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It's Still Hard To Get Birth Control Pills In California Without A Prescription

8 hours 37 min ago

Pharmacists in California will have to give women a short health consultation before providing contraceptives without a prescription.

Media for Medical/UIG via Getty Images

It has been more than 18 months since California's governor signed a law that allows pharmacists to distribute most types of hormonal birth control methods without a prescription.

That means that while women in the state still have to see a doctor to get an IUD, or a contraceptive implant, they should be able to simply walk into their local pharmacy and easily buy contraceptive pills, the patch or the vaginal ring — much like getting a flu shot, or buying over-the-counter medicine to fight a cold.

But good luck finding a pharmacy that will actually dispense birth control that way.

Calls to eight pharmacies around the San Francisco Bay Area — including large corporate locations and smaller, independent stores — yielded no pharmacies delivering these services. Most pharmacists said they still needed to undergo the state-mandated training and that their stores were in the process of figuring out what the service would look like.

There's confusion, too. One person told me that the law hadn't yet passed; another told me prescription-free birth control was only an option in Oregon, where a similar bill went into effect on Jan. 1.

Pharmacy giants Walgreens and Rite Aid both confirmed that they are not yet providing birth control pills or a contraceptive patch without a prescription.

Jim Graham, a spokesperson for Walgreens, which operates 629 pharmacies in California, said the company is "currently assessing" the law's requirements. "We plan to test the service in a small number of pharmacies," he said.

CVS said it is testing the service at a few select locations in the Los Angeles area to determine customer demand.

It's hard to pin down exactly how many — or how few — pharmacies have implemented the new law, because there is no database of pharmacists trained to distribute these birth control methods without a prescription.

Sally Rafie, a pharmacist and medication safety specialist for the University of California, San Diego Health System, specializes in birth control training and access. She estimated that of the approximately 7,000 pharmacies in California, fewer than 100 are actually distributing these types of nonprescription birth control to customers.

Rafie has been involved in training pharmacists to comply with the new law. Under a protocol developed by the state Board of Pharmacy, pharmacists first have to be trained to do a short consultation with the customer and help her select the appropriate birth control option, as well as identify potential red flags in terms of her underlying health, such as a history of blood clots or uncontrolled high blood pressure.

Online classes are also available for practicing pharmacists, and students in pharmacy programs in California now get this training as part of their graduate school curriculum.

At the California Pharmacists Association's annual meeting two weeks ago, 150 people took the birth control training workshop, according to Rafie. There are 29,000 registered pharmacists in the state.

Big players, like Rite Aid, Walgreens and CVS, have companywide processes that have to be standardized across all the stores, said Lisa Kroon, a professor at University of California, San Francisco's school of pharmacy, who has been involved in the implementation of the law.

"There are just a lot of hoops that a large corporation has to implement," she said.

Kroon spoke from experience. The Walgreens where she oversees pharmacy students on the UCSF campus has yet to implement the law.

Kroon said she is "really pushing" Walgreens to move the process along.

Stumbling blocks include: Who will answer incoming doctors' phone calls while the pharmacist provides the consultation, and where will the consultation happen? Rafie said that in the community pharmacy where she works in San Diego, a private consultation room has to be designed and remodeled.

All of this takes time. But there are other factors in play, pharmacists say.

Although the law finally went into effect on April 8, the state spent the previous 18 months developing regulations. Those were finalized earlier this year. Pharmacies had all that time to prepare to hit the ground running last month.

"I think that they're being cautious," said Virginia Herold, head of California's Board of Pharmacy. "They don't know what demand is going to be, and they're a little hesitant to ramp up."

Offering the new service is optional, according to the law, not mandatory, and there's no reason for pharmacies to opt in if there isn't an incentive for them to do so. And right now, there's actually a financial incentive for them not to comply.

"They have the authority to furnish birth control, but it didn't come with the requirement that they get paid for these services," said Kroon.

If you go to a gynecologist for a regular appointment or consultation, your insurance pays for the service (in addition to paying for the medication itself). But, right now, most insurance providers won't pay your pharmacist for the consultation. Customers either have to pay out of their own pocket, or the pharmacist has to work for free. In Oregon, in contrast, that state's Medicaid program reimburses a pharmacist $35 for the service. Kroon says there are efforts toward a similar law in California.

The bill to make these types of hormonal birth control available without a prescription was put forward by Sen. Ed Hernandez, a Democrat from West Covina, and sponsored by the California Pharmacists Association as part of a larger effort to put more primary care in the hands of pharmacists and other nonphysician providers.

"Pharmacists are accessible, and they're underutilized," said Herold.

Early on, some physicians' groups voiced concern that a woman who bypasses a visit to her doctor for birth control will also be less likely to get screened for cervical cancer or STDs.

Indeed, studies of U.S. residents living near the Texas border with Mexico found that women who obtained their birth control over the counter in Mexican pharmacies were somewhat less likely to go to the doctor for other preventive care, compared to women who got contraception at medical clinics. But women who had to go to a clinic were also more likely to stop using birth control, in part because of having to schedule a doctor's visit to get it.

The potential for controversy may be part of what has slowed some pharmacies from offering hormonal contraception to women directly. And, certainly, said Rafie, it requires a different marketing approach than flu vaccines or other services offered by pharmacists. Once it's clear that women want the service, though, she, Kroon and Herold all say they believe that pharmacies will get on board.

"By the end of the year, this will be very commonplace in California," Herold predicts.

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

Copyright 2016 KQED Public Media. To see more, visit KQED Public Media.
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For Female Fruit Flies, Mr. Right Has The Biggest Sperm

Wed, 05/25/2016 - 1:04pm
For Female Fruit Flies, Mr. Right Has The Biggest Sperm Listen· 3:43 3:43
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May 25, 20161:04 PM ET Heard on All Things Considered

Female Drosophila bifurca flies have an organ to store sperm (right) that male flies compete to fill, crowding out rivals.

Scott Pitnick/Nature

You can't help but notice that Scott Pitnick has a big tattoo. It's a sperm with a long tail that winds down his right arm.

People sometimes stare. "And when I tell them what it is, they either are very interested or they pivot on their heel and walk away," says Pitnick, an evolutionary biologist at Syracuse University. "All eye contact ceases."

Some people just don't like talking about sperm. But not him. He's spent his career trying to unravel the mystery of giant sperm.

The sperm are made by some fruit fly species, and they can be more than 2 inches long — or 20 times the length of the fly's body. The massive sperm get rolled up like a ball of yarn, and they're so costly to make that males produce very few of them.

"I mean, every decent scientist I know has this dogma-busting streak," says Pitnick. "And so you always have your eyes out for something that doesn't make any sense, that doesn't jive with prevailing theory."

And these bizarre sperm defied easy explanation. After all, males in most species typically produce tons of sperm. An adult man, for example, makes millions of new sperm each day. It's generally the females that produce relatively few eggs.

"So for me, discovering species where males have this very female-like reproductive strategy of producing very few high-investment gametes, or sperm, was a thrilling moment," says Pitnick.

The question was, why do the flies do this?

"Discovering species where males have this very female-like reproductive strategy of producing very few high-investment gametes, or sperm, was a thrilling moment," says Scott Pitnick.

Nathan Dappen

It's not unusual for males to try to impress females with big body parts. Consider antlers on deer, or elaborate tails on peacocks. Females check these out to decide who is good enough to mate with. "A crappy male in poor condition isn't able to afford to grow really huge antlers and carry them around on his head," Pitnick points out.

But the size of a fly's sperm isn't as obvious or flashy. Nonetheless, Pitnick and his colleagues have results from a study published Wednesday in the journal Nature comparing the evolution of long sperm in fruit flies, or Drosophila, with other male ornaments in the animal kingdom that are used to woo females — everything from deer antlers to stag beetle mandibles to lizard horns.

"Sperm length in Drosophila has been subject to incredibly strong sexual selection, more so than any other ornament that's ever been studied before," Pitnick says.

It turns out that as female flies flit around mating with different males, the females store the sperm inside a special organ before the eggs get fertilized, and the sperm jostle around in there.

"The advantage to having relatively long sperm is that they are better competitors for this limited storage space inside of the female reproductive tract," says Pitnick. Any increase in the size of the female's storage space seems to drive the evolution of longer sperm, and vice versa.

But that's not the only thing that's been working to make sperm longer and longer, he says.

"In the species with long sperm, males transfer very few sperm — a few to dozens of sperm per copulation," he says. "Females have to mate multiple times a day just to get an adequate supply of sperm."

Only the guys with the best genes can make enough long sperm to take advantage of all these mating opportunities. That's because making giant sperm isn't easy — it takes a lot out of the poor guys.

"As sperm get longer, the number of sperm males produce becomes more and more reliant on the health, the condition the male is in," says Pitnick.

That's a plus for females, who only want to make babies with the most hardy, manly flies.

"There's this whole world that we've barely scratched the surface of, of complex interactions between sperm and females," says Pitnick. "You have to understand that it's not just a simple game of numbers where males are competing through a lottery and the female reproductive tract doesn't matter. A lot of people, I think, still subscribe to the idea that females are passive vessels in which this competition plays out, and nothing can be further from the truth."

Biologist and sperm researcher Tim Karr, who is currently a visiting scholar at Kyoto Institute of Technology in Japan, says the new work is impressive and that these huge sperm have long been an enigma.

"The biology is so very different and there has been no good explanation or even attempt to explain it," says Karr. "I think it will spark an awful lot of conversation and hopefully additional research."

It's often the weird outliers that can reveal nature's secrets, says Karr, and this study shows how female choice and male competition can be linked together in surprisingly complex ways.

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

Asking Mom: 'Did You Know I Was Depressed In High School?'

Wed, 05/25/2016 - 11:25am
Asking Mom: 'Did You Know I Was Depressed In High School?' Listen· 7:50 7:50
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May 25, 201611:25 AM ET Heard on All Things Considered

From

Louise Ma for Only Human/WNYC

Rose has dealt with depression since high school. She'd put her head down, focus on school and get through. But during her senior year of college, Rose couldn't even concentrate on school anymore.

"I was struggling. I was feeling depressed. I was feeling isolated," Rose, now 24, says. "I was crying at Cheerios commercials, which is not normal."

Rose started seeing a therapist and feels like she has everything under control. She's even on her way to becoming a therapist herself, in her third year of a Ph.D. program in clinical psychology. (We're using first names only in this story to protect her patient-therapist relationships.)

She has never told her parents anything about her own depression. She worried about disappointing them. She also worried that her mental health issues were frivolous compared with the struggles that her parents, who grew up in Pakistan and emigrated to the United States, have endured.

And she was particularly worried about what her mom would say.

"So I had moved out for college, and that's not really the norm for my cultural background," Rose says. "I was afraid that I was going to share this with her and the response would be: 'I told you it wasn't good for you to move out. You should have stayed home.' "

A few weeks ago, Rose decided to take a huge step. In talking about this story, she realized this could be a good opportunity to tell her mother for the very first time about her struggles with depression. She got her mother's permission to record the conversation:

Rose: I don't think I've ever asked you how do you feel about my decision to be a psychologist?

Mama: Mmmm.

Rose: (Laughs.) Complicated feelings.

Mama: Yeah.

One of the reasons Rose was interested in sitting down with her mom for this story was because she plans to do her thesis on this very kind of thing. In general, children have trouble talking to their parents about mental health issues. But in Rose's case, and for a lot of first-generation Americans, there's not just the generation gap — there's also a culture clash.

Rose: I know you've seen family that's depressed. You've seen the symptoms like being cranky, sleeping a lot, not eating much. Those kind of things. Did you ever notice any of that in me when I was living here or even now?

Mama: No.

Rose: You never noticed any of that?

Mama: I don't think you have any of this problem.

Rose: Well, it actually has been a problem for me.

Mama: I know, but I think this is no big problem.

Rose: OK. So, you've noticed those things but it's not a big problem.

Mama: Yeah.

After that, Rose goes on for a while, explaining to her mom that she sort of hid her depression and maybe that's why it didn't look like a big problem.

Mama: You have depression, I understand. You live alone and nobody talk to you. And I know this is depression.

Rose: But you know I don't think it's because I live alone. Because I felt this way in high school when I lived here. This isn't brand new.

Then Rose told her mother that she was worried that her mother would judge her.

Rose: I didn't want you to think that I'm weak or ... broken or anything like that. Do you think of me any differently?

Mama: No. I am proud of you, and you are the angel of our life.

Rose: So after this conversation, what, if anything, do you think is going to change?

Mama: You move here.

Rose: (Laughs.) I'm not moving here. I think you know that.

That conversation ended on what seemed like a pretty nice note. But then Rose shut the recorder off. At that point, she says, her mom got mad about Rose going public, and told her that she would have a harder time getting married because of it. Rose says now:

I tried to be like, that's the point. That's why we're doing this. Because both in our American culture and in our Pakistani culture there's a stigma, and she knows it. Because now she's afraid that people are going to know this about me and judge me for it, and it's going to make it harder to have a future the way she wants me to have a future.

She regretted having shared all this with her mom. But then, the next day, Rose's mom started asking these little questions like, "Where did this start?" or "What could I have done differently?" Even, "Is this because I wouldn't let you wear makeup to school?" Rose started to feel like her mom was coming from a place of wanting to understand better, rather than judging.

And with a little time, Rose found herself doing the same thing — trying to understand her mom's reaction instead of judging it:

I've had years to come to terms with this knowledge about myself and I gave her, what, maybe an hour-long conversation and then expected her to, at the end of it, be totally understanding and calm and collected about it, which wasn't fair on my part.

Rose thinks that sharing and being open about mental illness may ultimately bridge these kinds of generational and culture gaps.

But people have to be prepared for a process, she says, not a hit-and-run conversation.

Laying everything out has made her and her mom more reflective. So maybe it wasn't such a bad idea after all.

For more on WNYC's Only Human podcast series on mental health, check here. You can stay in touch with @OnlyHuman on Twitter and @Only Human on Facebook.

Additional Information: Sharing Your Story

WNYC and NPR recently asked listeners: Have you ever had a hard time talking openly about your mental health? We'll be posting some of these responses on Facebook throughout the series.

Copyright 2016 WNYC Radio. To see more, visit WNYC Radio.
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Baby Boomers Will Become Sicker Seniors Than Earlier Generations

Wed, 05/25/2016 - 12:01am

There will be about 55 percent more people with diabetes as baby boomers become senior citizens, a report finds.

Rolf Bruderer/Blend Images/Getty Images

The next generation of senior citizens will be sicker and costlier to the health care system over the next 14 years than previous generations, according to a new report from the United Health Foundation. We're talking about you, baby boomers.

The report looks at the current health status of people ages 50 to 64 and compares them to the same ages in 1999.

The upshot? There will be about 55 percent more senior citizens who have diabetes than there are today, and about 25 percent more who are obese. Overall, the report says that the next generation of seniors will be 9 percent less likely to say they have good or excellent overall health.

That's bad news for baby boomers. Health care costs for people with diabetes are about 2.5 times higher than for those without, according to the study.

It's also bad news for taxpayers.

The Health Of Baby Boomers As They Age, For Better And Worse

  • GOOD: 50 percent fewer smokers
  • BAD: 55 percent more people with diabetes
  • BAD: 25 percent more people who are obese
  • BAD: 9 percent less likely to say they have "very good" or "excellent" health

Source: United Health Foundation

"The dramatic increase has serious implications for the long-term health of those individuals and for the finances of our nation," says Rhonda Randall, a senior adviser to the United Health Foundation and chief medical officer at UnitedHealthcare Retiree Solutions, which sells Medicare Advantage plans.

Most of the costs will be borne by Medicare, the government-run health care system for seniors, and by extension, taxpayers.

Some states will be harder hit than others. Colorado, for example, can expect the numbers of older people with diabetes to increase by 138 percent by 2030, while Arizona will see its population of obese people over 65 grow by 90 percent.

There is some good news in the report, too.

People who are now between 65 and 80 years old have seen their overall health improve compared to three years ago. And people who are aging into the senior community are far less likely to smoke than earlier generations.

"Some of these trends are very good and in the right direction," Randall tells Shots.

She says the decrease in smoking shows that it's possible to change health behaviors, noting that doctors, public health professionals and policymakers used a variety of strategies simultaneously to reduce smoking.

"That's a good model for what we need to look at to tackle the epidemic of diabetes and the big concern we have around obesity," she says.

The study also ranked states on the health of their current senior populations. Massachusetts topped the list, jumping to No. 1 from the No. 6 ranking it had the last time the rankings were calculated. Vermont slipped to No. 2.

Louisiana is the least healthy state for older adults.

Copyright 2016 NPR. To see more, visit NPR.
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To Cut Wait Times, VA Tries MinuteClinics In Northern California

Tue, 05/24/2016 - 11:55am

For simple care and prescriptions, veterans in Northern California can go to 14 CVS MinuteClinics.

Tom Starkweather/Bloomberg via Getty Images

Struggling with long wait times, the Veterans Affairs Health Care System is trying something new: a partnership with the CVS Pharmacy chain to offer urgent care services to more than 65,000 veterans.

The experiment began Tuesday at the VA's operations in Palo Alto, Calif.

Veterans can visit 14 CVS MinuteClinics in the San Francisco Bay Area and Sacramento, where the staff will treat them for conditions such as respiratory infections, order lab tests and prescribe medications that can be filled at CVS pharmacies.

The care will be free for veterans, and the VA will reimburse CVS for the treatment and medications. Whether the partnership will spread to other VA locales isn't yet clear.

The collaboration comes amid renewed scrutiny of the nation's troubled VA health system, which has tried without much success to improve long wait times for veterans needing health care.

Despite a $10 billion program called Veterans Choice that allows veterans to receive care outside the closed VA system, vets nationwide wait for an appointment even longer than they did before the program started in 2014, according to a federal audit.

The MinuteClinic partnership isn't part of the Veterans Choice program.

"The concern has always been, how do we make sure veterans get the care they need in a timely way and in a way that works for the veteran?" said Dr. Stephen Ezeji-Okoye, the Palo Alto VA's deputy chief of staff. The deal indicates that the VA is willing to try outside partnerships to meet veterans' needs, he said. "We want to have not just timely access but geographic access to care."

Shots - Health News Despite $10B 'Fix,' Veterans Are Waiting Even Longer To See Doctors

Sarah Russell, the Palo Alto VA's chief medical informatics officer, came up with the idea, said Ezeji-Okoye.

The VA will integrate MinuteClinics' patient records with its own electronic health records to provide consistency of care, Ezeji-Okoye said.

The Palo Alto VA fares better than some other facilities nationwide in providing timely care to veterans, according to VA data, and Ezeji-Okoye said most patients with urgent care needs are seen quickly.

But the system was so busy in the past year that about 11 percent of appointments at its network of hospitals and clinics — which stretch south from Sonora to Monterey — couldn't be scheduled within 30 or fewer days, which is considered an acceptable time frame, VA data show. That includes appointments that would require urgent care.

More than 5,000 appointments systemwide were scheduled more than 30 days out, but each hospital and clinic's performance varied widely. At a Fremont clinic, less than 2 percent of appointment requests couldn't be scheduled within 30 days. At the VA's rural Modesto clinic, by contrast, more than 17 percent of requests weren't scheduled within 30 days.

Once the MinuteClinic operation is well underway, Ezeji-Okoye anticipates that between 10 and 15 veterans — from among the estimated 150 who call the Palo Alto VA's advice nurse hotline daily — will be treated at the retail clinics on any given day.

About 95,000 veterans are eligible to use the Palo Alto system, one of the VA's largest in the Western United States. About 65,000 use it every year.

The $330,000 pilot project will be evaluated after one year. CVS' MinuteClinic president, Dr. Andrew Sussman, hopes it can be rolled out nationally if it succeeds. CVS is by far the biggest player in retail pharmacy clinics, operating 1,135 of them in 35 states.

"We'd love to have that opportunity to expand after we go through this phase," Sussman said. "We're well-suited to help because of our large footprint and ability to see people on a quick basis."

It is unclear, however, what the VA's nationwide plans are. The Veterans Health Administration office didn't respond to Kaiser Health News' request for comment.

Blake Schindler, a retired Army major who lives in Santa Clara near one of the participating MinuteClinics, was intrigued, but cautious about the idea. He counts himself lucky, because unlike some other veterans, he has access to the U.S. military's TRICARE health insurance program for active and some retired service members.

"It could make a big difference, but how much access are the veterans going to have? That was the big problem with the Veterans Choice program; it didn't end up the way it was supposed to," said Schindler, 58.

"I'm always hopeful when I hear about these things; I keep an open mind until I have experience with it," he added.

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation. You can follow Barbara Feder Ostrov on Twitter: @barbfederostrov.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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Doctor Yearns For Return To Time When Physicians Were 'Artisans'

Tue, 05/24/2016 - 9:38am

Dr. Abraham Nussbaum argues for medicine to reconnect with its past: Caring for patients should be a calling, not a job, he says.

PhotoAlto/Michele Constantini/Getty Images

In his recent book, The Finest Traditions of My Calling, Dr. Abraham Nussbaum, 41, makes the case that doctors and patients alike are being shortchanged by current medical practices that emphasize population-based standards of care rather than individual patient needs and experiences.

Nussbaum, a psychiatrist, is the chief education officer at Denver Health Medical Center and works on the adult inpatient psychiatric unit there. I recently spoke with him, and this is an edited transcript of our conversation.

Additional Information: The Finest Traditions of My Calling

One Physician's Search for the Renewal of Medicine

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Your book is in some ways a lament for times gone by, when physicians were "artisans" who had more time for their patients and professional independence. But you're a young doctor and you must have known at the outset that wasn't the way medicine worked anymore. Why do you stick with it?

The first thing I'd say was that I didn't know right away that medicine is no longer universally understood as a calling instead of a job. We are describing health as if it is just another consumer good, and physicians and other health practitioners as the providers of those goods. That is the language of a job. When you remember that being with the ill is a calling, then you remember that it is a tremendous privilege to be a physician. People trust you with their secrets, their fears and their hopes. They allow you to ask about their lives and to assess their bodies. So my lament is not for the loss of physician privilege — goodbye to that — but to the understanding of medicine as a calling.

You don't like checklists and quality improvement measures that dictate how physicians care for patients because you say it turns doctors into technicians and is an obstacle to "moral reasoning." But those tools, which generally take a systems approach to providing care and rely on evidence-based guidelines, aren't going away anytime soon. How do you do the kind of doctoring you want to do in this environment?

Quality improvement seems to be here to stay. Regulators at all levels require it. But I believe that evidence of its success is not as clear as they suggest. Just last week, The BMJ, formerly the British Medical Journal, published a study that found no evidence that introducing quality metrics has resulted in a significant reduction in patient mortality. The leaders of the quality movement's version of quality improvement developed out of industrial engineering, so they are always comparing the care of patients to things like the production of cars or the flying of airplanes. People are far more varied than cars on an assembly line or planes on the runway. So quality metrics always feel forced to me, especially for the more interactive medical encounters.

In my own specialty, the current quality metrics all encourage me to perform standardized screens on patients or to document carefully. None of them require me to develop a relationship with a patient so that I can, say, foster hope after a suicide attempt, or knit a psychotic person back into the life of their family. Yet that is was my patients want, those human relationships. It is also what physicians want, and the most recent studies suggest that most physicians are dispirited by quality metrics.

But not all physicians are equally skilled or conscientious. As a patient, I feel more comfortable knowing there are rules and standards that doctors have to meet.

I don't think physicians should be free to do whatever they want. Their thinking and decision-making should be held up to scrutiny. A physician's standard of quality should be evidence-based, but even more, it should be patient-centered. The standard should be what the patient defines as what matters. So if you are suffering chronic pain, it is not just a reduction of your score on a standardized pain scale, but your ability to resume the activities you identify as constitutive of your life.

You talk about wanting to be able to sit with patients and talk with them, to really "see" them. All that takes time that physicians don't generally have. I understand your book isn't a how-to manual. But, really, how can physicians do this, even if they want to?

It's a real challenge. It's important to use the time you have in service of the patient's needs. I don't review records while I'm in the room with a patient. I try to make every question be about the patient. I have to ask standard questions, but I try to do that as way to get to know the patient. For example, if I have to ask questions about what they can remember, I'd ask about a book they have with them. Part of my concern about checklists is that they train you to follow a script instead of following your patients.

Only 55 percent of psychiatrists take insurance compared with nearly 90 percent of physicians in other specialties. That puts their services out of financial reach for many people who could use their help. How does that square with your vision of doctors as healers and teachers?

It's deeply concerning to me. I've made a conscious choice to work at a safety net hospital, so I can see people regardless of their ability to pay. I hope that through things like the Medicaid expansion and mental health parity, more psychiatrists will work with people who have mental illness.

You talk about the virtues of "slow" medicine, similar to the slow food movement, where physicians reject providing care in a standardized, mass-produced fashion. One path that some physicians have chosen is to establish boutique practices that accept a limited number of patients who pay extra fees for more personal attention and better access. What's your perspective on that?

It sounds appealing to me. In most descriptions of boutique medicine, they talk about it like a lovely restaurant, one that I couldn't afford to go to every night. I think it's an interesting model but not a solution to the large problems facing medicine, in particular the ability to provide care to the most needy among us and the indigent.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter: @mandrews110

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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Mosquito Hunters Set Traps Across Houston, Search for Signs of Zika

Tue, 05/24/2016 - 5:05am
Mosquito Hunters Set Traps Across Houston, Search for Signs of Zika Listen· 4:02 4:02
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May 24, 20165:05 AM ET Heard on Morning Edition

From

Christy Roberts, an entomologist in Harris County, Texas, sorts mosquitoes with tweezers. They will be tested for viruses such as West Nile and Zika.

Carrie Feibel/Houston Public Media

Mosquito control is serious business in Harris County, Texas.

The county, which includes Houston, stretches across 1,777 square miles and is the third most populous county in the U.S. The area's warm, muggy climate and snaking system of bayous provide an ideal habitat for mosquitoes — and the diseases they carry.

The county began battling mosquitoes in earnest in 1965, after an outbreak of St. Louis encephalitis. Hundreds of people contracted the virus and 32 died.

These days, mosquito control efforts include chemical spraying on foot, by truck and occasionally from airplanes. But spraying happens strategically, after careful research reveals the geographic distribution of infected mosquitoes and sometimes birds, which can carry West Nile.

To that end, the county employs 50 scientists and technicians year-round. In the summer, the county hires two dozen more workers. They set traps, sort mosquitoes by species and conduct lab tests for five viruses: St. Louis encephalitis, West Nile, dengue and chikungunya. This year they've added Zika.

The county's tab for mosquito control runs $4 million or more a year.

The surveillance cycle begins outdoors. Technicians set and retrieve three kinds of traps every weekday, hiding them beneath manhole covers, in roadway medians and in yards (with homeowners' permission). The county is divided into 268 sectors, and researchers collect mosquitoes from each sector at least every other week.

Entomologist Christy Roberts makes her rounds in a white, county-issued pickup truck. At each stop she sets out orange traffic cones before retrieving traps that have typically been outside for about 12 hours.

One type, called a gravid trap, sits on top of a plastic tub of water. The stagnant, smelly water lures female mosquitoes. Alongside a house in one yard, Roberts pulls the tub out from underneath some bushes. She peers inside the trap's cylindrical net, spotting individual insects in the blur of flickering wings.

Mosquitoes in traps are transported back to the county's laboratory for analysis.

Carrie Feibel/Houston Public Media

"Lots of females, some of them are blood-fed, and we have males in there, too," she says. "The female will fly over the water and then land on top of the water to lay their eggs," Roberts explains. "And as they're floating on top of the water, the fan will suck them up into the net." The focus of surveillance is females: They need at least one blood meal in order to reproduce.

Roberts makes a circuit around southwest Harris County. The empty traps go in her truck bed, and she hangs the nets full of trapped mosquitoes inside from the roof of the cab. "We hang the nets so that the mosquitoes will be able to continue to fly," she says. "And they won't rub their scales off, which is what we need to identify them. And it also helps keep them alive until we can freeze them."

At the lab, the mosquitoes are killed by flash freezing, which helps preserve any viruses they might harbor. A technician puts the cold mosquitoes in a box, labels them by location, then sorts them by sex and species.

Roberts sits down at a lab bench and uses green tweezers to pick through the fragile, feathery bodies. To the untrained eye, they just look gray. But Roberts is searching for banding, wing color and variations in the shape and size of the insect's proboscis and other organs.

"I am sorting for Culex quinquefasciatus, which is our primary vector for West Nile. And I'm just placing them directly into the vial," she says. (As the Latin name indicates, that mosquito has five bands across its abdomen.)

Vials then go to Harris County's virology unit, where they are tested for West Nile, St. Louis encephalitis, dengue and chikungunya viruses.

For Zika testing, samples are currently sent to the University of Texas Medical Branch in Galveston. But soon, the lab will also be able to test for Zika on site. The county will spend $300,000 to renovate lab space and buy a PCR-assay testing machine.

Harris County is home to 56 different species of mosquitoes, says Dr. Mustapha Debboun, director of mosquito control. But only three species are relevant, because they carry viruses harmful to humans.

"We have the Aedes aegypti, which is the yellow fever mosquito. And also the Aedes albopictus, also known as the Asian tiger mosquito, and the Culex mosquito," Debboun explains. "These are the three that we are after. And thank God, we're only dealing with three."

Debbun says they mostly find West Nile — 1,286 cases in 2014, 406 in 2015, none so far this year. He says in the past five years, they've had four positive tests for St. Louis encephalitis (also carried by Culex), and none for dengue or chikungunya. Zika — as well as dengue and chikungunya — is transmitted by the Aedes mosquitoes and has not been found in Harris County mosquitoes.

In many municipalities, mosquito control simply means spraying chemicals, Debboun says. But in Harris County, spraying is done strategically. "We go hit the area where we know the mosquitoes have the disease in them," Debboun explains. "We don't just go randomly and just spray, and not only waste the pesticide, but also put a pesticide in the environment when you don't need to."

Selective spraying also keeps the insects from developing resistance, he says. Occasionally, the county will conduct aerial spraying, but that has happened only twice recently — after Hurricane Ike in 2008 and during a West Nile outbreak in 2014.

Debboun says his team is prepared for Zika. In 2013, he diversified the traps, purchasing models that are especially attractive to Aedes species, so his employees have had a few years to learn to use those traps. He's planning to ask the county commissioners for 74 more of the traps, at a cost of $300 each.

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

Copyright 2016 KUHF-FM. To see more, visit KUHF-FM.
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Building An Antibiotic To Kill Bad Microbes While Sparing Good Ones

Mon, 05/23/2016 - 3:36pm

What if a drug could knock out Staphylococcus aureus bacteria like these without disturbing the bacteria that help make you healthy?

NIAID/Flickr

Antibiotics can save lives, but sometimes they can work too well.

Most antibiotics can't tell the difference between good and bad bacteria. That means the medicines kill helpful bacteria in your gut while they're obliterating the bacteria making you sick.

The helpful bacteria make up what's known as your microbiome. Damaging the microbiome can cause a number of health problems, including making people more vulnerable to infections from other bacteria such as Clostridium difficile, which can cause debilitating diarrhea and be difficult to treat.

Researchers are working on an antibiotic that targets specific, harmful bacteria while sparing the microbiome.

A group from St. Jude Children's Research Hospital in Memphis, Tenn., is testing an experimental drug, Debio 1452, that targets the bacteria that cause staph infections. Staph bacteria include dangerous strains of methicillin-resistant Staphylococcus aureus, or MRSA, common causes of skin infections that can spread in hospitals. The study was published online by Antimicrobial Agents and Chemotherapy in early May.

Historically, antibiotics were designed to kill as many bacteria as possible. But not this one. "The idea was to develop a drug against staph, not against anything else," said the leader of the study, who works in the infectious disease department at St. Jude's. "This type of approach to antibiotic discovery and development is not very common."

The antibiotic targets a protein that is common to all staph bacteria. This protein, called FabI, isn't found in many other types of bacteria. When FabI is disrupted by Debio 1452, the structure of the bacterial cell is compromised.

The scientists working on the drug compared the microbiomes of mice treated with Debio 1452 or commonly used antibiotics, such as clindamycin and amoxicillin. The microbiomes in mice that received Debio 1452 didn't change much. In contrast, the microbiomes of mice treated with the other antibiotics were significantly depleted.

Once the mice were taken off antibiotics, their microbiomes began to return to normal. After two days, the microbiomes of the mice that were treated with Debio 1452 bounced back almost completely. The populations of good bacteria in the mice on the other antibiotics took up to a week to recover. It took even longer, up to 20 days, for the diversity of bacteria to return to normal.

The quick return in the variety of gut bacteria after Debio 1452 is important, the scientists say, because their diversity could be as important or more than their total number.

"All in all I am very enthusiastic about this," says Michael Gilmore, the Sir William Osler professor of ophthalmology, and microbiology and immunobiology at Harvard Medical School. "Staph is a good target because it is so common and the treatment will usually be right."

But, Gilmore says, better ways are needed to diagnose patients to make sure a targeted antibiotic is the right choice.

The latest results, of course, apply only to mice. Although Debio 1452, being developed by Swiss drugmaker Debiopharm Group, has completed preliminary safety and effectiveness testing in human, the drug would have to successfully pass larger clinical trials in humans and be approved by the Food and Drug Administration before doctors could prescribe it. Even if all the studies go perfectly, a drug wouldn't reach the market for years.

Copyright 2016 NPR. To see more, visit NPR.
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Inventing A Machine That Spits Out Drugs In A Whole New Way

Mon, 05/23/2016 - 3:12pm
Inventing A Machine That Spits Out Drugs In A Whole New Way Listen· 3:58 3:58
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May 23, 20163:12 PM ET Heard on All Things Considered

From

In a lab at the Massachusetts Institute of Technology, all the work that happens in a vast pharmaceutical manufacturing plant happens in a device the size of your kitchen refrigerator.

And it's fast. This prototype machine produces 1,000 pills in 24 hours, faster than it can take to produce some batches in a factory. Allan Myerson, a professor of chemical engineering at MIT and a leader of the effort, says it could become eventually an option for anyone who makes medications, which typically require a lengthy and complex process of crystallization.

"We're giving them an alternative to traditional plants and we're reducing the time it takes to manufacturer a drug," he says.

The Defense Department is funding this project because the devices could go to field hospitals for troops, hard-to-reach areas to help combat a disease outbreak, or be dropped at strategic spots across the U.S.

"If there was an emergency you could have these little plants located all over. You just turn them on and you start turning out different pharmaceuticals that are needed," Myerson says.

Sounds simple? It's not. This mini drug plant represents a sea change in how medications have been made for a long time.

"For roughly two centuries, to be honest," says Tim Jamison, a professor of chemistry at MIT and one of Myerson's partners, along with Klavs Jensen, a professor of chemical engineering at MIT. "The way that we tend to do chemistry is in flasks and beakers and that sort of thing, and we call that batch chemistry — one batch at a time," he says.

That's the way virtually all pharmaceuticals are made. Big batches of chemicals are synthesized, then they have to cool down, then are synthesized again to create new compounds. Then those compounds have to crystallize, filter and dry. Powders are added to make a tablet or capsule. These steps that can take months. This new device, says Jamison, produces medicine in one fast continuous process.

"We had to figure out new ways to make molecules, new ways to think about making molecules but from my perspective that has also provided us with a lot of opportunities that are very powerful," says Jamison. His lab and Myerson's also are collaborating with the Novartis- MIT Center for Continuous Manufacturing, which is funded by the pharmaceutical company Novartis.

The prototype raises the possibility that hospitals and pharmacies could make their own pills as needed, says James McQuivey, an analyst at Forrester Research.

"If it can done at lower cost, here's one way at least that we could reduce the exorbitant cost of medications and that could a social good as well as an economic good," McQuivey says.

Most of the cost of an expensive drug is not the materials or manufacturing or transportation says McQuivey; it's in the drug makers' monopoly control. So, he says, "If we can distribute the manufacturing of anything, pharmaceuticals included, so that more people have the opportunity to manufacture it, now there will be competition among those manufacturers."

Drug makers have at least two big concerns about the widespread use of this device, says Dr. Paul Beninger, who oversees pharmaceutical safety at manufacturer Genzyme Sanofi. He said first and foremost, the drug industry worries about intellectual property rights.

Drug manufacturers own exclusive rights to produce the drugs they develop for a period of time, typically three to five years depending on how much is new in the drug. His other worry is safety, including monitoring of machines to ensure quality and safety.

"There are some really significant issues that this MIT project has to deal with if they're going to try and make this a successful venture," he says.

MIT researchers say continuous monitoring would be built into the continuous production process. The Food and Drug Administration is working on how to oversee this type of process.

On the patent concern, MIT developers say the device is being tested to make generic drugs for now, but that pharmacies or hospitals might someday license the right to produce drugs that have just been approved, not existing ones.

For now, their focus is on making an even smaller more portable unit, producing more and more complex drugs and seeking FDA approval for the device.

This story is part of a reporting partnership with NPR, WBUR and Kaiser Health News.

Copyright 2016 WBUR. To see more, visit WBUR.
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Penicillin Shortage Could Be A Problem For People With Syphilis

Mon, 05/23/2016 - 4:29am
Penicillin Shortage Could Be A Problem For People With Syphilis Listen· 2:40 2:40
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May 23, 20164:29 AM ET Heard on Morning Edition

Syphilis can be wiped out with one to three shots of penicillin.

PhotoAlto/Eric Audras/Getty Images

Since it came onto the scene in 1943, penicillin has made syphilis a thing of the past — almost. Now, the sexually transmitted disease is making a comeback in the U.S. and there's a shortage of the medication used to treat it.

Pfizer, the company that supplies it, says it's experiencing "an unanticipated manufacturing delay," and in a letter to consumers wrote that it would be providing just one-third of the usual monthly demand until July.

The medication, called Bicillin L-A, is the recommended treatment for people with syphilis. It's also the only one available for pregnant women who are infected with or exposed to syphilis, which is caused by the bacterium Treponema pallidum. But the antibiotic can be used against other bacteria, like the one that causes strep throat.

The Centers for Disease Control and Prevention has asked that health care providers save the drug for people with syphilis, especially pregnant women. Even if a woman does not show symptoms, the infection can pass to a fetus during pregnancy and can cause miscarriage, stillbirth and complications including deformed bones, seizures and blindness.

"And the real tragedy is that it is a treatable infection," says Dr. Sarah Kidd, a medical epidemiologist with the CDC's Division of STD Prevention.

She's on a surveillance team that tracks syphilis transmission in the U.S. There were 20,000 cases in 2014. The vast majority of those patients would be treated with one to three injections of Bicillin L-A, also called penicillin G benzathine. Kidd says according to preliminary data, the climb continued in 2015, a trend that started in 2000.

"It is becoming a more common infection," says Kidd. "And because this is the preferred regimen for treatment for syphilis, it really is a critical problem for syphilis control."

Shots - Health News More Babies In The U.S. Are Dying Because Of Congenital Syphilis

It's routine for pregnant women to be tested for syphilis during their first prenatal visit and, if infected, to receive a course of Bicillin L-A. But after declining in the U.S. for four years, the incidence of babies born with syphilis rose sharply after 2012, likely due to a lack of prenatal care. In 2014, about 500 babies were born in the U.S. with syphilis.

Kidd says the CDC is working with state health departments to identify where there are shortages and send supplies of the medication there.

"If [patients] have to go to a different clinic or place to get their Bicillin shot, it just increases the odds of transmission further before they're cured. So it's another potential barrier in the prevention and control of syphilis."

This particular shortage is no rare event, says Erin Fox, director of the Drug Information Service at University of Utah Health Care, which tracks drugs across the country.

"Unfortunately there are constantly drug shortages. Right now we are following just over 200 active shortages," she says. That's a lot better than the 300 she was tracking before, she says, "But it's still something that hospitals are facing on a daily basis."

Most shortages are due to manufacturing problems, Fox says, like rusting machinery, moldy walls or particles getting into vials that are supposed to be sterile. Some of those events can take months or even years to clear up.

Generic drugs that come in the form of a shot, like Bicillin L-A, are particularly prone to shortages. They're cheap and hard to make, so only a few companies produce them. And when it comes to Bicillin L-A, Pfizer is the only supplier.

"The supply chain is really fragile because we really only have just a small number of companies that make these products," says Fox. "And so when you have a small number of factories and one has a problem, there just isn't additional capacity to make up that difference."

And the market is consolidating. Last year, Pfizer bought Hospira, one of the few U.S. companies manufacturing injectable generic drugs.

Fox says that patients usually get the medications they need because hospitals and pharmacies scramble to get the stocks to the right place, or to prescribe an alternative. But it's hard to plan for drug shortages. Fox says it's a little like preparing for natural disasters.

"Almost every hospital has a set plan for how they deal with drug shortages. The surprise that happens on a daily basis is 'What product is going to be short?'" she says. Often, the first time hospitals and pharmacies find out about a shortage is when a shipment of medications never arrives.

Luckily, says Fox, this situation appears to be short-term. Pfizer says the supply should be back to normal in July.

Copyright 2016 NPR. To see more, visit NPR.
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Do Women Need Periods?

Mon, 05/23/2016 - 4:29am
Do Women Need Periods? Listen· 3:52 3:52
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May 23, 20164:29 AM ET Heard on Morning Edition Hanna Barczyk for NPR

Six years of your life. Or 2,190 days. That's about how long the average woman will spend having her periods.

For some women, that's too many days, too many periods.

More women in their 20s and 30s are choosing contraception that may suppress their menstrual cycles, says Dr. Elizabeth Micks, who runs an OB-GYN clinic at the University of Washington in Seattle. "In general, I think views are changing really rapidly," Micks says. "That need to have regular periods is not just in our society anymore."

With traditional birth control, a woman takes a hormone pill for 21 days to stop her cycle. Then she takes a sugar pill for a week, so she can have what looks like a period.

But Micks says, physiologically this isn't a real period at all. And it isn't necessary. "There's absolutely no medical need to have a period when you're on contraception," she says.

So why have women been having all these "fake" periods for decades? "It's actually a historical thing," she says.

One of the doctors who helped invent the pill was Catholic. He thought the pope might accept the pill if it looked like women were having periods.

But the Catholic church never came around to the pill. And when doctors actually asked women if they wanted to have these fake periods, many said they didn't.

Today women have many options if they want to try to suppress their cycles. There's the hormonal IUD, an arm implant and a hormone shot. They can also take some types of birth control pills continuously.

Use of the IUD and implant has risen nearly fivefold in the past decade, a report from the Centers for Disease Control and Prevention found.

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And two top medical organizations — the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics — recommend these forms of contraception as the top choice for young women who want birth control. One study found the IUD and implant were nearly 20 times more effective at preventing pregnancies than birth control pills.

But none of these methods are a guarantee for getting rid of periods altogether. "It's not an on and off switch for menstruation," says Paula Hillard, an OB-GYN at Stanford University Medical Center.

Instead, most women have spotting or unscheduled bleeding when they first start these methods. "It can happen without a rhyme or reason, but it tends to improve over time."

For example, with the hormonal IUD, about 50 percent of women don't have periods after a year. But nearly all women will have lighter, shorter and less painful periods after about six months, Hillard says.

Even if a woman hasn't had a cycle in five to 10 years, there's no evidence that suppressing menstruation hurts future fertility, Hillard says. Most women can get pregnant right after they stop using the contraception, except for the hormonal shot — which can decrease fertility for months after it's discontinued, or even a year.

As with all forms of hormonal contraception, there are risks and side effects with these devices, such as an increased risk of blood clots. And some doctors think there isn't enough known about the long-term effects of menstruation suppression, especially with teenagers.

"Important studies, like what are the effects on the breast? What are the effects on bone — haven't been done," says Jerilynn Prior, an endocrinologist at the University of British Columbia.

She says women should think carefully before trying to suppress their cycle. Having a period does serve a purpose, she says: It tells you your reproductive system is working well and that you're not pregnant. It isn't a "disease" that needs to be treated away, she says.

"I think there is value in understanding and appreciating our own intrinsic hormonal cycles," Prior says. "It's our identity."

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Longtime Couples Get In Sync, In Sickness And In Health

Sun, 05/22/2016 - 5:00am
Robbie Porter/Ikon Images/Getty Images

We think of aging as something we do alone, the changes unfolding according to each person's own traits and experiences. But researchers are learning that as we age in relationships, we change biologically to become more like our partners than we were in the beginning.

"Aging is something that couples do together," says Shannon Mejia, a postdoctoral research fellow involved in relationship research at the University of Michigan in Ann Arbor. "You're in an environment together, and you're appraising that environment together, and making decisions together." And through that process, you become linked physically, not just emotionally.

It's like finishing each other's sentences, but it's your muscles and cells that are operating in sync.

Doctors tend to treat people as individuals, guided by the need to ensure patient confidentiality. But knowing about one partner's health can provide key clues about the other's. For instance, signs of muscle weakening or kidney trouble in one may indicate similar problems for the other.

Looking at married couples who were together less than 20 years and couples together for more than 50, Mejia and her colleagues have found striking similarities between partners who have spent decades together, especially in kidney function, total cholesterol levels and the strength of their grips, which is a key predictor of mortality. They presented their findings at the annual meeting of the Gerontological Society of America.

The data came from 1,568 older married couples across the United States. The couples were part of a larger dataset that included information on their income and wealth, employment, family connections and health, including information based on blood tests.

One obvious reason for partner similarity is that people often choose partners who are like them — people from the same stock, with similar backgrounds. But that didn't explain why there were more similarities between the long-time partners, compared to the others.

To learn more about this element of partner choice versus spending decades together, the researchers analyzed couples by age, education and race. When they accounted for the effect of partner choice, they found that the biological similarities persisted, based on markers in blood tests.

The way Mejia puts it, this likeness includes "something the couples co-created" over time, not just what they started with because they were similar at the beginning.

She's now studying what may be causing these "co-created" biological similarities. "We're working on a few things," she said, such as the effect of partners' shared experiences and of sharing an environment where they have similar advantages and disadvantages, like the ability to walk in their neighborhoods or find other ways to stay active.

Mejia's work follows that of Christiane Hoppmann, an associate professor at the University of British Columbia, in Vancouver. She and her colleagues found that longtime couples experienced similar levels of difficulty with daily tasks, such as shopping for food, making a hot meal and taking medications. They found the same for depression, and with both depression and daily task difficulties, they found that the couples changed, for better or for worse, in sync.

They also found that the effects crossed over from the mental to the physical. In other words, increases in feelings of depression in one spouse led to more daily task limitations in the other.

Hoppmann and Denis Gerstorf, of Humboldt University in Berlin, suggest that a key factor here could be physical activity. For instance, if a depressed partner refuses to leave the house, the other may feel compelled to remain at home, too. The longer the two remain sedentary, the more vulnerable they become to a range of problems, from worsening depression to diabetes, that can limit their ability to function from day to day.

But the news in these partner studies is not all bad.

William Chopik, an assistant professor of psychology at Michigan State University, has found evidence of the power of optimism. He and his research colleagues studied optimism, in addition to health and activity limitations, in 2,758 older couples in a national dataset. Optimism scores came from a test that measured their level of agreement or disagreement with statements such as "in uncertain times, I usually expect the best."

The researchers found that over a four-year period, when one partner's optimism increased, the other partner experienced fewer illnesses such as diabetes and arthritis compared to people whose partners did not become more optimistic. So, "the fact that (your spouse) increased in optimism is good for you," even if your optimism didn't rise, Chopik said.

He isn't sure why this is happening in their study, also presented at the Gerontological Society meeting. He and his colleagues had accounted for age, gender and education differences. He speculates that optimists are more likely to live healthy lives and use their influence over their partners to get them to live healthier, too.

Chopik is currently studying how two partners' levels of cortisol, a hormone related to stress, change and become coordinated over time. He plans to compare couples whose relationships span at least 40 years to those who have been together for less than two.

These investigations of how couples affect each other's health are relatively new, particularly the research into the biological changes, and the researchers are still searching for explanations.

Nevertheless, they say, the implications for health care are clear. People in relationships don't experience chronic health problems on their own. When a spouse comes in with a problem, the other spouse could be part of the cause — or the solution.

Lindsay Peterson is a graduate student and freelance science writer in Tampa, Fla.

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Today's Tools For Combating Zika Mosquitoes Hark Back To 1945

Sat, 05/21/2016 - 5:00am

The title card from a 1945 government film about the campaign to control Aedes aegypti mosquitoes and prevent dengue and yellow fever.

CDC/YouTube

"It's up to you," said a 1945 public service announced aimed at Americans. Find "one of man's worst enemies" and "destroy their foxholes."

The video came from the Office of Malaria Control in War Areas (now known as the Centers for Disease Control and Prevention). And it was talking about a particular species of mosquito, Aedes aegypti — the very same mosquito in the news now. Back then, public health officials were mostly worried about dengue and yellow fevers.

Additional Information:

A Boy Scout helpfully dumps out stagnant water — a potential breeding ground for dangerous mosquitoes.

The video opens with the cartoon image of a man bludgeoning a giant mosquito, its tongue hanging out and white-and-black striped legs akimbo. Pamphlets showed people how to destroy breeding sites. Boy Scouts, "prepared and anxious to undertake their duties," went from house to house dumping out wagons, telling housewives to change the water in vases every few days, and turning empty cans and bottles upside down. They also emptied tires and punctured cans in trash piles, so that they couldn't refill with water.

Activities like that were part of an international anti-mosquito campaign that started in the early 1900s and actually worked. Cases of yellow fever dropped in urban areas, and a 1961 map proclaimed that much of the Americas — including Brazil and Colombia — had made a big dent in the mosquito populations. But shortly after, the mosquitoes made a comeback.

And here we are, 70 years later, still trying to reduce populations of the same mosquito. The message is much the same — dump out containers of standing water, cover cisterns and rain barrels, and try to keep from being bitten. It's just that now there are probably fewer Boy Scouts involved.

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CDC: 157 Pregnant Women In The U.S. Have Tested Positive For Zika

Fri, 05/20/2016 - 11:41am
CDC: 157 Pregnant Women In The U.S. Have Tested Positive For Zika Listen· 1:59 1:59
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May 20, 201611:41 AM ET Heard on All Things Considered

Aedes aegypti mosquito photographed through a microscope.

Felipe Dana/AP

Over 150 pregnant women in the United States appear to have been infected with Zika virus. That's in addition to more than 120 women affected by Zika in U.S. territories, mainly Puerto Rico.

Those are the latest figures from the Centers for Disease Control and Prevention in Atlanta, which has been keeping track of all pregnant women in the U.S. and its territories who have lab tests suggestive of Zika virus infections.

So far, officials say they are aware of fewer than a dozen pregnancies that have had complications, although many of the pregnancies are ongoing. "We don't have full information yet on all of the outcomes," says Margaret Honein, chief of the CDC's birth defects branch.

Zika virus infection has been associated with miscarriage as well as birth defects like unusually small brains, called microcephaly. The exact risk posed by the virus remains unclear, and figuring that out is one reason the CDC is keeping track of affected pregnancies.

In the past, the CDC publicly reported on only those women who had both positive lab tests as well as symptoms. But officials say recent research suggests that women do not necessarily have to have symptoms to have their pregnancies affected. So the CDC is expanding its reporting to include women who didn't have symptoms.

"As the data accumulated about the risk of asymptomatic infections, it seemed more and more important to be very transparent and share publicly the numbers, the full number of pregnant women at risk of adverse outcomes associated with Zika," said Honein in a press briefing Friday.

Among the 157 pregnant women from U.S. states and the District of Columbia who are being monitored, only 49 percent reported symptoms consistent with Zika — mostly rash and fever.

Right now, CDC officials say they have no evidence that anyone has gotten Zika from being bitten by a mosquito in the continental United States. But public officials worry that this may eventually occur in places that have seen local transmission of other mosquito-borne disease, such as dengue.

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People With HIV Are Less Likely To Get Needed Cancer Treatment

Fri, 05/20/2016 - 10:37am

Cancer treatment for people infected with HIV has lagged behind the need.

Endai Huedl/fstop/Getty Images

We've made great progress treating people who are infected with HIV, but if they get cancer they're less likely to get the care they need, a recent study found.

Researchers examined treatment for a variety of cancers, including upper gastrointestinal tract, colorectal, prostate, lung, head and neck, cervix, breast, anal and two blood cancers. With the exception of anal cancer, treatment rates differed significantly between HIV-infected people and those who weren't infected, according to the study published online Tuesday by the journal Cancer.

For example, a third of patients with HIV and lung cancer failed to receive any treatment for the cancer, compared with 14 percent of those who were HIV-negative. Similarly, 44 percent of people who were HIV-positive didn't receive treatment for upper GI cancer versus 18 percent of those who weren't infected with HIV. Twenty-four percent of men with prostate cancer who were HIV-positive didn't get treatment, compared with 7 percent of men uninfected with HIV.

Cancer treatment was defined as radiation, chemotherapy and/or surgery.

"To have made such great strides with treating HIV only to have them succumb to cancer is devastating," said Dr. Gita Suneja, a radiation oncologist at the University of Utah's Huntsman Cancer Institute in Salt Lake City and the lead author of the study.

The study used the National Cancer Data Base to analyze treatment for adults younger than 65 who were diagnosed with any of the 10 most common cancers to affect HIV patients between 2003 and 2011. The study included 10,265 HIV-infected adults and 2.2 million without HIV.

The database, which is sponsored by the American Cancer Society and the American College of Surgeons, captures roughly 70 percent of newly diagnosed cancer cases in the United States.

The study noted that more than a third of the patients with HIV had stage 4 cancer — cancer that has metastasized — when they were diagnosed, while only 19 percent of those without HIV did.

Improvements in antiretroviral therapy to treat HIV have helped reduce the incidence of cancers such as Kaposi sarcoma that are closely linked to AIDS. But rates for other cancers often associated with normal aging have increased among HIV patients.

In addition, people with HIV have a higher incidence of some lifestyle-related cancers, such as lung cancer, which could be linked to higher rates of smoking. Cancer is now the second most common cause of death among HIV-infected people, behind AIDS-related causes.

HIV patients are more likely to be uninsured or underinsured, and lack of coverage can affect access to cancer care. But having insurance didn't eliminate the problem: Privately insured people with HIV were significantly more likely to be untreated for many cancers than were privately insured people without HIV, the study found.

"We know that people with Medicaid or who are uninsured receive subpar cancer treatment, and that's a big public health issue," said Suneja. "But even factoring that in, HIV-infected people are still less likely to receive cancer treatment. That means there are other drivers that we couldn't measure in the study."

Disparities in cancer treatment could exist for several reasons. For one thing, for most cancers there are no national treatment guidelines for HIV-infected patients, Suneja said. One of the few exceptions is anal cancer, the only cancer for which the study found little discrepancy in treatment among HIV-infected and uninfected patients. According to the research, the difference among those not receiving treatment was 4.8 percent for HIV patients versus 3.1 percent for others.

For other cancers, "the oncologist may pause and ask, 'Does the HIV infection mean they shouldn't get standard cancer treatment?' " Suneja added.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter: @mandrews110.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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FDA Considering Pricey Implant As Treatment For Opioid Addiction

Fri, 05/20/2016 - 4:40am
FDA Considering Pricey Implant As Treatment For Opioid Addiction Listen· 3:57 3:57
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May 20, 20164:40 AM ET Heard on Morning Edition

From

The FDA is is expected to decide by May 27 whether a long-acting, implantable version of this anti-addiction drug, buprinorphine, will be available in the United States. The implant is more convenient, proponents say, and less likely to be abused.

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Amid a raging opioid epidemic, many doctors and families in the U.S. have been pleading for better treatment alternatives. One option now under consideration by the Food and Drug Administration is a system of implanted rods that offer controlled release of buprenorphine — a drug already used in other forms to treat opioid addiction.

Because it's implanted in the skin, this version of the drug can't easily be sold on the illegal market, proponents say — a key treatment advantage. The FDA is expected to decide whether to approve the device — called Probuphine — within a week.

The implant system includes four rods, each about the size of a match stick, explains Dave, a paramedic in a small town outside of Boston; he was one of the patients recruited to test the device last year. Dave's worried about reprisal if co-workers find out he is addicted to opioid pain pills, so NPR agreed to use only his first name.

"My implants were placed in my left arm, just above my elbow on the inside," he explains. He's been in recovery for four years — previously with the help of daily buprenorphine pills. Last year, he agreed to be part of an experiment that delivered regular doses of the drug to him via an implant instead. He's sold on the new approach.

"I felt completely normal all the time," he says.

Probuphine implants, inserted under the skin by a trained doctor, are left in place for six months at a time. Dave says the rods are convenient, safe and discreet — they provided steady relief from his cravings.

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When he takes the daily buprenorphine pills, he says, he has to be careful to hide them so that his 2-year-old granddaughter can't get into them. And though he's supposed to take the tablets at least 15 minutes before he eats or drinks anything, he sometimes forgets. Or he forgets to take the pills at all.

"With the implant, you didn't have to worry about that," he says. "It was just there, and you felt good all the time."

The device doesn't work for everyone. During the study, 12 percent of patients who had implants relapsed. But the relapse rate for the pill version of the drug was 28 percent.

And there's a second reason implants can be better than pills, says Braeburn Pharmaceuticals CEO Behshad Sheldon: A lot of buprenorphine winds up being sold illegally on the street. Though the drug produces a less intense high than most opioids, it is still sometimes abused.

"Buprenorphine is the third most confiscated opioid by the DEA, so there's certainly diversion going on," Sheldon says.

But during the clinical trial, she says, there were no cases of anyone trying to remove their implant so they could get to the drug inside and sell it.

An FDA advisory committee recommended approval of the implant in January, and a final decision from the agency is expected by May 27.

"Anything that might help people beat their opioid addiction is a good idea," says Dr. Barbara Herbert, president of the Massachusetts Society of Addiction Medicine. But she says she also has reservations about this method of delivering treatment.

The main one is price. The company says it will price the implants to be competitive with other injectable treatments used to battle opioid addiction, including a shot that costs about $1,000 a month. Herbert says a high price may force providers to turn patients away — or cut back on other services.

"High profits in the middle of this epidemic are really unconscionable," she says.

Sheldon, of Braeburn Pharmaceuticals, says the company will offer rebates to make sure appropriate patients can get access to the implant. She plans to negotiate with insurers and providers on a price that takes both their cost and savings into account, she says.

"And if they don't realize those savings, we're happy to rebate them even further," Sheldon says.

If the implant is approved, demand for it is expected to be high even with the high price-tag, addiction specialists say.

Dave, the New England paramedic in recovery, says he's thought about trying to wean himself off the treatment drugs altogether.

"But then, the more I think about it, it scares the hell out of me," he says. "I'm scared of going backward. I honestly don't know what would happen."

That's a fear voiced by many of the growing number of Americans who have come to see their addiction as a chronic disease, a condition they may have to live with — and need treatment for — for many years.

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

Copyright 2016 WBUR. To see more, visit WBUR.
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Health Departments Cut Programs While Awaiting Zika Funding

Thu, 05/19/2016 - 4:26pm
Health Departments Cut Programs While Awaiting Zika Funding Listen· 2:48 2:48
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May 19, 20164:26 PM ET Heard on All Things Considered

A mosquito control inspector sprinkles larvicide in a storm drain in Miami Gardens, Fla., in an effort to stop the spread of Zika virus.

Joe Raedle/Getty Images

While Congress fidgets over whether and how to pay for the fight against the Zika virus, state and local health departments are scrambling and slimming down.

That's because these front-line public health agencies have already seen their budgets chopped because of the debate.

The Centers for Disease Control and Prevention in April cut $44 million from its fund that helps state and local governments prepare for public health emergencies. It was part of the $589 million the White House moved from other programs — mostly money allocated for domestic and international responses to the Ebola virus — to combat Zika as it awaited action on Capitol Hill.

New York City's health department lost $1.1 million in the deal.

Marisa Raphael, the deputy commissioner in New York's Office of Emergency Preparedness and Response, says she expects to have to cut jobs.

"We depend on this grant to create an infrastructure for our preparedness and our response," Raphael tells Shots. "That's everything from our lab staff to our surveillance staff, so when we have this cut, that does immediately impact our capabilities."

New York isn't unique. A survey of state and local health departments shows that many are struggling with the reduced funding. About a third of state health departments say they expect to lay people off, and the same number say they'll likely eliminate training programs.

The cuts will affect the kinds of things these departments normally do.

"A new measles outbreak? That's the job of the health department to discover and to control," says Thomas Inglesby, the CEO of the Center for Health Safety at the University of Pittsburgh Medical Center. "Or a new mumps outbreak on a college campus, or a meningitis outbreak. That's the day-in, day-out work of public health."

He says public health department budgets have been slashed over the past 10 years and they just don't have excess resources or people that can be cut.

"If you take funding from local health department preparedness that means people are fired or labs can't run the same way or disease surveillance has to stop," he says. "If we take people from those jobs to work on Zika, that will help with Zika, but that will hurt our other preparedness efforts."

President Obama in February made an emergency request of $1.9 billion to combat the Zika virus. The money would be used for research into a new vaccine, treatments and tests for the disease as well as to study and track how it spreads and try to control the population of mosquitoes that carry the virus.

Scientists agree that the Zika virus is linked to microcephaly, a condition in which babies are born with undersized brains and skulls. It is also linked to several other types of birth defects, and to Guillain-Barre syndrome in adults.

The House of Representatives this week passed a bill allocating $622 million for Zika response, about a third of the president's request. And all of the money comes from other programs.

House Appropriations Committee Chairman Hal Rogers, R-Ky., argued at a recent markup that the emergency money was a stopgap until Congress could allocate more money as part of the regular budget process.

The Senate is working on a separate bill that would provide $1.1 billion in new money for the disease.

Public health experts argue that three months is a long time to wait for what many say is an impending public health emergency.

And since Zika is just the latest in a string of infectious disease threats, many public health experts want to create a standing fund for public health emergencies.

Such a fund could operate like the one maintained by the Federal Emergency Management Agency. The agency can draw on it as needed in an emergency; it would be replenished in the regular government budgeting process.

Anthony Fauci, the director of the National Institute for Allergies and Infectious Diseases, part of the National Institutes of Health, and Thomas Frieden, the director of the CDC, advocated for such a fund in recent weeks.

"The whole idea is to have funding available urgently when it is needed urgently," says Melinda Moore, associate director of the Population Health Program at the Rand Corp.

She says FEMA money is "available as soon as it's needed, right on the heels of a hurricane, a tornado, et cetera. Some of these outbreaks — and Zika is a good example — are nearly as urgent as that."

Inglesby agrees that an emergency fund would eliminate these repeated budget fights.

But for Zika that debate is too late, he says. Congress should allocate emergency money for Zika now and then treat is as a regular part of our public health landscape.

"Zika is the new normal," Inglesby says. "Zika is something we're going to have to deal with not just this summer, but next summer and the summer after that."

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'You Are Getting Sleepy,' Said The Scientist To The Fruit Fly

Thu, 05/19/2016 - 12:45pm

Yawwwwn. Where's my bed?

John Tann/Flickr

We've all been caught in that hazy tug of war between wakefulness and sleep. But the biology behind how our brains drive us to sleep when we're sleep-deprived hasn't been entirely clear.

For the first time scientists have identified the neurons in the brain that appear to control sleep drive, or the growing pressure we feel to sleep after being up for an extended period of time. The findings, published online Thursday by the journal Cell, could lead to better understanding of sleep disorders in humans. And perhaps, one day, if the work all pans out, better treatments for chronic insomnia could be developed.

To explore which brain areas might be involved in sleep drive, Johns Hopkins neuroscientist Dr. Mark Wu and his colleagues turned to fruit flies, that long-tinkered-with subject of scientific inquiry. Despite our rather obvious physical distinctions, humans and fruit flies — or Drosophila — have a good deal in common when it comes to genes, brain architecture and even behaviors.

Included in the study were over 500 strains of fly, each with unique brain activation profiles (meaning certain circuits are more active in certain flies). By employing a genetic engineering technique in which specific groups of neurons can be activated with heat, the researchers were able to monitor the firing of nearly all the major circuits in the fruit fly brain and monitor the resulting effects on sleep.

Moreover, the neurons of interest were engineered to glow green when activated allowing specific cells to be identified with fluorescent microscopy. Wu found that activating a group of cells called R2 neurons, which are found in a brain region known as the ellipsoid body, put fruit flies to sleep, even for hours after the neurons were "turned off."

Next, using more generic tinkering, Wu engineered R2 neurons that can produce tetanus toxin in order to deactivate the cells by preventing the release of neurotransmitters (in other words cutting off communication with neighboring neurons). Flies that weren't sleep-deprived but whose R2 neurons expressed the toxic compound slept their usual amount. However sleep-deprived flies — their lab vials were mechanically shaken through the night — also with silenced R2 neurons experienced, on average, 66 percent less rebound sleep.

The authors took this to mean that the flies felt less tired following inadequate sleep. Cutting off R2 activity appeared to suppress sleep drive in the sleep deprived.

"We didn't know circuits for sleep drive even existed," Wu tells Shots in an email. "If we can find the analogous circuits in humans, we might be able to induce more powerful and long-lasting changes in sleep or wakefulness in patients that suffer from severe pathologic sleepiness or severe insomnia."

As Wu explains, for years sleep has been primarily attributed to the release of chemicals involved in arousal and circadian rhythm control, namely adenosine and melatonin. And these compounds certainly appear to play a role in sleep. However once released they are transient; scientists have wondered how then they contribute to prolonged sleep.

By using a technology called synaptic tagging with recombination — or STaR — that allows for the communication between two neurons to be visualized in live animals, Wu's group found that R2 neurons in sleep-deprived flies showed an increase in neurotransmitter release. The increased neuronal activity was still evident two hours after sleep disruption ended, possibly explaining how extended sleep is maintained. Following 24 hours of recovery sleep, the increased activity in R2 neurons subsided back to normal.

"The current view has been that the increase in sleep pressure with extended wakefulness is caused by an increase in the concentration of chemicals in the brain that induce sleep," says Frank A.J.L. Scheer, a sleep scientist at Harvard Medical School and Brigham and Women's Hospital.

"However, these chemicals typically have a short half-life on the order of minutes, while the buildup and dissipation of sleep pressure is on the order of hours," he continues. "[Dr. Wu's] elegant study in fruit flies shows that homeostatic sleep pressure is partially encoded by changes in how well neurons are connected."

Scheer says the findings provide a new model of how sleep is regulated in the brain. Yet he does express some reservations. "Whether and how it translates to the mammalian system, including humans, is currently unknown," he cautions.

Wu is upfront that applying his findings to humans is, for now, speculative. Still, the prospects are exciting. He envisions using sleep-drive neuron stimulation much in the way deep brain stimulation is now used for movement disorders such as Parkinson's disease. In other words, influencing neuronal activity with an implanted stimulator that monitors and controls sleep drive, boosting it or suppressing it as needed.

It's not hard to imagine the potential drawbacks of convincing the brain and body that they're not tired when in fact they are. Normally our brains alert us to sleep for a reason: to rest our cellular machinery; to restore energy reserves; to consolidate memories. What would be the consequences — health or otherwise — of, say, an overly ambitious, overworked surgeon stifling her innate sleep drive?

Given the early stages of this work, Wu doesn't appear concerned. He believes that a better understanding of mechanisms behind sleep drive could in the future help doctors treat patients with an overactive desire to sleep.

"I envision that sleep drive treatments would be used in patients with very severe disease who are resistant to existing therapies," he said.

Bret Stetka is a writer based in New York and an editorial director at Medscape. His work has appeared in Wired, Scientific American and on The Atlantic.com. He graduated from University of Virginia School of Medicine in 2005. He's also on Twitter: @BretStetka

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Does Swaddling A Baby Really Boost Risk Of SIDS?

Thu, 05/19/2016 - 9:43am
Does Swaddling A Baby Really Boost Risk Of SIDS? Listen· 3:25 3:25
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May 19, 20169:43 AM ET Heard on All Things Considered

People have been wrapping their babies like burritos since before there were burritos. My husband described the skillful nurses where I gave birth as "swaddling ninjas," and by my estimation he had at least his brown belt by the time we left.

But people have also been worrying about their babies dying in their sleep for millennia. Today, about 3,500 sleep-related infant deaths occur each year, including 1,500 from sudden infant death syndrome. It's only in recent years that researchers have explored whether the two are connected: Could the age-old practice of swaddling increase the risk of SIDS?

Headlines about a study in the journal Pediatrics would suggest as much, but the research didn't actually find increased risk when parents follow other safe sleep guidelines.

"This study was really looking at old data and trying to put together really apples and oranges," says Harvey Karp, an assistant professor of pediatrics at the University of Southern California School of Medicine. He says media coverage missed "the forest for the trees and emphasize[d] this scary outcome which the study wasn't even reporting."

The study is a meta-analysis, research that combines results of previously published studies and analyzes the data together. The most recent of the studies included in this meta-analysis was published in 2009, and the findings reaffirm much of what doctors already knew.

"We only found four studies and they were quite different, making it difficult to pool the results," senior author Peter Blair, a professor in social and community medicine at the University of Bristol in the United Kingdom, said in an email. "This we have emphasized as strongly as any of the findings, but does not seem to get as much media coverage. Given the weak evidence, we do not conclude that swaddling is a risk factor for SIDS but rather that more evidence is needed."

The four studies compared a total of 760 infants who died from SIDS with 1,759 infants who didn't. The researchers in each study noted the percentage of infants who were swaddled in each group, along with data on their ages and the positions the infants were placed down in and found in.

"More thought needs to go into at what age swaddling provides reduced benefit and potentially more risk as the infant grows," Blair said.

The combined analysis reiterated what scientists concluded in the 1990s: The biggest risk factor for SIDS is placing babies on their stomach to sleep. Swaddling just increases those odds further — 13 times more than placing them on their backs. Side sleeping also triples the odds of SIDS, partly because babies can too easily end up on their stomach.

"I would be shocked if there were any pediatricians out there who didn't already consider that to be a greater risk factor than prone sleeping when not swaddled," says Clay Jones, a neonatal hospitalist at Newton Wellesley Hospital in Newton, Mass.

Despite these unsurprising conclusions, media outlets seized upon the finding that swaddled babies placed on their back also have an increased risk of SIDS and that swaddled babies over 6 months old are twice as likely to die from SIDS. But those findings are "unconvincing," says Jones, concurring with the study authors. He found the conclusion about babies older than 6 months odd since SIDS risk is highest between 2 and 4 months.

"With so few cases occurring past 6 months, this could be a statistical fluke," Jones said. "Perhaps these were babies being placed in a very tight wrap in order to keep them swaddled, but I'm not convinced it is a real phenomenon."

It may also be that older babies can roll and break out of swaddles, increasing the risk of smothering or suffocation, the authors noted.

Still, swaddling has clear benefits, Jones says. The danger of media coverage suggesting otherwise can make strung out, exhausted parents feel they've lost a crucial tool for calming their babies and keeping them asleep.

"The issue really is about reducing crying and increasing sleep," says Karp, who included swaddling as one of the five strategies he recommends combining to calm crying babies in his book and DVD The Happiest Baby on the Block. (Disclosure: I enthusiastically recommend his evidence-based methods to all new parents because they saved my sanity with two kids.) "Those are the two biggest pain points that new parents have."

Discouraging a key strategy for addressing crying and poor sleep has been implicated as a risk factor for abusive head trauma, for example, when parents shake or otherwise injure a child out of sleep-deprived desperation.

"You damn well better know that swaddling is a problem before you encourage people to stop it or impugning it as a risk factor," Karp says. "If, as they say in this article that swaddling has been demonstrated to reduce crying and to increase sleep, then what happens if you stop swaddling is more crying and worse sleep."

That can then lead to more postpartum and parental depression, more child abuse, more women giving up breast-feeding and more parents resorting to unsafe sleeping arrangements, such as sleeping on the sofa or placing infants on their stomachs, Karp says.

"While they really showed no clear evidence it was a risk factor to swaddle your baby safely, they created this worry that may discourage people from swaddling, which may then have unintended consequences that increase infant deaths," Karp says. He, like Blair, argues for more research, plus a more "robust academic dialogue" about swaddling within the American Academy of Pediatrics.

In the AAP's technical report for its policy statement on safe infant sleeping environments, the Academy didn't issue an official recommendation on swaddling. Instead the group said, "Although swaddling may be used as a strategy to calm the infant and encourage use of supine position, there is not enough evidence to recommend it as a strategy for reducing the risk of SIDS." A past AAP article explores the controversy over swaddling among doctors, and the AAP provides guidelines for parents on proper, safe swaddling.

"The upstream issue is crying, exhaustion and feeling incompetent, and that's where we need to focus our efforts," Karp says. "If we can teach families to be better at calming babies and getting more sleep, we have a real chance at making a dent on these other serious issues."

Tara Haelle is the co-author of The Informed Parent: A Science-Based Resource for Your Child's First Four Years. She's on Twitter: @tarahaelle

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In Search For Cures, Scientists Create Embryos That Are Both Animal And Human

Wed, 05/18/2016 - 2:08pm
In Search For Cures, Scientists Create Embryos That Are Both Animal And Human Listen· 8:13 8:13
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May 18, 20162:08 PM ET Heard on All Things Considered Jeannie Phan for NPR

A handful of scientists around the United States are trying to do something that some people find disturbing: make embryos that are part human, part animal.

The researchers hope these embryos, known as chimeras, could eventually help save the lives of people with a wide range of diseases.

One way would be to use chimera embryos to create better animal models to study how human diseases happen and how they progress.

Perhaps the boldest hope is to create farm animals that have human organs that could be transplanted into terminally ill patients.

But some scientists and bioethicists worry the creation of these interspecies embryos crosses the line. "You're getting into unsettling ground that I think is damaging to our sense of humanity," says Stuart Newman, a professor of cell biology and anatomy at the New York Medical College.

The experiments are so sensitive that the National Institutes of Health has imposed a moratorium on funding them while officials explore the ethical issues they raise.

Nevertheless, a small number of researchers are pursuing the work with alternative funding. They hope the results will persuade the NIH to lift the moratorium.

"We're not trying to make a chimera just because we want to see some kind of monstrous creature," says Pablo Ross, a reproductive biologist at the University of California, Davis. "We're doing this for a biomedical purpose."

The NIH is expected to announce soon how it plans to handle requests for funding.

Recently, Ross agreed to let me visit his lab for an unusual look at his research. During the visit, Ross demonstrated how he is trying to create a pancreas that theoretically could be transplanted into a patient with diabetes.

The first step involves using new gene-editing techniques to remove the gene that pig embryos need to make a pancreas.

Working under an elaborate microscope, Ross makes a small hole in the embryo's outer membrane with a laser. Next, he injects a molecule synthesized in the laboratory to home in on and delete the pancreas gene inside. (In separate experiments, he has done this to sheep embryos, too.)

After the embryos have had their DNA edited this way, Ross creates another hole in the membrane so he can inject human induced pluripotent stem cells, or iPS for short, into the pig embryos.

Like human embryonic stem cells, iPS cells can turn into any kind of cell or tissue in the body. The researchers' hope is that the human stem cells will take advantage of the void in the embryo to start forming a human pancreas.

Because iPS cells can be made from any adult's skin cells, any organs they form would match the patient who needs the transplant, vastly reducing the risk that the body would reject the new organ.

But for the embryo to develop and produce an organ, Ross has to put the chimera embryos into the wombs of adult pigs. That involves a surgical procedure, which is performed in a large operating room across the street from Ross's lab.

Pablo Ross of the University of California, Davis inserts human stem cells into a pig embryo as part of experiments to create chimeric embryos.

Rob Stein/NPR

The day Ross opened his lab to me, a surgical team was anesthetizing an adult female pig so surgeons could make an incision to get access to its uterus.

Ross then rushed over with a special syringe filled with chimera embryos. He injected 25 embryos into each side of the animal's uterus. The procedure took about an hour. He repeated the process on a second pig.

Every time Ross does this, he then waits a few weeks to allow the embryos to develop to their 28th day — a time when primitive structures such as organs start to form.

Ross then retrieves the chimeric embryos to dissect them so he can see what the human stem cells are doing inside. He examines whether the human stem cells have started to form a pancreas, and whether they have begun making any other types of tissues.

The uncertainty is part of what makes the work so controversial. Ross and other scientists conducting these experiments can't know exactly where the human stem cells will go. Ross hopes they'll only grow a human pancreas. But they could go elsewhere, such as to the brain.

"If you have pigs with partly human brains you would have animals that might actually have consciousness like a human," Newman says. "It might have human-type needs. We don't really know."

That possibility raises new questions about the morality of using the animals for experimentation. Another concern is that the stem cells could form human sperm and human eggs in the chimeras.

"If a male chimeric pig mated with a female chimeric pig, the result could be a human fetus developing in the uterus of that female chimera," Newman says. Another possibility is the animals could give birth to some kind of part-human, part-pig creature.

"One of the concerns that a lot of people have is that there's something sacrosanct about what it means to be human expressed in our DNA," says Jason Robert, a bioethicist at Arizona State University. "And that by inserting that into other animals and giving those other animals potentially some of the capacities of humans that this could be a kind of violation — a kind of, maybe, even a playing God."

Ross defends what his work. "I don't consider that we're playing God or even close to that," Ross says. "We're just trying to use the technologies that we have developed to improve peoples' life."

Still, Ross acknowledges the concerns. So he's moving very carefully, he says. For example, he's only letting the chimera embryos develop for 28 days. At that point, he removes the embryos and dissects them.

If he discovers the stem cells are going to the wrong places in the embryos, he says he can take steps to stop that from happening. In addition, he'd make sure adult chimeras are never allowed to mate, he says.

"We're very aware and sensitive to the ethical concerns," he says. "One of the reasons we're doing this research the way we're doing it is because we want to provide scientific information to inform those concerns."

Ross is working with Juan Carlos Izpisua Belmonte from the Salk Intitute for Biological Studies in La Jolla, Calif., and Hiromitsu Nakauchi at Stanford University. Daniel Garry of the University of Minnesota and colleagues are conducting similar work. The research is funded in part by the Defense Department and the California Institute for Regenerative Medicine (CIRM).

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