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My Journey From Homeless Drug Addict To Magna Cum Laude

Sun, 04/13/2014 - 5:09am
My Journey From Homeless Drug Addict To Magna Cum Laude April 13, 2014 5:09 AM ET i i Maria Fabrizio for NPR

I was fighting a rat for the remnants of a corn dog I'd salvaged from the trash. That's when I realized I'd crossed the final line I had drawn.

I had told myself, as long as I don't shoot up, I'm OK. As long as I'm not homeless, I'm OK. But now I was shooting up and homeless, and there was nowhere left to draw. I had reached the bottom line of my existence.

I was constantly searching for something outside to fix how I felt inside. My first memory of that need was when I was about 8. My parents had divorced, and I was living with my grandmother. We had a difficult relationship. I wasn't fitting in at school, and I was overweight. I went into her kitchen pantry and ate an entire container of icing. I put the lid back on and placed it exactly where I had found it. Before long, I began to make excuses so I could hide in the pantry.

When I went back to my father, we moved around. I never stayed in the same school for more than a year. I was always the new and awkward tall kid, and I learned to downplay my intelligence in order to fit in.

Drugs and alcohol helped me feel at peace with myself, and opened the door to being liked by other kids. I tried anything I could get my hands on: pot, alcohol, crack, hallucinogens, pills, belladonna seeds and household products that I could huff. Only new and stronger chemicals masked how I truly felt about myself: unwanted, unworthy, useless and ugly.

Eventually, substance abuse became the common denominator among the people I allowed in my life. If you did not use, then I didn't have time for you.

My judgment began to deteriorate. I found myself in places I didn't want to be and doing things I didn't want to do. I would get in cars with strangers and drive to another state just on the promise of getting high. It is only by the grace of God that I think I was able to survive.

When I was 17, I had a daughter, but even the unconditional love of a child couldn't coax me away from the demon of addiction. When she was 3, she went to live with her father.

I sold just enough drugs to cover the cost of what I was using. I was now living with others in a riverbed under a freeway overpass. The drainage would bring large deposits of aluminum cans, which we would exchange for money. I was now an IV meth user and couldn't fathom how my life could get any worse. I didn't have the courage to kill myself, but I also couldn't muster the will to stop using.

My 34th birthday was the worst day of my life. I remember begging whomever would listen to either kill me or save me, but don't leave me here in hell.

I remember the next day like it was yesterday. I felt like a cockroach crawling out from under the bridge that morning. When my eyes adjusted to the sun, I saw the police officers. I had already had many run-ins with the law, and for a moment I weighed whether I could outrun the police this time. But my body was just too tired.

I knew I was again going to prison. But strangely, this didn't bother me. I felt a great weight lift off my shoulders. Somehow deep in my heart I knew that I was ready to never live this way again.

I did my time and, with the help of my family, I was paroled into a residential treatment center. The day I walked in was truly the first day of the rest of my life. My mind was ready to embrace the idea of a second chance.

At a 12-step meeting at the center one night, I heard a woman talk about an insatiable hunger she felt in the pit of her stomach — a hunger that could never be filled by any food, only drugs. She called this hole a "spiritual void." At that instant, I felt like a piece of my puzzle had finally snapped into place. I wasn't alone. There were others who felt the void, and who were waking up every day to fight to stay clean.

While in treatment, I went back to school. I was 35. Within two years, I graduated from community college. I took out student loans and transferred to a university, where I graduated magna cum laude with a bachelor's degree in business administration. I went after my recovery like I did my drugs and found I was able to accomplish anything I truly wanted.

Today I work with women who serve their prison sentences in residential treatment along with their children. My path to recovery led me to a job where my experience could help others, and that is why I feel my life hasn't been wasted. I hope I can continue counseling those who share my story. I hope I can continue to build my fragile relationship with my daughter. And sometimes, I just hope.

Hill lives in Southern California, where she works with recovering addicts and fosters dogs from an Akita rescue.

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

My Journey From Homeless Drug Addict To Magna Cum Laude

Sun, 04/13/2014 - 5:09am
My Journey From Homeless Drug Addict To Magna Cum Laude April 13, 2014 5:09 AM ET i i Maria Fabrizio for NPR

I was fighting a rat for the remnants of a corn dog I'd salvaged from the trash. That's when I realized I'd crossed the final line I had drawn.

I had told myself, as long as I don't shoot up, I'm OK. As long as I'm not homeless, I'm OK. But now I was shooting up and homeless, and there was nowhere left to draw. I had reached the bottom line of my existence.

I was constantly searching for something outside to fix how I felt inside. My first memory of that need was when I was about 8. My parents had divorced, and I was living with my grandmother. We had a difficult relationship. I wasn't fitting in at school, and I was overweight. I went into her kitchen pantry and ate an entire container of icing. I put the lid back on and placed it exactly where I had found it. Before long, I began to make excuses so I could hide in the pantry.

When I went back to my father, we moved around. I never stayed in the same school for more than a year. I was always the new and awkward tall kid, and I learned to downplay my intelligence in order to fit in.

Drugs and alcohol helped me feel at peace with myself, and opened the door to being liked by other kids. I tried anything I could get my hands on: pot, alcohol, crack, hallucinogens, pills, belladonna seeds and household products that I could huff. Only new and stronger chemicals masked how I truly felt about myself: unwanted, unworthy, useless and ugly.

Eventually, substance abuse became the common denominator among the people I allowed in my life. If you did not use, then I didn't have time for you.

My judgment began to deteriorate. I found myself in places I didn't want to be and doing things I didn't want to do. I would get in cars with strangers and drive to another state just on the promise of getting high. It is only by the grace of God that I think I was able to survive.

When I was 17, I had a daughter, but even the unconditional love of a child couldn't coax me away from the demon of addiction. When she was 3, she went to live with her father.

I sold just enough drugs to cover the cost of what I was using. I was now living with others in a riverbed under a freeway overpass. The drainage would bring large deposits of aluminum cans, which we would exchange for money. I was now an IV meth user and couldn't fathom how my life could get any worse. I didn't have the courage to kill myself, but I also couldn't muster the will to stop using.

My 34th birthday was the worst day of my life. I remember begging whomever would listen to either kill me or save me, but don't leave me here in hell.

I remember the next day like it was yesterday. I felt like a cockroach crawling out from under the bridge that morning. When my eyes adjusted to the sun, I saw the police officers. I had already had many run-ins with the law, and for a moment I weighed whether I could outrun the police this time. But my body was just too tired.

I knew I was again going to prison. But strangely, this didn't bother me. I felt a great weight lift off my shoulders. Somehow deep in my heart I knew that I was ready to never live this way again.

I did my time and, with the help of my family, I was paroled into a residential treatment center. The day I walked in was truly the first day of the rest of my life. My mind was ready to embrace the idea of a second chance.

At a 12-step meeting at the center one night, I heard a woman talk about an insatiable hunger she felt in the pit of her stomach — a hunger that could never be filled by any food, only drugs. She called this hole a "spiritual void." At that instant, I felt like a piece of my puzzle had finally snapped into place. I wasn't alone. There were others who felt the void, and who were waking up every day to fight to stay clean.

While in treatment, I went back to school. I was 35. Within two years, I graduated from community college. I took out student loans and transferred to a university, where I graduated magna cum laude with a bachelor's degree in business administration. I went after my recovery like I did my drugs and found I was able to accomplish anything I truly wanted.

Today I work with women who serve their prison sentences in residential treatment along with their children. My path to recovery led me to a job where my experience could help others, and that is why I feel my life hasn't been wasted. I hope I can continue counseling those who share my story. I hope I can continue to build my fragile relationship with my daughter. And sometimes, I just hope.

Hill lives in Southern California, where she works with recovering addicts and fosters dogs from an Akita rescue.

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

Ebola Drug Could Be Ready For Human Testing Next Year

Fri, 04/11/2014 - 4:00pm
Ebola Drug Could Be Ready For Human Testing Next Year April 11, 2014 4:00 PM ET Listen to the Story 4 min 22 sec  

In this colored transmission electron micrograph, an infected cell (reddish brown) releases a single Ebola virus (the blue hook). As it exits, the virus takes along part of the host cell's membrane (pink, center), too. That deters the host's immune defenses from recognizing the virus as foreign.

London School of Hygiene & Tropical Medicine/Science Source Additional Information: To Tame A Killer

Scientists hunting treatments for Ebola and related diseases are trying several approaches. So far, the following have only been tested against the virus in animals:

Small Molecules: These are drugs that can be put into a pill. BCX4430 is from a class of drugs called nucleoside analogues. These molecules may look a lot like the building blocks of the virus' own genetic material (RNA instead of DNA), but the drugs end up preventing the virus from reproducing.

Estrogen Blockers: A few of these FDA-approved medicines, including the fertility drug Clomid, turn out to protect rodents against Ebola in the laboratory, but nobody knows why. It's apparently not related to the drugs' effects on estrogen in the human body.

Small Interfering RNA (siRNA): These snippets of RNA are custom-tailored to bind to a virus' RNA while it is reproducing, and this kills the virus.

Therapeutic Vaccines: Scientists have produced vaccines against Ebola by engineering a different virus, such as vesicular stomatitis virus, to include harmless bits of the Ebola virus. Vaccines are generally designed to protect against infection, but this vaccine may also be useful after a person has been exposed to Ebola to prevent illness.

Engineered Antibodies: Immune system proteins called antibodies attach to foreign substances such as viruses and help a person fight off an infection. Scientists have tailored a particular sort, called monoclonal antibodies, to attack Ebola viruses and related species. Monkeys given the antibodies soon after exposure to what would normally be a lethal dose of Ebola survived.

The Ebola outbreak in West Africa is terrifying because there's no drug to treat this often fatal disease. But the disease is so rare, there's no incentive for big pharmaceutical companies to develop a treatment.

Even so, some small companies, given government incentives, are stepping into that breach. The result: More than half a dozen ideas are being pursued actively.

And these are boon days for drugs that can treat viruses. Think of treatments for AIDS and hepatitis C.

Potential treatments for Ebola pursue many strategies. These include conventional drugs, custom-built antibodies, and vaccines that are designed not simply to prevent the spread of a disease, but to treat it in people who are in the early stages of infection.

Each idea has shown some promise in animals. But nothing has yet passed critical human testing, so there's nothing ready to be tried during the current outbreak.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, is hopeful about this multipronged approach, but says, "I think it's really too early to make a prediction about what is the more or less promising one among them."

One challenge is that there are several different species and strains of Ebola-like viruses, so there may not be a one-size-fits-all solution.

But one experimental drug could conceivably fit that bill. It's called BCX4430. Travis Warren at the U.S. Army Medical Research Institute for Infectious Diseases lab in Frederick, Md., has been working on this antiviral drug.

"It worked great against both Ebola virus and [the closely related] Marburg virus" when tested in mice, he says. It also protected guinea pigs from these viruses and yellow fever.

So the next set of tests was in a small number of monkeys who had been infected with Marburg virus.

"When we started the drug either 24 hours or 48 hours after the infection, 100 percent of those animals survived," Warren says.

It's notable that this drug is being developed by a small company, called BioCryst Pharmaceuticals.

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"It just wouldn't make the cut at a major company," says Dr. William Sheridan, BioCryst's medical director, who once worked at the drug giant Amgen.

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Ebola, scary as it is, has only made about 2,500 people sick since it was discovered in 1976, killing about 1,700 of them. So the market for a drug like this is tiny.

Still, Sheridan says his company has good reason to pursue it, beyond his desire to address an important public health issue.

"There is a market, and the market is the U.S. government," he says.

The government has promised to buy a stockpile of drugs that are effective against Ebola, in case someone should try to use it as a biological agent on the battlefield, or in an act of terrorism. Federal agencies also are helping to pay for the research, so the company is pushing forward as quickly as it can.

"We're currently [manufacturing the] drug and will be conducting typical animal safety experiments that you typically do before you put drugs in humans," Sheridan says. "And once that's successfully completed, I anticipate by the middle of next year that we should have completed phase one studies in people."

Shots - Health News How An Antibody Found In Monkeys Could Help Make An Ebola Vaccine

Phase one tests will tell them whether the drug is relatively safe, but it won't tell them whether it would actually be an effective treatment. Assuming the drug seems safe, it would be ready for testing in a future outbreak of Ebola.

Of course, most potential drugs don't live up to their early promise, and there's no assurance this one will, either.

But Travis Warren at the Army lab says that given all the advances in developing drugs to treat viruses, something will emerge out of this broad quest for an Ebola drug.

"I'm absolutely certain it will happen," Warren says. "It's just a matter of time."

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

How A Person Can Recover From Ebola

Fri, 04/11/2014 - 1:52pm
How A Person Can Recover From Ebola April 11, 2014 1:52 PM ET

Testing for Ebola, a scientist in a mobile lab at Gueckedou, Guinea, separates blood cells from plasma cells to isolate the virus's genetic sequence.

Misha Hussain/Reuters /Landov

At least eight Ebola patients in Guinea have beaten the odds. They have recovered and been sent home. In past outbreaks, the death rate has been as high as 90 percent. In Guinea so far, about 60 percent of the 157 suspected cases have ended in death.

The first seven to 10 days after infection is the "peak of the illness," when people are most likely to die, says Barbara Knust, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta. But if the body begins to produce antibodies to fight off the infection, then there's hope.

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Doctors on the scene think the treatment regimen may play a role in boosting survival odds.

"It's hard to say conclusively that what we are able to give treatmentwise is causing that increased survival rate," says Tom Fletcher, an infectious diseases physician who is with the World Health Organization team in Guinea. "But we think interventions such as intravenous fluids, IV antibiotics and paying attention to symptom control and nutrition are probably all important." Such care has not always been available to patients during past Ebola episodes.

Adds critical care doctor Rob Fowler, also with WHO: "Outbreaks happen in places where it's very challenging to deliver medical care. Even when there's no specific therapy for the virus, with supportive care, people can have much better outcomes."

The first encouraging sign is when the symptoms fade — fever, vomiting, diarrhea, bleeding, fatigue and muscle aches. If a patient is symptom-free for several days, doctors run repeat blood tests to see if any virus remains in the bloodstream. "We're fortunate to have an Institut Pasteur lab here that gives us a result within four hours," Fletcher says.

But there are twists to this scenario, says Marie-Christine Férir, Brussels-based emergency coordinator for Doctors Without Borders. A man's blood may be free of Ebola, but the virus can persist in semen for two to three months after recovery. (That's because antibodies produced in the bloodstream don't reach the testicles.) Since Ebola can be transmitted through sexual contact, male survivors are sent home with condoms and instructed to use them for the next three months if they engage in intercourse.

The virus can also linger in breast milk, so mothers are told to wean any child who had been breast-feeding.

The Sources And Symptoms Of A Disease With A Global Reputation March 25, 2014

A clear blood test doesn't always mean a survivor is ready to be discharged. "The virus can really weaken a person, [and] they can lose a lot of weight," Knust says. "Sometimes they need extra support to get healthy enough so they aren't at risk of a secondary infection."

A Guinean physician, who was infected with Ebola but recovered, said he regained his strength by eating PlumpyNut — and got a psychological boost from the encouragement and guidance of his caregivers.

Ebola survivors do not have to worry about contracting the disease again, says Pierre Rollin, deputy director of the viral special pathogens branch of CDC, who has traveled to the site of previous Ebola epidemics over the past 20 years. "When they start to test negative, they're going to remain negative for the rest of their lives."

Mental health is another matter. Health care workers often check on patients in their homes to see how they are faring after the trauma of suffering through Ebola — and perhaps losing family members to the disease as well. They must also deal with the stigma associated with having had the virus.

Health workers teach the community that the Ebola survivor cannot infect them.

"They will do a lot of things, especially holding hands with [the patients], to publicly demonstrate that they're not afraid of these people," says Knust.

Adds Férir: "[In the past] we would bring the patient into the middle of the village, and we would give a big kiss to the patient to show that it's OK, no problem."

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

This Jet Lag App Does The Math So You'll Feel Better Faster

Fri, 04/11/2014 - 10:35am
This Jet Lag App Does The Math So You'll Feel Better Faster April 11, 201410:35 AM ET i i

You've been there, and you know it doesn't feel good. But an app based on the science of circadian rhythms could help reduce the suffering of jet lag.

iStockphoto

Jet lag is nobody's idea of fun. A bunch of mathematicians say they can make the adjustment less painful with a smartphone app that calculates the swiftest way to adjust.

Users plug in the time zone they're traveling to, and the app will do the calculations before spitting out a schedule specifying when the user should stay in bright light, low light or be in the dark, says Olivia Walch, a graduate student at the University of Michigan who designed the app.

"The conventional wisdom is for every hour you're shifting, it's about a day of adjustment," Walch says. So Washington, D.C., travelers going to Hong Kong — a 12-hour time difference — could take up to 12 days to adjust. The app can reduce that time to roughly four or five days, the inventors say.

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There are other jet lag apps out there, but few actually have science to back them up. The Entrain app is based on the premise that the body's circadian clock relies heavily on light to know what time of day it is.

"In your brain you have a central circadian clock ... [that] sends signals all throughout the body," says Danny Forger, a professor of mathematics and computational medicine at Michigan and the mastermind behind the app. And that central clock controls all of the body's biological functions.

The free app, which is named after that process of entrainment, recommends a schedule of light exposure to sync the body to a different time zone in the quickest way possible.

The app also can be customized based on the amount of light a person is actually getting. It then recalculates the schedule for the days ahead.

Unlike with many of the apps out there, Forger and his colleagues have more than 80 pages of complex science and calculus in a study, published Thursday in PLoS Computational Biology, to support their product.

Using two mathematical equations that predict how light affects the human circadian clock, Forger and his colleagues simulated the optimal schedules for more than 1,000 possible trips. They then applied two basic principles. One is to be exposed to one big block of light and one big block of dark in your day, Walch says. Another is to be exposed to the brightest possible light.

The Two-Way Jet-Lagged: NASA Engineer And His Family Are Living On Mars Time

The equations themselves aren't new; they have been used by NASA, the transportation industry and the military, according to Forger. But he says he's finally putting that technology in the palm of the average person's hand.

Think about flying from the East Coast of the U.S. to Japan, says Dr. Elizabeth Klerman, a sleep medicine and disorder researcher at Harvard Medical School. You can fly through each time zone one by one and have your circadian clock slowly adjust, or you can do what airplanes do.

"They basically fly up to the North Pole and skip across multiple time zones and then go back down again rather than having to cross each intermediate time zone," Klerman, who wasn't involved in the study, says. "Well, the equations that Forger used are able help you skip across time zones."

The Entrain app hasn't yet been flight tested, but Klerman thinks it should work.

"Theoretically, there would be ways to speed up re-entrainment, but you need to do experiments to make sure whether it works, because humans don't always respond the way mathematical models expect them to," she tells Shots. "But he has based his model on decades of thorough experiment, and a model that has been tested very thoroughly.

YouTube

"So I would like to think that he's right," she says.

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

The Ebola Survivors: Reborn But Not Always Embraced

Fri, 04/11/2014 - 3:51am
The Ebola Survivors: Reborn But Not Always Embraced April 11, 2014 3:51 AM ET Listen to the Story 4 min 28 sec  

Rose Komano, 18 and the mother of three, was the first Ebola patient to overcome the virus in southeastern Guinea, the epicenter of the outbreak. On April 3, she posed at a health clinic in the Gueckedou region.

Misha Hussain /Reuters /Landov

They call them the "Lazarus" cases, after the Biblical character who died but was revived by Jesus. They are survivors of the latest outbreak of Ebola.

Ebola often grabs global headlines as the killer virus that can result in a death rate of up to 90 percent. But in Guinea, the death rate in the current outbreak has been about 60 percent. So there are survivors — to the delight of the overworked doctors, health workers and, of course, the patients who have recovered.

"I feel reborn," says a vivacious young woman who chose not to give her name because of the stigma associated with the virus. She had tested positive for Ebola and was admitted to the isolation unit in the treatment center run by Doctors Without Borders, a cluster of tents located on the grounds of the main public hospital in Conakry, the capital city.

Her face wreathed in a smile, she tells how she went in with a raging fever and other telltale Ebola symptoms: "When I was admitted everyone was saying there's no cure, there's no vaccine, and I was frightened. That alone could kill you."

A week later, she was discharged. "I'm out — I've totally recovered, and I thank God and the doctors for helping me," she says.

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She is one of a handful of patients cleared to go home.

The first person to recover from Ebola and be discharged from the hospital in Conakry is a 30-year-old doctor, who also wants to remain anonymous. He was diagnosed after he began feeling unwell and went for a blood test and checkup.

Other medical professionals call this slight and reserved man a hero, for helping other Ebola patients in isolation. The recovery of the physician and others has given extra motivation to the medical staff, says Henry Gray, emergency coordinator in Guinea for Doctors Without Borders.

"Seeing some of our patients actually survive and walk out under their own steam, it's brilliant," says Gray. "For the patients themselves, they sometimes feel as though they're fighting against all odds, and when they do come through it, there's joy in what is often a sad and difficult place to work."

But with survival can come stigma, he warns.

"The community must understand that the survivor does not pose a threat," he says. The education falls to the medical team assembled by Doctors Without Borders, which includes local medics and others from the World Health Organization, the local Red Cross and the International Committee of the Red Cross. They all are in close contact with the Ministry of Health as well as political, religious and traditional leaders. "But that is a work in progress," Gray admits. "In Guinea, Ebola is an unknown disease; they're not used to it."

The community may think a person is still contagious, says the anonymous doctor who has recovered from the disease. With that fear may come rejection, marginalization and isolation.

He was pained to see how close friends shunned his wife and wouldn't eat the food she cooked — or buy the ginger juice she sells. But her physician husband says he understands people's misgivings.

Like the majority of Guineans, he and his wife are Muslims. "My wife is very religious," says the doctor, and Islam is a religion of forgiveness in his household. "She has forgiven them," he notes of the nervous acquaintances and neighbors. And now, day by day, the friends are coming back to their house to visit.

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

Scientists Publish Recipe For Making Bird Flu More Contagious

Thu, 04/10/2014 - 3:03pm
Scientists Publish Recipe For Making Bird Flu More Contagious April 10, 2014 3:03 PM ET i i

Street vendors sell chickens at a market in Phnom Penh, Cambodia, in early 2013. Last year Cambodia reported more cases of H5N1 bird flu than any other country.

Mak Remissa/EPA /LANDOV

The Dutch virologist accused of engineering a dangerous superflu a few years ago is back with more contentious research.

In 2011, Ron Fouchier and his team at Erasmus Medical Center took the H5N1 flu virus and made it more contagious. Now the team has published another study with more details on the exact genetic changes needed to do the trick.

The H5N1 bird flu is known to have sickened 650 people worldwide, and of those, 386 died. So far the virus hasn't been contagious in people.

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But Fouchier's work, plus some similar research from another lab, showed for the first time that the virus had the potential to change in a way that would make it a real pandemic threat. Only a few mutations were necessary to make the H5N1 bird flu spread through the air between ferrets, the lab stand-in for people.

Critics argued that the scientists had created a dangerous new superflu. And they pushed for the recipe not to be openly published. They feared that others would repeat the work and either not adequately safeguard the virus or would deliberately release it.

After a long debate about security versus scientific openness, the research findings did finally appear in a journal.

Now, in the journal Cell, Fouchier and his colleagues expand on that initial work. They identified five mutations that are sufficient to make H5N1 spread through the air between ferrets.

"Two mutations enable improved binding of the H5N1 bird flu virus to cells in the upper respiratory tract of mammals," Fouchier told Shots in an email. "Another mutation increases the stability of the virus. The two remaining mutations enable the virus to replicate more efficiently."

These findings are important for keeping one step ahead of the virus , Fouchier thinks, and for helping to prepare for a possible pandemic.

"If we increase our understanding of how influenza viruses become airborne between mammals, we may be able to identify at some point which viruses [out of many that are circulating in nature], we need to keep an eye on because of public health risks," he added.

It's still unknown how deadly these engineered viruses would be in people. Fouchier says his group has lab studies underway to determine the pathogenicity of the virus.

Before Fouchier and his colleagues published the current work, it underwent multiple layers of review to assess the level of danger it might pose to the public. The team had to get an export license from the Dutch government that normally applies to technology that can be weaponized. The paper was also reviewed by the U.S. National Institute of Allergy and Infectious Diseases, which funded the research.

All that oversight causes delay, Fouchier said. But in the end, flu researchers are still able to do the work they need to do and see it published.

"That does not mean that we have reached general consensus about the need to do this type of work, and how to do it safely," Fouchier wrote. "But general consensus will be impossible to reach on any topic. We will keep the dialogues going with everyone, but at the same time need to continue this important line of work."

Not everyone agrees with that. "I still don't understand why such a risky approach must be taken," says microbiologist David Relman of Stanford University. "I'm discouraged."

Relman served on a government advisory committee that considered whether this research should be openly published. He questions whether these studies really will help give public health officials advance warning of the next emerging flu pandemic.

And even if the studies might provide a real benefit, Relman says, we won't see it for some time. "And we have, meanwhile, just bought ourselves even more risk," he says.

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

Even A Very Weak Signal From The Brain Might Help Paraplegics

Thu, 04/10/2014 - 2:09pm
Even A Very Weak Signal From The Brain Might Help Paraplegics April 10, 2014 2:09 PM ET i i

Kent Stephenson, a research participant at the University of Louisville's Kentucky Spinal Cord Injury Research Center, has his level of muscle activity and force measured by Katelyn Gurley.

Courtesy of the University of Louisville

A report that four young men who are paralyzed below the waist were able to move toes, ankles or knees when their lower spine was electrically stimulated was hailed as a breakthrough.

But it's hard not to be skeptical about anything labeled a medical breakthrough these days, and that's especially true when it comes to spinal cord regeneration, which has seen more than its share of hype. For the quarter of a million people with spinal cord injuries, dashed hopes can be devastating.

A treatment or cure for spinal cord injury remains elusive, but the study by researchers at the University of Louisville appears to add important information: Even a very weak signal from the brain can trigger movement.

To figure out what this means, we talked it over with John Donoghue, director of the Brown Institute for Brain Science and leader of the BrainGate II project, which in 2012 made it possible for two people immobilized by strokes to control a robotic arm with their thoughts. He wasn't involved in the Louisville research. The conversation has been edited for length and clarity.

When a spinal cord is severed, that causes paralysis. There have been decades of efforts to bridge that gap. Some reports say that's what's happened here, but others say no. What did happen?

It isn't like there was no connection there, it literally got severed, and then you got something. There has to be a connection to the brain.

Spinal Implant Spurs Motion In Paralyzed Man

The important thing, I think, is that it's not magic. It's sort of a hidden or masked connection. This suggests that when they put in the electrical stimulation, they revealed that there's a hidden connection that's hard to detect. And if it's there, it's really, really weak. You're doing something that reveals that the pathway is there.

In the past you and other researchers have been skeptical that having a few remaining neurons bridging that gap, or restoring a few, would be enough to restore function. Does this change your thinking?

This is wonderful news, I think. But these people are not playing basketball or anything. Is this functional movement? Well, in a sense, but to me, it's pushing us in a direction to say that for people with damaged spinal cords there's a way to get a small input to have a meaningful effect.

In engineering there are command signals and control signals. Emilio Bizzi at MIT has talked about this for years. Bizzi said you don't have to have control signals coming down from the brain, you just have to have command signals.

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Spinal cord circuitry is remarkably complicated. It's a machine that does a lot. My favorite analogy that I teach medical students, you're walking down the street and you stumble on a crack in the sidewalk. You catch yourself before you fall. Almost all of that action in your leg and foot is preprogrammed in the spinal cord. It's a beautifully coordinated machine.

So that's the control mechanism, and we might not need nearly as much command mechanism as we thought?

There are about a million fibers coming down from your brain. That's a lot. What Bizzi and others are saying is maybe you don't need that many fibers. Maybe a very weak command signal is enough to make something happen. I think these guys have done that.

Obviously there's a long way to go from the small movements shown here and being able to walk. How do you imagine that might happen?

The electrical simulation used here is a very crude stimulation. Here's the scenario. Because of the injury there's a bunch of inhibitory neurons that are making it impossible for signals to get through. You shut down the inhibitory neurons with the stimulation, but they're grossly shut down. Now imagine you could shut them down in some coordinated pattern.

What if they could give you coordinated leg action? And if you could get trunk and hip support, then the person could stand up and take a step. That's going to be really hard. Vivian Mushahwar in Canada has been working on that for a long time. So are Eb Fetz at the University of Washington, Simon Giszter at Drexel and Gregoire Courtine in Switzerland. He's got locomoting rats. I've seen them. It's pretty impressive.

If walking is going to be tough, what other functions could help people with paralysis?

I've talked to a number of young people who have paraplegic lower spinal cord injury. They lose bladder and bowel control, and that's not just a question of dignity — it can be life-threatening. It turns out that's a really complicated problem — at the same time you want to squeeze one muscle and relax another one. But if you do something simple like stimulate the nerve, both muscles contract. That's not what you want to have happen.

Even if one might consider [the Louisville research] not gigantic progress, this opens up a whole lot of thoughts of how we might go forward, especially for disabled people.

University of Louisville/YouTube

A research participant demonstrates how turning on a device that electrically stimulates the lower spine makes it possible for him to move his leg.

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

Doctors' Billing System Stays Stuck In The 1970s For Now

Thu, 04/10/2014 - 3:33am
Doctors' Billing System Stays Stuck In The 1970s For Now April 10, 2014 3:33 AM ET Listen to the Story 4 min 11 sec   i i

The health care industry spent millions preparing for a huge upgrade of coding for medical diagnoses and procedures that has now been delayed.

Courtesy of Intelicode

For doctors, hospitals and insurance companies, all the complexities of medicine get boiled down into a system of codes.

These codes are used to track and pay for every procedure you can think of. There's 813.02 for mending a broken forearm, and 800.09 for treating a concussion. There's even 960.0 for being hurt in an "unarmed fight or brawl."

But this coding system is now four decades old. The codes were scheduled to be upgraded in October, but last week Congress delayed the switch.

JaeLynn Williams, for one, is seriously bummed out. "It's kind of like looking forward to Christmas, and it doesn't come," she says

Williams and her company, 3M Health Information Systems, are helping about 5,000 hospitals upgrade from the old coding system, called ICD-9, to the new one, ICD-10.

It's a $100 million project for 3M Health. Williams is passionate about the upgrade since it will give doctors, hospitals, researchers and insurance companies better data — which will allow them to zero in on the best, most cost-effective treatments.

"With ICD-9 there's only so much information that's captured with each code," she says. ICD-9 offers about 4,000 codes for procedures. ICD-10 has about 72,000.

Without very specific codes, cardiologists, for example, can't differentiate between the dozens of different kinds of implants now commonly used to open clogged arteries, Williams says, "So we can't use the data to analyze which implant had a better outcome," she says. "We can't use the data to determine which implant results in the shortest recovery time. You won't be able to use the data to understand which implant had the best long-term success."

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For better research, health care needs to upgrade to ICD-10, and everybody needs to do it at the same time. The White House has been trying to coordinate the shift for the last five years, But some doctors in smaller practices welcome the delay, like Eric Novack, an orthopedic surgeon in Phoenix.

"It's good news for us because there are enough challenges going on now with things changing in health care," he says.

For Novack, upgrading to the new coding system would have a significant impact on the ability of the 10 doctors in the practice to take care of patients efficiently. And support staff needs expensive training, too.

"We can put that on hold, and not have to worry about having to spend that big chunk of money at this time," he says.

Doctors and small hospitals are already struggling with big information technology challenges beyond the ICD-10 upgrade, such as implementing electronic health records in the first place, says Joe Lavelle, a health information technology consultant.

"We've asked way more than we've ever asked from an IT standpoint, from a project standpoint, from a dollar standpoint," Lavelle says. "Their vendors haven't provided them updated software, so they can't start testing or planning, and they just haven't gotten started or pushed their vendors to get started."

But big hospitals and insurance companies have invested heavily in being ready to switch to ICD-10 six months from now.

They've already sunk millions into re-training staff, and many have started testing the new systems in anticipation of the October, 2014 deadline. After all, the Department of Health and Human Services was calling that date solid as recently as February.

And HHS didn't ask Congress for the delay, it was part of a political compromise. Congress pushed back the deadline, which many doctors wanted, at the same time it passed a major Medicare bill that doctors didn't like.

3M's Williams says her clients worry the delay will make upgrading harder in the future. "I think the biggest issue with the delays is the lack of trust that any new deadline will be held to," she says.

In a written statement to NPR, HHS says it is studying Congress' action, and "will provide guidance" on a new deadline for the coding upgrade "soon."

This story is part of a partnership between NPR and Kaiser Health News.

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

Why My Wife Didn't Choose A Double Mastectomy

Wed, 04/09/2014 - 6:03pm
Why My Wife Didn't Choose A Double Mastectomy April 09, 2014 6:03 PM ET

Yet another entertainment figure has gone public with her decision to have a double mastectomy after a breast cancer diagnosis. Samantha Harris is the latest in a series of entertainers who've decided on that surgery as treatment for the disease.

Harris, a 40-year-old mother of two and former co-host of Dancing with the Stars, said she chose this procedure after consulting with three specialists. It was a difficult choice, she reports, but she feels it enabled her "to take control" and that she is "so much calmer."

As the husband of a breast cancer survivor, I can relate to what Harris says. A welcome sense of control and calm follows the agony of wrestling with treatment options.

I have also learned that a double mastectomy is not the best choice for all breast cancer patients. Nor does it eliminate fear of recurrence.

Nonetheless, double mastectomies are on an extraordinary upward swing in the United States.

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"Twenty years ago, only 1 to 2 percent of women with cancer in one breast made that choice," says Dr. Todd Tuttle, chief of surgical oncology at the University of Minnesota. "Now the rates are 15, 20, 25 percent."

Many of those women have a sound medical rationale for selecting double mastectomy. It is appropriate treatment for a patient diagnosed with cancer in one breast and at high risk for recurrence because of family history. A double mastectomy is also recommended for women not yet diagnosed if they carry the BRCA1 or 2 gene, with its high risk of developing the disease. That was the case for actress Angelina Jolie.

The rates may have risen in part because genetic testing is identifying more women at risk for the genes, says Tuttle. Yet some women make the double mastectomy decision believing it will increase their odds of survival.

It won't. Women have an exaggerated perception of their risk of getting cancer in the other breast, Tuttle says. He was senior author of a study showing that women with cancer in one breast thought the risk of a tumor in the other breast was around 30 percent in the decade ahead. It's actually 4 to 5 percent.

And from personal experience, I know that doctors do not always present surgical choices in a fair-minded way. After my wife had been diagnosed with a tumor in each breast, our HMO's surgeon told her: "I can tell by the look on your face you're a worrier, so I'd recommend a double mastectomy."

I remember thinking, "Doc, if she didn't look worried, there'd be something wrong!"

My wife had always thought if she were diagnosed with breast cancer she'd say, "Off with my breasts." But the prospect of giving up her "girls" plunged her into a state of sorrow. She didn't want to say goodbye to part of herself. She was also aware that the mastectomy surgery was more invasive and recovery would take longer.

Shots - Health News What If Husbands Had A GPS To Help Wives With Breast Cancer?

So she sought second and third opinions. They said a lumpectomy in each breast followed by chemotherapy and radiation offered Marsha the same survival odds.

Double lumpectomy is what Marsha chose. Thirteen years later, she is in good health.

As Marsha and I learned, the important thing is to talk to surgeons who devote a great portion of their practice to breast cancer — and then to make a decision that seems right to both doctor and patient.

In his practice, Tuttle sees the lumpectomy vs. mastectomy debate play out every day.

"A woman comes and she has a small breast cancer. Before I can even examine her, she'll say, 'I've already decided I want a double mastectomy,' " Tuttle told Shots.

He tells women that mastectomy takes four to six hours, compared with an hour for a lumpectomy. That the complication rate is low from lumpectomy and "moderate to high" for mastectomy. And that in many cases, with lumpectomy plus radiation, "there is absolutely no difference in survival for women who do not have hereditary breast cancer."

Some women will reply, "I didn't realize that." Others will say, "That's very interesting. When can I have my double mastectomy?"

As for the husband's role in this process, he needs to understand that it's not his job to tell his wife what to do. But that doesn't mean he's useless. He can act as a sounding board as his partner mulls over options. It helps, too, to say those three little words: "I love you." And then you'd be wise to follow the breast cancer husband's motto: Shut up and listen to your wife.

Marc Silver is the author of Breast Cancer Husband: How to Help Your Wife (and Yourself) Through Diagnosis, Treatment, and Beyond.

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

Medicare Pulls Back The Curtain On How Much It Pays Doctors

Wed, 04/09/2014 - 3:59pm
Medicare Pulls Back The Curtain On How Much It Pays Doctors April 09, 2014 3:59 PM ET

Partner content from:

Listen to the Story 3 min 57 sec   i i

New data show how much individual physicians received in 2012 from Medicare.

Medicare.gov

Medicare's release Wednesday of records of millions of payments made to the nation's doctors comes as the government is looking to find more cost-efficient ways to pay physicians, particularly specialists.

The federal government published data tracing the $77 billion that Medicare paid to physicians, drug-testing companies and other medical practitioners throughout 2012, and the services they were being reimbursed for.

The data cover 888,000 different practitioners. More than 6,000 procedures are included, and the full database is so large that it requires statistical software to analyze it.

While the database provides tantalizing details, showing, for instance, the huge amount ophthalmologists are paid to treat common eye disorders, analysts cautioned that the data can be easily misunderstood and could lead to some doctors being unfairly pilloried.

The release comes 35 years after a court-issued gag order prevented anyone from revealing Medicare Part B payments to individual doctors. Advocates for more transparency in health care payments heralded the release as a leap forward. "Taxpayers have the right to understand what is being paid for and how it is being paid for," said Jonathan Blum, principal deputy administrator for the Centers for Medicare & Medicare Services.

He asked the public to comb through the information to help find waste and fraud and also encouraged researchers to use it to try to determine why spending on health care for the elderly varies so much in different parts of the country. This could replicate on the physician level what the Dartmouth Atlas of Health Care has been doing for decades in showing variances in Medicare's hospital spending.

"The uses of this data can and will go significantly beyond the identification of fraud, waste and abuse," said Niall Brennan, the Medicare official who oversaw the development of the database.

The release also comes at a propitious time for the government's effort to refashion the way America's health care system is financed. Earlier this year Medicare invited advice on how it should devise new ways of paying specialists to replace the current system, in which doctors are paid a set fee for each visit or procedure. The goal of these approaches is to remove the financial incentive for practitioners to overdo care.

Under the authority of the federal health care law, the Obama administration has already launched experiments aimed mostly at hospitals and large medical groups. There are hundreds of trial efforts under way to pay medical practitioners a set fee to treat a particular ailment, such as replacing a knee, with the fee covering all aspects of the care from before the operation through the recovery and any setbacks.

Medicare is in the midst of creating a similar program for cancer specialists. In February, the government's Center for Medicare & Medicaid Innovation invited suggestions on how it should fashion new payment programs that "would be designed to improve the effectiveness and efficiency of specialty care, in part by clarifying the specialist practitioner's clinical role." The deadline for ideas and suggestions is Thursday.

Dr. Kavita Patel, a former White House health care staffer and a researcher at the Brookings Institution, said the administration's timing wasn't coincidental. "They are building the case for doing targeted specialty payment models," she said. "The administration is trying to get at the delivery system from all angles."

Unsurprisingly, medical specialists whose work involves expensive drugs, such as oncologists and ophthalmologists, appeared at the top of the list of biggest reimbursements. That's because in 2012 Medicare paid doctors for the market cost of drugs they used plus 6 percent, Blum said. (That amount has been lowered by the spending cuts imposed by Congress, known as the sequester.)

Despite their volume, the Medicare records omit as much important information as they include. The records don't include any treatments doctors provide to patients not covered by Medicare, such as the privately insured, those with Medicaid and other who pay cash. The records also lack any information about roughly a quarter of Medicare beneficiaries who have coverage through Medicare Advantage private insurance plans, and for various payment experiments the government is trying.

The payments for some doctors may be larger than it appears in the data because they also could have billed Medicare through a combined medical practice or other medical organization.

Fred Trotter, a health care data specialist, warned ahead of time: "We should be very careful to not draw any conclusions at the low end of the spectrum. That doctor who 'only' performed procedure X 11 times? That probably means nothing. What the doctor is actually doing with his/her patients is just not showing up at all."

Procedures billed to one doctor may actually have been performed by a number of workers in one practice such as medical residents, nurses and physician assistants. A Los Angeles rheumatologist whom Medicare paid $5.4 million in 2012 told The Washington Post that about $5 million of that paid for very expensive drugs and the billings also helped cover his staff of 40 people.

CMS' Brennan said that one goal of the release was to encourage each individual medical practitioner to bill Medicare directly, so that the government could get a better handle on spending.

In a note published on the website of the Association of Health Care Journalists, Charles Ornstein, a senior reporter at the investigative nonprofit ProPublica, cautioned reporters to be careful in interpretation: "Don't just assume that because a number is large, a doctor has done something wrong."

In addition, there's no information about the quality of the care provided, and no information about how sick the patients were or why a particular procedure was performed. In fact, to ensure that the identity of any patient could not be known, Medicare has only included procedures that each doctor performed at least 11 times.

And large numbers of procedures performed by a doctor may be a good sign. Someone billing a lot might well be a very talented practitioner, since research has found that medical skill tends to improve the more times a physician performs the same operation.

In fact, health care analysts often encourage patients to choose a doctor based on the volume of cases the physician has done. Alternatively, in some cases — probably a small number — a doctor with lots of billing could be ripping off the system.

Several doctors with the biggest Medicare payments are already under investigation for potential fraud, such a Dr. Salomon Melgen, a Florida ophthalmologist who The New York Times said was paid $21 million in 2012. His lawyer said Melgen has followed all Medicare rules.

The the gag order on the data stretches back to 1979, when a Florida court issued a permanent injunction barring the government from releasing information about Medicare payments to individual physicians in any manner that would allow the doctor to be identified. In 2011, the parent company of The Wall Street Journal successfully sued to overturn the injunction as the paper prepared a detailed look at Medicare spending.

The American Medical Association complained that physicians weren't allowed to review the data for inaccuracies. However, Medicare's previous release of similar information about hospital payments did not result in reports of any major errors. Brennan pointed out that the data is based on claims medical providers billed to Medicare and were reimbursed for. "We are quite confident this data is accurate," Brennan said.

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

Pop Stars Are Sippin' On Patron, And Teens Are Bingeing

Wed, 04/09/2014 - 3:52pm
Pop Stars Are Sippin' On Patron, And Teens Are Bingeing April 09, 2014 3:52 PM ET i i

Shots, shots, shots, shots! Redfoo and Sky Blu keep the Ciroc vodka flowing in the music video for their party anthem "Shots."

LMFAOVEVO/Youtube

Ke$ha says that to start the day she'll brush her teeth with a bottle of Jack Daniel's whiskey. Nicki Minaj likes to "have a drink, have a clink" of Bud Light. And the party-rockin' hip-hop duo LMFAO like Ciroc, and they love Patron. "Shots, shots, shots, shots everybody!"

All that name-checking of alcohol brands encourages teens to drink, researchers say. Adolescents who liked songs like these were three times as likely to drink, and were twice as likely to binge than their peers who didn't like those songs.

Don't think music can make you want to drink? Try our remix.

Researchers from the University of Pittsburgh surveyed more than 2,500 young people and asked them whether they liked or owned 10 randomly selected top 40 singles that referenced alcohol.

The kids who most enjoyed those hits were also the most likely to drink and binge, even after controlling for age and parental alcohol use. Only 8 percent could recall the specific brand names mentioned in the songs, but they were even more likely to drink than the rest.

The findings were published Tuesday in Alcoholism: Clinical and Experimental Research.

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"It is unclear how much very specific information adolescents do or do not get from popular music," says Dr. Brian Primack, an associate professor of medicine at the University of Pittsburgh and the study's lead author. But, he says, it's clear that the music adolescents are listening to does have some impact on their drinking habits.

Parents and peers' drinking habits can also influence young people, previous research has shown. But seeing people drink in real life is a lot different than seeing them drink in a music video, Primack tells Shots. In real life, you see the negative side effects of drinking. But most musicians don't talk about hangovers and addiction, he says.

Of course, this study only shows that listening to certain types of music is associated with young people's drinking habits. It doesn't show that one causes the other. While it could be that the music is encouraging young people to drink, it might also be that young people who drink are more likely to listen to songs about parties and alcohol.

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This isn't the first time researchers have looked at alcohol references in popular music. In December, researchers from Boston University and Johns Hopkins University combed through Top 40 hits from 2009 through 2011 and found that about a quarter referenced alcohol.

The most name-dropped brands of alcohol were Patron tequila, Hennessy cognac, Grey Goose vodka and Jack Daniel's whiskey. And that's not a coincidence, says David Jernigan, the director of Hopkins' Center on Alcohol Marketing and Youth, and one of the researchers behind that study.

"There are some really lucrative deals being made between artists and particular brands," Jernigan tells Shots. Rapper and producer Sean Combs is a paid spokesperson for Ciroc vodka. Grey Goose sponsored a 2011 music tour featuring rappers like Lil Jon, the study points out, while Jack Daniel's sponsored a party celebrating top Nashville singers and songwriters. Many of these brands also sponsor musicians' album release parties and music festivals, according to the study.

"For at least some of these artists, promoting alcohol has become part of their business models," Jernigan says. Reversing that trend may be one way to reduce young people's exposure to alcohol in music.

The tobacco industry, for example, is banned from paying for product placements in movies. Jernigan says that kind of regulation is unlikely to happen with alcohol in the music industry. But he hopes the companies can be persuaded to exercise restraint.

And he says teaching kids to beware of what they hear and see in the media couldn't hurt.

We here at Shots listened up and made a very unscientific remix of recent songs celebrating alcohol. Take a listen, and let us know if it puts you in the mood to take some shots.

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

Gut-Eating Amoeba Caught On Film

Wed, 04/09/2014 - 3:28pm
Gut-Eating Amoeba Caught On Film April 09, 2014 3:28 PM ET i i

Not nice: A gut-eating amoeba (green) nibbles on a live human cell (purple) under the microscope. The parasite chews on the cell before killing and discarding it.

Courtesy of Katy Ralston

Most of us have heard of the brain-eating amoeba. You know, the little guy that crops up in neti pots and backyard swimming holes every now and then.

Now let me introduce you to its cousin: the gut-eating amoeba.

This nasty critter can wreak havoc in your intestinal tract and cause a dreadful case of food poisoning that may last months or years.

Now scientists have figured out how this amoeba makes us sick. Its tactics are more nefarious than we thought.

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The single-cell animal bites off tiny chunks of intestine, chews on them for a while and then spits them out, microbiologists report Wednesday in the journal Nature.

That's right, folks, the little parasites — called Entamoeba histolytica — don't even have the courtesy to kill your cells before they take a bite. They don't even digest the parts they eat.

Internist William Petri and his team at the University of Virginia caught all the treachery under the microscope. They filmed a bunch of the amoebae munching down on both gut and red blood cells. And they watched as the parasites used the chew-and-spit method to dismantle an intestinal wall.

The team named the process trogocytosis, from the Greek trogo, or "to nibble."

Pathogens have many options when it comes to upsetting our stomachs. E. coli and cholera secrete toxins. Other protozoa hoard all the nutrients or trigger inflammation — that's how the brain-eating amoeba damages tissue.

So why does E. histolytica choose such a vicious and wasteful strategy?

The microbiologists still don't know. But one hypothesis is that the nibbling "creates a more spacious environment" for the amoeba to invade the intestine, Petri and his team write.

They hope their findings will lead to better drugs against E. histolytica one day. Unlike brain-eating amoebae, this parasite is common. It causes millions of cases of dysentery and colitis each year in tropical regions and developing countries.

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

WHO Calls For High-Priced Drugs For Millions With Hepatitis C

Wed, 04/09/2014 - 9:54am
WHO Calls For High-Priced Drugs For Millions With Hepatitis C April 09, 2014 9:54 AM ET

Partner content from:

Advocates demonstrate in favor of cheaper generic drugs to treat hepatitis C in New Delhi on March 21. The disease is common among people who are HIV positive.

Saurabh Das/AP

Authors of the first-ever global guidelines for treating hepatitis C went big Tuesday, advocating for worldwide use of two of the most expensive specialty drugs in the world.

The new guidelines from the World Health Organization give strong endorsement to the two newest drugs. Gilead Sciences' Sovaldi costs $1,000 per pill, or $84,000 for a 12-week course of treatment. Olysio, sold by Johnson & Johnson's Janssen Pharmaceuticals unit, costs $66,360 for a three-month course.

The high prices have ignited a firestorm of objection. In the United States, doctors and insurers argue that the cost of the drugs will make their widespread use impossible. And critics say even if the prices are heavily discounted in other countries, the drugs will still be unaffordable in most of the world.

The WHO endorsement of treatment with Sovaldi and Olysio was made without taking the cost of the two drugs into consideration. That's because the price of the drugs outside the U.S. was unknown in December, when the WHO panel wrapped up its work.

But the price of the drugs isn't the only issue. The WHO recommends that all 150 million or so people around the globe with chronic hepatitis C infection be assessed for treatment — a gargantuan task in itself. Authors of the report are quick to acknowledge that neither the assessment of people's health status nor actual treatment will happen anytime soon.

Shots - Health News Healthier Patients May Have To Wait For Costly Hepatitis C Drugs

"A lot has to happen for this to really take off in a big way," says the guidelines' chief architect, Dr, Stefan Wiktor. "Even if prices came down dramatically tomorrow, that doesn't mean there would be an immediate rush to treatment."

Screening programs for hepatitis C need to be ramped up. Labs to determine the genetic type of the virus (crucial in choosing treatment regimens) have to be built and staffed. Medical personnel need to be able to assess when viral liver damage has progressed to the point when treatment is urgent. And drugs have to be chosen wisely and administered carefully.

Fewer than a quarter of Americans with chronic hepatitis C currently have had or are getting any treatment. In Europe, treatment has reached only 3.5 percent. And in most countries, Wiktor says, "hardly anyone is getting treatment."

The WHO guidelines are setting a deliberately high standard in the hope, Wiktor says, of replicating the remarkable dissemination of antiviral therapy for HIV.

Shots - Health News Maker Of $1,000 Hepatitis C Pill Looks To Cut Its Cost Overseas

Starting from a similar point of little distribution 15 years ago, antiviral treatment for HIV now reaches around 10 million people, most of them in the poorest countries of sub-Saharan Africa. HIV infects more than 35 million people globally (and almost a third of those also have hepatitis C). That makes chronic hepatitis C infection at least four times more prevalent.

But HIV requires lifelong antiviral treatment. The big difference with hepatitis C is that suddenly there are drugs that can actually cure more than 90 percent of patients with a three-month regimen. "Treatments are getting better, shorter and safer," Wiktor says.

The controversy over the cost is apparently beginning to have an effect on pricing. Egypt, which has the world's highest infection rates – somewhere around 20 percent of the population – has negotiated a 99 percent discount on Sovaldi, to $900 for a 12-week course.

Gilead, Sovaldi's maker, is tiering prices for the drug in other countries too — $55,000 in Canada, $66,000 in Germany, and reportedly around $2,000 for a generic version that may be licensed to several Indian companies.

But those discounts don't impress some critics, such as Rohit Malpani of Doctors Without Borders. "When you're starting from such an exorbitant price in the U.S., the price Gilead will offer middle-income countries like Thailand and Indonesia may seem like a good discount," Malpani says. "But it will still be too expensive for many of these countries to scale up treatment."

Other forces may drive prices lower. "A number of other medicines are coming down the pike — at least 20," WHO's Wiktor says. "That in itself will provide competition as companies try to assure market share."

A flood of new data on the effectiveness of new medicines is expected this week at an International Liver Congress in London, where the new WHO guidelines were unveiled.

"The dynamism around hep C is really remarkable," Wiktor says. "Once you know you can cure somebody, that really changes the tone of the conversation."

But until the prices fall, and until (or unless) pressure develops to shake loose massive new amounts of funding to pay for access to the new drugs, hard choices loom.

For instance, the WHO guidelines say that treatments will have to be rationed, starting with patients whose livers are heavily scarred or cirrhotic – putting them at high risk for liver cancer or the need for liver transplants.

"We don't have reliable figures, but about 20 percent of people with chronic hep C are in that stage," he says. "That would be 26 to 30 million people globally."

Or around three times the number receiving HIV treatment.

This report is produced as part of a partnership with NPR and Kaiser Health News.

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

Lessons Learned For 2015 From This Year's Obamacare Sign-Ups

Wed, 04/09/2014 - 3:32am
Lessons Learned For 2015 From This Year's Obamacare Sign-Ups April 09, 2014 3:32 AM ET Listen to the Story 4 min 40 sec  

Maritza Martinez worked with an insurance agent at a kiosk in a Miami mall to find the right health insurance plan for 2014.

Joe Raedle/Getty Images

President Obama was thrilled last week when he was able to announce that more than 7 million people have signed up for insurance under the Affordable Care Act.

"This law is doing what it's supposed to do," the president said in the Rose Garden. "It's working."

But that's not to say it couldn't work better. Among those suggesting ways to help is the consumer group Families USA. The group's got a list of 10 specific changes it says could improve outreach and make the overall process easier for people to navigate.

Perhaps the best thing about this particular list, is that "none of these recommendations require legislation from the Congress," said Ron Pollack, the group's executive director. "These changes can either be implemented by the Department of Health and Human Services or state marketplaces."

Less Reliance On Websites, More Face-To-Face Chats

Pollack's group proposes, for example, more funding for navigators and other people who can provide in-person, individual counseling to help people select and sign up for health plans, along with more education about the availability of financial support to help offset the cost of monthly premiums.

Shots - Health News First Step In Health Exchange Enrollment: Train The Helpers

Another proposal, which has come in various versions, would create a special new enrollment period right around the time people are filing their taxes. Rachel Klein, who co-authored the report for Families USA, says that option would be particularly important for people who are still uninsured at tax time next year.

"There are a number of people who will find they are subject to a penalty because they did not have insurance in 2014," she said on a conference call with reporters. "Those people will have missed the open enrollment opportunity for coverage in 2015 and thus they will be subject to two penalties."

A Special Tax-Time Open Enrollment Period?

In other words they will owe one penalty for not having coverage in 2014, and another because they missed the 2015 open season, so they will remain uninsured for that year, too. Allowing people to purchase coverage for 2015 at that point could help minimize some of what is sure to be a backlash against the law next spring.

Others have recommended that going forward, the general open enrollment period should be shifted from the autumn to instead coincide more with tax season. For one thing, that's when people who are uninsured may be likelier to have extra money to put toward health insurance.

Shots - Health News How A Series Of Mistakes Hobbled Minnesota's Health Exchange

For another, says Klein, "that will also enable tax preparers to play a much more significant role in helping people to understand their coverage options and helping them get signed up."

Meanwhile, others remain concerned that choosing a health plan simply remains much too difficult a task for the average consumer.

"People can't figure [it] out: 'Is a $200 deductible and a $10,000 out-of-pocket limit better for me than a $2,000 deductible and a $3,000 out-of-pocket limit?' " says Robert Krughoff. He heads Consumers' Checkbook, a nonprofit based in Washington, D.C., that publishes ratings of a wide array of services, including health care. "And taking into account coinsurance and copayments and all those things, people just can't do it," he says. "Ph.D. economists can't do it."

Online Tool For Better Comparisons of Health Plan Options And Costs

Consumer's Checkbook has for 35 years published a guide to help federal workers choose from the dozens of health insurance options available to them each year. So Krughoff and colleagues decided to see if they could do something similar for the health exchanges. The first thing they realized, he says, is that too many people are choosing plans based on premiums alone.

"They would look at a premium that looks like it's going to save them $1,500 a year [and think] 'Great!' " he says. But after doing more precise estimates, "it turns out that plan will cost them $2,500 more a year than some other plans. They really shouldn't do it on premium alone."

Nor should people choose plans based on deductibles, or even "metal levels" — gold, silver or bronze, he says. Those, too, provide misleading results.

Instead, Krughoff and his staff built an online tool that lets people estimate all health their costs (in a good or a bad year) in about five minutes by answering a few questions — about their health status, family and income demographics, and about any anticipated health spending. They can also plug in the names of their doctors.

So far their program has only been up and running in Illinois. But Jillian Phillips, a healthcare navigator with the Campaign for Better Healthcare in Chicago, said she used the tool this year and likes it a lot.

"It was really helpful because it saved me a lot of time," she says, "versus having to crunch all the numbers and show them what it would add up to be."

Krughoff says it would be cost-prohibitive for his group to try to replicate the tool for all 50 states, or even for the 36 states in the federal exchange. But he hopes the federal government might step in to help make sure people don't land in plans that aren't necessarily the right fit.

Too much attention has been focused on delays in getting signed up, he says, and not enough attention on making sure each family gets into the right plan. Having to wait an extra two weeks to get insurance "might be catastrophic for some people," he says. "But paying $2,000 more for your insurance than you need to — that could be pretty catastrophic, too. And there hasn't been enough emphasis on that."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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The Forgotten Childhood: Why Early Memories Fade

Tue, 04/08/2014 - 5:08pm
The Forgotten Childhood: Why Early Memories Fade April 08, 2014 5:08 PM ET Listen to the Story 7 min 41 sec   i i

Eight-year-old Francis Csedrik pauses mid-swing in his backyard in Washington, D.C. Like most kids, he's gradually losing his memories of things that happened when he was 3 years old.

Meg Vogel/NPR

Francis Csedrik, who is 8 and lives in Washington, D.C., remembers a lot of events from when he was 4 or just a bit younger. There was the time he fell "headfirst on a marble floor" and got a concussion, the day someone stole the family car ("my dad had to chase it down the block"), or the morning he found a black bat (the furry kind) in the house.

But Francis looks puzzled when his mom, Joanne Csedrik, asks him about a family trip to the Philippines when he was 3. "It was to celebrate someone's birthday," she tells him. "We took a long plane ride, two boat trips," she adds. Francis says he doesn't remember.

That's a classic example of a phenomenon known as childhood amnesia. "Most adults do not have memories of their lives for the first 3 to 3 1/2 years," says Patricia Bauer, a professor of psychology at Emory University.

Scientists have known about childhood amnesia for more than a century. But it's only in the past decade that they have begun to figure out when childhood memories start to fade, which early memories are most likely to survive, and how we create a complete autobiography without direct memories of our earliest years.

Childhood Amnesia Starts In Childhood

For a long time, scientists thought childhood amnesia occurred because the brains of young children simply couldn't form lasting memories of specific events. Then, in the 1980s, Bauer and other researchers began testing the memories of children as young as 9 months old, in some cases using gestures and objects instead of words.

"What we found was that even as young as the second year of life, children had very robust memories for these specific past events," Bauer says. So, she wondered, "Why is it that as adults we have difficulty remembering that period of our lives?"

More studies provided evidence that at some point in childhood, people lose access to their early memories. So several years ago, Bauer and her colleague Marina Larkina decided to study a group of children to see what happened to their memories over time.

TED Radio Hour How Do Experiences Become Memories?

At age 3, the children were all recorded speaking with a parent about recent events, like visiting an amusement park or a visit from a relative. Then as the kids got older, the researchers checked to see how much they remembered.

The Salt Hours After A Meal, It's The Memory That Matters

And they found that children as old as 7 could still recall more than 60 percent of those early events, while children who were 8 or 9 recalled less than 40 percent. "What we observed was actually the onset of childhood amnesia," Bauer says.

It's still not entirely clear why early memories are so fragile. But it probably has to do with the structures and circuits in the brain that store events for future recall, Bauer says.

When a child is younger than 4, those brain systems are still quite immature, Bauer says. "It doesn't mean they're not working at all," she says. "But they're not working as efficiently — and therefore not as effectively — as they're going to be working in later childhood, and certainly in adulthood."

Memories That Persist

Some early memories are more likely than others to survive childhood amnesia, says Carole Peterson at Memorial University of Newfoundland. One example, she says, is a memory that carries a lot of emotion.

Peterson showed this in a study of children who'd been to a hospital emergency room when they were as young as 2 for injuries such as a broken bone or a cut serious enough to require stitches. "These were very emotional, very significant events," Peterson says. "And what we have found is that even 10 years later, children have enormously good memory of that."

Eight-year-old Francis Csedrik certainly remembers the events that led to his emergency room visit. He was at school when a friend said, "I want to carry you down the stairs," Francis says. "I didn't want him to, but he didn't listen. He did it. And I fell headfirst on a marble floor."

i i

Francis Csedrik remembers details of being bonked hard on the head when he was 4, and having to go to the emergency room.

Meg Vogel/NPR

That memory is from when Francis was 4. But a child in one of Peterson's studies recalled an event from when he was just 18 months old. It was the day his mother went to the hospital to give birth to a sibling. "He remembers crying on the floor of the kitchen, and he remembers how upset he was," Peterson says. "And he can remember the pattern of his teardrops on the linoleum."

Findings like that are persuading courts to allow more eyewitness testimony from children, Peterson says. In the past, she says, courts thought children couldn't tell the difference between fact and fantasy. But studies have shown that they can, and that "the amount they remember is staggering."

The key to using children as witnesses is to make sure they are questioned in a noncoercive way, Peterson says. "They want to be cooperative," she says, "so you have to be very careful not to put words in their mouth."

The Power Of Story

Another powerful determinant of whether an early memory sticks is whether a child fashions it into a good story, with a time and place and a coherent sequence of events, Peterson says. "Those are the kinds of memories that are going to last," she says.

And it turns out parents play a big role in what a child remembers, Peterson says. Research shows that when a parent helps a child give shape and structure and context to a memory, it's less likely to fade away.

That's something Joanne Csedrik has worked on with Francis ever since his concussion. At first, he just talked about it with her. But more recently, he's described the incident in school writing assignments.

"I just like writing that story because I just don't want to forget it," Francis says.

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"Because it reminds you to be careful," his mother says. "Right. You don't want to have that happen again."

StoryCorps For Man With Amnesia, Love Repeats Itself

"I think that's a day I'll always remember," Francis says.

It's not hard to see an evolutionary reason for memories like this. Kids who recall stories about danger or injuries are probably more likely to survive to become adults.

And stories become important for a different reason in adolescence, Peterson says. That's when people usually begin knitting together all of these smaller stories into a larger life story, "in order to explain why you are the kind of person you are," she says.

Interestingly, a person's life story usually includes events that should have been lost to childhood amnesia. That's because when our own memories start to fail, Peterson says, we rely on family members, photo albums and videos to restore them.

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

Wave Of Newly Insured Patients Strains Oregon Health Plan

Tue, 04/08/2014 - 5:02pm
Wave Of Newly Insured Patients Strains Oregon Health Plan April 08, 2014 5:02 PM ET

fromOPB

Listen to the Story 4 min 9 sec   i i

Cheryl Stumph goes over paperwork with a medical worker. She finally has health insurance to take care of her family's medical needs.

Kristian Foden-Vencil for NPR

Millions of Americans who didn't have health insurance last year now do because of the Affordable Care Act.

In Lane County, Oregon, Trillium Community Health Plan is struggling to deal with a huge influx of new patients looking for health care. CEO Terry Coplin says the company figured 26,000 people would sign up in the first few years. Instead, about that many signed up right off the bat.

"We weren't expecting to get such a large assignment of patients in the first two months," says Coplin. "These patients who are coming onto the program — many have not seen a physician for years. We're dealing with not just a large number of patients, but also what appears to be a much sicker population of patients."

Cheryl Stumph is one of them. She and her husband, Mike, run Green Streak Automotive, an all-service garage in Veneta, Ore.

"Cars and trucks and tractors and generators and lawn mowers and boats and motor homes, and I think the only thing I haven't done is an airplane, so far," she says.

Last November, Stumph's 27-year-old son had a stroke and died at the wheel of his tow truck. The stroke stemmed from a genetic problem, so Stumph spent the winter worrying about her six other kids.

Shots - Health News Oregon Shines On Medicaid, As Texas Stalls On Sign-Ups

Genetic testing is expensive, and she didn't have health insurance. But now she and her family get Medicaid through Trillium Health.

"That was really relieving," Stumph says. "You know, because we can check on the other kids and maybe not lose them. Oh, my God, we're 50 and aren't there things we're supposed to do at this age of our lives? And, you know, we're doing it, and it's great. It just gives you hope."

She's thrilled to be able to get a mammogram and treatment for a stubborn infection. The kids can get genetic testing. She says her husband has a chronic medical problem that needs attention, too.

Stories like Stumph's are being repeated across Oregon. Trillium Health is overwhelmed.

Trillium's Coplin says the health plan has come up with a four-part plan to deal with this unexpected influx.

First, it will pay bonuses to doctors who accept new patients covered by Trillium.

Second, Trillium is giving Lane County $900,000 to open a new clinic in an existing building. "They have proposed ways that they can get this clinic up and running by mid-year," says Coplin.

Third, Trillium is hiring a consultant to see if existing clinics can increase efficiency, for example, by changing who fills out forms. "Having physicians do clerical work is really a waste of valuable resources," Coplin says.

And finally, Trillium is offering $500,000 to any clinic or group of physicians willing to expand their practice to take on another 5,000 adult patients.

Meanwhile, Trillium is making some short-term fixes to help new enrollees find a doctor in the area.

Coplin says if people suffer serious accidents, they can go to the emergency room. If the injuries are less serious, they can go to urgent care.

But someone suffering a minor complaint can fall through the cracks.

Lane County Public Health Officer Dr. Patrick Luedtke thinks Trillium's plans will probably work, but he's anxious about those cracks.

"We have a shrinking pool of providers, and we have a growing need, in an aging population, for health care," he said. "So we need to get creative, and that's what we're doing."

Stumph is pleased to be getting treatment, but there have been hitches. "It took a month, I think, to get the first appointment for my husband," she says.

They've been to several appointments and the doctor told Cheryl she'd have to give up smoking, get a little more exercise and follow all the usual doctor recommendations. She says she's working on it.

This story is part of a partnership with NPR, Oregon Public Broadcasting and Kaiser Health News.

Copyright 2014 Oregon Public Broadcasting. To see more, visit http://www.opb.org.
Categories: NPR Blogs

The Ebola Outbreak 3 Weeks In: Dire But Not Hopeless

Tue, 04/08/2014 - 4:56pm
The Ebola Outbreak 3 Weeks In: Dire But Not Hopeless April 08, 2014 4:56 PM ET Listen to the Story 4 min 36 sec   i i

The new normal in Guinea is washing hands with a mixture of water and bleach—shown here at the border entrance of Buruntuma, in the Gabu area on Tuesday.

Tiago Petinga/EPA /LANDOV

Guinea is on high alert. At the international airport, travelers' temperatures are monitored for signs of infection. In the capital city of Conakry, people rarely shake hands and are advised to regularly wash their hands with bleach-diluted water.

This is what life is like nearly three weeks after an outbreak of the deadly Ebola virus.

The World Health Organization has confirmed 157 cases in Guinea, with 101 deaths. Neighboring Liberia has 21 reported cases and 10 deaths. Suspected cases also are being monitored in Sierra Leone and Mali.

WHO described the Ebola outbreak in Guinea as one of the most challenging in the history of the disease because the virus has crossed borders and is in a large capital city, home to 2 million people. What's more, it's the virulent "Zaire" strain.

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There's a lot of fear in Guinea, notes Stéphane Hugonnet, with the WHO Department of Global Preparedness, Surveillance and Response. Hugonnet, who returned to Geneva from southeast Guinea this weekend, says in every Ebola outbreak it's difficult to convince sick people to enter isolation units at a health center.

"The mortality rate is extremely important," Hugonnet says. "Nine out of 10 patients will die. If we look at this from the population's perspective, why would you go to a hospital if you have almost a zero chance of getting out of it."

But, he stresses, isolating Ebola victims is one of the most important tactics to stop the spread of the virus.

Shots - Health News Why Anthropologists Join An Ebola Outbreak Team

Guinea's health minister, Remy Lamah, has implored Guineans to remain calm and to ignore rumors that foreign health workers brought Ebola to Guinea. Misinformation is a mighty problem, he says. The virus can be transmitted to humans from wild animals, including fruit bats and monkeys – both of which are culinary delicacies in some parts of Guinea.

Direct human contact with another person's sweat, blood, feces and other bodily fluids, as well as the unprotected handling of infected corpses, can also lead to infection.

Local media are giving blanket coverage to the outbreak. A radio debate included medical personnel, ministers, and ordinary people – as well as one survivor.

"Not everyone dies of Ebola," says Aissata Diallo, a 20-year-old hygienist who has been assisting at a hospital where the international medical charity Doctors Without Borders treats patients. "Yes, of course it's contagious. But there are cases where people get well and go home. That's wonderful. And that makes us happy that people are leaving here alive."

WHO, meanwhile, expects to remain in Guinea for some time.

"Our expectation is that we'll continue to see cases for some number of months," says Assistant Director-General Keiji Fukuda. "Because we are dealing with Ebola, what we typically do is look and make sure that we go through a couple of incubation periods to see if the outbreak is really over."

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

Global Aid For Health Hits Record High As Funding Sources Shift

Tue, 04/08/2014 - 12:01pm
Global Aid For Health Hits Record High As Funding Sources Shift April 08, 201412:01 PM ET

A pregnant Somali woman gets a tetanus shot at a clinic in Mogadishu in 2013. The vaccination initiative was launched by the GAVI Alliance, UNICEF and the World Health Organization.

Carl de Souza/AFP/Getty Images

International development aid has hit an all-time high, despite some nations dramatically slashing their foreign assistance budgets. As patterns of international assistance shift, an increasing amount of money is being invested in improving health in the developing world.

Donors from wealthy nations, aid groups, U.N. agencies and other charitable organizations spent $31.3 billion in 2013 on health projects in the developing world, according to a new analysis from the Institute for Health Metrics and Evaluation at the University of Washington.

The numbers, published online Tuesday in the journal Health Affairs, reflect a shifting funding landscape in which nonprofits, public-private partnerships and large foundations — mainly the Bill and Melinda Gates Foundation — now overshadow the influence of regional development banks and other traditional funders.

Some of the biggest jumps in spending came from issue-focused agencies.

International Spending on Health 1990-2013

Credit: Institute for Health Metrics and Evaluation/University of Washington

The GAVI Alliance, for example, which supports vaccination, disbursed $1.5 billion in 2013 — 32 percent higher than the year before.

The Global Fund to Fight AIDS, Tuberculosis and Malaria boosted its distributions by roughly 17 percent, pouring $4 billion in to programs primarily in Africa.

At the same time the Organization for Economic Cooperation and Development says overall international aid rebounded last year to a new high. The OECD says rich nations dedicated $134.8 billion to foreign development assistance in 2013.

While the U.S. government continues to be the largest donor for all types of development assistance globally, American spending on international health declined by almost $1 billion — from $8.3 billion in 2012 to $7.4 billion in 2013.

The U.K. posted a dramatic 28 percent boost in development spending last year, as it increased assistance to reach a U.N. Millennium Development Goal of allocating .7 percent of gross domestic product to international aid by the year 2015.

Here's a cool interactive graphic on international aid that lets you compare trends in giving, country by country:

Additional Information:

The new analysis finds that the big losers down the road could be middle-income countries such as Mexico, India and Brazil, as donors focus more of their resources on the poorest of the poor.

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Nevada Offers Rare Deal: Year-Round Sales Of Health Plans

Tue, 04/08/2014 - 11:50am
Nevada Offers Rare Deal: Year-Round Sales Of Health Plans April 08, 201411:50 AM ET

Partner content from:

i i

Put your money down and buy insurance — all year long.

Kajdi Szabolcs/iStockphoto

For months, consumers have been warned that they have to buy health insurance by the end of open enrollment or remain uninsured until next year. But a little noticed provision of the health law may give some consumers another chance.

Insurers that sell individual plans have to offer insurance to all comers during an annual open enrollment period, which this year ended for most people on March 31. However, the health law allows insurers to sell individual plans on the exchange outside the regular open enrollment if they wish to do so, as long as they don't discriminate against people who are sick.

Health policy analysts say they don't expect insurers to take advantage of the extra selling opportunity often. "The assumption is that no insurance company would do that because they'd just open themselves up to too much adverse selection," says Sabrina Corlette, project director at the Georgetown University Center on Health Insurance Reforms.

Still, at least one state is embracing the option. Under a Nevada law that took effect in January, any insurer that sells individual health plans outside the state's health insurance exchange has to offer those plans year round. To discourage people from waiting until they get sick to buy a plan, insurers can require a waiting period of up to 90 days for coverage to take effect.

"We recognized that there could be a time when a consumer in Nevada needs or wants to purchase insurance off of the exchange for whatever reason without having had one of the special qualifying events" that create an enrollment opportunity on the exchanges, says Jake Sunderland, a spokesman for the Nevada Division of Insurance. "We wanted to allow for that."

No other state has taken Nevada's tack so far.

Under the health law, people who don't get insurance through their jobs can shop for plans during a designated open enrollment period each year. This year, open enrollment ran from Oct. 1, 2013, through March 31, 2014. Open enrollment for 2015 coverage starts Nov. 15, 2014, and ends Feb. 15. Insurers on and off the exchanges must allow consumers to enroll in their plans during these windows.

After the annual open enrollment periods ends, in general people can't buy a plan again until the next open enrollment period unless they get married, have a child or experience other big changes in their life circumstances. So unless they live in Nevada or an insurer makes a rare offer of insurance outside of open enrollment, people who don't buy coverage during open enrollment and subsequently get sick may have to pay for their own medical care for the remainder of the year in addition to facing a penalty for not having health insurance.

Because of the bumpy rollout of the health insurance exchanges, many people didn't finish enrolling in coverage by the March 31 deadline. The federal government gave people until April 15 to complete the process in the 36 states where it operates the health insurance exchanges to enroll in exchange plans. Many states that operate their own exchanges followed suit, extending the length of time people could sign up for a plan on and off the exchanges into April.

In a statement following the announcement of the extra time to sign up through the federal exchange, America's Health Insurance Plans, a trade group for the insurance industry, urged that any extension be limited.

"This helps to ensure there is an incentive for people to enroll. It is also necessary so health plans know who is covered as they develop and submit premiums for next year, which is required in some states as early as April," the statement said.

Under normal circumstances, insurers might balk at offering people a chance to sign up outside the regular open enrollment period. But this April's exended time frame may be a special case. With so much speculation that young and generally healthy people would likely wait until the last minute to enroll in a plan, insurers might be more than usually willing to leave the enrollment doors open in the hope of snagging some of the "healthy procrastinators," Georgetown's Corlette says.

"It may well be that issuers are assuming that these procrastinators are people that they want to have," she says.

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