NPR Health Blog

Syndicate content Shots - Health News
The NPR Health Blog
Updated: 6 min 2 sec ago

Why Won't The Fear Of Airborne Ebola Go Away?

Fri, 10/17/2014 - 4:18pm
Why Won't The Fear Of Airborne Ebola Go Away? October 17, 2014 4:18 PM ET Listen to the Story 4 min 12 sec  

The Ebola virus as seen under an electron microscope.

BSIP/UIG via Getty Images

How many times do top officials have to say that the Ebola virus is not airborne?

A lot, apparently.

Here is President Obama Thursday: "This is not an airborne disease. It is not easy to catch."

And the day before: "It is not like the flu. It is not airborne."

And Friday, a reporter asked the inevitable question about airborne Ebola when Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, held a press briefing about nurse Nina Pham's transfer to the National Institute of Health.

Shots - Health News No, Seriously, How Contagious Is Ebola?

"There is no evidence whatsoever that this virus is airborne-transmitted," said Fauci emphatically. "Everything we know about this virus is that it is direct contact with bodily fluids."

Shots - Health News Poll: Majority Of Americans Worried About U.S. Ebola Outbreak

This gets said over and over. It's backed up by epidemiological studies of past outbreaks. Yet the possibility of Ebola spreading through the air keeps being raised.

At a hearing Thursday, for example, lawmakers grilled Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention.

"You've already said a couple of times that you don't believe that this is airborne," said Republican Congresswoman Renee Ellmers from North Carolina. And yet, she noted, the two nurses still got sick. "They followed precautions, I am sure, and now we are having this conversation and I'm very concerned about that."

Frieden responded that the investigation is ongoing but the nurses treated the Ebola patient when his vomit and diarrhea contained a lot of virus: "We are confident this is not airborne transmission."

When government officials keep saying this isn't airborne, it seems like what they're really trying to tell the public is, "Don't worry about catching this virus in the course of your normal daily activities."

"I think that what they are trying to convey with the idea that 'it's not airborne' is that you likely need to be relatively close to the person where there are some bodily fluids present," says Rachael Jones, who studies infectious disease transmission at the University of Illinois at Chicago.

She says if someone down the hall from you had Ebola and threw up vomit that contains the virus, "those particles are not going to travel hundreds of feet or hundreds of meters to cause an infection."

But if a health care worker or a family member gets very close to someone who has a lot of symptoms, which is when people with Ebola are most contagious, Jones says droplets of body fluid could potentially travel through the air for short distances.

"If you vomit there are projectile droplets that could spray up," she notes.

And she says there's reason to be concerned that an Ebola patient might produce even smaller droplets that someone in close quarters could inhale and get sick from — during medical procedures like putting in a breathing tube.

"A lot of these medical processes that health care workers perform produce small aerosols," says Jones. This is why she and a colleague recently wrote a commentary saying this needs to considered when protecting health care workers.

So even though Jones takes issue with the White House's flat statement that the Ebola virus cannot spread through air, she says this is really not a concern for the public.

"There is not epidemiological evidence that community-based exposure, such as being at a shopping mall or walking down the street or riding a bus, is associated with disease transmission," she notes.

Still, what if the Ebola virus mutates? That's another fear that keeps surfacing. The chairman of the Joint Chiefs of Staff, Gen. Martin Dempsey, spoke about that on CNN this week.

"I'm worried about it because we know so little about it," he said. "You'll hear different people describe whether it could become airborne." He said that scientists did not agree. "I don't know who's right. I don't want to take that chance. So I'm taking it very seriously."

It's true that researchers can't absolutely rule out the idea that mutations might change how the virus spreads, but this seems unlikely, says Alan Schmaljohn, a virologist the University of Maryland School of Medicine. He said the chance of that is "very low, probably in the range of winning the multi-state lottery."

On Capitol Hill, the CDC's director said his team has been on the lookout for any significant genetic mutations. "What we've seen is very little change in the virus," Frieden told lawmakers. "We don't think it is spreading by any different way."

Chances are that's not the last time he'll have to say that.

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

California Nurses' Union Pulls Ebola Into Contract Talks

Fri, 10/17/2014 - 4:04pm
California Nurses' Union Pulls Ebola Into Contract Talks October 17, 2014 4:04 PM ET

fromKQED

Listen to the Story 2 min 23 sec  

Members of the California Nurses Association rallied in Sacramento, Calif., in May, in anticipation of contract negotiations with Kaiser Permanente that began in this fall.

April Dembosky / KQED

The powerful California Nurses Association has put Ebola on the bargaining table in its negotiations for a new contract with Kaiser Permanente.

Contract talks have been going on for months, and the nurses' most recent demands are focused on Ebola — better training, more staffing, protective gear that goes beyond what's recommended by federal officials and even a special life insurance policy.

Shots - Health News Nurses Want To Know How Safe Is Safe Enough With Ebola

"We'd like to have an extra supplemental coverage, for specifically Ebola, if we were to contract Ebola while we're at work," says Diane McClure, a nurse at Kaiser Permanente's hospital in Sacramento, where a patient suspected of having Ebola was treated in August. He later tested negative for the virus.

She says even a month after the Ebola scare at her hospital, nurses hadn't received any meaningful hands-on training.

"They felt that all they had to do was pull up some [Centers for Disease Control and Prevention] information online and put some flyers on the tables and in the bathroom and that was it," says McClure, who is a member of the nurses' bargaining team.

Leaders from California's union and its partner in lobbying, National Nurses United, are quick to label the problems with training as a symptom of the country's fragmented health care system. The CDC issues guidelines, state departments of public health pass them on, then it's up to each hospital to take it from there.

The unions say fragmentation and a lack of protocols are the reasons two nurses at Dallas' Texas Health Presbyterian hospital were infected with Ebola. They've hosted several rallies for the nurses at the Dallas hospital, while noting that it isn't unionized.

Shots - Health News California Nurses Union Braces For Contract Battle

Joanne Spetz, an economics professor at the nursing school of the University of California San Francisco, says National Nurses United is doing what any other group that's looking to gain membership would do.

"Of course it's opportunistic," says Spetz, but "Texas is a state that has had virtually no union representation for registered nurses. So NNU may view this as an opportunity to demonstrate to nurses in the state what the value of their representation might be."

Kaiser Permanente has yet to respond to all of the California Nurses Association's demands. In a statement, Kaiser Permanente said that it is rolling out new training this week, including videos and simulation exercises. And it is supplying protective gear that is consistent with current CDC guidelines.

This story is part of a reporting partnership that includes KQED, NPR and Kaiser Health News. Kaiser Health News is not affiliated with Kaiser Permanente.

Copyright 2014 KQED Public Media. To see more, visit http://www.kqed.org.
Categories: NPR Blogs

Spike In ER, Hospital Use Short-Lived After Calif. Medicaid Expansion

Fri, 10/17/2014 - 2:02pm
Spike In ER, Hospital Use Short-Lived After Calif. Medicaid Expansion October 17, 2014 2:02 PM ET

fromKQED

One rationale for extending Medicaid coverage to more people is to help them get to a doctor or clinic before a minor illness becomes a medical emergency.

iStockphoto

While the expansion of Medicaid under the Affordable Care Act may lead to a dramatic rise in emergency room use and hospitalizations for previously uninsured people, that increase seems to be largely temporary and should not lead to a dramatic impact on state budgets, according to an analysis from the UCLA Center for Health Policy Research released Wednesday.

Researchers reviewed two years of claims data from nearly 200,000 Californians, including patients who had enrolled in public health programs well in advance of last January's expansion of Medi-Cal, the state's version of Medicaid.

These programs were designed to ease the expansion of Medicaid by providing insurance to low-income adults who weren't eligible for Medi-Cal at that point but would be when the health law's expansion went into effect. The researchers divided the group into four categories, based on the researchers' assessment of each category's pent-up demand for health care.

“ What our findings say to the country is, concerns about Medicaid expansion being financially unsustainable into the future are unfounded.

In July 2011, after being enrolled in California's Low Income Health Program, the group with the highest pent-up demand had a rate of costly emergency room visits that was triple or more that of the other groups. But from 2011 to 2013, that high rate dropped by more than two-thirds and has remained "relatively constant," according to the analysis.

"We were hoping that this would be the case," says lead author Jerry Kominski, director of the UCLA Center for Health Policy Research, "because we think that, that's what access to care does for low-income individuals." Among people who haven't been able to afford to see a doctor, you see an additional increase in demand for services initially, he says. But "that demand, or utilization, drops off pretty rapidly."

Rates of hospitalization for the "highest pent-up demand" group also started high and dropped by almost 80 percent over the two-year period. Interestingly, you might think that as ER and hospitalization rates drop, outpatient visits might rise, as newly insured people who had been accustomed to heading to the ER for sore throats and rashes now consult their family doctor instead. But that wasn't the case; the rate of outpatient visits was largely unchanged during the two-year period.

Kominski says that one of the fears raised about the Medicaid expansion was the potential high cost of low-income patients. He thinks that this analysis should ease those fears.

"What our findings say to the country is, concerns about Medicaid expansion being financially unsustainable into the future are unfounded," he says. Under the Affordable Care Act, the federal government pays states 100 percent of the cost of the newly eligible under the Medicaid expansion, but in 2017 that contribution will phase down until it reaches 90 percent in 2020.

Twenty-seven states and the District of Columbia are implementing the Medicaid expansion; 21 have not, and in two states, Indiana and Utah, the question of expansion is an "open discussion," according to a tally from the Kaiser Family Foundation.

Matt Salo, executive director of the National Association of Medicaid Directors, says the study was "certainly consistent with what we hope to do" by expanding health insurance access. Insurance is "just the first step," he says. "The next step is health care homes so that the individual can actually get better care."

Shots - Health News Oregon Shines On Medicaid, As Texas Stalls On Sign-Ups Shots - Health News Oregon's Medicaid Experiment Represents A 'Defining Moment'

One factor in helping drive down the higher rates of use, Kominski says, is better coordination for Medi-Cal beneficiaries. For example, virtually all Medi-Cal beneficiaries are now enrolled into a Medi-Cal managed care plan. "To the extent that other states don't have adequate coordinated care mechanisms in place for their Medicaid populations, then the kinds of drop-off that we observed in California may not occur there," Kominski said.

The UCLA analysis makes explicit reference to — and rebuts — a similar study, the Oregon Health Insurance Experiment. In Oregon in 2008, 10,000 residents literally won Medicaid coverage in a lottery, creating a true randomized controlled trial opportunity for researchers who compared those who won coverage with those who didn't. In the Oregon study, researchers reported a 40 percent increase in ER visits in the 18 months after that expansion.

Kate Baicker, a health economist at the Harvard School of Public Health, was one of the social scientists who analyed the Oregon experiment. She says her team did not find "any evidence of utilization tailing off over that 18-month window."

Still, Baicker says, an increase in the use of health care services, such as emergency room visits or hospitalizations, "does not mean that Medicaid should not be expanded; part of the goal is to increase access to health care."

The UCLA study was funded by the California Department of Health Care Services and Blue Shield of California Foundation.

This story is part of partnership that includes NPR, KQED, and the Kaiser Family Foundation.

Copyright 2014 KQED Public Media. To see more, visit http://www.kqed.org.
Categories: NPR Blogs

Take Your Medicine, Tap Your Phone And Collect A Prize

Fri, 10/17/2014 - 11:37am
Take Your Medicine, Tap Your Phone And Collect A Prize October 17, 201411:37 AM ET

A view of the rewards screen on the Mango Health app.

Meredith Rizzo/NPR

As a neurosurgeon in Connecticut, Dr. Katrina Firlik saw too many patients make the same mistakes, over and over again.

At her hospital in Greenwich she'd see patients with hemorrhagic strokes that could have been prevented. "They didn't take their hypertension medications for the last couple decades," she says.

A new tool from HealthPrize syncs with your smartphone to let the company know when you've taken your medication so you can reap your rewards.

HealthPrize

Firlik wanted to try to stop these problems. In 2009, she co-founded the company HealthPrize with two other health care entrepreneurs, Tom Kottler and James Jorasch, to create an app that would motivate people to take their meds.

HealthPrize offers reward points, much like Candy Crush or Fruit Ninja, to get people to stick with their prescriptions.

The company has recently partnered with West Pharmaceutical Services, a company that makes specialized devices for drugs that are injected, such as insulin. The customized tools ping a patient's smartphone when a drug has been injected. HealthPrize tracks the pings to verify that people have taken their medicines.

Patients who don't take their medicines, as Firlik saw, are at risk for strokes, heart attacks, blood clots and even death. The failure to follow through on doctors' prescriptions leads to problems that cost the U.S. health care system more than $290 billion a year, according to a report conducted by the New England Healthcare Institute. The costs include additional hospital admissions and extra emergency room visits.

The reasons patients don't take their drugs range from unwillingness to fork over a copay to worries about side effects. Another reason is that many chronic conditions, such as high blood pressure, don't have symptoms. And unlike an antibiotic or painkiller, the drugs people take to control many chronic conditions don't make them feel better.

Cholesterol-lowering statins are among the most-prescribed drugs in the U.S., but about 50 percent of patients don't take them as they should. "The No. 1 reason people don't take statins is because they don't really believe they need them," says Josh Benner, founder of RxAnte, a company that consults health groups on what types of patients don't take their medications. People don't think they're going to get a heart attack or a stroke, so they pass on the pills.

That's why startups like HealthPrize and Mango Health use rewards to make taking medicines part of a larger game to give people a boost of motivation.

Running through HealthPrize's blood are ties to Priceline and research in consumer motivation, casinos and gaming. "We understand consumers when it comes to Las Vegas, vending machines, lottery tickets," says Firlik.

Similarly, Mango Health's brightly colored fruit logo and friendly mobile interface sprang from the minds of former gaming industry executives. It makes sense to use a gaming angle to get you to take your meds, says Jason Oberfest, the CEO of Mango Health, because "our [demographic] looks very similar to mobile games."

He describes the average user of the Mango Health app as a woman, early to mid-50s, who enjoys Instagram and uses mobile banking apps. She would like a simple app on her phone to help her manage her recently diagnosed condition and the drugs her doctor told her she needs to start taking.

HealthPrize and Mango Health partner with health care groups, such as pharmaceutical companies, health insurance companies or physicians, to offer specific incentives for medical conditions and associated prescriptions. They verify that patients are refilling their prescriptions through the drug companies or pharmacies, while patients enter data on an app or mobile website, saying they took their medication.

Patients who take their medicines can collect various rewards, including gift cards to Amazon or Starbucks, cookbooks or donations to their favorite charities. "It's the immediacy of the reward that's critical," says Firlik. For HealthPrize, "the most common items that are redeemed are for $5 or $10 gift cards."

Depending on the app, the bill for the rewards is footed by a pharmaceutical company (HealthPrize) or the company itself (Mango Health).

In a study of 300 patients using HealthPrize over 20 months, they were, on average, 54 percent more likely to take their blood pressure medication than patients taking the same drugs but not in the program, according to the company.

In a study of 7,800 patients taking an acne prescription, those using HealthPrize refilled their prescription nearly three times as much as those not using it. Mango Health's first six months of data indicate that the rates of patients taking their medication with Mango Health are 20 to 25 percent higher than those not enrolled in the program.

However, neither HealthPrize nor Mango Health has published peer-reviewed studies, which leaves some cautious of the claims. "It's hard for me to imagine the apps overcoming understanding the need for treatment or fear of side effects," says Benner. "Those are, in our experience, best addressed by health care professionals."

However, Benner says he hopes the companies will sharpen their focus on people who could get help from apps. "They're just not going to be appropriate or effective for everybody," he says. But for those experiencing their first long-term everyday pill, an app could provide just the kick they need.

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

Just Seeing Charts And Graphs Makes Drug Claims More Credible

Fri, 10/17/2014 - 8:02am
Just Seeing Charts And Graphs Makes Drug Claims More Credible October 17, 2014 8:02 AM ET

When people see charts like this, they think the drug is more effective than if they just read about the data, a study finds.

Source: Cornell University

Graphs and formulas say "Science!" to consumers, so much so that simply seeing claims about a new drug that were accompanied by data visualizations made people more likely to believe the claims.

The effect is especially true if people have a strong belief in science to begin with.

That's the conclusion of a study published online in the journal Public Understanding of Science. It includes three experiments. In the first, 61 people read a paragraph saying that a nonexistent new drug enhances immune function and reduces the likelihood of catching a cold by 40 percent. Half of the people also saw a graph that repeated the numbers but contained no new information.

Of those who saw the text and the graph, 97 percent said they believed the drug worked, compared with 68 percent for the people who saw only the text.

The Salt Eaters Worldwide Are Skeptical of Manufacturers' Health Claims

The researchers, from the Cornell Food and Brand Lab, wanted to be sure that difference wasn't just because one group had the information repeated for them in graph form. So a separate group of 56 people saw the text and the graph, or the text plus an extra sentence repeating some of the information.

Again, the people who saw the graph rated the medication as more effective – especially those who said they believed in science.

Finally, the researchers wanted to make sure that the effect didn't just hold for visual representations of information such as a graph.

Shots - Health News Big Data Peeps At Your Medical Records To Find Drug Problems

So a different group of 57 people received information about another hypothetical drug. For half, that included the drug's chemical formula. Those who saw the formula believed the drug would work two hours longer than those who didn't get the formula.

Even "trivial elements that are associated with science ... can enhance persuasion," the authors said. That's important in an era of sometimes-dubious health claims for foods and supplements as well as medications. Indeed, a Nielsen survey a few years back found that while most people say they don't believe the claims on food labels, they were more likely to believe claims backed by numbers.

Cornell behavioral economist Aner Tal, an author of the study, says there's nothing inherently illegitimate about product information, marketing materials or advertisements that include graphs or formulas. It's just that those elements make the marketing message more convincing. So he warns that it's important to consider the source of all that information, no matter the form it takes. Is it from the company itself or a source funded by the company? Or is it from an independent source?

He says it can't hurt to approach "science-y" information like graphs or formulas with a more critical attitude. But he doesn't know if putting your guard up can make you immune to the bias.

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

Women Can Freeze Their Eggs For The Future, But At A Cost

Thu, 10/16/2014 - 5:19pm
Women Can Freeze Their Eggs For The Future, But At A Cost October 16, 2014 5:19 PM ET Listen to the Story 4 min 6 sec  

A doctor uses a microscrope to view a human egg during in vitro fertilization (IVF), which is used to fertilize eggs that have been frozen.

Mauro Fermariello/ScienceSource

Until recently, freezing a woman's eggs was reserved mainly for young women facing infertility as a result of cancer treatments like chemotherapy.

But recent advances in technology have made freezing eggs easier and more successful, and likely have a lot to do with the recent decisions by Facebook and Apple to offer female employees a health benefit worth up to $20,000 to freeze their eggs.

Making Babies: 21st Century Families Egg Freezing Puts The Biological Clock On Hold

The benefit is intended for women who don't need to freeze eggs for medical reasons, but rather as a choice. This would likely appeal to women who want to focus on their careers instead of child rearing, as well as women who just haven't yet met "Mr. Right."

Doctors have had the technology since the mid-1980s. But, according to Dr. Richard Paulson, director of the fertility program at the University of Southern California, it just didn't work very well. "Everybody figured there was something wrong with the eggs after freezing them; you just couldn't get them to fertilize," he says. Then, about 10 years ago, someone came up with the smart idea to use technology typically used to help weak sperm fertilize an egg.

No Longer Experimental, Egg Freezing May Appeal To More Women

"I think it would be fair to say the 'ah-ha' moment came when someone figured out that you could bypass the hardened egg shell," he says.

When eggs are frozen, their "shells" harden. Researchers bypassed the hardened shells by injecting sperm through the shell and directly into the egg. Then, within a few years, a rapid new freezing method enabled eggs to be quickly frozen with their quality preserved, putting the eggs into a "state of suspended animation," says Paulson.

Even so, age remains a major caution. Since eggs degenerate with age, the younger a woman is when she freezes her eggs, the better. For example, if a 30-year-old freezes her eggs and then uses them at age 38 or 40, she will be getting pregnant with the eggs of a 30-year-old with lower risk of miscarriage and genetic defects, including Down syndrome.

Health With Egg-Freezing So Expensive, Should Long-Term Boyfriends Chip In?

Egg freezing doesn't stop the biological clock, says Paulson. It just sort of "pauses it," he says, giving women the option to delay childbearing until they're ready.

While egg freezing is "an exciting new option," it shouldn't be relied on to make family-planning decisions, says Dr. Valerie Baker, a fertility specialist at Stanford University Medical Center. "We wouldn't want to have people think this is a substitute for making family building decisions in a broader context. It's not a guarantee that if a woman freezes her eggs she's eventually going to be able to have a baby with one of those eggs."

Baker says it's more reliable for women to try to get pregnant at a younger age, if possible, rather than banking eggs and hoping to get pregnant later in life. Even so, in vitro fertilization, or IVF, either with fresh or frozen eggs certainly boosts a woman's chance of getting pregnant at any age.

But egg freezing is costly, both emotionally and financially. Many women will have to undergo the procedure more than once. It cost about $10,000 to harvest eggs from the ovaries, after a woman has taken medications for several weeks to stimulate egg production. Then the eggs need to be frozen and stored, at a cost of about $500 a year. Each time eggs are thawed, fertilized and transferred to the uterus with IVF it costs about $5,000.

Baker adds another caution: Not all women have the same biological clock. "Some women are running out of eggs when they're in their late 20s/early 30s, whereas other women may have reasonably good fertility into their mid- to late 30s," she says. Reproductive specialists can help women figure out which category they are in, which is an important factor to consider when thinking about freezing eggs.

Most insurance companies don't cover the cost of egg freezing, not even for medical reasons when a young woman's fertility is jeopardized by cancer. So the decision by Facebook and Apple to foot the bill is a significant benefit for women who want to freeze their eggs.

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

Poll: Majority Of Americans Worried About U.S. Ebola Outbreak

Thu, 10/16/2014 - 2:04pm
Poll: Majority Of Americans Worried About U.S. Ebola Outbreak October 16, 2014 2:04 PM ET

An ambulance carrying Amber Vinson, the second health care worker to be diagnosed with Ebola in Texas, arrives at Emory University Hospital in Atlanta on Wednesday.

David Tulis/AP

How are Americans sizing up the threat from Ebola?

A Harvard School of Public Health poll finds that more than a third of Americans (38 percent) are worried that Ebola will infect them or a family member over the next year.

Most (81 percent) believe Ebola can spread from someone who is sick and has symptoms. And that's correct.

Body fluids, such as blood, urine and feces, can carry the virus from one person to another. And almost all of the poll respondents (95 percent) agreed that direct contact with body fluids from a person with Ebola symptoms was likely to cause infection.

A large proportion (85 percent) of people believe the virus can be transmitted by a sneeze or cough. That's highly unlikely. "Common sense and observation tell us that spread of the virus via coughing or sneezing is rare, if it happens at all," the World Health Organization says.

Shots - Health News Ebola In The United States: What Happened When

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center, says there is no known case of Ebola being spread that way.

"I think the public has received Ebola 101, but not Ebola 102," he said of the Harvard poll results on Wednesday's All Things Considered. "Those kinds of subtleties actually are pretty hard to communicate."

The telephone poll of 1,004 adults was conducted Oct. 8-12. Thomas Eric Duncan died in Dallas the day the poll was put into the field. The death of the first person diagnosed with Ebola in the U.S. may have weighed on poll respondents.

More than half of them (52 percent) said they were worried about an Ebola outbreak in the U.S. within a year. When asked the same question in August, 39 percent of people polled said they were concerned about an Ebola outbreak here.

While there have been setbacks already in dealing with Ebola in the U.S., public health officials say the country can cope with the virus.

"As we learn from the recent importation case in Dallas and subsequent transmissions, and continue the public health response there, we remain confident that Ebola is not a significant public health threat to the United States," CDC Director Dr. Thomas Frieden said in written testimony submitted for a House oversight committee Thursday.

Ebola, he wrote, "is not transmitted easily, and it does not spread from people who are not ill, and cultural norms that contribute to the spread of the disease in Africa — such as burial customs and inadequate public-health measures — are not a factor in the United States. We know Ebola can be stopped with rapid diagnosis, appropriate triage and meticulous infection-control practices in American hospitals."

Americans appear confident that if someone in their community gets sick with Ebola, they will receive good care. Some 80 percent said that someone infected with Ebola would survive an infection if he or she got prompt medical care.

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

Despite Legal Reprieve On Abortion, Some Texas Clinics Remain Closed

Thu, 10/16/2014 - 10:37am
Despite Legal Reprieve On Abortion, Some Texas Clinics Remain Closed October 16, 201410:37 AM ET

from

Listen to the Story 2 min 4 sec  

A man walks past the former site of a clinic that offered abortions in El Paso, Texas.

Juan Carlos Llorca/AP

Texans on both sides of the abortion issue are taking stock after the U.S. Supreme Court intervened in a lawsuit over a state law that would require clinics that provide abortion services to conform to standards for ambulatory surgery centers.

The court issued an order late Tuesday saying 13 Texas clinics that had to close can reopen their doors for now.

The clinics had shut down Oct. 3 because they couldn't meet the standards of ambulatory surgery centers. That's one of the Texas law's requirements. But now the U.S. Supreme Court has said those clinics can continue to operate while the law is appealed.

"I was really surprised and really delighted in a way I hadn't expected," said Amy Hagstrom Miller, founder and chief executive of Whole Woman's Health. Whole Woman's is the lead plaintiff in the lawsuit for this case. The company once had six clinics in Texas, but the law forced all but one to close.

Miller said she will reopen her clinic in McAllen by Friday, which would make services available to low-income women in the Rio Grande Valley. Women in the area had to travel to San Antonio, but many couldn't afford the trip or take time off from work, she said.

"To begin with there were only two clinic facilities in the Rio Grande Valley, and both of us had to close, which meant that women had to travel upwards of 250 miles round-trip in order to get an abortion safely," Hagstrom said.

Hagstrom is also working to reopen a second clinic in Fort Worth.

But even with this ruling, the legal fight in Texas appears to have fundamentally changed the landscape for abortion providers, and not all the clinics are likely reopen.

Whole Woman's clinic in Austin no longer has a lease or a state license. The company once had a clinic in Beaumont, but doctors there can't obtain admitting privileges at nearby hospitals, so Miller closed it in March.

In addition, any clinic that reopens might have to close again if the 5th Circuit Court of Appeals eventually rules the Texas law can stand.

Planned Parenthood in Houston was one of only eight places left in the state to get an abortion after the noncompliant clinics closed Oct. 3.

"Limiting abortion access to eight in Texas — eight simply isn't enough," said Rochelle Tafolla, a Planned Parenthood spokeswoman. "We were overwhelmed with phone calls."

Texas is the country's second-most populous state, with about 26 million people.

When the other clinics closed, Planned Parenthood received over 500 calls in just one day, about six times the normal volume.

Some women whose appointments were canceled drove to the Houston clinic off the Gulf Freeway. "Women were scared, they were nervous, they didn't understand what was happening," Tafolla said. "We're just thrilled the court stepped in to stop this terrible law and we hope that it will eventually and ultimately be overturned."

The Supreme Court's intervention means that the cycle of emergency motions is over. The 5th Circuit has agreed to expedite the full appeal, which could be heard as soon as December.

Houston-based Texas Right to Life supports the law and its strict new rules for providers. Emily Horne, a legislative associate, says the surgery center rule will make abortion safer for women.

Horne said it's discouraging that some clinics can now reopen, because she believes they don't offer good medical care. But she remains optimistic the law will stand in the long term.

"The encouraging thing for us is that this case is still before the 5th Circuit, and the 5th Circuit has already said a lot of positive things about the state's merit and likelihood of success," Horne said. "And none of that actually changed with what the Supreme Court said."

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

Copyright 2014 KUHF-FM. To see more, visit http://www.houstonpublicmedia.org.
Categories: NPR Blogs

How A No-Touch Thermometer Detects A Fever

Wed, 10/15/2014 - 6:03pm
How A No-Touch Thermometer Detects A Fever October 15, 2014 6:03 PM ET

A school official shows a pupil an infrared digital laser thermometer before taking his temperature in Lagos, Nigeria, in September. Starting this week, similar hand-held devices are checking foreheads for fever at some U.S. airports.

Akintunde Akinleye/Reuters/Landov

In the battle to stop Ebola's spread, health officials worldwide have been deploying thermometers in hopes of detecting the earliest symptoms among people who might be sick. The no-contact thermometer, already broadly used in some airports in Africa, has come to U.S. airports this week — now at New York's John F. Kennedy Airport, and, starting Thursday, at D.C.'s Dulles, Chicago's O'Hare, Atlanta's Hartsfield-Jackson, and Newark's Liberty.

The goal is to detect fever; for public screening purposes, according to guidance from the Centers for Disease Control and Prevention, an elevated temperature higher than 100.4 Fahrenheit (if you have reason to think you might have been exposed to Ebola) merits follow-up.

Of course, lots of illnesses — many that are mild and others that are severe — can cause fever, and checking for fever at airports didn't start with Ebola. In 2003, some Asian airports used thermometers as part of their screening of passengers for symptoms of severe acute respiratory syndrome, or SARS. And in 2009, with prompting from the World Health Organization, airports checked the temperature of some travelers, looking for symptoms of H1N1 flu.

As the NPR blog Goats & Soda reported previously, there are pros and cons to different types of temperature-taking devices, from the fairly common ear gun thermometer to the full-body scanner.

The CDC rush-ordered 80 Caregiver thermometers this week to five airports around the U.S., according to the manufacturer.

Thermomedics

The hand-held, no-touch thermometer seems to have emerged as the most popular for Ebola screenings, doctors say, because it's fast, easy to use, noninvasive, pretty accurate, relatively inexpensive, and minimizes the chance of spreading illness.

No-touch thermometers were originally used in industry, from manufacturing to firefighting, and they're a trusted resource, says physiologist Dr. Benjamin Levine at the University of Texas Southwestern Medical Center.

"It's very accurate at measuring whatever it's pointed at," Levine tells Shots. In this case, that's a forehead, which doesn't precisely reflect the human body's internal temperature, but is a close enough match for the rough purposes of screening, Levine says. "It's a quantitative way of having your mother put her hands or lips against your forehead."

The thermometer tells how hot a person is by measuring the infrared energy coming off the body. "Human skin is a very good — or very efficient — emitter of infrared energy," says Gary O'Hara, chief technology officer for Sanomedics, which manufactures CareGiver, the brand of thermometer now being used in some airports.

CareGiver captures that energy coming off the body, and the device is calibrated to translate that energy reading into the temperature of an object. A sensor relies on a silicon lens to focus the infrared energy so the reading isn't "of the wall, or of your hair," says O'Hara, "We want to read the temperature of a precise spot on your forehead." That's part of what differentiates a human no-touch thermometer from an industrial one, he says — the narrow field of view. The other difference is the algorithm the machine uses in its translation.

"That's our special sauce," says Keith Houlihan, CEO of Sanomedics. CareGiver's algorithm is based on data from clinical studies of patients, some with fevers and some without. "We crunch that data and put it into a mathematical algorithm so that it converts the temperature taken from the forehead into this oral equivalent," says O'Hara. The result, he says, is a thermometer that matches an oral thermometer typically within two-tenths of a degree and ASTM International's thermometer standard to within four-tenths of a degree.

No-touch thermometers are useful, in part, because they're unlikely to pass infection from person to person, according to the Centers for Disease Control and Prevention. However, the CDC also notes that this particular type of fever detector is most accurate when measuring the temperature of dry skin, in a draft-free room.

"If someone is sweating or has been in front of a fan and the forehead skin has become cool," he could register at a normal temperature when he is actually running hot, says Levine. And, of course, aspirin and some other pain relievers can reduce body temperature, too, and mask a low fever. No thermometer is perfect.

But for the fast pace of airport screenings, health officials say, if the goal is to pick up symptoms in some people before they even realize they're sick, no-touch thermometers are the best bet.

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

Ebola In The United States: What Happened When

Wed, 10/15/2014 - 12:51pm
Ebola In The United States: What Happened When October 15, 201412:51 PM ET

When Ebola virus resurfaced in West Africa in December 2013, public health officials were hopeful that it could be contained, as it had been in past outbreaks.

But the virus continues to ravage communities in Africa and has now spread to the United States and Europe. The number of new cases in Africa make it likely that there will be more cases in other countries.

We've put together a timeline to track the U.S. response to Ebola, with the most recent events at the top. (International coverage by NPR continues at the Goats and Soda blog.) Check back, as we'll be updating this list.

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

Embryonic Stem Cells Restore Vision In Preliminary Human Test

Tue, 10/14/2014 - 6:33pm
Embryonic Stem Cells Restore Vision In Preliminary Human Test October 14, 2014 6:33 PM ET Listen to the Story 8 min 48 sec  

Isabella Beukes, of Santa Rosa, Calif., has been legally blind for more than 40 years. An experimental treatment derived from embryonic stem cells seems to have enabled her now to see not just color but also some shapes.

Tim Hussin for NPR

Scientists are reporting the first strong evidence that human embryonic stem cells may be helping patients.

The cells appear to have improved the vision in more than half of the 18 patients who had become legally blind because of two progressive, currently incurable eye diseases.

The researchers stress that the findings must be considered preliminary because the number of patients treated was relatively small and they have only been followed for an average of less than two years.

But the findings are quite promising. The patients had lost so much vision that there was no expectation that they could benefit, the researchers say.

"I'm astonished that this is working in the way that it is — or seems to be working," says Steven Schwartz, a UCLA eye specialist who led the study, which was published Tuesday in the British medical journal The Lancet. "I'm very excited about it."

Other researchers agreed the work is preliminary, but also highly promising.

"It really does show for the very first time that patients can, in fact, benefit from the therapy," says Dr. Anthony Atala, a surgeon and director of the Wake Forest Institute for Regenerative Medicine at Wake Forest University.

“ What we did is put them into patients who have a disease where those particular cells are dying; and we replaced those dying tissues with new tissue that's derived from these stem cells. In a way it's a retinal transplant.

"That allows you to say, 'OK, now that these cells have been used for patients who have blindness, maybe we can also use these cells for many other conditions as well, including heart disease, lung disease and other medical conditions,' " Atala says.

Human embryonic stem cells have the ability to become any kind of cell in the body. So scientists have been hoping the cells could be used to treat many diseases, including Alzheimer's, diabetes and paralysis. But the study is the first human embryonic stem cell trial approved by the Food and Drug Administration that has produced any results.

"It is really a very important paper," Atala says.

The study involved patients suffering from age-related macular degeneration and Stargardt's macular dystrophy, the two leading causes of adult and juvenile blindness in the developed world, Schwartz says. The diseases destroy a person's central vision.

"Whatever you're looking at is gone — whether it's faces, or reading or food on a plate, or whether something is a step or stripe," Schwartz says. "It's very, very difficult to perform activities of daily life that we, you know, don't even think about."

Working with Advanced Cell Technology Inc. of Marlborough, Mass., Schwartz and his colleagues took human embryonic stem cells and turned them into the kind of cells that are killed by these diseases — retinal pigment epithelial cells. Then, they infused between 50,000 and 150,000 cells into the retinas of the patients.

"What we did is put them into patients who have a disease where those particular cells are dying; and we replaced those dying tissues with new tissue that's derived from these stem cells," Schwartz said. "In a way it's a retinal transplant."

“ I don't want patients to come in to their doctor saying, 'Hey, I heard about the stem cells on the radio and I'd really like to get that treatment done, and what do you think?' It's not ready.

No one expected the cells to help any of these patients see better, because the study was designed mostly just to see if doing this was safe. Researchers were concerned the cells could destroy whatever vision was left or lead to tumors in the volunteers' eyes. So Schwartz picked patients whose eyes were so far gone that they weren't risking losing any vision. That also meant that there was little hope the cells could help either.

"We did not expect to help these patients, and they did not expect to be helped," Schwartz says.

Some patients experienced side effects from the procedure itself and from the drugs they had to take to suppress the immune system, but none of the side effects were considered serious. The cells themselves have produced no safety problems so far, the researchers reported.

And, surprisingly, many of the patients did start to see better, according to the report. Ten of the 18 patients can see significantly better. One got worse, but the other seven either got better or didn't lose any more vision.

"These are patients that didn't see better for 30 years and all of a sudden they're seeing better," Schwartz says. "It's amazing."

The patients include a graphic artist who could suddenly make out the woodwork carved on a piece of furniture in her bedroom, an international consultant who regained the ability to walk through busy airports without help, and an elderly rancher who's riding his horse again, Schwartz says.

"He couldn't see things like a barbed-wire fence or whether in the distance a stray cow was under a tree," Schwartz says. "And six months after the transplant he's back to running his cattle again. And he can, in fact, see a snake on the ground or sort of tell whether a distant shadow is a cow or something else. So it's made a big difference for him in his life."

Isabella Beukes of Santa Rosa, Calif., has been legally blind for more than 40 years. But within weeks of getting the cells, she started to see better. She could make out the cursor on her computer screen and the color of her clothes. Today, she can hike the hills near her house all by herself.

"The improvement, I mean, from where I was coming is just, it's very, very significant for me. I think it's fantastic," Beukes says. "I just think to be part of groundbreaking research work is amazing."

Just being able to see well enough to to hike the hills around her Santa Rosa home by herself is a huge improvement, Beukes says.

Tim Hussin for NPR

The research is controversial, however. Embryos are destroyed to get the cells, and some people think that's immoral.

"The problem we have with embryonic stem cells is simply the fact that you have to destroy a young human being to get embryonic stem cells," says David Prentice, senior fellow for life science at the Family Research Council, an advocacy group. "We would reject the idea that any human being be destroyed for experimental purposes."

For his part, Schwartz says he's just trying to help blind people see better. But he cautions that this work is still at a very early stage.

"I don't want patients to come in to their doctor saying, 'Hey, I heard about the stem cells on the radio and I'd really like to get that treatment done, and what do you think?' " he says. "It's not ready. Maybe in a few years. Maybe not. We have to wait and see. The jury is way out still."

Schwartz has continued treating more patients using larger doses of cells and trying it on patients who haven't lost as much vision to see if that works even better. He has also expanded his study to Boston, Miami, Philadelphia and London.

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

California Ballot Measure Pits Doctors Against Lawyers

Tue, 10/14/2014 - 5:07pm
California Ballot Measure Pits Doctors Against Lawyers October 14, 2014 5:07 PM ET

fromKQED

Listen to the Story 5 min 5 sec  

Alana and Troy Pack died in 2003 when a woman abusing pain pills hit the children with her car. The accident has led to a ballot measure that, among other things, would put new constraints on physicians.

Courtesy of the Pack family

Troy and Alana Pack had spent the day at their neighborhood Halloween party in Danville, a suburb of San Francisco. Ten-year-old Troy went as a baseball player, and 7-year-old Alana was a good witch. In the afternoon, they changed out of their costumes and set out for a walk with their mother. Destination: Baskin-Robbins.

"Alana, she liked anything with chocolate," says their father, Bob Pack. "Troy, for sure, bubble gum ice cream, because he liked counting the bubble gums that he would get."

Bob Pack stayed home. His family made it only half a mile down the road before his phone rang: "I received a call from a neighbor screaming there'd been an accident. And I raced down there."

An impaired driver had veered off the road and hit Troy and Alana head-on. Pack was doing CPR on Troy when the paramedics arrived.

"I remember telling them I love them, and hang on. Just praying that they could hang on," he says

Troy and Alana were pronounced dead at the hospital. In the months after their death, Pack's wife, Carmen, found solace in her Catholic faith. Bob Pack was angry.

"I think, for me to get through, I needed action," he says, "and I needed to take action for justice for Troy and Alana, and also for doing something that I thought maybe I could change to benefit others in the future."

That was nearly 11 years ago. Pack quit his tech job to become an advocate. Over the past decade, he has helped write seven bills in California's Legislature. None of his efforts have been bigger than the one he's working on for the November election: Proposition 46, a patient safety initiative. It's complex and has three distinct proposals.

Requires Doctors To Check Prescription Database

The first proposal aims to curb so-called doctor shopping. Investigators in the Pack case found the driver who killed his children was abusing prescription narcotics.

"She had gone to numerous doctors, saying that she was under different pain — neck pain, back pain, leg pain, elbow pain," Pack says. "They, in my view, recklessly wrote prescriptions for her, for thousands of pills."

Bob and Carmen Pack testify at a hearing in 2006 in Sacramento to authorize the building of a database that tracks the number of times a patient is prescribed potent narcotics.

Courtesy of the Pack family

Pack set out to help the state build a database where doctors can see how many times a patient has been prescribed serious narcotics, like Vicodin or Oxycontin. The result is the Controlled Substance Utilization Review and Evaluation System, or CURES database.

Proposition 46 would make it mandatory for doctors to consult the database. California would become one of nine states requiring doctors to check before prescribing painkillers to first-time patients.

After passing similar laws, both Tennessee and New York saw a significant drop in the number of narcotics prescriptions written. Studies have verified the correlation, but they acknowledge that drug abusers may be turning to street drugs such as heroin instead.

Many doctors in California like the database. Some have called it indispensable. But they don't like being told how to practice medicine.

"The problem with the current way the ballot measure is written is it makes it mandatory to have that database checked," says Dr. Richard Thorp, president of the California Medical Association. He says technical glitches have made the database unreliable.

Lifts Cap On Malpractice Awards

Many doctors are also unhappy about another big piece of the measure: a proposed change to the cap on "pain and suffering" awards in medical malpractice lawsuits.

After his kids died, Bob Pack wanted to sue the doctors who prescribed drugs to the driver. "I set out and talked to about eight lawyers," he says.

They all turned him down. They told him a 1975 state law limited the malpractice award he could get to $250,000. That meant puny attorneys' fees. The case wouldn't be worth the lawyer's time.

"My reaction was 'What?!' That's not democratic. That's not America," Pack says. "We all have the right to the court system."

The law that set the cap is called MICRA, the Medical Injury Compensation Reform Act of 1975, passed with the intention of keeping medical liability insurance costs low. Several other states followed suit. California's law caps only noneconomic damages, or pain and suffering awards. Economic damages — for medical expenses or lost wages — aren't capped.

But economic damages were no help for Pack. Children have no jobs, no lost wages. And his children had no ongoing medical bills.

"So the victim gets victimized a second time," Pack says. "[He gets] no accountability or justice through the legal system."

Some states have ruled such caps on pain and suffering awards unconstitutional.

Pack thinks California's noneconomic malpractice award should at least be adjusted for inflation. Proposition 46 would raise the cap from $250,000 to $1.1 million and provide an annual adjustment for inflation in the future.

But the CMA's Thorp sees a big problem: "That will encourage additional lawsuits in the system." He argues more lawsuits will cause malpractice insurance premiums to go up, and those costs could drive doctors out of California.

"You'll start to see it become more difficult to recruit doctors to California," he says.

Mandates Drug And Alcohol Testing For Doctors

The third proposal in the proposition has been the centerpiece of the "Yes on Prop. 46" campaign, inspiring campy ads of airline pilots and police officers dancing through the stalls of a public restroom.

Adding doctors to that list seemed like an easy sell. Early polls indicated voters strongly favored the idea — many thought it was already law. In fact, if Proposition 46 passes, California would be the first state in the country to require drug testing of doctors.

Proposition 46 would give the Medical Board of California a year to set up a system to test doctors for drug and alcohol use, both randomly and within 12 hours after an unexpected patient death or serious injury at the hospital.

Doctors groups say that goes too far.

"This approach is too heavy-handed and too inappropriate," says Thorp. He says hospitals already have systems in place to suspend doctors who show up to work intoxicated.

The two campaigns have fought back and forth over just how much of a problem there is with impaired doctors.

Regardless, Proposition 46 author Pack says, not enough is being done.

"The medical board has no authority and no mandate to be able to find out who these guys are, and weed them out or get them help," he says.

But the focus groups revealing voter support for the idea of doctor drug testing were convincing. That has opponents calling the provision nothing more than a political gimmick.

"The only reason that was added to the proposition is because it polled well with voters," says Thorp. "They're just hiding the fact that they're trying to increase the cap on noneconomic damages so that the payouts to trial attorneys can increase."

Doctors and insurance companies have amassed $57 million to fight Proposition 46, making this the most expensive campaign of the fall election. They're outspending lawyers 10 to 1 on ads aimed at swaying voters toward a "no" vote. None of them even mentions doctor drug testing.

Early polls showed strong support for the measure — 58 percent. But that support had dropped to 34 percent support in mid-September. Twenty-nine percent of voters said they hadn't yet decided.

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

Copyright 2014 KQED Public Media. To see more, visit http://www.kqed.org.
Categories: NPR Blogs

Nurses Want To Know How Safe Is Safe Enough With Ebola

Tue, 10/14/2014 - 4:22pm
Nurses Want To Know How Safe Is Safe Enough With Ebola October 14, 2014 4:22 PM ET

Nurses were worried about Ebola long before nurse Nina Pham became the first person to become infected with the deadly virus in the United States.Now they're worried and mad. And they've got lots of questions about how to care for future Ebola patients safely.

Pham, 26, was part of the team caring for Ebola patient Thomas Eric Duncan at a Dallas hospital until he died last Wednesday. She was diagnosed with Ebola on Sunday, and is reported to be in stable condition at Texas Health Presbyterian Hospital hospital.

Her case is especially troubling because as far as anyone can tell she was following the hospital's infection control procedures, which included wearing a gown, mask, face shield and gloves when working with the patient. The hospital and the Centers for Disease Control and Prevention are investigating whether invasive procedures used on Duncan, including intubation and kidney dialysis, could have increased the risk of infection.

We called Diana Mason, a professor of nursing at Hunter College and president of the American Academy of Nursing, to talk about what needs to be done to make hospitals safe for patients and staff when dealing with Ebola. This is an edited version of our chat.

Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said on Sunday that a "breach in protocol" led to Pham becoming infected with Ebola. It sounds like that didn't go over very well with nurses.

There's a lot of outrage about Frieden's comments. It's blame the nurse again.

But the CDC now says they're trying to figure out what happened, and to make sure lessons leaned in Dallas are communicated with hospitals nationwide. Where are the weak points in the system?

If I'm working with most patients with isolation in the United States, there's a separate room where I gown and degown. But that's probably not sufficient with Ebola. You don't want to gown and degown in the same place.

U.S. Hospitals Redouble Efforts To Prep For Ebola

If you look at the hazmat suits that Emory used, that's not what most nurses in the United States are going to have. So it's really important that when I gown up that I have someone watching me to make sure I'm doing it correctly, and the same thing when I take all this equipment off.

That's why I think the CDC is thinking of regionalizing the care of Ebola, because most hospitals don't have that capacity, to have that kind of space for suiting up properly and degowning properly.

What about staffing? Many nurses work a 12-hour day.

If I've been working 12 hours and I'm going into my 13th hour, the likelihood that I'll have a lapse is huge. That's human nature.

You won't want an exhausted worker caring for Ebola. You just do not. We need to make sure that hospitals are putting in place the best practices with staffing as well as with infection control.

Nina Pham sounds very dedicated to her patients. Do you think she knew what she was getting in for?

Well, I went into nursing when I was 18. I really didn't think about the hazards. And even then, nurses are committed to caring for people. Sometimes that means you are exposed to things that other people wouldn't even want to witness. It's just what you do.

Someone asked a nurse, what do you make? I make sure your seriously ill father is cared for. I make sure that when you're incontinent you're cared for.

It's this everyday, profound yet intimate work that people do. People don't understand it. It requires incredible cognitive and emotional intellect to do it. You are with someone at the most difficult and challenging and joyous moments of their lives.

If your hospital's not prepared for Ebola, the nurses will know it. You want to pay attention to what they're saying. But I'll tell you that many nurses who speak up end up being given a really hard time in some institutions.

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

Can Changing How You Sound Help You Find Your Voice?

Tue, 10/14/2014 - 2:05pm
Can Changing How You Sound Help You Find Your Voice? October 14, 2014 2:05 PM ET Listen to the Story 7 min 46 sec   Katherine Streeter for NPR

Just having a feminine voice means you're probably not as capable at your job.

At least, studies suggest, that's what many people in the United States think. There's a gender bias in how Americans perceive feminine voices: as insecure, less competent and less trustworthy.

This can be a problem — especially for women jockeying for power in male-dominated fields, like law.

“ I want to be taken more seriously, from the first words out of my mouth to the last.

Monica Hanna, a tough litigator in New York City, is about 5 feet tall and has a high voice. She has always had misgivings about how she sounds, but things came to a head a few years ago, when one of the partners at her firm assessed a presentation she gave by telling her: "Your voice is very high."

"And then he didn't say anything else," says Hanna. "He didn't have any other comment to make about my presentation at all."

Many people would have been humiliated — or furious. But Hanna doesn't have that type of personality. She's action-oriented. So, when her high voice came up again in an evaluation about a year ago, she decided to try to change this thing about herself that most of us think of as unchangeable.

Additional Information: Explore This NPR Series The Changing Lives Of Women

"I came back to my desk," Hanna says, "and I Googled 'problems with a very high voice' and 'how to change a high voice.' "

First she looked into surgery to lower her pitch. The likelihood of getting the change she wanted from something that extreme wasn't great, she learned, but there's more to sounding feminine than pitch alone. Speech patterns and intonation, it turns out, play a huge part, too.

Men often speak in more of monotone, with a percussive, staccato rhythm, explains Annette Masson, a voice coach at the University of Michigan who works with actors, singers and sometimes other professionals, like Hanna. Feminine speech patterns — more musical, with more pitch variation — reflect the different way women connect with other people, she says.

Women tend to be more collaborative communicators than men, Masson says. We say "we" more than we say "I." Even voice patterns that women are criticized for — like uptalk (going up in pitch at the end of every sentence? like you're asking a question?) — demonstrate a collaborative style of conversation.

According to Masson, uptalk asks the listener, "Are you still with me? Are you paying attention here?" It's a way to check in and keep the listener engaged.

But the pattern can come across as a request for permission to speak — evidence of insecurity. Hanna wanted and needed to command attention in the courtroom. To learn how, she decided to work with a speech-language pathologist, Christie Block.

Block is one of very few voice therapists who specialize in working with transgender people.

Some of Block's clients are transitioning to life as men; others are starting to live as women. But all of them share a common goal — they're trying to change deeply ingrained vocal patterns. Block helps each client find a voice that matches his or her physical appearance and personality.

To work with Hanna, Block borrowed some of the same techniques she uses to work with transgender men to help them have more presence and sound more assertive.

Hanna learned to open her throat, creating more oral resonance, to adopt what she now calls her "big voice." Block says she also taught Monica to use fewer words and be more direct.

Instead of asking, "Got a minute?" when she wants to talk to a colleague, she now declares, "One minute." She carefully enunciates, "Hello," instead of chirping, "Hi!" like she used to.

After months of practice, the difference between Hanna's "big voice" and her small one is subtle. But she says she is perceived differently now at work.

She likes feeling more confident, she says. "And also having the voice to carry that message across, and say, 'No, no, this is something you actually need to hear.' "

When Christie Block works with transgender women, on the other hand, the feminine speech patterns that Hanna worked so hard to undo are carefully taught, one by one.

“ I think if you talk to transwomen, voice is psychologically far more important to their sense of acceptance than everything else that everyone else obsesses with.

First, the women learn to hit a target pitch — G, third octave. They hum at that pitch, then count at that pitch, and then try saying actual sentences, with rising and falling intonation, all hovering around that pitch.

Then they learn to stretch out their vowels, to slow down — discarding the quicker, more monotone, staccato speech many men use. The mechanics alone can take months to learn. The whole process usually takes years.

Tina White, a director of information management at Pfizer, worked with Christie Block a few years ago.

"It is a very intensive, introspective process to go through," says White. "On TV we like to talk about transwomen dressing up, changing their bodies, and everyone's all titillated by all those sexual parts. I think if you talk to transwomen, voice is psychologically far more important to their sense of acceptance than everything else that everyone else obsesses with."

Around the Nation 'I'm Not The Only One': Transgender Youth Battle The Odds Shots - Health News Why Saying Is Believing — The Science Of Self-Talk

That's because no matter how feminine you look physically, if a male-sounding voice comes out of your mouth, people will probably raise their eyebrows — or worse.

Transgender women are more likely than other LGBT people to be victims of violent hate crime. They're most vulnerable when they stand out, so finding a voice that matches their physical presentation, and helps them blend in, can be a matter of life and death.

"When being able to use a restroom, not being laughed at, at work, not getting beat up on the train on the way home, are dependent on your voice, you are terrified," says White.

Violence from the outside world isn't the only danger. Transgender women experience much higher rates of depression and suicide than the general population. White sees this in her own community. "I've known one [woman] in particular who has been hospitalized three times for trying to commit suicide, and voice is not a small part of that."

White did voice work for about nine months before she finally felt confident enough to try out her new voice at the office. But then came a new fear: that she wouldn't be taken as seriously as a woman.

"I think that I used to enjoy white male privilege," she says. "And so I could be kind of sloppy." Just standing in front of a room and talking back then was usually enough to feel listened to.

Now, White explains, "I find that I have to think a little bit more and be a little bit more prepared and precise."

So there can be some trade-offs to finding a voice that really expresses who you are — trade-offs that both Tina White and Monica Hanna are willing to put up with.

Hanna says that initially some people close to her didn't approve of the changes she was making in her voice; some called the changes anti-feminist. But for Hanna, the goal was not to work against her identity as a woman, but to find a way to make her voice less distracting.

"I want to be taken more seriously," she says, "from the first words out of my mouth to the last. I'm never going to be a baritone powerhouse. There's something to be said about doing something to improve yourself in a way that adds to your craft and adds to your credibility."

White, meanwhile, can now give voice to the internal — and very feminine — monologue that she spent her life censoring, certain she would be ridiculed.

"I'm finally happy," White says, "because [this voice] lets me express the feelings that I have inside, that I was always keeping bottled up."

That's the goal of all this hard work: for women like White and Hanna to find their voices, so the world can stop focusing on how they sound and pay attention to what they're saying.

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

Health Premiums And Costs Set To Rise For Workers Covered At Work

Tue, 10/14/2014 - 10:28am
Health Premiums And Costs Set To Rise For Workers Covered At Work October 14, 201410:28 AM ET

fromKHN

Fall is enrollment season for many people who get insurance through their workplace. Premium increases for 2015 plans are expected to be modest on average, but the shift toward higher out-of-pocket costs overall for consumers will continue as employers try to keep a lid on their costs and incorporate health law changes.

Recent surveys of employers suggest that premiums will rise a modest 4 percent in 2015, on average, slightly higher than last year but lower than typical recent increases.

"That's really low," says Tracy Watts, a senior partner at benefits consultant Mercer.

Even so, more employers say they're making changes to their health plans in 2015 to rein in cost growth; 68 percent said they plan to do so in 2015, compared with 55 percent just two years earlier, according to preliminary data from Mercer's annual employer benefits survey.

They are motivated in part by upcoming changes mandated by the health law. Starting in January, companies that employ 100 workers or more generally have to offer those who work at least 30 hours a week health insurance or face penalties.

"The more people you cover, the more it's going to cost," says Watts.

In addition, consultants who monitor benefits say, employers are moving to avoid a 40 percent excise tax on expensive health plans — those with premiums that exceed $10,200 for individuals or $27,500 for families — that will take effect in 2018.

More employees can expect to be offered high-deductible health plans linked to health savings accounts or health reimbursement arrangements in 2015. Nearly three-quarters of companies with more than 1,000 workers offer such plans, according to the 2014 Towers Watson/National Business Group on Health employer health care survey. Nine percent said they planned to add them in 2015.

For a growing number of employees, those plans may be the only ones available through work. For 2015, 30 percent of large employers said they expected to offer only an account-based plan to workers, nearly double the percentage that did so in 2014, the Towers Watson/NBGH survey found.

When employers shift toward plans with higher deductibles, they often try to sweeten the deal for employees by offering to put money into the financial accounts to help defray the workers' increased cost, says Brian Marcotte, president and CEO of the National Business Group on Health. The extra cash — an average $600 per employee — is often tied to wellness activities such as agreeing to get health screenings, says Marcotte. As employees evaluate their health plan offerings this fall, it's worth checking to see if such incentives are offered.

Also this year, workers may find it increasingly expensive to cover their spouses, especially if they have coverage available through their own jobs.

Employers have been increasing workers' costs to cover dependents, including spouses, in recent years. Nearly half of employers say they've hiked employee contributions for dependent coverage, and another 19 percent plan to do so in 2015, according to the Towers Watson/NBGH survey. Upcoming increases are particularly aimed at spouses, including $50 to $100 monthly surcharges for spousal coverage, says Sandy Ageloff, a senior consultant at benefits consultant Towers Watson.

"Legally under the Affordable Care Act, plans can't exclude coverage for kids," says Ageloff. "But they're really trying to shift the onus back onto spouses."

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation, a nonprofit organization based in Menlo Park, Calif.

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

A Polar Bear Might Keep The Measles Away, But Shots Work Better

Mon, 10/13/2014 - 10:03am
A Polar Bear Might Keep The Measles Away, But Shots Work Better October 13, 201410:03 AM ET

The heroines of a best-selling book series have been enlisted in the global effort to eradicate measles.

Sophie Blackall

In the bestselling Ivy and Bean books, 7-year-old Bean puts a lot of energy into avoiding chores and reading. So when her friend Ivy brings up measles shots, Bean is ready with alternatives:

  • Wear a hazmat suit for the rest of your life.
  • Make an anti-measles force field with 24 hula hoops.
  • Cover yourself in a 6-inch protective layer of lard.

The inventive duo will soon be appearing on posters in pediatricians' offices as part of an effort by the American Academy of Pediatrics and international public health organizations to get children vaccinated.

Measles cases spiked in the United States this year, with 594 cases and 18 outbreaks, the highest number since 2000. They were caused by people traveling to the U.S. and infecting people who hadn't had measles shots.

Sophie Blackall

Measles worries public health officials. It's much more contagious than Ebola virus and kills about 120,000 people each year worldwide.

Sophie Blackall, the illustrator for the Ivy and Bean books, has traveled to Congo and India to design posters for the Measles and Rubella Initiative, a consortium that includes the Centers for Disease Control and Prevention, the Red Cross, the World Health Organization, The UN Foundation and UNICEF. So she was a natural for this new domestic effort.

"I've long wanted to join these two worlds, the work I've done for measles and my main life, which is in the children's book world," Blackall, an Australian who lives in Brooklyn, N.Y., told Shots. So she asked her publisher, Chronicle Books, if Ivy and Bean could enlist. She got an enthusiastic yes.

"Bean is thinking of every possible way of avoiding a shot; who wants a needle?" Blackall says. "Surely there are ways to avoid it."

Bean's notions would indeed protect against the measles but would be difficult to sustain, whether they involve moving to the moon or being adopted by a polar bear.

In the end, the girls agree that getting a measles shot would be a simpler, easier form of protection. "And sometimes you get a lollipop," Blackall says. "So it's a win-win."

Of course, children usually don't have a lot of say over whether they're getting shots. "We wanted to give doctors something that would speak to the kids, something funny and eye-catching that they can put up in the waiting room and that families can discuss," Blackall says. "It sometimes gets lost in the whole noise about children's health, but it's so important."

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

A Benefit For Rural Vets: Getting Health Care Close To Home

Mon, 10/13/2014 - 3:21am
A Benefit For Rural Vets: Getting Health Care Close To Home October 13, 2014 3:21 AM ET Listen to the Story 5 min 4 sec  

For some rural vets who live far from a VA hospital, getting medical care has meant driving a day or two from home, and missing work.

iStockphoto

Army veteran Randy Michaud had to make a 200-mile trip to the Veterans Affairs hospital in Aroostook County, Maine, near the Canadian border, every time he had a medical appointment.

Michaud, who was medically retired after a jeep accident in Germany 25 years ago, moved home to Maine in 1991. He was eligible for VA medical care, but the long drive was a problem.

He's one of millions of veterans living in rural America who must travel hundreds of miles round-trip for care.

"If I get an appointment in the winter, I'll cancel that sucker and I'll live with the pain until spring time," he says.

Even in the summer, the trip for Michaud — and other vets like him — meant a day, or sometimes two, of missed work, with a night in a motel, plus the cost of gas. The VA reimburses those costs, but this is not a rich area, and people don't always have the cash upfront.

Michaud says the worst part is an empty, 100-mile strip of Interstate 95 north of Bangor.

"Especially in the winter time," he says. "That 95 is treacherous, and it's not necessarily always cleared and stuff like that. I've wrecked a couple times on that road. It's just cold, and a lot of these are older veterans; they can't make that trip down there."

“ When they came knocking on my door and said, 'Jim, you got to go to war,' I was there. I went, no questions asked. Now it's your turn. It's your turn to take care of me.

To make it easier for vets to get care, the VA started a program called Access Received Closer to Home, or ARCH. A trial program began three years ago in five states.

This summer, Congress extended the program for two years, as part of a law aimed at reforming the VA. It will allow veterans to use private doctors if they live far from a VA hospital or can't get a VA appointment within 30 days.

It means Michaud can make appointments only 10 miles up the road, at the 65-bed Cary Medical Center in the town of Caribou. Kris Doody, a registered nurse, and the center's CEO, says getting care near home and family is healthier for vets, and helps them avoid that 400-mile round trip.

"We actually keep track for the VA the number of patients who are seen every month and what their distance would have been. And the savings — and that's just savings in mileage — was $600,000," Doody says.

The ARCH program is just one part of a plan to use private health care to reach more vets. Private care already accounts for about $5 billion in VA health care spending a year.

Shots - Health News Can Civilian Health Care Help Fix The VA? Congress Weighs In

Accounting for those funds has been a challenge: The VA inspector general has issued seven reports in recent years documenting errors in payments to private health care providers —errors that wasted about $1 billion.

The Two-Way House Approves $16 Billion Plan To Improve Health Care For Vets

The new VA reform law creates another $10 billion private care initiative. This one will allow a veteran to walk into almost any clinic and bill the VA by using a voucher.

The voucher system will be the VA's most complicated private care program yet, says Roscoe Butler, deputy director for health care at the American Legion, and retired director of the VA medical center in Minneapolis.

"It's going to be critical to make sure that the services they're paying for [are] actually the services provided," Butler says. "It requires that the VA pay the provider within 30 days ... There are a lot of moving pieces to be coordinated back through the VA."

Vets like Jimmy Grenier, who served in Vietnam, don't much care how the VA handles the accounting. They just like getting care closer to home.

"I got PTSD, if you know what that is," Grenier says. "I got it really bad." It doesn't take much to set him off, he says, adding that for him, the ARCH program is "the best thing that ... ever could have happened up here."

Grenier, 67, did three combat tours, and had a series of minor strokes three years ago. Before the new program, he had to drive 440 miles round trip to see a doctor. He'll never do that again, he says.

"Why should I have to?" says Grenier. "When they came knocking on my door and said, 'Jim, you got to go to war,' I was there. I went, no questions asked. Now it's your turn. It's your turn to take care of me."

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

In Hopes Of Fixing Faulty Genes, One Scientist Starts With The Basics

Mon, 10/13/2014 - 3:20am
In Hopes Of Fixing Faulty Genes, One Scientist Starts With The Basics October 13, 2014 3:20 AM ET Listen to the Story 8 min 27 sec  

Jennifer Doudna and her colleagues found an enzyme in bacteria that makes editing DNA in animal cells much easier.

Cailey Cotner/UC Berkeley

Whether they admit it or not, many (if not most) scientists secretly hope to get a call in October informing them they've won a Nobel Prize.

But I've talked to a lot of Nobel laureates, and they are unanimous on one point: None of them pursued a research topic with the intention of winning the prize.

That's certainly true for Jennifer Doudna. She hasn't won a Nobel Prize, but many are whispering that she's in line to win one for her work on something called CRISPR/Cas9 — a tool for editing genes.

“ I thought, wow, if this could work in animal or plant cells, this could be a very, very useful and very powerful tool.

The idea came when she and her colleagues at the University of California, Berkeley were in essence trying to figure out how bacteria fight the flu. The goal was really more of a basic science question, Doudna says.

It turns out bacteria don't like getting the flu any more than the rest of us do. Bacteria have special enzymes that can cut open the DNA of an invading virus and make a change in the DNA at the site of the cut — essentially killing the virus.

As Doudna was studying a group of these enzymes, she realized something. The enzymes had what amounted to a short template inside that could attach to a specific string of letters in the viral DNA. What if she could modify the template so that it could recognize any DNA sequence, not just the sequences in viruses?

"I thought, wow, if this could work in animal or plant cells, this could be a very, very useful and very powerful tool," she says.

What's more, with CRISPR/Cas9, you not only can recognize a viral sequence — you can modify it, too. "You can take it out, or you can change it, or you can add to it," says Doudna.

That's incredibly valuable, because it's been a frustrating time for biomedical researchers. The Human Genome Project gave them what amounts to the genetic book of life. The question is, what do you do with that information?

"You've got the book," says Doudna. "And you can see there's a word that's incorrect on page 147, but how do I get there and erase that word and fix it?"

Shots - Health News A CRISPR Way To Fix Faulty Genes

Until now, the tools for fixing or replacing a gene in animals were cumbersome, if they worked at all. CRISPR/Cas9 changes that by allowing scientists to work inside cells, making changes in specific genes far faster — and for far less money — than ever before.

Shots - Health News Chemists Expand Nature's Genetic Alphabet

The implications for medicine could be enormous. Let's say two people who are each carriers of the cystic fibrosis gene want to have children but don't want to risk having a child with the disease. Doctors already can use IVF to create an embryo; one day they might also be able to use CRISPR/Cas9 to then fix the damaged gene.

It's also possible to imagine treating blood disorders, like sickle cell anemia, that are caused by a single gene.

"You can envision removing blood cells from a patient, doing the editing and putting those cells back into the patient," Doudna says.

In addition to the positive uses of CRISPR/Cas9, Doudna acknowledges there is a dark side. Genetically modifying human beings brings to mind images of Frankenstein monsters. And the technique could be used for trivial or even harmful uses.

"Once the discovery is made, it's out there," says Doudna. "Anybody with basic molecular biology training can use it for genome editing. That's a bit scary."

Her work with CRISPR/Cas9 comes at an interesting time for Doudna. Yes, she's had a successful career in research, but, as the years wore on, she'd started to have a nagging worry that her science wasn't solving any societal problem, wasn't making people's lives better.

Now, with this new tool, she thinks there's good likelihood that it will.

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

Slippery When Coated: Helping Medical Devices Prevent Blood Clots

Sun, 10/12/2014 - 1:03pm
Slippery When Coated: Helping Medical Devices Prevent Blood Clots October 12, 2014 1:03 PM ET

The slide on the right has been treated with a coating that repels blood.

Wyss Institute via Vimeo

A carnivorous plant has inspired an invention that may turn out to be a medical lifesaver.

Nepenthes, also known as tropical pitcher plants or monkey cups, produce a superslippery surface that causes unfortunate insects that climb into the plant to slide to their doom.

Scientists at Harvard's Wyss Institute for Biologically Inspired Engineering wondered if they could find a way to mimic that surface to solve a problem in medicine.

The medical problem is blood clots. Whenever blood flows over an artificial surface, whether it's an implanted pacemaker or the tubing that blood flows through on the way to a dialysis machine, there's an increased risk that a dangerous clot will form.

To prevent this, doctors often turn to blood thinning medicines such as Coumadin. But these medicines can also cause their own problems, such as brain bleeds.

The Harvard scientists wondered if they could find a coating that would have the same properties as the nepenthe's slippery surface; something that could be applied to tubing or devices that come in contact with blood.

As they report in the journal Nature Biotechnology, they tested man-made materials known as perfluorocarbons, searching for one that would have the same characteristics as the nepenthe's coating. As luck would have it, they found one called perfluorodecalin which was already being used in medical applications.

Blood on a non-coated surface and blood on a perfluorocarbon-coated surface.

Credit: Wyss Institute at Harvard University

The researchers tested the coating in pigs. They diverted blood coming from a pig's heart through a loop of tubing before returning it the pig's blood supply. They compared tubes with the new coating, and without. Blood flow through the coated tubes remained virtually constant over the 8 hours of the experiment, whereas clots formed in tubing without the coating, substantially slowing blood flow with time.

The Harvard group isn't the only one tackling the clotting problem. The Sorin Group and Medtronic are also testing coatings that keep blood from clotting. Donald Ingber, founding director of the Wyss Institute and senior author on the Nature Biotechnology paper says he is looking for an investor or partner to further develop the substance.

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

Frozen Poop Pills Fight Life-Threatening Infections

Sat, 10/11/2014 - 3:03pm
Frozen Poop Pills Fight Life-Threatening Infections October 11, 2014 3:03 PM ET

Fecal transplant pills help patients avoid invasive procedures while restoring healthy gut bacteria.

Courtesy of the Hohmann Lab

Fecal transplants can be life-saving for people with stubborn bacterial infections, but they're not for the faint of heart. So doctors have come up with a way to make them more palatable: the frozen poop pill.

People infected with Clostridium difficile suffer debilitating diarrhea, but the bug often defies antibiotics. Doctors have recently discovered that a fecal transplant will restore good gut bacteria that banishes the C. diff. But the procedure is awkward, requiring a donation of fresh feces, usually from a relative, and a colonoscopy to deliver it.

Researchers at Massachusetts General Hospital figured they could improve on that. First they tried delivering the fecal transplant through a tube snaked down the nose and into the stomach. It delivered the healthy bugs but wasn't much fun.

Shots - Health News Microbe Transplants Treat Some Diseases That Drugs Can't Fix

"Just getting the tube down is a problem," Dr. Elizabeth Hohmann, a staff physician in infectious diseases at Mass General, told Shots. And the doctors worried that if people gagged and vomited, they could inhale fecal matter. "That's pretty scary."

Enter the poop pill.

A pill wouldn't require invasive procedures, the researchers speculated, and would be less likely to cause vomiting. And if they froze the pills, donors wouldn't need to be standing by.

To test that hypothesis, the researchers got donations from young, healthy volunteers screened to make sure they didn't have HIV, hepatitis or other infectious diseases. They froze the material and waited four weeks to test the donors again. Once the donors got a clean bill of health, pill production began.

By now you're probably wondering what a poop pill looks like.

"When I first started doing this, I had in my mind that it would be a little red-and-white banded capsule, like a Tylenol capsule," Hohmann says. "That was my dream." But alas, the capsules had to be acid-resistant so they could make their way past the stomach into the large intestine, where the good microbes work their magic.

And acid-resistant capsules only come in translucent. "So they are sort of brownish-colored capsules," Hohmann says. "Fortunately, because they're frozen, when you take them out of the freezer they sort of frost up a bit and they're not too gross."

Shots - Health News FDA Backs Off On Regulation Of Fecal Transplants

Twenty people with recurrent C. diff infections took 15 pills a day, about the size of a large multivitamin, for two days. Fourteen of them were free of diarrhea almost immediately, with no recurrences. The other six tried the treatment again; that did the trick for four of them. The two people who failed to get results were in poorer health overall, the study found. But the treatment worked for people from age 11 to age 89.

The Mass General group has since treated another 21 people with the pills, with similar success. The results were announced Saturday at the IDWeek meeting in Philadelphia and published in JAMA, the Journal of the American Medical Association.

"We're really jazzed that a journal of this stature has picked this up," Hohmann says. "I've been a microbiology researcher for 25 years, and this is the biggest thing we've done."

Has she been published in JAMA before? "Oh no, no, never."

Despite the impressive results, poop pills may turn out to be not the silver bullet they seem today. Though the treatment appears safe and effective, "there's always the possibility that unknown infectious agents could be transmitted this way," Hohmann says. "We screen these people to be as healthy as we can determine in 2014, but who knows?"

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