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Life Expectancy In U.S. Drops For First Time In Decades, Report Finds

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December 8, 201612:02 AM ET Heard on Morning Edition Image Source/Getty Images

One of the fundamental ways scientists measure the well-being of a nation is tracking the rate at which its citizens die and how long they can be expected to live.

So the news out of the federal government Thursday is disturbing: The overall U.S. death rate has increased for the first time in a decade, according to an analysis of the latest data. And that led to a drop in overall life expectancy for the first time since 1993, particularly among people younger than 65.

"This is a big deal," says Philip Morgan, a demographer at the University of North Carolina, Chapel Hill who was not involved in the new analysis.

"There's not a better indicator of well-being than life expectancy," he says. "The fact that it's leveling off in the U.S. is a striking finding."

Now, there's a chance that the latest data, from 2015, could be just a one-time blip. In fact, a preliminary analysis from the first two quarters of 2016 suggests that may be the case, says Robert Anderson, chief of the mortality statistics branch at the National Center for Health Statistics, which released the new report.

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Anderson says government analysts are awaiting more data before reaching any definitive conclusions.

"We'll have to see what happens in the second half of 2016," he says.

Still, he believes the data from 2015 are worth paying attention to. Over that year, the overall death rate increased from 724.6 per 100,000 people to 733.1 per 100,000.

While that's not a lot, it was enough to cause the overall life expectancy to fall slightly. That's only happened a few times in the past 50 years. The dip in 1993, for example, was due to high death rates from AIDS, flu, homicide and accidental deaths that year.

On average, the overall life expectancy, for someone born in 2015, fell from 78.9 years to 78.8 years. The life expectancy for the average American man fell two-tenths of a year — from 76.5 to 76.3. For women, it dropped one-tenth — from 81.3 to 81.2 years.

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"It's remarkable," Morgan says. "There are lots of things about this that are unexpected."

Most notably, the overall death rate for Americans increased because mortality from heart disease and stroke increased after declining for years. Deaths were also up from Alzheimer's disease, respiratory disease, kidney disease and diabetes. More Americans also died from unintentional injuries and suicide. In all, the decline was driven by increases in deaths from eight of the top 10 leading causes of death in the U.S.

"When you see increases in so many of the leading causes of death, it's difficult to pinpoint one particular cause as the culprit," Anderson says.

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The obesity epidemic could be playing a role in the increase in deaths from heart disease, strokes, diabetes and possibly Alzheimer's. It could also be that doctors have reached the limit of what they can do to fight heart disease with current treatments.

The epidemic of prescription opioid painkillers and heroin abuse is probably fueling the increase in unintentional injuries, Arun Hendi, a demographer at Duke University, wrote in an email. The rise in drug abuse and suicide could be due to economic factors causing despair.

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"Clearly, that could be related to the economic circumstances that many Americans have experienced in the last eight years, or so, since the recession," says Irma Elo, a sociologist at the University of Pennsylvania.

Whatever the cause, the trend is concerning, especially when the death rate is continuing to drop and life expectancy is still on the rise in most other industrialized countries.

"It's pretty grim," says Anne Case, an economist at Princeton University studying the relationship between economics and health.

Copyright 2016 NPR. To see more, visit NPR.
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Mental Health Care Gets A Boost From 21st Century Cures Act

Wed, 12/07/2016 - 5:08pm

Rep. Tim Murphy, R-Pa., Sen. Chris Murphy D-Conn., Rep. Eddie Bernice Johnson, D-Texas, Rep. Fred Upton, R-Mich., and Sen. Lamar Alexander, R-Tenn., called for Senate passage of the 21st Century Cures Act on Monday.

Alex Wong/Getty Images

The 21st Century Cures Act that gained congressional approval on Wednesday has been championed as a way to speed up drug development, but it's also the most significant piece of mental health legislation since the 2008 law requiring equal insurance coverage for mental and physical health.

The bill includes provisions aimed at fighting the opioid epidemic, strengthens laws mandating parity for mental and physical health care and includes grants to increase the number of psychologists and psychiatrists, who are in short supply across the country.

It also would push states to provide early intervention for psychosis, a treatment program that has been hailed as one of the most promising mental health developments in decades.

"It is time to fix our broken mental health care system," says Sen. Bill Cassidy, R-La., a physician whose mental health bill was folded into the 21st Century Cures Act.

Sen. Chris Murphy, D-Conn., who worked with Cassidy on the bill, says he hopes to alleviate the suffering of people with serious mental illness.

"I'd heard too many devastating stories of people struggling with serious mental illness and addiction whose lives were forever changed because they couldn't get the care they need," Murphy says. "I'd seen up close the heartbreak and frustration that families suffered trying to find care for a loved one — care that seemed impossible to find and even harder to pay for."

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But Rep. Frank Pallone, D-N.J., says he's concerned that proposed Republican changes to the health care system could undercut any progress made by the bill. Millions of Americans with mental illness could lose coverage if Congress repeals the Affordable Care Act or cuts spending on Medicaid, which pays for about 25 percent of all mental health care, he says.

Many mental health advocates celebrated the bill's passage.

Ronald Honberg, national director of policy and legal affairs at the National Alliance on Mental Illness, called the bill's mental health provisions "necessary and promising." He says he appreciates the bill's focus on "preventing the most horrific consequences of untreated mental illness," including homelessness, incarceration and suicide.

The bill generally requires states to use at least 10 percent of their mental health block grants on early intervention for psychosis, using a model called coordinated specialty care, which provides a team of specialists to provide psychotherapy, medication, education and support for patients' families, as well as services to help young people stay in school or their jobs. Research from the National Institutes of Health shows that people who receive this kind of care stay in treatment longer; have greater improvement in their symptoms, personal relationships and quality of life; and are more involved in work or school compared to people who receive standard care.

The bill also sets up a $5 million grant program to provide assertive community treatment, one of the most successful strategies for helping people with serious mental illnesses such as schizophrenia. Like the early intervention program, assertive community treatment is designed to provide a team of professionals that is on call 24 hours a day. The bill also expands a grant program for assisted outpatient treatment, which provides court-ordered care for people with serious mental illness who might otherwise not seek help.

Although the bill authorizes these grants, a future Congress would have to approve funding for the programs. "The fact that a program has been authorized is no guarantee that it will be funded," Honberg says. "It's a necessary first step."

Mental health advocates will lobby for Congress to approve funding for the most critical programs, Honberg says.

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While funding treatments for mental illness is expensive, "it's more expensive to ignore it," says Rep. Eddie Bernice Johnson, D-Texas, who co-sponsored mental health legislation in the House that folded into the 21st Century Cures Act.

Other sections of the bill, based on legislation introduced by Sen. John Cornyn, R-Texas, give communities more flexibility in how they use federal grants. For example, communities could use community policing grants to train law enforcement officers to deal with patients in the midst of a psychiatric crisis. Another provision would require the U.S. attorney general to create at least one drug and mental health court pilot program, which would aim to help people with mental illness or drug addiction receive treatment, rather than jail time, after committing minor offenses.

Senate Majority Whip John Cornyn, R-Texas, speaks in favor of mental health reform legislation on Monday. Also appearing are (from left) Rep. Tim Murphy, R-Pa., Sen. Bill Cassidy, R-La., Rep. Eddie Bernice Johnson, D-Texas, and Sen. Chris Murphy, D-Conn.

Tom Williams/CQ-Roll Call, Inc.

The legislation will help "those suffering from mental illness in the criminal justice system can begin to recover and get the help they need instead of just getting sicker and sicker," Cornyn says. "This bill also encourages the creation of crisis intervention teams, so that our law enforcement officers and first responders can know how to de-escalate dangerous confrontations. This is about finding ways to help the mentally ill individual get help while keeping the community safe at the same time."

The mental health provisions have been scaled back significantly since they were first introduced.

An earlier version of a bill introduced in the House of Representatives would have changed a federal privacy law to allow doctors, under certain circumstances, to share mentally ill adults' medical information with their family caregivers. Doctors today often shut families out of their loved one's care, refusing to share even basic information, such as appointment times, for fear of violating the Health Insurance Portability and Accountability Act, or HIPAA.

Many health professionals misunderstand HIPAA, refusing to listen to the families of patients who are too disabled by psychosis to provide key details of their medical history, says Rep. Tim Murphy, R-Pa., who first introduced the House bill in 2013 in response to the shootings at Sandy Hook Elementary School in Newtown, Conn.

Some advocates for the disabled objected to that change, however, arguing that patient privacy is essential, and that people might avoid care if they believe their doctors might disclose confidential information.

The legislation instructs the secretary of the Department of Health and Human Services to clarify when doctors can share patients' medical information with family caregivers, as well as educate health care providers about what the law actually says.

"It's a step in the right direction," Honberg says. "There is so much misinformation about HIPAA. It's one of the most mischaracterized laws out there."

The bill also aims to better coordinate mental health care. Although eight federal agencies today fund 112 programs that provide mental health care, these agencies rarely coordinate their efforts to make sure patients get the help they need and to avoid duplicating services, says Tim Murphy.

The bill would make structural changes to the way federal agencies provide mental health services:

  • A new committee would link leaders of key agencies involved in mental health care, such as the Department of Veterans Affairs, the Department of Justice and the Substance Abuse and Mental Health Services Administration, or SAMHSA.
  • A new position — the assistant secretary for mental health and substance use — would oversee SAMHSA and promote the most successful approaches to treating mental illness.
  • An advisory board, the National Mental Health and Substance Use Policy Laboratory, would analyze treatments and services to help decide which ones should be expanded.

Chris Murphy said he wishes the final bill had included more resources for outpatient mental health care, as well as for inpatient hospital bills for people in psychiatric crisis. He also said the current bill provides a starting point but that he hopes Congress will continue working to improve mental health care in its next session.

"This doesn't solve all the problems in the mental health system," says Chris Murphy, noting that Congress may still need to change the HIPAA law to allow families to better care for people with mental illness. "We may still have to look at this down the line."

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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A Brighter Outlook Could Translate To A Longer Life

Wed, 12/07/2016 - 4:29pm
Luciano Lozano/Getty Images

Older women who look on the bright side of life were less likely to die in the next several years than their peers who weren't as positive about the future.

The research, published Wednesday in the American Journal of Epidemiology, is the latest to find an association between a positive sense of well-being and better health, though it's not yet clear whether one causes the other.

In this study, researchers used data from 70,021 women who were part of the long-running Nurses' Health Study, looking at their level of optimism as assessed by a brief, validated questionnaire in 2004. For example, they were asked to what degree they agreed with the statement "In uncertain times, I usually expect the best." Their average age was about 70 years old. Then the researchers tracked deaths among the women from 2006 to 2012. (That two-year lag was to avoid including women who were already seriously ill.)

They found that after controlling for factors including age, race, educational level and marital status, the women who were most optimistic were 29 percent less likely to die during the six-year study follow-up than the least optimistic. That reduced risk was seen in cancer (16 percent lower), heart disease (38 percent), stroke (39 percent), respiratory disease (37 percent) and infection (52 percent).

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The researchers didn't see a difference in their results when they controlled for depression. When the researchers ran additional analyses controlling for existing health conditions such as high cholesterol, diabetes and cancer, the risk of dying was 27 percent lower among the most optimistic women. When controlling for health behaviors like smoking and exercise: 14 percent lower. And when controlling for all those factors, the risk of dying was still 9 percent lower among the most optimistic women.

This study is significant because of its size, and because it digs into the effect of those potentially confounding variables, says Nancy Sin, a health psychologist at Penn State University who studies the psychosocial factors involved in heart health and aging and was not involved in the study. Other studies have also shown a relationship between optimism and physical health, particularly in cardiovascular health.

Optimism could conceivably lead to improved health outcomes through several mechanisms, says Eric Kim, an author of the study and research fellow at the Harvard T.H. Chan School of Public Health. First, people who are more optimistic also tend to have healthier behaviors when it comes to diet, exercise and tobacco use. But the study shows that the relationship persists even when those behaviors are controlled for, suggesting something else is also going on.

It's also possible that more optimistic people cope better, says Kim. "When they face life challenges, they create contingency plans, plan for future challenges and accept what can't be changed," he says.

And finally, "optimism may directly impact biological function," says Kim, possibly through better immune function or lower levels of inflammation.

There are some short-term studies suggesting that optimism can be taught. But it's not yet clear whether there are easy techniques that can permanently change how hopeful someone is about the future. Nor is it known whether making someone more optimistic will also make them healthier. That would require a clinical trial.

Moreover, "not everyone wants to be optimistic," says Kim. "We should be sensitive to people's preferences." In addition, it's important to emphasize that optimism is only partly under our control. People have diseases for all sorts of reasons, many of which are not under their control no matter how optimistic they are, he says.

"It's important not to place any blame on patients," says Sin. She says it's important to understand exactly what it is about optimistic people that is potentially relevant to health — for example, perhaps they have better social relationships and support.

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: @katherinehobson.

Copyright 2016 NPR. To see more, visit NPR.
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Doctors And Hospitals Tell Patients: Show Us The Money Before Treatment

Wed, 12/07/2016 - 9:01am

Doctors and hospitals are increasingly asking patients to pay up front for deductibles, which can cost thousands.

PhotoAlto/Michele Constantini/Getty Images/PhotoAlto

Tai Boxley needs a hysterectomy. The 34-year-old single mother has uterine prolapse, a condition that occurs when the muscles and ligaments supporting the uterus weaken, causing severe pain, bleeding and urine leakage.

Boxley and her 13-year-old son have health insurance through her job as an administrative assistant in Tulsa, Okla. But the plan has a deductible of $5,000 apiece, and Boxley's doctor said he won't do the surgery until she prepays her share of the cost.

His office estimates that will be as much as $2,500. Boxley is worried that the hospital may demand its cut as well before the surgery can be performed.

"I'm so angry," Boxley said. "If I need medical care, I should be able to get it without having to afford it up front."

At many doctors offices and hospitals, a routine part of doing business these days is estimating patients' out-of-pocket payments and trying to collect the money up front. Eyeing retailers' practice of keeping credit card information on file, "there's certainly been a movement by health care providers to store some of this information and be able to access it with patients' permission," said Mark Rukavina, a principal at Community Health Advisors in Chestnut Hill, Mass., who works with hospitals on addressing financial barriers to care.

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But there's a big difference between handing over a credit card to cover a $20 copayment and suddenly being confronted with a $2,000 charge to cover a deductible, an amount that might take months to pay off or exceed a patient's credit limit.

Doctors may refuse to provide needed care before the payment is made, even as patients' health hangs in the balance.

The strategy leaves patients financially vulnerable, too. Once a charge is on a patient's credit card, they may have trouble contesting a medical bill. Likewise, a service placed on a credit card represents a consumer's commitment that the charge was justified, so nonpayment is more likely to harm a credit score.

Approximately three-quarters of health care and hospital systems ask for payment at the time services are provided, a practice known as "point-of-service collections," estimated Richard Gundling, a senior vice president at the Healthcare Financial Management Association, an industry group. He couldn't say how many were doing so for higher priced services or for patients with high-deductible plans, situations that would likely result in out-of-pocket outlays of hundreds or thousands of dollars.

"For providers, there's more risk with these higher deductibles, because the chance of being able to collect it later diminishes," Gundling said.

But the practice leaves many patients resentful.

After arriving by ambulance at the emergency department, Susan Bradshaw lay on a gurney in her hospital gown with a surgical bonnet on her head, waiting to be wheeled into surgery to remove her appendix at a hospital near her home in Maitland, Fla. A woman in street clothes approached her. Identifying herself as the surgeon's office manager, she demanded that Bradshaw make her $1,400 insurance payment before the surgery could proceed.

"I said, 'You have got to be kidding. I don't even have a comb,' " Bradshaw, a 68-year-old exhibit designer, told the woman on that night eight years ago. "I don't have a credit card on me."

The woman crossed her arms and Bradshaw remembers her saying, "You have to figure it out."

As providers aim to maximize their collections, many contract with companies that help doctors and hospitals secure payments up front, often providing scripts that prompt staff to talk with patients about their payment obligations and discuss payment scenarios as well as software that can estimate what a patient will owe.

But as hospitals and doctors push for point-of-service payments to reduce bad debt from patients with increasingly high deductibles, the risk is that patients will delay care and end up in the emergency room, Rukavina said. "Patients are essentially paying for their procedures up front," he said. "It may not be a significant amount compared to their salary, but they don't necessarily have it available at the time of service."

The higher their deductible, the less likely patients are to pay what they owe, according to an analysis of 400,000 claims by the Advisory Board, a health care research and consulting firm. While more than two-thirds of patients with a deductible of less than $1,000 were likely to pay at least some portion of what they owe, just 36 percent of those with deductibles of more than $5,000 did so, the analysis found.

Fifty-one percent of workers with insurance through their employer had a deductible of at least $1,000 for single coverage this year, according to the Kaiser Family Foundation's annual survey of employer health insurance. (KHN is an editorially independent program of the foundation.)

Boxley pays $110 a month for her family plan. She could not afford the premiums on plans with lower deductibles that her employer offered. She plans to talk with the doctor and hospital about setting up a payment plan so she can get the surgery in January.

"I'll make payments," Boxley said, although she acknowledged what she could pay monthly would be small. If that doesn't pan out, she figures she'll have to use student loan money she got for graduate school to cover what she owes.

Still, experts say that trying to pin patients down for payment in more acute settings, such as the emergency department, may cross a line.

Under the federal Emergency Medical Treatment and Labor Act, a patient who has a health emergency has to be stabilized and treated before any hospital personnel can discuss payment with them. If it's not an emergency, however, those discussions can occur before treatment, said Dr. Vidor Friedman, an emergency physician who is the secretary-treasurer of American College of Emergency Physicians' board of directors.

Bradshaw finally got her appendix removed by calling a friend, who read his MasterCard number over the phone. The surgery was uneventful and Bradshaw was home within 24 hours.

"It's a very murky, unclear situation," Friedman said of Bradshaw's experience, noting that a case might be made that her condition wasn't life threatening. "At the very least it's poor form, and goes against the intent if not the actual wording of" federal law.

Michelle Andrews is on Twitter:@mandrews110.

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

Going Bare Down There May Boost The Risk Of STDs

Tue, 12/06/2016 - 10:21am
Image Source/Getty Images

Frequent removal of pubic hair is associated with an increased risk for herpes, syphilis and human papillomavirus, doctors at the University of California, San Francisco, reported Monday in the journal Sexually Transmitted Infections.

People who have "mowed the lawn" at least once in their lifetimes were nearly twice as likely to say they had had at least one STD. And "extreme groomers" – those who remove all their pubic hair more than 11 times each year — were more than four times as likely to have had an infection. "High-frequency groomers," who just trim their hair a few times a month, fell between the two extremes. They were about three times more likely to have reported an STD.

"We were surprised at how big the effect was," says Benjamin Breyer, a urologist at the University of California, San Francisco, who led the study. "Right now, we have no way knowing if grooming causes the increase in risk for infections. All we can say is that they're correlated. But I probably would avoid an aggressive shave right before having sex."

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In the study, Breyer and his team surveyed about 7,500 men and women between ages 18 and 65. They asked them about their grooming habits: How often do you shave or wax? Do you shave it all off or just give it a trim? And they asked about their sex lives: How many partners have you had? What STDs have you had?

About two-thirds of men and more than 80 percent of the women said they had done some manscaping or tended their lady garden at least once before. And a little more than 10 percent said they were "extreme groomers," who like to keep things completely hairless.

Infections that affect the skin, such as HPV and syphilis, were most strongly associated with aggressive grooming. But for other types of sexually transmitted infections, such as gonorrhea and lice, the link wasn't as clear. Lice actually cement their eggs to hair shafts. So if you remove all your hair, there's nowhere for the insects to breed.

"This is an excellent study," says Scott Butler, who studies STDs in college students at Georgia College & State University. "It's good for health care providers to be aware of this connection."

But there also are some big limitations to the study, Butler says. Although the analysis took into the number of sexual partners people said they had, it did not consider whether people were having safe sex or getting vaccinated for HPV. And the survey didn't ask people whether they were diagnosed with the STD before or after they started grooming.

That said, it makes sense biologically that shaving and waxing could make you more vulnerable to infections, says Jennifer Gunter, an OB-GYN at Kaiser Permanente Northern California who wasn't involved in the study.

"We know that shaving creates microtears and cuts," Gunter says. And if men and women are doing it right before sex, those wounds might not be healed, making it easier for viruses and bacteria to enter skin.

"Pubic hair is there for a reason," Gunter says. "It's a mechanical barrier, like your eyebrows. It traps bacteria and debris. And there could be health consequences to removing it."

Copyright 2016 NPR. To see more, visit NPR.
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Signed Out Of Prison But Not Signed Up For Health Insurance

Tue, 12/06/2016 - 5:00am
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December 6, 20165:00 AM ET Heard on Morning Edition

Kara Salim, 26, got out of the Marion County, Indiana, jail in 2015 with a history of domestic-violence charges, bipolar disorder and alcoholism — and without Medicaid coverage. As a result, she couldn't afford the fees for court-ordered therapy.

Philip Scott Andrews for KHN

Before he went to prison, Ernest killed his 2-year-old daughter in the grip of a psychotic delusion. When the Indiana Department of Correction released him in 2015, he was terrified something awful might happen again.

He had to see a doctor. He had only a month's worth of pills to control his delusions and mania. He was desperate for insurance coverage.

But the state failed to enroll him in Medicaid, although under the Affordable Care Act Indiana had expanded the health insurance program to include most ex-inmates. Left to navigate an unwieldy bureaucracy on his own, he came within days of running out of the pills that ground him in reality.

This investigation comes from Beth Schwartzapfel at The Marshall Project, a nonprofit news organization covering the U.S. criminal justice system, and Jay Hancock, Kaiser Health News, a nonprofit news service covering health policy issues at the federal and state level.

Radio story for Morning Edition by Jake Harper with WFYI and Side Effects Public Media, a news collaborative covering public health.

"I have a serious mental disorder, which is what caused me to commit my crime in the first place," said Ernest, who asked reporters to use only his middle name to protect his privacy. "Somebody should have been pretty concerned."

The health law was supposed to connect Ernest and almost all other ex-prisoners for the first time to Medicaid coverage for the poor, cutting expensive visits to the emergency room, improving their prospects of rejoining society and reducing the risk of spreading communicable diseases that flourish in prisons.

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But Ernest's experience is repeated millions of times across the country, an examination by The Marshall Project and Kaiser Health News shows.

Most of the state prison systems in the 31 states that expanded Medicaid have either not created large-scale enrollment programs or operate spotty programs that leave large numbers of exiting inmates — many of whom are chronically ill — without insurance.

Local jails processing millions of prisoners a year, many severely mentally ill, are doing an even poorer job of getting health coverage for ex-inmates, by many accounts. Jail enrollment is especially challenging because the average stay is less than a month and prisoners are often released unexpectedly.

Ex-inmates with the worst chances of getting insurance and care are in 19 states that did not expand Medicaid. Only a few qualify for coverage. Enrollment efforts by prisons and jails for them are almost nonexistent.

Nationally, some 375,000 inmates leave state prisons every year with minimal or nonexistent Medicaid signup programs, according to a survey by The Marshall Project.

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Failure to link people leaving jail or prison to health insurance is a missed opportunity to improve health and save money on care, advocates say. Better care also helps by reducing recidivism. Studies show Medicaid access in Florida and Washington cut return trips to jail among the mentally ill by 16 percent.

Advocates for improved sign-ups argue, What better place to enroll people eligible for Medicaid than a building where they're already assembled?

"I hate to say it — it's a captive audience," said Monica McCurdy, who as head of a clinic for Project HOME in Philadelphia sees homeless, recently released prisoners without Medicaid coverage. "You have somebody there! You know they're going to be released in a few weeks. Why not do the handoff that's needed to prevent this person winding up in the ER? It defies common sense."

Health Risks Soar After Release

Before the Affordable Care Act, Medicaid covered mainly children, pregnant women and disabled adults, which included only a small number of ex-offenders. That's still generally the case in the 19 states that didn't expand Medicaid.

President-elect Donald Trump has vowed to repeal the health act and replace it with something else, leaving the law's Medicaid expansion and eligibility for ex-prisoners in doubt. Rep. Tom Price, Trump's pick to head the health and human services department — which oversees Medicaid — has been one of Congress's most vociferous critics of Obamacare.

But some analysts expect parts of the law to survive, perhaps including Medicaid expansion managed more directly by states than by Washington.

Even some Republicans have supported the expansion of Medicaid, suggesting that revoking its coverage from millions of new recipients would be difficult. Republican Gov. John Kasich expanded Medicaid in Ohio in part for ex-inmates, he has said, "to get them their medication so they could lead a decent life."

Other parts of the health law received more attention, but advocates saw giving Medicaid coverage to ex-inmates as one of its most transformative aspects. Illness for illness, inmates are the sickest people in the country.

Shots - Health News When Time Behind Bars Cuts Addiction Treatment Short

They have far higher rates of HIV, hepatitis and tuberculosis than the general population. They're also more likely to have high blood pressure, diabetes, and asthma. More than half are mentally ill, according to the Bureau of Justice Statistics, with up to a quarter meeting criteria for psychosis. Between half and three-quarters have an addiction problem.

Prisons and jails have their own doctors, but their responsibility to provide care stops upon an inmate's departure. Inmates generally aren't eligible for Medicaid while imprisoned.

No time is more critical than the days immediately after release. One study showed that in the first two weeks, ex-prisoners die at a dozen times the rate of the general population. Heart disease, drug overdose, homicide and suicide are the main causes.

But even in states that expanded Medicaid, the most vulnerable and sometimes dangerous ex-inmates are often left on their own.

Ernest went to prison for shooting and killing his daughter amid a psychotic religious delusion. Re-enacting the biblical story of the sacrifice of Isaac, he thought God would intervene to save the girl. News reports from the time say police found him naked, carrying the child's lifeless body through the streets of an Indianapolis suburb.

Indiana expanded Medicaid under the health law in February 2015 and set up a system to enroll all eligible prisoners upon release. Yet when Ernest got out in August 2015, he was not enrolled in Medicaid, let alone connected to doctors.

Prison officials say they applied for Medicaid on Ernest's behalf, but Medicaid records show he applied when he got home. It's not clear where the system failed.

"It is important that the offenders have some accountability in the process," said Douglas Garrison, a spokesperson for the Indiana Department of Correction. "The IDOC has worked diligently to ensure released offenders are receiving coverage."

Ernest's letters to Medicaid and a clinic before he got out didn't help. He had to start the application process from scratch after he got home, making increasingly frantic calls and scrambling to find his birth certificate and other paperwork as his supply of lithium and perphenazine, an antipsychotic, dwindled.

Shots - Health News Even In Prison, Health Care Often Comes With A Copay

"Somebody who's committed a violent felony because of a mental illness is getting out of prison, and we don't have anything set up yet?" said Ernest, whose Medicaid coverage was authorized a little more than a month after his release. He's now living with his brother and looking for work.

Failure to sign up ex-inmates for health care are repeated every day in states that expanded Medicaid under the health law, even in places such as Indiana where agencies have provided enrollment assistance.

No Enrollment For Thousands Of Chronically Ill People

Two-thirds of the 9,000 chronically ill prisoners released each year by Philadelphia's jails aren't getting enrolled as they leave, said Bruce Herdman, medical director for the jails. The city also lacks the $2 million necessary to supply a month's worth of medication for released inmates with prescriptions, he said.

Calvin Henderson, 61, spent 60 days in an Indiana work-release center after serving 15 years for robbery and a parole violation. Because he could leave the work-release facility to go to the doctor, the state didn't provide medical care. Federal rules say people in work release are still incarcerated, so they don't qualify for Medicaid.

Philip Scott Andrews for KHN

"They give you like two weeks' supply of medication," said Ricky Platt, 49, who left the Philadelphia jail in 2015, quickly ran out of Zoloft, an antidepressant, and became homeless. "They don't give you any resource of where to go or get a doctor and get your prescription filled or anything."

Emergency doctors at Thomas Jefferson University Hospital in Philadelphia often see released inmates with kidney failure who are at risk of dying if they don't receive dialysis almost immediately, said Dr. Priya Mammen, one of the hospital's emergency physicians.

"We're kind of the go-to spot for many people, but particularly for people who have been released from prison," she said. "Either in the first week we see them or when their prescriptions run out."

Kara Salim, 26, got out of the Marion County, Indiana, jail in 2015 with a history of domestic-violence charges, bipolar disorder and alcoholism — and without Medicaid coverage. As a result, she couldn't afford the fees for court-ordered therapy.

Without therapy she wasn't allowed to see a psychiatrist for her medications. Without medication she spiraled downward, eventually threatening suicide at a court hearing. When court officers tried to bring her to a psychiatric hospital, she erupted, kicking and scratching them and landing back in jail, with new felony charges: battery against a public safety officer.

"I wish I could tell you she's the exception," said Sarah Barham, an addiction counselor with Centerstone, a nonprofit that provides behavioral health services in Indiana.

Medicaid enrollment requires resources that many prison systems and local jails — often overcrowded and operating in crisis mode for years — lack or have been reluctant to commit.

"Most of the county sheriffs don't have the proper staff they need to even run the jails," said Bill Wilson of the Indiana Sheriffs' Association. Many jails are making an effort, but in some places "pulling the resources out to enroll an inmate in Medicaid is not something the sheriff's able to do."

Shots - Health News Helping Ex-Inmates Stay Out Of The ER Brings Multiple Benefits

Seven states — Minnesota, Alaska, Hawaii, Arizona, Montana, Louisiana, and Illinois — expanded Medicaid but have not implemented a large-scale enrollment program.

In many states, even successful prerelease registration requires a follow-up visit to a local Medicaid or welfare office to activate the coverage on release. Obtaining a phone, paying for minutes and navigating bus lines to state offices can be daunting for newly released inmates, who often struggle with basic needs such as food and shelter.

Indiana officials applied for Medicaid on behalf of more than 7,000 state prisoners from March through September — nearly 90 percent of those released. (Many of the others were released to other states or deported, officials said.) Yet only a little more than half called to activate their coverage when they got home, according to state data. The state says in recent weeks it eliminated the requirement to activate coverage with a call.

William Santee, 46, released from Pennsylvania state prison this year, has diabetes, high cholesterol and high blood pressure. He learned about Medicaid enrollment requirements and the need to visit a welfare office from workers at a homeless shelter.

The prison "didn't tell me about where to go or anything like that," he said. "They don't consider that their responsibility." Waiting in line and completing the welfare-office paperwork took five hours.

Getting The Details Right

Almost as critical as successful enrollment is choosing a Medicaid plan that covers medicines and services ex-inmates need. Jail and prison workers are rarely equipped to wade through such details.

"That's a huge issue for us," said Susan Jo Thomas of Covering Kids and Families, a nonprofit that helps enroll people in Medicaid in Indiana. "You finally get a person to the place they are ready to make the decision to go into detox, but if they have aligned with an insurance company that doesn't cover the medicine that program uses, then you have a problem."

Marion County Jail, in Indianapolis, is working with inmates to enroll them in Medicaid.

Philip Scott Andrews for KHN

A few states and localities reap praise for innovative and comprehensive attempts to enroll emerging prisoners in Medicaid.

Ohio recently finished phasing in Medicaid registration at all state prisons and is one of the few states giving inmates a managed care insurance card as they leave, said John McCarthy, that state's Medicaid director. Chicago's huge Cook County jail puts prisoners on the Medicaid books as they enter, rather than before they leave, to sidestep the common problem in jails of unpredictable release dates.

More often the process looks like what was happening one recent Friday in Indiana's Marion County jail, where Lt. Debbie Sullivan was trying to rouse sleepy women to sign up for health insurance.

The document she distributed was three pages long, authorizing a Medicaid application on inmates' behalf. It asked for names, addresses, birth dates and Social Security numbers. The handwritten information would later be entered into computers — a recipe for transposed digits and misspelled names.

"The program remains a work in progress," said Katie Carlson, a spokeswoman for the Marion County Sherriff's Office, which runs the jail. "It has proven a daunting task to enroll, track and provide meaningful information on both Medicaid and health care."

Such sessions require a half-hour or more, so inmates can get the details right, pick the right plan and learn how to follow up with doctors and insurance officials after release.

Sullivan's knowledge of the women's next steps was minimal. In response to questions, she simply told them to contact their local social service office when they get out. She walked out of the block with about 30 signed applications. It was over in 15 minutes.

"Thank you ladies!" she called on her way out, as the heavy steel door slammed behind her.

Marshall Project interns Deonna Anderson, Josiah Bates, Jonathan Gomez and Rachel Siegel contributed research to this article.

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

Drivers Beware: Crash Rate Spikes With Every Hour Of Lost Sleep

Tue, 12/06/2016 - 12:01am
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December 6, 201612:01 AM ET Heard on All Things Considered

If you haven't had at least seven hours of sleep in the last 24, you probably shouldn't be behind the wheel, traffic safety data suggests.

Katja Kircher/Maskot/Getty Images

Traffic safety officials regularly warn us of the risks of driving while drunk or distracted.

But Americans still need to wake up to the dangers of getting behind the wheel when sleepy, according to a recent study of crash rates.

A report released Tuesday by the AAA Foundation for Traffic Safety suggests that drivers who sleep only five or six hours in a 24-hour period are twice as likely to crash as drivers who get seven hours of sleep or more.

And the less sleep the person behind the wheel gets, the higher the crash rate, according to the findings. For instance, drivers in the study who got only four or five hours of shut-eye had four times the crash rate — close to what's seen among drunken drivers.

"If you have not slept seven or more hours in a given 24-hour period, you really shouldn't be behind the wheel of a car," says Jake Nelson, director of Traffic Safety Advocacy & Research for AAA.

Prior research has shown that about 20 percent of fatal accidents in the U.S. involve a drowsy driver. Last year, a total of 35,092 people died in auto accidents in the U.S, according to data from the National Highway Traffic Safety Administration. This was a 7.2 percent increase in fatal crashes over 2014.

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The foundation based its current report on data from the NHTSA's National Motor Vehicle Crash Causation Survey. The data were drawn from police-reported crashes in which at least one vehicle had to be towed away from the accident scene, and/or emergency medical services were summoned. Drivers involved in these crashes were asked to report how much sleep they got in the 24-hour period preceding the crash.

As a nation, we tend to give shut-eye short shrift, many studies find. More than one in three Americans don't get enough sleep on a regular basis, according to an analysis by the Centers for Disease Control and Prevention. In addition to highway accidents, sleep deprivation has been linked to weight gain and depression. Sleep specialists generally recommend that adults get between seven and nine hours of sleep per night.

"Sleep is a bigger priority for me now," says Karen Roberts, a nurse in Cincinnati who fell asleep behind the wheel several years ago after working an overnight shift. She crossed the double line while driving home and caused an accident. Sleep is not a luxury, Roberts now knows. "It's a necessity," she tells Shots.

Roberts says she did consider stopping for a soda or another pick-me-up that night as she was driving home. "I remember feeling so tired," she says. But she was only a few miles from home and convinced herself that she could power through the fatigue.

"It happens in an instant," Roberts says. "I struck someone head on."

Fortunately, the driver in the other car walked away with only minor injuries. Roberts says she recovered from her own injuries but has continued to struggle with health problems related to the crash, including headaches.

Nelson has this tip for drivers: If you're feeling sleepy, stop and take a nap.

"Taking a 10 to 20 minute nap every couple of hours on a long drive has huge safety benefits in terms of your ability to drive without crashing," he says.

It's also possible to catch up on missed sleep — to a point. If you get only five hours of sleep during a night, you can make up the deficit by sleeping two hours during another part of the day.

"As long as you get seven to eight hours of sleep within a 24-hour period before you get behind the wheel of a car," Nelson says, "you're OK."

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Scientists Battle In Court Over Lucrative Patents For Gene-Editing Tool

Mon, 12/05/2016 - 3:41pm
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December 5, 20163:41 PM ET Heard on All Things Considered

Emmanuelle Charpentier (left) and Jennifer Doudna have a case for being the inventors of CRISPR-cas9, a transformative tool for gene editing.

Miguel Riopa/AFP/Getty Images

The high-stakes fight over who invented a technology that could revolutionize medicine and agriculture heads to a courtroom Tuesday.

A gene-editing technology called CRISPR-cas9 could be worth billions of dollars. But it's not clear who owns the idea.

U.S. patent judges will hear oral arguments to help untangle this issue, which has far more at stake than your garden-variety patent dispute.

"This is arguably the biggest biotechnology breakthrough in the past 30 or 40 years, and controlling who owns the foundational intellectual property behind that is consequentially pretty important," says Jacob Sherkow, a professor at the New York Law College.

Shots - Health News A CRISPR Way To Fix Faulty Genes

The CRISPR-cas9 technology allows scientists to make precise edits in DNA, and that ability could lead to whole new medical therapies, research tools and even new crop varieties.

"Part of what makes it such a fun spectator sport is the amount of money that's at stake," says Robert Underwood, at the Boston law firm McDermott Will & Emery. "These could potentially be the most valuable biotech patents ever."

The dispute pits high-prestige universities and well-regarded scientists against one another.

On one side of the dispute are research collaborators Jennifer Doudna at the University of California, Berkeley and her European colleague Emmanuelle Charpentier (currently at the Max Planck Institute for Infection Biology in Berlin).

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Feng Zhang, of the Broad Institute, is one of the contenders vying for royalties from CRISPR patents.

Anna Webber/Getty Images for The New Yorker

"When they filed their patent application [in 2012], they did a great job disclosing how to use CRISPR for bacteria, but were a little lighter on details about how to use CRISPR in the cells of higher organisms" such as human cells, Sherkow says.

"Later in 2012, Feng Zhang at the Broad Institute at MIT and Harvard files his patent application that gives a pretty detailed description about how to use CRISPR in the cells of higher organisms," Sherkow continues.

And since the most important use of the technology is its ability to edit DNA in higher organisms, the real battle is over who can claim that invention.

Zhang's patent went through the process faster, so it was issued first. But when the Berkeley patent came up for a decision, that created what's known in patent parlance as an "interference." So now the patent office needs to sort out exactly what the invention is and who invented it first.

"The dispute largely does appear like a winner-take-all affair," Sherkow says.

But the patent court could decide that there are distinct inventions, each meriting its own patents.

Or it could decide that it's not patentable at all, for various reasons.

"The other thing that could happen is the patents could be made moot by other discoveries," says Anette Breindl, senior science editor at the trade journal BioWorld. "I'm sure the existing patents are written to be broad, but there could be new discoveries that just get around those patents."

The stakes are enormous. Breindl says three companies built around these patents already have a billion dollars of investment behind them, and a fourth company has a stake in the technology that could be worth $2 billion.

The scientists themselves stand to gain a great deal — and so do their universities, which are listed on the patents as well.

Robert Cook Deegan, at Arizona State University's School for the Future of Innovation in Society, says regardless of how this legal battle comes out, academic researchers can still use the CRISPR technology without worrying about ownership rights, "but if you're doing any research that might eventually be commercially valuable well, then you've got a problem."

Shots - Health News In Hopes Of Fixing Faulty Genes, One Scientist Starts With The Basics

Those researchers would need to license the technology's rightful owner, whoever that ends up being, "and the concern is how many licenses you're going to have to pick up, and if there's going to be one dominant patent that everybody has to license from a particular firm," he says.

Some companies have already placed their bets, and they've licensed the right to use CRISPR from one or the other of the companies involved in the patent battle. If that patent evaporates, Underwood says, "I don't think you'd get your money back."

And any inventions based on the patent wouldn't be protected, or possibly legal to sell. So companies in this field are anxiously awaiting the outcome of the patent dispute. Tuesday's hearing is just one step in a process that's likely to last through 2017.

In court, the two sides are expected to give brief answers to questions from the patent judges and jockey for position, trying to get the case framed in the way most favorable to their interests.

"Whatever the resolution is, if there's no settlement, we can expect appeals that will last for years," he says.

And, on top of the patent dispute, scientists widely assume that CRISPR will earn Nobel Prizes for the scientists who are ultimately recognized as the inventors of this transformative technology.

You can email Richard Harris at

Copyright 2016 NPR. To see more, visit NPR.
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Advice For Doctors Talking To Parents About HPV Vaccine: Make It Brief

Mon, 12/05/2016 - 5:39am
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December 5, 20165:39 AM ET Heard on Morning Edition

The HPV vaccine has reduced the prevalence of the cancer-causing human papillomavirus by as much as 65 percent among those who are vaccinated.

Matthew Busch for The Washington Post/Getty Images

A full decade after the Food and Drug Administration approved a vaccine to fight the sexually transmitted, cancer-causing human papillomavirus, almost half of all adolescents have still not received their first dose. This low vaccination rate is dramatic when compared to other routine childhood immunizations like polio and measles, mumps and rubella, where compliance is above 90 percent.

In order to boost HPV vaccination, doctors should be more assertive when bringing up the topic with parents, says Noel Brewer, a health and behavior scientist at the University of North Carolina. Brewer knew from earlier research that doctors contribute to that low vaccination rate because "most doctors and parents don't want to talk about sex," he says, especially when children are 11 or 12 — the age at which the Centers for Disease Control and Prevention recommends the vaccine be given.

Shots - Health News Doctors, Not Parents, Are The Biggest Obstacle To The HPV Vaccine

Brewer wanted to figure out a better way for physicians to communicate the value of the vaccine to parents. So he conducted a study involving 30 North Carolina pediatric and family medicine clinics. The clinics were each divided into three groups of doctors. One group was trained how to make brief statements that assumed parents were ready to have their child vaccinated. This involved saying short, direct sentences such as, "Now that Michael is 12 there are three vaccines we give to kids his age. Today he'll get meningitis, HPV and Tdap [tetanus, diphtheria, pertussis]."

Another group of clinic doctors was trained to engage parents in somewhat lengthy discussions about the timing, safety and effectiveness of the vaccine. A control group of doctors received no training.

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It turns out that more talk is less effective: When doctors made brief statements that presumed parents intended to vaccinate their child, vaccine rates increased by 5 percent. There was no increase in vaccination rates following the lengthy discussions. There was also no increase in the control group.

The straightforward approach — when the message is short, direct and brief — makes the HPV vaccine just like any other vaccine recommendation, Brewer says.

"Having a long conversation seems to communicate that there's a problem with the vaccine, and that worries parents," he says.

The study findings are published online Monday in the journal Pediatrics.

Something else that may help boost HPV vaccination rates is a recent recommendation from the Centers for Disease Control to reduce the number of doses for younger children. Because the vaccine is more effective at ages 11 and 12, the CDC now recommends only two doses instead of three. However, if children don't get vaccinated until age 15, they'll still need the full three doses.

Shots - Health News Parents Feel Better About HPV Shots For Preteens If They Can Opt Out

"The HPV vaccine is an amazing tool to protect our younger generation against many types of cancer," says Dr. Margaret Stager, a pediatrician with Metro Health Medical Center in Cleveland and a spokesperson for the American Academy of Pediatrics. She says strains of HPV are responsible for the vast majority of HPV-related cancers, including cervical cancer and cancers of the anus, vagina and penis. It can also cause cancer in the back of the throat. So it's an important vaccine for both girls and boys, she says.

Preventing cancer should be the critical take-home message for parents, according to Stager. After all, she says, "HPV prevalence has already decreased as much as 65 percent among vaccinated youth, dramatically lowering the odds they will face a life-threatening form of cancer in adulthood."

Copyright 2016 NPR. To see more, visit NPR.
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Helping Ex-Inmates Stay Out Of The ER Brings Multiple Benefits

Mon, 12/05/2016 - 5:39am
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December 5, 20165:39 AM ET Heard on Morning Edition

While incarcerated, Mark Baskerville says he suffered five diabetic comas. He says he's now doing a better job of managing his health.

Rae Ellen Bichell/NPR

The Washington, D.C., jail has big metal doors that slam shut. It looks and feels like a jail. But down a hall in the medical wing, past an inmate muttering about suicide, there's a room that looks like an ordinary doctor's office.

"OK, deep breaths in and out for me," Dr. Reggie Egins says to his patient, Sean Horn, an inmate in his 40s. They talk about how his weight has changed in his six weeks in jail, how his medications are working out and whether he's noticed anything different about his vision. Egins schedules an ophthalmology appointment for Horn.

Horn says before he arrived here, things were not looking good.

"I looked real bad. I was homeless, for one, and not taking my medicine," says Horn, who has depression, high blood pressure and gout, among other things.

When he was out on the streets, Horn says, it was hard for him to get his medications or to see a doctor. So he just didn't. He got sicker and sicker.

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"I had two heart attacks and my gout flared up a whole lot of times when I was out there," he says.

Horn is no outlier. People with a history of incarceration are typically much sicker than the general population, especially returning inmates like Horn. Studies done primarily in Ohio and Texas have found that more than 8 in 10 returning prisoners have a chronic medical condition, from addiction to asthma. Egins says a lot of it has gone untreated, for a range of reasons — because the health care system is tough to navigate, because they're homeless and don't have insurance, or because they don't trust doctors.

"The first thing is that they usually have no permanent address, which means that they cannot apply for health insurance and/or there's nowhere to receive those documents if they do," says Egins, a family doctor who does correctional health care, splitting each week between serving patients at the D.C. jail and at Unity Health Care, a network of community health centers.

Now, being in jail is not healthy. But for a lot of people, the best health care they'll receive is what they get behind bars. About 40 percent of inmates are newly diagnosed with a chronic medical condition while incarcerated. Outside, many only interact with doctors when they're in the emergency room.

And when they are released, as millions are each year, they enter a risky time, says Dr. Emily Wang, a primary care doctor with the Yale University School of Medicine.

"Man, if there is any one single thing in the literature that is compelling, it's that there's a significantly higher risk of dying in the first two weeks following release from a correctional facility," she says.

Wang says the primary causes of death after incarceration include overdose, heart disease, suicide and cancer — often treatable things, if you catch them early enough.

It's not just a matter of getting insurance. "Insurance is necessary, but it's not sufficient," says Wang. "Our patients will often come with insurance, but they don't know the first thing about how to use the health care system to their benefit."

Behind bars, patients get three meals a day and line up to get their daily medications handed to them by a nurse.

"When they come home from prison, they have to learn to use the pharmacy, learn to get a refill, learn to make their appointments ... on top of trying to get housing, get employed, figure out where to get food for the day," she says.

So many former inmates put off getting medical care until they wind up in the emergency room, with conditions that have become a lot worse than they could've been. That means they are also more expensive to treat, costs that are often picked up by hospitals and taxpayers.

Drs. Lisa Puglisi and Emily Wang talk with a community health worker about the patients they're about to see at a clinic for ex-offenders in New Haven, Conn.

Rae Ellen Bichell/NPR

Wang and her colleagues are trying to make it easier for ex-inmates to manage their health care so they don't end up in the ER. They work at the Transitions Clinic Network, which now has 14 sites across the U.S. and in Puerto Rico. They're funded by private donations and by grants like one from the Center for Medicare & Medicaid Innovation.

Their patients qualify for Medicaid based on income, and the clinics are reimbursed by Medicaid. The difference is that they offer more services than Medicaid typically does — like helping patients find a halfway house they can afford.

Joe McFadden has experienced how much of a difference those extra services can make. McFadden spent 40 days in solitary confinement before being released two weeks later.

"You're just locked up like an animal. That's not good or healthy at all," says McFadden, who is in his 40s and was homeless and living on the streets of New Haven, Conn., when I spoke with him. "It's not easy, coming home from being incarcerated to a world where you're being discriminated against," he says.

Shortly after release, McFadden ended up in the emergency room with a ballooning leg. It was a blood clot. "I thought I had pulled a muscle. It took me like a week to go in because I didn't know the symptoms of having blood clots," he says. He'd rarely been to the doctor before that, but now he comes in for regular visits at the Transitions clinic in New Haven. The staff there helped him find a substance abuse program, and a place where he could visit his two kids.

"Our rationale for this program is by organizing primary care in this manner, we improve public health," Wang says. "Our patients are sicker than the general population, so by caring for them, fewer communicable diseases are transmitted, substance use is treated, etc." She adds: "Moreover, it makes good business sense for the health system."

In a randomized control trial looking at 200 recently released prisoners in San Francisco, Wang and her colleagues showed that bringing that population to see doctors significantly reduced emergency room visits and hospitalizations. That lessens the strain on emergency departments, and the cost burden that emergency treatment puts on the health care system.

Wang works at the New Haven clinic, which gets additional funding from the Community Foundation for Greater New Haven, the Yale-New Haven Hospital and the Substance Abuse and Mental Health Services Administration.

The staff starts off the morning by running through a list of the patients coming in. One patient is worried about relapsing on a drug addiction and wants to talk about options for staying clean. Another patient with an infection in his leg has finally gone to see orthopedics.

"That was a huge accomplishment. Getting him to an appointment is a feat," says Dr. Lisa Puglisi, one of the physicians at Transitions.

The patient came to his appointment because of Jerry Smart. As a community health worker with Transitions, Smart is the clinic's secret weapon, because patients might not trust doctors, but they do trust him.

"This population, you know, they've been dealing with probation, parole, dealing with correctional officers. So they don't trust people," says Smart.

Like all Transition's community health workers, Smart knows what it's like to be an ex-inmate. It has been 30 years since he did time, but he remembers feeling judged by doctors and thinking they didn't care about his well being.

"A lot of these guys feel the same way. But when they meet me, I just let them know we have a great team. The physicians care about you, they care about your needs," says Smart. "So once they buy into me, then they buy into the whole thing."

No one wants to be sick, he says, but sometimes the whole health care system can be intimidating. He'll go with patients to their appointments, check in with some of them regularly on the phone, and he'll even take frantic calls at 2 a.m. about whether they should go to the emergency room or not.

Mark Baskerville, who lives in New Haven, is one of the clinic's success stories. He's in his mid-50s, and he has been in and out of prison four times.

On the bus coming home, he says, "First it's anxieties that pick up: 'Man, am I going to do all right?' Things are in your hands and you're in control of it now."

Health problems are easy to push aside, he says.

Baskerville has been living with diabetes for about 20 years, about 12 of which he spent in the correctional system. He says he had five diabetic comas while he was an inmate. But since re-entering the community, he has come for regular visits at the clinic and says he's doing better.

"It was easy. I know what I got to do to take care of my diabetes. You got to work with your doctor," says Baskerville.

If you don't, he says, you'll never be able to enjoy your freedom.

Copyright 2016 NPR. To see more, visit NPR.
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In House Majority Leader's Home District, Many Depend On Health Law He Wants To Scrap

Sun, 12/04/2016 - 6:00am

House Majority Leader Kevin McCarthy has supported the repeal of the Affordable Care Act, despite health coverage it has brought to many of his constituents.

Andrew Harnik/AP

House Majority Leader Kevin McCarthy wants to repeal the Affordable Care Act first and replace it sometime later. That doesn't sit well with Victoria Barton, who lives in McCarthy's rural California district.

"It's like they dangled the carrot and now they're taking it away," said Barton, 38, of Bakersfield, an unpaid photographer and stay-at-home mother of two.

Barton and her husband, a contract computer technician, had been uninsured for most of their adult lives. When Obamacare expanded Medicaid, they were finally able to qualify for the low-income health program. This year, California's version of Medicaid, known as Medi-Cal, paid for surgery to remedy Barton's long-standing carpal tunnel syndrome.

When McCarthy returns later this month to his congressional district, a mostly agricultural region in California's Central Valley including the city of Bakersfield and Edwards Air Force Base, he is likely to face quite a few confused and frustrated constituents.

The Two-Way Only 26 Percent Of Americans Support Full Repeal Of Obamacare, Poll Finds

Two counties represented by the Republican leader are among the most heavily dependent on Medi-Cal in the state. Roughly half of the residents are covered by Medi-Cal, which added about 212,000 enrollees after Obamacare took effect.

Nearly 29,000 residents have purchased health plans through Covered California, the state's insurance exchange, with coverage heavily subsidized by the federal government.

Some of those who favor the law, or rely on it, see a conflict between McCarthy's stated goals as a national leader and the needs of so many of his constituents.

"Those comments he made [about repeal] just demonstrate how disconnected he is from the people he's supposed to be representing," said Edgar Aguilar, program manager for Community Health Initiative of Kern County, an organization that helps enroll residents in Medi-Cal and Covered California in Bakersfield.

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McCarthy's staff in Washington, D.C., said there wasn't anyone available to comment.

The complexities of repealing Obamacare are laid bare in the 23rd Congressional District that McCarthy represents, highlighting what other Republican politicians from less affluent areas may face.

On one hand, the district is considered a safe Republican haven. McCarthy easily defeated his Democratic challenger in November, winning about 70 percent of the vote. More than half of voters in Kern and Tulare counties chose President-elect Donald Trump. Some of McCarthy's constituents vocally support his promise to get rid of Obamacare.

On the other hand, constituents like Barton worry about the consequences of repealing the health law without an immediate replacement. They fear losing all or part of their health coverage, or losing jobs in the health care industry.

Unemployment in Kern and Tulare counties runs between 9 percent and nearly 11 percent, twice as high as the state average. About a quarter of residents live in poverty, according to U.S. Census data.

With Obamacare, "we've made this gigantic step ... and then suddenly to just take it away without any rational plan in place seems totally irresponsible," says Bill Phelps, chief of program services at Clinica Sierra Vista, a network of health care clinics serving 200,000 patients. "They're playing chess with the American population."

Since the Affordable Care Act was signed into law in 2010, the health care network where Phelps works has hired more than 100 employees and opened at least four new health centers, although some clinics were planned beforehand.

A repeal of the Medi-Cal expansion may require the clinic system to shed some nursing and case management jobs, clinic officials said.

"Health care is such an integral part of the economy," said Phelps, adding that he hopes McCarthy will look into the "details" before scrapping Obamacare. "You just can't turn off the switch."

But McCarthy seems to want a quick repeal. He told reporters that ending the Affordable Care Act is "easier and faster" than passing an alternative policy, which would require more votes.

"I want to make sure it gets done right," he said of replacing Obamacare in an interview with The Washington Post.

Still, some in McCarthy's district will be glad to see Obamacare go, and as soon as possible. "This whole system has been a disaster from Day 1," said Rodger Harmel, an insurance agent in Bakersfield. "Rates have been at an all-time high."

Harmel says most of his Covered California clients earn too much to qualify for the federal subsidies that reduce monthly premiums. He said most are paying more now than they did before the law and didn't need the new rules to be able to buy insurance. "A forced coverage system is not the answer," he said.

But health care advocates in Sacramento have sharply criticized McCarthy's remarks, saying his plan could create "chaos" in California's individual insurance market.

"The elimination of financial help in Covered California — even if delayed — would not just cause people to drop coverage and insurers to leave the market, but would force skyrocketing rates for those left in a smaller and sicker insurance pool," said Anthony Wright of Health Access California, a statewide consumer advocacy coalition.

Meanwhile, Aguilar, the program manager for Community Health Initiative of Kern County, said roughly six people are referred to his organization each month by a local cancer center. They have been diagnosed with cancer or another serious illness but don't have insurance, he said.

For people like this, a full repeal of Obamacare without a replacement would be devastating, Aguilar said.

"It's just horrible thinking about those people who are having the worst experience in their life and now they're not going to have anywhere to turn in order to get the coverage they need to get their medical care," Aguilar said.

"I'm afraid people can lose their lives without the coverage they need," he added.

The Tate family, David, Bradley, Lucas and Kristel, struggled when youngest son Lucas was diagnosed with acute lymphoblastic leukemia in 2009. David credits the Affordable Care Act for providing security and peace of mind in the years after his son's diagnosis and treatment.

Courtesy of the Tate family/KHN

Worry about Obamacare's repeal is not confined to residents who depend on the government for coverage.

Bakersfield resident David Tate, a 34-year-old school nurse, has a son, Lucas, who was diagnosed with acute lymphoblastic leukemia in 2009, when he was 7 months old. The boy survived after intensive chemotherapy treatments.

Tate, who then had a private market plan to cover Lucas, credited two provisions of the Affordable Care Act for giving his family security and peace of mind after Lucas' initial treatment was over. One was a requirement to cover people with pre-existing conditions. "If the ACA hadn't been there and I needed another private plan, they would have denied him coverage," Tate said.

The second provision prohibited insurance companies from placing lifetime limits on most benefits in most plans.

"Lucas had essentially used his lifetime maximum for treatments in that first year," Tate said. "Could you imagine if Lucas had relapsed? We would have been completely out of benefits. We would have just been hosed."

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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

How A Psychedelic Drug Helps Cancer Patients Overcome Anxiety

Sat, 12/03/2016 - 7:00am
Katherine Streeter for NPR

The brilliantly-colored shapes reminded Carol Vincent of fluorescent deep-sea creatures, and they floated past her languidly. She was overwhelmed by their beauty — and then suddenly, as if in a dream, she was out somewhere in deep space instead. "Oh, wow," she thought, overwhelmed all over again. She had been an amateur skydiver in her youth, but this sensation didn't come with any sense of speeding or falling or even having a body at all. She was just hovering there, gazing at the universe.

Vincent was having a psychedelic experience, taking part in one of the two studies just published that look at whether cancer patients like her could overcome their death-related anxiety and depression with a single dose of psilocybin.

It turned out they could, according to the studies, conducted at New York University and Johns Hopkins and reported this week in the Journal of Psychopharmacology. NYU and Hopkins scientists gave synthetic psilocybin, the hallucinogenic component of "magic mushrooms," to a combined total of 80 people with advanced cancer suffering from depression, anxiety, and "existential angst." At follow-up six months or more later, two-thirds of the subjects said their anxiety and depression had pretty much disappeared after a single dose.

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And about 80 percent said the psilocybin experience was "among the most personally meaningful of their lives," Roland Griffiths, a professor of psychiatry and leader of the Hopkins team, said in an interview.

That's how it was for Vincent, one of the volunteers in Griffiths' study. By the time she found her way to Hopkins in 2014, Vincent, now 61, had been living for six years with a time bomb of a diagnosis: follicular non-Hodgkin's lymphoma, which she was told was incurable. It was asymptomatic at the time except for a few enlarged lymph nodes, but was expected to start growing at some undefined future date; when it did, Vincent would have to start chemotherapy just to keep it in check. By 2014, still symptom-free, Vincent had grown moderately anxious, depressed, and wary, on continual high alert for signs that the cancer growth had finally begun.

"The anvil over your head, the constant surveillance of your health — it takes a toll," says Vincent, who owns an advertising agency in Victoria, British Columbia. She found herself thinking, "What's the point of this? All I'm doing is waiting for the lymphoma. There was no sense of being able to look forward to something." When she wasn't worrying about her cancer, she was worrying about her son, then in his mid-20s and going through a difficult time. What would happen to him if she died?

Participating in the psilocybin study, she says, was the first thing she'd looked forward to in years.

The experiment involved two treatments with psilocybin, roughly one month apart — one at a dose high enough to bring on a markedly altered state of consciousness, the other at a very low dose to serve as a control. It's difficult to design an experiment like this to compare treatment with an actual placebo, since it's obvious to everyone when a psychedelic experience is underway.

The NYU study used a design similar to Hopkins' but with an "active placebo," the B vitamin niacin, instead of very-low-dose psilocybin as the control. Niacin speeds up heart rate but doesn't have any psychedelic effect. In both studies it was random whether a volunteer got the dose or the control first, but everyone got both, and the order seemed to make no difference in the outcome.

Vincent had to travel from her home in Victoria to Baltimore for the sessions; her travel costs were covered by the Heffter Research Institute, the New Mexico nonprofit that funded both studies. She spent the day before each treatment with the two Hopkins staffers who would be her "guides" during the psilocybin trip. They helped her anticipate some of the emotional issues — the kind of baggage everyone has — that might come to the fore during the experience.

The guides told Vincent that she might encounter some hallucinations that were frightening, and that she shouldn't try to run away from them. "If you see scary stuff," they told her, "just open up and walk right in."

They repeated that line the following day — "just open up and walk right in" — when Vincent returned to Hopkins at 9 a.m., having eaten a light breakfast. The treatment took place in a hospital room designed to feel as homey as possible. "It felt like your first apartment after college, circa 1970," she says, with a beige couch, a couple of armchairs and some abstract art on the wall.

Vincent was given the pill in a ceramic chalice, and in about 20 minutes she started to feel woozy. She lay down on the couch, put on some eye shades and headphones to block out exterior sights and sounds, and focused on what was happening inside her head. The headphones delivered a carefully-chosen playlist of Western classical music, from Bach and Beethoven to Barber's "Adagio for Strings," interspersed with some sitar music and Buddhist chants. Vincent recalled the music as mostly soothing or uplifting, though occasionally there were some brooding pieces in a minor key that led her images to a darker place.

Shots - Health News Your Brain On Psilocybin Might Be Less Depressed

With the music as background, Vincent started to experience a sequence of vivid hallucinations that took her from the deep sea to vast outer space. Listening to her describe it is like listening to anyone describe a dream — it's a disjointed series of scenes, for which the intensity and meaning can be hard to convey.

She remembered seeing neon geometric shapes, a gold shield spelling out the name Jesus, a whole series of cartoon characters — a fish, a rabbit, a horse, a pirate ship, a castle, a crab, a superhero in a cape — and at some point she entered a crystal cave encrusted with prisms. "It was crazy how overwhelmed by the beauty I was," she says, sometimes to the point of weeping. "Everything I was looking at was so spectacular."

At one point she heard herself laughing in her son's voice, in her brother's voice, and in the voices of other family members. The cartoon characters kept appearing in the midst of all that spectacular beauty, especially the "comical crab" that emerged two more times. She saw a frightening black vault, which she thought might contain something terrifying. But remembering her guides' advice to "just open up and walk right in," she investigated, and found that the only thing inside it was herself.

When the experience was over, about six hours after it began, the guides sent Vincent back to the hotel with her son, who had accompanied her to Baltimore, and asked her to write down what she'd visualized and what she thought about it.

Griffiths had at first been worried about giving psychedelics to cancer patients like Vincent, fearing they might actually become even more afraid of death by taking "a look into the existential void."

But even though some research participants did have moments of panic in which they thought they were losing their minds or were about to die, he said the guides were always able to settle them down, and never had to resort to the antipsychotic drugs they had on hand for emergencies. (The NYU guides never had to use theirs, either.)

Shots - Health News How LSD Makes Your Brain One With The Universe

Many subjects came away feeling uplifted, Griffiths says, talking about "a sense of unity," feeling part of "an interconnected whole." He adds that even people who are atheists, as Vincent is, described the feeling as precious, meaningful or even sacred.

The reasons for the power and persistence of psilocybin's impact are still "a big mystery," according to Griffiths. "That's what makes this research, frankly, so exciting," he says. "There's so much that's unknown, and it holds the promise for really understanding the nature of human meaning-making and consciousness."

He says he looks forward to using psilocybin in other patient populations, not just people with terminal diagnoses, to help answer larger existential questions that are "so critical to our experience as human organisms."

Two and a half years after the psychedelic experience, Carol Vincent is still symptom-free, but she's not as terrified of the "anvil" hanging over her, no longer waiting in dread for the cancer to show itself. "I didn't get answers to questions like, 'Where are you, God?' or 'Why did I get cancer?' " she says. What she got instead, she says, was the realization that all the fears and worries that "take up so much of my mental real estate" turn out to be "really insignificant" in the context of the big picture of the universe.

This insight was heightened by one small detail of her psilocybin trip, which has stayed with her all this time: that little cartoon crab that floated into her vision along with the other animated characters.

"I saw that crab three times," Vincent says. The crab, she later realized, is the astrological sign of cancer — the disease that terrified her, and also the sign that both her son and her mother were born under. These were the three things in her life that she cared about, and worried over, most deeply, she says. "And here they were, appearing as comic relief."

Science writer Robin Marantz Henig is a contributing writer for The New York Times Magazine and the author of nine books.

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

Winners And Losers With The 21st Century Cures Bill

Fri, 12/02/2016 - 1:18pm

Rep. Tim Murphy, R-Pa., embraces Rep. Fred Upton, R-Mich., during a media briefing about the 21st Century Cures Act on Capitol Hill on Nov. 30.

Susan Walsh/AP

Updated 12/7/16: A sprawling health bill that passed the Senate Thursday by a 94 to 5 vote and is expected to gain President Obama's signature is a grab bag for industries, academic institutions and patient groups that spent oodles of time and money lobbying to advance their interests.

Senate Majority Leader Mitch McConnell calls it "the most important legislation that Congress will pass this year."

Who wins and who loses?

Here's the rundown of what's at stake in the 21st Century Cures Act:


Pharmaceutical and Medical Device Companies

Shots - Health News Congress Poised To Pass Sweeping Law Covering FDA And NIH

The law would likely save drug and device companies billions of dollars when it comes to bringing products to market by giving the Food and Drug Administration more discretion in the kinds of studies required to evaluate new devices and medicines for approval.

The changes represent a massive lobbying effort by 58 pharmaceutical companies, 24 device companies and 26 biotech companies, according to a Kaiser Health News analysis of lobbying data compiled by the Center for Responsive Politics. The groups reported more than $192 million in lobbying expenses on the Cures Act and other legislative priorities, the analysis shows.

Medical schools, hospitals and doctors

The law would provide $4.8 billion over 10 years in additional funding to National Institutes of Health, the federal government's main biomedical research organization. (The funds aren't guaranteed, however, and would be subject to annual appropriations.)

The money could help researchers at universities and medical centers get hundreds of millions more dollars in research grants, most of it toward research on cancer, neuroscience and genetic medicine.

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The bill attracted lobbying activity from more than 60 schools, 36 hospitals and several dozen groups representing physician organizations. They reported spending more than $120 million in lobbying disclosures that included the Cures Act.

Advocates for mental health and substance abuse treatment

The law would provide $1 billion in state grants over two years to address opioid abuse and addiction. While most of that money would go to treatment facilities, some would fund research.

The Cures Act would also boost funding for mental health research and treatment, with hundreds of millions of dollars authorized for dozens of existing and new programs.

Mental health, psychology and psychiatry groups spent $1.8 million on lobbying disclosures that included the Cures Act as an issue.

Patient groups

Groups focused on specific diseases and patient advocacy generally supported the legislation and lobbied vigorously for it. Many of these groups get a portion of their funding from drug and device companies. The bill includes more patient input in the drug development and approval process, and if it becomes law would boost the clout of such groups.

More than two dozen patient groups reported spending $6.4 million in disclosures that named the bill as one of their issues.

Health information technology and software companies

The law would push federal agencies and health providers nationwide to use electronic health records systems and to collect data to enhance research and treatment. Although the Cures Act wouldn't specifically fund the effort, IT and data management companies could gain millions of dollars in new business.

The Food and Drug Administration would get more money for hiring, but probably not enough to solve its personnel problems.

Andrew Harnik/AP

More than a dozen computer, software and telecom companies reported Cures Act lobbying. The groups' total lobbying spending was $35 million on it and other legislation.


Public health

The Cures Act would cut $3.5 billion — about 30 percent — from the Prevention and Public Health Fund established under Obamacare to promote prevention of Alzheimer's disease, hospital acquired infections, chronic illnesses and other ailments.

Consumer and patient safety groups

Groups like Public Citizen and the National Center for Health Research either fought the bill outright or sought substantial changes. Although they won on some points, these groups still say the Cures Act opens the door for unsafe drug and device approvals and doesn't address rising drug costs.

Medicaid patients seeking hair growth

The act says Medicaid would no longer help pay for drugs that help patients restore hair. The National Alopecia Areata Foundation spent $40,000 on lobbying disclosures this cycle that included the Cures Act.

Food and Drug Administration

The law would gives FDA an additional $500 million through 2026 and more hiring power, but critics say it isn't enough to cover the additional workload under the bill. The agency also would get something it has opposed: renewal of a controversial voucher program that rewards companies for getting drugs approved to treat rare pediatric diseases.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. KHN's coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

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

Time For Homeopathic Remedies To Prove That They Work?

Fri, 12/02/2016 - 5:00am

Drugstore shelves carry medications approved by the Food and Drug Administration as well as unregulated supplements and homeopathic remedies.

Christopher Dilts/Bloomberg via Getty Images

Homeopathy has been around since the 1700s, but despite having devoted followers, there is no scientific evidence that it works. Soon, packages for homeopathic products might say just that.

On Nov. 15, the Federal Trade Commission released an enforcement policy statement about labeling for over-the-counter homeopathic products. Homeopathic treatments have increasingly been marketed in drug store and supermarket aisles, alongside Food and Drug Administration-approved over-the-counter medications like Tylenol and Mucinex.

Some homeopathic remedies have disclaimers that say their products aren't regulated by the FDA. Some don't have any disclaimers at all. One product even claims that homepathic remedies are regulated just like other medicines, which is not true.

Homeopathy is based on the notion that "like cures like." Remedies include a tiny amount of a substance that might spark similar symptoms, but the amount in most products is so small as to be undetectable. Because they're sold next to medications, the FTC believes that they need to be held to the same labeling standards when it comes to making medical claims on their packaging.

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And the FTC outlined very specific ways to do so.

First of all, the people producing the remedies need to be able to provide evidence that they work. If they can't, they need to add a disclaimer to packaging that says "there is no scientific evidence that the product works" and "the product's claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts."

According to Richard Cleland, assistant director of the division of advertising practices at the FTC, we might not be seeing that exact languages on boxes, but the products need to both say that their claims are not based on scientific evidence, and also say what they are based on.

A current label on a homeopathic remedy.

Erin Ross/NPR

"And they can't just say that it's based on homeopathic principles. People don't know what those are," says Cleland. So in some way, companies need to convey that that means 300-year-old widely-rejected theories.

The FTC didn't stop there. On the label, the disclaimer needs to be close to the medical claims the product is making, or even be incorporated into the claims themselves. There will be no hiding this message with a footnote at the bottom of the box or label.

It's unclear how long it will take for the FTC to take action against homeopathic products with misleading labels or packaging. In past cases, the FTC has waited several months after issuing an enforcement policy statement to allow companies time to comply or change their practices. Then they send warning letters, and eventually go after the most egregious offenders.

Understandably, the homeopathy community isn't happy with these regulations. But Skipp Neville, the president and CEO of Clear Products, a small company based in San Diego that makes homeopathic products, says he'll update the language on his packages — if his lawyers agree he should. "We follow the guidelines for what the FDA requires. The FTC, I can't speak on that — obviously there's legal issues."

The legal issue is this: Some people within the natural remedy community don't believe the FTC has jurisdiction to enforce claims on labeling. Daniel Fabricant, the executive president of the Natural Products Association, says that "this is a clear example of jurisdictional creep."

Drug stores increasingly sell homeopathic remedies, even though there is no scientific evidence that they have health benefits.

Erin Ross/NPR

Labels, he says, are not advertisements. The FTC regulates claims in advertisements. He believes that the labels on homepathic packaging are the FDA's territory.

But the FTC disagrees, and so does Jonathan Turley, a law professor at George Washington University who teaches courses on labeling. "The FDA effectively struck a deal with the homeopathic industry that says they won't be regulated as other drugs, as long as they don't say they're FDA approved. Obviously, the FTC sees it differently."

And according to Turley, the FTC does have the ability to require certain label wording.

Still, Fabricant believes these new guidelines unfairly target homeopathic remedy manufacturers by requiring them to back up their medical claims with evidence like double-blind trials.

"There's no double-blind trial for plenty of over-the-counter drugs — like aspirin, for example," says Fabricant. Actually, aspirin might have been the wrong example — it's been the subject of tons of double-blind trials.

"Other products need to support their claims, so why shouldn't homeopathic products?" counters the FTC's Cleland. "They're not different; they're going to be held to the same standard."

Cleland doesn't think the labeling will necessarily dissuade people from purchasing homeopathic remedies, and that's not the FTC's goal. "We believe the consumer should have as much accurate information as they can before making purchasing decisions."

Still, there's always the possibility that these labeling changes might make homeopathy fans like the products even more.

Some people who use alternative medicine are distrustful of traditional medicines. Learning that the product isn't supported by modern medicine might be just the endorsement they need.

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

Zap! Magnet Study Offers Fresh Insights Into How Memory Works

Thu, 12/01/2016 - 2:19pm
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December 1, 20162:19 PM ET Heard on All Things Considered Fanatic Studio/Collection Mix: Sub/Getty Images

Forget where you just left your car keys? A magnetic pulse might help you remember.

Some dormant memories can be revived by delivering a pulse of magnetic energy to the right brain cells, researchers report Thursday in the journal Science.

The finding is part of a study that suggests the brain's "working memory" system is far less volatile than scientists once thought.

"This changes how we think about the structure of working memory and the processes that support it," says Nathan Rose, a neurocognitive psychologist studying memory at the University of Notre Dame and one of the authors of the research.

Working memory, he explains, is what allows the brain to retain a new piece of information even when our attention is temporarily directed elsewhere.

Say you're at a cocktail party, for example. You meet two people, learn their names, and start a conversation. As you talk, the conversation shifts to just one of those people.

"But you don't want to forget who the other person is, in case the conversation shifts back," Rose says. And, usually, you don't forget, because your brain has been keeping the name in working memory — ready to use at a moment's notice.

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Since the 1950s, the dominant theory about working memory has been that it required continuous activity in the brain cells associated with a particular item, like someone's name. If the activity level dropped, the memory was gone forever, scientists figured.

But Rose and a team of researchers weren't so sure. So they did a series of experiments.

In one, people watched a screen while researchers monitored the activity in their brains.

"We presented two items — like a face and a word," Rose says. The participants were told they needed to remember both.

That caused a distinct pattern of activity in two groups of brain cells: one that was keeping track of the face and another that was keeping track of the word.

But then, Rose says, the researchers had people focus on just one of the items they'd seen. And when they did that, the brain activity associated with the other item disappeared.

"It was almost as if the item had been forgotten," Rose says.

But it wasn't forgotten. When prompted, the participants were able to retrieve their memory of the item. And that caused the associated brain cells to start firing again.

Then the researchers provided an even more dramatic demonstration. They used transcranial magnetic stimulation (via an electromagnetic coil held to the forehead) to deliver a pulse of energy to the brain.

Shots - Health News Electric Currents And An 'Emotional Awakening' For One Man With Autism

"And when we did that, we saw a brief reactivation of the unattended memory item, as if it was brought back into focal attention," Rose says. The technique only worked, though, if people believed they would need to remember the item at some later time.

This ability to revive a thought with a magnetic pulse quickly became known as "the Frankenstein effect" among scientists in the lab, Rose says.

The results offer strong evidence that brain cells don't have to remain active to sustain a working memory, Rose says. But he's concerned that the public will assume magnetic stimulation can help them recover memories.

"Boy, wouldn't that be great?" he says. "But I think we're a ways away from that."

What's closer, though, is a better understanding of how short-term memory works.

The study strongly suggests that working memories can be stored by changing the connections among neurons, says Joel Voss, a brain scientist at Northwestern University who was not involved in the research

"If you imagine that a particular set of connections can represent a memory, then that set of connections could be reconfigured," he says. "And it could stay in that configuration, even if the neurons aren't persistently active."

Scientists believe that's how long-term memories are stored. And if some short-term memories also use this mechanism, it could explain how they can become long-term memories.

"In order for a long-term memory to happen there has to be some physical trace of that memory," he says. And that's exactly what the study seems to have found.

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

Life Inside The Alzheimer's Ward: A Hidden World Revealed

Thu, 12/01/2016 - 11:55am
Maja Daniels

Inside the walls of a geriatric hospital in France, time stands still. Light falls across two stockinged feet on a bed. The fading floral pattern on a swath of wallpaper is interrupted by an unused corkboard. And between these scenes of stillness, residents approach a pair of locked doors with modest curiosity, expectation and even anger.

Swedish photographer Maja Daniels says those doors, which were locked to prevent the residents from wandering, were crucial early in the project.

"I found myself on the other side of those doors looking at someone looking at me, waving at me to get my attention and not knowing why," Daniels says. "That vision just stuck with me."

Daniels is the inaugural winner of the Bob and Diane Fund, a $5,000 grant for visual storytelling about Alzheimer's disease and dementia. National Geographic's Gina Martin started the fund this year and named it in honor of her mother, Diane, who died from Alzheimer's in 2011, and her father, Robert.

"It's very hard to document Alzheimer's disease," Martin said. "I think people will find [Maja's] work to be very smart, fresh and modern."

Maja Daniels

After spending time with the hospital residents and their families and getting permission to photograph, Daniels visited the hospital for about a week each month over three years.

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With the backing of the grant, Daniels plans to create a publication of the work that will be distributed as part of a larger project on aging.

Shots caught up with Daniels to talk about her project. The interview has been edited for clarity and length.

Interview Highlights
  • Hide caption Daniels spent three years working on her project, Into Oblivion, which documents life inside a geriatric unit in France. Previous Next Maja Daniels
  • Hide caption Daniels spent three years working on her project, Into Oblivion, which documents life inside a geriatric unit in France. Previous Next Maja Daniels
  • Hide caption Daniels spent three years working on her project, Into Oblivion, which documents life inside a geriatric unit in France. Previous Next Maja Daniels
  • Hide caption Daniels spent three years working on her project, Into Oblivion, which documents life inside a geriatric unit in France. Previous Next Maja Daniels
  • Hide caption Daniels spent three years working on her project, Into Oblivion, which documents life inside a geriatric unit in France. Previous Next Maja Daniels
  • Hide caption Daniels spent three years working on her project, Into Oblivion, which documents life inside a geriatric unit in France. Previous Next Maja Daniels
  • Hide caption Daniels spent three years working on her project, Into Oblivion, which documents life inside a geriatric unit in France. Previous Next Maja Daniels

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How did you first get into the project?

I was studying at university and was part of a photographic collective. We were approached by this really dynamic director of a geriatric hospital who was keen to have image makers come in and collaborate. It's very rare to have this opportunity — it's a very closed world. That's also why it's frightening to many people. We don't always know what's hiding behind those doors.

Maja Daniels

What was it like to spend time on the other side getting to know the people who were there?

The power of the project lies in its very strict viewpoint and simplistic storytelling. It's not trying to tell everything that's going on; it's taking the standpoint of one of the residents and lingering with that. I wanted to get into the spirit of being a part of this world. How does that affect someone? That door would always remain shut for them. Even though there are activities and people rushing in and out to care for them, a large majority of the time is spent without much happening at all. So that silence is something I wanted to get across, partly because it felt like part of some interior silence as well. When you're experiencing this disease it's like the world is slowly fading.

How did the residents first respond to you when you began shooting?

Part of the preparation work was to introduce myself to residents, to their families, to the carers and the hospital in general. I'd do it without cameras, and just spend time meeting people. The residents took to me as a human presence in the ward that was appreciated. Someone there who could tie them to the now or to the everyday. If you're just left to yourself, you kind of float around in your mind, you can go to other places, but with someone else in your space, you're tied to that moment in time.

It was interesting to see how the camera got to play its own role because it was something that many residents would relate to. There's a lot of corporeal memory that's stuck in your body that doesn't leave with Alzheimer's disease. For instance, if you've been singing a lot in your life, you'll still have this urge to sing. There was a mechanic and he was absolutely fascinated with the camera. He took a lot of pictures himself and was positively pleased by its presence there.

How did the families respond to the work?

It's often very difficult to look at a photograph of a person you know because the photograph becomes something else to you. It was very hard for them to look at [the work], but they were motivated to let the story get out there and to hopefully bring more attention to the topic, to care policies and how institutions work. Some families didn't want their residents to be photographed at all, which was absolutely fine as well.

Maja Daniels

Has this changed the way you view Alzheimer's?

Yeah, of course. I didn't know much at the onset. I didn't know that there were these moments of lucidity where it becomes clear to the person that they are losing their memories. And these moments can cause trouble. Depression kicks in or other aspects of violence or frustration. This is something I didn't know about the disease beforehand. It's all very complex.

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

Abortion-Rights Groups Challenge Restrictions In 3 States

Wed, 11/30/2016 - 3:29pm

People await a decision outside the Supreme Court on June 27. The court struck down a Texas law restricting abortions.

Pete Marovich/Getty Images

There's no shortage of speculation about how the incoming Trump administration, whose appointees so far are staunch abortion opponents, might crack down on access to the procedure.

But reproductive rights groups say the big picture is getting lost: Women in large parts of the country already have limited access to abortion, due to hundreds of Republican-backed laws passed by state legislatures over the past half-decade.

"People are forced to travel hundreds of miles, cross state lines, miss work, lose wages and jeopardize their health and safety to obtain an abortion," says Carrie Flaxman, an attorney with Planned Parenthood.

On Wednesday, Planned Parenthood joined the ACLU and the Center for Reproductive Rights in filing legal challenges to abortion restrictions, targeting laws in three states:

North Carolina. The lawsuit challenges a law banning abortion after 20 weeks of pregnancy, except in the case of a medical emergency. That is several weeks earlier than the generally agreed point of fetal viability, before which the 1973 Roe v. Wade decision says women have a constitutional right to abortion.

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Alaska. A four-decade-old restriction effectively bans second-trimester abortions in outpatient health centers. Abortion-rights advocates say for many women the only option would be to fly out of state, if they can afford it.

Missouri. Restrictions require doctors who perform abortions to have admitting privileges in hospitals, and clinics have to have the same health and safety standards as ambulatory surgical centers. Abortion-rights advocates say this has left the state with just one clinic that provides abortions.

The Missouri laws are similar to those in Texas that were struck down in a landmark Supreme Court ruling last June. Julie Rikelman, interim vice president of the Center for Reproductive Rights, says that precedent could help overturn the other restrictions as well. She says the ruling makes clear that states must consider whether a restriction actually benefits women's health, and they must "look at real and credible evidence." She says, "They can't look at junk science."

In the case of 20-week bans, abortion opponents often claim that fetuses can feel pain at that point, an assertion disputed by most medical research. That claim is not made in the North Carolina law.

Denise Burke, vice president of legal affairs for Americans United for Life, thinks that North Carolina's 20-week ban will withstand this new challenge for another reason. An amendment that took effect this year set a stricter standard for exemptions, saying a woman can have the procedure after 20 weeks only if her life is in danger or there is a "serious risk of substantial and irreversible physical impairment of a major bodily function."

"The plaintiffs are simply saying the exception [in the North Carolina law] is too narrow," Burke says. But even if it's overturned, she does not consider this a broad challenge to other such laws. "Texas' 20-week abortion ban remains in effect, as do 20-week limitations in other states."

Meanwhile, Burke says abortion opponents will continue to push for new restrictions. Texas this week announced it will soon require some aborted fetuses to be buried or cremated, not disposed of as medical waste. Courts have blocked similar measures in Indiana and Louisiana, but Burke says she expects that more states will propose versions of her organization's Unborn Infants Dignity Act when lawmakers convene next year.

The Two-Way Supreme Court Strikes Down Abortion Restrictions In Texas

Burke notes that the Supreme Court ruling also said that health and safety standards can be constitutional if they show evidence of harmful conditions inside clinics that perform abortion. She says, "AUL is preparing a special project to present such evidence."

As reproduction-rights groups launch more legal challenges, they have a new concern. By the time these cases wend their way up to the Supreme Court, President-elect Donald Trump may have appointed one or more justices to it. He has said he will make it a priority to choose people who would overturn the constitutional right to an abortion in Roe v. Wade.

"We know it is now at greater risk than it was before," says Rikelman of the Center for Reproductive Rights. But the right to abortion "has stood the test of time and been approved by a variety of justices appointed by a variety of administrations."

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Obamacare's Test Kitchen For Payment Experiments Faces An Uncertain Future

Wed, 11/30/2016 - 1:58pm

Will a change in administration curtail experiments in how the government pays for health care?

Hero Images/Getty Images

Joint replacements. Cardiac care. Chemotherapy.

What do those things have to do with the repeal of the Affordable Care Act?

Well, an often overlooked part of Obamacare is a test kitchen within the Department of Health and Human Services that experiments with new ways for the government to pay for some expensive and frequently used health care services, including those three.

But with the Affordable Care Act up for potential repeal, will Congress preserve the Center for Medicare & Medicaid Innovation, whose goals include lowering costs and improving quality?

Rep. Tom Price, an orthopedic surgeon who is President-elect Trump's choice to run HHS, has been a vociferous critic of Obamacare and the Center for Medicare & Medicaid Innovation. In September, Price and other GOP lawmakers wrote to CMS officials asking that CMMI "stop experimenting with Americans' health, and cease all current and future planned mandatory initiatives."

Shots - Health News Trump Chooses Rep. Tom Price, An Obamacare Foe, To Run HHS

Republican lawmakers have complained — along with some in the health care industry — that the law under the Obama administration gave too much authority to the head of HHS to create and expand projects. Now, however, that very same authority may look appealing as Republicans head the department and may want to use the center to test their own ideas, including those that would revamp Medicare or Medicaid.

"You can dislike that authority, until you have the opportunity to use the authority," said Rodney Whitlock, a vice president at ML Strategies, a government consulting firm in Washington, D.C., and former Republican staff member of the Senate Finance Committee.

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As lawmakers debate and discuss ways to repeal the Affordable Care Act, they will weigh the fate of innovation center, funded through the health law with $10 billion for 2011 to 2019, and another $10 billion for each subsequent decade. The Congressional Budget Office estimates the center would increase federal spending initially, but ultimately result in lower costs and save up to $34 billion over the next 10 years.

Congressional Republicans haven't yet hinted whether they will keep, modify or kill the program, but they generally support the cost-saving goal of the center and many observers think they will want to keep it.

"If health care providers can do a better job of delivering patient care ... at the same or lower costs, that's the kind of flexibility the system needs more of," said Dr. Mark McClellan, a professor of health policy at Duke University who headed Medicare for two years in the George W. Bush administration.

One group that generally supports the broad cost-saving goal of the innovation center, nonetheless warned that Congress should place limits on it. Otherwise, "there is nothing preventing [the center] from testing a model ... that includes all Medicare and/or Medicaid beneficiaries in the U.S," the Healthcare Leaders for Accountable Innovation in Medicare said in a white paper. "In effect [the center] could test a model that completely restructures the Medicare or Medicaid program."

Billions of dollars have already been spent by the center, testing a variety of ideas, from ways to improve care for at-home dialysis to ways to foster more collaboration between doctors and hospitals to efforts to reduce unnecessary hospital visits by chronically ill Medicare patients. Many of the projects look at ways to move from Medicare's traditional fee-for-service payment system — that economists and policymakers say drive up costs — and instead set up reimbursement that rewards coordinated care. Few of the projects have been in place long enough for the center to determine if they truly save money and improve care.

Even if the center were eliminated, many experts say these types of payment reforms will continue because of private sector interest.

"Pay-for-value is going to be a guiding principle going forward irrespective of who is in power," said Dan Mendelson, president and CEO of the consulting firm Avalere Health. "It would surprise me to see wholesale U-turn from that policy."

To date, most of the programs funded by the innovation center are voluntary, but controversy has arisen over several recent initiatives that require participation by doctors or hospitals.

What may happen is that there will be fewer of these mandatory efforts. This year, one such project got underway, testing a method of "bundling" payments for joint replacements at 800 hospitals in 67 metro areas. For their Medicare patients, the project requires a single bundled payment to cover the cost of these procedures, including in-patient and post-operative care, instead of separate payments for each doctor, hospital or nursing home visit. A similar mandatory project for certain kinds of cardiac care has also been proposed.

In the end, the center's future will be determined by whether the Republican majority believes it is one of the best ways to slow rising medical costs, said Christopher Condeluci, principal at CC Law & Policy in Washington, D.C., and the former tax and benefits counsel to the Senate Finance Committee.

"If the answer is yes, they will keep it and it might go to new heights," Condeluci said.

But economist Joe Antos, a resident scholar at the American Enterprise Institute, doesn't think the new administration – or many members of Congress – will push to use the center's authority to create broad, mandatory nationwide experiments with Medicare.

"I can't imagine a Trump administration saying we want the bureaucrats to decide on the health care your grandmother is going to get," said Antos. "Anything that is that much of a marquee issue absolutely has to go through Congress."

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Julie Appleby is on Twitter: @Julie_appleby.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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Glowing Human Cells May Shed Light On Sickness And Health

Wed, 11/30/2016 - 9:08am

In a cluster of glowing human stem cells, one cell divides. The cell membrane is shown in purple, while DNA in the dividing nucleus is blue. The white fibers linking the nucleus are spindles, which aid in cell division.

Allen Institute for Cell Science

A nonprofit research group is giving scientists a new way to study the secret lives of human cells.

On Wednesday, the Allen Institute for Cell Science provided access to a collection of living stem cells that have been genetically altered to make internal structures like the nucleus and mitochondria glow.

"What makes these cells special is that they are normal, healthy cells that we can spy on and see what the cell does when it's left alone," says Susanne Rafelski, director of assay development at the institute. Under a microscope, "they are a wonder to behold," she says.

Dividing cells

Left: A highly magnified time-lapse movie shows the nuclei of glowing human stem cells moving and dividing. The nucleus contains most of a cell's DNA. Right: The nuclei inside a colony of stem cells.

Source: Allen Institute for Cell Science

The cells originally came from skin. But they have the potential to become many different types of cells, including those found in the heart and brain.

And they could help scientists answer basic questions about how cells specialize as they develop, how disease changes a cell and how experimental drugs affect certain types of cells.

"We're creating a powerful resource and a tool that any biologist can use," says Ruwanthi Gunawardane, director of stem cells and gene editing at the Allen institute.

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Initially, the institute is releasing five cell lines through the Coriell Institute for Medical Research. Each line has a different internal structure that glows, allowing researchers to see how that structure moves and changes during a cell's life.

"What's really cool about this is that we can watch the cell as it divides," Gunawardane says.

Any scientist can order the cells online for a price that reflects only the distribution cost. "Our goal was to make this absolutely accessible to any person working on stem cells," Gunawardane says.

Beating Heart Cells

Healthy heart cells beat in a petri dish.

Source: Allen Institute for Cell Science

Until now, many scientists have had to rely on cells that grow abnormally or have mutations, Gunawardane says. And there has been no good way to see a living cell's internal structures without disrupting its normal operation.

The new cell lines are the product of cutting-edge technology found in just a few labs, Gunawardane says. "We would not have been able to do this two years ago," she says.

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Millions Of People Are Having An Easier Time Paying Medical Bills

Wed, 11/30/2016 - 12:02am

Juana Rivera (left) speaks with agent Fabrizzio Russi about buying insurance through the Affordable Care Act in Miami in 2014.

Joe Raedle/Getty Images

The number of people who have trouble paying their medical bills has plummeted in the past five years as more people have gained health insurance through the Affordable Care Act and gotten jobs as the economy has improved.

A report from the National Center for Health Statistics released Wednesday shows that the number of people whose families are struggling to pay medical bills fell by 22 percent, or 13 million people, in the past five years.

And that's good news, according to consumer and health policy advocates.

"The effect on families is profound," says Lynn Quincy, director of the Healthcare Value Hub at the Consumers Union. "Health care costs are a top financial concern for families, far above other financial concerns."

Quincy says the No. 1 determinant of whether people can pay medical bills is whether they have insurance.

"The fact that this report shows it's getting easier, it seems like we should lay a good part of this at the door of the ACA," she says.

The decline in families worrying about medical bills corresponds with a huge increase in the number of people who have health insurance. In 2011, 46.3 million in the U.S. were uninsured. In June of this year, that figure had fallen to 28.4 million people.

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Much of that increase is a result of the Affordable Care Act, whose insurance exchanges were launched in 2013 for coverage starting in 2014.

About 20 million people this year have health insurance because of the ACA, according to the Department of Health and Human Services. That includes about 10 million people who gained coverage through the expansion of Medicaid and another 10 million who buy insurance on the Obamacare exchanges or are young adults covered through their parents' insurance.

Kevin Lucia, a research professor at Georgetown's Health Policy Institute, says the insurance offered under Obamacare has more financial protections than pre-ACA policies.

"The coverage is more protective in many ways," he says. "It doesn't include annual limits [or] lifetime limits, and it includes a comprehensive benefit package. That may be contributing to the improved data."

Some of the relief could also come because more people have jobs, so they can more easily pay their bills.

The unemployment rate has fallen from 9.1 percent in January 2011 to just 4.9 percent in June, according to the Bureau of Labor Statistics.

The finding that people are having an easier time paying medical bills may seem surprising because of reports that insurance premiums and cost-sharing have been rising in recent years.

A report in September by the Kaiser Family Foundation shows that more and more companies are offering their employees health insurance plans that carry higher deductibles.

But Quincy says simply having coverage is the key.

"People speak loudest when they are faced with increasing deductibles and increase cost sharing," she says. "But nothing determines the affordability of care more than that binary equation: Do you have coverage or do you not?"

The report comes just as President-elect Donald Trump is naming officials to his health policy team who are determined to dismantle the Affordable Care Act. Trump has pledged to repeal and replace the health law, and on Tuesday named Rep. Tom Price, R-Ga., a vocal opponent of Obamacare, to lead the Department of Health and Human Services.

Repealing the law would hurt the people who are seeing relief from high medical bills as highlighted in this report, says Jay Angoff, a former Missouri insurance commissioner who helped implement the Affordable Care Act at HHS.

"There are millions of people who have coverage under Obamacare," Angoff says. "What are they going to tell those guys?"

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