serious ways with regards to providing patients with the environment that they want at the end of life," says Dr. David Goodman, who studies end-of-life care at Dartmouth College's Geisel School of Medicine.

The reasons they do this are many, but most experts agree that it has less to do with the unique characteristics and desires of people in New York and New Jersey than the health care system and culture that has evolved here.

At the end of life, all this translates to more people dying in the hospital, often in an intensive care unit on a ventilator or feeding tube; more doctor visits leading to tests, treatments and drug prescriptions; and more money being spent by the government, private insurers and patients themselves.

Specialists at the Dartmouth Healthcare Atlas maintain that one of the main drivers of this phenomenon is quantity: People end up in hospitals here so often, they say, because this region simply has a lot of hospital beds.

"One of the truisms of health care is that whatever resources are available, or whatever beds are built, they tend to get filled," Goodman says.

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

A second driver is that every region has its own medical "culture," and the one in New York is built around highly trained specialists and sub-specialists who see it as their job to cure illness. Dr. Diane Meier says that means, "that if there's a cancer it needs chemotherapy, that if there's heart failure, it needs a procedure."

Meier is a geriatric specialist at Mount Sinai and the director of the Center to Advance Palliative Care

She says also driving the culture of heavy treatment is the high proportion of specialists and sub-specialists who constantly refer patients to each other — both because that is how they were trained and because it is good for business.

"If I'm an endocrinologist, if I refer to the cardiologist, the cardiologist will refer back to me for endocrine problems," says Meier. "It's like a cottage industry."

At Mt. Sinai, the chair of surgery now demands his staff discuss hospice alternatives with terminally ill patients — and make an electronic note of the conversation that can be tracked. If it does not happen, he demands to know why. Meier said every hospital doctor should follow this example.

"All of medicine needs to be willing to say, 'Why did this person with end-stage dementia have three or four hospitalizations in the last three months of life and die in the intensive care unit? This was a terrible experience for the patient and family. A lot of unnecessary suffering. Over a million dollars cost to the taxpayer. How did that happen?' " she says.

Ron Faber is still asking that question.

A year after his wife Paula died, he still believes her oncologist at Beth Israel Hospital was strangely optimistic about her prospects. Faber acknowledges it was Paula's decision to fight the cancer "every inch of the way," but he thinks she might not have, if her doctors had told her more about the upsides of palliative care and the downsides of aggressive treatment.

"I think they sold her on it," he says. "She was so afraid of death that she was ready to buy, and they knew it. And I think it happens a lot."

Hospice had come up before as an option, but the Fabers thought of that only as a place to go and die, and no one had told them otherwise. Then a social worker explained that hospice is something that can happen at home, too. Belatedly, Faber said, the couple chose that option, and hospice workers from the Visiting Nurse Service of New York came to their apartment in Greenwich Village.

"Once they arrived, it was like putting everything together," he said. "And from that moment on, everything was right."

It turned out to be the Fabers' final five days together, after almost 50 years.

This story is part of a reporting partnership with NPR, WNYC and Kaiser Health News. Special thanks to WNYC's Data Team.

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

Fair-Trade Condoms: Latex That Lets You Love The World

Sat, 09/20/2014 - 8:37pm
Fair-Trade Condoms: Latex That Lets You Love The World September 20, 2014 8:37 PM ET

Finding the right condom just got a little bit more like finding a good cabbage.

Picky shoppers might notice labels on condom boxes these days that say fair trade, non-GMO and all natural.

Condoms don't just fall off trees, but most of them do start there. The major ingredient in most condoms is natural latex, which comes from rubber trees. A lot has to happen to make tree sap into a Jimmy hat. A number of companies are trying to make that process more ethical, from tree to ... well, you know.

There are Sir Richard's, GLYDE, Fair Squared, Condomi, L. Condoms, French Letter and now Sustain, which hit U.S. stores this summer.

Some of these condoms are certified by the Fair Rubber Association, others by Green America. A PETA sticker ensures that the product hasn't been tested on animals. Many have non-GMO labels. Some claim to have eliminated nitrosamines, a class of carcinogens that's regulated in rubber nipples for baby bottles and pacifiers, but not in condoms.

Rubber drips from a tree into a bucket.

Faisal Akram/Flickr

For all-natural folk, some companies use dyes derived from red cabbage and carrots; some have natural licorice flavoring. For vegans, there are rubbers with something like thistle extract instead of casein, a milk protein that's a common condom ingredient.

All this might leave you wondering how, exactly, a condom is made.

For millennia, the answer was: with whatever's available. "They were made out of fish guts, lamb intestine, beef intestine, and linen," says Aine Collier, who wrote a book about the history of the condom. "The ancient Egyptians used papyrus. The Japanese used extremely fine leather, and they even used a kind of shell that could be pounded. So, latex was a huge step forward, both for comfort and for safety."

Condoms are still made from lamb intestines. But polyurethane, natural rubber and a synthetic rubber called polyisoprene are also used.

These days, step one for a latex condom is to go to a rubber tree plantation in South Asia, armed with a bucket and knife. Getting rubber out of a tree is a little like tapping for maple syrup.

When the sap cools down at night, it turns to liquid. When the sun resurfaces, it congeals back into a solid. Rubber tappers wake up in the wee hours of the morning to get to the sap before that happens. They make incisions in the bark to get it flowing, place a bucket below and let the milky sap bleed.

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"And this is the raw material for balloons, football bladders, household gloves, baby bottle teats and condoms," says Martin Kunz, founder of the Fair Rubber Association. The liquid travels to a factory, often near the plantation, where it's processed, formed, tested and packaged. Kunz estimates that one tree can produce enough rubber to make about 100,000 condoms.

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From tree to package, most of the human labor that goes into making a condom happens on the plantation. As with tea and coffee, rubber that's certified fair trade costs more — about 25 cents extra for each pound of rubber. The money goes toward better housing and education, access to electricity, clean drinking water and health care for plantation workers.

The good deeds abroad are sometimes packaged with benefits at home. For every paraben-free love sock that L. Condoms sells, the company donates another to public health partners in sub-Saharan Africa.

Collier says while fair trade certifications may be valuable, in the grand history of condoms, eco-condoms aren't particularly revolutionary. "I think what we're seeing now, this sort of eco-twist to it, doesn't really represent anything fantastic as far as research and development. Fair trade rubber is still rubber."

In the end, Collier says, it may be just one more phase in the condom's long history of creative packaging. A 17th-century sheath might have come with a pink ribbon. In the 1920s and 1930s, condom tins came with flapper silhouettes. Others sold then appealed to people's fascination with Egypt.

"It wasn't about the quality of the condom. Many were absolute crap. But people were buying them with the eye," says Collier. "They loved the packaging, because it fit the lifestyle they were trying to lead. And I think that's exactly what this fair trade, biodegradable, green, vegan condom sales thing is all about. It's just marketing."

Regardless, condoms are still the most effective way to keep sex safe.

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

A Single Insurer Holds Obamacare's Fate In 2 States

Fri, 09/19/2014 - 2:24pm
A Single Insurer Holds Obamacare's Fate In 2 States September 19, 2014 2:24 PM ET

Partner content from

Here's a health law pop quiz: Which two states have the least successful Obamacare exchanges?

You might guess a state in the Deep South where political opposition to the health law has been fierce. Or maybe you'd say Missouri. It passed a state law saying consumer advisers funded by the Affordable Care Act aren't allowed to give advice about plans to consumers.

But those answers would be wrong.

Iowa and South Dakota are the two states where the ACA insurance marketplaces have struggled the most. In both states, just 11.1 percent of residents eligible for subsidized insurance signed up for it — the lowest rates in all 50 states and the District of Columbia, according to data from the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

What happened in Iowa and South Dakota? The answer lies in commerce, not politics.

The individual insurance market in both states is dominated by one insurer, Wellmark Blue Cross and Blue Shield. Wellmark BCBS chose not to sell on the ACA exchanges in the first year, locking out its consumers from buying subsidized plans from the company. And it has decided to stay out of the Iowa and South Dakota exchanges for Year 2.

Before last year's enrollment, Wellmark had 87 percent of the individual market in Iowa and 73 percent of South Dakota's market.

That means Wellmark BCBS is the biggest name in health insurance in both states and that marketing muscle and brand recognition are on the sidelines during the first two years of the health law.

In contrast, Florida Blue, a dominant insurer in that state (but not as dominant as Wellmark BCBS) aggressively marketed its Obamacare plans — with TV and radio commercials and even building retail stores where people could get more information about insurance. In Florida, nearly 40 percent of the people eligible for marketplace insurance bought a plan, 1 in 3 of them buying a Florida Blue plan.

Wellmark BCBS cited technical problems with the back end of HealthCare.gov as a reason it is staying out of the market in 2015. A spokeswoman said data discrepancies in the enrollment process could affect consumer subsidies and eligibility.

"How data is transferred between the system, government entities and ultimately, health insurers continues to be problematic," Wellmark BCBS Public Relations Manager Traci McBee writes in an email. "Because we rely on this information to serve our members, we need to ensure the information we receive is timely, secure and accurate."

Wellmark says despite not selling on the exchange in 2014, it sold more ACA-compliant plans through its website and insurance agents than any of its competitors did in the two states.

Wellmark's Competition in Iowa

Iowa's federally facilitated partnership exchange has two statewide insurers — an Aetna company called Coventry Health Care of Iowa and the nonprofit, consumer-owned CoOportunity Health.

Cliff Gold, chief operating officer of CoOportunity Health, says its Iowa enrollees are "decidedly older and less healthy" than its policyholders in Nebraska, and that's partly because Wellmark decided not to join the exchange.

"If one wanted to cleanse their risk pool, there is no better way to do it than to stay off the exchange where presumably lower-income, less healthy people would come on," says Gold.

Gold says Wellmark's decision to allow Iowans to renew plans that don't comply with the Affordable Care Act was the other major factor.

"It keeps a lot of people out of the open market," says Gold. "All of the old plans have medically underwritten people in them, so they're healthier than average risk pools."

Medical underwriting was the process that insurers used to exclude people with pre-existing conditions before the ACA. Consumers would have to fill out detailed health history forms, and if an insurer didn't want to take on the risk of someone who had high cholesterol or back pain, it didn't have to. Insurers can't do that anymore, but they can work to keep customers they already have — and have already screened.

CoOportunity Health has proposed a 14.3 percent premium rate increase for 2015, which Gold says is double what it would have proposed had Wellmark canceled its non-ACA-compliant policies and entered the exchange.

Its competitor in the exchange, Coventry Health Care of Iowa, says its decisions are not swayed by what Wellmark does. The company's president is committed to selling through the exchange in the future. It has proposed an 8.7 percent average premium increase for its plan holders in 2015.

This story is part of a reporting partnership that includes Capital Public Radio, NPR and Kaiser Health News.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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How To Get Children To Behave Without Hitting Them

Fri, 09/19/2014 - 12:21pm
How To Get Children To Behave Without Hitting Them September 19, 201412:21 PM ET

There's plenty of evidence that spanking, paddling or hitting children doesn't improve their behavior in the long run and actually makes it worse.

But the science never trumps emotion, according to Alan Kazdin, head of the Yale Parenting Center and author of The Everyday Parenting Toolkit.

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After NFL star Adrian Peterson was indicted for child abuse after disciplining his 4-year-old son by hitting him with a switch, there's been a lot of conversation about how race and culture affect parents' approach to discipline. OK, what about the science? Behavioral psychologists say that people respond very predictably to others' words and actions, and parents can use that predictability to improve children's behavior without shouting or hitting.

We talked with Kazdin by phone about why parents use corporal punishment and what options they have for teaching good behavior. Here are highlights of that conversation.

Why do parents use physical discipline?

There are three reasons, Kazdin says. "The brain is hard-wired to pick up negative things in the environment; this is just how humans and mammals are." So parents naturally pay more attention to a child's bad behavior, rather than to all the good things they may be doing the rest of the day.

Second, there is increasing evidence that watching or engaging in aggressive behavior excites the reward centers in the brain, giving an incentive for aggression.

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"And the third context is the Bible," Kazdin says. "Some religions view hitting the child, use of the rod, not just as all right but obligatory. You're not living up to your responsibility if you're not hitting your child.

"Those things are really critical. It's nice for me to say, 'Here's the science,' but if it's context-free, it's silly."

You've worked with many families where the situation has gone way beyond a swat on the behind to serious child abuse. Why do parents escalate the punishment to that level?

"I see parents who abuse their children all the time, and almost always they know it's not working. The children don't change their behavior. So the parent thinks, 'You need something stronger than me talking; I need to hit you or shake you.' Unfortunately, children adapt to it."

So how do you get those parents to stop the abuse?

When you're drowning, you can't teach someone how to swim, Kazdin says. "We don't reason with them, we don't moralize with them, we don't tell them about the science. That kind of talking doesn't influence behavior."

Instead, Kazdin has parents practice what they'll say to a child, with words carefully chosen to get a specific response. The goal is to teach children to respond differently, without the problem behavior.

Why are the words important?

What happens before a child misbehaves is critical, Kazdin says. Knowing that gives parents the opportunity to head off bad behavior before it happens.

"We know when a parent comes home from a stressful day at work they're going to get more noncompliance," Kazdin says. "Nobody's at fault. But we know that the tone of voice that a parent uses after a stressful day increases the odds that a child will not be compliant."

So what can we say to encourage compliance?

"You put choice in there, even if it's not a real choice," Kazdin says. " 'Would you put on your red coat or your green coat and we're going out?' You put 'please' in front. If you put please in front of a parental request, it changes your tone of voice."

But there have to be consequences for bad behavior. How do you punish a child?

Parents typically think of consequences as punishment, but decades of research in behavioral psychology has shown that promptly praising a child for good behavior is much more effective in improving behavior than punishment, Kazdin says. Punishment should be brief, simple and used sparingly.

Recently you've spent more time focusing on the everyday problems parents have with children's behavior: getting homework done, cleaning their rooms. I'd really like to know how to get a kid to practice the piano without nagging, for one.

That change won't happen in a day, alas. But small changes can make a big difference, Kazdin says. He says he can't give specific advice without knowing more about me and my child, but the gist would go something like this:

"You'd say, 'Can we sit down at the piano and play for two or three minutes together?' Then you'd say, 'See if you can do one minute by yourself. You might not be able to, because it's something that teenagers can do. But see if you can do it.' Come back in one minute. And at the end, ask her to teach you something that she learned. Do that for a few days, and stretch out the period of time when you're gone.

"Then when you come back you say, 'Are you sure you're not a teenager? Did you have a few birthdays when I'm not looking?' Then she'll laugh, like you are. And if you can end the session where she gets to choose something, 'Chopsticks' or scales, that's critical. Make it so it's enjoyable. And give her one day of the week where she can say, 'Not today. I'm not practicing today.' Freedom for a not-today day.

"The funny thing is, it's not rocket science," Kazdin says. "But implementation is hard. If you were here we would practice it; we would sit down at the piano together."

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

Why Do You Care About Fairness? Ask A Chimp

Thu, 09/18/2014 - 3:37pm
Why Do You Care About Fairness? Ask A Chimp September 18, 2014 3:37 PM ET

What do you mean you got a grape? I only got a carrot!

iStockphoto

Anyone who has spent time with a child knows the all too familiar refrain: "That's not fair!" But it's not just humans who recognize when they're not getting an equitable share of pie (or toys, or time with Mom and Dad, as the case may be). Some animals, including monkeys, fish and dogs, can also detect inequity.

What we haven't known is whether animals notice when they get favored treatment and will reject a treat to keep things equal. Primate researchers Sarah Brosnan of Georgia State University and Frans de Waal of Emory University say yes — but only some species will.

"The response to getting less than a partner ... is widespread throughout the animal kingdom in species that cooperate," Brosnan tells Shots. "Cooperative species" include primates, some species of fish, and wolf packs, among many others. But the second half of fairness, she adds, is noticing when you get more, and doing something about it to maintain that social relationship.

"This second aspect is something special," Brosnan says. Getting less of something in the short run, in exchange for a social gain — like having a happy partner by your side — is unusual. In fact, only humans and their closest ape cousins seem to do it.

The findings are part of Brosnan and de Waal's broader review of inequity among nonhuman primates and other animals, published Thursday in Science. One study they cite found that when two capuchin monkeys worked together to achieve rewards, if one received a grape and the other a cucumber (less yummy, I'd have to agree), the monkey with the cucumber would toss it away, in apparent anger.

YouTube

On the flip side, when two unrelated chimps put side by side were presented with a tasty grape and a less tasty carrot, the chimp with the grape sometimes threw it away. "I would say that the most likely cause was either fear of retribution or just general discomfort about being around an individual getting less than you," says Brosnan. Differences in the social hierarchy also played a role, she says. Dominant chimps were angrier when they were on the receiving end of a lesser reward than those lower in the pecking order.

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The results among the chimps are indicative of highly cooperative societies, where relying on someone else is especially crucial. This may be why chimpanzees and humans will avoid inequity, Brosnan suggests, to have long-term cooperation from friends.

However, she cautions against calling it fairness exactly: "Fairness is a social ideal" she says. ... [The animals] don't have social ideals in the same sense [that people do]." Her research reveals behaviors that may look like a push for fairness; but that doesn't mean strategic, higher-order thinking is driving it. The explanation may be much simpler, based more on emotion, Brosnan says: "When my social partner gets upset, I give them something that makes them happy."

If you, too, are the type of person who demands your fair share in life, this may be evolutionarily advantageous. "If that's the kind of person you are, then there's some evidence that you do better in the world," Robert Frank, economist at Cornell's Johnson Graduate School of Management, tells Shots. "People aren't going to strike one-sided bargains with you; they'll know not to mess with you."

So complain on, complainers. Your strict sense of fairness may be doing you good.

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

San Francisco Politician Goes Public With His Choice To Take Anti-HIV Drug

Thu, 09/18/2014 - 11:00am
San Francisco Politician Goes Public With His Choice To Take Anti-HIV Drug September 18, 201411:00 AM ET

fromKQED

San Francisco Supervisor Scott Wiener (left) says he started taking a drug to prevent HIV infection earlier this year.

Lisa Aliferis/KQED

In an effort to combat stigma that has arisen around a treatment that prevents HIV, a San Francisco elected official announced publicly Wednesday that he is taking the medicine.

City Supervisor Scott Wiener said he is taking Truvada, a drug that dramatically reduces the risk of HIV infection. He appears to be the first public official to make such an announcement.

Wiener wrote about his experience for The Huffington Post:

Each morning, I take a pill called Truvada to protect me from becoming infected with HIV. This strategy, also known as pre-exposure prophylaxis, or PrEP, reduces the risk of HIV infection by up to 99 percent if the pill is taken once a day. This makes PrEP one of the most effective HIV-prevention measures in existence. ...

As an elected official, disclosing this personal health decision was a hard but necessary choice. After all these years, we still see enormous stigma, shame, and judgment around HIV, and around sexuality in general. That is precisely why I decided to be public about my choice: to contribute to a larger dialogue about our community's health.

In an interview at Wiener's office in San Francisco's City Hall, he said, "My hope is that by disclosing my PrEP use publicly that I can help move the conversation forward and get more people thinking about PrEP as a possibility, and encouraging people to consult with their medical provider."

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Truvada combines two different drugs into a single pill that, when taken daily, can reduce the risk of HIV infection by more than 90 percent. It was approved by the FDA in 2012. Both the Centers for Disease Control and the World Health Organization recommend its use by people who are at high risk of HIV infection. Still, it is the subject of debate, especially within the gay community.

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Wiener, 44, was first elected to the Board of Supervisors in 2011. He says he started coming out as a gay man in 1990, at what he called the height of the AIDS epidemic.

"Coming out in that environment was challenging and stressful," he said. "Immediately associating sex with illness and death was very stressful, and many, many people, I think, had that same experience." He spoke of friends who recently started taking the pill to prevent infection and who told him "that their general anxiety level around intimacy has gone down significantly."

Wiener said only a few people knew that he was taking Truvada. James Loduca, vice president of philanthropy for the San Francisco AIDS Foundation, called Wiener's disclosure "incredibly courageous."

"We need more people like Supervisor Wiener," Loduca said. "In my own personal network, many of my HIV-negative gay male friends are on PrEP. None of them talk about it publicly, and that is a reflection of the enormous stigma and shame that we still have around sex, around a desire to have intimacy. ... It's an important watershed moment for our community that someone so visible steps forward and says 'PrEP is helping me.' "

Wiener spoke openly of people availing themselves of all options to prevent acquiring the virus, including the use of condoms and being tested regularly. If someone becomes infected with HIV, identifying the infection sooner yields more immediate treatment, which has positive long-term health outcomes.

Wiener's announcement comes on the eve of a rally to be held Thursday, coordinated by San Francisco Supervisor David Campos. Campos is calling for the city to make PrEP available to San Franciscans regardless of income. New York Gov. Andrew Cuomo has made a similar proposal for his state.

Nationally, there have been 50,000 new HIV infections every year for the past 20 years. "PrEP is the first new tool in our fight to protect ourselves from HIV since the epidemic began," Campos said in a release.

Wiener backs the effort. "In order for PrEP to be successful, we have to do three things," he said. "We need to raise awareness about it, make sure people know about it. ... We need to secondly remove the stigma around it, so people are able to talk about it, are able to consider it, and finally, we need to expand access."

But that kind of community-wide campaign is exactly the wrong idea, some advocates say. "To deploy [PrEP] as a communitywide preventive is a public health disaster in the making," said Ged Kenslea, spokesman for AIDS Healthcare Foundation, a global advocacy group. He stressed that the organization is not opposed to the use of PrEP on a case-by-case basis.

"The crucial problem is adherence to the medication," he said. He also pointed out that condoms are effective at protecting against not only HIV infection but also other sexually transmitted diseases "for which PrEP does nothing." Kenslea said he's worried that people "seem to be throwing condoms out the window."

Dr. Robert Grant with the UCSF Gladstone Institute led the research that ultimately showed Truvada's effectiveness as a preventive agent against HIV and has followed it since.

He said there's no link between PrEP and increasing high-risk sexual behavior. He also supports efforts to make PrEP available more widely and compared having a variety of tools to fight HIV with having a variety of methods of birth control available.

"Just like contraception," he said, "we're happy to have people using different methods — same way with HIV. We have to have lots of different methods for people to use, so people can find one that's attractive to them."

Grant said that in his research "we have not seen anyone become infected who has taken PrEP daily or nearly daily."

Updated 12:30 p.m.: When taken to prevent HIV infection, Truvada carries a risk of side effects that include headache, abdominal pain and weight loss. Potentially serious side effects include kidney problems, liver damage and a buildup of lactic acid in the blood.

This story is part of a partnership that includes KQED, NPR and Kaiser Health News.

Copyright 2014 KQED Public Media. To see more, visit http://www.kqed.org.
Categories: NPR Blogs

Europe's Family Tree Gets A New Branch

Wed, 09/17/2014 - 4:47pm
Europe's Family Tree Gets A New Branch September 17, 2014 4:47 PM ET

This skull, from the Swedish archaeological site called Motala, is thought to have come from a hunter-gatherer who died there about 8,000 years ago.

Anna Arnberg

For those who eagerly trace their genetic lineage or subscribe online to find their earliest ancestors, there's a new group to consider adding to the furthest reaches of your list. A previously unrecognized population of ancient north Eurasians may be a major third braid in the genetic twist that gave rise to most modern Europeans and their kin.

Scientists have known from previous work that more than 8,000 years ago, a population of dark-haired, light-eyed hunter-gatherers from Western Europe, and a group of dark-haired, brown-eyed farmers from the Near East got together and had kids. But new data suggest a third group from north Eurasia may have swaggered into the ancient party many years later — after agriculture was introduced — contrary to previous thought. These traveling Eurasians are evidence that people were moving into Europe later than expected, scientists now say, after the continent was already densely settled.

The evidence, from a team led by geneticist David Reich, at the Howard Hughes Medical Institute, and Johannes Krause, at the University of Tübingen, in Germany, was published Wednesday in Nature. The scientists analyzed DNA from nine ancient skeletons and from 2,345 modern-day people from across the globe. In particular, you might thank the remains of a 7,000-year-old farmer from Germany and eight 8,000-year-old hunter-gatherers from Luxembourg and Sweden; DNA from their bones or teeth was harvested for science.

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"We were using the whole genome," Reich tells Shots, which means they compared the DNA libraries of each individual, looking for areas in the genome that are variable among different populations. In the end, their statistical analysis found that a computer model incorporating these three very different populations of ancestors seemed to best explain the genetic patterns seen among most Europeans today.

Prior to the study, the third lineage was considered a "ghost population" — thought to exist, based on genetic patterns seen in the genomes of modern Europeans, but without any ancient DNA evidence to confirm that. Interestingly, though Reich's team solved the mystery of one ghost population, they've created another. Their genetic data indicates that there's likely at least one more group whose physical remains haven't yet turned up: "It's a population that split off from all other Eurasian populations before they separated" into the three, Reich says.

"I think the most exciting aspect of this work is that it is a powerful demonstration of how ancient DNA analyses can provide insights into human history that would be difficult, or impossible, to make from genetic data of contemporary individuals alone," says Joshua Akey, a geneticist at the University of Washington School of Medicine. "I suspect this study, and several others recently published, are a harbinger of things to come."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Kids' Perception Of Parents' Favoritism Counts More Than Reality

Wed, 09/17/2014 - 3:13pm
Kids' Perception Of Parents' Favoritism Counts More Than Reality September 17, 2014 3:13 PM ET

If a child feels like the odd person out, it could mean more problems in the teenage years, psychologists say.

iStockphoto

We all know which kid Mom and Dad liked best, and odds are you're thinking it's not you.

But does that really make a difference? It can, researchers say, but not always the way you might think.

Less-favored children are more likely to be using drugs, alcohol and cigarettes as teenagers, according to researchers at Brigham Young University in Provo, Utah.

But what matters is not how the parents actually treat the children, but how the kids perceive it.

Who's Daddy's girl? Researcher Alex Jensen says he really loves Charlotte, 3, and Olivia, 2, equally. But he couldn't resist staging this photo after researching favoritism in families.

Alex Jensen/BYU

"There's this cultural perception that you need to treat your children the same, or at least fairly," says Alex Jensen, a professor of psychology who led the study, which was published in the August Journal of Family Psychology. "But if kids perceive that it's not fair, that's when issues start to arise."

Earlier studies have found that many if not most parents do have a favorite child. And though parents usually strive to hide that, it's not always successful. That differential treatment has been linked to problems with family relationships and risky behavior in teens.

Jensen (the youngest of six and his mother's favorite, he says), wanted to dig deeper. So he and a colleague tested 282 teenage sibling pairs, ages 12 to 17. He asked each person how parents treated the children overall, who if anyone was favored, and how the family functioned.

They found no correlation between thinking you're the unfavored child and delinquency. There was a correlation between feeling on the outs and substance abuse.

But it's even more complicated than that, the researchers say.

In families that weren't particularly close, the child who felt less favored was more likely to be a substance abuser. The more dramatic the difference they perceived in preferential treatment, the more likely they were to be using.

But when family members were more engaged with each other, the perceived favoritism had less impact, at least when it came to substance abuse.

Obviously there's a chicken-and-egg issue here; teenagers who are more likely to be using substances may just be more likely to see themselves as the odd kid out. Jensen's next task is to try to figure that out.

Parents can try to minimize any ill effects of perceived favoritism by letting the kids know that you really do love them, Jensen says, annoying teenage attitude and all.

"See them as individuals and love them for who they are," he told Shots. "Show them how you love them. Hopefully you do, but try to communicate that love."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Colorado Tries Hard To Convince Teens That Pot Is Bad For You

Wed, 09/17/2014 - 1:01pm
Colorado Tries Hard To Convince Teens That Pot Is Bad For You September 17, 2014 1:01 PM ET

Colorado's "don't be a lab rat" campaign tries to make the point that we don't know what marijuana does to the teenage brain.

via dontbealabrat.com

Colorado's new campaign to deter teen marijuana use tries to make the case that weed is bad for your brain.

One TV ad shows a group of teens lighting up inside a dark car as moody music plays in the background. The commercial cites a Duke University study that found a link between regular marijuana use and a lower IQ.

"Some dispute the study," the PSA admits. "But what if years from now you learn those scientists were right?" The kicker comes as the scene fades to black: "Don't be a lab rat."

The campaign, which launched last month, is designed to target kids in the 12 to 15 age group. It also includes a website with links to news stories about the negative effects of marijuana (including a few on NPR.org).

To further reinforce the message, the agency has installed huge, human-sized rat cages near libraries and skate parks in Denver and at concert venues like Red Rocks Amphitheater. "It's like a big art installation," says Mike Sukle, who runs Sukle, the ad agency the state hired to design the campaign. "It's the coolest thing that we've ever gotten to work on," Sukle says. "But it's a huge challenge."

This human-scale lab rat cage is parked near a skate park in Denver, Colo., to make a point about the lack of science on marijuana.

Richard Feldman Studio/Sukle Advertising and Design

Ever since recreational marijuana was legalized in Colorado in January, public health officials have faced an unprecedented challenge: explaining to teens why they shouldn't smoke weed even though it's legal for their parents to do so.

Surveys and focus groups the state conducted prior to launching the campaign suggest that some teens didn't have a clue that smoking marijuana could hurt them, Sukle says. "Because of medical marijuana, a lot of kids thought it cured cancer. They really started thinking there was no harm to it."

Campaigns against teen drinking and tobacco use have generally focused on the health risks. But while there's no dearth of research that shows tobacco is bad for us, the research on marijuana's effects is still in the preliminary stages. Since marijuana isn't legal in most states, it's been hard for researchers to get federal funding for studies, as well as access to large amounts of the substance. The Colorado campaign depends on small studies that are hardly bulletproof.

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

"The brains of teen marijuana users show significant abnormalities," the website says. That's technically true — researchers from Northwestern University observed differences in the brains of 20 casual pot users as compared to 20 nonusers. However, the researchers can't say that these differences are caused by marijuana use, and there isn't any evidence to show that these differences are associated with any harm. Plus the number of people in the study is so small it's not reliable.

"A lot of the facts are from studies that are preliminary. And we wanted to be honest with the kids about that," Sukle says. Hence the 'lab rat' theme. "Maybe [marijuana] isn't going to be as bad as it looks," he says, but it could be really damaging. The campaign asks teens whether they want to take that risk.

To be sure, there is a growing body of evidence that shows that marijuana isn't good for the developing brain, says Dr. Herbert Kleber, who directs the Division on Substance Abuse at Columbia University. "The adolescent brain is still maturing," he says, and teens who use marijuana are more likely to become dependent on it than adults.

Plus these days marijuana contains more of the psychoactive ingredient THC than the stuff that John Lennon used to smoke back in the 60s, Kleber says.

The trouble is, those messages aren't quite as specific or compelling as the ones in Colorado's campaign. That's part of the challenge in developing a public health campaign, says Kathleen Kelly, the director of the Center for Marketing and Social Issues at Colorado State University who is not involved in the "lab rat" campaign.

"What you have to be very careful about is that your message is credible and it's believable," Kelly says. "Don't be a lab rat" is a far cry from scare campaigns like Refer Madness, the 1939 anti-marijuana film that has become a camp classic. "They're not positioning the message as this is absolutely fact."

Colorado's approach seems promising, Kelly says. "Colorado is trying to use a strategy that's somewhat similar to what they do with the Truth campaign against cigarettes," she says.

That campaign, which is funded by the nonprofit American Legacy Foundation, aims to expose "Big Tobacco's lies and manipulation" and show kids how the industry tries to trick them into smoking. "The underlying message is don't be made a fool," Kelly says. "Don't let them convince you that this is safe"

In Colorado, Sukle's firm and third-party evaluators are tracking how teenagers are responding to the message. Still, while the campaign may discourage some teens from trying marijuana, it doesn't teach those who are going to use it anyway how to reduce risk.

"The first message we need to get out there is 'Don't use marijuana,' " says Dr. Leslie Walker, chief of the Adolescent Medicine division at Seattle Children's Hospital. "But if you do, don't get behind the wheel."

Researchers and public health officials are still trying to figure out the best ways to talk to teens about the drug, Walker says. "I think we have some more work to do."

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

How Catholic Insurance Companies Outsource Contraceptive Coverage

Wed, 09/17/2014 - 12:02pm
How Catholic Insurance Companies Outsource Contraceptive Coverage September 17, 201412:02 PM ET

Partner content from

Contraceptive coverage has long been required by state laws or sought by nonreligious employers the religious health plans serve.

iStockphoto

Catholic and other religious hospitals and universities have been arguing in federal court for much of the past two years that they shouldn't have to offer or facilitate birth control as part of their employee health plans because it violates their religious beliefs.

But what happens when the insurance company is itself Catholic? It turns out that Catholic health plans have for years been arranging for outside firms to provide contraceptive coverage to their enrollees.

That's because such coverage has long been required by state laws or sought by nonreligious employers the religious health plans serve.

The federal health law requires most health insurance plans, including all new plans in the individual and small group markets, to provide contraceptive coverage at no out-of-pocket cost to women.

That divergence between the Catholic court claim that any link to contraceptive coverage is forbidden and the actions of Catholic insurance plans is likely to draw more attention as more large Catholic hospital systems add insurance plans to their portfolios.

Already a bishop in Arkansas is raising questions about one of the insurers in his state.

No one is keeping track of just how many Catholic health plans are entering the insurance market and selling to non-Catholics. The latest entry is Catholic Health Initiatives, the nation's fifth-largest nonprofit health system, with facilities in 18 states.

Juan Serrano, who heads CHI's new insurance subsidiary, Prominence Health, said in an interview that over the next year and a half, Prominence plans to "expand our health plan footprint into additional Catholic Health Initiative markets ... where they make the most sense."

He said that "as relates to the mandated benefits that are required in the marketplace, we are taking the same position that has been taken by other Catholic health plans, and it is to cede or contract with a third-party administrator who will administer the ERD-related benefits in an arm's-length manner."

ERD refers to the Ethical and Religious Directives for Catholic Health Care, a document from the Conference of Catholic Bishops that among other things makes contraception off-limits for Catholic institutions.

While CHI's third-party strategy might please health law advocates, the bishop who heads the Diocese of Little Rock, Ark., raised a red flag when the company purchased QualChoice, its first commercial plan in that state, last spring.

"Having given this matter serious thought and prayer, I am not fully convinced by CHI's reasoning that their acquisition of QualChoice will pose no moral or ethical conflicts," Bishop Anthony Taylor said in a statement.

MergerWatch, a reproductive health advocacy group that tracks deals involving secular and religious health institutions, is keeping a close eye on Catholic plans in the commercial market.

"We're now seeing more and more of these plans moving into the commercial market in a big way," said Lois Uttley, director of the group. "Under the Affordable Care Act, these plans are supposed to be covering contraception. So they have to figure out some way to get that to their enrollees, despite their religious objections to contraception."

MergerWatch has been closely watching how Fidelis Care, a Catholic-owned insurer that this year was the second-most-popular plan on the New York state health exchange, is handling reproductive health services.

Fidelis has arranged for a third party to provide women's reproductive health services, although that's not clear on the plan's website. In its handbook for health care providers Fidelis explains it "has elected not to offer all reproductive and family planning services, including abortion, sterilization, and artificial contraception, as a standard benefit nor to receive premium dollars from the State of New York for such services."

Instead, the company "will inform these same providers that the New York State of Health Marketplace has approved Unified IPA, LLC to provide New York State of Health marketplace-mandated family planning services, independent of Fidelis Care." The online marketplace operates under the health law, offering competing plans to people who generally don't have approved employer-based coverage.

A spokeswoman for Fidelis wrote in an email that health plan members need not worry about getting special access to the outside insurer because "the process is seamless for members. Providers simply bill the outside firm."

Mike Elliott, a principal with Unified IPA, the outside firm, says he contracts with the same health care providers that Fidelis does and works with the same pharmacy benefit firms to ensure that prescriptions are filled without Fidelis having to participate.

"From the member's perspective they're getting to see the same doctor, they have the same benefit package ... and we utilize the same ID number as the health plan," said Elliott, who says he has been providing reproductive health services to religious health plans for nearly three decades.

With Fidelis, that process has not been exactly seamless, says MergerWatch. Uttley said her group called several health plans asking about contraceptive coverage, and the response from Fidelis "was particularly confusing. The customer service woman said, 'Well, Fidelis covers contraception if you need it to regulate yourself,' whatever that means. If you need it for other reasons, you have to call this IPA."

That's troublesome, said Uttley, because "that's confusing even to a sophisticated insurance consumer used to having health insurance, and what we have now coming into the marketplace is a lot of people who have never had insurance. It's enough of a challenge to get them to understand how health insurance works without having this wrinkle in it."

Another problem for the group is that Fidelis, unlike many other nonreligious health plans, refuses to allow Planned Parenthood into its network of covered providers, "not even for prenatal or primary care," Uttley said. "It's not clear to us that women enrolling in Fidelis in New York understand they can't use that coverage at a Planned Parenthood if that's been their primary source of family planning services in the past."

In Arkansas, the bishop's concerns remain unresolved. Taylor sought clarification from the Vatican, and according to diocesan spokesman Dennis Lee, "Bishop Taylor has received a substantive response from the Vatican regarding CHI's acquisition of QualChoice, and he is actively involved in ongoing, private discussions with CHI on how best to comply with the Vatican's response."

The issues are clearer to other Catholic health plans that don't have to meet the needs of non-Catholics in the commercial insurance market. They're arguing in court that any participation with the contraceptive mandate is forbidden.

The Little Sisters of the Poor religious order, which provides long-term-care services with employees insured by Christian Brothers Services, is rejecting the Obama administration's newest policy: allowing religious employers to notify the government, instead of their insurer, that they have a religious objection to providing contraceptive coverage. "Any provision of the Mandate's services through the plan ... would violate the Christian Brothers' and Little Sisters' faith," the lawyers argue.

In the case of Christian Brothers, the administration argues that because it is itself a religious plan, it is exempt from the requirements anyway.

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

Top Scientists Suggest A Few Fixes For Medical Funding Crisis

Wed, 09/17/2014 - 4:11am
Top Scientists Suggest A Few Fixes For Medical Funding Crisis September 17, 2014 4:11 AM ET Listen to the Story 5 min 49 sec  

Dr. Harold Varmus, a Nobel Prize winner, cancer biologist and director of the National Cancer Institute.

Manuel Balce Ceneta/AP

Many U.S. scientists had hoped to ride out the steady decline in federal funding for biomedical research, but it's continuing on a downward trend with no end in sight. So leaders of the science establishment are now trying to figure out how to fix this broken system.

It's a familiar problem. Biomedical science has a long history of funding ups and downs, and, in the past, the system has always righted itself with the passage of time and plumper budgets.

“ We have to remember that this is a fragile system. 'Do no harm,' the doctor's mantra, is very applicable here.

"You know I lived through those [cycles]; I know what they were like," says cancer biologist Dr. Harold Varmus, whose long research career includes a Nobel Prize. However, he says, the funding challenges "were never, in my experience, anywhere as dramatic as they are now."

Varmus knows the problem well — now head of the National Cancer Institute, he directed the entire National Institutes of Health in 1998, when President Clinton started an ambitious push to double the NIH budget.

"It has to be recognized that we actually weren't asking for that much that fast at that time," Varmus says. "And many voices — including my own — were saying, 'Yes, this is great, and we can spend the money well; but you have to be prepared for what you do at the end of that five years.' "

Doubling the budget, he realized, would, of course, encourage rapid growth — so smaller, continual increases would then be required to keep this bigger enterprise humming.

And the annual budget did grow to an impressive size — surpassing $30 billion. But (adjusting for inflation) today's federal budget for biomedical research has given up much of that gain.

Many scientists say the obvious solution is to give them more money.

"There's no doubt that having a bounce back — an increase in our funding — would be helpful," Varmus says. "But I don't think it's going to solve all the problems at this point."

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There are now deep structural problems in the way research is financed. Scientists and universities alike are thinking less and less about the exciting frontiers of science, and more and more about tactics they can use simply to stay afloat.

"It's difficult to operate, and difficult to operate in an adventurous way," Varmus says. And that's bad not just for the scientists, but for patients and universities hoping to benefit from the fruits of a scientist's labor.

One of the biggest changes is in how NIH money is used. These days, it's not simply for conducting experiments — it's increasingly spent on scientists' salaries and even to repay the loans on new laboratory buildings that sprang up like mushrooms during budget boom times.

"This is a very tricky business," Varmus says, "because we recognize that universities are under tremendous pressures. In states, for example, that have some of the best public universities in the country, the amount of money that can be used to support research activities has declined precipitously."

So the NIH can't simply make bold new rules about how these universities can spend grant dollars. Instead, Varmus and some colleagues have been focusing on gentler changes that might help.

"We have to remember that this is a fragile system, Varmus says. " 'Do no harm,' the doctor's mantra, is very applicable here."

One idea is to reduce the number of young scientists being trained for careers that don't exist, and to instead hire staff scientists to carry out more of the day-to-day lab work that the apprentices now perform.

"Staff scientists don't necessarily have to have Ph.D.'s," Varmus says. "They might have master's degrees. And being a staff scientist these days is quite an appealing way to practice science," because you can concentrate on doing the work, and not get tangled up in the sometimes noxious process of fighting for funding.

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The NIH could also help some scientists avoid the money scramble by following the example of the Howard Hughes Medical Institute, Varmus suggests. This private philanthropy gives generous grants to individual scientists, based on that person's broad ideas and talents, rather than funding a specific research proposal.

Whether scientists can gently solve the structural problems remains to be seen, Varmus says. Last April, he and some colleagues laid out several broad ideas in "Rescuing U.S. biomedical research from its systemic flaws," an avidly read article in the Proceedings of the National Academy of Sciences.

He and his co-authors are hoping to broaden the conversation. "We want to bring together folks who are in government, administration, scientific societies, advocacy groups, students, faculty, even members of Congress," Varmus says.

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One idea, he says, among other possibilities, might be to convene a summit akin to the Asilomar conference in 1975, where scientists gathered to set their own rules for dealing with genetic engineering.

Whatever the ultimate solution, much is at stake.

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

Maybe, eventually, the threat of losing this competitive edge will spur the U.S. Congress to address the underlying problems in the way it authorizes funding for biomedical research. But that appears to be a distant prospect. In the meantime, another ancient injunction to doctors, "Physician, heal thyself," seems apt. The research establishment will try to find a way to ease the pain, on its own.

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

Breast Cancer Patients Seek More Control Over Research Agenda

Tue, 09/16/2014 - 4:11pm
Breast Cancer Patients Seek More Control Over Research Agenda September 16, 2014 4:11 PM ET Listen to the Story 6 min 51 sec  

Coalitions of patient advocates now help steer research funding toward particular projects.

Lilli Carré for NPR

The federal government has poured more than $3 billion into breast cancer research over the past couple of decades, but the results have been disappointing. The disease remains a stubborn killer of women.

“ We decided we could no longer afford to have the scientists set the agenda, and that we were going to decide what questions need to be answered.

So the National Breast Cancer Coalition is trying something bold: The advocacy group has decided that it's not simply going to lobby for more research dollars. Instead, its leaders are sitting down at the table with scientists studying the disease and telling them how they'd like that money to be spent.

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"We've come to a phase in our lives where we're just sick of losing our friends," says Joy Simha, a member of the coalition's board. "We are looking into the eyes of our children and saying, 'No more! No more! We need a deadline.' "

That deadline is January 2020. The goal is not to eradicate breast cancer by that date, but to have figured out by then how to put an end to the disease.

"There's no question, when we started the National Breast Cancer Coalition we thought naïvely: If we just got enough money to the scientific community, they would get the answers we need," says Fran Visco, president of the NBCC. "And then we came to learn that it is much more complicated than that."

In the old days, an individual scientist would come up with an idea related to one small question regarding breast cancer, get funding and then retreat to his or her lab to run experiments to test the idea. Good ideas have resulted in better understanding of breast cancer and better treatments, but years have turned into decades without a cure.

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"We decided we could no longer afford to have the scientists set the agenda," Visco says, "and that we were going to decide what questions need to be answered, and we were going to bring together the necessary scientific expertise, collaborating with advocates, to answer those questions."

So, three years ago, the coalition started what it calls the Artemis Project. The project asks: If you're going to end breast cancer, what would you need to do? The first answer, the coalition decided, is, "Prevent the disease." A vaccine would be ideal — if someone could figure out how to make one. Next, for women who already have breast cancer, the challenge is to keep it from spreading throughout the body — the process of metastasis.

"If you could figure out how to prevent metastasis so that no one died of breast cancer and no one died of the treatment for breast cancer, we believe we will have achieved the goal."

Should the National Institutes of Health, rather than a nonprofit organization, be sponsoring a collaborative project like this?

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"Yes," Visco says, quietly, but adds, "You know, the goal of the NIH is to fund the scientific community. It is not the mission of the NIH to end breast cancer." She says she's not discounting research initiated by scientists.

"The process by which a scientist comes up with an idea and then wants to pursue it is a process that must continue," Visco says. "We need that process. We need discovery."

The backdrop for this new patient-driven paradigm for treating disease is a quiet crisis in funding for biomedical research. Scientists studying diseases are fighting over a steadily shrinking pool of money for research. But for breast cancer, Visco believes, the problem isn't a shortage of funding — it's how it's being spent.

Dr. H. Kim Lyerly, a professor of surgery at Duke University, is part of the breast cancer coalition's Artemis Project. He likens the collaboration to the highly coordinated Apollo project that put men on the moon.

To succeed with Apollo, he says, scientists needed one team to build the rocket to get the spacecraft to the moon, and also a navigation system. "Scientists and experts in the booster rocket may or may not be the same scientists and experts in the navigation system," he says.

Similarly, many types of medical researchers have been working on breast cancer, Lyerly says, but they haven't been working toward one clear, common goal, as the Apollo engineers and scientists did. He's certainly not promising that the Artemis Project's coordination will enable scientists to figure out breast cancer by January 2020, but he is impressed by this collective approach to medical problem-solving.

"I think that is a remarkable opportunity," he says, "and even that achievement would be one that I think would be a positive for science."

At the National Cancer Institute, director Harold Varmus defends the scientific establishment's current strategy.

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"I would never abandon the opportunity for anybody who's got the spark of genius to make an application to do something that is novel and individual," Varmus says. "I do believe that individual labs still have an important role to play. But people who think that we don't have a lot of collaborative work — team science — are wrong. We've always had that for years, and we continue to support it."

The breast cancer advocates are pushing the medical establishment to make those collaborations much deeper and more ambitious.

"I think the national breast cancer coalition's model is incredibly sophisticated and smart," says Daniel Sarewitz, a science policy researcher at Arizona State University. "They recognize that you can't turn a problem of great social concern — such as women's mortality from breast cancer — over to scientists and expect them to solve the problem."

Sarewitz acknowledges that breast cancer advocacy is sometimes criticized for its single-minded focus, which leads breast cancer to absorb a disproportionate share of research dollars. But he says that success also gives them more leverage to change the system.

"They're in the lead in understanding how difficult the problem is and how science needs to reorganize to address the problem. If they succeed, everyone else will want to be like them."

Fran Visco says this is her best — and last — shot. If the group can't reach its ambitious goal by January of 2020, she plans to end her long, celebrated career of trying to conquer the disease.

"I understand there are people who believe that it's going to take decades, maybe a century, to end breast cancer," she says. "And I wish them a great deal of luck."

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

Americans' Waistlines Are Expanding, And That's Not Good Fat

Tue, 09/16/2014 - 4:05pm
Americans' Waistlines Are Expanding, And That's Not Good Fat September 16, 2014 4:05 PM ET

If your belt needs to be let out a notch, you're not alone. The average American waistline is growing even though obesity rates haven't grown. And excess abdominal fat increases the risk of heart disease, diabetes and stroke.

The collective American waistline grew by more than an inch from 1999-2000 to 2011-2012, according to a study published Tuesday in JAMA, the Journal of the American Medical Association.

The study results come at a time when the percentage of Americans who are overweight or obese has stabilized. In short, people haven't been getting fatter, but their waistlines are still increasing.

"We're a little bit puzzled for explanations," Dr. Earl Ford, a medical epidemiologist at the Centers for Disease Control and Prevention and lead author of the study, tells Shots. The two measures are closely related: While body mass index or BMI measures fat overall, waist circumference helps measure fat distribution.

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Stress, hormonal imbalances, environmental pollutants, poor sleep or medications that help pack on abdominal weight are possible causes, health and nutrition researchers speculate. And older adults typically lose muscle as they age, while fat continues to increase.

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Ford and his team used data from the National Health and Nutrition Examination Survey (NHANES), which polled 32,816 adult men and women who were not pregnant. The mean waist circumference of Americans increased from 37.6 inches in 1999-2000 to 38.8 inches in 2011-2012. Men, women, non-Hispanic whites, non-Hispanic blacks and Mexican-Americans showed significant gains.

The prevalence of abdominal obesity (a waist circumference of greater than 40.2 inches or size 44 in men and 34.6 inches or size 12/14 in women) increased from 46.4 percent of the sample in 1999-2000 to 54.2 percent in 2011-2012.

Generally, as waist circumference increases, the amount of belly fat increases, too. But that's not true for everyone. African-Americans tend to have somewhat less abdominal fat for the same waist size than do whites and Hispanics.

Regardless, "people should not only watch their weight, but also their waistline," Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health, tells Shots via email.

Ford believes it's important to continue looking at abdominal obesity to judge how American health is doing.

"I can't really say exactly why BMI has gained favor in our national statistics," he says. "It may have to do that height and weight have been more consistently measured and that waist circumference has been included on some [statistics] but not as many as height and weight have been."

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

Colleges Brainstorm Ways To Cut Back On Binge Drinking

Tue, 09/16/2014 - 3:46pm
Colleges Brainstorm Ways To Cut Back On Binge Drinking September 16, 2014 3:46 PM ET Listen to the Story 5 min 22 sec  

Frostburg State University police officer Derrick Pirolozzi conducts a "knock and talk" at a house near campus, reminding students of laws on underage drinking and open containers.

Jennifer Ludden/NPR

It's early Friday night, and Frostburg State University police officer Derrick Pirolozzi is just starting the late shift. At a white clapboard house, he jumps out of his SUV to chat with four students on the front steps.

"S'up guys!" he calls out, assuring them he just wants to chat. All are underage but one, and that one tells Pirolozzi he has a string of alcohol violations from past years. Pirolozzi banters a bit. He tells them to "call anytime," and reminds them not to walk around the street with open containers.

"Think about me when you're having a good time!" he says, laughing as he turns to move on.

Cute, huh? A poster that's part of Frostburg State University's social media campaign.

Courtesy of Frostburg State University

Pirolozzi's presence here is part of a notable turnaround at this campus in Maryland's Appalachian mountains, one others may look to copy as stepped-up scrutiny of campus sexual assault puts more pressure on schools to address the related problem of binge-drinking.

In 2012, an unusual agreement gave Frostburg's campus and city police joint jurisdiction. Now Pirolozzi can patrol off campus, where he can tell who's gearing up for house parties.

"Can you see right there?" He points through a fence to where students are dancing in a back yard. Others hang out on porches. Small clusters stroll the streets, cases of Bud Light in tow.

On this weekend night, the university is also helping to pay overtime costs for a show of force: State, county, city and campus police all circle these blocks. The aim is not to arrest everyone.

"We know there's going to be underage drinking," Pirolozzi says. "We can't card everybody. But we want to make sure everybody does it the right way and safe way."

In other words, he hopes to keep students from doing something stupid so he doesn't have to come back and arrest them later.

"The thing that's so striking to me is that many universities perceive [binge drinking] as an intractable problem and that there's nothing they can do," says Jonathan Gibralter, president of Frostburg State University.

When Gibralter became president in 2006, he says, he found the party scene "out of control." As at other schools, heavy drinking at Frostburg has led to injuries and deaths. It's also linked to poor grades, mental health problems and is a factor in the majority of campus sexual assaults.

FSU is among dozens of schools being investigated for its handling of sexual assault. But Gibralter has also made the school a leader in tackling binge drinking. The joint police patrols are just one of many changes.

There are now more Friday morning classes, to discourage Thursday night drinking. Gibralter led the push for Maryland's recent ban on the sale of grain alcohol, that potent, tasteless drink used in homemade punch. With a state grant, the school formed a coalition that includes not just police but also city officials, parents and businesses to tackle underage drinking across the community.

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"I have met with bar owners where they said nobody would come, and there weren't enough seats in this room," Gibralter says. "I said, 'Hey, guys, we need your help.' "

There's been pushback, of course. The surprise is from whom. Gibralter says his biggest critics are parents and alumni who say they all drank in college and wonder what's so wrong with it.

"When I tell parents that 1,800-plus college students drink themselves to death every year, they are stunned," Gibralter says. "They have no idea."

That number has gone up in the past two decades.

Not all students like the changes, either.

"No matter what they do, it's still gonna happen. It's college," says sophomore Alissa Barlow, speaking between classes. "To be honest, the more rules you put down, it's like if your parents tell you 'No.' You're going to do it anyway most of the time."

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Still, several older students tell me the off-campus house parties are nothing like they used to be.

"I would be walking home from campus and I would see large gatherings outside with tables and kegs, and it was in the middle of an afternoon on a weekday," says senior Sara King. "Now, I don't see that at all."

Some resent the changes and call them heavy-handed. One recent graduate says it felt like trying to party "in a police state."

But since 2006, the share of Frostburg students who binge drink at least once every two weeks has fallen from 57 percent to 41 percent, according to the university. The average number of drinks students have each week has dropped in half, from eight to four.

That's somewhat more in line with the 40 percent of college students who binge drink at least once a month, according to the 2012 National Survey on Drug Use and Health.

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One group of juniors tells me they like the anti-booze efforts, especially the monthly alcohol-free parties at the student center.

"Really good food," says Andrew Bock. His friend likes the iPads and Xboxes given away as door prizes. Another student says she shows up early to beat the crowds.

"What's happened in the last decade is the science around preventing the abuse of alcohol has really improved," says Kevin Kruger, president of Student Affairs Administrators in Higher Education.

He says more colleges are training staff to screen for problem drinkers and are expanding alcohol education efforts. But many effective strategies boil down to changing the culture around drinking and what students consider "normal."

Kruger says this can be as small as getting a liquor store not to sell pingpong balls next to its beer to promote the popular game beer pong.

Rich Godlove, owner of Zen-Shi bar and restaurant in Frostburg, Md., says training paid for by the university has helped his staff recognize sophisticated fake IDs.

Jennifer Ludden/NPR

"It's not like college students can't go find pingpong balls," he says. "But why put it out there for them so it's so easy to do that?"

Frostburg State also has a social marketing campaign, sending regular emails and putting up posters for a campaign it calls "Reality Check." One says: "Not Everyone's Doing It: 36 percent of FSU students reported they did not drink alcohol in the last 30 days." Another shows a young woman bent over a toilet, mouth open, with the caption, "Glamorous, Isn't It?"

Another key strategy is simply making it harder for students to get alcohol, Kruger says, any way you can.

Hamilton College in New York made such a change this fall. Dean of Students Nancy Thompson says the school runs a bus to the nearby town of Clinton. But the only things open there at night are bars, and the return ride would be full of drunken students.

"There was damage to the vehicles," Thompson says, "and disruptive behavior."

So Hamilton has banned underage riders after 10 p.m. on weekends (though anyone already in town can still get a ride back). Thompson says the move has not gone over well with students. But "when we have a chance to sit down and talk with them about our rationale," she says, "it's hard to argue that the college should be in the business of driving students to bars. Especially students who are underage."

At Frostburg State University, students can walk to bars, but the school has made it harder for them to get served. In something of a quid pro quo, it has paid the sheriff's office to carry out monthly undercover compliance checks. The school also pays for training to help bar staff spot the fake IDs students get online these days.

"Honestly, these IDs are so good it's ridiculous," says Rich Godlove, owner of Zen-Shi bar and restaurant. "In fact, as soon as we had the class last year, we came in, probably caught two or three fake IDs and recognized the kids as people we thought were of age."

Far from cutting into business, Godlove says it has worked out well. Last year, his staff, using other strategies learned in the new training, cut off three drunken students one night. The next day they came back to have lunch, and to thank him.

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

Farewell, Heating Pad: Physical Therapists Say It Doesn't Help

Tue, 09/16/2014 - 12:19pm
Farewell, Heating Pad: Physical Therapists Say It Doesn't Help September 16, 201412:19 PM ET

The physical therapist will advise, but you're going to have to do the work.

iStockphoto

I have fond memories of listening to NPR while lounging at the physical therapist's with a heating pad on my shoulder. Don't do that, the nation's physical therapists' association says.

Heat therapy, electrical stimulation, ultrasound and other "passive physical agents" almost never help, according to a list released Monday by the Choosing Wisely campaign. Instead, they siphon time and money away from what you really want from a physical therapist — an exercise program that will restore strength and mobility.

Well, this is certainly going to make physical therapy less restful.

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But seeing as I've been to several physical therapists over the years and they've all used this stuff, the fact that the American Physical Therapy Association put passive physical agents on top of their list of things not to do seems like big news.

So I called up Tony Delitto, chairman of the department of physical therapy at the University of Pittsburgh, to find out what gives. He was chairman of the group that wrote the "what not to do" list for Choosing Wisely. It's aimed at getting health care professionals and civilians to pick medical treatments that are proven to do good.

Heating pads in the PT's office, alas, are not on the list.

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"The evidence for any beneficial effect is almost nil," Delitto told Shots. "When I graduated with my physical therapy degree in 1979, these physical agents were a large part of practice. We've had a hard time getting rid of them."

One reason why, Delitto says, is that insurers continue to pay for passive physical agents. I know my health insurer did. The Choosing Wisely campaign, which is run by the American Board of Internal Medicine Foundation, aims to put pressure on insurers to change their ways, too.

Also on the physical therapists' list:

  • Don't underprescribe exercise for older adults.
  • Don't prescribe bed rest for people with acute deep vein thrombosis once they're properly medicated.
  • Don't use continuous passive motion machines for people who have had knee replacements.
  • Don't use whirlpool baths for wound management.

If you detect a pattern there, you're right. The emphasis is on physical activity, and on doing it yourself with the guidance of a physical therapist so you work hard enough to get stronger and don't get hurt.

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"You're leaning on the physical therapist's expertise to see what activities you can do and how to carry them out on your own," Delitto says. "What to look for so you don't overdo it, and how to progress."

Many physical therapists are hesitant to give older people challenging exercises, but as a result the exercises don't do any good. "We underestimate what they can do," Delitto says. It's a bit trickier to hit the right balance between challenge and safety, he notes, but "it can be done safely."

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The continuous passive motion machines were thought to prevent stiff knees in people who had knee replacements, but studies have found that they don't help. "It turned out to be a very expensive device that was not adding any quality," Delitto says. "But people make money on the machines."

Physical therapy can be a cost-effective first stop for people, Delitto says, because therapists are trained to recognize when a person needs to see a doctor instead. "We're sort of an inexpensive route for patients."

Without the heating pad, that is. I guess I'm going to have to find another place to listen to NPR.

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Categories: NPR Blogs