NPR Health Blog

The Unsafe Sex: Should The World Invest More In Men's Health?

by Michaeleen Doucleff

May 18, 2013 8:38 AM Enlarge image i

A man smokes a cigarette as he takes a break at a fruit market in Hyderabad, India. Smoking tobacco is eight times more prevalent among Indian men than women.

Noah Seelam/AFP/Getty Images

On average, men aren't as healthy as women.

Men don't live as long, and they're more likely to engage in risky behaviors, like smoking and drinking.

But in the past decade, global health funding has focused heavily on women.

Programs and policies for men have been "notably absent," says Sarah Hawkes from the University of London's Institute of Global Health.

She and a colleague published a commentary in The Lancet on Friday calling for more gender equality in global health funding.

"If you look at the top 10 health problems around the world, they are much more common in men," she tells Shots. "But the current focus is predominantly on women's health. "

Take for instance, the United Nations's Millennium Development Goals. In 2000, global leaders agreed on eight ways to improve the lives of the poorest people around the world.

The fifth goal is specifically aimed at maternal health. And all of the other goals "touch on essential aspects of women's well-being, and in turn, women's empowerment is critical for achieving the goals," the U.N. Women's website says.

Additional Information: Shots - Health News Saving Newborns: 'Kangaroo Care' Could Go A Long Way Shots - Health News Despite Rocky Economy, Money For Global Health Remains Solid

There isn't a specific goal targeted at men.

Hawkes agrees that maternal health is important and should be funded. "We don't want to see this money diverted away from women's health," she says. "But focusing on maternal health means you miss the biggest burdens of disease."

Hawkes says that when you look at recent data, men lose three times more years of healthy living than women because of tobacco, alcohol and unsafe driving.

"It's cool to be a man that smokes and drinks — who drives a fast motorbike, or fast cars," she says. "If you were really serious about saving lives, you would spend money tackling unhealthy gender norms" that promote these risky behaviors.

Health economist Karen Grepin of New York University agrees that more focus should go to stopping tobacco and alcohol use. But she doesn't think there should be specific policies for men versus women. "If we focus on closing inequality, we'll miss the boat," she says. "The goal is to reduce mortality, not to reduce inequalities in the measure of mortality."

Grepin, who wasn't involved with the commentary, also doesn't think that the recent focus on women's health is a bad thing.

"Women are politically, economically disadvantaged around the world," she tells Shots. "There are really important consequences for women's health. They play a large role in taking care of children. When they get sick, there's a spillover effect in the house — for the next generation."

Grepin thinks that maternal health may have been undervalued and underfunded in the past. "In many places, women still have a high risk of dying during childbirth, which is completely avoidable," she says. "The fact that this still happens is appalling. It's a blight on society that needs to be addressed."

With the recent emphasis on maternal health, she says, the world is making progress on this front. The risk of a mother dying during childbirth has declined by nearly half worldwide since 1990.

"Has that necessarily driven up mortality in men?" she asks. "Probably not."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

The Unsafe Sex: Should The World Invest More In Men's Health?

by Michaeleen Doucleff

May 18, 2013 8:38 AM Enlarge image i

An man smokes a cigarette as he takes a break at a fruit market in Hyderabad, India. Smoking tobacco is eight times more prevalent among Indian men than women.

Noah Seelam/AFP/Getty Images

On average, men aren't as healthy as women.

Men don't live as long, and they're more likely to engage in risky behaviors, like smoking and drinking.

But in the past decade, global health funding has focused heavily on women.

Programs and policies for men have been "notably absent," says Sarah Hawkes, from the University of London's Institute of Global Health.

She and a colleague published a commentary in The Lancet Friday calling for more gender equality in global health funding.

"If you look at the top 10 health problems around the world, they are much more common in men," she tells Shots. "But the current focus is predominatly on women's health. "

Take for instance, the United Nations's Millennium Development Goals. In 2000, global leaders agreed on eight ways to improve the lives of the poorest people around the world.

The fifth goal is specifically aimed at maternal health. And all of the other goals "touch on essential aspects of women's well-being, and in turn, women's empowerment is critical for achieving the goals," the U.N. Women's website says.

Additional Information: Shots - Health News Saving Newborns: 'Kangaroo Care' Could Go A Long Way Shots - Health News Despite Rocky Economy, Money For Global Health Remains Solid

There isn't a specific goal targeted at men.

Hawkes agrees that maternal health is important and should be funded. "We don't want to see this money diverted away from women's health," she says. "But focusing on maternal health means you miss the biggest burdens of disease."

Hawkes says that when you look at recent data, men lose three times more years of healthy living than women because of tobacco, alcohol and unsafe driving.

"It's cool to be a man that smokes and drinks — who drives a fast motorbike, or fast cars," she says. "If you were really serious about saving lives, you would spend money tackling unhealthy gender norms," that promote these risky behaviors.

Health economist Karen Grepin, of New York University, agrees that more focus should go to stopping tobacco and alcohol use. But she doesn't think there should be specific policies for men versus women. "If we focus on closing inequality, we'll miss the boat," she says. "The goal is to reduce mortality, not to reduce inequalities in the measure of mortality."

Grepin, who wasn't involved with the commentary, also doesn't think that the recent focus on women's health is a bad thing.

"Women are politically, economically disadvantaged around the world," she tells Shots. "There are really important consequences for women's health. They play a large role in taking care of children. When they get sick, there's a spillover effect in the house — for the next generation."

Grepin thinks that maternal health may have been undervalued and underfunded in the past. "In many places, women still have a high risk of dying during childbirth, which is completely avoidable," she says. "The fact that this still happens is appalling. It's a blight on society that needs to be addressed."

With the recent emphasis on maternal health, she says, the world is making progress on this front. The risk of a mother dying during childbirth has declined by nearly half worldwide since 1990.

"Has that necessarily driven up mortality in men?" she asks. "Probably not."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Experts Agree: 'Psychiatry's Bible' Is No Bible

by Jon Hamilton

May 17, 2013 5:07 PM Enlarge image i

The new version of the psychiatric "bible" is more of a dictionary, psychiatrists say.

iStockphoto.com

When the American Psychiatric Association releases its new Diagnostic and Statistical Manual of Mental Disorders — DSM-5 — this weekend, lots of journalists and commentators will refer to it as "psychiatry's bible."

That's a term that makes the manual's authors and other mental experts cringe.

"Bible implies that it's been handed down by some deity as the absolute truth," says Michael First, a psychiatrist at Columbia University who's had a hand in the past two revisions of the DSM. "We don't consider this to be a bible. It's a guidebook."

Dr. Thomas Insel, director of the National Institute of Mental Health, also wants people to know the DSM isn't some sacred text. "It's a dictionary, not a bible," he says.

The DSM has taken on biblical proportions over the years because its list of several hundred disorders is often used to decide whether a particular behavior is abnormal and insurance will cover a problem. DSM-5, for example, has provoked lots of debate about new diagnoses like Binge Eating Disorder or Disruptive Mood Dysregulation Disorder in children.

But insurance coverage and defining what's normal are not why the DSM was created. It was created to solve a communication problem.

Before DSM-III came along in 1980, "It was really chaotic," Insel says. "We had no common language" for describing mental disorders. The new manual provided clear definitions for the first time, he says, so that "when one person says major depressive disorder another person will know what that is."

Revisions since then have updated those definitions and added or eliminated diagnoses based on the latest research, First says. "The DSM is a synthesis of the best knowledge at this moment in time," he says. "So DSM-5 is the culmination of research in the past 20 years."

That makes the DSM "a tool used by clinicians to take care of patients," not a bible, First says.

Insel adds that the DSM only becomes a problem when mental health professionals forget that and start "looking at the manual instead of listening to their patients. That's never a good outcome."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Up For Discussion: Cost Of Cancer Care Avoided Too Often

by Scott Hensley

May 17, 2013 2:42 PM Enlarge image i

A cancer pill can cost patients more than the same treatment given as an infusion.

iStockphoto.com

When the diagnosis is cancer, the expenses can pile up in a hurry.

Even people with insurance can face steep copayments for drugs, a sizable share of hospital bills and significant incidentals. These side effects of cancer care are sometimes even called "financial toxicity."

So wouldn't it make sense for doctors and patients to talk over the financial strain that cancer treatment might bring and what might be done to manage it?

Well, it's not always easy for patients to bring it up, says S. Yousuf Zafar, a gastrointestinal cancer specialist at Duke Cancer Institute. He and his colleagues recently asked hundreds of insured cancer patients at Duke and three affiliated rural cancer clinics about their financial concerns.

Median household income for the people in study was about $60,000 a year, and the median out-of-pocket costs for their care were nearly $600 a month .

"The bottom line was that patients want to talk about the cost but only a minority actually do," Zafar tells Shots.

The people who did talk about financial issues told the researchers it was helpful to do so. "They said it helped decrease their expenses," Zafar says. Unfortunately, in this study the researchers didn't get into the details of how that happened.

But he drew one possible way from his own practice. "I treat colon cancer, and I have the option of giving a drug as an IV or an oral pill," he says. "If I give the pill form, the patient faces a copay even if they have insurance, and that copay goes away if I give the intravenous version."

The two forms of the drug are pretty much the same when it comes to effectiveness, though the side effects differ a little. "For the most part, it doesn't matter to me," he says. "It comes down to patient preference and cost."

Cost Of Cancer Pills Can Be Hard For Medicare Patients To Swallow May 15, 2012

Why don't most patients ask about costs?

"Many said they didn't think their financial problems were bad enough to bring it up," he says. "Many said they wanted the best care regardless of costs." And they may have been worried that doctors might cut corners on care after a cost discussion.

Some patients said it's not their doctor's job to think about the costs, Zafar says, and others figured the doctor wouldn't know what to do about them anyway.

Patients might have a point there. "I don't think the majority of oncologists are prepared to have a discussion about cost," he says. "Quite honestly, we haven't received the training to do so."

In the meantime, doctors can direct patients to social workers and financial counselors to lend a hand. "Any help is likely better than none," Zafar says.

Doctor need to get with it, though. "We can't necessarily give the best care to patients unless we address cost," Zafar says.

The research hasn't been published yet. Zafar will present the findings to cancer specialists at the American Society of Clinical Oncology annual meeting in Chicago in a few weeks.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Doctors Confirm Black Lung In Victims Of Mine Blast

by Howard Berkes

May 17, 201312:47 PM

A memorial at the entrance to Massey Energy's Upper Big Branch coal mine represents the 29 coal miners who were killed in an explosion in 2010.

Jeff Gentner/AP

The tragic deaths of 29 coal miners in a massive explosion in 2010 have provided new evidence of a resurgence of the disease known as black lung.

On Monday, a team of pathologists and lung disease experts will present the results of a detailed study of lung tissue from some of the victims of the Upper Big Branch mine disaster in West Virginia. They'll describe the findings at the American Thoracic Society's annual conference in Philadelphia this weekend.

Black Lung Returns To Coal Country What Is Black Lung?

"Our pathology — where we actually see the lung tissue, we actually see the scars, we see the dust — confirms we're seeing a problem," says Robert Cohen, the lead researcher and chairman of pulmonary and critical care medicine at Cook County Health and Hospitals System in Illinois.

Cohen's team reviewed lung tissue obtained from autopsies of seven of the Upper Big Branch victims. Only seven families of the deceased coal miners granted permission for the study.

Six of the seven samples bore telltale scarring that indicates black lung. One of the samples showed a "fairly advanced form of the disease."

One of the miners worked for less than five years underground, and several had worked about 10 years in coal mines. They ranged in age from about 30 to 60. The names and specific information about the miners weren't disclosed because their families were promised confidentiality.

Cohen says the relatively young ages of some of the miners and limited tenure underground "means that there were probably some intense exposures and excessive exposures over a short period of time. That raises some concerns."

Extraordinarily high rates of black lung in the Upper Big Branch victims were first found during autopsies just after the explosion. The West Virginia medical examiner told mine disaster investigators that 24 of the victims had sufficient lung tissue for testing. He concluded that 71 percent had black lung, a rate 10 times the average for southern West Virginia.

“ There is a problem in our control of our exposure to dust that's causing worsening disease and resurgent disease.

- Robert Cohen

At the time, investigator Davitt McAteer, a former federal mine safety chief, said the autopsy results were shocking because of "the number of miners who showed evidence of black lung, particularly among younger miners and miners who you would not have expected to have black lung."

McAteer asked Cohen to assemble a team of experts to examine the lung tissue of as many victims as possible.

Cohen acknowledges that the sample size is limited. "It's a small number of miners," Cohen says. "But the miners who were referred to the study were a random sample — people who just happened to be working in that mine that day who were killed in the disaster."

Several investigations of the disaster concluded that mine owner Massey Energy had permitted dangerous accumulations of coal dust in the mine. That may explain the high rate of black lung in the tested lung samples of victims.

"Mines that tend to have accidents do tend to be less clean than mines that don't have accidents," Cohen says. But Upper Big Branch "may be representative of a number of mines in the United States today," he says.

Cohen also says the tissue analysis "adds supportive information" in the wake of a number of studies documenting a resurgence of black lung in portions of Appalachia, onset of the disease among younger miners and more rapid progression to advanced stages of disease.

Cohen and another group of researchers summarized those studies in a report last month in the American Journal of Respiratory and Critical Care Medicine.

That report, Cohen says, tackles "ancient legendary teachings" about black lung that have led to misdiagnoses and rejection of claims for black lung benefits payments.

"Contemporary medical school training and residency training and even fellowship training hasn't really kept up with the latest research and science in coal-mine dust lung diseases," Cohen contends.

"Many pulmonary physicians were diagnosing miners with lots of exposure to coal dust as having disease as unknown cause," he adds.

The report says many physicians erroneously believe that only round scars on lung tissue, and only scars in upper lobes, are signs of black lung. "That's not true," Cohen says. The disease "can cause irregular scars or linear scars all over the lungs."

Additional Information: Related Stories Black Lung Returns To Coal Country As Mine Protections Fail, Black Lung Cases Surge Black Lung Returns To Coal Country Black-Lung Rule Loopholes Leave Miners Vulnerable The Picture Show Documenting 'Dirty' Jobs: Miners At Work

The report urges more frequent X-rays and lung function tests for coal miners. It also urges physicians to "take exposure histories" for coal miners, including the jobs they performed, the machinery they operated, the kind of mines that employed them and how long they worked.

A spokeswoman for the National Mining Association, a trade group, responded narrowly to the report, noting the group's support for mandatory X-ray testing of coal miners. The testing is voluntary now.

"This would provide miners and mine operators the information required to take corrective actions where miners are found to suffer from lung disease," says NMA spokeswoman Nancy Gravatt.

Federal law gives miners the right to seek reassignment to jobs with less coal dust exposure when they have indications of disease, but miners' advocates worry that mandatory testing will give coal companies the ability to dismiss workers with signs of black lung.

Cohen says the lung tissue testing of the Upper Big Branch victims and the new report for physicians confirm "that there is a problem in our control of our exposure to dust that's causing worsening disease and resurgent disease."

The federal Mine Safety and Health Administration said in 2010 that tougher coal-mine dust exposure limits are a top priority. Congressional Republicans delayed action on new limits until the Government Accountability Office could complete a study. The GAO study was issued last August, and it supported MSHA's efforts.

The agency set a target date for next month for rule-making on its proposal, but it's unclear whether that deadline will be met. MSHA spokeswoman Amy Louviere says, "I have no new information about the dust rule."

Black lung has killed 70,000 coal miners since 1970. NPR, the Center for Public Integrity and The Charleston (W.Va.) Gazette documented widespread industry cheating in the coal-dust control system and weak federal regulation in a series of stories last year.

Update 5:15 pm:

"These results are beyond disturbing," says Wes Addington, an attorney at the Appalachian Citizens' Law Center, which represents coal miners seeking black lung benefits.

"I don't care how small the sample," Addington adds. "To find black lung in 85 percent of these miners shouldn't be happening in this country."

Coincidentally, the National Institute of Occupational Safety and Health has just published a study in the American Journal of Public Health that assesses the accuracy of its black lung data documenting the resurgence of the disease in Appalachia.

Industry critics were concerned that researchers tested miners who already had symptoms. But the NIOSH review found that healthy miners with no X-ray indications of black lung participated in the NIOSH screening and returned for additional testing even when they had no symptoms.

The NIOSH study reviewed its reporting for bias and concludes that it is "broadly accurate, although the data likely underestimated the national prevalence of [Coal Workers Pneumoconiosis]," the formal label for black lung.

The undercount, the researchers say, is likely due to the fact that the surveillance system is limited by federal mandate to working coal miners and does not include those who have retired. Black lung is progressive and retired miners may still develop symptoms and advanced disease.

The report also reviewed NIOSH data on other possible causes of lung disease suffered by coal miners and found the "increasing prevalence of pneumoconiosis among coal miners could only be attributed to inhalation of unsafe amounts of coal mine dusts, and could not be attributed to age, smoking, other diseases, or background radiographic abnormalities."

NIOSH concludes the study by urging MSHA to adopt its proposed new standard for coal mine dust exposure, which NIOSH first recommended in 1995.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Biking To Work: Healthful Until You Hit A Pothole

by Nancy Shute

May 17, 201311:43 AM Enlarge image i

Bartender Matt Carucci told NPR in 2012 that he rarely feels safe biking in the city but often rides without a helmet anyway. "There are a lot of other ways to hurt yourself," he said.

John Rose/NPR

There's a lot to love about biking to work: the exercise, the fresh air, the cost savings and the benefits for the environment.

But does it make you healthier?

That's a question that's not as easy to answer as you might think. But since today is Bike to Work Day, we'll give it a try.

A large study of 30,000 people in Copenhagen over 14 years found that those who biked to work lowered their risk of death by 40 percent compared to sedentary people. And in the short term, another study of 100 people in Perth, Australia, who replaced some car commutes with bike trips over the course of a year, found the bicycling improved aerobic fitness, cholesterol numbers, and lowered the risk of heart attacks and strokes.

Why Do Bike-Share Riders Skip Helmets? May 3, 2012

That seems pretty straightforward. But what about the risk of getting crushed by a trash truck? Anyone who's bicycled even a little bit knows all too well the fear of an encounter with a motor vehicle. Just yesterday the Washington Post reported on 20-year-old bicyclist who was critically injured after being hit by a car in downtown Washington.

In 2011, 677 bicyclists died in collisions with motor vehicles. According to the U.S. Department of Transportation, bicycle travel accounts for 2 percent of traffic deaths and just 1 percent of trips.

But that stat doesn't account for the miles traveled by bicyclists, and how long it takes them to travel those miles, as well as the type of road they're on, and time of day. (Bicycling later in the day is riskier, and alcohol use may be a factor in that, on the part of both motorists and bicyclists.)

Data on bike accidents is even sketchier, since bicyclists don't typically report crashes to insurers the way drivers do.

A very unscientific survey on the NPR science desk found that almost all of the bike commuters have been injured at least once, with most of the injuries involving broken ribs and collarbones.

Many of them involved collisions with other bicyclists or pedestrians. Some involved another bicyclist violating traffic laws, and some were just bad luck. That includes the time Joe Palca hit a pothole, crashed, and wiped out Richard Harris, who was riding beside him. Both suffered broken bones. Harris says that's the only accident he's had in 21 years of bike commuting to NPR.

"For me, biking to work is the only reason that I've kept in even marginal shape throughout my 20s and 30s," says global health reporter Michaeleen Doucleff. At age 20 she mangled the cartilage in one knee when she hit a pedestrian; he broke a wrist. "Otherwise, I've been pretty lucky. Sixteen years of commuting and just one major accident. Knock on wood."

Several studies have tried to weigh the risk of injury and death in weighing the health aspects of bike commuting. A 2011 study of a bikeshare program in Barcelona found that the increased life expectancy due to better health substantially outweighed the accident risk. Biking's health benefits also outweighed harms caused by exposure to pollution. The further the bicyclists traveled and the more days they biked, the greater the health benefits.

A 2010 study that compared bike commuting to car commuting in the Netherlands estimated that the health benefits of biking adds 3-14 months of life, compared to 5-9 days lost due to accidents, and 0.8 to 40 days lost due to air pollution exposure.

And a 2009 study in The Lancet estimated that switching to biking would do more to reduce greenhouse gas emissions and improve health than using low-emissions vehicles.

But these studies were done using computer models, not by actually measuring the health of bicyclists and drivers over time. And they were done using data from European cities, where longstanding acceptance of bicycle travel should make for safer commutes.

Indeed, one of the more fascinating threads to emerge from the skimpy science of bike commuting in America is that the more people bike, the safer it may become. In cities like Seattle, Portland, and Minneapolis, bike travel has soared in the past few years, but accident rates have stayed stable. That may be because of new bikeways that separate cars and bikes, or the fact that drivers are getting used to sharing the road with cyclists.

What next for bike commuters? Expect plenty of argument over whether adults should be required to wear bike helmets.

"Helmets prevent 85 percent of brain injuries," says Frederick Rivara, a professor of pediatrics at the University of Washington who has studied helmets and injury. "One of the concerns now is that with the bikeshare programs like the one that's going to start in New York and the one you have in DC, they have not dealt with the whole helmet issue."

Some proponents of increased urban biking say that helmets shouldn't be required because it discourages bicycle use for short commutes, errands, and impromptu rides. They point to enviable safety data from European cities where most bike commuters don't wear helmets. A 2012 study of bicycle riders in DC and Boston found that 20 percent of bikeshare riders used helmets, compared to 50 percent of adults using their own bicycles.

But the doctors aren't buying it. "Concussion is what we're trying to prevent," says Dr. David Milzman, a professor of emergency medicine at Georgetown University and co-author of the study. "There's all this crazy literature that the helmet makes you actually more likely to get injured, because people think they're safer with a helmet. That stuff is crap."

Get a concussion, Milzman says, and you'll be lucky if you miss just a few weeks of work.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Biking To Work: Healthful Until You Hit A Pothole

by Nancy Shute

May 17, 201311:43 AM Enlarge image i

Bartender Matt Carucci told NPR in 2012 that he rarely feels safe biking in the city but often rides without a helmet anyway. "There are a lot of other ways to hurt yourself," he said.

John Rose/NPR

There's a lot to love about biking to work: the exercise, the fresh air, the cost savings and the benefits for the environment.

But does it make you healthier?

That's a question that's not as easy to answer as you might think. But since today is Bike to Work Day, we'll give it a try.

A large study of 30,000 people in Copenhagen over 14 years found that those who biked to work lowered their risk of death by 40 percent compared to sedentary people. And in the short term, another study of 100 people in Perth, Australia, who replaced some car commutes with bike trips over the course of a year, found the bicycling improved aerobic fitness, cholesterol numbers, and lowered the risk of heart attacks and strokes.

Why Do Bike-Share Riders Skip Helmets? May 3, 2012

That seems pretty straightforward. But what about the risk of getting crushed by a trash truck? Anyone who's bicycled even a little bit knows all too well the fear of an encounter with a motor vehicle. Just yesterday the Washington Post reported on 20-year-old bicyclist who was critically injured after being hit by a car in downtown Washington.

In 2011, 677 bicyclists died in collisions with motor vehicles. According to the U.S. Department of Transportation, bicycle travel accounts for 2 percent of traffic deaths and just 1 percent of trips.

But that stat doesn't account for the miles traveled by bicyclists, and how long it takes them to travel those miles, as well as the type of road they're on, and time of day. (Bicycling later in the day is riskier, and alcohol use may be a factor in that, on the part of both motorists and bicyclists.)

Data on bike accidents is even sketchier, since bicyclists don't typically report crashes to insurers the way drivers do.

A very unscientific survey on the NPR science desk found that almost all of the bike commuters have been injured at least once, with most of the injuries involving broken ribs and collarbones.

Many of them involved collisions with other bicyclists or pedestrians. Some involved another bicyclist violating traffic laws, and some were just bad luck. That includes the time Joe Palca hit a pothole, crashed, and wiped out Richard Harris, who was riding beside him. Both suffered broken bones. Harris says that's the only accident he's had in 21 years of bike commuting to NPR.

"For me, biking to work is the only reason that I've kept in even marginal shape throughout my 20s and 30s," says global health reporter Michaeleen Doucleff. At age 20 she mangled the cartilage in one knee when she hit a pedestrian; he broke a wrist. "Otherwise, I've been pretty lucky. Sixteen years of commuting and just one major accident. Knock on wood."

Several studies have tried to weigh the risk of injury and death in weighing the health aspects of bike commuting. A 2011 study of a bikeshare program in Barcelona found that the increased life expectancy due to better health substantially outweighed the accident risk. Biking's health benefits also outweighed harms caused by exposure to pollution. The further the bicyclists traveled and the more days they biked, the greater the health benefits.

A 2010 study that compared bike commuting to car commuting in the Netherlands estimated that the health benefits of biking adds 3-14 months of life, compared to 5-9 days lost due to accidents, and 0.8 to 40 days lost due to air pollution exposure.

And a 2009 study in The Lancet estimated that switching to biking would do more to reduce greenhouse gas emissions and improve health than using low-emissions vehicles.

But these studies were done using computer models, not by actually measuring the health of bicyclists and drivers over time. And they were done using data from European cities, where longstanding acceptance of bicycle travel should make for safer commutes.

Indeed, one of the more fascinating threads to emerge from the skimpy science of bike commuting in America is that the more people bike, the safer it may become. In cities like Seattle, Portland, and Minneapolis, bike travel has soared in the past few years, but accident rates have stayed stable. That may be because of new bikeways that separate cars and bikes, or the fact that drivers are getting used to sharing the road with cyclists.

What next for bike commuters? Expect plenty of argument over whether adults should be required to wear bike helmets.

"Helmets prevent 85 percent of brain injuries," says Frederick Rivara, a professor of pediatrics at the University of Washington who has studied helmets and injury. "One of the concerns now is that with the bikeshare programs like the one that's going to start in New York and the one you have in DC, they have not dealt with the whole helmet issue."

Some proponents of increased urban biking say that helmets shouldn't be required because it discourages bicycle use for short commutes, errands, and impromptu rides. They point to enviable safety data from European cities where most bike commuters don't wear helmets. A 2012 study of bicycle riders in DC found that 20 percent of Capital Bikeshare riders used helmets, compared to 50 percent of adults using their own bicycles.

But the doctors aren't buying it. "Concussion is what we're trying to prevent," says Dr. David Milzman, a professor of emergency medicine at Georgetown University and co-author of the study. "There's all this crazy literature that the helmet makes you actually more likely to get injured, because people think they're safer with a helmet. That stuff is crap."

Get a concussion, Milzman says, and you'll be lucky if you miss just a few weeks of work.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Why Is Psychiatry's New Manual So Much Like The Old One?

by Jon Hamilton

May 16, 2013 5:21 PM Listen to the Story

All Things Considered

8 min 27 sec

• Playlist
• Download
• Transcript

  Enlarge image i

Despite significant advances in neurology and imaging, researchers still don't have simple lab tests for diagnosing patients with mental disorders. Diagnoses are still mostly based on a patient's signs and symptoms.

BSIP/UIG via Getty Images

The American Psychiatric Association is about to release an updated version of its Diagnostic and Statistical Manual of Mental Disorders. The DSM helps mental health professionals decide who has problems such as depression, anxiety and schizophrenia.

Psychiatry's new manual, DSM-5, has been nearly 20 years in the making. During that time, scientists have learned a lot about the brain. Yet despite some tweaks to categories such as autism and mood disorders, DSM-5 is remarkably similar to the version issued in 1994.

"There are lots of changes throughout the manual that reflect the research in the last 20 years," says Michael First, a clinical psychiatrist at Columbia University who was involved in creating both DSM-IV and DSM-5. (The APA abandoned Roman numerals for the new manual.) "But because that kind of research hasn't allowed for a paradigm shift, the DSM is not a paradigm shift either," First says.

Specifically, DSM-5 will continue to use symptoms as the primary way to decide whether a person has a particular disorder. That may not sound odd until you consider what's happened in other fields of medicine, like cardiology.

If you go to a hospital with chest pain these days, chances are you'll get a diagnosis based on tests of the electrical activity in your heart, the enzymes in your blood, and the blood flow through your arteries. But if your problem is emotional pain, your diagnosis will probably be based on a conversation.

So why is psychiatry still so last-century? Scientists say it has to do with the nature of the brain itself.

The Hippo Problem

When psychiatrists began work on DSM-5, they expected to come up with a document that would signal a new era in mental health care, First says.

"We were hoping and imagining that research would advance at a pace that laboratory tests would have come out," he says. "And here we are 20 years later and we still unfortunately rely primarily on symptoms to make our diagnoses."

That's not ideal, First says. Not for doctors. Not for patients. Not for scientists.

The problem is that the new DSM is still classifying mental disorders based on their surface appearance, not their underlying biology. And the history of science shows that appearances can be deceiving.

Take hippos, for example. Early naturalists thought hippos must be related to pigs. After all they look somewhat alike and have similar teeth. But fossils and genetic studies showed that hippos' closest living relatives are actually dolphins and whales.

So to avoid the hippo problem, many areas of medicine have begun to look beneath the superficial appearance of an illness.

A New Kind Of Medicine

"For literally centuries, doctors have looked at diseases using signs and symptoms," says Susan Desmond-Hellman, an oncologist who is chancellor of the University of California, San Francisco. So, she says, doctors would ask questions like, "Do you have a lump somewhere?"

But now, many scientists are concerned that this emphasis on the signs and symptoms of a disease "could be seen as holding us back," Desmond-Hellman says. Instead, she's been advocating something called "precision medicine," which tries to classify diseases in a way that indicates what's truly causing the problem.

A good example of this new approach is breast cancer, Desmond-Hellman says. "I'm a cancer doctor and had the incredible opportunity to work on revolutionizing how we treat breast cancer based on what's in your DNA that's signaling the breast cancer to grow," she says. "And it's a wonderful opportunity because if a patient has a breast cancer that's driven by something in the genome, we can turn it off."

This revolution happened in part because cancer researchers looked beyond the old way of classifying tumors according to simply what body part they appeared in, Desmond-Hellman says. And something similar needs to happen in mental health because, she says, "everything from autism to Alzheimer's is classified in ways that clearly don't work today."

Desmond-Hellman adds that she's not criticizing psychiatrists or psychologists for using the DSM. It's still the best option because there still aren't genetic tests or brain scans that offer a better way to classify patients with mental disorders.

Brain Research Looks Ahead

So why haven't researchers developed simple lab tests for mental disorders?

"We've tried," says Thomas Insel, director of the National Institute of Mental Health. "You know we've actually looked — using brain imaging, using various endocrine tests, looking at a range of other kinds of biomarkers. So far that has been found wanting."

Health What's A Mental Disorder? Even Experts Can't Agree

For example, researchers tried for many years to find a genetic test or a brain-scanning technique that could identify people with depression. That approach would make sense if scientists knew that all depression can be linked to the same underlying problem. But what if it can't, Insel says. What if depression is like a fever?

"Some people who have a fever have a bacterial infection, some a viral infection, some an endocrine problem," Insel says, "a whole range of reasons why that would be your presenting symptom and a whole range of different treatments that you need for each of those causes."

So a few years ago, the NIMH began moving away from research based on categories defined only by symptoms. Instead, it's pushing an approach it calls Research Domain Criteria that emphasizes basic functions in the brain. Researchers might get money to study circuits involved in fear, or so-called working memory.

This sort of research has the potential to uncover problems in the brain that will change the way mental disorders are classified, Insel says. "A biological thing that presents with depression in some people might present with psychosis or anxiety in others," he says. "And so maybe what you'll find is a problem that cuts across the current diagnostic categories."

Insel says findings like that are years off. Maybe they'll get here in time for the next version of the DSM. Maybe.

A Better Future?

Michael First, the psychiatrist who spent much of his career working on the DSM, says he's learned to be cautious about anticipating major advances in any problem that affects the brain.

Enlarge image i

The Diagnostic and Statistical Manual of Mental Disorders, or DSM, is the official list of all the mental disorders doctors can use to diagnose mental illness. It's updated every 20 years or so.

Ellen Webber/NPR

Back in the 1990s, when he was writing a guidebook to DSM-IV, First says, he made an unfortunate prediction about Alzheimer's. "I stuck my neck out," he says. "We said that by the time DSM-5 comes out, Alzheimer's will be the first diagnosis that has a laboratory test."

That hasn't happened. Even though scientists have learned a huge amount about the plaques and tangles associated with Alzheimer's and even though high-tech scans can reveal ever more subtle changes in the brains of people with the disease, there's still no lab test that's good enough to diagnose Alzheimer's.

First says migraine headaches are another brain problem still waiting for a lab test. "If you have a headache and you go to a neurologist, even though they might run some blood tests, the actual diagnosis of a migraine vs. a cluster headache depends on the description of the symptoms," he says. "So psychiatry is not unique."

In fact, almost every specialty that deals with the brain has run into the same roadblocks facing psychiatrists. "The brain is very, very complicated and it really hasn't yielded its secrets yet," First says.

And that, he says, is the primary reason mental health isn't more like cardiology or oncology, why psychiatrists and psychologists still rely on symptoms, rather than lab tests. The human brain is the most complicated thing in the universe. It has nearly 100 billion neurons and many trillions of connections, and its complex wiring changes all the time.

But the daunting complexity of the brain is no reason to give up on the DSM or the ability of mental health professionals to treat mental disorders, First says. "When people walk into our offices they come for help, not some explanation of the neurobiology of what's going on," he says. "They want some relief of suffering and the DSM remains the most valuable tool for psychiatrists to be able to do that."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

A Small Shock To The System May Help Brain With Math

by Geoff Brumfiel

May 16, 2013 4:14 PM Enlarge image i

Ever get stuck on these?

iStockphoto.com

Stimulating the brain with a very small electrical current through the forehead could boost a student's ability to learn and remember basic mathematics, a provocative experiment suggests.

The work, published online Thursday by the journal Current Biology, could help those who struggle with mental arithmetic. But the study was small and the long-term effect wasn't profound.

The study tested something called transcranial random noise stimulation, a technique that sends a tiny current to the brain.

The current, generated by a small electronic device, is delivered through two electrodes attached to the temple. The electricity seems to affect the brain's neurons, which themselves use electrical signals to communicate with each other.

The results are preliminary, and alpha parents seeking an edge for their children shouldn't risk electrocution. "Do not try this at home," says Jackie Thompson, a psychologist at the University of Oxford in the U.K.

Some studies suggest that up to 1 in 5 of us has difficulty learning basic math, according to Thompson. Thompson and her colleagues thought that very slight electrical stimulation could help. Electrical stimulation has sometimes been shown to boost basic cognitive skills, Thompson says.

To find out if it could help with more complex brain functions, the team tried mathematics. They took 25 students and asked them to memorize a series of made-up mathematical equations. For example, 4 # 12 = 17. The idea was to test their ability to memorize sums that they hadn't seen before.

EDITOR'S ADD NOTE, Friday, May 17, 10:48 a.m.

The team also had the students execute problems with several arithmetic steps, such as 12 - 4 + 10 + 12 = 30. The idea was to test their ability both to calculate math problems and to memorize sums that they hadn't seen before.

And the original post continues...

All the students had two electrodes stuck to their foreheads, but only half received the tiny electrical signal. The signal was too small to be felt, and even the researchers conducting the tests didn't know who had received a signal and who hadn't.

When they went back and checked, they found that those who had received the stimulation appeared to memorize their sums faster and better than those who hadn't. Moreover, the effect seemed to last for six months after the stimulation. But it wasn't as strong.

Researchers aren't quite sure how it works, but co-author author Thompson says that the electrical signal may get brain cells synchronized: "Kind of like if you have eight rowers in a boat, if they're all rowing together they go faster," she says.

Researchers hope that their new technique could eventually be developed into a tool to help those with learning disabilities, or anyone who finds they are severely math challenged. But Thompson says that more research is needed to see what method of stimulation works best.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Swell Of Goodwill For First Medicare Chief Confirmed Since 2004 But Will It Last?

by Julie Rovner

May 16, 2013 3:07 PM Enlarge image i

Presenting Marilyn Tavenner, the first official official in charge of the Centers for Medicare and Medicaid Services in years.

Manuel Balce Ceneta/AP

When the Senate voted Tuesday to make Marilyn Tavenner the official administrator of the Centers for Medicare and Medicaid Services, it was the first time the world's greatest deliberative body had approved someone to head the huge health agency since 2004.

That's right, you have to go way back to the Bush administration to find Dr. Mark McClellan, the last person to be officially put in the post.

Tavenner, who has been running the agency in an acting capacity since late 2011, has a big job. CMS oversees Medicare, Medicaid, and the Children's Health Insurance Plan, which together serve north of 100 million Americans and have a combined budget larger than the Defense Department's.

CMS is also playing a major role in the implementation of the Affordable Care Act. The agency is in charge of the Medicare changes in the law, the creation of health exchanges and a significant expansion in Medicaid.

She comes to the agency with a reservoir of good will that eluded two previous nominees for the job, Obama appointee Donald Berwick and Bush appointee Kerry Weems.

Tavenner, a nurse, hospital executive, and one-time Virginia health secretary won the backing of House Majority Leader Eric Cantor, which made it safe for many Senate Republicans to support her.

She also benefited from auspicious timing. Weems' nomination got caught up in the politics of the Children's Health Insurance Program renewal; Berwick's in the furious fight over the Affordable Care Act. Even McClellan's nomination was held up briefly because then Sen. Byron Dorgan, D-N.D., was irritated because McClellan, in his previous position as commissioner of the Food and Drug Administration, had opposed Dorgan's legislation allowing easier importation of cheaper prescription drugs from Canada and other industrialized nations.

Tavenner also takes over just as the agency is getting some good news from the Congressional Budget Office.

It seems that CBO is among the agencies now predicting a slowdown in health spending. The latest 10-year spending estimates for Medicare and Medicaid, according to CBO, are down some $225 billion ($138 billion for Medicare and $89 for Medicaid) from where they were in March 2010.

Finally, of course, Tavenner takes the reins officially with a groundswell of goodwill from those whose economic future she now controls. Within moments of her confirmation, reporters' inboxes were flooded with congratulations and praise.

"Her leadership, extensive experience and strong knowledge of the healthcare system are huge assets in tackling our nation's healthcare challenges moving forward," said Scott Serota, president and CEO of the Blue Cross/Blue Shield Association.

Agreed Rich Umbdenstock, president and CEO of the American Hospital Association, "As acting administrator, Marilyn has demonstrated her willingness to listen to, learn from and work in partnership with the nation's health care providers."

She better enjoy it now. It only gets harder from here.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Everybody In The Pool! But Please Leave The Poop Behind

by Nancy Shute

May 16, 2013 1:00 PM Enlarge image i

Is it safe? The water in many public pools is contaminated with E. coli, a study finds.

iStockphoto.com

Perhaps you've noticed a toddler's sagging swim diaper and wondered if it's really keeping the poop out of your neighborhood pool.

The Centers for Disease Control and Prevention has the answer for you: no.

Last summer, researchers at the federal public health agency collected 161 filter samples from public swimming pools in the Atlanta area. More than half of those samples, 58 percent, were contaminated with E. coli.

That, the CDC reported today, "signifies that swimmers introduced fecal matter into pool water."

Toddlers who aren't toilet trained are just one source of the problem, according to the study, which was published in the latest Morbidity and Mortality Weekly Report.

People who don't shower with soap before swimming bring E. coli on their backsides, the CDC reports. And people who swim while sick with diarrhea are much more likely to introduce E. coli, Cryptosporidium, and other yucky germs into the water.

That takes some of the shine off the opening of summer pool season, doesn't it?

Fortunately, a properly chlorinated pool can kill E. coli quickly. So if your local pool is doing a good job maintaining chlorine and pH levels, that takes care of that problem.

The testing method used in this study couldn't tell if the E. coli was alive or had already been killed. And no outbreaks of pool-related disease were reported last summer in Atlanta.

Wondering why the lifeguards kick you out of the pool for 30 minutes after a "fecal incident"? That's the amount of time the CDC recommends to make sure that E. coli, by far the most common fecal pathogen, has been killed.

Other bugs are a lot harder to kill, unfortunately. It can take 45 minutes to kill Giardia, which causes diarrhea, in a pool chlorinated with 1 part per million of free chlorine. But it can take more than a day to kill Cryptosporidium, even with 10 times as much chlorine.

The CDC wants you to do your part by showering before you get in the pool. Children should be taken to the bathroom every hour, and diapers should be checked and changed at least that often. Most important, stay out of the pool when suffering from diarrhea.

Oh, and the CDC knows you pee in the pool, too. The nitrogen in urine depletes free chlorine in pool water, making it harder to kill germs. Nitrogen also converts the chlorine into a form that irritates the eyes and lungs. So stop doing that.

But this subject isn't a complete bummer. It's given us here at Shots an excuse to revisit the classic Baby Ruth in the pool scene from the 1980 movie "Caddyshack." Enjoy!

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Human Scent Is Even Sweeter For Malaria Mosquitoes

by Michaeleen Doucleff

May 16, 201311:48 AM Enlarge image i

An Anopheles gambiae mosquito feasts on a human.

Jim Gathany/CDC

People smell yummy to mosquitoes.

So yummy, in fact, that our scent is a big way the pesky insects track us down.

But just how much mosquitoes like Eau de Human may not be entirely up to the bugs.

Mosquitoes are more attracted to human odors when they're infected with the malaria parasite, scientists reported Wednesday in the journal PLOS ONE.

Entomologists at the London School of Hygiene and Tropical Medicine gave malaria-transmitting mosquitoes two places to land: a clean, nylon stocking and one worn for 20 hours on the foot of young Dutch woman (who happens to be an author on the study).

All the mosquitoes gravitated more toward the dirty sock than the fresh one. But the bugs infected with malaria landed on the smelly nylon more frequently. And while they were there, the parasite-possessed bugs were more likely to try and bite the stocking than the malaria-free insects.

Enlarge image i

Mosquitoes detect odors with their antennae. Here an Anopheles gambaie mosquito has been beheaded to photograph its antennae and eyes.

Courtesy of the Zwiebel Lab/Vanderbilt University

It's almost like mind control. The parasite changes the behavior of the insects for its own benefit. The more biting the bugs do, the more they spread the protists.

This kind of parasitic mind control isn't limited to mosquitoes and malaria. One type of fungus is notorious for turning carpenter ants into so-called zombies. After the Ophiocordyceps unilateralis infects the ants, the insects march to a precise location on a leaf that is optimal for dispersing the fungus's spores. Eventually, the ant dies at this location and the Ophiocordyceps sprouts from the dead corpse.

Malaria appears to be more subtle with its subterfuge. It just amplifies the mosquitoes' preference for human blood.

Scientists have known for a decades that the malaria vector Anopheles gambaie is highly attracted to people. In fact, these ladies – it's only the females that bite us — actually prefer to feast on humans than many other animals. They even have a strong aversion to cow odor.

So what's in our bouquet that makes us so alluring to mosquitoes?

Human skin emits over 350 different odor molecules. The An. gambaie mosquitoes have odor receptors in their antennae specifically built to detect a handful of these scents.

One these compounds, known as mushroom alcohol (because it's made by mushrooms), gives our skin a moldy or meaty smell. Another compound, diacetyl, has a buttery scent. It's the same molecule found in Chardonnay and added to microwave popcorn to simulate butter.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Cloning, Stem Cells Long Mired In Legislative Gridlock

by Julie Rovner

May 16, 2013 3:04 AM Listen to the Story

Morning Edition

3 min 55 sec

• Playlist
• Download
• Transcript

 

After President Obama overturned Bush-era policy restricting federal funding of embryonic stem cell research in 2009, Nebraska Right to Life led a protest of the research outside the University of Nebraska regents' meeting.

Nati Harnik/AP

The news that U.S. scientists have successfully cloned a human embryo seems almost certain to rekindle a political fight that has raged, on and off, since the announcement of the creation of Dolly the sheep in 1997.

"The issue of legislation on human cloning is about to get hot again," says Hank Greely, director of the Center for Law and the Biosciences at Stanford Law School.

But it's a fight that has, over the past decade and a half, produced a lot of heat and light and not a lot of policy.

Human Cloning

In fact, for all the arguing about the issue that's happened in Washington over the years, human cloning is still technically legal, at least in much of the country.

"There are already 60 countries in the world that have laws on their books banning human reproductive cloning, and this prohibition is also in a number of international agreements" says Marcy Darnovsky, executive director of the Center for Genetics and Society, which is devoted to the responsible use of new genetic and reproductive technologies. "But in the U.S., we have not managed to put such a law on the books at the federal level."

At least 15 states ban cloning, either for reproductive purposes or research or, in come cases, both, according to the National Conference of State Legislatures.

But Congress has mostly fought issues of both stem cell research and cloning to a draw.

"What we saw the last time cloning was in the headlines was that the discussion really got mired in the abortion controversy," Darnovsky said.

The House passed bills banning all forms of cloning in 2001 and 2003; the Senate failed to act in both cases.

"All the other issues got completely swamped," she said. "And I really hope that doesn't happen this time."

But both the issues of cloning — for research and reproduction — and embryonic stem cell research have been mired in the abortion controversy from the start.

Stem Cell Research

About the only law that has been able to pass is language that gets added to the funding bill for the Department of Health and Human Services every year since the mid-1990s — the so-called Dickey-Wicker Amendment, named for its original House sponsors, Reps. Jay Dickey, R-Ark., and Roger Wicker, R-Miss. It bars the use of federal funds for research that could destroy or harm a human embryo.

The Clinton administration decided that federal funding of embryonic stem cell research using cell lines derived from embryos destroyed with private funds did not violate that law.

President Bush put that policy into force but severely limited the cell lines available to researchers.

"I have concluded that we should allow federal funds to be used for research on these existing stem cell lines, where the life-and-death decision has already been made," he said in a televised address to the nation.

Meanwhile, over the years Congress debated several bills to expand federal funding of embryonic stem cell research, under specific ethical guidelines, as well as legislation to ban cloning intended to make a baby. None, however, was able to pass both the House and Senate and get the president's signature.

When he came into office in 2009, President Obama used his executive authority to expand federal funding for embryonic stem cell research, while maintaining guidelines such as not paying women for their eggs.

"The majority of Americans, from across the political spectrum, and from all backgrounds and beliefs, have come to a consensus that we should pursue this research," he said.

FDA Rules

But Congress remains deadlocked over the bioethical issues — which is not to say that there is no federal regulation.

Jonathan Moreno, a bioethicist at the University of Pennsylvania, points out that the Food and Drug Administration has, from the start, said it would closely regulate anything it deemed to be human cloning, whether reproductive or therapeutic.

Shots - Health News Scientists Clone Human Embryos To Make Stem Cells

"Once you start talking about putting many of the products of these cells into people, then you get into an area where the FDA is very interested," he said.

Meanwhile, Darnovsky of the Center on Genetics and Society says she hopes this new development might break the legislative logjam.

"This development, if it turns out to be replicable, will mean that there will be cloned human embryos in labs around the country," she said. "And we really need to make sure that no unscrupulous person would ever try to use those to produce a cloned human being."

Congress, however, has been unable to pass much of anything this year. It's unclear yet if this will rise to the level of must-pass.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

How Researchers Cloned Human Embryos

by Michaeleen Doucleff

May 15, 2013 3:14 PM Enlarge image i

Human embryos grow in a petri dish two days after scientists in Oregon cloned them from a donor's skin cell.

http://www.flickr.com/photos/ohsunews/8726915230/in/photostream//Courtesy of OHSU Photos

Scientists in Oregon have achieved something that many thought might be impossible.

They said Wednesday that they have cloned human embryos and then harvested the embryo's stem cells.

The discovery, if it holds up, means scientists would be able to make personalized stem cells, with their genetic code almost perfectly matched to that of a patient.

One day, designer cells like these could help to treat an array of diseases, like diabetes, Parkinson's and heart problems.

So how did the scientists do it?

Specifically, they used a method called somatic cell nuclear transfer. Despite its complex name, the technique is pretty simple. Take an egg donated by a woman and pull out its DNA. Then insert DNA from a patient's skin cell into the empty egg.

Additional Information: Another Way To Make Personalized Stem Cells

Back in 2007, Shinya Yamanaka of Kyoto University in Japan, figured out a way to turn skin cells into stem cells without using an egg.

This method involves simply switching on four genes inside the skin cells, which transforms them into another class of stem cells, called induced pluripotent stem cells, or iPSCs.

Since you don't need to destroy a human embryo to make iPSCs, they are less controversial than embryonic stem cells. But scientists still aren't sure if iPSCs work as well.

Yamanka won a Nobel Prize last year for discovering iPSCs.

Shots - Health News Nobel Winners Unlocked Cells' Unlimited Potential

As the embryo develops, it makes stem cells that the scientists can collect and grow in the lab.

The technique dates back to the 1960s, when John Gurdon at Oxford University cloned a frog using just one cell from a tadpole's gut. He eventually won a Nobel Prize for that experiment.

Then in 1996, a team in Scotland used a similar method to clone the first mammal: a sheep named Dolly. This discovery triggered a rash of clonings — rabbits, horses, cows, goats and, of course, cats and dogs.

But getting the technique to work with humans eggs has been an exercise in frustration.

For more than a decade, researchers have been tripped up at the same point. After they drop the new DNA into a human egg, it divides a few times and then it gets stuck. It stops growing.

But Shoukhrat Mitalipov and his team at Oregon Health & Science University figured out how to keep the embryo dividing until it creates stem cells.

Mitalipov says they had to trick the egg into thinking it's been fertilized by a sperm. "Even if you transplant the skin cell inside the egg, the egg still needs some kind of signaling — usually [it's] delivered by the sperm."

The magic signal is quite complex. It includes an electric shock, a cocktail of chemicals and a splash of caffeine. Really.

Adding a little caffeine to the embryo's food helps it grow and make stem cells.

Mitalipov and his team then harvested the caffeine-charged cells and demonstrated that they could be transformed into a variety of cell types, including heart cells that beat inside a petri dish.

The process is efficient enough, Mitalipov says, that he can get stem cells from each women who donates five to 15 eggs.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Breast Cancer, Risk And Women's Imperfect Choices

Lydia Zuraw and Nancy Shute

May 15, 2013 1:00 PM Enlarge image i

Actress Angelina Jolie has prompted a national discussion about breast cancer prevention.

Leon Neal/AFP/Getty Images

Just about anything that Angelina Jolie does is pretty much guaranteed to make news. But her announcement that she had decided on a preventive double mastectomy to reduce her unusually high risk of cancer sparked an outpouring of passionate comment on breast cancer prevention and treatment.

[View the story "Suddenly, we're talking about mastectomies..." on Storify] Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Scientists Clone Human Embryos To Make Stem Cells

Rob Stein and Michaeleen Doucleff

May 15, 201312:01 PM Listen to the Story

All Things Considered

5 min 23 sec

• Playlist
• Download
• Transcript

  Enlarge image i

A scientist removes the nucleus from a human egg using a pipette. This is the first step to making personalized embryonic stem cells.

Courtesy of OHSU Photos

Scientists say they have, for the first time, cloned human embryos capable of producing embryonic stem cells.

The accomplishment is a long-sought step toward harnessing the potential power of embryonic stem cells to treat many human diseases. But the work also raises a host of ethical concerns.

"This is a huge scientific advance," said Dr. George Daley, a Harvard stem cell scientist who wasn't involved in the work. "But it's going to, I think, raise the specter of controversy again."

The controversy arises from several factors. The experiments involve creating and then destroying human embryos for research purposes, which some find morally repugnant. The scientists also used cloning techniques, which raise concerns that the research could lead to the cloning of people.

Ever since human embryonic stem cells were discovered, scientists have had high hopes for them because the cells can morph into any kind of cell in the body. That ability means, in theory, that they could be used eventually to treat all sorts of illnesses, including diabetes, Alzheimer's, Parkinson's and spinal cord injuries.

So for years, scientists have been trying to use cloning techniques to make embryonic stem cells that are essentially a genetic match for patients. The idea is that such a close match would prevent their bodies from rejecting the cells.

"It's been a holy grail that we've been after for years," says Dr. John Gearhart, a stem cell pioneer at the University of Pennsylvania.

But every previous attempt ended in failure or fraud, leading many scientists to wonder if the goal might be impossible to reach.

Making Personalized Stem Cells

Scientists report Wednesday that they have successfully cloned human embryos from a person's skin cells. Here's how they could eventually use the technology to create new therapies for a patient.

Source: Mitalipov Lab/OHSU

Credit: Adapted for NPR by Alyson Hurt

However, Shoukhrat Mitalipov of the Oregon Health & Science University and his colleagues never gave up. They succeeded in mice and monkeys. And in this week's issue of the journal Cell, Mitalipov's team reports they finally did it in humans.

"I'm very excited," Mitalipov says. "It's a very significant advance."

The researchers first recruited women who were willing to provide eggs for the research. Next, they removed most of the DNA from each egg and replaced the genetic material with DNA from other peoples' skin cells.

Then, after a long search, they finally found the best way to stimulate each egg so that it would develop into an embryo without the need to be fertilized with sperm. The key turned out to be a combination of chemicals and an electric pulse.

"We had to find the perfect combination," Mitalipov says. As it turned out, that perfect combination included something surprising: caffeine.

"The Starbucks experiment, I guess," quipped Daley. "This little change in the cocktail was what really allowed the experiment to really ultimately succeed."

Enlarge image i

Shoukhrat Mitalipov, of Oregon Health & Science University, first cloned monkey embryos before trying his method on human eggs.

Courtesy of OHSU Photos

That ingredient, plus other tweaks in the process, including using fresh eggs and determining the optimal stage of each egg's development, Mitalipov says.

The researchers showed that the resulting embryos could develop to a stage where they could produce healthy stem cells containing the genes from the skin cells. They even showed that the stem cells could be turned into other types of cells, including heart cells that in a laboratory dish could pulse like a beating heart.

The work drew immediate criticism because of ethical concerns.

First of all, the Oregon researchers compensated women financially to donate eggs for the experiments — something many in the field have considered ethically questionable.

But beyond that, the creation and destruction of a human embryo is morally repugnant to people who believe an embryo has the same moral standing as a human being.

"This is a case in which one is deliberately setting out to create a human being for the sole purpose of destroying that human being," says Dr. Daniel Sulmasy, a professor of medicine and a bioethicist at the University of Chicago. "I'm of the school that thinks that that's morally wrong no matter how much good could come of it."

Moreover, Mitalipov used the same method that researchers used previously to clone Dolly the sheep. That approach raises the possibility that scientists could try to clone a human being.

"This raises serious problems because it is the first actual human cloning," Sulmasy says. "We already know there are people out there who are itching to be able to be the first to bring a cloned human being to birth. And I think it's going to happen."

But Mitalipov dismisses those concerns. He says the embryos he created aren't the equivalent of a human being because they weren't fertilized naturally. And his experiments with monkeys indicate that it's unlikely that they could ever develop into a healthy baby.

"The procedures we developed actually are very efficient to make stem cells, but it's unlikely that this will be very useful for kind of reproductive cloning," Mitalipov says.

Other researchers agree with him and argue that the possible benefits of the research outweigh the concerns. "Where you can improve [a patient's] quality of life tremendously through this kind of technology, I personally believe that it is ethical to use material like this," Gearhart says.

The scientists acknowledge that it will be years before anyone knows whether this step will actually result in treatments that might help patients. In the meantime, it's clear that the intense debate over embryonic stem cells is far from over.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Angelina Jolie's Mastectomy Decision And Weighing Cancer Risks

by Scott Hensley

May 15, 201310:29 AM

Peggy Orenstein talks with David Greene on Morning Edition

Enlarge image i

Hollywood star Angelina Jolie has sparked a discussion about breast cancer risk and how to manage it.

Burhan Ozbilici/AP

On Wednesday's Morning Edition, David Greene talks with writer and breast cancer survivor Peggy Orenstein about actress Angelina Jolie's decision to have a double mastectomy to reduce her risk of breast cancer.

Jolie, whose mother died at 56 from ovarian cancer, has a genetic variant that puts her at high risk for ovarian and breast cancer. She made public her thinking and ultimate decision in an op-ed in Tuesday's New York Times. The disclosure has sparked discussion about breast cancer risk and prevention.

Orenstein recently wrote about her own experience and the downsides of cancer awareness in a much talked about cover story for the Times' Sunday Magazine called "Our Feel-Good War on Breast Cancer."

Orenstein tells Greene that Jolie's op-ed resonates with her, but she has some concerns about Jolie going public:

"I feel that it's really really important that women recognize that Angelina Jolie is in this very particular group of women that has this genetic mutation. She's not a woman of average risk, and to take her experience and generalize it either to ordinary women of average risk or even women with a family history, that concerns me."

Orenstein says the high volume of messages about breast cancer creates problems, too.

"Women are bombarded with breast cancer pretty much everywhere they go now. there's something pink that's reminding you of breast cancer. And the unfortunate result, and this is an unintended consequence, is that even as we have an epidemic of breast cancer, the average woman has an exaggerated sense of her own personal risk, so that we make decisions that are not in our own best interest."

Heart disease remains the No. 1 killer for women in the U.S. Cancers of all kinds come in second.

Orenstein had a recurrence of breast cancer 15 years after her first diagnosis and faced fresh set of decisions about her care:

Shots - Health News Angelina Jolie And The Rise Of Preventive Mastectomies

"We live with risk. And breast cancer is one of those risks. When your risk is not particularly elevated, removing a body part has its own risks. I've had a mastectomy; it's pretty tough. And the reconstruction, while it looks really good and Angelina Jolie's probably looks better, it doesn't have sensation. So you're going to lose that as well."

On Jolie's risk factors and how they compare with those that are more common, Orenstein says:

"She had to make a decision about a very elevated risk in a family where there's been significant death from cancer. That's a different situation from where you have not a particularly elevated risk in your other breast. So what my doctors said to me was, if you make a decision to remove your other breast that's a psychological decision having to do with your risk tolerance — not a medical decision."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

How A Florida Medical School Cares For Communities In Need

by Greg Allen

May 14, 2013 4:40 PM Listen to the Story

All Things Considered

4 min 42 sec

• Playlist
• Download
• Transcript

  Enlarge image i

With community-based health care a central part of its curriculum, Florida International University's medical school turned an RV into a mobile health clinic so that students could treat families in neighborhoods where medical care is scare.

Greg Allen/NPR

If it's a Monday, you can usually find Dr. David Brown parked next to a lake in Miami, spending the day inside a 36-foot-long RV. He's not on vacation.

Brown is chief of family medicine at Florida International University's medical school. The RV is the school's mobile health clinic.

Every Monday it's parked at the Royal Country Mobile Home Park in northwest Miami-Dade County. "It's a beautiful place right here," he says. "But this is not a wealthy community."

Brown helps direct FIU's Neighborhood HELP program. It's part of the school's curriculum that connects medical students with families in neighborhoods where medical care is scarce.

Students visit families in their homes where they conduct examinations and provide basic care. But some things are better done in a clinic. So the medical school bought its own RV. "We're able to bring free basic primary care to our households relatively close to their community," Brown says.

In one of the RV's exam rooms, third-year medical student Veronica Alvarez met recently with patient Maritza Flores. Flores has diabetes and high blood pressure. With help from the school's faculty, Alvarez has been treating her since January.

Shots - Health News New York Medical School Widens Nontraditional Path For Admissions

Flores says with Alvarez's encouragement, she's begun exercising more and has improved her diet. And, thanks to FIU's doctors, she's begun taking medication for her diabetes and high blood pressure. In just a few months, Alvarez says, she's seen a big improvement. "The high blood pressure and the diabetes together is what you worry about," Alvarez says. "And now, her diabetes is well-controlled and her hypertension is well-controlled as well."

Shots - Health News New Medical School Wants To Build Ranks Of Primary Care Doctors

Over the last decade, a pressing need for new doctors has led many universities to open medical schools. Seventeen new schools have been accredited since 2005, and several are looking at new ways to train doctors.

When it was founded just four years ago, Florida International University took on a mission — to improve the health of nearby communities. Another focus for the school is to train more doctors in primary care.

Nationally, there's a shortage of primary care doctors — one that's expected to worsen as millions more Americans get access to health care under the Affordable Care Act.

But Dr. John Rock, the medical school's dean, says the two missions go together. Sending students out to treat patients in their communities teaches them the art of primary care.

FIU just graduated its first class from the medical school. Nearly half of the students, Rock says, are doing residencies in primary care.

Several other new medical schools are also developing programs that allow students to develop ongoing relationships with patients. And there are others that, like FIU also have a social mission — to improve the quality of life in medically-underserved communities.

In Miami, that includes places like Miami Gardens, where med student Danny Castellanos got to know a family that has 10 members, including a great-grandmother and five children.

“ We're able to bring free basic primary care to our households relatively close to their community.

- Dr. David Brown

Castellanos saw the family as part of a team that included a faculty advisor, a nursing student and a social worker. One of the first things they did was get all of the children qualified for Medicaid, which paid for their coverage.

Over the three years, Castellanos became involved in the healthcare of the entire family, including most recently the great-grandmother. She's now taking part in a telemedicine pilot program.

Castellanos says the school installed an electronic unit in the household. "It has a screen," he says. "It has a camera. It has a blood pressure cuff on it, a stethoscope which allows us to hear the heart sounds. We just ask her to place it in certain areas on her chest, ask her to put the blood pressure cuff on. And we get those kind of readings electronically."

The telemedicine pilot will be evaluated for its cost-effectiveness.

But, overall, FIU's Rock says the school's focus on improving the health of targeted communities already is a success.

And for families in the program, the benefits are even more tangible. They're much more likely now to receive regular checkups and less likely to use emergency rooms. "We also have increased health literacy, so they have a keen understanding of what some of the issues are," Rock says.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Feds Push For Lower Alcohol Limits For Drivers

by Scott Hensley

May 14, 2013 3:16 PM

A car driven by a 19-year-old man crashed into a tree in Bates Township, Mich., in April. The Iron County Sheriff's Department said investigators believed the driver, who survived the crash, was drunk and speeding.

AP

To curb drunken driving, the federal National Transportation Safety Board has voted to recommend that states tighten the legal limit for drivers' blood alcohol.

The threshold now for drunken driving is a blood alcohol concentration of 0.08. (The BAC equals alcohol divided by the volume of blood it's in.)

The NTSB would push for it to be lowered to 0.05, in line with the limits in countries such as Denmark, the Philippines and Switzerland.

How many drinks would it take to run afoul of the new limit? The answer depends on weight, gender and how long a person has been drinking.

A man weighing 180 pounds who drank three beers in an hour would have a BAC of 0.052, according to a calculator on the Wisconsin Dept. of Transportation website. A 120-pound woman would hit the same level drinking two beers over 60 minutes.

At 0.05 BAC, drivers have worse coordination and can't keep track of moving objects all that well, the National Highway Traffic Safety Administration says.

"We need as much attention today on impaired driving as we saw in the early 1980s when organizations like MADD were founded and the drinking age became 21," said the text of a speech to be given by Deborah A.P. Hersman, chairman of the NTSB, at the start of a two-day meeting on impaired driving. "Over that decade, real progress was achieved in the United States."

More than 10,000 highway deaths in 2010 involved an alcohol-impaired driver, according to the NTSB. While that's down from more than 18,000 in 1988, the NTSB says it could be reduced further still with strichter alcohol limits.

But it looks like a tough sell. "When the limit was .10, it was very difficult to get it lowered to .08," Jonathan Adkins, a spokesman for Governors Highway Safety Association told USA Today. "We don't expect any state to go to .05."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

A Sharper Abortion Debate After Gosnell Verdict

by Julie Rovner

May 14, 201311:49 AM Enlarge image i

Jack McMahon, the defense attorney for abortion doctor Kermit Gosnell, speaks outside the Philadelphia courthouse after the guilty verdicts Monday.

Matt Rourke/AP

The murder conviction in Philadelphia of abortion provider Dr. Kermit Gosnell in the deaths of three babies and one of his female patients is likely to further inflame the already heated abortion debate.

Both sides of the abortion divide have been gearing up for what comes next for some time now.

The irony of this case is that those on both sides of the debate were hoping for a conviction. That's because what Gosnell means to the abortion debate really comes down to this: Was he an exception? Or are there more abortion providers like him who just haven't been discovered yet?

Abortion rights backers insist he's an outlier.

"The fact is that what he did was illegal — unethical, unscrupulous, illegal," says Jodi Jacobson. "And it bears no comparison to safe abortion care or even late abortion care, because he performed abortions post-viability on women without indications for such, so they were illegal."

Jacobson, who runs RH Reality Check, an online daily news service about reproductive rights and sexual politics, says most states already have laws that bar abortions late in pregnancy — except when there are medical reasons.

"If you have a late abortion situation in the third trimester, you are facing either a threat to the life or the health of the mother, or a fetus with anomalies incompatible with life," she says.

Abortion opponents, however, say Gosnell is anything but an exception.

Additional Information: As Heard On Morning Edition Doctor's Murder Conviction Likely To Inflame Abortion Debate 3 min 41 sec

• Add to Playlist
• Download

 

"The tentacles of this type of approach to abortion are all over the country," says Marjorie Dannenfelser, president of the Susan B. Anthony List. "He is not an outlier. You just have to do a Google search and you'll find in the last several months many other examples" of rogue abortion providers, she said.

But whether or not there are more doctors like Gosnell, anti-abortion forces say they'll try to harness the public outrage created by this trial to further their cause.

Republicans on the House side of Capitol Hill have already launched a series of efforts. Leaders of the Energy and Commerce Committee are asking state public health officials to provide "details on state licensing of abortion clinics and providers, information on revoked licenses, state inspections of clinics" and other details about regulation of abortion providers. The deadline for responses is May 22.

Meanwhile, House Judiciary Committee Chairman Bob Goodlatte, R-Va., has asked every state attorney general "if state and local governments are being stymied in their efforts to protect the civil rights of newborns and their mothers by legal or financial obstacles that are within the federal government's power to address."

Dannenfelser says she hopes the case will help efforts to pass legislation to ban abortions after a certain point in pregnancy.

"The question would be, is there a point where the civil rights of the unborn child comes into play? And there is a solid majority that says that late in pregnancy, that point exists," she says. "Anywhere from 18 to 20 weeks, there is a good 60, 70, 80 percent support for that type of measure."

Both 18 and 20 weeks, however, are well before fetal viability, and thus would challenge the current Supreme Court holding for when abortion should be generally legal.

Abortion rights groups, meanwhile, are using the Gosnell case, too. They're making the case that as abortion becomes more and more restricted, women will have fewer and fewer options, and will end up turning to sketchier providers like Gosnell.

"He was acting wholly outside the law, and the fact that that is the case really suggests the reason why we need to make sure that we have good providers, that abortion has to be safe and legal and accessible," says Nancy Northup, president and CEO of the Center for Reproductive Rights.

One thing is clear coming out of the Gosnell case. It is likely to once again shift the emphasis of the abortion debate. Until recently, it's been on birth control, where abortion-rights groups enjoy broader public support. Now it's likely to swing back to later abortions, where abortion opponents have the public-opinion edge.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.