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Poets Give Voice To The Toll Of Type 2 Diabetes

Sat, 09/13/2014 - 10:34am
Poets Give Voice To The Toll Of Type 2 Diabetes September 13, 201410:34 AM ET

Young poets Monica Mendoza (clockwise from top left), Erica Sheppard McMath, Obasi Davis and Gabriel Cortez have written about how Type 2 diabetes affects their families and communities.

Courtesy of The Bigger Picture

It may not seem like spoken-word poetry and diabetes have a lot to do with one another, but public health educators in California are using the art form to engage young people about the disease.

"Between growing up in Colón, Panama and a tour in the U.S. army, Grandpa is a proud old soldier marching through a never-ending war," Gabriel Cortez, 24, wrote in his poem "Perfect Soldiers." "At 66, we are scared that another stroke could do what no war ever could and cut him to the ground."

Two of Cortez's grandparents have diabetes. "Half of our neighborhood [looks] like the emergency ward of a hospital," he wrote.

"If you look at our community, you see it, but to have it named, I think, is an important thing," he tells Shots. Writing poetry is "another way of opening up the conversation."

Cortez wrote his poem last year during a workshop run by The Bigger Picture, a project that brings together University of California, San Francisco's Center for Vulnerable Populations and the literary nonprofit Youth Speaks. The goal is to encourage them to talk about diabetes and the risks it poses to the health of young people.

About 95 percent of the 29 million Americans with diabetes have the Type 2 variety, and the number of young adults and children with it is rapidly increasing. The problem is acute in poor, urban neighborhoods and in communities of color. Half of African-American youths and a third of Latino youths born in 2000 are expected to develop Type 2 diabetes at some point in their lives.

Back in 2011, Dr. Dean Schillinger heard Erica Sheppard McMath's poem, "Death Recipe" at a Youth Speaks event. The poem recounts the struggle of McMath, now 22, to stay healthy while much of her family struggles with obesity and diabetes:

It's like knowing most of your family has diabetes

but your still smacking on sour patches

as you're walking your aunt to her dialysis appointment

It's like Auntie Marlow being blind at 32

It's like Grandma Susie dying from a heart attack at 51

It's like cousin Kieara shooting insulin in her nine year old arm

"Young people can be such vocal and articulate revolutionaries in ways that old-fart doctors can't be," Schillinger says. He started the partnership between UCSF and Youth Speaks because he thought poetry could be a way to spark more conversations with young people about Type 2 diabetes.

The collaboration aims to shift the focus of the diabetes epidemic away from people's personal decisions. Schillinger says that Type 2 diabetes needs to be talked about in terms of a social disease.

The Bigger Picture holds workshops for teens and young adults to teach them about diabetes and to help them translate their reactions to the information into poetry.

Some of the best poems have been turned into short films that the organizers see as public service announcements. They've made about 20 so far, ranging from personal stories like McMath's to an over-the-top commercial satire called "Block O' Breakfast."

The Bigger Picture also takes its show on the road, conducting high school assemblies. So far, the team has worked with 40 poets and about 2,500 students in Northern California.

Twenty-nine-year-old José Vadi, who participated in the first Bigger Picture workshop and later facilitated them, now helps direct the project at Youth Speaks. He says that Type 2 diabetes is as much about class and access as it is health and diet.

"If you're traditionally disadvantaged economically, and you don't have the time to prepare a meal with fresh ingredients and whatnot, the idea of ... just putting something in your body to not be hungry, speaks to larger issues of inequality," Vadi says.

The Bigger Picture community also looks at the role food and beverage industries' marketing to minorities has played in the rise of diabetes. In the poem "A Taste of Home," 21-year-old Monica Mendoza says that "dinner has become an expedition where we lick our plates clean and swallow cups of nostalgia — nostalgia that isn't even from our own country. Our tongues have been colonized with the belief that this cup of Coke is home."

Cortez says he hopes the Bigger Picture poems will inspire youth anywhere in the country to write down their own experiences in a poem or a song, or to talk to their parents and friends "in a way they hadn't been able to before."

Lydia Zuraw is Washington, D.C., correspondent for the website Food Safety News.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Opponents Spar In Court Over Texas Clinics That Do Abortions

Fri, 09/12/2014 - 5:47pm
Opponents Spar In Court Over Texas Clinics That Do Abortions September 12, 2014 5:47 PM ET

from

Listen to the Story 2 min 24 sec  

Abortion-rights advocates filled the rotunda of the state capitol in July 2013 as Texas senators debated sweeping abortion restrictions. Some of those restrictions are now under federal review.

Tamir Kalifa/AP

A federal appeals court in New Orleans is reviewing whether 11 clinics that provide abortion in Texas must immediately close their doors because they don't comply with a state law requiring that they meet all the standards of an outpatient surgical center.

Shots - Health News Federal Judge Blocks Texas Restriction On Abortion Clinics Shots - Health News A Doctor Who Performed Abortions In South Texas Makes His Case

A three-judge panel heard arguments Friday for more than 90 minutes, first from the Texas solicitor general and then from a lawyer with the Center for Reproductive Rights, which is representing many of the Texas clinics. The questions from the judges centered mainly on what constitutes an "undue burden" when a woman is trying to get an abortion, and what fraction of Texas women would be affected.

Advocates say that about 20 clinics that perform abortions in Texas have already closed in advance of the law; if the court rules in Texas' favor, fewer than 10 clinics that provide abortion would remain in a state with a population of 26 million.

Both sides agreed that if the law is upheld, women in the Rio Grande Valley would have to travel more than 200 miles to San Antonio to get an abortion. But Jonathan Mitchell, the Texas solicitor general, said there was no good evidence that women weren't figuring out how to deal with that, and no evidence that if the abortion rate in Texas had fallen, that it was related to the law.

"An abortion law cannot be enjoined based on conjecture," Mitchell said. Judge Jennifer Elrod questioned him about a clinic's survey of 20 patients, presented at the trial in August. An expert testifying for the clinics said one patient surveyed said she did not get an abortion after the Texas law went into effect.

"He did not report she was unable to get it; he did not report she encountered an undue burden," Mitchell answered. "She could simply have changed her mind."

Supporters and opponents of Texas's controversial abortion law gathered Friday afternoon outside the 5th Circuit Court of Appeals in downtown New Orleans. Emily Horne (left) is a legislative associate with Texas Right to Life, a group that lobbied for the law.

Carrie Feibel/KUHF

Furthermore, patients in El Paso (where another clinic might close because it doesn't meet the standards of an outpatient surgical center) could just travel to New Mexico for an abortion, Mitchell added.

Stephanie Toti, with the Center for Reproductive Rights, argued on behalf of affected clinics such as Whole Woman's Health. She says lots of evidence was presented at the trial that women were facing numerous burdens exercising their constitutional right to an abortion. For example, a San Antonio clinic had offered gas cards and free bus tickets to women in the Rio Grande Valley who were seeking abortions, to help them travel north. But the patients told the clinic it wasn't just the distance and lack of money that made such travel difficult, but also problems with child care, getting time off work, and explaining to family why they needed to travel so far away.

Toti said a health outreach worker testified at the trial that women were experiencing obstacles to getting the procedure legally after clinics closed in the Rio Grande Valley. "She says she personally observed women turning to illegal means to get an abortion," Toti told the judges.

In a rebuttal, Mitchell called that testimony "vague," and said the worker couldn't give specific numbers of women doing that, and couldn't provide evidence that those choices stemmed from restrictions in the Texas law.

The three judges did not indicate when they would render their decision; but if they rule in favor of the state of Texas, the clinics would probably close immediately. The judges could also decide that some of the most isolated clinics could remain open, while others must close.

Federal district Judge Lee Yeakel ruled in August that the surgery center regulation had no health benefit and would place numerous burdens on any woman seeking an abortion, especially if she lived in the Rio Grande Valley or West Texas. Yeakel allowed the noncomplying clinics to remain open, but the state asked for an emergency motion to overrule Yeakel's decision and close them.

Sandy Jones (from left) of Houston, with Amelie Hahn and Michelle Colon, of Mississippi. Hahn and Colon are with Pink House Defenders, a group fighting for the last remaining abortion clinic in Mississippi.

Carrie Feibel/KHUF

Mitchell told the panel the state of Texas has a compelling interest in closing any clinics that it deems unsafe, and that's why the state sought an emergency motion to stay Yeakel's decision.

"If there is a Kermit Gosnell-type clinic in a state, and that's the last clinic in the state, I think everyone could agree that clinic could be shut down," Mitchell said, referring to a notorious doctor who performed abortions and was convicted of murder in Philadelphia last year.

Outside the courtroom, protesters carried signs.

Bethany Van Kampen, a recent law school graduate and board member of the New Orleans Abortion Fund, attended the hearing. She said it seemed that the judges were asking very hard questions of Toti.

"It's a bit discouraging," she said. "It felt very targeted. I felt our line of questioning was harder and more difficult and I think we tried to do our best."

Sandy Jones, an activist with Stop Patriarchy, traveled from Houston to attend. She said it seemed the judges had too narrow a focus.

"These are forces that are determined to criminalize every abortion, every woman, and make it inaccessible to every woman," Jones said. "And birth control, as we know, is not far behind. This is a war on women. This is a state of emergency."

Abortion opponents had also traveled from Austin and Fort Worth to listen.

"It's hard to say how this will go," said Emily Horne, a legislative associate for Texas Right to Life.

She said there was a need for Texas to seek this emergency hearing to shut down the noncomplying clinics right away. "It is a direct safety measure for the health and safety of Texas women, so we think that sooner is better to implement that," Horne said.

She said it was exciting to be there, and important for all states, not just Texas.

"Texas is definitely setting some precedents as far as what states are being allowed to pass," Horne added, "so there is a lot that does hinge on this."

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

Health Costs Inch Up As Obamacare Kicks In

Fri, 09/12/2014 - 11:44am
Health Costs Inch Up As Obamacare Kicks In September 12, 201411:44 AM ET

Partner content from

Whoa!

iStockphoto

Doctors and hospitals treated more patients and collected more payments in the spring as millions gained insurance coverage under the health law, new figures from the government show.

But analysts called the second-quarter increases modest and said there is little evidence to suggest that wider coverage and a recovering economy are pushing health spending growth to the painful levels of a decade ago.

Thursday's results from the Census Bureau's survey of service industries join other recent cost indicators that "are quite a bit lower than what the folks at CMS were projecting," said Charles Roehrig, director of the Center for Sustainable Health Spending at the Altarum Institute, a nonprofit research and consulting outfit. "And they're lower than what we were expecting as well."

CMS is the Centers for Medicare & Medicaid Services, the government's main health care bookkeeper. Last week CMS projected that health-expenditure growth would accelerate to 5.6 percent this year from an estimated 3.6 percent in 2013.

But health and social spending as measured by the Census Bureau grew by only 3.7 percent from the second quarter of 2013 to the same quarter of 2014. Hospital revenue increased 4.9 percent during the same period. Revenue for physician offices barely budged, growing by only 0.6 percent. Medical lab revenue rose 1.9 percent.

The report is far from being the last word. It doesn't include spending on prescription drugs, which has been rising this year thanks to new very expensive medicines for hepatitis C.

And while the Census Bureau's year-over-year results for the second quarter show tame cost trends, the increase from the first quarter to the second was more substantial. Total health and social spending rose at an annual rate of more than 12 percent from first quarter to the next. If sustained, such acceleration would raise alarms and actuaries' blood pressure.

But some who follow costs closely don't think the pace will continue.

First, health spending suffered a mini-crash over the winter, as bad storms kept people away from caregivers. Hospitals and doctors billed less from January to March than they did last fall. Part of the second-quarter recovery may just have been catch-up, analysts said.

At the same time, many people covered through the health law's online marketplaces didn't sign up until close to the deadline at the end of March. Much of the spring increase may represent a one-time surge as those folks sought treatment for previously neglected conditions.

For those reasons, the year-over-year results for the second quarter may give a better indication of longer-term cost trends than the change from the first quarter to the second, Roehrig said.

Estimates vary, but no one disputes the idea that the Affordable Care Act's health insurance marketplaces and expansion of Medicaid for the poor have added millions of previously uninsured people to coverage rosters this year.

History and logic suggest that expanded coverage and an improving economy will boost long-term, national health expenditures from their average growth rate of 3.7 percent during the past five years. (That's spending by everybody — government programs, employer insurance, commercial plans and consumers paying out of pocket.)

But so far the speedup seems nowhere close to the near-double-digit rates in the early 2000s.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Changing Tack, GOP Candidates Support Over-The-Counter Birth Control

Fri, 09/12/2014 - 3:30am
Changing Tack, GOP Candidates Support Over-The-Counter Birth Control September 12, 2014 3:30 AM ET Listen to the Story 4 min 53 sec  

A string of Republican candidates for Senate are supporting an issue usually associated with Democrats: easier access to contraception.

They're supporting it on the road and in ads, like one from anti-abortion conservative Cory Gardner. In it, he says he believes "the pill ought to be available over the counter, round the clock, without a prescription." Tom Tillis and Ed Gillespie, also anti-abortion conservatives, have made similar statements.

YouTube

Some of them have been associated with state legislation to restrict abortions or with so-called personhood amendments that would give constitutional rights to fertilized eggs.

So what gives? First of all, Republicans are in a deep hole with female voters, and polls show all voters are less likely to support candidates who restrict women's reproductive rights. Republican strategist Katie Packer Gage says the GOP needed to get out of its defensive crouch.

She says when Republicans saw what happened to Mitt Romney in 2012, "where women's groups very falsely and very aggressively attacked him claiming that he wanted to do away with birth control," the party "started to say, 'Look, we're going to have to play offense on this message because otherwise we're going to be totally misdefined by our opponents.' "

Calling for an over-the-counter pill allows Republicans to support access to birth control while also supporting the right of corporations to avoid covering it. Getting the pill at a pharmacy without a prescription leaves insurers and employers out of the picture altogether.

But some Republicans are having trouble with their new talking points. Colorado Rep. Mike Coffman stumbled on the issue in a recent debate: "I am just pro-life, and I'm proud of that. And, uh, I do not support personhood. But, uh, I support a woman's access to, to, um, certainly to — this Hobby Lobby decision — to uh, to get ... "

YouTube

At that excruciating moment, Coffman is rescued by the audience, which feeds him the word he's been looking for: "birth control."

The exchange is followed by laughter, but Democrats do not find this the least bit funny.

"It really is quite ironic that suddenly now the Republican Party and candidates, after voting repeatedly to take away birth control access for women, are trying to kind of do this before the November elections," says Cecile Richards, president of Planned Parenthood Federation of America.

"It has no credibility based on their voting records. ... What it demonstrates is how important women's health is as an issue to women voters and how important it will be in this election," she says.

Planned Parenthood is also for over-the-counter birth control. But so far, no drug company has asked the FDA for permission to sell contraception over the counter.

Democratic pollster Celinda Lake says Democrats should respond to Republicans with an argument about cost and fairness because insurers generally do not cover over-the-counter medicine, and the pill can cost $600 a year.

"When voters hear that Republicans support your employer denying coverage for birth control when Viagra is still covered, they're very angry about it," she says. "When we make the argument, it really backfires because women say this is going to cost me $600 and this is a very cynical ploy."

But Republican pollster Kellyanne Conway says Republicans have finally found a way to blunt the Democrats' charge that the GOP is conducting a so-called "war on women."

"What's happened with the over-the-counter birth control issue is that the Democrats didn't see it coming," says Conway. "They think that they've got a monopoly on talking to women from the waist down. Anything that has to do with reproduction and birth control and abortion — they call it women's health, then they call it women's issues. They feel like how dare the loyal opposition go ahead and take them on and really neutralize and defang this issue."

There's no doubt Republicans are trying harder this election year to appeal to women, which is a big difference from the past two cycles when some GOP candidates alienated female voters with comments about rape and unwanted pregnancies. Republicans know they can't eliminate the gender gap altogether; they just hope to shrink it enough to win elections.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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A Doctor Who Performed Abortions In South Texas Makes His Case

Thu, 09/11/2014 - 5:35pm
A Doctor Who Performed Abortions In South Texas Makes His Case September 11, 2014 5:35 PM ET Listen to the Story 6 min 58 sec  
  • Hide caption Dr. Lester Minto has closed his Texas clinic, Reproductive Services of Harlingen, after 35 years. Previous Next Lisa Krantz/San Antonio Express-News/Zuma Press
  • Hide caption Though Reproductive Services of Harlingen has been shuttered for months, the surgery rooms seem frozen in time. Previous Next Maisie Crow
  • Hide caption Minto's shirt still hangs in the doorway of a former surgery room at the clinic. Minto continues to work as a physician — these days as a family care practitioner in the Rio Grande Valley. Previous Next Maisie Crow
  • Hide caption Jackets, once worn by staff members in the lab, hang unused. Previous Next Maisie Crow
  • Hide caption Boxes of tissue are stacked in what used to be the clinic's reception window. Previous Next Maisie Crow
  • Hide caption

    Signs used to be posted outside the clinic warning of venomous snakes. Minto says the signs were part of an effort to deter protesters from the clinic's front lawn.

    Previous Next Maisie Crow
  • Hide caption Minto still gets messages via the former clinic's phone number. Women still call for help. "I'll never lie to a patient," he says. "If they come to me and ask for information with regards to how they can handle their situations, I tell them the truth. However, I don't encourage them to do illegal things to obtain their medications." Previous Next Maisie Crow
  • Hide caption Artwork that once hung on the waiting room walls now sits in empty chairs. After he closed the clinic earlier this year, Minto and his staff packed up and sold much of the contents. Previous Next Maisie Crow

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In a Brownsville family clinic, a powerfully built, bald doctor treats a never-ending line of sick and injured patients. He has been practicing for nearly four decades, but family medicine is not his calling.

"For 35 years I had a clinic where I saw women and took care of their reproductive needs, but mostly terminating pregnancies," Dr. Lester Minto says.

He seems an unlikely doctor to perform abortions. The son of an Army officer, he grew up in a deeply religious family in rural Texas. His career path was shaped by an experience in medical school in the early '70s. A young woman whose uterus had been accidentally pierced by a backroom abortionist bled to death in front of him. After Roe v. Wade was decided, the young doctor devoted his career to helping poor and working-class women terminate their unwanted pregnancies in South Texas.

"Ninety-eight percent were Hispanics," Minto says. "I would go days where I wouldn't speak English because they were all Spanish speakers — which is great.

"Getting this level of care has always been available to rich women," Minto points out. "They can always go somewhere else — another state, another country. They can go to their gynecologist and get a 'menstrual extraction' or something that's not called an abortion. So they're OK."

Nearly half of Minto's patients were teenagers, and he averaged more than 4,000 abortions each year.

But Minto had to close his clinic after laws passed by the Texas Legislature in 2013 rendered his clinic obsolete. It doesn't meet all the standards of an ambulatory surgical center, with amenities like extra-wide hallways.

The other important restriction in the new Texas law (under review this week by a federal appeals court) requires all doctors who perform abortions to obtain admitting privileges at a nearby hospital. Both the American Congress of Obstetricians and Gynecologists and the American Medical Association say these two requirements are medically unnecessary. If one of Minto's patients were to have a medical crisis during an abortion, she would be rushed to the closest hospital emergency room. Doctor privileges aren't an issue in emergencies.

"I've been there 30-plus years," Minto says. In that time, only two of his clinic patients have had to go to the hospital, he says, and that was because they had bleeding conditions that kept their blood from clotting.

Nevertheless, the laws led to the closing of half of the 40 clinics across the state that offer abortion services. It's not just the valley. In vast swaths of Texas, there are no longer any such clinics in operation.

Minto has been getting calls from women desperate for help. "When they hear that I've closed after all these years, they cry," he says. "They ask me, 'What do I do, Doctor?' "

But there are plenty of people in South Texas who enthusiastically support the restrictions. While the Rio Grande Valley is deeply Democratic it's also very Catholic.

"I take the position that life begins in conception and ends in natural death," says Eddie Lucio Jr., a Democrat and Texas state senator, who has represented the valley for nearly 30 years. "I was an outspoken advocate for the bill."

Bill sponsors Rep. Jodie Laubenberg and Sen. Glenn Hegar of Texas hug after Texas abortion restrictions are signed into law in July 2013.

Lisa Krantz/San Antonio Express-News/Zuma Press

Lucio and his allies in the state Legislature say the restrictions increase patient care and reduce medical complications — the closing of clinics that do abortions is a happy byproduct.

The Texas Legislature has thrown up as many obstacles to abortion as the federal courts will allow, including waiting periods, ultrasounds and outdated protocols for administering abortion pills that require women to repeatedly return to the clinic.

And for women on the state's border with Mexico, there's another barrier — an inland Border Patrol checkpoint on the highway to San Antonio. Women whose visas confine them to the border, or who are completely undocumented, can't get past the checkpoint to San Antonio.

For Lucio that's a plus. "I'm OK with that," he says. "Because all they're looking for is putting an end to a life. And I'm not for that."

Lucio and his allies had abortion-rights supporters on the run in Texas, until U.S. District Judge Lee Yeakel intervened in late August and struck down as unconstitutional the requirements regarding admitting privileges and that clinics providing abortions be held to all the same standards as outpatient surgical centers. In his decision, the judge ruled that the abortion rights of women along the border were particularly endangered by those regulations.

"The requirements erect a particularly high barrier for poor, rural or disadvantaged women," Yeakel wrote. "A woman with means, the freedom and ability to travel and the desire to obtain an abortion will always be able to obtain one," he wrote, echoing Minto's sentiments. "Roe's essential holding, guarantees to all women — not just those of means — the right to a pre-viability abortion," the judge concluded.

Yeakel's ruling has had an immediate impact in Texas. Amy Hagstrom Miller, the CEO of Whole Woman's Health, says her group is reopening its clinic to provide abortions in the Rio Grande Valley. But with a hearing on Yeakel's ruling still looming from the U.S. Court of Appeals for the 5th Circuit, it could be only a matter of days before Hagstrom Miller is forced to close the clinic for good.

"I'm very careful with hope in the state of Texas, being an abortion provider," Hagstrom Miller says. "But I am hopeful for a couple of reasons: We put on a very strong case with very strong evidence. And I'm encouraged by the 5th Circuit giving us two weeks with this injunction, instead of ruling immediately."

The 5th Circuit is one of the most conservative federal courts in the country and has a history of reversing the legal decisions of its federal judges in Texas, who've generally ruled to protect women's rights to abortion. Oral arguments begin tomorrow.

This is the first in a series of NPR reports airing on All Things Considered that will explore abortion and maternal health around the world.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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FDA Approves New Diet Pill That's Made Of Old Medicines

Thu, 09/11/2014 - 5:01pm
FDA Approves New Diet Pill That's Made Of Old Medicines September 11, 2014 5:01 PM ET

When does a diet drug tip the balance for health?

iStockphoto

There's another pill to help people lose weight.

After years of study and lots of questions from the Food and Drug Administration questions, a pill called Contrave finally got the agency's OK Thursday.

It's the third diet medicine to get the regulatory go-ahead in recent years. But the other drugs — Qsymia and Belviq — haven't proved that popular. Many insurers have been reluctant to cover the medicines.

Contrave, for better or worse, is a combination of two drugs that have been around for a long time. One is bupropion, an antidepressant sold as Wellbutrin, that's also been used to help people stop smoking. The other is naltrexone, a medicine that's prescribed to help people stay off drugs and alcohol.

Contrave is intended for people who are obese or who are overweight and have other weight-related health problems, such as high blood pressure and type 2 diabetes.

In a study of people without diabetes, 42 percent of patients who got Contrave lost at least 5 percent of their weight over about a year compared with 17 percent for those who took a placebo. A study in people with diabetes found that 36 percent received Contrave lost at least 5 percent of their weight compared with 18 percent who got a placebo. (You can find the study details in the instructions to doctors who might consider prescribing the drug.)

Shots - Health News FDA Rejects Diet Pill, Casting Pall Over Future Of Weight-Loss Medicines

People in the studies also reduced the calories they consumed and exercised. In one study the patients also got counseling about weight loss. Contrave is supposed to be used in combination with other weight-loss approaches.

Shots - Health News Takeda And Orexigen Make Deal For Diet Pill

Contrave has side effects. The most common ones include nausea, constipation and headache. About a quarter of people taking the drugs in clinical tests stopped taking the drug because of side effects.

Contrave also comes with a stern warning about the potential for suicidal thoughts and behavior, which is consistent with the instructions for Wellbutrin.

All told, almost half of people taking Contrave or the placebo used for comparison stopped taking their pills before the studies were finished. The FDA says people who haven't lost at least 5 percent of their weight after taking Contrave for 12 weeks should stop the medicine because it's unlikely to help them.

Back in 2011, the FDA rejected the Contrave application, despite a recommendation for approval from an outside panel of experts. The agency was concerned, among other things, about potential heart risks. Orexigen Therapeutics, developer of the drug, agreed to run a study looking at cardiovascular risks.

The interim results apparently were reassuring enough for the FDA to approve Contrave. But the company hasn't released the data. Orexigen and Takeda agreed to conduct a new study looking at heart risks as a condition for approval of the drug.

Contrave will be available in pharmacies this fall, according to Takeda Pharmaceuticals and Orexigen, the companies working on the drug's marketing.

How much will it cost? The companies won't say yet. "For price, it's not Takeda's policy to disclose," spokesman Bob Skinner told me in an email. He said Takeda will offer a savings program to make the medicine more affordable for people whose insurance won't cover the medicine.

Insurance coverage has been a sore spot for obesity drugs. "There's very little value perceived in anti-obesity care," Dr. Jeffrey I. Mechanick, immediate past president of the American Association of Clinical Endocrinologists, tells Shots. A conference convened by the group found that many insurers said they don't cover obesity interventions because they've not been asked to do so. Still, he said another drug is a "good thing" because it gives patients and doctors another option for care.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Rare Virus Has Sickened Hundreds More Children, Hospitals Say

Thu, 09/11/2014 - 4:03pm
4fcf700d064b47868ebe5c98b0cac862Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Some Things You Can Do In Your Sleep, Literally

Thu, 09/11/2014 - 1:32pm
Some Things You Can Do In Your Sleep, Literally September 11, 2014 1:32 PM ET

For those who find themselves sleeping through work — you may one day find yourself working through sleep.

People who are fast asleep can correctly respond to simple verbal instructions, according to a study by researchers in France. They think this may help explain why you might wake if someone calls your name or why your alarm clock is more likely to rouse you than any other noise.

After people learned to sort words while awake, their brains were able to do the same task while asleep.

Courtesy of Current Biology, Kouider et al.

The connections between sleep, memory and learning aren't new — but the research is notable for its examination of automatic tasks. The study, published Thursday in Current Biology, first recorded the brain waves of people while they were asked to identify spoken words as either animals or objects while they were awake. After each word, the participant used one hand to push a button for animals, and the other hand to push a button for objects.

The brain map produced by the EEG showed where activity was taking place in the brain and what parts of the brain were being prepped for response. This preparation might include hearing the word elephant and then processing that an elephant is an animal. The participants did this until the task became automatic.

The researchers then lulled the participants to sleep, putting them in a dark room in a reclining chair. Researchers watched them fall into the state between light sleep and the deeper sleep known as rapid eye movement (REM). They were then told a new list of words.

This time, their hands didn't move, but their brains showed the same sorting activity as before. "In a way, what's going on is that the rule they learn and practice still is getting applied," Tristan Bekinschtein, one of the authors of the study, told Shots. The human brain continued, when triggered, to respond even through sleep.

But the researchers weren't fully satisfied, so they took it a step further. They did it all again, but instead of animals and objects, they used real words and fake words. They also waited until the participants were more fully asleep.

Author Interviews Of Neurons And Memories: Inside The 'Secret World Of Sleep'

Again, they found that the sleeping participants showed brain activity that indicated they were processing and preparing to move their hands to correctly indicate either real words or fake words were being spoken.

"It's pretty exciting that it's happening during sleep when we have no idea," Ken Paller, a cognitive neuroscientist at Northwestern University who is unaffiliated with the study, told Shots. "We knew that words could be processed during sleep." But, Paller adds, "we didn't know how much, and so this takes it to, say, the level of preparing an action."

Shots - Health News Bursts Of Light Create Memories, Then Take Them Away

While this sounds like great news for those who could use a few extra hours in the day for memorizing irregular verbs or cramming for the bar exam, the researchers caution that the neural activity they found may apply only to automated tasks. They hope that future studies may look into whether any similar cognitive task begun in an awake state might continue through early sleep — like crunching calculations.

"It's a terrible thought, in the modern world," says Bekinschtein, referring to the pride people take in forgoing sleep for work. "I think, in a way, these experiments are going to empower people ... that we can do things in sleep that are useful."

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

Suicides Rise In Middle-Aged Men, And Older Men Remain At Risk

Wed, 09/10/2014 - 4:50pm
Suicides Rise In Middle-Aged Men, And Older Men Remain At Risk September 10, 2014 4:50 PM ET

Men have historically been more likely to commit suicide than women, but a new, vulnerable group is emerging from their ranks: middle-aged men. That age group includes comedian Robin Williams, who committed suicide last month at age 63. The rate for middle-aged men now eclipses older men, who historically have had the highest rate of suicide.

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In 2011, 39,518 people committed suicide -– a rate of 12.7 per 100,000 and the highest in the last 12 years, according to the federal Centers for Disease Control and Prevention. The middle-aged — people 45 to 64 years — had the highest rate, the result of an upward trend since since 1999.

Younger people consistently have lower suicide rates than their older counterparts.

Additional Information: Men, Suicide And Pain

Shankar Vedantam talks with All Things Considered's Audie Cornish on how social isolation may play a role in suicides among men.

Listen to the story 4 min 13 sec  

Men were also more likely to commit suicide than women. In particular, death rates for middle-aged men have increased since 2000 from 21.3 to 29.2 in 2010, more than women in the same age group. And these numbers are probably low, the CDC notes, because deaths are reported in different ways around the country.

The rising rate of suicide in middle-aged men, and the fact that older men continue to have the highest rate of suicide, points to the need for more suicide prevention efforts aimed at men, the CDC says.

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

Women Who Eat Fish Twice Weekly Cut Their Risk Of Hearing Loss

Wed, 09/10/2014 - 3:48pm
Women Who Eat Fish Twice Weekly Cut Their Risk Of Hearing Loss September 10, 2014 3:48 PM ET

Researchers speculate that the Omega-3 fatty acids in fish may help maintain good blood flow to the inner ear.

iStockphoto

Are you finding it tougher to follow conversations in a noisy restaurant? Or does it seem like people are mumbling when you speak with them?

These are two questions commonly used to screen for hearing loss, which affects more than one-third of people over age 65, according to the National Institutes of Health.

So, what to do to cut the risk?

Women who eat fish regularly have a lower risk of developing hearing loss compared to women who rarely or never eat fish, according to a study published Wednesday in the American Journal of Clinical Nutrition.

Shots - Health News Here's Fish Oil In Your Eye

Women who ate two or more servings of fish per week had a 20 percent lower risk of hearing loss, according to Dr. Sharon Curhan, a researcher at Brigham and Women's Hospital and co-author of the study.

And though she and her colleagues had a hunch that certain types of fish may be more protective than others, it didn't turn out that way. "Eating any type of fish — whether it's tuna, dark fish [like salmon] or light fish was a associated with a lower risk," Curhan told Shots.

The omega-3 fatty acids found in fatty fish are linked to a range of health benefits, including cutting the risk of heart disease, depression and possibly, memory loss.

The Salt Eat Fish And Prosper?

"Omega-3 antioxidants, polyunsaturated fatty acids, and vitamin C have been the focus of a growing body of evidence showing potential hearing benefits," says Dr. Gordon Hughes, program director of clinical trials for the National Institute on Deafness and Other Communication Disorders, which funded the study.

The findings come by way of the Nurses' Health Study — yes, that huge, long-term research study that includes more than 100,000 nurses.

The nurses were aged 27 to 42 when they started completing detailed surveys about what they ate and drank. And they were also asked whether they had a hearing problem and, if so, at what age they first noticed it.

The blood flow to the inner ear needs to be very well-regulated and "higher fish consumption may help maintain adequate cochlear blood flow," Curhan says. This could help protect against hearing damage.

Curhan and her colleagues are not the only researchers to document a connection between fish consumption and hearing. In an Australian study of about 800 men and women, those who ate fish had a lower incidence of hearing loss

And it looks like lots of people have an opportunity for improvement. Curhan points out that only one-third of Americans eat fish once a week, and almost half eat fish only occasionally or not at all.

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

Heavier Teen Pot Smoking Linked To Problems In Young Adults

Wed, 09/10/2014 - 12:00pm
Heavier Teen Pot Smoking Linked To Problems In Young Adults September 10, 201412:00 PM ET

Does smoking pot make it less likely that you'll go to college?

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There's a lot of argument over how teenage marijuana use might affect people through life, but distressingly little data to help figure it out. That leaves parents, policymakers and young people pretty much in the dark when it comes to making decisions about use and legalization.

Three long-running studies of teenagers and young adults in Australia and New Zealand might help. An analysis of the studies found a dose-response relationship: The more someone smoked pot as a teenager, the more likely that person would struggle as a young adult.

People who were daily marijuana smokers before age 17 were much more likely to have not completed high school or graduated from college than were those who never smoked; their odds were 63 percent and 62 percent lower. They were also much more likely to be dependent on marijuana and to be using other illegal drugs in adulthood. The risk of a suicide attempt also increased, though more modestly than the other factors.

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Earlier studies also have found that marijuana use makes it less likely that students will succeed in school. But those findings, and all of these studies, look at correlation, not causation. And they are muddied by confounding factors, like the fact that adolescents living in low-income communities are more likely to use marijuana.

There will almost certainly never be a randomized controlled trial on teenage marijuana use, so observational studies, confounders and all, are what we've got. The studies used in this analysis are among the best: long-term studies with lots of participants that tracked their behavior and health in real time, rather than retrospectively. Altogether the studies followed 3,765 teenagers starting at age 13 until they reached age 30.

The researchers looked at two milestones in making the transition to adulthood: graduating from high school or college. They also looked at whether the young adults were dependent on marijuana; used other illicit drugs; had attempted suicide; were diagnosed with depression; or were dependent on welfare.

Shots - Health News Evidence On Marijuana's Health Effects Is Hazy At Best

Once the researchers used statistical analyses to adjust for confounding factors, they found that depression and welfare dependence were not associated with adolescent pot use. But the associations with completing school, drug use and suicide attempts remained strong. The likelihood of problems increased as smoking frequency increased, on a scale that ranged from less than monthly to daily.

The results were reported Wednesday in the journal The Lancet Psychiatry.

Earlier studies have found that heavy marijuana use in adolescence affects learning and memory, and that teenagers' thinking skills are more impaired than those of adults. But they didn't look at long-term effects.

"Youth is a very vulnerable period in life," Merete Nordentoft, a suicide prevention researcher at the University of Copenhagen, wrote in a commentary accompanying the study. It's a time when people are developing skills to meet the demands of adult life, she notes. "Cannabis use, especially frequent uses, impairs this development and reduces the likelihood that a young person will be able to establish a satisfactory adult life."

Shots - Health News Poll: Yes To Medical Marijuana, Not So Much For Recreational Pot

Surveys in the United States, including one poll conducted earlier this year by NPR, find that although almost half of people support legalization of marijuana, they overwhelmingly oppose legalization for teenagers. And half of our respondents also thought that there should be age restrictions on use of medical marijuana.

"The reason that people are concerned is that they recognize that this is an addictive substance, and some portion of the population that uses it will become addicted to it and have very bad outcomes," Dr. Sharon Levy, director of the adolescent substance abuse program at Boston Children's Hospital, told Shots in May. "As with all addictive products, the risk is greatest in adolescence."

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

Love And Sex In The Time Of Viagra — 16 Years On

Tue, 09/09/2014 - 6:00pm
Love And Sex In The Time Of Viagra — 16 Years On September 09, 2014 6:00 PM ET Listen to the Story 4 min 45 sec  

Mountains of "little blue pills" and their chemical kin have transformed the way many people think about sex and aging.

Raphael Gaillarde/Gamma-Rapho/Getty Images

The lives of older men have changed in a significant way since 1998, or at least their sex lives have changed. That's the year Viagra was introduced. Cialis and Levitra followed a few years later.

The once taboo subject of erectile dysfunction is now inescapable for anyone who watches TV. Late-night comedians continually mine the topic. By 2002, Jay Leno had told 944 Viagra jokes, according to the Wall Street Journal. We couldn't independently verify that number. Actually, we didn't try.

The drugs have been pitched by former Sen. Bob Dole, Chicago Bears coach Mike Ditka and dozens of attractive, anonymous actors canoodling on sofas and lounging in bathtubs.

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A retired Marine Corps pilot named Mike — he asked us just to use his first name — says his own experience wasn't much different from the scenes on TV.

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"It was fantastic," he says.

Mike's been married for 47 years. He's been using either Viagra or Cialis for the past 10.

Movies In Quest For A Female Viagra, Many An Odd Twist

"I was having some 'issues,' " Mike explains. So he discussed the problem with his son, who's a doctor and suggested Mike try the drugs.

Mike's wife was all for it, too, and he says they've lived happily ever after. "I believe my wife and I became closer," he says, because a source of anxiety vanished from their relationship.

Before Viagra, relieving that anxiety required measures that could cause plenty of anxiety themselves, says Dr. Edward Schneider, a professor of gerontology, medicine and biology at the University of Southern California. They're "just medieval, these things," he says.

For example, there's the vacuum pump, "where you essentially cause an erection by creating a partial vacuum around the penis, drawing blood into the penis," Schneider explains. He's never tried it himself, he says, but "I imagine it's awful."

Schneider says other remedies on the market include a surgically implantable pump; a Viagra-like drug you can inject directly into the penis; and a little pill that can be inserted directly into the tip of the penis.

All these methods are still in use, explains Schneider, because some men can't take the oral medications. But the men who can take them have made Viagra, Cialis and Levitra wildly successful: The three drugs took in more than $2.5 billion last year.

Dr. Jacob Rajfer, a urologist at UCLA Medical School, says there's another reason the drugs are so profitable: Erectile dysfunction "happens to all men."

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Not all at once, but gradually over time, "such that men in their 40s have a 40 percent chance of having this problem," Rajfer says. "For every decade after 40, there's a 10 percent increase." That means that a man in his 70s would have a 70 percent chance of having a problem, at least once in a while.

Rajfer says this happens because after a man's prime reproductive years, smooth muscle — the type found within the walls of blood vessels and in the penis — starts to deteriorate. In fact years before Viagra hit the market, Rajfer helped identify nitric oxide as the chemical in the body that acts on smooth muscle and makes erections possible. Viagra-type drugs work by keeping nitric oxide from breaking down too quickly.

The drug is much more than the sum of its chemical parts — and its physiological effects, says a man named David, who also asked that we not use his last name. "It's something that gives that sense that intimacy can continue," he says. "You can feel less alone as a result."

David is 66 years old, a recently retired community college professor, and a widower. He's now in a new relationship.

"I was simply concerned at my age that I wasn't as capable as I wanted to be," he says. "And after I got the prescription I told her I had done that so that she would know.

And he says she was fine with it.

"Women have their own concerns as they age," says David. "She was also concerned about how we were going to be as older people making love."

With people living longer, David notes that he and the new woman in his life could spend 25 years together.

"I wanted to keep that intimacy as long as possible because I love this person and I expect to be with her for a long time," he says.

And now because of a little pill, being physically intimate with the woman he loves isn't something that will be lost to old age.

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

When Scientists Give Up

Tue, 09/09/2014 - 4:27pm
When Scientists Give Up September 09, 2014 4:27 PM ET Listen to the Story 7 min 41 sec  

Randen Patterson left a research career in physiology at U.C. Davis when funding got too tight. He now owns a grocery store in Guinda, Calif.

Max Whittaker/Prime for NPR

Ian Glomski thought he was going to make a difference in the fight to protect people from deadly anthrax germs. He had done everything right — attended one top university, landed an assistant professorship at another.

But Glomski ran head-on into an unpleasant reality: These days, the scramble for money to conduct research has become stultifying.

So, he's giving up on science.

Ian Glomski outside his home in Charlottesville, Va. He quit an academic career in microbiology to start a liquor distillery.

Richard Harris/NPR

And he's not alone. Federal funding for biomedical research has declined by more than 20 percent in the past decade. There are far more scientists competing for grants than there is money to support them.

That crunch is forcing some people out of science altogether, either because they can't get research funding at all or, in Glomski's case, because the rat race has simply become too unpleasant.

"My lab was well-funded until, basically, the moment I decided I wasn't going to work there anymore," he says during an interview on the porch swing of his home in Charlottesville, Va. "And I probably could have scraped through there for the rest of my career, as I had been doing, but I would have had regrets."

Glomski's problem was that he could only get funding to do very predictable, unexciting research. When money gets tight, often only the most risk-averse ideas get funded, he and others say.

"You're focusing basically on one idea you already have and making it as presentable as possible," he says. "You're not spending time making new ideas. And it's making new ideas, for me personally, that I found rewarding. That's what my passion was about."

At his lab at the University of Virginia, Glomski had a new idea about how to study an anthrax infection as it spread through an animal — and doing this with scans, rather than having to cut the animal open.

Shots - Health News U.S. Science Suffering From Booms And Busts In Funding

"I think if it did what I hoped it would, it would have revolutionized a lot of the research that I was focusing on," Glomski says. It would have given him important new insights, he thinks, into how this bacterium does its deadly damage.

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But it was not a surefire idea. Like a lot of science, it might not have worked at all. Glomski never found out. His repeated grant applications to the National Institutes of Health never made the cut. Funding is so competitive that reviewers shy away from ideas that might not pan out.

"You actually have to be much more conservative these days than you used to," Glomski says, "and being that conservative I think ultimately hurts the scientific enterprise." Society, he says, is "losing out on the cutting-edge research that really is what pushes science forward."

Historically, payoffs in science come from out of the blue — oddball ideas or unexpected byways. Glomski says that's what research was like for him as he was getting his Ph.D. at the University of California, Berkeley. His lab leader there got funding to probe the frontiers. But Glomski sees that farsighted approach disappearing today.

"That ultimately squashed my passion for what I was doing," he says. So two years ago, at the age of 41, he quit.

Instead of helping society improve its defenses against deadly anthrax, he's starting a liquor distillery, Vitae Spirits. He's actually excited about that. It's a big challenge, and it allows him to pursue an idea with passion, rather than with resignation.

Meanwhile, Randen Patterson is not passionate about his post-science career as a grocery store proprietor. He recently bought the Corner Store in the tiny town of Guinda, Calif.

Randen Patterson (right) mans the register at the Corner Store in Guinda.

Max Whittaker/Prime for NPR

Patterson, 43, once worked for Dr. Solomon Snyder at Johns Hopkins University in one of the top neuroscience laboratories in the world. His research is published in some of the most prestigious journals.

And Patterson got there against the odds. He was raised in a trailer park in Pennsylvania by a single parent, he says, and stumbled into science quite by accident. Mentors realized his potential and encouraged him to make a career of it.

“ I shouldn't be a grocer right now. I should be training students. I should be doing deeper research. And I can't. I don't have an outlet for it.

He landed a tenure-track assistant professorship at Penn State University, and then moved on to a similar job at University of California, Davis (a 45-minute drive from his new "hometown" of Guinda).

But Patterson struggled his entire career to get grants to fund his research, which uses computer simulations to probe the complex chemistry that goes on inside living cells. And he chose an arcane corner of this field to focus his intellectual energy.

"When I was a very young scientist, I told myself I would only work on the hardest questions because those were the ones that were worth working on," he says. "And it has been to my advantage and my detriment."

Over the years, he has written a blizzard of grant proposals, but he couldn't convince his peers that his edgy ideas were worth taking a risk on. So, as the last of his funding dried up, he quit his academic job.

"I shouldn't be a grocer right now," he says with a note of anger in his voice. "I should be training students. I should be doing deeper research. And I can't. I don't have an outlet for it."

When the writing was on the wall a few years ago, Patterson says he bought his own souped-up computer so he could continue dabbling in research on the side. But those ideas aren't adding to the world's body of knowledge about biology.

"The country has invested, in me alone, $5 million or $6 million, easily," Patterson says, thinking back on the funding he received for his education and his research. And he's just one of many feeling the brunt of the funding crunch.

There are no national statistics about how many people are giving up on academic science, but an NPR analysis of NIH data found that 3,400 scientists lost their sustaining grants between 2012 and 2013. Some will eventually get new funding, others will retire; but others, like Glomski and Patterson, will just give up.

"We're taking all this money as a country we've invested ... and we're saying we don't care about it," Patterson says.

He watches with some trepidation as his daughter, a fresh college graduate, hopes to launch her own career in science.

The funding squeeze could persist for his daughter's generation as well. So Patterson is hoping she will settle on a field other than biomedical research — one where money isn't quite so tight.

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

Get The Measles, Get Ready To Be Out For Two Weeks

Tue, 09/09/2014 - 2:52pm
Get The Measles, Get Ready To Be Out For Two Weeks September 09, 2014 2:52 PM ET

Helen Down holds her 14-month-old daughter, Amelia, for an MMR shot in Swansea, Wales, April 2013. The vaccination was in response to a measles outbreak.

Geoff Caddick/AFP/Getty Images

Measles is often lumped in with flu and chickenpox as mild childhood illnesses. But people who got measles during outbreaks in the United Kingdom say they were pretty darned sick, missing two weeks of school or work on average.

A bout of the measles lasted 14 days on average, according to a study by the London School of Hygiene & Tropical Medicine and Public Health England. That added up to having to take 10 days off work or school. More than a third of people needed someone to stay home to take care of them, too.

And they felt crummy. This study is one of the few that actually asks people how they feel when they're sick. They said they felt high levels of pain and anxiety, and weren't able to do their usual activities.

Shots - Health News Fifteen Years After A Vaccine Scare, A Measles Epidemic

"People with the measles report that they're far more sick than if they have flu or chickenpox," Dominic Thorrington, a graduate student in epidemiology and lead author of the study, told Shots. The study was published Tuesday in the journal PLoS ONE.

The researchers asked people who had become infected during the 2012 and 2013 measles epidemics in the United Kingdom how they felt and how they coped.

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Being unable to manage school, work and other usual activities was the biggest complaint, with 97 percent of people saying they had severe problems or some problems with that. Another 90 percent said they suffered pain or discomfort. About half said measles severely compromised their mobility, and 40 percent said they couldn't care for themselves.

The vast majority of 203 people in the study had never been vaccinated for measles.

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Earlier research has shown that the measles outbreaks in the United Kingdom followed a vaccine scare prompted by a 1998 paper that implicated the measles, mumps and rubella vaccine in autism. The study was later proven to be fraudulent, but the number of children who did not get vaccinated spiked in the following decade.

The virus spreads easily in unvaccinated communities. Researchers say the higher numbers of unvaccinated people in the U.K. led to the outbreaks.

"I just hope that when people read this, they realize that measles is not a disease that has gone away and it is a disease that has quite severe implications when there's an outbreak," Thorrington says. "The best way to protect yourself is through vaccination."

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

Can I Buy Insurance After Being Injured In An Accident?

Tue, 09/09/2014 - 10:36am
Can I Buy Insurance After Being Injured In An Accident? September 09, 201410:36 AM ET

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Now that the federal health law forbids denial of insurance for pre-existing condition, some people have wondered if they can wait until they get sick to buy health coverage.

Let's say an uninsured person is in a car accident, has emergency surgery and is hospitalized, and after awaking from surgery asks to purchase insurance right away. Under the health law, would his medical costs be covered since he can't be denied insurance because of a pre-existing medical condition? An article I saw said the hospital would even enroll people and pay their premiums. Is that correct?

It's unlikely that this hypothetical person would be able to sign up for coverage after being injured, says Judith Solomon, a vice president for health policy at the Center on Budget and Policy Priorities.

"It's true that you can't be denied because you have a pre-existing medical condition, but you generally have to sign up during an open enrollment period," says Solomon. Employers generally offer insurance through an enrollment period in the fall. People buying coverage individually on or off the online marketplaces set up under the health law can sign up during open enrollment starting Nov. 15. But there's a lag between when a person signs up and when coverage begins.

The reason for open enrollment is clear: If people could sign up anytime, chances are they would wait until they got sick to do so, wreaking havoc on the health insurance market that relies on spreading the insurance risk among sicker and healthier people.

Hospitals may sometimes pay premiums for patients' existing policies or enroll people before they get sick. But in general it's not possible to purchase coverage after you've already been injured and admitted to the hospital, says Solomon.

There is one important exception, however. Enrollment in a state's Medicaid program for low-income people is open year-round. If someone lives in a state that has expanded Medicaid coverage to people with incomes up to 138 percent of the poverty level (currently $16,105 for an individual), enrollment would generally be retroactive to the first day of the month that the person applied for coverage. In addition, if someone was eligible for Medicaid during the three months preceding the application, medical care received during that time could be covered as well.

My work offers health insurance, but I opted to go into the marketplace last winter and buy it individually instead. Was this not allowed? Should I terminate my coverage and get on my boss's plan even though I don't want that coverage?

The answer depends on your circumstances. Most people can opt to buy a marketplace plan during open enrollment rather than sign up for employer coverage if they want; there's nothing in the health law that prohibits it.

The real question is whether you're eligible for subsidies to make coverage more affordable if you do so. If you have good, affordable employer coverage available — meaning it costs less than 9.5 percent of your income and covers at least 60 percent of your medical costs — you won't be eligible for subsidies. Nor will you qualify for subsidies if your income is more than 400 percent of the federal poverty level ($46,680 for an individual next year).

If you take subsidies out of the equation, however, there's no reason not to buy a plan on the state marketplace if you prefer it over your on-the-job coverage, says Solomon.

My employer is telling me that an excise tax will be assessed if our company pays more than 80 percent of the cost of our health insurance premium. I thought it was based on the value of the plans, that if individual coverage exceeds $10,250 and family coverage $27,500 our company would be taxed. Can you tell me when the excise tax will be assessed and who pays the tax?

The excise tax that will be assessed on so-called Cadillac health plans with very generous benefits starts in 2018. It isn't related to how much the employer or employee pay in premiums. The tax will be charged based on the total value of a plan, including both employer and employee premium contributions.

Under the health law, if the total value is more than $10,200 for individual coverage or $27,500 for family coverage, the employer or insurer will be responsible for paying a 40 percent tax on amounts over those thresholds.

"There's nothing to preclude an employer from passing along some or all of that tax to an employee," says Amy Bergner, managing director at tax and human resources consultant PwC.

By the time the tax takes effect in 2018, expect the thresholds to be higher, says Bergner, because of consumer price index adjustments, among other things.

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

U.S. Science Suffering From Booms And Busts In Funding

Tue, 09/09/2014 - 3:03am
U.S. Science Suffering From Booms And Busts In Funding September 09, 2014 3:03 AM ET Listen to the Story 7 min 51 sec   Leif Parsons for NPR

Ten years ago, Robert Waterland got an associate professorship at Baylor College of Medicine and set off to study one of the nation's most pressing health problems: obesity. In particular, he's been trying to figure out the biology behind why children born to obese women are more likely to develop the condition themselves.

Waterland got sustaining funding from the National Institutes of Health and used it to get the project going.

But after years of success in this line of research, he's suddenly in limbo. His NIH grant ran out in 2012 and he hasn't been able to get it renewed.

"We're in survival mode right now," he says.

His research can't move forward without funding. And he has plenty of company. Nationwide, about 16 percent of scientists with sustaining (known as "R01") grants in 2012 lost them the following year, according to an NPR analysis. That left about 3,500 scientists nationwide scrambling to find money to keep their labs alive — including 35 at the Baylor College of Medicine.

The root cause is plain, and it's not just about a current shortage in funding: The NIH budget shot steadily upward from 1998 to 2003. That spawned great jubilation in biomedicine and a gold-rush mentality. But it didn't last. Since 2004, the NIH budget has decreased by more than 20 percent. (That's not counting the hefty two-year bump the budget got from stimulus funds via the American Recovery and Reinvestment Act of 2009.)

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Grants are the lifeblood of university research. Scientists rely on that steady stream of cash to hire staff, buy equipment and run the experiments. Their results help propel innovation, medical advances and local economies. Academic research is a major reason the United States remains a leader in medicine and biotechnology; but the future is uncertain.

"If I don't get another NIH grant, say, within the next year, then I will have to let some people go in my lab. And that's a fact," Waterland says. "And there could be a point at which I'm not able to keep a lab."

He notes that the hallway in his laboratory's building is starting to feel like a ghost town as funding for his colleagues dries up. He misses the energy of that lost camaraderie.

"The only people who can survive in this environment are people who are absolutely passionate about what they're doing and have the self-confidence and competitiveness to just go back again and again and just persistently apply for funding," Waterland says.

Dan Burke, a biochemist at University of Virginia, will likely have to close his lab. Research institutions overspent on infrastructure in boom times, he says.

Richard Harris /NPR

He has applied for eight grants and has been rejected time and again. He's still hoping that his grant for the obesity research will get renewed — next year.

Baylor College of Medicine is suffering more than most. Its NIH funding dropped from a peak of $252 million in 2002 to $184 million in 2013. But many other schools are in the same fix. The University of Virginia, for example, regarded as one of the top public universities in the nation, watched its NIH funding shrink from a peak of $159 million in 2005 to $110 million in 2013.

Take Dan Burke, a professor of biochemistry and molecular genetics, who is one of about 30 scientists at University of Virginia who lost their sustaining grants between 2012 and 2013. Until that point, he'd had continuous funding since 1987 to conduct studies about the basic mechanics of DNA. He has had to fire his lab staff and is planning to close his lab.

It seemed like great fortune when the NIH budget soared more than a decade ago.

"Unfortunately, a lot of research institutions and medical schools were hogs to the trough," Burke says. "They hired a lot of people and built a lot of buildings with the expectation that that would continue. And when that flattened off, and started losing money to inflation, the institutions were essentially bloated."

Additional Information: Search NIH Grant Data By Institution Tyrone Turner/Getty Images/National Geographic

Use NPR's interactive search box to create year-by-year charts of NIH grant funding given to individual biomedical institutions and laboratories.

His institution sought to cash in on those boom times. University of Virginia doubled the amount of biomedical laboratory space on campus between 2007 and 2013 — from 233,000 square feet to 416,000 square feet. Funding for some of that expansion was supposed to come from the grants that its scientists garnered.

The university touted plans to add 700 new scientists and support staff to fill these labs. Instead, last year it eliminated more than 300 jobs — many held by highly skilled workers — as funding for biomedical research sank. New labs built to handle dangerous germs and small animals are now lightly used.

"The U.Va. swings in overbuilding or unused space for specialized facilities really have been extremely moderate, compared to the scaling that occurred either at larger institutions or at some of the large private medical centers," Tom Skalak, vice president for research at the university, told NPR.

To help close the budget gap, the university has raised tuition. (The commonwealth of Virginia now provides only 10 percent of its flagship university's funding.) Skalak defends using tuition to help pay for new laboratories, saying undergraduates can enhance their education by working in a lab.

The University of Virginia's building boom was twice the national average. Nationwide, National Science Foundation data show that universities have expanded laboratory space by 50 percent in the past decade, expecting a funding boom that turned out to be a bust.

In absolute terms, there is still a lot of money for biomedical research — the NIH budget is about $30 billion a year. But with the doubling and subsequent decline in funding, supply and demand are completely out of whack.

"It's an unstable system," says Paula Stephan, a labor economist at Georgia State University. "It really depended on funding growing and growing and growing. And so we need to find some way for it to reach equilibrium."

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Many scientists hold out hope for a simple solution: more money. But the current U.S. Congress has no appetite to spend more — even on health research that has broad, bipartisan public support.

So a group of leading scientists is trying to figure out how to repair the hobbled biomedical enterprise without a cash infusion.

"We have to remember that this is a fragile system, says Dr. Harold Varmus, who was head of the NIH when the funding doubled; he now runs the National Cancer Institute. " 'Do no harm,' the doctor's mantra, is very applicable here," he says.

Varmus is helping to organize a major summit meeting on this funding crisis, to be held later this year.

"We have a system that has worked well in the past, that has made the U.S. the leader in biomedical research worldwide," Varmus says. "And while I don't think we've lost that yet, we do see a rising tide in lots of places."

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Researcher Urges Wider Genetic Screening For Breast Cancer

Mon, 09/08/2014 - 4:24pm
Researcher Urges Wider Genetic Screening For Breast Cancer September 08, 2014 4:24 PM ET Listen to the Story 3 min 58 sec  

Lisa Schlager of Chevy Chase, Md., demonstrates outside of the Supreme Court as arguments were made in a case seeking to determine whether the BRCA breast cancer genes can be patented. The court ruled in 2013 that individual genes can't be patented.

Tom Williams/CQ Roll Call/Getty

A prominent scientist has started a big new debate about breast cancer. Geneticist Mary-Claire King of the University of Washington, who identified the first breast cancer gene, is recommending that all women get tested for genetic mutations that can cause breast cancer.

"My colleagues and I are are taking a really bold step," King said. "We're recommending that all adult women in America, regardless of their personal history and regardless of their family history, be offered genetic testing for the breast cancer genes."

But others say that one study is far from enough evidence to know if these women face a higher risk of getting cancer, and that universal testing could lead women to undergo unnecessary surgery, doing more harm than good.

The breast cancer genes are called BRCA1 and BRCA2. Women who have mutations in these genes are much likely to get breast cancer and ovarian cancer. From 5 to 10 percent of breast cancer is caused by BRCA mutations, according to the National Cancer Institute.

Doctors usually recommend women get tested only if one of those cancers runs in their families.

"The difficulty with that approach is that it misses identifying some women who have mutations in these genes," says King, who laid out her arguments in an article published Monday in JAMA, the journal of the American Medical Association. King was awarded a Lasker-Koshland prize Monday for her work on BRCA.

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In fact, about half of the women who carry mutations in BRCA1 or BRCA2 have no family history of breast or ovarian cancer, she says.

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But no one has recommended screening all women for a very good reason: No one knew how dangerous the mutations were for the average woman.

"There was a big piece of the puzzle missing," King says.

So King and her colleagues decided to try to find that missing piece. They identified more than 400 women who were carrying the mutations even though they had no family history.

"The women turned out to have the same high risks of developing either breast or ovarian cancer that we see among those who are identified by virtue of their family history," says King, who reported the findings in a paper published last week in the Proceedings of the National Academy of Science.

King thinks that's the tipping point — it's time to recommend all women get screened.

"People who are positive can do something about it. Some women, for instance Angelina Jolie, wrote elegantly about her decision to have a double mastectomy," she says. They could also have their ovaries removed to make sure they never get ovarian cancer.

But that's exactly what has a lot of breast cancer advocates worried.

"We are far, far from being ready to recommend that all women be screened for genetic predisposition to breast cancer," says Fran Visco, president of the National Breast Cancer Coalition.

Visco and others aren't convinced the new data are strong enough to know anything for sure. Just because a woman has one of these mutations doesn't mean she'll definitely get cancer. Thus a woman could undergo radical surgery for no good reason.

"These are very serious surgeries that women have to undergo. Removing their breasts. Removing their ovaries. We're talking about surgery to remove healthy body parts. If we give women this message, we may very well end up doing more harm than good," Visco says.

In addition, screening tests can cost hundreds to thousands of dollars depending on insurance coverage.

"Having the genetic mutation doesn't mean you're definitely going to get cancer," says Dr. Olufunmilayo Olopade, a geneticist at the University of Chicago.

Women who find out they are carrying the mutations could get regular MRIs to try to catch any cancer early, when it's most treatable, Olopade says. They could also do things to try to minimize their chances of getting cancer in the first place. "If you have children, breast-feed children, don't gain weight and eat right — exercise. All those things modify the risk for mutation carriers."

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CDC Warns Of Fast-Spreading Enterovirus Afflicting Children

Mon, 09/08/2014 - 4:02pm
CDC Warns Of Fast-Spreading Enterovirus Afflicting Children September 08, 2014 4:02 PM ET

13-year-old Will Cornejo of Lone Tree, Colo., recovers at Rocky Mountain Hospital for Children in Denver from what doctors suspect is enterovirus 68. His parents found him unconscious on the couch and called 911. He was flown to Denver for treatment.

Cyrus McCrimmon/Denver Post/Getty Images

A rarely seen virus is sending children to the hospital with severe respiratory infections, and the federal Centers for Disease Control and Prevention is warning doctors and parents to be on the alert.

"Hospitalizations are higher than would be expected at this time of year," Dr. Anne Schuchat, head of infectious diseases for the CDC, said Monday at a press briefing on enterovirus 68. "The situation is evolving quickly."

In August, health officials in Illinois and Missouri reported a surge in emergency room visits for severe respiratory illnesses in Chicago and Kansas City. That surge is continuing. Enterovirus 68 has been identified in 19 of 22 people tested in Kansas City, and 11 of 14 cases in Chicago. The sick patients have all been children and teenagers, and 68 percent have a history of asthma or wheezing, according to a report published Monday in Morbidity and Mortality Weekly Report. No one is known to have died.

So far about a dozen states have reported higher-than-usual numbers of severe respiratory infections, and the CDC is working with them to figure out if EV-68 is to blame, Schuchat says. "This is a very dynamic situation, an unusual virus, and we're just beginning to understand it."

Some patients have become sick enough to end up in the intensive care unit on oxygen. Many have wheezing, even those who don't have asthma.

Enteroviruses are very common, with 10 to 15 million infections in the United States a year. They usually cause mild illness, if they make people sick at all.

But EV-68 is a rarer critter. It was first identified in California in 1962, but then was almost never seen until 2009 to 2012, when there were outbreaks in Japan, the Philippines and the Netherlands, and small clusters of cases in the United States.

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The strain of the virus in these current cases is not new, Schuchat says, and is the same as earlier EV-68 cases in the United States and in other countries. It's unclear why it's making people sicker and how it's spreading, but respiratory viruses spread very easily. Cold season typically peaks in September when children return to school, and the enterovirus cases may be following a similar pattern.

Parents shouldn't worry about runny noses and sniffles, Schuchat says, but should act quickly if a child has difficulty breathing. "This can be a scary thing to hear about for parents," Schuchat says. "If your child is having difficulty breathing, you want to get medical attention."

And parents of children with asthma should make extra-sure that the children are taking medications and the asthma is well controlled, she adds.

There is no vaccine or specific treatment for EV-68.

In 2014, five children in California suffered a polio-like illness that left an arm or leg paralyzed. Two of those children tested positive for EV-68. There have been no reports of paralysis or other neurological issues in the current cases, Schuchat said Monday.

"I can't say if we'll be seeing this in many more states or not," Schuchat concluded. "It's just too soon to say."

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New Option For Getting Rid Of Old Drugs: The Pharmacy

Mon, 09/08/2014 - 3:52pm
New Option For Getting Rid Of Old Drugs: The Pharmacy September 08, 2014 3:52 PM ET

Soon there will be disposal choices beyond the take-back drives for old medicines.

DEA

If you have old or unused narcotic painkillers in the medicine cabinet, your main choices for getting rid of them have been to toss them in the trash, flush them down the toilet or drop them off at the police station.

But soon it will be possible to take them to the local drugstore or even mail them back.

The Drug Enforcement Administration is loosening up its rules so that people will have more ways of disposing of drugs that can be risky to keep around after they're no longer needed. New disposal options could also alleviate environmental concerns that crop up when people put their old drugs in the toilet or the garbage.

Narcotics are tightly controlled because they can be abused. By regulation, narcotics couldn't be taken back to drugstores before. It's why the usual take-back sites have been police stations.

Under a regulation that takes effect in a month, drugstores, hospitals with pharmacies, drugmakers and even drug-treatment centers can serve as collection points for unused narcotics.

The change is "long overdue," said Dr. G. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins Bloomberg School of Public Health, according to The New York Times.

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In 2013, there were 230 million prescriptions written for opioid painkillers, such as Vicodin and Percocet, dispensed in the U.S. More Americans now die from drug overdoses than auto accidents.

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"It's baffling that it's so easy to get a prescription for opioids and yet so difficult to dispose of these drugs safely," Alexander said.

The new regulation focuses on controlled substances, but a DEA spokesman confirmed that a collection box that's OK for narcotics would also be OK for the return of other prescription drugs.

Now, there's no requirement that drugstores have to add collection boxes or return-by-mail options. A spokeswoman for the National Association of Chain Drugstores, a trade group, said it "is reviewing the final DEA rule with our members."

Walgreen didn't immediately respond to calls about their plans once the regulation takes effect.

The DEA suggested in the official notice of the change that participation could have advantages. Drugstores and hospitals that take part may garner goodwill by "providing a valuable community service," the DEA wrote. The companies and organizations that use a mail-back option could benefit from the chance to "distribute to consumers promotional, educational, or other informational materials with the mail-back packages."

Updated 4:23 p.m.: After the initial version of this post was published, a CVS spokesman emailed that the company "is committed to combating prescription drug abuse in multiple ways" and is "reviewing the new federal regulation announced today as part of our on-going commitment to measures that can help prevent prescription drug abuse."

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The Start Of School Is Not The Only Risky Time For Campus Rape

Mon, 09/08/2014 - 3:24am
The Start Of School Is Not The Only Risky Time For Campus Rape September 08, 2014 3:24 AM ET Listen to the Story 2 min 47 sec   iStockphoto

It's sometimes called "the red zone" — from the first day on campus to Thanksgiving break — when female students are thought to be at higher risk of sexual assault.

Students away from home for the first time with no parental supervision are trying to make friends and fit in. Add parties and alcohol, and it can be a dangerous mix.

"It's assumed the highest-risk period is at the beginning of the first semester," says Bill Flack, an associate professor of psychology at Bucknell University in Pennsylvania.

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Flack remembers seeing posters on campus warning female freshmen to be wary of the "red zone," but he couldn't find much evidence to back it up. So Flack conducted two studies on two different college campuses. What he found was surprising.

One study did find higher reports of sexual assault at the beginning of the first year, but there was also an increased risk during the winter term. Students at this small liberal arts college only take one class during the winter term and describe it as a time of less work, more socializing and heavier drinking.

The second study, at another liberal arts college, didn't find any higher risk at the beginning of the first semester. In fact, the reports of sexual assault were higher at the start of the second year, when students were taking part in sorority and fraternity rush. The higher-risk periods on the two different campuses were at different times, but both coincided with periods of more partying.

"Alcohol consumption tends to go hand in hand with sexual assault," Flack says.

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It's the combination of alcohol consumption and students who are on their own for the first time that can make the first few weeks of school particularly dangerous.

Research shows that a small percentage of male college students are responsible for most of the campus rapes. These predators are looking for people who are vulnerable, says Melissa Osmond, the associate director for health promotion at Lewis and Clark College in Portland, Ore.

"A lot of times those are young women who may be under the influence of alcohol, and these perpetrators will sometimes help that along," Osmond says.

She says it's a mistake to think the first few weeks are the only dangerous time.

"I truly believe it can happen anytime, and it doesn't have to be in the first six weeks or 15 weeks, and it's not always freshmen women," Osmond says. "It can happen at any time in your college career."

A White House Task Force to Protect Students from Sexual Assault has asked each college to do a climate survey to find out the extent of the problem on campus and develop strategies to stop it. One of the problems is that so few sexual assaults are actually reported. A government website called NotAlone.gov provides a host of information, including enforcement data on different campuses and advice on how to file a federal complaint.

And as students head back to college, many are being required to undergo sexual assault prevention training.

"Consent is hot, assault is not," is one of the marketing slogans for the state of Indiana prevention program, which also cautions students to "ask for my sober consent."

Good advice, considering alcohol is involved in the majority of sexual assaults.

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