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What's At Stake If Supreme Court Eliminates Your Obamacare Subsidy

1 hour 26 min ago
What's At Stake If Supreme Court Eliminates Your Obamacare Subsidy April 21, 2015 3:56 AM ET

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Jeff Cohen

Carlton Scott pays $266.99 per month for his subsidized health insurance plan. He worries he and his neighbors would lose their insurance without the subsidy.

Jeff Cohen/WNPR

The Affordable Care Act requires all Americans to get health insurance or pay a penalty. To help coax people to buy a health plan, the federal government now subsidizes premiums for millions of Americans.

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In just a couple of months, the Supreme Court will rule in a major case concerning those subsidies. The question to be decided is whether the law authorized that financial help nationwide, or just in the minority of states that set up their own insurance exchanges. A decision to take away those subsidies could leave millions without insurance.

Attorney Tom Goldstein, who runs SCOTUSblog, has closely followed the case and says the law is ambiguous. "This is a real, serious question," he says. "The law doesn't tell you whether Congress wanted to limit the subsidies only to those states where the state itself went to the trouble of setting up the exchange, or whether Congress wanted everybody who needed the help to be able to get the subsidies."

In my home state of Louisiana, a lot of people could be affected by the upcoming court decision. About 186,000 people there have used HealthCare.gov to buy insurance, and nearly 90 percent of them get subsidies. Here are the stories of a few of the people I spoke with:

Carlton Scott

Carlton Scott: "You never know what's going to happen to you."

Carlton Scott is 63. Sitting at the kitchen table of his home in Prairieville, La., near Baton Rouge, Scott tells me he worked at a chemical plant for 30 years before he retired. Last fall his company let him know it was scaling back his retiree benefits.

"Around October, he says, "they wrote me a letter saying [that] in December we'll no longer be covered."

Those reduced benefits included Scott's health insurance, which he was really counting on.

"I thought they would take me to my grave," he says. "I really thought the company would take me to my grave."

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He was deeply angry, and in a bind. At 63, Scott is too young for Medicare, and Louisiana hasn't expanded Medicaid. Obamacare, he says, was a good option for him.

He pays $266.99 per month, "to the penny" for his plan from BlueCross BlueShield of Louisiana. Like a lot of people I spoke with, Scott could rattle off the exact amount. Money is tight and people track their expenses carefully.

If Scott loses his subsidy, he may eventually lose his health insurance, too. He could pay more for a little while if he has to, he says. He gets $2,600 a month between Social Security and his pension. But he worries about friends who don't make as much.

"I got a friend of mine ... down the street," Scott says. "He gets Social Security and pension too. But it's not as much as mine — not half as much."

When asked about the case soon to be decided by the justices of the Supreme Court, Scott laughs.

"They all got insurance, too," he says. "I guarantee you that. They all got insurance."

He thinks the court should "leave it like it is. I mean, what are people going to do? Get sick, go to the hospital [and say], 'I don't have insurance. Won't you please help me anyway?' " It just won't happen, he says.

LaTasha Perry

LaTasha Perry says she couldn't afford the health plan offered by the community health center where she works. But with a subsidized plan, she has insurance and money left over "to buy food for my kids."

Jeff Cohen/WNPR

LaTasha Perry: "I'm hardly ever sick."

LaTasha Perry is at the other end of her career. She's 31 and works at the front desk of a community health center in Plaquemine, La. She's healthy and rarely needs a doctor, she says, but bought coverage under Obamacare because it was cheaper than paying the penalty.

Perry's children have Medicaid as their health coverage. Her job offers health insurance, but she doesn't buy it. Like a lot of people who work but don't make a lot of money, she says she can't afford the insurance her company offers.

"I would pay at least $100 a month for the insurance here," Perry says. "With my subsidy, I pay $13."

That leaves her money for other necessities, she says. "Food for my kids. I'm a single parent. It's hard."

Charles Dalton

A retired paramedic, Charles Dalton is now disabled. He pays $149 each month for his subsidized health insurance. "If you get a helping hand," he says, "the last thing you need is for it to be snatched out from under you."

Jeff Cohen/WNPR

Charles Dalton: "Losing my insurance is not an option."

Charles Dalton, of Shreveport, was very glad to get Obamacare coverage. He's 64, and after retiring as a paramedic didn't have any health insurance. Then he got sick.

"I'm disabled," Dalton says. "But I would be totally incapacitated without seeing this doctor."

Before the Affordable Care Act became law, insurance companies could take a person's health status into account when setting the price of the monthly premium, and even refuse an applicant for health reasons. That used to make insurance unavailable or unaffordable for many sick people. And now — with subsidies — Dalton says he pays $149 a month. He hopes the Supreme Court doesn't touch the subsidies.

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"They're just going to make a difficult situation more difficult," Dalton says. The Affordable Care Act, he says, has helped make his existence "more livable."

"You're not asking for a handout," Dalton says. "But if you get a helping hand, the last thing you need is for it to be snatched out from under you."

Attorney Tom Goldstein says the Supreme Court justices have a particularly tough job, trying to balance the specifics of the law with its human dimensions.

"The consequences are so real and so powerful," Goldstein says, "that, if the challengers win here — and maybe they deserve to win, maybe it's what Congress intended — but it's hard to avoid the conclusion that millions of people would lose access to health insurance."

This story is part of NPR's reporting partnership with WNPR and Kaiser Health News.

Copyright 2015 Connecticut Public Radio. To see more, visit http://www.wnpr.org.
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Federal Panel Revisits Contested Recommendation On Mammograms

Mon, 04/20/2015 - 5:08pm
Federal Panel Revisits Contested Recommendation On Mammograms April 20, 2015 5:08 PM ET Katherine Hobson Listen to the Story 4 min 2 sec  

In 2009, I was among the scrum of reporters covering the controversial advice from the U.S. Preventive Services Task Force that women in their 40s think twice about regular mammograms. The task force pointed out that the net benefits in younger women were small and said women should weigh the pros and cons of screening before making a decision.

Those guidelines kicked off a heated debate about the benefits and harms of mammography that is rekindled with every new study.

Shots - Health News Review Finds Mammography's Benefits Overplayed, Harms Dismissed

I wasn't yet 40 back then, but what I learned about mammograms stuck with me: I haven't yet had the test. I took to heart the warnings of the task force and of many other physicians that mammography has minuses as well as pluses. I wasn't so worried about a false positive result. But I was very concerned about overdiagnosis, or being diagnosed with and treated for a cancer that would never have caused me any harm.

I'm now 43 and am thinking that I should get a mammogram. So when I found out the USPSTF was doing a routine update of its breast cancer screening recommendations, I hoped it would help me decide.

As it turns out, the suggested changes to the recommendations — which are in draft form and may be altered after a public comment period — are small ones.

What is new? For the first time, the task force looked at the evidence behind 3-D mammography, also known as tomosynthesis. The USPSTF said there's not enough evidence to make a recommendation for or against using the technology to screen women. It also said there was insufficient evidence to say whether women with dense breasts should have screening with MRI, ultrasound or other methods in addition to mammography.

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But the task force's basic advice has not changed. The group recommends that women ages 50-74 get a screening mammogram every two years. And women between 40 and 49 should make their own decision, in consultation with their doctors, based on "health history, preferences and how they value the different potential benefits and harms of screening." (Women with a family history of breast cancer may benefit more from screening in their 40s, the task force says.)

The task force reiterates that there isn't enough evidence to say whether or not women 75 and older should be routinely screened.

Screening mammography means looking for potential cancer in women who are healthy and who don't have any symptoms. People with symptoms should be seen by a doctor, no matter their age. And these recommendations don't apply to women who have previously been diagnosed with the disease or who are at higher risk because of a genetic mutation or other condition.

"We want to reaffirm the importance of mammography to help prevent death from breast cancer," Kirsten Bibbins-Domingo, a physician and vice chairwoman of the USPSTF, told Shots.

And mammograms do save lives in women between 40 and 49 — it's just that there's a disproportionate level of harm.

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The USPSTF's draft includes statistical models estimating the lifetime consequences of screening women from ages 50-74 and also from 40-74. For every 1,000 women screened, the model finds that screening women in their 40s means an estimated one additional breast cancer death averted (from eight to seven), but with 576 additional false positive tests (1,529 vs. 953), 58 unnecessary biopsies (204 vs. 146) and two additional overdiagnosed tumors (20 vs. 18).

The draft recommendations also repeat the USPSTF's earlier advice that women be screened every other year rather than annually, said Bibbins-Domingo. That time frame provides "most of the benefits while minimizing the harm," she said.

Guidelines from medical groups differ on when a woman should start regular screening.

The American Cancer Society, for example, recommends yearly mammograms starting at age 40. Richard Wender, chief cancer control officer of the ACS, says there's much common ground between the guidelines, however. "The task force reconfirmed its conclusion that mammography reduced breast cancer deaths for women in their 40s," he said. The ACS is reviewing its own breast cancer screening guidelines this year.

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As for my fear of overdiagnosis? Wender said it's an issue, but the exact extent of the problem is unknown. And, he added, much of overdiagnosis happens in women with ductal carcinoma in situ, which is Stage 0 cancer that hasn't yet become invasive.

In the not-so-far future, molecular tools may help physicians give those women a more accurate prognosis, Wender says, so those at lower risk can opt for less aggressive treatments — or simply watchful waiting. "The next 10 years are going to be good news for helping women really make decisions about treatment, not just about screening," he said.

So why am I planning to get a mammogram this year? In part, simply because I'm a few years older. The 50-year cutoff isn't a clear line in the sand, and as Bibbins-Domingo told me, the value of the test increases with age.

But to be honest, the main change has little to do with the numbers. I now have a young daughter, and my fear of dying prematurely has become far, far stronger than my fear of getting chemo or even a mastectomy I might not need. I understand the statistics, but I'd feel like a total jerk if I didn't get screened and that unlucky statistic were me.

And on the flip side, if my mammogram did show breast cancer and I was treated successfully, I'd probably be grateful I'd been screened, even if there was no way to know whether the treatment was necessary.

In other words, then and now, I weighed the benefits and the risks and made my own decision, which is exactly what the USPSTF suggests.

NPR's Richard Harris discussed the recommendations on All Things Considered.

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

Doctors Don't Always Ask About Pet-Related Health Risks

Mon, 04/20/2015 - 3:07pm
Doctors Don't Always Ask About Pet-Related Health Risks April 20, 2015 3:07 PM ET

Reptiles like leopard geckos can bring Salmonella along with them.

iStockphoto

If you're being treated for cancer, an iguana might not be the pet for you.

Ditto if you're pregnant, elderly or have small children at home.

Pets can transmit dozens of diseases to humans, but doctors aren't always as good as they should be in asking about pets in the home and humans' health issues, a study finds.

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And that goes for people doctors and animal doctors. "The fact that they're equally uneducated is concerning," says Jason Stull, an assistant professor of veterinary preventive medicine at Ohio State University and lead author of the review, which was published Monday in the Canadian Medical Association Journal. "There hasn't been a great dialogue between the veterinary community, the human health community and the public."

The people doctors aren't asking their patients what kind of pets they have, Stull says, and veterinarians aren't asking owners about health issues that might increase their risk of acquiring unpleasant, even life-threatening, infections. His paper includes a long list of possibilities, including:

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  • Dog and cats can transmit bacteria like Campylobacter jejeuni that cause nasty intestinal problems, as well as antibiotic-resistant bugs like MRSA. Pets might pick up MRSA while visiting people in the hospital, the report notes.
  • Amphibians, reptiles, rodents and young poultry can spread Salmonella. Back in 2013 the Centers for Disease Control and Prevention warned of an outbreak of a rare strain of Salmonella among people who had pet hedgehogs, and suggested that people lay off cuddling the adorable creatures.
  • Parasites like giardia and Cryptosporidium cause diarrheal disease and can be spread by dogs and cats. Those are nasty but treatable. Rarer parasites like Echinococcus tapeworms can cause liver failure and death.

People should be sure to let their human health-care providers know that they have pets, Stull says, and let the vet know if there are family members who are at greater risk of animal-borne infections. That includes children under age 5, pregnant women, older people, and anyone with a weakened immune system due to things like chemotherapy, HIV/AIDS or organ transplants.

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If you're intrigued by the notion of Fluffy as disease vector, you've got friends at Worms and Germs, a blog from the University of Guelph. They're closely following the new outbreak of canine flu, for example.

"People don't even think of their pets as a possible source of disease," Stull says. "I'm not saying that people should be overly concerned, for the vast majority of the public." Good hand-washing habits can go a long way toward reducing risk in many cases, he adds.

"We're not saying get rid of pets. We're not saying stop getting pets. We're just saying make good choices."

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

Humans' Use Of Pain-Relief Creams Proves Fatal To Felines

Mon, 04/20/2015 - 11:39am
Humans' Use Of Pain-Relief Creams Proves Fatal To Felines April 20, 201511:39 AM ET Poncie Rutsch

Contact between cats and their owners may have exposed the animals to toxic levels of medication.

iStockphoto

Veterinarians have long warned that pain medications like ibuprofen are toxic to pets. And it now looks like merely using a pain relief cream can put cats at risk.

That's what happened in two households, according to a report issued Friday by the Food and Drug Administration. Two cats in one household developed kidney failure and recovered with attention from a veterinarian. But in a second household, three cats died.

When the veterinarians performed necropsies on the three dead cats, they found toxic levels of nonsteroidal anti-inflammatory drugs, or NSAIDs. NSAIDs include ibuprofen, like Advil and Motrin, and naproxen, which is in Aleve.

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Ibuprofen is the most common drug that pets eat, according to the American Veterinary Medical Association, perhaps since many of the pills are candy-coated. In pets, the drugs can cause stomach or intestinal ulcers and kidney failure.

But these cats died by flurbiprofen, another NSAID. In the case of its most recent victims, the cat owner applied a lotion or cream containing flurbiprofen to treat muscle or arthritis pain. And it's highly unusual for a cat to show up at the vet's office; usually it's the dogs that get into trouble from exposure to NSAIDs.

"I can't even remember the last cat I've seen that got into ibuprofen or an NSAID," Erica Reineke, an assistant professor at the University of Pennsylvania's School of Veterinary Medicine, tells Shots. "We've seen more cats that get into antidepressants."

Reineke says that she probably treats a pet for some sort of ingestion problem every day, but usually it's chocolate or chewing gum, or the owner's medication. As little as 50 milligrams of ibuprofen for every kilogram a cat weighs can cause problems; for dogs, it's 100 milligrams for every kilogram. Reineke says she's never seen flurbiprofen toxicity in her office and would have a hard time estimating how much would be toxic to a cat or dog.

This isn't an animal mistreatment issue — none of the cats died because owners were applying their medications to the cats. The owners reported using the product on their necks or feet, and somehow the animals were exposed. The third cat died after the owner had stopped using the medication.

The FDA recommends that pet owners store all medications away from pets and to discard anything used to apply the medication. If any furniture or carpeting becomes contaminated, clean it immediately.

And keep an eye on those pets – if they show signs of lethargy, vomiting or lack of appetite, go see a vet immediately.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Mellow Pastimes Can Be Good For Your Health, Too

Mon, 04/20/2015 - 3:48am
Mellow Pastimes Can Be Good For Your Health, Too April 20, 2015 3:48 AM ET Listen to the Story 1 min 46 sec  

Painting

iStockphoto

This makes total sense: When you're engaged in an activity you truly enjoy, you're happy. And, when you're happy you're not dwelling on all the negative things in life, nor are you stressed about obligations or problems. Certainly this is a good thing from an emotional point of view, but it also has physical benefits.

We know exercise reduces stress, but it turns out that more simple stationary things, like doing puzzles, painting or sewing can help, too.

To find that out, Matthew Zawadzki, an assistant professor of psychology with the University of California, Merced, looked at how the body reacts to leisure activities, defined as anything a person does in his or her free time.

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In the study, 115 men and women from different racial groups, ages 20 to 80, were asked to wear little electrodes attached to their chest which measured heart rate throughout the experiment. They were then monitored over the course of three consecutive days, taking surveys at random times throughout the day. The survey questions included what they were doing at that very moment and how they felt about it.

Virtually all the participants reported reduced stress and had a lower heart rate during leisure activities, as compared to parts of the day when they weren't involved in leisure. Leisure could include exercise and socializing, but in many cases it was simple stationary things like listening to music, doing puzzles, sewing, even watching movies or TV. The people said they were 34 percent less stressed, 18 percent less sad and their heart rate dropped, on average, by 3 percent.

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The positive benefits of leisure activities even appeared to persist for hours after the activity itself ended.

"We're still talking about the short term, but there was a definite carryover effect later in the day," says Zawadzki, "and if we start thinking about that beneficial carryover effect day after day, year after year, it starts to make sense how leisure can help improve health in the long term."

When a person is stressed, "their body is worked up – heart rate, blood pressure, hormones – so the more we can prevent this overworked state, the less of a load it builds up," he says.

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You could think of this as a sort of mental escape. When you're totally engaged in and enjoying what you're doing, you don't have time to ruminate and worry. You also don't have time to get bored. And boredom, says Zawadzki, can be dangerous.

"There's something called 'boredom eating'," he says, "where people just binge on junk food as a way to distract themselves. We'll often watch TV passively for hours at a time, rather than actively engage or really think about it. People smoke, drink, do drugs when they're bored."

So the next time you're absorbed in a good book or a good movie, or even just listening to your favorite music, remember you're not only enjoying yourself. You're helping your health.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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FDA Ponders Putting Homeopathy To A Tougher Test

Mon, 04/20/2015 - 3:46am
FDA Ponders Putting Homeopathy To A Tougher Test April 20, 2015 3:46 AM ET Listen to the Story 4 min 51 sec   Katherine Streeter for NPR

It's another busy morning at Dr. Anthony Aurigemma's homeopathy practice in Bethesda, Md.

Wendy Resnick, 58, is here because she's suffering from a nasty bout of laryngitis. "I don't feel great," she says. "I don't feel myself."

The traditional treatments just weren't helping me at all.

Resnick, who lives in Millersville, Md., has been seeing Aurigemma for years for a variety of health problems, including ankle and knee injuries and back problems. "I don't know what I would do without him," she says. "The traditional treatments just weren't helping me at all."

Aurigemma listens to Resnick's lungs, checks her throat and then asks detailed questions about her symptoms and other things as well, such as whether she's been having any unusual cravings for food.

Aurigemma went to medical school and practiced as a regular doctor before switching to homeopathy more than 30 years ago. He says he got disillusioned by mainstream medicine because of the side effects caused by many drugs. "I don't reject conventional medicine. I use it when I have to," Aurigemma says.

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Throughout his career, homeopathy has been regulated differently from mainstream medicine.

In 1988, the Food and Drug Administration decided not to require homeopathic remedies to go through the same drug-approval process as standard medical treatments. Now the FDA is revisiting that decision. It will hold two days of hearings this week to decide whether homeopathic remedies should have to be proven safe and effective.

There is no question that it helps patients.

When Aurigemma is finished examining his patient, instead of pulling out a prescription pad, he uses a thick book to come up with a homeopathic diagnosis. He then searches through heavy wooden drawers filled with rows of small brown glass vials filled with tiny white pellets. They're homeopathic remedies. He pulls out two.

"So this will be the first dose," he says. "Then I'll give you a daily dose, to try to get underneath into your immune system to try to help you strengthen your energy, basically."

Homeopathic medicine has long been controversial. It's based on an idea known as "like cures like," which means if you give somebody a dose of a substance — such as a plant or a mineral — that can cause the symptoms of their illness, it can, in theory, cure that illness if the substance has been diluted so much that it's essentially no longer in the dose.

Homeopathy is an excellent example of the purest form of pseudoscience.

"We believe that there is a memory left in the solution. You might call it a memory. You might call it energy," Aurigemma says. "Each substance in nature has a certain set of characteristics. And when a patient comes who matches the physical, mental and emotional symptoms that a remedy produces — that medicine may heal the person's problem."

Critics say those ideas are nonsense, and that study after study has failed to find any evidence that homeopathy works.

"Homeopathy is an excellent example of the purest form of pseudoscience," says Steven Novella, a neurologist at Yale and executive editor of the website Science-Based Medicine. "These are principles that are not based upon science."

Novella thinks consumers are wasting their money on homeopathic remedies. The cost of such treatments vary, with some over-the-counter products costing less than $10.

Some of the costs, such as visits to doctors and the therapies they prescribe, may be covered by insurance. But Novella says with so many people using homeopathic remedies, the costs add up.

There's also some concern that homeopathic remedies could be dangerous if they're contaminated or not completely diluted, or even if they simply don't work.

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Somebody who's having an acute asthma attack, for example, who takes a homeopathic asthma remedy, "may very well die of their acute asthma attack because they were relying on a completely inert and ineffective treatment," Novella says.

For years, critics like Novella have been asking the FDA to regulate homeopathy more aggressively. The FDA's decision to revisit the issue now was motivated by several factors, including the growing popularity of homeopathic remedies and the length of time that has passed since the agency last considered the issue.

The FDA is also concerned about the quality of remedies, according to Cynthia Schnedar, director of the FDA's Center for Drug Evaluation and Research Office of Compliance. The agency has issued a series of warnings about individual homeopathic products in recent years, including one that involved tablets being sold to alleviate teething pain in babies.

"So we thought it was time to take another look at our policy," Schnedar says.

The FDA's decision to examine the issue is making homeopathic practitioners like Aurigemma and their patients nervous. "It would be a terrible loss to this country if they were to do something drastic," he says.

He also disputes claims that homeopathy doesn't work and is unsafe.

The potential risk to consumers is if any change in regulation were to limit access to these products.

"There's no question that it helps patients. I have too many files on too many patients that have shown improvements," Aurigemma says, although he acknowledges some homeopathic products sold over the counter make misleading claims.

Companies that make homeopathic remedies defend their products as well.

"Homeopathic medicines have a very long history of safety," says Mark Land, vice president of operations and regulatory affairs for Boiron USA, which makes homeopathic products. "One of the hallmarks of homeopathic medicines is safety," says Land, who is also president of the American Association of Homeopathic Pharmacists.

"The potential risk [of greater FDA regulation] to consumers is if any change in regulation were to limit access to these products," says Land.

That's what worries Resnick. She says homeopathic remedies have helped alleviate a long list of health problems she's experienced over the years. "Why would they want to take that away from us?" she says. "Let us have the freedom to decide what works the best for us."

The FDA says this week's hearing is just a chance to start gathering information to decide what — if anything — the agency should do about homeopathy.

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

The State Of The Cancer Nation

Fri, 04/17/2015 - 11:30am
The State Of The Cancer Nation April 17, 201511:30 AM ET Matt Stiles $(function() { var pymParent = new pym.Parent( 'responsive-embed-cancer-obesity-rate', 'http://apps.npr.org/dailygraphics/graphics/cancer-obesity-rate/child.html', {} ); });

While a cure for cancer remains elusive, we already know how to keep many cases of the disease from developing in the first place.

People can reduce cancer risks by keeping a healthful weight and avoiding cigarettes.

But smoking, obesity and other major cancer risk factors remain common, and they still vary widely across the country.

Researchers working with the American Cancer Society recently compiled nationwide survey data on rates of smoking, obesity, lack of exercise and poor diet — all factors that significantly increase lifetime risks of developing or dying from cancer.

The researchers also looked at the adoption of early prevention methods, such as cancer screenings, skin protection and vaccinations.

Find other stories about the state of cancer in the U.S. in the Living Cancer series at WNYC.org.

WNYC

What did they find? A mixed bag of incremental progress that, in some cases, depends on where Americans live, their race or ethnicity, their socioeconomic status — and, of course, whether they have health insurance. The researchers relied on data collected by the Centers for Disease Control and Prevention.

"Much of the suffering and death from cancer could be prevented by more systematic efforts to reduce tobacco use, improve diet, increase physical activity, reduce obesity and expand the use of established screening tests," the authors wrote in the biennial report.

The research focuses on the most common — and preventable — risk factors for cancer, with some cross tabulations by gender, age and other variables. (You can read those here).

The society estimates that about 1.6 million people in the U.S. will develop cancer this year. Topping the list of risk factors is tobacco use, particularly smoking, which could contribute to as many as 170,000 cancer deaths in the U.S. this year, according to the society.

Overall, adult smoking rates are down: from 23.5 percent in 1999 to 17.8 percent today. The report found that rates have fallen among all education levels, but particularly among people with undergraduate and graduate degrees.

In general, the state-by-state prevalence of the risk factors varied widely (view a complete table at the bottom of this post). That's true with smoking: Only 10 percent of adults in Utah reported being current smokers, for example, compared with 27.3 percent of those in West Virginia.

This map shows the variation, with many states in the South leading the country in smoking rates:

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

Obesity, poor nutrition and physical inactivity are also major risk factors for cancer, second only to smoking.

In 2013, more than two-thirds of Americans were overweight or obese. The prevalence of weight problems increased rapidly after the mid-1970s but has stabilized in recent years, according to the report.

Like smoking, obesity varies by state — again with higher rates in parts of the South. (See map at top of post.) About 21 percent of adults in Colorado are obese, compared with 35.1 percent of those in Mississippi, which has the highest rates in the country.

The researchers found that the proportion of Americans who meet physical activity and nutrition guidelines remains low. For example, only 15 percent of adults report eating three or more servings of vegetables each day.

The three maps below show the rates for adults who reported getting no leisure-time physical activity for 30 days — as well as those who reported not eating at least two daily servings of fruit or three daily servings of vegetables.

(Darker shades in all these maps show higher instances of behaviors that increase risk for cancer. With smoking, obesity and lack of exercise, higher rates are represented with darker shades. With fruit and vegetable consumption guidelines, however, areas with places with lower rates are in darker shades.)

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

In addition to documenting the risk factors, the researchers also studied the prevalence of prevention efforts, such as breast and colorectal screenings, abstaining from tanning machines and vaccinations associated with decreases in some cancers.

The researchers note that the rate of colorectal screening remains lower than that of breast and cervical cancer.

Screening rates vary by geography and socioeconomic classes as well. About 60 percent of people age 50 or older have received a recent colorectal test, which can detect cancers, of course, but also help prevent them by spotting precancerous polyps. But only 22 percent of people without health insurance have received such a test.

"There's a lot of room for improvement across all cancer screening types among the uninsured and among lower socioeconomic populations," said Stacey Fedewa, director of risk factor screening and surveillance at the American Cancer Society.

We've compiled all the risk data in the table below which, like the maps, uses darker shades to represent higher instances of risk. The table is separated by region, which makes it easy to see how some areas of the country face higher risk factors than others. You can read the full report, with highlights annotated by NPR, here.

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

Matt Stiles, a former data editor on NPR's visuals team, is a freelance writer based in Seoul, South Korea. Follow him @stiles.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Top Hospital Ratings Prove Scarce In Medicare's Latest Tally

Fri, 04/17/2015 - 10:27am
Top Hospital Ratings Prove Scarce In Medicare's Latest Tally April 17, 201510:27 AM ET

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Jordan Rau

Vacuum cleaners get them. Movies get them. Now hospitals are being given star ratings to help patients decide which ones to use.

On Thursday the federal government awarded its first star ratings to hospitals based on the opinions of patients. Some of the nation's most lofty hospitals—the ones featured in best hospital lists—received mediocre ratings, while the maximum number of stars often went to small, regional hospitals and others that specialize in lucrative surgeries.

Evaluating hospitals is becoming increasingly important as more insurance plans offer patients limited choices. Medicare already uses stars to rate nursing homes, dialysis centers and private Medicare Advantage insurance plans. Medicare publishes dozens of quality measures on its Hospital Compare website, but many are tough to decrypt. Most consumers don't use them.

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Many in the hospital industry fear Medicare's 5-star scale won't accurately reflect quality and may place too much weight on patient reviews, which are just one measurement of hospital quality. Medicare also reports the results of hospital care, such as how many patients died or got infections during their stay, but those are not yet assigned stars.

"We want to expand this to other areas like clinical outcomes and safety over time, but we thought patient experience would be very understandable to consumers so we started there," Dr. Patrick Conway, chief medical officer for the Centers for Medicare & Medicaid Services, said in an interview.

Medicare's new summary star rating, posted on Hospital Compare, is based on 11 facets of patient experience, including how well doctors and nurses communicated, how well patients believed their pain was addressed, and whether they would recommend the hospital to others.

In assigning stars, Medicare compared hospitals against each other, essentially grading on a curve. It noted on Hospital Compare that "a 1-star rating does not mean that you will receive poor care from a hospital" and that "we suggest that you use the star rating along with other quality information when making decisions about choosing a hospital."

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The American Hospital Association offered its own caution, saying: "There's a risk of oversimplifying the complexity of quality care or misinterpreting what is important to a particular patient, especially since patients seek care for many different reasons."

Nationally, Medicare awarded the top rating of five stars to 251 hospitals, about 7 percent of all the hospitals Medicare judged, a Kaiser Health News analysis found. Many are small specialty hospitals that focus on lucrative elective operations such as spine, heart or knee surgeries. They have traditionally received more positive patient reviews than have general hospitals, where a diversity of sicknesses and chaotic emergency rooms make it more likely patients will have a bad experience.

A few five-star hospitals are part of well-respected systems, such as the Mayo Clinic's hospitals in Phoenix, Jacksonville, Fla., and New Prague, Minn. Mayo's flagship hospital in Rochester, Minn., received four stars.

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Medicare awarded three stars to some of the nation's most esteemed hospitals, including Cedars-Sinai Medical Center in Los Angeles, NewYork-Presbyterian Hospital in Manhattan, and Northwestern Memorial Hospital in Chicago. The government gave its lowest rating of one star to 101 hospitals, or 3 percent. (You can see all hospital ratings here.)

On average, hospitals scored highest in Maine, Nebraska, South Dakota, Wisconsin and Minnesota. Thirty-four states had no one-star hospitals.

Hospitals in Maryland, Nevada, New York, New Jersey, Florida, California and the District of Columbia scored lowest on average. Thirteen states and the District of Columbia did not have a single five-star hospital.

In total, Medicare assigned star ratings to 3,553 hospitals based on the experiences of patients who were admitted between July 2013 and June 2014. Medicare gave out four stars to 1,205 hospitals, or 34 percent of those it evaluated. Another 1,414 hospitals — 40 percent — received three stars, and 582 hospitals, or 16 percent, received two stars. Medicare did not assign stars to 1,102 hospitals, primarily because not enough patients completed surveys during that period.

While the stars are new, the results of the patient satisfaction surveys are not. They are presented on Hospital Compare as percentages, such as the percentage of patients who said their room was always quiet at night. Often, hospitals can differ by just a percentage point or two, and until now Medicare did not indicate what differences it considered significant. Medicare also uses patient reviews in doling out bonuses or penalties to hospitals based on their quality each year.

Some groups that do their own efforts to evaluate hospital quality questioned whether the new star ratings would help consumers. Evan Marks, an executive at Healthgrades, which publishes lists of top hospitals, said it was unlikely consumers would flock to the government's rating without an aggressive effort to make them aware of it.

"It's nice they're going to trying to be more consumer friendly," he said. "I don't see that the new star rating itself is going to drive consumer adoption. Ultimately, you can put the best content up on the Web, but consumers aren't going to just wake up one day and go to it."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Use Of E-Cigarettes Triples Among U.S. Teens

Thu, 04/16/2015 - 6:19pm
Use Of E-Cigarettes Triples Among U.S. Teens April 16, 2015 6:19 PM ET

Nicotine exposure at a young age "may cause lasting harm to brain development," warns Dr. Tom Frieden, chief of the Centers for Disease Control and Prevention.

iStockphoto

A national survey confirms earlier indications that e-cigarettes are now more popular among teenage students than traditional cigarettes and other forms of tobacco, federal health officials reported Thursday.

The findings prompted strong warnings from Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, about the effects of any form of nicotine on young people.

"We want parents to know that nicotine is dangerous for kids at any age," Frieden said.

CDC/CDC National Youth Tobacco Survey

"Adolescence is a critical time for brain development," he added, in a written statement. "Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction and lead to sustained tobacco use."

The statistical findings, published in this week's issue of Morbidity and Mortality Weekly Report, come from the CDC's National Youth Tobacco Survey. The latest survey found that the use of e-cigarettes increased from 1.1 percent in 2013 to 3.9 percent in 2014 among middle school students, and from 4.5 percent to 13.4 percent among high school students. That translates to a total of 450,000 middle school students now using e-cigs, alongside 2 million high school students

The findings are similar to those from a study reported in December.

The CDC survey also found that hookah use doubled among middle schoolers and high school students, while use of traditional cigarettes fell for high school students and remained the same for middle school students.

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The new evidence comes as the Food and Drug Administration is deciding how strictly to regulate e-cigarettes. The devices heat a nicotine-laced fluid, which then becomes a vapor that users inhale. While many doctors say the vapor of e-cigarettes is likely less damaging than the smoke of burned tobacco leaves, there is intense debate about how safe e-cigarettes are. Some public health researchers say the electronic devices may be useful for helping some smokers give up traditional cigarettes. But many also fear the devices may hook a new generation on nicotine and lead them to start smoking traditional cigarettes.

"The release of this survey couldn't be better timed," said Nancy Brown of the American Heart Association in a written statement. "The take-away message is loud and clear: Tobacco regulations need to be finalized now. We cannot stand by while more and more youth put themselves at risk for heart disease, stroke or even an early death."

But the makers of e-cigarettes argue that the devices may be helping drive down the rate of regular cigarette use among teens.

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"While the use of vapor products by teens should be discouraged, the data is clear that as teen experimentation with vaping has grown over the last three years, youth smoking has experienced the largest decline in the history of the ... survey," Gregory Conley, of the American Vaping Association, told Shots in an email.

"This dramatic fall in teen smoking should be part of the discussion," Conley said, "but the CDC deemed this finding to not be worthy of a single line in their press release. That is not surprising, as it would interfere with the CDC's evidence-free attempts to paint e-cigarettes as a potential gateway to traditional cigarettes."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Scientists Probe Puppy Love

Thu, 04/16/2015 - 2:45pm
Scientists Probe Puppy Love April 16, 2015 2:45 PM ET Listen to the Story 3 min 26 sec  

A direct, friendly gaze seems to help cement the bond of affection between people and their pooches.

Dan Perez/Flickr

It's a question that bedevils dog owners the world over: "Is she staring at me because she loves me? Or because she wants another biscuit?"

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Research published Thursday in the journal Science suggests that love (or something close) could be behind that stare. The work shows that when dogs and their people gaze into each other's eyes, all get a boost in their circulating levels of oxytocin — a hormone thought to play a role in trust and emotional bonding.

The results suggest that both dogs and people feel it, something few dog owners would doubt.

"It's really cool that there's actually some science to back this up now," says Evan MacLean, an evolutionary anthropologist and co-director of Duke University's Canine Cognition Center.

For thousands of years, humans have bred dogs for obedience, and that has altered their brains as well. For example, MacLean says, dogs are excellent at understanding gestures like pointing. They're also good with language.

But have humans also bred dogs for affection?

"Well, it's a harder one to get at, partially because emotions are so subjective," MacLean says. For instance, many owners say their dog feels guilty after behaving badly, but that's not true.

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"There have been good studies to show that, actually, what's happening in those situations is that dogs are ... just responding to people," he says. In other words, the dog looks guilty to you because you look angry to the dog.

A team led by Takefumi Kikusui, at Azabu University's school of veterinary medicine in Japan, has now found a more quantitative measure of emotion. The scientists let owners and dogs interact. And rather than just watching each pair, the team took urine samples from the people and the dogs.

"They measured oxytocin, which is a hormone that has been very associated with trust and social bonds," says MacLean, who was not part of the research team.

Oxytocin is the same bonding hormone thought to give parents warm fuzzies when looking at their infants.

Researchers found that when dogs stared into their owner's eyes, oxytocin levels rose in both the people and the dogs. The same was not true for wolves, who were observed with their handlers. The team also found that when dogs were given a shot of oxytocin, they would stare into the eyes of their owners for a longer period, and that gazing, in turn, would boost the oxytocin levels in the owners. That increase points to a hormonal feedback loop between the dogs and the humans.

Taken together, MacLean says, the findings suggest a special bond between dogs and people — a bond that may have evolved as humans bred them. "I'm perfectly happy saying that we can love dogs, and they can love us back," MacClean says, "and oxytocin is probably a piece of how that happens."

But not everyone is buying this hormonal connection.

"There is a fashion in science at the moment, to identify changes in hormone levels with changes in emotional and feeling states," says Clive Wynne, a psychologist at Arizona State University who studies how dogs and people interact.

In fact, oxytocin is not always associated with love, he points out. The hormone can also be linked to feelings of emotional isolation — even aggression in some animals. The wolves used in the study didn't make a lot of eye contact, Wynne says. If they had, their oxytocin might have gone up too.

But Wynne adds that, oxytocin or no, he believes the bonds between dogs and humans are real.

"I think the best evidence that any dog lover has that their dog loves them is what the dog does was when it's around them," Wynne says. "We're entitled to trust the evidence of our own senses."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Study: Insurers Fail To Cover All Prescribed Contraceptives

Thu, 04/16/2015 - 1:38pm
Study: Insurers Fail To Cover All Prescribed Contraceptives April 16, 2015 1:38 PM ET

Will the health plan pay for the contraceptives the doctor prescribes?

MediaforMedical/Emmanuel Rogue/Getty Images

Some women may be paying hefty fees for birth control pills, vaginal rings and emergency contraception, despite a federal requirement that insurers pay their full cost. And some women only have coverage for a less effective type of emergency contraception, according to a report released Thursday by the Kaiser Family Foundation.

The analysis looked at 20 health insurers in five states and found companies that provided limited or no coverage for some forms contraception. In some cases, the insurers imposed copays or required women to pay the full cost of a drug.

For example, seven insurers didn't pay the full cost of vaginal rings, and one company does not pay for ParaGard, the only nonhormonal IUD available to women. It can cost up to $1,000.

"That's a flagrant violation of the law," says Gena Madow, a spokeswoman for Planned Parenthood.

Nevertheless, Planned Parenthood said the study revealed many positive trends. "Many plans are meeting the law and covering the full range of contraceptive methods with no cost sharing and no medical management restrictions," the group said in a statement. "However, the report also shows that stronger enforcement of the birth control benefit is critical."

Consider the case of ella, an emergency contraceptive. A recent study found that the pill could be more effective at preventing pregnancies than Plan B, the traditional and more widespread emergency contraceptive, particularly in heavier women.

Despite that finding, the Kaiser study showed that several plans still only cover Plan B, meaning women may face a difficult choice: get a less effective emergency contraceptive free, or pay for a better one.

America's Health Insurance Plans, an industry trade group, says insurers aren't doing anything illegal because federal guidelines give them some latitude. "The guidance makes clear that plans do not have to cover every single form of birth control," says Clare Krusing, a spokesperson for AHIP.

Krusing says the guidance makes clear that insurers can use "reasonable medical management" techniques to limit costs, such as requiring patients to pay co-pays for brand name drugs, when lower-cost generic versions are available.

"If health plans were required to cover every single kind of contraception, premiums would become more expensive, and insurance plans would risk becoming unaffordable," she says.

Insurers offer an appeals process, Krusing says, so that women can get special coverage for contraceptives prescribed by their doctors that don't happen to be on health plans' preferred lists, or formularies.

But Planned Parenthood says the insurers aren't, in fact, meeting guidelines laid out by the Institute of Medicine, Centers for Disease Control and Prevention and Department of Health and Human Services.

The group says it is asking the government to make sure that insurance companies comply with the law.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Men Strive To Give More To Charity When The Fundraiser Is Cute

Thu, 04/16/2015 - 1:00pm
Men Strive To Give More To Charity When The Fundraiser Is Cute April 16, 2015 1:00 PM ET

We donate to charities for lots of reasons: because we're generally magnanimous people, because we care deeply about certain issues or because it's the only way to get Meg to stop talking about the plight of the endangered proboscis monkey.

And for men, there may be another force at play: a subconscious desire to impress the ladies.

Researchers in the United Kingdom reviewed thousands of online donation pages from the 2014 Virgin London Marathon. Runners participating in the marathon usually put up a fundraising page where they can raise money for a charity of their choice. And donations are made publicly, so the researchers could keep track of donors' names and how much they contributed.

It turned out that everyone was a little competitive on online donation platforms: people on average gave about £10 more after seeing others' large donations.

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But men donating to attractive female fundraisers were extra competitive. They contributed £28 more than the last guy, on average.

"The results were quite surprising, actually, in that they were completely in line with the theory that men are hardwired to act competitively in this way," says Sarah Smith, an economist at the University of Bristol and a one of the researchers behind the study.

The researchers came to this conclusion by first having independent reviewers rate the attractiveness of each fundraiser's profile photo. They then looked at how much people donated to each fundraiser. When someone donated £50 or more, the researchers studied how subsequent donors reacted.

Attractive fundraisers raised more money, as did those whose profiles featured nice smiles. That worked for both male and female fundraisers. "Maybe not everybody can be the most attractive, but everybody can give a smile," Smith says. "That's something to keep in mind the next time you're trying to raise money."

This doesn't mean that people who donate to charities don't have noble intentions, Smith notes. People usually decide to donate because they care about a cause. But this subconscious competitiveness may be subtly influencing how much they choose to donate.

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It's also worth noting that the researchers weren't able to account for the donors' sexual preferences or relationship status. "So we just don't know how being married or being attracted to other men would affect the competitiveness," Smith says. "But I think it's safe to assume if we excluded men have no incentive to compete for the fundraiser, we probably would have seen even more competiveness."

"This sort of thing happens in the animal kingdom all the time," says Nichola Raihani, an evolutionary biologist at University College London who worked with Smith on the paper. "The classic example would be the peacock. The male is so showy — trying to impress with his huge plume. And the female really holds all the cards. It's the same thing here, in the context of male donors."

By donating to charities, men signal that they're caring and generous, as well as wealthy, Raihani says. "We found that women aren't competitive with each other in the same way in this context," she notes. "And that may be because men and women prioritize different things when evaluating potential partners. Studies show that women are more likely to prioritize cues that the man can be a good provider."

Culture and hormones can help explain the behavior as well, notes David Geary, an evolutionary psychologist at the University of Missouri who wasn't involved with the study, which was published Thursday in Current Biology.

"Basic competitiveness is evolved and related in part to testosterone," Geary said in an email. But how the competitiveness is expressed depends on context. "You'd only find competitive donations in wealthy societies," he adds. Other cultures may define success in other ways.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Letters About Dense Breasts Can Lead To More Questions Than Answers

Thu, 04/16/2015 - 10:57am
Letters About Dense Breasts Can Lead To More Questions Than Answers April 16, 201510:57 AM ET

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Barbara Feder Ostrov

Caryn Hoadley, 45, from Alameda, Calif., with her two children. Hoadley received a letter that said her mammogram was clean but that she has dense breast tissue, which has been linked to higher rates of breast cancer

Courtesy of Poppins Photography

Earlier this year, Caryn Hoadley received an unexpected letter after a routine mammogram.

The letter said her mammogram was clean but that she has dense breast tissue, which has been linked to higher rates of breast cancer and could make her mammogram harder to read.

"I honestly don't know what to think about the letter," said Hoadley, 45, who lives in Alameda, Calif. "What do I do with that information?"

Millions of women like Hoadley may be wondering the same thing. Twenty-one states, including California, have passed laws requiring health facilities to notify women when they have dense breasts. Eleven other states are considering similar laws and a nationwide version has been introduced in Congress.

The laws have been hailed by advocates as empowering women to take charge of their own health. About 40 percent of women have dense or extremely dense breast tissue, which can obscure cancer that might otherwise be detected on a mammogram.

But critics say the laws cause women unnecessary anxiety and can lead to higher costs and treatment that doesn't save lives or otherwise benefit patients.

"While I think the intent of these laws is well meaning, I think their impact is going to be a significant problem, where we end up doing more harm than good," said Dr. Laura Esserman, a University of California, San Francisco surgeon and breast cancer specialist.

Typically, the laws require a notice be sent to a woman if she has dense breast tissue seen on a mammogram. Some notifications suggest that a woman talk to her doctor about additional screening options.

But in some states, not including California, the laws go further by requiring health providers to offer a supplemental screening, such as an ultrasound, to women with dense breasts even if their mammograms are clean. Connecticut, Illinois and Indiana even require insurers to pay for screening ultrasound after mammography if a woman's breast density falls above a certain threshold.

Otherwise insurers don't routinely cover supplemental screening for women with clean mammograms, even if they have dense breasts. The Affordable Care Act doesn't require it.

The problem, Esserman says, is that no medical consensus exists on whether routine supplemental screening for women with dense breasts is worthwhile.

A recent Annals of Internal Medicine study using computer modeling found that offering an ultrasound to women with dense breasts after a clean mammogram wouldn't significantly improve breast cancer survival rates but would prompt many unnecessary biopsies and raise health care costs.

Another study conducted in Connecticut after its notification law went into effect found that supplemental ultrasound screening for women with dense breasts did find a few additional cancers — about 3 per 1,000 women screened. But the probability that such screenings would find life-threatening cancers was low.

Dense breast notification laws have added another layer of complexity to the long-running and often emotional debate over how best to screen women for breast cancer.

Breast cancer is the second most common form of cancer among American women, behind skin cancers, and the second leading cause of cancer death. An estimated 231,840 U.S. women will be diagnosed with invasive breast cancer in 2015, according to the American Cancer Society.

About 38.5 million mammograms are performed each year in an attempt to find signs of cancer early enough to treat it successfully. Emerging technologies like tomosynthesis, a 3-D digital X-ray of the breast, may become cheap enough to replace conventional mammography and make the notification laws irrelevant, but their widespread use is years away.

For a long time, women were advised to start yearly mammograms at about age 40, but in 2009, the U.S. Preventive Services Task Force issued controversial recommendations that most women without a family history of breast cancer or other risk factors should wait until age 50 to begin mammograms, and repeat them every two years. Patient advocates decried the recommendations as rationing preventive health care for women.

In the meantime, Nancy Cappello, an education administrator from Connecticut, was pushing to pass what became the nation's first dense breast notification law. Just two months after a clean mammogram, she had been diagnosed with breast cancer that had spread to her lymph nodes. She had extremely dense breasts, something her radiologist knew but Cappello wasn't told. Dense breasts have more glandular and fibrous tissue, which block the X-rays used in mammograms more than fatty tissue does.

Eventually, she founded a patient advocacy organization and took her campaign national.

"There's no evidence that we're scaring women. Most women I've talked to are very happy to get these notifications," said Cappello, whose cancer is in remission. "We want to make informed decisions ... to have a better chance of surviving the disease."

Dr. Jane Kakkis, a breast cancer surgeon in Fountain Valley, Calif., supports dense breast notification laws and testified in front of Nevada lawmakers before that state passed its law in 2013. Like Cappello, she dismisses concerns that the notification laws will cause undue fear.

"You have no idea what fear is until you have a cancer that's already spread to your lymph nodes," Kakkis said. "Patients will say in disbelief, 'But I just had a mammogram and it was normal.' They can't believe how advanced it is. Dense breast notification is bringing up a whole conversation about risk that wouldn't come up otherwise."

Catharine Becker of Fullerton, Calif., was diagnosed with stage 3 breast cancer at 43 despite having a clean mammogram. The mother of three didn't know she had dense breast tissue until after she was diagnosed.

Heidi de Marco/Kaiser Health News

One of Kakkis' patients, Catharine Becker of Fullerton, was diagnosed with breast cancer six years ago. She'd felt a lump three months after a clean mammogram. Because Becker had a family history of breast cancer – her mother died from the disease – she started mammograms early, at age 35. But they never showed any cancer. Until she was diagnosed, she didn't know she had dense breast tissue.

"To be told at age 43 I had stage 3 cancer after a clean mammogram was really a shock," Becker said, crediting her survival to breast self-exam and her doctors. "I'd rather have more information than less."

Women with moderately dense breasts have about a 20 percent higher chance of getting breast cancer than women who don't. Those with the highest-density breasts have about double. To put these numbers into perspective, if an average 50-year-old woman has a 2.38 percent chance of getting cancer in the next 10 years of her life, a woman with the highest density breasts would have a 4.76 percent chance of being diagnosed.

New ways of classifying dense breast tissue could put even more women in the category of receiving dense breast notifications, said Dr. Priscilla Slanetz, who recently wrote in the New England Journal of Medicine questioning the effectiveness of dense breast notification laws.

One reason she wrote the article, she said, was "in our state [Massachusetts] very few of our primary care providers have any knowledge about breast density and strengths and limitations of these different tests" for supplemental screening.

The same may hold true in California, where a small survey of primary care doctors found that only half of them had heard of the state's 2013 dense breast notification law and many felt they didn't have enough education to address what breast density meant for their patients.

On this point, both supporters and critics of the laws agree: Doctors need better tools to help their patients identify their individual cancer risks.

To that end, specialists are developing more personalized screening protocols that result in low-risk women being screened less often than higher-risk women.

"It's not rationing, it's being rational," said Esserman, who has a $14 million grant to study the issue. "We should be testing different approaches for screening women with dense breasts, and then pass legislation once we know what to do."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Tylenol Might Dull Emotional Pain, Too

Thu, 04/16/2015 - 3:49am
Tylenol Might Dull Emotional Pain, Too April 16, 2015 3:49 AM ET Angus Chen Listen to the Story 3 min 50 sec   Paul Taylor/Getty Images

A common pain medication might make you go from "so cute!" to "so what?" when you look at a photo of a kitten. And it might make you less sensitive to horrifying things, too. It's acetaminophen, the active ingredient in Tylenol. Researchers say the drug might be taking the edge off emotions — not just pain.

"It seems to take the highs off your daily highs and the lows off your daily lows," says Baldwin Way, a psychologist at Ohio State University and the principal investigator on the study. "It kind of flattens out the vicissitudes of your life."

The idea that over-the-counter pain pills might affect emotions has been circulating since 2010, when two psychologists, Naomi Eisenberger and Nathan DeWall, led a study showing that acetaminophen seemed to be having both a psychological and a neurological effect on people. They asked volunteers to play a rigged game that simulated social rejection. Not only did the acetaminophen appear to be deflecting social anxieties, but it also seemed to be dimming activity in the insula, a region of the brain involved in processing emotional pain.

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"But [the insula] is a portion of the brain that seems to be involved in a lot of things," Way says. In older studies, scientists saw that people with damage in their insula didn't react as strongly to either negative or positive images. So Way and one of his students, Geoffrey Durso, figured that if acetaminophen is doing something to the insula, then it might be having a wider effect, too.

The researchers gave about 40 people the equivalent of two extra-strength Tylenols and gave another 40 people a placebo. Then they asked the volunteers to rate pictures ranging from weeping, starving children to kids playing with kitties on how pleasant or depressing each photo was and how powerful they found the image.

On average, the people who'd taken the acetaminophen said they felt nearly 20 percent less happy when they saw the delightful photos and nearly 10 percent less sad when they saw the dreadful photos compared to those who'd taken the placebo. The same was true for their ratings for the power of each image. The results were reported this month in Psychological Science,

"It's a surprising finding," says Nathan DeWall, a professor of psychology at the University of Kentucky who was not involved in the study. Typically, he says, we think of acetaminophen as numbing painful experiences. Instead, DeWall says this study suggests that the drug may have a broader impact by muffling all emotions.

That's intriguing, for sure, but this is a small preliminary study, and Durso and Way admit the effects they measured were small, too.

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For one thing, it's unclear how acetaminophen might be manipulating our minds. "I'd say there's a common mechanism — a common lever, if you will, where one can affect both positive and negative systems in the brain," Way speculates. Or maybe there are two levers to dampen each system, and the pain medication just seizes them both at the same time, numbing our entire emotional connection to the world. "The bottom line is we don't know," Ways says.

It's also a puzzle to Dr. Lewis Nelson, a medical toxicologist at NYU Langone Medical Center who says though this new study is well done, he's not entirely convinced that acetaminophen is having a measurable effect on people's emotions.

"I'd like to know more about how it might happen," he says. "One way to think about things in medicine is to understand the biological plausibility."

And while science works to figure that out, popping a Tylenol when your nerves get a little jangly isn't a good idea, says Nelson, who's also an emergency room doctor. "This is not the kind of drug we want people to use to any sort of excess."

The greatest value from the study might be in what acetaminophen could lend toward future research. "The door here has been propped open in ways we haven't recognized," says social psychologist Steve Heine, whose lab at the University of British Columbia has also been studying acetaminophen. "Both as a tool for helping us identify how the brain works, but also for practical purposes. There might be some real consequences to having acetaminophen work in your system."

If what Way and Durso are saying is true, he ventures, there could be other effects that acetaminophen has on our minds that we have yet to uncover. But for now, what the drug is doing and how deeply it might influence emotion is a matter of speculation.

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

Why Knuckles Crack

Wed, 04/15/2015 - 4:59pm
Why Knuckles Crack April 15, 2015 4:59 PM ET Listen to the Story 3 min 28 sec  

NPR intern Poncie Rutsch takes a crack at making a big sound.

Meredith Rizzo/NPR

Scientists think they may have solved an old question about the cracking of knuckles: Why does it make that sound?

The crack apparently comes from a bubble forming in the fluid within the joint when the bones separate, according to a study published Wednesday. It's like a tiny air bag inflating.

The findings confirm the original theory about knuckle-cracking, which was first proposed in 1947 but challenged in the 1970s.

According to Greg Kawchuk, a professor of rehabilitation medicine at the University of Alberta, that second group of scientists came along and said, " 'No, no, no — wait! We think what's happening is, the gas bubble forms but then it subsequently collapses. That's what makes the big sound.' "

While many people accepted the bubble-bursting theory, no one was sure. So Kawchuk and a team of scientists figured out a little test, enlisting the help of a pal who is really good at cracking his knuckles.

"We called our colleague the 'Wayne Gretzky of finger-cracking,' " Kawchuck says. "He can make this happen in all 10 of his fingers."

They asked the volunteer to put his hand inside a special type of MRI scanner, and made a movie of the inside of his knuckles as they pulled on the end of each finger to make it crack.

"We've been calling it the 'Pull My Finger Study,' " Kawchuk says.

What they saw was clear: The cracking sound comes when a bubble forms between the bones of the knuckle joint — not when it collapses.

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"Our jaws hit floor," he says. "This is the exact answer. It feels pretty great."

Other researchers praised the study, which appears in the online journal PLOS ONE.

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"This is the first time we're actually seeing what's going on inside the joint when a knuckle is being cracked," says Dr. Kevin deWeber, who studies sports medicine in Vancouver, Wash. "It's really exciting."

DeWeber says the discovery also reinforces previous research that challenged a common misconception about knuckle-cracking — that it causes arthritis.

"It's mostly an urban myth ... perpetuated by mothers who are sick of hearing their kids crack their knuckles," deWeber says. He thinks cracking knuckles might actually be good for the joints — sort of a massage of the cartilage.

"This study helps us understand the biomechanics of the knuckle-cracking event," deWeber says. "We are reassured that nothing harmful is happening inside. And ... maybe something helpful is happening."

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Personalizing Cancer Treatment With Genetic Tests Can Be Tricky

Wed, 04/15/2015 - 2:49pm
Personalizing Cancer Treatment With Genetic Tests Can Be Tricky April 15, 2015 2:49 PM ET Listen to the Story 3 min 55 sec  

Sequencing the genes of a cancer cell turns up lots of genetic mutations — but some of them are harmless. The goal is to figure out which mutations are the troublemakers.

Kevin Curtis/Science Source

It's becoming routine for cancer doctors to order a detailed genetic test of a patient's tumor to help guide treatment, but often those results are ambiguous. Researchers writing in Science Translational Medicine Wednesday say there's a way to make these expensive tests more useful.

Here's the issue: These genomic tests scan hundreds or even thousands of genes looking for mutations that cause or promote cancer growth. In the process, they uncover many mutations that scientists simply don't know how to interpret — some may be harmless.

"What we found is, you essentially get a lot of inaccurate information," says Dr. Victor Velculescu, a professor of oncology and pathology and co-director of cancer biology at the Johns Hopkins Kimmel Cancer Center.

The consequences of misinterpreting these results could be significant.

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"You can imagine patients being placed on a particular therapy, with all the side effects of that therapy but without any of the benefits," Velculescu says. "You can imagine that it prevents the patient from getting the right therapy. And then, finally, there are the additional costs of having therapies that aren't really useful in any way."

Velculescu and his colleagues now report that about half of all people whose tumors are examined with a genome test get results that are potentially misleading.

They argue there's a way to refine these results: by studying the DNA of a person's healthy tissue at the same time the tumor is sampled. That way, doctors can distinguish mutations that are unique to the cancer and more likely to be related to the disease.

Velculescu has an economic reason for making this argument. He co-founded a company that tests healthy cells alongside tumor cells. That said, other scientists do agree with his fundamental point.

But they also say that existing tests are actually quite accurate when used appropriately.

Genomic tests reliably identify mutations that are clearly linked to certain cancers, "and those are the ones that are used clinically for making decisions about what to do for a patient and what's the optimal way to take care of that patient," says Dr. Neal Lindeman, a Harvard University pathology professor who runs a cancer genome program at Dana Farber Cancer Center and Brigham and Women's Hospital.

However, Lindeman says, genetic tests also spot a lot of ambiguous information, and that can sometimes lead people into clinical trials that are wrong for them.

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A comparison with a genetic profile of healthy tissue would add clarity to situations like this, by homing in on mutations that are more likely to be contributing to the cancer.

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At the moment, many companies that perform these genomic tests don't run that additional, expensive comparison. The genome test alone can cost more than $5,000, and a second test of normal tissue would increase that price substantially. Velculescu says insurance often won't pick up that additional cost.

Foundation Medicine, a company that ran more than 25,000 cancer genome tests last year, sorts its results so that doctors can readily distinguish between clear and speculative results.

"I have seen reports from other vendors or institutions where they just throw everything together and that does create this potential where one could be treating the patient on the basis of something that is not a cancer-driving alteration," says Dr. Vincent Miller, the company's chief medical officer. "But we clearly make that distinction."

There's room for this confusion because the booming cancer-genomics industry is not tightly regulated by the Food and Drug Administration.

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Some Doctors Still Dismiss Parents' Concerns About Autism

Wed, 04/15/2015 - 12:20pm
Some Doctors Still Dismiss Parents' Concerns About Autism April 15, 201512:20 PM ET Poncie Rutsch

Some doctors aren't up to date on how to assess autism symptoms in very young children.

iStockphoto

Most children with autism get diagnosed around age 5, when they start school. But signs of the developmental disorder may be seen as early as 1 year old.

Yet even if a parent notices problems making eye contact or other early signs of autism, some doctors still dismiss those concerns, a study finds, saying the child will "grow out of it." That can delay diagnosis and a child's access to therapy.

"Autism should be something that primary care pediatricians are really comfortable with, like asthma or ADHD, but it's not," says lead researcher Katharine Zuckerman, a pediatrician at Oregon Health & Science University, whose study was published Tuesday in The Journal of Pediatrics. "If you see a general pediatrician like me, I can't actually diagnose your child with autism."

Diagnosing autism often starts when parents notice subtle differences in their baby's development. The child might not make eye contact as much as other babies do, or he might not be grasping objects at 6 months. Other early signs include not smiling when smiled at, or not responding to a familiar voice.

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To get a better sense of how children with autism get delayed on the road to diagnosis, Zuckerman looked at the Centers for Disease Control's Survey of Pathways to Diagnosis and Services, which includes detailed data about 1,420 children between ages 6 and 17 with autism. She documented three significant dates each child: the date parents first worried; the date they first mentioned their concerns to a physician; and the date the child was diagnosed. She also noted what the parents recalled about the physician's response to their concerns.

Some doctors called for further tests or referred parents to a specialist, while others took no action other than reassuring the parents that their child was normal or it was too early to tell if anything was wrong.

Zuckerman compared the information for children who were eventually diagnosed with an autism spectrum disorder to children with an intellectual disability or developmental delay, two other intellectual problems that first show up in early childhood. About 14 percent more of the children with an autism spectrum disorder received a passive response from the health care practitioner, and were diagnosed about three years later than the children with other intellectual problems.

So what's delaying the pediatricians? Rebecca Landa, the director of the Center for Autism and Related Disorders at the Kennedy Krieger Institute, says there are a number of reasons why health care practitioners don't always jump at the first mention of autism. First, many parents with young children tend to worry over minor problems. Health care practitioners are listening for certain words, and if the parents don't seem particularly alarmed, it's easy to dismiss their concerns.

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And even if parents are persistent, autism is hard to diagnose. The symptoms are subtle, particularly in young children. "People expect that autism [in infancy] is going to look like autism in infancy, and that's not what happens." explains Landa. A baby who sits unsteadily at 6 months may have autism, or he might just be a slow sitter. "Babies do weird things," says Landa.

But perhaps the biggest problem isn't that it's hard to spot a young child with autism, but that most doctors and other health care practitioners aren't trained to identify those early signs.

Researchers knew far less about autism when most doctors practicing today studied medicine. Unless a pediatrician spent her or his residency in a field like neurodevelopmental pediatrics, they wouldn't have been trained to diagnose autism.

The children in the study were diagnosed around age 5, the average age of autism spectrum diagnosis in the U.S. But Zuckerman says that children could be diagnosed much earlier. And an earlier diagnosis means that children and parents can get help learning techniques to make life with autism a little more manageable a little sooner.

If anything, the study points to the need to get resources to physicians so that they can recognize signs of trouble. "We need to give them the skills they need so they can identify kids," says Zuckerman.

The American Academy of Pediatrics recommends that pediatricians screen children at their 18-month checkup and again when the child is between 24 and 30 months old. But it will take a few years for this practice to truly take root.

Meanwhile, Zuckerman says parents can find online tests and videos, so that they have a better idea of that to look for.

"We screen for blood pressure in kids and for vision," says Zuckerman. "There's no reason we can't screen for autism."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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When Keeping A Secret Trumps The Need For Care

Wed, 04/15/2015 - 10:08am
When Keeping A Secret Trumps The Need For Care April 15, 201510:08 AM ET

Will adult children seek care if their parents can find out about it?

Maria Fabrizio for NPR

Dana Lam was insured under her parent's health plan until the end of 2014, thanks to a provision of the Affordable Care Act that allows young adults to stay on family health insurance until they turn 26.

The arrangement worked out well until she needed treatment for depression. Lam knew that if she used her parents' health plan to see a psychotherapist or psychiatrist, her visit would show up on their insurance statements.

She wasn't ready to talk to them about her mental health issues. "I was just so afraid of having that conversation with them," she says.

She was able to use her school's free counseling services instead, but there was a catch. "Medication is really what I needed," Lam says. She couldn't afford to pay for medicine without using insurance, she says, so she didn't take any.

When she graduated, Lam's part-time job didn't come with benefits, so she stayed on her parent's insurance and she stopped getting help of any kind. "I looked around for free mental health care or community centers, but I didn't find much of anything," Lam says.

Now Lam is 26 and teaches English as a second language in Orange County, Calif. She has her own insurance, which she bought on the state exchange. She's getting the help she needs, and she recently told her parents what had been going on. "But if I didn't have to worry about privacy, I definitely would have gotten help sooner," she says.

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Lam's situation isn't unique. Millions of young adults have been able to stay on their family insurance plans since that provision of the Affordable Care Act took effect in 2010. But studies show that young people often hesitate to get certain types of medical care, such as mental and behavioral health care, birth control and sexual health screenings, because they don't want their parents to find out through insurance statements.

Now several states are testing ways to solve the problem, but none has a foolproof solution.

"The issue of maintaining confidentiality while a dependent is one that has existed for a long time," says Abigail English, president of the Center for Adolescent Health and the Law, a nonprofit advocacy group. "It's just receiving more attention now, because of the ACA and the increase in the number of dependents."

On NPR's Facebook page, we asked young adults to tell us about their concerns about privacy while on their parents insurance. Some said they avoided the doctor altogether, while others paid out of pocket or sought low-cost or free treatment at Planned Parenthood and community clinics.

Those who want to use their family insurance while maintaining privacy do have some options. Under the national medical privacy law, known as HIPAA, dependents have the right to ask insurance companies to redirect statements detailing sensitive medical information to a different address.

But the law implies that insurance companies are obligated to honor such requests only in cases where sharing medical information with parents would endanger the patient, English says. And it doesn't make it clear what patients have to do in order to prove that they're in danger.

Often, patients find the process of making such privacy requests too complicated or daunting, she says.

And then there's the issue of awareness. "Many young people don't even know that they have the right to do this," English says. So, many young patients avoid using their insurance to get some types of care.

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That's what Becca Holt, 23, did when she was in high school. Her parents' insurance would have covered birth control, but she didn't want them to know that she was sexually active.

"I was so nervous about them finding out. So I just went to Planned Parenthood, and I told them about my situation," she says. Holt lived in Sacramento, Calif. at the time, and Planned Parenthood helped her sign up for a statewide assistance program that helps people pay for birth control and preventative sexual health appointments.

People worried about privacy should try community clinics, says Clare Coleman, who heads National Family Planning and Reproductive Health Association.

But in the long term, it can put a strain on public funds allocated to helping those who truly lack health care, she says. "Wouldn't it be much better if patients who have insurance could just use that resource without worrying?"

A California law that took effect this year now allows people to ask insurance companies to keep sensitive health information private by submitting a single page-long form. Those who fill out the form can have their billing information sent to a different address, sent via email or made accessible online.

"It's designed to close loopholes in the existing federal laws," says Kathleen Tebb, an assistant professor at the University of California, San Francisco School of Medicine. Patients don't have to explain why they want their information kept private, and insurance companies are required to comply.

But the process isn't as simple as it seems, Tebb says. Not all insurance companies have the infrastructure in place to honor these requests.

Even when young patients manage to have insurance statements redirected, their parents can call up the insurance company ask about billing information, such as how much of their deductible has been met. Mom or Dad may wonder how their $2,000 deductible was met so quickly, and ask the kids what they've been using the family plan for.

Washington and Maryland have laws similar to the one in California. Colorado does, too, though it only applies to patients who are over the age of 18. Connecticut, Delaware and Florida offer confidentiality for treatment of sexually transmitted disease. In Massachusetts, advocates are pushing for laws that would require insurance companies to automatically withhold billing information for sensitive services.

"A number of states are struggling with this," she says. "Because it's extremely difficult to balance the privacy needs of dependents and the needs of policy holders."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Marathon Bombing Survivors Face A World That Still Feels Out Of Control

Wed, 04/15/2015 - 3:40am
Marathon Bombing Survivors Face A World That Still Feels Out Of Control April 15, 2015 3:40 AM ET

from

Martha Bebinger Listen to the Story 3 min 46 sec  

Martha Galvis has undergone 16 surgeries on her left hand, which was injured by a bomb at the 2013 Boston Marathon.

Jesse Costa/WBUR

It's just the crumb of a muffin, but Martha Galvis must pick it up. Lips clenched, eyes narrowed, she pushes it back and forth across a slick table, then in circles.

"I struggle and struggle until," Galvis pauses, concentrating all her attention on the thumb and middle finger of her left hand. She can't get them to close around the crumb.

"I try as much as I can, and if I do it, I'm so happy — so happy," she says, giggling.

"She had a very beautiful wedding ring that was two fine bands, kind of wrapped around each other. The force of a bomb going off right next to your hand — it's kind of like a miniature hurricane."

Galvis has just finished a session of physical therapy at Brigham and Women's Faulkner Hospital, where she goes twice a week. She's learning to use a hand that doctors are still reconstructing. It's been two years since she almost lost it to the explosions at the Boston Marathon.

On April 15, 2013, Martha and her husband, Alvaro Galvis, stopped to watch the marathon from three different spots along the course; they enjoyed the race and boisterous crowd. Their last stop was near the finish line.

Watching the race was a ritual that began in the mid-1970s when the Galvises, who are both from Colombia, met in Boston. Their three children grew up celebrating the marathon as a family holiday, and Martha and Alvaro Galvis had planned to continue the annual event after retirement.

Martha and Alvaro Galvis used to travel from New Hampshire to Boston to watch the marathon every year. Both were hurt in the bombing two years ago.

Jesse Costa/WBUR

"But not anymore," says Martha, waving both hands in front of her face. "I don't feel secure to do this."

The former preschool teacher tries not to think about the moment when, just as she was reaching into a bag at her feet, a pressure cooker bomb on the ground nearby exploded, hurling nails and BBs into her left leg and hand.

"My hand," she says, "was destroyed — destroyed, it was so bad."

Dr. George Dyer, an orthopedist with Brigham and Women's Hospital, began rebuilding Martha Galvis' hand about 30 minutes after that bomb went off. Dyer was able to save everything except her ring finger.

"She had a very beautiful wedding ring that was two fine bands, kind of wrapped around each other," Dyer says. "The force of a bomb going off right next to your hand — it's kind of like a miniature hurricane. It unwrapped these fine gold bands, and then wrapped them together very tightly around her finger, and just cut it off in place."

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Dyer picked pieces of the ring out of bone and tissue and saved them for Galvis. He salvaged parts of the ring finger to replace joints and tissue missing from its companions. In Galvis' 16th surgery, Dyer took bone from her hip, where the marrow has the best potential to stimulate healing, and grafted it to a joint in her pinkie. Doctor and patient are waiting to see if she'll need further operations. Galvis calls Dyer a magician.

There were just a few serious hand injuries that day, because the deadly spray went sideways, not up. The bomb also severed nerves in Galvis' left leg. After two years of surgery and rehab Galvis says she feels worn down.

"But then, I'm thinking about when I was going to the marathon and I was cheering the people," she says, "and I say, 'Come on, keep going, keep going; one more mile.' So, I look at my hand and I say, 'Come! Come on, keep going. You can do it, this is like a marathon.' And I can feel people in Boston say, 'Yes, you can do it! Come on, keep going. Keep going.' "

"People tell me time heals. But it's a very slowly turning clock to me."

The jeweler in Boston who made Galvis' original wedding ring took the shattered, twisted pieces and molded a new band. But Galvis says that for a long time, she was afraid to put it on.

"It's silly, maybe," she says with a sheepish shrug. But she couldn't shake the worry that, "something might happen, and I could lose my hand again — the other hand."

For some survivors of the marathon bombing, the emotional and psychological scars are healing more slowly than the physical ones. Galvis pauses and reaches over to stroke her husband's back.

"People tell me time heals," says Alvaro Galvis, a health insurance salesman. "But it's a very slowly turning clock to me." He had two surgeries to repair his right leg; doctors removed from it a piece of the exploded pressure cooker — 1 inch by 2 1/2 inches. That hunk of metal became evidence in the trial of now-convicted bomber Dzhokhar Tsarnaev.

"I don't know if we are wired as human beings to be able to deal with tragedies like this," Alvaro says. "I don't know if we will ever be able to. We're trying ... we keep trying."

Alvaro Galvis struggles with flashbacks; he's jittery and anxious. He says he can't get used to the feeling that he has no control over his surroundings.

"You think about a lot of things, you know, in two years of trying to understand," he says. "That's part of the healing."

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Neither Alvaro nor Martha Galvis has been able to return to work since the bombing, and they aren't sure if they ever will. They say they were getting better, before the trial. But with the verdict last week, the anniversary of the race this week and sentencing next week, they are constantly on edge. So Martha Galvis prays.

"I ask God," she says. " 'Please, in my heart, I don't want to hate him.' I don't want to hate him because it's no good for me to feel I hate him. And I ask God for him. But he has to be punished. Because he did horrible things, and he has to be punished."

Martha and Alvaro Galvis stop the interview. This is too much for them. They leave the hospital, arm in arm — supporting and protecting each other as they enter a world that they've learned they cannot control.

This story is part of NPR's reporting partnership with WBUR and Kaiser Health News.

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No Rest For Your Sleeping Brain

Tue, 04/14/2015 - 3:43pm
No Rest For Your Sleeping Brain April 14, 2015 3:43 PM ET Listen to the Story 2 min 41 sec  

There's new evidence that the brain's activity during sleep isn't random. And the findings could help explain why the brain consumes so much energy even when it appears to be resting.

"There is something that's going on in a very structured manner during rest and during sleep," says Stanford neurologist Dr. Josef Parvizi, "and that will, of course, require energy consumption."

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For a long time, scientists dismissed the brain's electrical activity during rest and sleep as meaningless "noise." But then studies using fMRI began to reveal patterns suggesting coordinated activity.

To take a closer look, Parvizi and a team of researchers studied three people awaiting surgery for epilepsy. These people spent several days with electrodes in their brains to help locate the source of their seizures. And that meant Parvizi's team was able to monitor the activity of small groups of brain cells in real time.

"We wanted to know exactly what's going on during rest," Parvizi says, "and whether or not it reflects what went on during the daytime when the subject was not resting."

In the study published online earlier this month in Neuron, the team first studied the volunteers while they were awake and answering simple questions like: Did you drive to work last week?

"In order to answer yes or no, you retrieve a lot of facts; you retrieve a lot of visualized memories," Parvizi says.

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As expected, the team saw activity in two widely separated brain areas known to be involved in episodic memories. And the activity was highly coordinated — suggesting the different brain regions were working together to answer the questions.

Next, the volunteers were allowed to rest and even go to sleep while the researchers continued to monitor signals from the two brain areas. And the signals from the two regions remained coordinated, as if they were still working together, Parvizi says.

"What we found," he says, "was that the same nerve cells that were activated to retrieve memories ... have a very coordinated pattern of noise."

The brain may be working to maintain the relationship between regions that have cooperated recently, and may need to again, Parvizi says. This would help explain why the brain, unlike the body, consumes a lot of energy whether or not it has a specific job to do.

"Any brain is designed in such a way that it's using a lot of energy at what we call a 'resting state,' " Parvizi says. "So it's not really a resting brain."

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