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First U.S. Case Of Ebola Confirmed In Dallas

Tue, 09/30/2014 - 5:42pm
First U.S. Case Of Ebola Confirmed In Dallas September 30, 2014 5:42 PM ET

A patient at the Texas Health Presbyterian Hospital in Dallas has a confirmed case of Ebola, the Centers for Disease Control and Prevention says. He is being treated and kept in strict isolation.

LM Otero/AP

The Centers for Disease Control and Prevention confirmed Tuesday that the first case of Ebola has appeared in the U.S.

A man in Dallas has tested positive for the virus, the agency said. The man flew to the U.S. from Liberia, arriving on Sept. 20, NPR has learned. He wasn't sick on the flight, and had no symptoms when he arrived.

Goats and Soda How Do You Catch Ebola: By Air, Sweat Or Water?

He first developed symptoms on Wednesday, Sept. 24, according to the CDC, and first sought care on Friday. On Sunday, he was placed in isolation at Texas Health Presbyterian Hospital in Dallas, according to the Texas Department of State Health Services.

Health officials have already started reaching out to people who may have come into close contact with the man. The virus is spread only through direct contact of bodily fluids, and it isn't contagious until a person starts showing symptoms.

Update at 7:15 p.m. ET. Handful Of People Exposed

A "handful" of people may have been exposed to the virus, the CDC's Director Dr. Tom Frieden said Tuesday at a news conference. These include several family members of the man and a few people in the community, Frieden said.

The man could have passed Ebola to these people during the four days when he was sick but not yet isolated.

Goats and Soda Ebola 101: The Facts Behind A Frightening Virus

But passengers on the plane with the man were not exposed to Ebola, Frieden said. "There is zero risk of transmission on the flight. He was checked for fever before getting on the flight."

The CDC has been planning for an Ebola case in the U.S, Frieden said. And the agency, together with state health departments, has successfully dealt with similar viruses — Lassa and Marburg — on five previous occasions.

"The bottom line here is that I have no doubt that we will control this importation, or case of Ebola," he said, "so that it does not spread widely in this country."

Our Original Post Continues:

This isn't the first time somebody has been treated for Ebola in the U.S. Several American aid workers in recent months caught the virus while working in West Africa and were flown back to the U.S. for treatment.

But it's the first time the disease has been diagnosed in a person in the U.S. The CDC is sending a team to Dallas to work with state and local health officials.

Goats and Soda A Few Ebola Cases Likely In U.S., Air Traffic Analysis Predicts

The Ebola epidemic in West Africa continues to grow rapidly. As of Thursday, there have been more than 6,500 cases across Liberia, Sierra Leone and Guinea. More than 3,000 people have died of the disease, the World Health Organization says.

Specialists studying infectious diseases have predicted for weeks that a few Ebola cases would likely turn up in the U.S. And hospitals around the country have been preparing to diagnose and treat such cases.

Because Ebola only spreads through body fluids, officials say that any case like this will likely be quickly identified and contained, and not lead to a widespread outbreak like the one happening now in West Africa.

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BRAIN Initiative Bets on Wearable Scanners, Laser-Controlled Cells

Tue, 09/30/2014 - 5:06pm
BRAIN Initiative Bets on Wearable Scanners, Laser-Controlled Cells September 30, 2014 5:06 PM ET Andrew Ostrovsky/iStockphoto

Eighteen months after its launch, President Obama's plan to explore the mysteries of the human brain is finally taking shape. During separate events Tuesday, the White House and National Institutes of Health offered details about which projects are being funded and why.

At a morning press conference, NIH officials announced $46 million in grant awards to more than 100 investigators. Most of the researchers are working on tools that can "transform how we study the brain," said NIH Director Francis Collins.

Among the grants:

  • Researchers at West Virginia University will try to engineer a "wearable PET scanner" intended to monitor the brain activity of people while they do things like take a walk in the park.
  • Several teams will develop systems that use lasers to control the activity of individual cells and circuits in the brain.
  • A team from the Allen Institute for Brain Science will attempt to characterize the different cell types in brain circuits involved in vision and other sensations.
  • Researchers from the Massachusetts Institute of Technology will try to adapt functional MRI so that it can show the activity of individual brain cells.
Shots - Health News Obama's Plan To Explore The Brain: A 'Most Audacious' Project

Researchers badly need new tools like these because, despite recent advances, the brain is still an enigma, said Dr. Tom Insel, director of the National Institutes of Health. "Relative to what we know about the heart and the kidney and the liver, we don't even have a parts list for the brain," he said. "This is a time of discovery."

Today, "we can look at hundreds or even thousands of neurons, but we need [to be able to look at] millions," said Cornelia Bargmann of The Rockefeller University during an afternoon media event at the White House. "The tools need to be 100 times better than they are now."

Shots - Health News Federal Brain Science Project Aims To Restore Soldiers' Memory

The BRAIN Initiative is an attempt to push science ahead very quickly and to involve investigators who haven't previously been involved in brain research, Collins said. As a result, grants went to physicists and engineers as well as researchers in the biological sciences.

The effort is likely to take a decade or more and to cost at least $4.5 billion, Collins said. He described the effort as a "moon shot," but one with the potential to dramatically improve treatments for problems ranging such as Alzheimer's, schizophrenia, epilepsy and autism.

In May, the Defense Advanced Research Projects Agency (DARPA) announced $70 million in contracts related to the BRAIN Initiative. These included development of implanted devices intended to treat problems including depression, anxiety and post-traumatic stress disorder.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Putting Caffeine In Your Underwear Won't Make You Slimmer, Alas

Tue, 09/30/2014 - 11:43am
Putting Caffeine In Your Underwear Won't Make You Slimmer, Alas September 30, 201411:43 AM ET

An online ad for Wacoal's iPant, which incorporates caffeine and other added ingredients.

via Neiman Marcus

I love caffeine. I would love to trim my derriere. Combining the two seems like such an obvious win. Evidently some manufacturers of women's undergarments thought so, too. And now they're $1.5 million poorer.

The Federal Trade Commission has ordered two companies, Norm Thompson Outfitters Inc. and Wacoal America, to stop marketing shapewear infused with caffeine. The firms claimed that the amped-up underwear would cause fat loss and a reduction in body size.

The Norm Thompson company marketed its garments by saying they would "reduce the size of your hips by up to 2.1 inches and your thighs by up to one inch, and would eliminate or reduce cellulite and that scientific tests proved those results."

But the federal government says those claims are false and not supported by scientific evidence.

Shots - Health News Caffeine Gives Athletes An Edge, But Don't Overdo It

"If someone says you can lose weight by wearing the clothes they are selling, steer clear," Jessica Rich, director of the FTC's Bureau of Consumer Protection, said in a statement Monday. "The best approach is tried and true: diet and exercise."

Tried and true, perhaps, but not nearly as much fun as donning the "iPant long leg shaper," which sells for $60 and promises to "mobilize fats."

I am well caffeinated as I type this, thanks to the NPR coffee machine, and by amazing coincidence happen to be wearing a shaping undergarment. Could I be mobilizing fats while I sit?

The Salt Coffee Myth-Busting: Cup Of Joe May Help Hydration And Memory

Unfortunately, there's no evidence that caffeine's slight metabolic boost results in any measurable weight loss (though it does help with thinking and athletic performance). So my shapewear isn't doing much aside from banishing the visible panty line.

Still, a girl can hope. And I'm not alone. Among the Amazon reviews for the iPant you'll find this: "I have worn my iPant shapers every day for about 1 month, and my skin is definitely smoother. In fact, my husband even noticed that my thighs are smoother and thinner!!!"

Keep that husband, honey. And you may not be out of luck on the pants, either. As part of the FTC settlement, the $1.5 million that the firms must pay will be used to reimburse customers who bought the caffeinated skivvies.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Database Flaws Cloud Sunshine On Industry Payments To Doctors

Tue, 09/30/2014 - 10:57am
Database Flaws Cloud Sunshine On Industry Payments To Doctors September 30, 201410:57 AM ET

Partner content from

Editor's note: The Open Payments database is live and can be found at here.

The government's release of a trove of data Tuesday detailing drug and device companies' payments to doctors has been widely hailed as a milestone for transparency. Once posted, the information will let patients see if their physicians receive money from any of the companies whose products they prescribe.

4 Years Of Lessons Learned About Drugmakers' Payments To Doctors 4 min 11 sec  

But the database is also something else: a very limited window into the billions in industry spending. Before you dive in and search your doctor, here are five caveats to keep in mind.

1) The data don't cover all payments.

The Physician Payment Sunshine Act, part of the 2010 Affordable Care Act, called for the first public release of this data 18 months ago. But because of delays writing detailed rules implementing the law, the first release of data will happen today, and it will only cover payments for a few months, from August to December 2013.

So if you search for your doctor and you do not find him or her, it doesn't mean that he or she didn't receive a payment.

Also, those few months may not be representative of a company's spending over an entire year. Some companies may try to concentrate promotional talks at the start of a year, and those wouldn't be represented in these data.

Some of these problems will be resolved by the time the government releases data on payments for the full calendar year 2014, expected next summer.

2) By design, some data on research payments won't be included.

The Sunshine Act allows drug and device companies to delay the publication of data related to research of new products or, in some cases, new uses for existing products. The payments won't be made public until the product is approved by the Food and Drug Administration, or four calendar years after the payment was made, whichever comes first. It is unclear how much money is involved, but, again, just because a doctor doesn't show up as receiving a research payment doesn't mean he or she hasn't received one.

Beyond that, not all types of health professionals are included. You'll find physicians (medical doctors and osteopaths), dentists, chiropractors, podiatrists and optometrists. But companies do not have to report payments to nurse practitioners or physician assistants, so you won't find them.

3) Because of errors, additional data aren't being released.

The federal Centers for Medicare and Medicaid Services has acknowledged that one-third of the payment records submitted by companies for last year had data problems that could lead to cases of mistaken identity. The names associated with those payments won't be released today. Federal officials are asking companies to recheck the data, which should be released publicly next year.

CMS officials discovered the problem while investigating a physician's complaint that payments were being attributed to him even though they were made to another physician with the same name. In the process of reviewing that issue, it found "intermingled data," meaning physicians were being linked to medical license numbers or national provider identification numbers that were not theirs.

4) Not all payments have the same significance.

When consumers go to the federal website, they will see payments divided into different categories: consulting fees, speaking fees (called "services other than consulting"), research payments, honoraria, gifts, entertainment, food and beverage, travel and lodging, educational items, charitable contributions, royalties, ownership interests, and grants.

Those different types of payments signal different levels of involvement with a company.

Educational items, for instance, include medical textbooks and reprints of journal studies given to doctors. Research payments can include more than the pay a doctor got to lead a study. Payments for clinical studies may include costs associated with patient care and supplies, as well as the time spent by health care professionals treating patients and managing the study.

Educational items that directly benefit patients (such as anatomical posters) and medication samples do not have to be reported and won't be displayed.

5) This is the first federal release of these data: Expect errors.

While the payments database is a far cry from HealthCare.gov — and less complex — it's reasonable to expect some glitches. CGI Federal, the company that led what turned out to be the botched launch of HealthCare.gov, is also responsible for the release of the payment data.

Beyond that, drug and device manufacturers sometimes make their own errors. Doctors have similar names, and a payment made to one may be attributed to a different one.

The government gave doctors a 45-day window to review and dispute payments attributed to them before the information becomes public, but it's unclear how many did. The American Medical Association as well as pharmaceutical and device trade groups say the process has been confusing.

Many doctors may notice payments attributed to them in the days to come when they search their names on Google.

If you can't find what you're looking for on the government's website, you might try our Dollars for Docs feature, where we have been tracking payments by some large companies for four years. We've just added data from 2013, and have included 17 drug companies accounting for half of U.S. drug sales that year. In some cases, that will be more complete than the federal data.

If you have a question about what your doctor received, you should ask your doctor.

ProPublica is a nonprofit investigative reporting newsroom based in New York.

Copyright 2014 ProPublica. To see more, visit http://www.propublica.org/.
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Vaccine Controversies Are As Social As They Are Medical

Tue, 09/30/2014 - 3:35am
Vaccine Controversies Are As Social As They Are Medical September 30, 2014 3:35 AM ET Listen to the Story 7 min 9 sec  

Daniela Chavarriaga holds her daughter Emma as Dr. Jose Rosa-Olivares administers a measles vaccination at Miami Children's Hospital.

Joe Raedle/Getty Images

When essayist Eula Biss was pregnant with her son, she decided she wanted to do just a bit of research into vaccination. "I thought I would do a small amount of research to answer some questions that had come up for me," she tells NPR's Audie Cornish. "And the questions just got bigger the more I learned and the more I read."

In the U.S., vaccination rates are high; for measles, mumps and rubella, the Centers for Disease Control and Prevention estimates that about 90 percent of infants receive vaccinations. The vaccination of children born between 1994 and 2013 will prevent 322 million illnesses, according to the CDC.

But resistance to vaccination has existed nearly as long as vaccination itself. And Biss found that questions about vaccination were also questions about environmentalism, citizenship and trust in the government. Biss traces some of this history in a series of essays called On Immunity: An Inoculation.

Interview Highlights Additional Information: On Immunity

An Inoculation

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More on this book:

On finding "middle ground" in a highly politicized issue

In writing this book, I became very wary of the idea of a middle ground. What I saw when I was doing research is that in pursuit of a middle ground, people will kind of split the difference between the two extremes that they're hearing. And I think what's problematic is that people are seeing vaccinating on schedule, on time as an extreme position. So they're splitting the difference between that and the other extreme — which is not vaccinating at all — and doing partial or spaced-out vaccinations. And I'm not actually convinced that that's a viable middle ground.

On "splitting the difference between information and misinformation"

There's a great blog, Science-Based Medicine — and one of the writers on that blog pointed out that when you split the difference between information and misinformation, you still end up with misinformation. So I think there are situations where a middle ground is not desirable. Though I'm the kind of thinker who's very drawn to compromises and to nuances, I think in this particular area, the position that is sometimes seen as extreme — which is vaccinating a child fully and on time — I've come to believe is not an extreme position. I think that protecting children at the age where they're most vulnerable against diseases that are highly contagious is prudent.

On whether the medical community has done enough to educate the public and counter misinformation

I think they're working very hard and I think there are some great minds going at it. But I think that sometimes what the medical community is doing is too limited. And I don't think that's necessarily their fault. They're often addressing medical questions. And I don't think that this debate is always a medical debate — I think it's actually often not a medical debate. I think it's often a social debate. And I think that people's resistance to vaccination isn't going to disappear until we address some of the nonmedical reasons for that resistance and people's discomfort and distrust of the government. That's bigger than what most medical professionals can handle.

Eula Biss is also the author of Notes From No Man's Land and The Balloonists.

Graywolf Press

On the way distrust of the government affects the way parents view vaccination

This isn't the only country where you see that causing a problem. There are countries where it's a much bigger problem, and those tend to be countries where the political situation is much worse than it is here. Nigeria and Pakistan are two countries that have had a lot of trouble with polio. And part of the reason is that there's a lot of political unrest and people really distrust what the government is doing. That has an effect on people's health and it has an effect on the health of children. And so, this is one more reason for us to be invested in good political systems, because it's a public health concern.

On how to understand the modern anti-vaccination movement

There are so many different reasons people don't vaccinate that I'm not even sure it can be looked at as a cohesive movement. Some people have concerns that are really health-based, and some people are resisting capitalism when they resist vaccination. Some people are resisting what they feel is the corrupt pharmaceutical system and corrupt medical system. So there are all kinds of different angles here, and I do think I came to understand all of them better through this research. And I also came to understand my own reservations better.

Shots - Health News How Vaccine Fears Fueled The Resurgence Of Preventable Diseases

On making choices for her own son

Really, the project of this book — it's a social critique, but it started out as a self-critique. I was curious about why I, myself, was reluctant to vaccinate my son. And that did give me some insight into why other people aren't vaccinating. I would prefer for my son to have as little medical care as possible, as little contact with the medical system as possible. I think vaccination is actually one way to try to help ensure that — making sure that he doesn't get something like pneumonia that might mean a hospital stay, where things will be done to him that will make me uncomfortable or that he will be treated in a way that might feel excessive to me. I think the best way for me to keep him out of that system is to engage in this highly effective preventative medicine.

Read an excerpt of On Immunity

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4 Years Of Lessons Learned About Drugmakers' Payments To Doctors

Mon, 09/29/2014 - 3:36pm
4 Years Of Lessons Learned About Drugmakers' Payments To Doctors September 29, 2014 3:36 PM ET

Partner content from

Listen to the Story 4 min 11 sec  

On Tuesday, the federal government is expected to release details of payments to doctors by every pharmaceutical and medical device manufacturer in the country.

The information is being made public under a provision of the 2010 Affordable Care Act. The law mandates disclosure of payments to doctors, dentists, chiropractors, podiatrists and optometrists for things like promotional speaking, consulting, meals, educational items and research.

It's not quite clear what the data will show — in part because the first batch will be incomplete, covering spending for only a few months at the end of 2013 — but we at ProPublica have some good guesses. That's because we have been detailing relationships between doctors and the pharmaceutical industry for the past four years as part of our Dollars for Docs project.

We've aggregated information from the websites of some large drug companies, which publish their payments as a condition of settling federal whistle-blower lawsuits alleging improper marketing or kickbacks. Today, in cooperation with the website Pharmashine, we've added data for 2013, which now covers 17 drug companies accounting for half of United States drug sales that year. (You can look up your doctor using our easy search tool.)

Here are some facts we've learned from the data.

Many, many health professionals have relationships with industry.

Dollars for Docs now includes 3.4 million payments since 2009, totaling more than $4 billion, of which $2.5 billion was for research. For 2013 alone, there were 1.2 million payments valued at nearly $1.4 billion.

It's not possible to calculate the exact number of physicians represented, because drug companies haven't used unique identification numbers that cross company lines. But it's clear that the figure is in the hundreds of thousands.

Excluding research payments, the drugmaker Pfizer appeared to have interactions with the most health care professionals last year — about 142,600. AstraZeneca came in second with about 111,200. Johnson & Johnson and Forest Labs each had nearly 100,000. There are an estimated 800,000 to 900,000 active doctors in the United States.

"Most physicians that are in private practice are touched in some way" by the industry, said George Dunston, co-founder of Obsidian HDS, the creator of Pharmashine.

Surveys conducted in 2004 and again in 2009 showed that more than three-quarters of doctors had at least one type of financial relationship with a drug or medical device company. The figure dropped from about 94 percent in 2004 to 84 percent in 2009, said the lead author, Eric Campbell, a professor of medicine at Harvard Medical School and director of research at the Mongan Institute for Health Policy at Massachusetts General Hospital.

Dr. Campbell, who has been critical of physician-industry ties, says he hasn't conducted a follow-up survey but suspects that the percentage of doctors receiving payments has probably decreased somewhat since then.

"I think they're being much more targeted and specific," he said.

Some doctors have relationships with many companies.

Those who read the fine-print disclosures accompanying medical journal articles know that doctors often have relationships with several companies that compete in a drug category (such as heart drugs or those for schizophrenia). Our data bear that out.

Some highly sought-after key opinion leaders, as they are known in the industry, work for half a dozen or more companies in a given year.

Dr. Marc Cohen, chief of cardiology at Newark Beth Israel Medical Center, received more than $270,000 last year for speaking or consulting for six companies listed in Dollars for Docs. He is a prolific researcher and author.

In an interview, Cohen said he works only with companies whose drugs are backed by large clinical studies. "In general terms, the science behind the product is very strong," he said.

The biggest companies aren't always the ones that spend the most. Some smaller drug companies spend big, too.

Consider Forest Labs, a midsize drug company that was acquired in July by Actavis, a larger company based in Dublin. Forest's $3.8 billion in United States drug sales in 2013 placed it on the edge of the top 20 companies, according to IMS Health, a health information company.

Its sales were far lower than those of Novartis and Pfizer, the top two companies by sales last year. Yet Forest easily outspent these competitors on promotional speaking events last year.

Forest spent $32.3 million on paid talks in 2013, compared with $12.7 million for Novartis and $12.6 million for Pfizer.

An Actavis spokesman declined to comment on the company's strategy, but a Forest spokesman said last year that the company spent more on speakers because it didn't use pricey direct-to-consumer TV marketing. It also had more new drugs than its competitors.

Companies with newer drugs or newly approved uses for their existing drugs often seem to spend more. Companies that don't have many new products or have lost patent protection on their drugs, or are about to lose it, tend to pull back.

"A lot of this has to do with where companies are in their development cycle of new products or emerging products, rather than an industry-specific trend," said John Murphy, assistant general counsel at the Pharmaceutical Research and Manufacturers of America, an industry trade group.

Meals vastly outnumber all other interactions between drug companies and doctors. But they account for a much smaller share of costs.

Food accounted for nearly 50,000 of Amgen's 55,000 payment reports, excluding research, in 2013, or roughly 91 percent. But at a cost of $3.1 million, those meals represented only about 20 percent of its payments. By comparison, the company spent almost double that amount, $6 million, on just 600 physician speakers.

Other companies followed the same pattern; speakers can command $2,000 to $3,000 per engagement, or more.

Given doctors' busy schedules treating patients, mealtimes are often the only time to reach them, said Murphy, PhRMA's lawyer.

Researchers say that whatever the motivation, even small gifts or meals can influence a doctor's perception of a drug and lead to more prescribing of it.

ProPublica is a nonprofit investigative reporting newsroom based in New York.

Copyright 2014 ProPublica. To see more, visit http://www.propublica.org/.
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More Active Play Equals Better Thinking Skills For Kids

Mon, 09/29/2014 - 2:12pm
More Active Play Equals Better Thinking Skills For Kids September 29, 2014 2:12 PM ET

Good for bodies and good for brains, the scientists say.

iStockphoto

As schools cut down on physical education and recess, kids are spending more time than ever in a desk. And while nerdy second-graders like me didn't ever consider arguing for more gym, there's increasing evidence that being active helps not just children's waistlines but their brains.

Shots - Health News To Get Kids Exercising, Schools Are Becoming Creative

"If you consider the anthropology of humankind, we were designed to move," Charles Hillman, a professor of kinesiology at the University of Illinois at Urbana-Champaign tells Shots.

Shots - Health News Why Exercise May Do A Teenage Mind Good

Hillman and colleagues have added more evidence as to how activity helps kids. His study, published Monday in Pediatrics, shows 7- to 9-year-old children who run around and play like, well, children, for at least 70 minutes a day show improved thinking skills, particularly in multitasking, compared to children who aren't as active.

The researchers looked at a nine-month after-school program, called Fitness Improves Thinking in Kids (FITKids) at the University of Illinois. The 109 students met after school nearly every day for a snack and a quick lesson on fitness and nutrition. Most importantly, the children spent 70 minutes running around and playing tag, soccer, jump rope and other games. The focus was not on competition, but playing like kids normally do.

Brain activity during the multitasking test for active kids (left) and non-active kids (right). Red indicates more activity, blue indicates less.

Courtesy of Charles Hillman

"Kids tend to move and get their exercise intermittently," says Hillman. "They don't go out and run four miles" like an adult might."

In one multitasking test, children were shown a character on the screen and indicated with a thumb press whether the character was a certain color and a certain shape. The kids who had participated in FITKids were significantly faster and more accurate at identifying the color and shape than children who weren't exercising.

Scans of the FITKids children's brains showed increased brain activity during the task, in a network known to correspond to paying attention. Interestingly, the changes in brain activity correlated to the amount of time kids spent in FITKids. The more times they attended, the greater the change.

The researchers also looked at the children's ability to selectively focus attention and resist distraction, but did not find as strong an association with physical activity.

Shots - Health News To Make Children Healthier, A Doctor Prescribes A Trip To The Park

Hillman says the significant effects resulted from only small changes to the kids' activity. "We're not taking them from low-fit to high-fit," he says. "We're taking them from low-fit to slightly-less low-fit." In fact, the overall change in fitness was only about 6 percent.

Other scientists say this is yet more evidence that physical activity improves school performance. "It might actually help," says Catherine Davis, a professor of pediatrics at Georgia Regents University. "I think that parents need to go to the educators and say, 'Why is my child sitting down for six hours a day when he's a 7-year-old boy and he needs to move?' "

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

What We Don't Know About Heart Disease Can Kill Us

Mon, 09/29/2014 - 1:10pm
What We Don't Know About Heart Disease Can Kill Us September 29, 2014 1:10 PM ET iStockphoto

Heart disease is the number one killer of people worldwide, so you'd think that we'd be up to speed on the risks. Evidently not, based on a poll of people in the United Kingdom.

Are you smarter than a Brit when it comes to risk factors? Take our quickie quiz and find out:

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So are you smarter than a Brit? Here's how the 2,000 people polled by the British Heart Foundation fared:

  • Ninety percent wrongly believe that high blood pressure comes with symptoms. Alas, no.
  • One-third of people don't realize that smoking doubles the risk of having a stroke or heart attack.
  • Half of Brits said there's no link between diabetes and heart disease. In fact, people with diabetes are twice as likely to develop heart disease, and often at a younger age.
  • And maybe you don't want to worry, but cardiovascular disease is much more likely to kill you than cancer, HIV or Ebola. Heart attacks and stroke are the number one and number two causes of death, according to the World Health Organization, accounting for 14 million deaths each year.

We Americans may be a bit more up to speed than our colleagues across the pond, according to surveys by the American Heart Association. A 2013 poll found that 23 percent of Americans consider themselves at risk for heart disease, and 14 percent think it's the greatest health problem facing Americans, behind obesity and cancer.

Shots - Health News I Thought It Was Just Stress, Until It Broke My Heart

Even better, the vast majority of people know they should be exercising more, lowering blood pressure, reducing cholesterol levels and dropping the cigs to reduce their risk.

Still, 43 percent of Americans think their heart health is ideal, according to the heart association poll, even though 8 percent of those folks have been diagnosed with a heart condition, and two-thirds have at least one health issue that puts them at risk.

And even though we know how to reduce risk, we aren't stepping up our efforts to have a healthy heart.

You can put me in the lazy optimist camp. Maybe it's time for me to stop typing and head out for a walk.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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A Doctor Unlocks Mysteries Of The Brain By Talking And Watching

Mon, 09/29/2014 - 3:26am
A Doctor Unlocks Mysteries Of The Brain By Talking And Watching September 29, 2014 3:26 AM ET Listen to the Story 7 min 55 sec  

Dr. Allan Ropper speaks with residents and fellows as they do rounds at the neuroscience intensive care unit at Brigham and Women's Hospital in Boston.

M. Scott Brauer for NPR

The heavyset man with a bandage on his throat is having trouble repeating a phrase. "No ifs ..." he says to the medical students and doctors around his bed at Brigham and Women's Hospital in Boston.

"Can I hear you say no ifs, ands or buts?" says Dr. Allan Ropper, the Harvard neurologist in charge. The patient tries again. "No ifs, buts, ands or," he says.

Ropper has heard enough. "I think he's probably had a little left temporal, maybe angular gyrus-area stroke," he tells the students and doctors, once they're assembled outside the patient's room. A brain scan confirms his diagnosis.

Later, Ropper tells me that the patient's inability to repeat that simple phrase told him precisely where a stroke had damaged the man's brain. "What we did was, on clinical grounds we nailed this down to a piece of real estate about the size of a quarter," he says.

This reliance on bedside observation and conversation is what makes neurology such a remarkable specialty, Ropper says. "The rest of medicine has moved very strongly toward laboratory diagnosis" and scans like MRI and CT, he says. But the brain, he says, "is too complicated to believe that by looking just at the images you can sort out what's going on for an individual patient."

Ropper says a neurologist's job is to find a way to understand the odd landscape of a damaged brain.

M. Scott Brauer for NPR

Ropper shows me example after example of this as I follow him on rounds. The hospital allowed me to record what I saw and heard so long as I didn't use the names of any patients.

In one room, we meet a woman in her late 60s who came in for back surgery but ended up with another problem. "I came out of surgery and I opened my eyes and everything was double," she says.

The surgeons thought her double vision might be from a stroke. But Ropper checks the muscles that control her eyes and realizes they're being affected by something else.

"Do you have trouble with your eyelids drooping?" he asks. "Do you have trouble with your head staying upright at the end of the day?" The woman answers yes to both questions.

Ropper suspects she has myasthenia, a disease that causes muscles to weaken rapidly with use. So he has her repeatedly squeeze a rolled-up blood-pressure cuff. The pressure gauge on the cuff shows that each squeeze is weaker than the previous one.

That clinches the diagnosis for him, although a blood test will eventually confirm his bedside assessment. "That's an example of the craft of neurology," Ropper says. "There's no book that would have extracted that diagnosis from that lady."

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When someone develops a serious brain problem, Ropper says, it can be like falling down a rabbit hole and entering an Alice in Wonderland world — where nothing looks or works the way it's supposed to. A neurologist's job is to find a way to understand the odd landscape of a damaged brain, he says.

"You're querying the organ that has the problem and you're asking it to talk to you, but it can't do it properly because of that damage," he says. "That's the Alice in Wonderland part. You have to figure out with mirrors and metaphors how to get at the problem."

Ropper and coauthor Brian Burrell describe that process in a new book, called Reaching Down the Rabbit Hole. An entire chapter is devoted to patients whose problems cannot be detected by any test or scan.

We meet one of these patients during morning rounds. She's a charming, soft-spoken woman in her 30s who says her left leg is so weak she can't move it.

Ropper turns the exam over to Dr. Shamik Bhattacharyya, a senior resident at Brigham and Women's. It's a part of Ropper's mission to make sure the next generation of neurologists also knows how to reach down the rabbit hole.

During a long conversation, the woman tells Bhattacharyya about a similar episode a few months earlier. At the time, doctors ordered nerve conduction studies, ultrasound, MRI — pretty much everything medical technology has to offer. Nothing turned up a problem.

So Bhattacharyya tries a low-tech approach that doctors have been using for a century. He has the woman lie on her back and lift her healthy leg. When the woman does this, she involuntarily pushes down hard with the supposedly disabled leg.

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Neurologists know this as Hoover's sign and it confirms what Bhattacharyya suspected. The problem isn't physical; it's psychological. But it's hard to treat, Ropper says, because the weakness is very real to the person experiencing it.

"You've got a normal functioning brain that somehow goes out of its way to produce blindness, paralysis, tremor, walking difficulty and so on," he says "There's no other organ that does that. Your liver doesn't decide one day to wake up and say, I'm going to feign liver failure."

But the brain isn't like other organs. And Ropper says that's why he gets up and goes to work each day.

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

'Courage Unmasked' Turns Symbol Of Cancer's Torture Into Art

Sun, 09/28/2014 - 5:43am
'Courage Unmasked' Turns Symbol Of Cancer's Torture Into Art September 28, 2014 5:43 AM ET

fromWPLN

Emily Whittington, a radiation therapist at Vanderbilt-Ingram Cancer Center, pulls down a cancer patient's mask. Originally created to guide radiation beams, some masks are now part of an art exhibit.

Emily Siner/NPR

Every 15 minutes, for 10 hours a day, another patient walks into the radiation room at Vanderbilt-Ingram Cancer Center, in Nashville. Each picks up a plastic mesh mask, walks to a machine, and lies down on the table underneath.

Nurses fit the mask over the patient's face and shoulders. And then they snap it down.

"It was awful," says Barbara Blades, who was diagnosed with cancer in her lymph nodes and tongue nine years ago. "It was awful to have your head bolted to a table. Not being able to move. Not being able to move your head."

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"I can remember lying there, thinking that I'm glad I'm not claustrophobic," says Oscar Simmons, who had cancer in his tonsils.

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"I sort of fibbed to myself," says Bob Mead, who was diagnosed with salivary gland cancer in 2011. "I thought, if I had to, I could sit up and pull the mask off."

Mead later realized he couldn't have pulled up his mask. It's designed to restrain his head so that the radiation targets the exact same spots — down to the millimeter — across several weeks.

The mask is made out of a kind of white plastic mesh that forms to a patient's face. It's see-through, but it looks almost human, like a ghostly person frozen in place.

Other survivors, like Steve Travis, who had tumors on his throat and neck and went through several weeks of radiation, say it felt comforting under the mask.

But when he finished treatment, Travis says, just thinking about the mask made him angry.

"Because it sort of represented everything that had happened for the last four months," he says. "And, so I destroyed it."

Cancer patient Troy Creasey lies under a radiation machine at Vanderbilt-Ingram Cancer Center. Radiation therapists snap it to the table to keep his head in place.

Emily Siner /NPR

Travis took it out to a family farm in West Tennessee and set it up next to a tree. He shot at it with two magazines from a .45 automatic — and then, for good measure, he burned it.

"I kept it for the longest time, and it just sat there," says Barbara Blades, the woman with tongue cancer. "I couldn't bring it myself to throw it away, because I had radiation five days a week for seven weeks. It was a part of me for that amount of time."

Blades ended up keeping the radiation mask in her garage. She finally threw it out after it was damaged during a flood four years ago.

But Bob Mead, who had salivary gland cancer, held onto his mask with a sense of pride.

"It's shaped like me. It fits me," Mead says. "It's like a favorite pair of jeans. People might not think of a mask that fondly, but there's a familiarity to it. But the mask is actually part of me, and it's that badge of honor that I have survived what is believed to have killed my cancer."

Oscar Simmons, who had tonsil cancer, gave it to an artist who turned the mask into a sculpture of a mountain with a landscape around it.

"Its goal is to restrain, and they're going to expand," Simmons says. "And so, it's a thing of contrasts, I guess."

As for Mead's mask — he still hasn't decided what to do with it.

Arts & Life One Sculptor's Answer To WWI Wounds: Plaster, Copper And Paint

" Mine's actually sitting on my sun porch, on my shelf," he says.

Every once in a while, he says he'll pick it up and put it on his face. It still fits. And that's OK, he says, because now, he's free to take it off.

Copyright 2014 Nashville Public Radio. To see more, visit http://www.wpln.org/.
Categories: NPR Blogs

Unmasked, Cancer Survivors Face The Symbol Of Their Torture

Sun, 09/28/2014 - 5:43am
Unmasked, Cancer Survivors Face The Symbol Of Their Torture September 28, 2014 5:43 AM ET

fromWPLN

Listen to the Story 4 min 5 sec  

Emily Whittington, a radiation therapist at Vanderbilt-Ingram Cancer Center, pulls down a mask intended to guide radiation beams into patients with head and neck cancer.

Emily Siner/NPR

Every 15 minutes, for 10 hours a day, another patient walks into the radiation room at Vanderbilt-Ingram Cancer Center in Nashville. Each picks up a plastic mesh mask, walks to a machine, and lies down on the table underneath.

Nurses fit the mask over the patient's face and shoulders. And then they snap it down.

"It was awful," says Barbara Blades, who was diagnosed with cancer in her lymph nodes and tongue nine years ago. "It was awful to have your head bolted to a table. Not being able to move. Not being able to move your head."

Shots - Health News Breast Cancer Patients Seek More Control Over Research Agenda

"I can remember lying there, thinking that I'm glad I'm not claustrophobic," says Oscar Simmons, who had cancer in his tonsils.

Shots - Health News Insurers Cautious As Proton Beam Cancer Therapy Gains Popularity

"I sort of fibbed to myself," says Bob Mead, who was diagnosed with salivary gland cancer in 2011. "I thought, if I had to, I could sit up and pull the mask off."

Mead later realized he couldn't have pulled up his mask. It's designed to restrain his head so that the radiation targets the exact same spots — down to the millimeter — across several weeks.

The mask is made out of a kind of white plastic mesh that forms to a patient's face. It's see-through, but it looks almost human, like a ghostly person frozen in place.

Other survivors, like Steve Travis, who had tumors on his throat and neck and went through several weeks of radiation, say it felt comforting under the mask.

But when he finished treatment, Travis says, just thinking about the mask made him angry.

"Because it sort of represented everything that had happened for the last four months," he says. "So I destroyed it."

Cancer patient Troy Creasey lies under a radiation machine at Vanderbilt-Ingram Cancer Center. Radiation therapists snap the mask to the table to keep his head in place.

Emily Siner /NPR

Travis took it out to a family farm in West Tennessee and set it up next to a tree. He shot at it with two magazines from a .45 automatic — and then, for good measure, he burned it.

"I kept it for the longest time, and it just sat there," says Barbara Blades, the woman with tongue cancer. "I couldn't bring it myself to throw it away, because I had radiation five days a week for seven weeks. It was a part of me for that amount of time."

Blades ended up keeping the radiation mask in her garage. She finally threw it out after it was damaged during a flood four years ago.

But Bob Mead, who had salivary gland cancer, held onto his mask with a sense of pride.

"It's shaped like me. It fits me," Mead says. "It's like a favorite pair of jeans. People might not think of a mask that fondly, but there's a familiarity to it. But the mask is actually part of me, and it's that badge of honor that I have survived what is believed to have killed my cancer."

Oscar Simmons, who had tonsil cancer, gave it to an artist who turned the mask into a sculpture of a mountain with a landscape around it as part of a project called Courage Unmasked, which has turned dozens of masks from survivors into art.

"Its goal is to restrain, and they're going to expand," Simmons says. "And so, it's a thing of contrasts, I guess."

As for Mead's mask — he still hasn't decided what to do with it.

Arts & Life One Sculptor's Answer To WWI Wounds: Plaster, Copper And Paint

"Mine's actually sitting on my sun porch, on my shelf," he says.

Every once in a while, he says he'll pick it up and put it on his face. It still fits. And that's OK, he says, because now, he's free to take it off.

Copyright 2014 Nashville Public Radio. To see more, visit http://www.wpln.org/.
Categories: NPR Blogs

I Thought It Was Just Stress, Until It Broke My Heart

Sat, 09/27/2014 - 5:25pm
I Thought It Was Just Stress, Until It Broke My Heart September 27, 2014 5:25 PM ET Katherine Streeter for NPR

That Friday, I was dizzy and sick to my stomach with what felt like food poisoning, only sometimes my chest throbbed. I declined my husband's offer of a ride to the emergency room because I had to prepare for a crucial school meeting on Monday.

Our six-year-old son, a gifted child with a disability, had been repeatedly sent home for eloping from class and disruptive behavior. The school had laid a paper trail to ship him to a more restrictive program across town, but I was blocking the exits. My goal for Monday was to keep him in his class and get him support to develop coping skills. I was afraid he would learn to hate school.

While I liked my new job, day care kept evaporating. One after-school program kicked our son out without notice while my husband was out of the country. Our kid had already trashed the other semi-affordable options. Hey, but what working mom isn't stressed? It seemed that whenever I solved one problem, another wrapped a tentacle around my leg to drag me down.

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The day before I got sick, I received emails that another school parent had been circulating for months, making our son out to be a menace to society and lobbying to have him removed from school.

At the Monday meeting, we were congratulated on our son's progress. He was welcomed to second grade, where he would receive a trained aide. I was relieved.

But I could feel my heartbeat flicker erratically. It didn't hurt, but it wasn't normal, so after work I asked my husband to take me to the emergency room. A burly nurse with a tattooed neck joked during the electrocardiogram. But his expression changed as he looked at the screen. With breathtaking speed I was hoisted onto a gurney, stripped, wrapped in a hospital gown, had an IV jammed in each arm and was pumped full of heparin.

Somebody told me I was having a heart attack.

"Your troponin levels are rising," said a doctor who resembled a hedgehog with glasses. "It's a protein your heart gives off when it is damaged." People kept asking me about chest pain, but I had none.

"I'm sorry for leaving you with the kids!" I called to my husband as EMTs rolled me away. I feared that not going to the emergency room earlier may have fatally damaged my heart.

An echocardiogram showed that my left ventricle had ballooned and the tip of my heart wasn't working. I was scheduled for an angiogram the next morning. Any artery blockage, and I'd get a stent.

On Tuesday I lay sedated in a chilly operating room while a cardiologist snaked a probe through a vein in my right wrist straight to my heart. The last time I got narcotics this good was when I gave birth to the twins.

I woke up afterward with my right wrist in a splint, but no stent in my heart. The cardiologist looked pleased. "Your arteries are completely clear," he said.

I was shocked. My dad had a heart attack at 40, but he was a smoker. I was in my early 50s, and I knew that with less estrogen my risk of heart disease was rising. What I didn't realize is that symptoms of a heart attack in women are different from those in men.

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But it turned out that I hadn't had a heart attack at all. Instead, it was a rare condition called Takotsubo cardiomyopathy or "heartbreak syndrome" that mimics one.

The cardiologist said he saw perhaps 25 cases a year out of hundreds of heart patients. Triggered by intense emotional or physical stress, the left heart ventricle distends to resemble the shape of a traditional Japanese octopus trap. Cases tend to spike after earthquakes and hurricanes, particularly in women past menopause.

I hadn't experienced an earthquake. I had been internalizing too much stress for too long. The doc told me that my heart now pumped at only two-thirds of normal capacity, but that the damage would likely heal within months.

And a few months since being takotsubo-ed, I am stronger. Our son's behavior has been stellar in second grade. He adores his teacher. A trained "class substitute" helps everybody out; and both our children have made new friends in the city after-school program that welcomes all kinds of kids.

The poison-letter writer moved out of the district. One parent invited my son to join his child's Aikido dojo. A neighbor offered help with after-school pickup.

I have used my reprieve to take my kids to the beach as often as possible. I wear a red bikini under my rash guard. Yoga irks me, but I'm trying to touch my toes anyway. Retraining the stress response of a lifetime is difficult, but it helps to remind myself what I can't control and what I can.

My heart's got to keep going for another 30 or 40 years.

Wendy Wolfson is a science writer in Orange County, Calif.

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

Will .Health Make It More Likely That You'll Get Scammed?

Fri, 09/26/2014 - 12:55pm
Will .Health Make It More Likely That You'll Get Scammed? September 26, 201412:55 PM ET

Double-check that URL before you diagnose yourself.

iStockphoto

You wake up feeling gross – stuffy and full of aches. A quick Google search of your symptoms confirms that yes, you probably have a cold and not the plague. But what if you were directed to a site that had a legitimate sounding name but wasn't really accurate at all?

It sounds like a problem from the ancient days of the Internet. Since then people have learned that .gov leads to bona fide government sites, but .com could be anyone selling you anything.

How do you feel about .health? A new slew of web domains is coming down the pike, like ".health," ".doctor," and ".clinic." They're not required to have any medical credentials. That's deeply worrying to some public health advocates.

Blog Of The Nation Social Media Medicine

"When [consumers] see .edu, they consider it an educational institution," says Tim Mackey, director of the Global Health Policy Institute at the University of California, San Diego School of Medicine. He worries that a consumer reading diet.health, for example, will follow its dietary recommendations, without knowing their validity.

He gives the example of Ryan Haight, a teenager who died in 2001 from an overdose of prescription drugs illegally purchased from an online pharmacy, and of the sites selling bogus cures that popped up during the H1N1 flu epidemic.

"There's an Ebola outbreak going on," Mackey says. "If I wanted to take advantage of this option I may sign up for ebola.health." That, he says, would look more legit than ebolacures.com.

Until the legitimacy of .healths can be addressed, Mackey wants a moratorium on the .health domain.

While we might pay a few hundred bucks to buy a personal domain name, the people who own domains like .health pay millions of dollars to an international nonprofit corporation, the Internet Corporation for Assigned Names and Numbers (ICANN), for domain rights. Since 2013, this has been bidding and auctioning process, with the highest bidder walking away with the ability to dole out thousands, even millions of new sites tagged with a domain.

Shots - Health News Who's Watching When You Look For Health Information Online?

In 2011, ICANN announced it was selling a list of new health-related domain names (.health, .doctor and .med, among others). A number of leading health groups including the World Health Organization, the World Medical Association and Save the Children started calling foul.

The problem, they say, is that there's no system in place for vetting ownership of the health domains.

A company called DotHealth, LLC was awarded the domain just weeks ago, after other bidders bowed out. It could sell www.tobacco.health to the American Lung Association or to a tobacco company, Mackey says, but the two sites would be very different.

"[Buying a .health domain] absolutely falls into the tobacco industry's decades-long history ... of associating its products with health," John Stewart, Director of the Challenge Big Tobacco Campaign, tells Shots. He says companies like McDonald's are likely to grab sites like www.mcdonalds.health "to associate its unhealthy food with healthy things."

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Mackey authored a commentary in the journal Globalization and Health warning of these potential dangers. He says companies like Phillip Morris who can pay big money to companies like DotHealth,LLC for the names, whether it's www.vaccines.health or www.miraclecure.health, are going to win out.

The DotHealth, LLC website says the firm won't allow illicit online pharmacies on their domain, but Mackey thinks that's not enough. He wants something closer to the guidelines for .edu, which require accreditation by a third party. Other sites like .aero use an aeronautical trade association to manage use of .aero urls, to ensure that people aren't using .aero sites to sell fraudulent airplane parts.

That's proof that "ICANN has the ability to do this," says Mackey, "but they haven't for this round of domains." He'd like to see a panel of prominent members of the online health community discuss how to govern health-related domains.

ICANN officials say they are leaving it up to the winners of the domain to make the decisions. "ICANN doesn't go about regulating content or dictating the registries themselves," says James Cole, Global Media Coordinator at ICANN.

"We need more time to figure this out," says Mackey, because the impact on people's health could continue for years.

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

Debate Grows Over Employer Health Plans Without Hospital Benefits

Fri, 09/26/2014 - 10:58am
Debate Grows Over Employer Health Plans Without Hospital Benefits September 26, 201410:58 AM ET

Partner content from

There's just one catch: hospital care isn't covered.

iStockphoto

Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits.

"There's not a glitch in this system," said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. "This is the way the calculator was designed."

Timothy Jost is pretty sure the whole thing was a mistake.

"There's got to be a problem with the calculator," said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits "is certainly not what Congress intended," he said.

As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own.

At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act's toughest standard for large employers, the "minimum value" test for adequate benefits.

The software is used by large, self-insured employers that pay their own medical claims but often outsource the plan design and administration. Offering a calculator-certified plan shields employers from penalties of up to $3,120 per worker next year.

Many insurance professionals were surprised to learn from a recent Kaiser Health News story that the calculator approves plans lacking hospital benefits and that numerous large, low-wage employers are considering them.

Although insurance sold to individuals and small businesses through the health law's marketplaces is required to include expensive hospital benefits, plans from large, self-insured employers are not.

Many policy analysts, however, believed it would be impossible for coverage without hospitalization to pass the minimum-value standard, which requires insurance to pay for at least 60 percent of the expected costs of a typical plan.

And because calculator-approved coverage at work bars people from buying subsidized policies in the marketplaces that do offer hospital benefits, consumer advocates see such plans as doubly flawed.

Kaiser Health News asked the Obama administration multiple times to respond to criticism that the calculator is inaccurate, but no one would comment.

Calculator-tested plans lacking hospital benefits can cost half the price of similar coverage that includes them.

While they don't include inpatient care, the plans offer rich coverage of doctor visits, drugs and even emergency-room treatment with low out-of-pocket costs.

Who will offer such insurance? Large, well-paying employers that have traditionally covered hospitalization are likely to keep doing so, said industry representatives.

"My members all had high-quality plans before the ACA came into existence, and they have these plans for a reason, which is recruitment and retention," said Gretchen Young, a senior vice president at the ERISA Industry Committee, which represents very large employers such as those in the Fortune 200. "And you're not going to get very far with employees if you don't cover hospitalization."

But companies that haven't offered substantial medical coverage in the past — and that will be penalized next year for the first time if they don't meet health-law standards — are very interested, benefits advisors say.

They include retailers, hoteliers, restaurants and other businesses with high worker turnover and lower pay. Temporary staffing agencies are especially keen on calculator-tested plans with no hospital coverage.

"We've got many dozens of staffing-firm clients," said Alden Bianchi, a benefits lawyer with Mintz Levin in Boston. "All of them are using these things."

Advisors and brokers declined to identify employers sponsoring the plans, citing client confidentiality.

Benefits administrators offering the insurance say it makes sense not only for employers trying to comply with the law at low cost but for workers who typically have had little if any job-based health insurance.

"This is a stepping-stone to bring in employers who have never [offered] coverage and now they're willing to come forward and do something," said Bruce Flunker, president of Wisconsin-based EBSO, a benefits firm.

The plans are an upgrade for many workers at retailers, staffing agencies and similar companies, he said.

"OK, if I go to the hospital I don't have coverage," he said. "But I don't have [hospital] coverage now. And what I get is a doctor. I can go to a specialist. I get a script filled at the pharmacy. I get real-life coverage."

Companies considering such plans include a restaurant chain with 1,000 workers, a trucking firm with 500 employees and dependents, a delicatessen, a fur farm and firms working the oil boom in upper Midwest, Flunker said.

Employer interest in the plans "is definitely picking up pretty quickly," said Kevin Schlotman, director of benefits at Benovation, an Ohio firm that designs and administers health coverage. "These are organizations that are facing a significant increase in expenses. They're trying to do their best."

Because hospital admissions are rare, plans paying for routine care are more valuable to low-wage workers than coverage of expensive surgery and other inpatient costs, say consultants offering them.

Such plans come with deductibles as low as zero for doctor visits and prescriptions and co-pays of only a few dollars, they say. Emergency-room visits cost members in the $250 or $400 range, depending on the plan.

By contrast, health-law-approved insurance with inpatient benefits often includes deductibles — what members pay for all kinds of care before the insurance kicks in — of $6,000 or more.

Generous coverage of routine care is "what these people want," said Shnider. "They want to be able to go to the doctor. Take care of their kids, go to the emergency room."

In some cases, employers sponsoring calculator-approved plans without hospital coverage also offer "fixed indemnity" coverage that does pay some hospital reimbursement, advisors say. But the benefits are typically a small fraction of hospital costs, leaving members with the likelihood of large bills if they are admitted.

Concerned for their reputations, larger administrators are wary of managing benefits without hospitalization, even if they do pass the calculator.

"Our self-funded customers hand out insurance cards to their employees with Blue Cross all over it," said Michael Bertaut, health care economist at BlueCross BlueShield of Louisiana, which has no plans to handle such coverage. "Do we really want someone to present that card at a hospital and get turned away?"

There are two health-law coverage standards that large employers must meet to avoid paying a penalty.

One, for "minimum essential coverage," merely requires some kind of employer medical plan, no matter how thin, with a potential penalty next year of up to $2,080 per worker. Many low-wage employers are meeting that target with "skinny" plans that cover preventive care and not much else, say brokers and consultants.

The calculator tests the health law's second, more exacting standard — to offer a "minimum value" plan at affordable cost to workers. Failure to do so triggers the second penalty, of up to $3,120 per worker.

The argument over the calculator is whether plans carving out such a large chunk of benefits — hospitalization — can mathematically cover 60 percent of expected costs of a standard plan.

They probably can't, Washington and Lee professor Jost said. The fact that the calculator gives similar, passing scores to plans with hospital benefits and plans costing half as much without hospital benefits suggests that it's flawed, he said. Plans with similar scores should have similar costs, he said.

On the other hand, others ask, why did the administration make a calculator that allows designers to leave out inpatient coverage? Why didn't the law and regulations require hospital coverage for self-insured employers — as they do for commercial plans sold through online marketplaces?

"The law and calculator were purposely designed as they are!" Fred Hunt, past president of the Society of Professional Benefit Administrators, said in an email widely circulated among insurance pros. "No 'glitch' or unintended loophole."

"That's baloney," said Robert Laszewski, a consultant to large insurers and a critic of the health law. "Nobody said we're going to have health plans out there that don't cover hospitalization. That was never the intention ... I think they just screwed up."

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

To Predict Nobel Winners, Skip Vegas And Check The Fine Print

Thu, 09/25/2014 - 4:47pm
To Predict Nobel Winners, Skip Vegas And Check The Fine Print September 25, 2014 4:47 PM ET

Molecular biologist Randy Sheckman, who shared the 2013 Nobel Prize in physiology or medicine, acknowledges applause after receiving his prize during the ceremony in Stockholm last December.

Pascal Le Segretain/Getty Images

Some people like to bet on horses. Others wager on football games. And while there may not be any money in picking the next Nobel Prize winner, that's no reason not to have a little fun trying.

On Monday Oct. 6, a scientist or two, or maybe even three, will get called from Sweden with good news about the Nobel Prize for physiology or medicine. Who will it be?

Some folks at Thomson Reuters have some ideas. They've essentially pored over the footnotes in scientific papers to figure out whose work has been referenced the most often in influential journals.

The analysis was a little bit more complicated than that. They crunched the numbers in databases of citations to figure out how many times possible winners got their papers cited. They also compared that number with how many times average scientists in the field got their papers cited.

The analysts, working in Thomson Reuters' intellectual property and science unit, went beyond these numbers: They handicapped the work subjectively. They gave credit to research that overturned dogma or has already made a big difference in science or medicine. As you would expect, the Nobel committee often likes that type of research.

The analysts also considered whether a Nobel has been awarded in the last couple of years for work in the same general area. If so, it's likely the prize committee would wait a while to recognize even worthy research.

Who are the scientists to watch?

A drum roll, please, for this year's Citation Laureates, as Thomson Reuters calls them, for physiology or medicine. Consider it the research Daily Racing Form.

For fundamental discoveries concerning eukaryotic transcription and gene regulation:

James E. Darnell Jr., Rockefeller University, New York

Robert G. Roeder, Rockefeller University, New York

Robert Tjian, University of California, Berkeley, and president of the Howard Hughes Medical Institute

"These are real giants of molecular biology," says David Pendlebury, an analyst with Thomson Reuters. They helped unravel details about how and when cells turn on genes. That is, how cells know when to synthesize RNA using the DNA, so it can make proteins. "You scratch your head: Why didn't these guys win already?" Pendelbury tells Shots.

For elucidating molecular mechanism of pain sensation:

David Julius, University of California, San Francisco

The work, begun in the 1990s, used capsaicin, the chemical that makes peppers hot. "It's fundamental science," Pendlebury says, but researchers in academia and industry are already making use of the insights to come up with potential new therapies for pain, anxiety and depression.

For their discovery of large-scale copy number variation and its association with specific disease:

Charles Lee, Jackson Laboratory for Genomic Medicine, Farmington, Conn.

Stephen W. Scherer, The Hospital for Sick Children and University of Toronto

Michael H. Wigler, Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y.

Each of us has about 20,000 genes on our chromosomes. But large stretches of our genome can get duplicated or even copied several times. The specific number of copies, at each location, can vary quite a bit from person to person.

"Most of the time [this variation] has no effect," Pendlebury says. But Scherer and Wigler have been exploring the association between these genetic duplications and some diseases, such as autism, schizophrenia and even cancer. The work has helped overturn dogma that held individual genetic variation was relatively small.

Since Thomson Reuters began naming Citation Laureates in 2002, 35 of the 211, or 17 percent, have gone on to win Nobel Prizes. When it comes to picking the winners for any given year, it's pretty tough. Pendlebury says the yearly calls have been exactly right five times.

"What we're really doing is saying that our indicators tell us that this person is of Nobel class," he says. "We would expect they'd be a strong contender."

There are somewhere in the neighborhood of 200 to 300 people nominated for each Nobel, he says, so there are always more people of prize caliber than actually win.

"These researchers deserve public recognition, and they don't often get it," Pendlebury says. The Citation Laureate is one way to do it.

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To Prevent Repeat Hospitalizations, Talk To Patients

Thu, 09/25/2014 - 3:23am
To Prevent Repeat Hospitalizations, Talk To Patients September 25, 2014 3:23 AM ET

fromGPB

Listen to the Story 4 min 18 sec  

Kevin Wiehrs is a nurse in Savannah, Ga. But instead of giving patients shots or taking blood pressure readings, his job is mostly talking with patients like Susan Johnson.

Kevin Wierhs and Susan Johnson confer about what works and what doesn't in managing diabetes.

Sarah McCammon/Georgia Public Broadcasting

Johnson, 63, is a retired restaurant cook who receives Medicare and Medicaid. She has diabetes, and has already met with her doctor. Afterward, Wiehrs spends another half-hour with Johnson, talking through her medication, exercise and diet.

"So it sounds like you cut back on your sweets, things that have a lot of sugars in them. What about vegetables, your portions of food?" Wiehrs asks Johnson. "Have you made any changes with that?"

"A little bit," Johnson says. "Ain't gonna lie — a little bit."

Wierhs, 51, was a hospice nurse for 15 years and a social worker before that. Now he is one of five new care coordinators at Memorial Health, a medical system based in Savannah. He was hired to pay special attention to patients with poorly controlled chronic conditions like diabetes and heart disease.

"Some of these patients have fought with their diabetes for many years and get very complacent with the whole situation and feel that, 'No matter what I do, it's not going to make a difference,' " he says. "But it does."

It's hard to persuade people to change, Wiehrs says. And patients are sometimes skeptical about his role in their care. He says they often approach him and say, "I've been coming to this office before; I've seen these physicians. And now you're somebody new. What are you doing, and why do you want to talk to me?"

Getting these patients to trust Wiehrs is an important part of the hospital's strategy for dealing with rising costs. Memorial is investing $500,000 a year in care coordination, in the belief that the program will save money in the long run and improve the quality of care.

Memorial CEO Maggie Gill wants Wiehrs to teach patients to care for themselves.

By improving the management of medical conditions outside the hospital, Gill says, "you can help people prevent crises from happening."

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She says Memorial provides about $30 million in free care each year. Because Georgia is not among the states that have chosen to expand Medicaid under the Affordable Care Act, the hospital is going to continue to give a lot of free care to people who have low income and are uninsured, Gill says. On top of that, Medicare is penalizing hospitals (via lower reimbursements) when patients have to be admitted repeatedly for some specific conditions. Gill hopes Wiehrs can prevent some of those repeat visits.

Gill recalls one Memorial care coordinator who helped with a particularly difficult case — another patient with diabetes who tended to show up in the emergency department two or three times a year. Working with the patient's wife until she felt comfortable measuring her spouse's insulin levels, and comfortable delivering insulin, made a big difference.

"They avoided at least two emergency department visits by having that resource," Gill says.

On a typical day, Wiehrs meets with three or four patients and calls people who have just been released from the hospital.

He says patients end up trusting him. He makes sure they're feeling well, taking their medication and that they know when to come in for a follow-up. Wiehrs gives them his direct phone number so they don't have to hassle with the front office. And for those who can't afford their medications, Wiehrs says, he'll call drug companies or do research online to help find discount drug programs.

"Sometimes you have to get creative and you have to spend the extra time to see what might be available," he says. "That's the benefit of me being a care coordinator and having the experience that I have. I know how to navigate the health care system."

Wiehrs says he's encouraged by the results he's seeing already — like the patient who practically bounded into his office recently, breathing easier thanks to new asthma inhalers.

The hope is that lots of little improvements like that will add up to big savings to the health system — and will improve the health of patients.

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

Copyright 2014 Georgia Public Broadcasting. To see more, visit http://www.gpb.org/.
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Research Institutions Will Have To Identify 'Dual-Use' Pathogens

Wed, 09/24/2014 - 3:11pm
Research Institutions Will Have To Identify 'Dual-Use' Pathogens September 24, 2014 3:11 PM ET

Biohazard suits used to handle dangerous microbes hang in a laboratory at the U.S. Army Medical Research Institute of Infectious Diseases in Fort Detrick, Md.

Patrick Semansky/AP

Any research institution that receives federal funding will soon have to screen certain kinds of scientific experiments to see if the work could potentially be misused to endanger the public.

The new policy will take effect next year, and it's the latest effort by the U. S. government to come to grips with so called "dual-use" biological research—legitimate medical or public health studies that could reveal how to make already-worrisome germs or toxins even more destructive.

Only a small number of experiments are expected to raise this type of concern; one official said a recent review of already-funded research found only a handful of projects. But some of this research, including a lab-altered bird flu virus, has proven hugely contentious, with scientists sharply divided on whether it should even be done.

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Research institutions have long had "biosafety" review boards charged with making sure that infectious agents and toxins will stay safely contained within labs. The new policy means that universities and other federally-funded science organizations will have to consider whether certain kinds of experiments might generate knowledge that could provide a recipe for a weapon or attack.

The required review covers work that involves a list of 15 nasty toxins and pathogens, such as Ebola and anthrax, and seven categories of sensitive experiments that scientists sometimes call "the Seven Deadly Sins." These include studies that could make a germ more deadly or contagious, or that would let it evade existing treatments or diagnostic tests.

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The new policy for research institutions is similar to another one issued in March of 2012 that requires government funding agencies like the National Institutes of Health (NIH) to screen proposed research projects for potential dual-use dangers before issuing grants.

"It's a complementary process," says Amy Patterson, associate director for biosecurity and biosafety policy at the NIH. "I think it is important for institutions and investigators to also gain expertise in the mind-set." As a project is underway, she adds, "They are going to have to be mindful as well of whether dual-use issues emerge during the conduct of the science."

All of this regulatory action came in the wake of a high-profile controversy over two experiments that made a kind of highly-pathogenic bird flu more contagious in ferrets, the lab stand-in for humans. Critics said that the researchers had created super-flus that could cause a pandemic in people, if they ever fell into the wrong hands or got out of the lab.

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The government put a special review process in place for this type of flu research, but scientists are still arguing about the wisdom of conducting research intended to give pathogens new properties, sometimes called "gain-of-function" work.

"The U. S. government's approach to gain-of-function studies is definitely an area that we are actively discussing," says Andrew Hebbeler, assistant director for biological and chemical threats at the White House Office of Science and Technology Policy.

He says officials want advice on gain-of-function studies from a government advisory committee called the National Science Advisory Board for Biosecurity.

That committee reviewed the controversial bird flu experiments back in 2011 and 2012. But the government has not convened this advisory group for almost two years. Federal officials recently appointed a slew of new members and have scheduled a meeting for next month.

"One of the agenda items will include thinking through risks and benefits associated with gain-of-function studies," says Hebbeler. "As these discussions advance within the government, we hope to have more to share with you in the future."

The National Academies of Sciences is also planning to wade into the debate soon, with a symposium that could be held later this year.

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When Cigarettes Cost More, People Drink Less. Except For Wine

Wed, 09/24/2014 - 12:46pm
When Cigarettes Cost More, People Drink Less. Except For Wine September 24, 201412:46 PM ET

Either we smoke or we drink or we break up.

iStockphoto

For those who count Don Draper among their TV loves (or love-to-hates), it comes as no surprise that drinking and smoking go hand in hand. Public health researchers have long known that smokers tend to drink, drinkers tend to smoke, and heavy smokers (see: nearly anyone on Mad Men) tend to drink even more heavily.

We've also known that increasing state taxes on cigarettes actually reduces smoking and helps people break the habit.

Raising cigarette taxes also lowers the amount of drinking, the most recent analysis finds. The study, published Wednesday in Alcoholism: Clinical & Experimental Research, highlights the tie between the vices.

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"It seems logical that as smoking decreases due to these policies that drinking might also decrease," Melissa Krauss, a data analyst at the Washington University School of Medicine and one of the authors of the study, tells Shots.

However, the beneficial effect only applied to beer and spirits, not wine. Wine drinkers, the authors say, are more likely to have healthier lifestyle habits than beer or spirits drinkers. As Krauss says: "[The results] made sense to us because prior research shows that wine drinkers are less likely to smoke." (Granted, this doesn't explain Betty Draper's propensity to light up.)

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Krauss and her fellow researchers analyzed U.S. data between 1980 and 2009, looking at how much alcohol was consumed per state, per person; each state's price for a pack of cigarettes; and their smoke-free air policies.

Controlling for other variables like income, unemployment rate and religious affiliation, they saw the price of cigarettes (a median of just $1.76 per pack in 1980, compared to $5.68 in 2009) and adoption of smoke-free policies increase, while alcohol consumption dropped. States that showed the highest tax increases per pack also showed the greatest reduction in drinking — 26 percent, compared to just 5 percent in states with low cigarette price increases.

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The researchers suggest it's possible to kill two birds with one stone; a 20 percent increase in cigarette price would correlate to a nearly 2 percent reduction in per capita drinking.

"We already know that strengthening tobacco policies has great benefit in reducing smoking prevalence," says Krauss. "This shows that there are unintended consequences that are having good public health benefits as well."

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After The NIH Funding 'Euphoria' Comes The 'Hangover'

Wed, 09/24/2014 - 11:54am
After The NIH Funding 'Euphoria' Comes The 'Hangover' September 24, 201411:54 AM ET

When Richard Larson co-wrote a scientific paper about the perils of up-and-down funding for the National Institutes of Health, he noted that the research cycled between states of "euphoria," and a "hangover" far greater than you'd expect.

The editors of the journal Service Science at first argued that those labels were inflammatory, says Larson who is an engineering professor at the Massachusetts Institute of Technology. But he successfully argued that the wording was spot on.

It turns out there's a natural amplifier in the NIH grant-funding system. It leads to higher highs and lower lows when budgets rise and fall. And Larson's analysis offers lessons for avoiding the pain of boom-and-bust funding that is currently causing some scientists to spend more time writing grant proposals than they spend conducting research.

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The key ingredient in this surprise budget problem is that most grants given out to scientists are promised for four years. One-quarter of the funding is given out in four consecutive years.

One consequence of that system is that in any given year, three-quarters of the budget goes to pay for grants approved in the three previous years. The remaining quarter — for grants that have run their four-year course — is available for new projects.

This formula works fine when funding is the same year to year. But Larson looked at what happens in a year when there's a big increase. It turns out a 20 percent increase in funding for one year leads to a whopping 80 percent increase in money available for new grants. That's a huge jump.

How so? Well, existing grants don't require any more funding than before, so the entire increase goes to new projects. If funding increases from $10 billion to $12 billion, for example, existing grants require three-quarters of the $10 billion — $7.5 billion. That leaves $4.5 billion for new grants. That's a huge jump from the previous year, where new grants garnered $2.5 billion.

That's the "euphoria" part of this equation. But wait. A "hangover" is on the way.

In the case of the real NIH budget, funding doubled between 1998 and 2003. After that, the funding flattened out. Naturally, the existing grants given out during the time of budget increases required a lot more money to support. And as a result, the amount of money available for new grants took a huge tumble.

In fact, money for new grants plunged by more than 35 percent in a single year, according to Larson's simplified mathematical model, even though the overall budget was simply flat.

That's a bad hangover.

"Once you see it in black and white you say, 'Oh my God, it's obvious'," Larson tells Shots. "It's very simple mathematics, but the implications for policy are profound."

Scientists who had the bad fortune of having their grants expire in a hangover year were in big trouble. The chances of getting renewed fell through the floor.

As Larson and his colleagues at MIT and Ohio State University ran the numbers, they found a simple mathematical solution to this. The NIH could have avoided the worst of the hangover by holding back some of the largess, and spreading it out over several years. That's what a prudent business could have done. Not so the NIH. "By federal law they have to spend everything. They can't carry over," he says.

Larson says the NIH can use other techniques to limit funding shocks for scientists. For example, they can adjust the length of grants, so some run three years, some go for four and others go for five. That would reduce the euphoria and hangovers. But it may give some scientists headaches, since they tend to think in terms of four-year funding blocks, and they plan their research accordingly.

Sally Rockey, the NIH Deputy Director for Extramural Research, says the institute is acutely aware of these mathematical quirks, and takes steps to minimize them.

For example, last year the federal budget sequester removed $1.5 billion from the NIH budget, so the agency reduced the number of grants — but also took the extraordinary step of reducing the size of grants that had previously been approved.

This year, congress returned about $1 billion to the NIH budget it had withheld from the sequester, and that enabled NIH to increase the number of new grants approved by 500 to 600, Rockey says. The NIH contemplated the future commitments involved in new grants when deciding how many more to fund. And of course, NIH doesn't know what lies in store for future grants.

"Obviously it would be a lot easier if our budget was on some sort of stable trajectory, if we had something that gave us more predictability and a little growth each year," she tells Shots.

Larson can relate. He's hoping to explore other solutions to the NIH problem — that is, if he can get fresh funding. His four-year NIH grant to study this issue has expired.

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Hearing That Things Can Change Helps Teens Dodge Depression

Wed, 09/24/2014 - 10:17am
Hearing That Things Can Change Helps Teens Dodge Depression September 24, 201410:17 AM ET

Depression is common in teenagers, with 11 percent being diagnosed by age 18, and many more having depressive symptoms. Social and academic stress can trigger depression, and rates of depression tend to peak in adolescence around the age of 16.

It doesn't help that stressed-out teens often fall into hopelessness, says David Yeager, an assistant professor of psychology at the University of Texas at Austin. "When kids have hard things happen to them, they think it'll be like that way into the future."

Researchers started noticing back in the 1980s that many teens felt that social and personality traits were immutable — that someone who is once a loser is always a loser.

So what if we could convince kids that things can change for the better — would that help mitigate the high rates of depression? Yeager tested that out. The results of his latest study, published Monday in Clinical Psychological Science, suggests that it does.

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The study divided 600 ninth-graders into two groups. Half participated in a brief intervention program designed to help them understand that people and circumstances can change. These teenagers were shown several articles, including one about brain plasticity, and another about how neither bullies nor victims of bullying are intrinsically bad.

"We didn't want to say something to teenagers that wasn't believable," Yeager says. "We just wanted to inject some doubt into that problematic world view that people couldn't change."

The students also read advice from older students reassuring them that high school gets better, and they were asked to draw from their own experience and write about how personalities can change.

Nine months later, the researchers checked up on all the students. Among those who didn't participate in the intervention, rates of depression symptoms such as feeling constantly sad and feeling unmotivated rose from 18 percent to 25 percent — about what the researchers expected, Yeager says. The group that participated in this intervention showed no increase in depressive symptoms, even if they said they were bullied.

Of course this is a fairly small study. And the intervention doesn't treat clinical depression. At most, it helps kids who may be prone to depression cope better.

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"I would say the research is at an early stage," says Gregory Walton, an assistant professor of psychology at Stanford University who wasn't involved in the study. "But this is a fairly promising start."

For one, the intervention is pretty easy to start and scale up, Walton says.

And Yeager's previous research indicates that the intervention also helps with aggression and general health. Other researchers have found that similar interventions help teens do better academically.

Like teens, many adults tend to feel that people and circumstances don't change, Walton says. "But adolescence might be a good window of opportunity to target that belief."

Anything that could help prevent the onset of depression in teens is worth testing and trying out, he says. "Depression is a recurrent disorder. Kids who have an episode of depression in adolescence are likely to have another episode as adults," he notes. So intervening early could make a huge impact in a teenager's future.

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