NPR Health Blog

Syndicate content Shots - Health News
NPR's online health program
Updated: 25 min 33 sec ago

5 Things To Know About The Latest Supreme Court Challenge To Health Law

Fri, 02/27/2015 - 9:09am
5 Things To Know About The Latest Supreme Court Challenge To Health Law February 27, 2015 9:09 AM ET

Partner content from

Julie Rovner

The Affordable Care Act will take center stage at the Supreme Court on March 4.

Drew Angerer/Getty Images

The Affordable Care Act is once again before the Supreme Court.

On March 4, the justices will hear oral arguments in King v. Burwell, a case challenging the validity of tax subsidies helping millions of Americans buy health insurance if they don't get coverage through an employer or the government. If the court rules against the Obama administration, those subsidies could be cut off for everyone in the three dozen states using HealthCare.gov, the federal exchange website. A decision is expected by the end of June.

Here are five things you should know about the case and its potential consequences:

1) This case doesn't challenge the constitutionality of the health law.

The Supreme Court has already found the Affordable Care Act is constitutional. That was settled in 2012's NFIB v. Sebelius.

At issue in this case is a line in the law stipulating that subsidies are available to those who sign up for coverage "through an exchange established by the state." In issuing regulations to implement the subsidies in 2012, however, the IRS said that subsidies would also be available to those enrolling through the federal health insurance exchange. The agency noted Congress had never discussed limiting the subsidies to state-run exchanges and that making subsidies available to all "is consistent with the language, purpose and structure" of the law as a whole.

Last summer, the U.S. Court of Appeals for the 4th Circuit in Richmond ruled that the regulations were a permissible interpretation of the law. While the three-judge panel agreed that the language in the law is "ambiguous," they relied on something called "Chevron deference," a legal principle that takes its name from a 1984 Supreme Court ruling that held courts must defer to a federal agency's interpretation as long as that interpretation isn't unreasonable.

Those challenging the law, however, insist that Congress intended to limit the subsidies to state exchanges. "As an inducement to state officials, the Act authorizes tax credits and subsidies for certain households that purchase health insurance through an Exchange, but restricts those entitlements to Exchanges created by states," wrote Michael Cannon and Jonathan Adler, two of the fiercest critics of the IRS interpretation, in Health Matrix: Journal of Law-Medicine.

In any case, a ruling in favor of the challengers would affect only the subsidies available in the states using the federal exchange. Those in the 13 states operating their own exchanges would be unaffected. The rest of the health law, including its expansion of Medicaid and requirements for coverage of those with pre-existing conditions, would remain in effect.

2) If the court rules against the Obama administration, millions of people could be forced to give up their insurance.

A study by the Urban Institute found that if subsidies in the federal health exchange are disallowed, 9.3 million people could lose $28.8 billion of federal help paying for their insurance in just the first year. Since many of those people would not be able to afford insurance without government help, the number of uninsured could rise by 8.2 million people.

A separate study from the Urban Institute looked at those in danger of losing their coverage and found that most are low and moderate-income white, working adults who live in the South.

3) A ruling against the Obama administration could have other effects.

Disallowing the subsidies in the federal exchange states could destabilize the entire individual insurance market, not just the exchanges in those states. Anticipating that only those most likely to need medical services will hold onto their plans, insurers would likely increase premiums for everyone in the state who buys their own insurance, no matter where they buy it from.

"If subsidies [in the federal exchange] are eliminated, premiums would increase by about 47 percent," said Christine Eibner of the RAND Corporation, who co-authored a study projecting a 70 percent drop in enrollment.

Eliminating tax subsidies for individuals would also impact the law's requirement that most larger employers provide health insurance. That's because the penalty for not providing coverage only kicks in if a worker goes to the state health exchange and receives a subsidy. If there are no subsidies, there are also no employer penalties.

4) Consumers could lose subsidies almost immediately.

Supreme Court decisions generally take effect 25 days after they are issued. That could mean that subsidies would stop flowing as soon as July or August, assuming a decision in late June. Insurers can't drop people for not paying their premiums for 90 days, although they have to continue to pay claims only for the first 30.

Although the law's requirement that individuals have health insurance would remain in effect, no one is required to purchase coverage if the lowest-priced plan in their area costs more than eight percent of their income. So without the subsidies, and with projected premium increases, many if not most people would become exempt.

5) Congress could make the entire issue go away by passing a one-page bill. But it won't.

All Congress would have to do to restore the subsidies is pass a bill striking the line about subsidies being available through exchanges "established by the state." But given how many Republicans oppose the law, leaders have already said they won't act to fix it. Republicans are still working to come up with a contingency plan should the ruling go against the subsidies. Even that will be difficult given their continuing ideological divides over health care.

States could solve the problem by setting up their own exchanges, but that is a lengthy and complicated process and in most cases requires the consent of state legislatures. And the Obama administration has no power to step in and fix things either, Health and Human Services Secretary Sylvia Burwell said in a letter to members of Congress.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

From Naked Mole Rats To Dog Testicles: A Writer Explores The Longevity Quest

Thu, 02/26/2015 - 2:38pm
From Naked Mole Rats To Dog Testicles: A Writer Explores The Longevity Quest February 26, 2015 2:38 PM ET Listen to the Story 38 min 35 sec   Additional Information: Spring Chicken

Stay Young Forever (Or Die Trying)

by Bill Gifford

Hardcover, 366 pages | purchase

Purchase Featured Book
Title
Spring Chicken
Subtitle
Stay Young Forever (Or Die Trying)
Author
Bill Gifford

Your purchase helps support NPR Programming. How?

More on this book:

When journalist Bill Gifford turned 40, his friends gave him a cake shaped as a tombstone with the words, "R.I.P, My Youth." As he reflected on his creeping memory lapses and the weight he'd gained, Gifford got interested in the timeless quest to turn back the aging clock — or at least slow it down.

His latest book, Spring Chicken, explores everything from some wacky pseudo-cures for aging to fascinating research that point to causes of aging at the cellular level.

"In high school biology we pretty much learn that cells divide and divide forever and that's kind of what they thought up until about 1960," Gifford tells Fresh Air's Dave Davies. "Now they know that cells actually have a kind of lifespan — they have a limit to the number of times that they can divide."

Gifford says that after they're done dividing, the cells go into a state called "replicative senescence."

"So they go from being these lively dividing cells to basically retiring," he says. "And they're sitting there and they're kind of grumpy."

Scientists have learned that these cells are "basically toxic," he says.

"It's sort of like certain people bring everybody down," Gifford says. "Senescence cells are kind of the same way. Some people think that senescence cells actually drive much of what we recognize as aging."

Gifford's book not only explores the research at the cellular level, but he also looks at the history of anti-aging, how exercise, diet and stress affect growing old and interesting phenomena in the natural world — like the naked mole rat. It lives long, shows no increase in mortality with age, never gets cancer and never experiences menopause.

"They live underground; they're from Africa and they live in a colony," Gifford says. "I held one in my hand and she was the size of between a mouse and a rat — and she was 28 years old, whereas a mouse lives to about two years old. In human terms, it was like a 600-year-old person ... and she was pregnant."

These animals, Gifford says, have repair mechanisms in their cells that allow the cells to survive damage and live longer.

Scientists "recently sequenced the mole rat genome so they're looking pretty hard for what that might be," he says. "On the other hand, it might just be an anomaly ... we don't know. The point is that nature knows how to let animals live a very long time."

Interview Highlights

Bill Gifford is a contributing editor for Outside Magazine. His previous book was called Ledyard: In Search of the First American Explorer.

Darryl Patterson/Courtesy of Grand Central Publishing

On the late 19th century scientist Charles-Édouard Brown-Séquard

He was one of the great scientists of the 19th century; he's regarded as the founder of endocrinology, the study of glands. When he got to be about 70 years old he wasn't feeling so hot and he started to wonder why. He thought the answer had to do with something produced in the gonads, so he mixed up a little mixture of crushed up dog testicles, testicular blood and semen, mixed it all up and injected himself with it for a period of about three weeks. In 1889, he gave a triumphant address to the society of biology in Paris describing this experiment and how it had miraculously rejuvenated him, an old man, he could work through the night now, he could lift much more weight, he could urinate farther, all these fantastic things and people were horrified. ...

He was already 70 or 71 and he lived about another five years, so he did pretty well for the 19th century, but whether the treatment extended his lifespan, [it's] difficult to say. They now think it was pretty much a placebo effect.

It became a cultural sensation. ... It was called the Séquard Elixir and all kinds of quacks set up mail order businesses where you could get 10 syringes for $2.50. There were songs written about it; it was written up in all the papers. People went crazy. He never made a dime off it. ...

In a way, Séquard's elixir was kind of a precursor of the testosterone replacement and estrogen replacement therapies that are extremely popular right now. So he was onto something.

On the controversial pre-Depression era scientist John Brinkley

In between the elixir and the testosterone, there was an unfortunate intermediate step where a salesman named John Brinkley down in Texas began implanting goat testicles in worn out middle-aged men and he did similar surgeries in women. Obviously [this was] not a good idea and many people died on his operating table, but he became fabulously wealthy. He was one of the richest men in the pre-Depression era. He actually had a radio station down there. He was just across the border in Mexico because they kicked him out of the country, but he had this hugely powerful radio station that broadcast some of the early country music stars.

On the conference for anti-aging and human growth hormones

It was founded by these two doctors in Chicago who basically pioneered the use of human growth hormone as a treatment for aging back in the '90s. And a study had come out in about 1990 saying that older men gained muscle mass when they were on an exercise program and human growth hormone.

"The scientists I spoke to feel that human growth hormone, far from reversing aging, actually accelerates aging."

So they kind of took this and ran with it, and now, 20 years later, older Americans inject themselves with about $1.4 billion worth of human growth hormone per year and the system of injections costs about $10,000 to 12,000 a year. ...

[But] the scientists I spoke to feel that human growth hormone, far from reversing aging, actually accelerates aging. It turns on these pro-growth, pro-aging pathways. And there aren't clinical trials of this stuff because it's technically illegal for this use, but let's just say the longest [living] laboratory mice had zero growth hormone. Their cells had no growth hormone receptors. So human growth hormone might make you feel better for a short time, but it's very doubtful that it will lengthen your life and may do the opposite.

On anti-aging supplements

Additional Information: Related NPR Stories Shots - Health News Anti-Aging Hormone Could Make You Smarter Shots - Health News Like All Animals, We Need Stress. Just Not Too Much The Salt Eat Plants And Prosper: For Longevity, Go Easy On The Meat, Study Says

There's very little evidence for most of these supplements that you see marketed to older people. Supplements are very poorly regulated in this country and there just aren't the same evidentiary standards that you need for say, a drug. There was just a recent case where the attorney[s] general of several states found that supplements sold in places like Walmart had things like grass clippings in them.

On studying people who are over 100 years old

At [Albert] Einstein College of Medicine ... the theory is that that they have genes that protect them from the diseases of aging that the rest of us get. So they get to 100 and they don't have diabetes; they don't have heart disease; they don't have cancer; they've been protected somehow. So the question is: Do they have genes that protect them from these diseases and what are the genes and ... can we make a drug that can kind of imitate the action of those genes.

On how exercise affects aging

Anything really, is better than nothing. Basically, we evolved to move around, to run, to walk, to use our bodies and not to just sit around the way most of us do for most of the day. There's kind of an idea of use it or lose it and that's really programmed into our biology. The more you use your muscles, the more you're walking around, the more you're going to hang on to your muscle as you get older. That's really important because muscle wasting with age is the second leading cause of admission to nursing homes after Alzheimer's disease.

On the theory that short-term, controlled physical stress is good for longevity

[Blogger Todd Becker] believes in small amounts of stress as a way of life. It sounds completely crazy but there's actually a scientific basis to it. ... He wakes up in the morning every day and he takes a freezing cold shower, that's how he starts off. Then he'll skip lunch at work and then at the end of the day, without having eaten all day, he'll go for a trail run in Palo Alto, [Calif.], where he lives. ... I started looking into the science and cold water exposure actually has some pretty interesting affects. [There are] studies of cold water swimmers and they are healthier than people who don't go cold-water swimming. ...

"Organisms that are exposed to stress in certain ways respond to it and become stronger. ... On the cellular level ... it has an effect of almost like cleaning up or reorganizing your proteins so they're in better shape."

The idea is this concept of hormesis — that's the stress response. That's another thing we have hard-wired into our biology. Organisms that are exposed to stress in certain ways respond to it and become stronger. One obvious example is exercise. You stress out your muscles, you lift a weight or whatever, they're damaged, and then they come back stronger. On the cellular level it also works. It has an effect of almost like cleaning up or reorganizing your proteins so they're in better shape.

On the theory that eating less helps you live longer

[There is] something called the Caloric Restriction Society, and there are people who basically make a great effort to eat anywhere from 15 percent to 30 percent less than most of us eat. So obviously they're very skinny, but they're doing this because research for decades has shown feeding mice and other animals a lot less seems to make them live longer. ...

When we were hunter gatherers, we didn't get three meals a day, we might get three meals a week. So the people who survived — or the critters who survived — were the ones who could go for pretty decent periods without food and even then, not eat a whole lot of food. So our biology is kind of tuned to survive famines, to survive low-nutrient conditions. What that does [is it] puts our cells in a sort of stress-resistant state that ends up prolonging life.

Read an excerpt of Spring Chicken

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

From Naked Mole Rats To Dog Testicles: A Writer Explores The Longevity Quest

Thu, 02/26/2015 - 2:38pm
From Naked Mole Rats To Dog Testicles: A Writer Explores The Longevity Quest February 26, 2015 2:38 PM ET Listen to the Story 38 min 35 sec   Additional Information: Spring Chicken

Stay Young Forever (Or Die Trying)

by Bill Gifford

Hardcover, 366 pages | purchase

Purchase Featured Book
Title
Spring Chicken
Subtitle
Stay Young Forever (Or Die Trying)
Author
Bill Gifford

Your purchase helps support NPR Programming. How?

More on this book:

When journalist Bill Gifford turned 40, his friends gave him a cake shaped as a tombstone with the words, "R.I.P, My Youth." As he reflected on his creeping memory lapses and the weight he'd gained, Gifford got interested in the timeless quest to turn back the aging clock — or at least slow it down.

His latest book, Spring Chicken, explores everything from some wacky pseudo-cures for aging to fascinating research that point to causes of aging at the cellular level.

"In high school biology we pretty much learn that cells divide and divide forever and that's kind of what they thought up until about 1960," Gifford tells Fresh Air's Dave Davies. "Now they know that cells actually have a kind of lifespan — they have a limit to the number of times that they can divide."

Gifford says that after they're done dividing, the cells go into a state called "replicative senescence."

"So they go from being these lively dividing cells to basically retiring," he says. "And they're sitting there and they're kind of grumpy."

Scientists have learned that these cells are "basically toxic," he says.

"It's sort of like certain people bring everybody down," Gifford says. "Senescence cells are kind of the same way. Some people think that senescence cells actually drive much of what we recognize as aging."

Gifford's book not only explores the research at the cellular level, but he also looks at the history of anti-aging, how exercise, diet and stress affect growing old and interesting phenomena in the natural world — like the naked mole rat. It lives long, shows no increase in mortality with age, never gets cancer and never experiences menopause.

"They live underground; they're from Africa and they live in a colony," Gifford says. "I held one in my hand and she was the size of between a mouse and a rat — and she was 28 years old, whereas a mouse lives to about two years old. In human terms, it was like a 600-year-old person ... and she was pregnant."

These animals, Gifford says, have repair mechanisms in their cells that allow the cells to survive damage and live longer.

Scientists "recently sequenced the mole rat genome so they're looking pretty hard for what that might be," he says. "On the other hand, it might just be an anomaly ... we don't know. The point is that nature knows how to let animals live a very long time."

Interview Highlights

Bill Gifford is a contributing editor for Outside Magazine. His previous book was called Ledyard: In Search of the First American Explorer.

Darryl Patterson/Courtesy of Grand Central Publishing

On the late 19th century scientist Charles-Édouard Brown-Séquard

He was one of the great scientists of the 19th century; he's regarded as the founder of endocrinology, the study of glands. When he got to be about 70 years old he wasn't feeling so hot and he started to wonder why. He thought the answer had to do with something produced in the gonads, so he mixed up a little mixture of crushed up dog testicles, testicular blood and semen, mixed it all up and injected himself with it for a period of about three weeks. In 1889, he gave a triumphant address to the society of biology in Paris describing this experiment and how it had miraculously rejuvenated him, an old man, he could work through the night now, he could lift much more weight, he could urinate farther, all these fantastic things and people were horrified. ...

He was already 70 or 71 and he lived about another five years, so he did pretty well for the 19th century, but whether the treatment extended his lifespan, [it's] difficult to say. They now think it was pretty much a placebo effect.

It became a cultural sensation. ... It was called the Séquard Elixir and all kinds of quacks set up mail order businesses where you could get 10 syringes for $2.50. There were songs written about it; it was written up in all the papers. People went crazy. He never made a dime off it. ...

In a way, Séquard's elixir was kind of a precursor of the testosterone replacement and estrogen replacement therapies that are extremely popular right now. So he was onto something.

On the controversial pre-Depression era scientist John Brinkley

In between the elixir and the testosterone, there was an unfortunate intermediate step where a salesman named John Brinkley down in Texas began implanting goat testicles in worn out middle-aged men and he did similar surgeries in women. Obviously [this was] not a good idea and many people died on his operating table, but he became fabulously wealthy. He was one of the richest men in the pre-Depression era. He actually had a radio station down there. He was just across the border in Mexico because they kicked him out of the country, but he had this hugely powerful radio station that broadcast some of the early country music stars.

On the conference for anti-aging and human growth hormones

It was founded by these two doctors in Chicago who basically pioneered the use of human growth hormone as a treatment for aging back in the '90s. And a study had come out in about 1990 saying that older men gained muscle mass when they were on an exercise program and human growth hormone.

"The scientists I spoke to feel that human growth hormone, far from reversing aging, actually accelerates aging."

So they kind of took this and ran with it, and now, 20 years later, older Americans inject themselves with about $1.4 billion worth of human growth hormone per year and the system of injections costs about $10,000 to 12,000 a year. ...

[But] the scientists I spoke to feel that human growth hormone, far from reversing aging, actually accelerates aging. It turns on these pro-growth, pro-aging pathways. And there aren't clinical trials of this stuff because it's technically illegal for this use, but let's just say the longest [living] laboratory mice had zero growth hormone. Their cells had no growth hormone receptors. So human growth hormone might make you feel better for a short time, but it's very doubtful that it will lengthen your life and may do the opposite.

On anti-aging supplements

Additional Information: Related NPR Stories Shots - Health News Anti-Aging Hormone Could Make You Smarter Shots - Health News Like All Animals, We Need Stress. Just Not Too Much The Salt Eat Plants And Prosper: For Longevity, Go Easy On The Meat, Study Says

There's very little evidence for most of these supplements that you see marketed to older people. Supplements are very poorly regulated in this country and there just aren't the same evidentiary standards that you need for say, a drug. There was just a recent case where the attorney[s] general of several states found that supplements sold in places like Walmart had things like grass clippings in them.

On studying people who are over 100 years old

At [Albert] Einstein College of Medicine ... the theory is that that they have genes that protect them from the diseases of aging that the rest of us get. So they get to 100 and they don't have diabetes; they don't have heart disease; they don't have cancer; they've been protected somehow. So the question is: Do they have genes that protect them from these diseases and what are the genes and ... can we make a drug that can kind of imitate the action of those genes.

On how exercise affects aging

Anything really, is better than nothing. Basically, we evolved to move around, to run, to walk, to use our bodies and not to just sit around the way most of us do for most of the day. There's kind of an idea of use it or lose it and that's really programmed into our biology. The more you use your muscles, the more you're walking around, the more you're going to hang on to your muscle as you get older. That's really important because muscle wasting with age is the second leading cause of admission to nursing homes after Alzheimer's disease.

On the theory that short-term, controlled physical stress is good for longevity

[Blogger Todd Becker] believes in small amounts of stress as a way of life. It sounds completely crazy but there's actually a scientific basis to it. ... He wakes up in the morning every day and he takes a freezing cold shower, that's how he starts off. Then he'll skip lunch at work and then at the end of the day, without having eaten all day, he'll go for a trail run in Palo Alto, [Calif.], where he lives. ... I started looking into the science and cold water exposure actually has some pretty interesting affects. [There are] studies of cold water swimmers and they are healthier than people who don't go cold-water swimming. ...

"Organisms that are exposed to stress in certain ways respond to it and become stronger. ... On the cellular level ... it has an effect of almost like cleaning up or reorganizing your proteins so they're in better shape."

The idea is this concept of hormesis — that's the stress response. That's another thing we have hard-wired into our biology. Organisms that are exposed to stress in certain ways respond to it and become stronger. One obvious example is exercise. You stress out your muscles, you lift a weight or whatever, they're damaged, and then they come back stronger. On the cellular level it also works. It has an effect of almost like cleaning up or reorganizing your proteins so they're in better shape.

On the theory that eating less helps you live longer

[There is] something called the Caloric Restriction Society, and there are people who basically make a great effort to eat anywhere from 15 percent to 30 percent less than most of us eat. So obviously they're very skinny, but they're doing this because research for decades has shown feeding mice and other animals a lot less seems to make them live longer. ...

When we were hunter gatherers, we didn't get three meals a day, we might get three meals a week. So the people who survived — or the critters who survived — were the ones who could go for pretty decent periods without food and even then, not eat a whole lot of food. So our biology is kind of tuned to survive famines, to survive low-nutrient conditions. What that does [is it] puts our cells in a sort of stress-resistant state that ends up prolonging life.

Read an excerpt of Spring Chicken

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Doctors Join Forces With Lawyers To Reduce Firearms Deaths

Thu, 02/26/2015 - 11:51am
Doctors Join Forces With Lawyers To Reduce Firearms Deaths February 26, 201511:51 AM ET

Closing loopholes in background checks for gun purchases would reduce the risk of death and injury, doctors' and attorneys' groups say.

Alexa Miller/Getty Images

Each year more than 32,000 people die in the United States as a result of suicides, homicides and accidents with firearms.

For years doctors have tried to reduce the toll by addressing gun injuries and deaths as a public health issue; there's ample evidence that ease of access to is linked to the number of suicides and homicides. But those efforts haven't gained much traction.

Shots - Health News How A Patient's Suicide Changed A Doctor's Approach To Guns

On Monday, six medical organizations including the American College of Physicians and professional societies for surgeons, family doctors, obstetricians and gynecologists, pediatricians and emergency physicians joined with the American Public Health Association and the American Bar Association in a "call to action" aimed at reducing the health consequences of firearms. Shots talked with Dr. Steven Weinberger, executive vice president and CEO of the American College of Physicians and leader of the effort, on what the doctors hope to change. This is an edited version of the conversation.

Your top priority is expanding criminal background checks to cover all firearm purchases. Why is that so important?

Right now there are loopholes in the background checks and there are certainly quite a few people who end up purchasing firearms through those loopholes, whether through private sales from an individual or gun show sales. All of a sudden the background checks are no longer effective. We feel that should be a universal requirement.

But you're also worried about laws that require doctors to report people who have mental health or substance abuse problems; some states bar them from buying or owning firearms. Why is that?

U.S. Battling Suicide In A 'Gun State' Means Treading Carefully

This is the tricky one. There needs to be better access to mental health care in the United States, I think there's no question about that. People who get adequate treatment are less likely to commit acts of violence. But if reporting of all people with mental health and substance abuse disorders is made a requirement, then people have a disincentive to seek care. We feel this has to be done on a case-by-case basis, not merely based on the presence of a mental or substance abuse disorder, but whether that person is at risk of doing harm to himself or herself or to others.

The paper says that private ownership of assault weapons represents a "grave danger to the public" and you want tighter restrictions on their use. How did you decide on that?

The tricky thing was how to define these particular types of firearms. We chose "military" type. We know gun manufacturers have done all sorts of things to get around those requirements in the past. It's relatively easy for the general public to say this is a military-style assault weapon in terms of the appearance and the magazine capacity. We really don't see any need for civilian use for those types of weapons or ammunition. And they have been of major import in mass shootings. So we feel it's critical to eliminate private use of those.

The Two-Way Fatal Shooting At Firing Range Sparks Debate About Safety

Obviously the gun lobby has been against anything at all that has any sort of restrictions on firearms or the type of person who can use firearms. Our hope is that there may be some ability to move this forward since we have the American Bar Association on this with us. We can speak to the medical and public health issues on this, but we are not constitutional law scholars. They have confirmed that these recommendations are constitutionally sound.

Some states have attempted "gag laws" that bar doctors from talking with patients or parents about gun safety or asking them if they have firearms in the house. As doctors you think this is a very bad idea. Why?

Shots - Health News Doctors' Questions About Guns Spark A Constitutional Fight

This is something that unfortunately comes up all the time. The idea that a pediatrician can't be speaking with a patient about the issue of firearm safety and whether there's a firearm in the home is really problematic. It does violate First Amendment rights, but beyond that it interferes with the physician-patient relationship in a really inappropriate way. With the things we've seen with a child going into a mother's pocketbook and pulling out a gun and shooting someone, it's tragic and it's unconscionable.

Doctors have been fighting this battle for years and not making much progress, frankly. It's got to be frustrating.

It is frustrating. One of the other authors on the report said that the number of people who are killed with firearms is the equivalent of a 747 going down with all its passengers once a week throughout the year. If we saw that would there be public uproar.

And these are preventable deaths. Homicides and suicides are things we can control. Obviously we recognize that this is an uphill battle. But it's such an important public health issue, we can't give up on it.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Doctors Join Forces With Lawyers To Reduce Firearms Deaths

Thu, 02/26/2015 - 11:51am
Doctors Join Forces With Lawyers To Reduce Firearms Deaths February 26, 201511:51 AM ET

Closing loopholes in background checks for gun purchases would reduce the risk of death and injury, doctors' and attorneys' groups say.

Alexa Miller/Getty Images

Each year more than 32,000 people die in the United States as a result of suicides, homicides and accidents with firearms.

For years doctors have tried to reduce the toll by addressing gun injuries and deaths as a public health issue; there's ample evidence that ease of access to is linked to the number of suicides and homicides. But those efforts haven't gained much traction.

Shots - Health News How A Patient's Suicide Changed A Doctor's Approach To Guns

On Monday, six medical organizations including the American College of Physicians and professional societies for surgeons, family doctors, obstetricians and gynecologists, pediatricians and emergency physicians joined with the American Public Health Association and the American Bar Association in a "call to action" aimed at reducing the health consequences of firearms. Shots talked with Dr. Steven Weinberger, executive vice president and CEO of the American College of Physicians and leader of the effort, on what the doctors hope to change. This is an edited version of the conversation.

Your top priority is expanding criminal background checks to cover all firearm purchases. Why is that so important?

Right now there are loopholes in the background checks and there are certainly quite a few people who end up purchasing firearms through those loopholes, whether through private sales from an individual or gun show sales. All of a sudden the background checks are no longer effective. We feel that should be a universal requirement.

But you're also worried about laws that require doctors to report people who have mental health or substance abuse problems; some states bar them from buying or owning firearms. Why is that?

U.S. Battling Suicide In A 'Gun State' Means Treading Carefully

This is the tricky one. There needs to be better access to mental health care in the United States, I think there's no question about that. People who get adequate treatment are less likely to commit acts of violence. But if reporting of all people with mental health and substance abuse disorders is made a requirement, then people have a disincentive to seek care. We feel this has to be done on a case-by-case basis, not merely based on the presence of a mental or substance abuse disorder, but whether that person is at risk of doing harm to himself or herself or to others.

The paper says that private ownership of assault weapons represents a "grave danger to the public" and you want tighter restrictions on their use. How did you decide on that?

The tricky thing was how to define these particular types of firearms. We chose "military" type. We know gun manufacturers have done all sorts of things to get around those requirements in the past. It's relatively easy for the general public to say this is a military-style assault weapon in terms of the appearance and the magazine capacity. We really don't see any need for civilian use for those types of weapons or ammunition. And they have been of major import in mass shootings. So we feel it's critical to eliminate private use of those.

The Two-Way Fatal Shooting At Firing Range Sparks Debate About Safety

Obviously the gun lobby has been against anything at all that has any sort of restrictions on firearms or the type of person who can use firearms. Our hope is that there may be some ability to move this forward since we have the American Bar Association on this with us. We can speak to the medical and public health issues on this, but we are not constitutional law scholars. They have confirmed that these recommendations are constitutionally sound.

Some states have attempted "gag laws" that bar doctors from talking with patients or parents about gun safety or asking them if they have firearms in the house. As doctors you think this is a very bad idea. Why?

Shots - Health News Doctors' Questions About Guns Spark A Constitutional Fight

This is something that unfortunately comes up all the time. The idea that a pediatrician can't be speaking with a patient about the issue of firearm safety and whether there's a firearm in the home is really problematic. It does violate First Amendment rights, but beyond that it interferes with the physician-patient relationship in a really inappropriate way. With the things we've seen with a child going into a mother's pocketbook and pulling out a gun and shooting someone, it's tragic and it's unconscionable.

Doctors have been fighting this battle for years and not making much progress, frankly. It's got to be frustrating.

It is frustrating. One of the other authors on the report said that the number of people who are killed with firearms is the equivalent of a 747 going down with all its passengers once a week throughout the year. If we saw that would there be public uproar.

And these are preventable deaths. Homicides and suicides are things we can control. Obviously we recognize that this is an uphill battle. But it's such an important public health issue, we can't give up on it.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Attention, Shoppers: Prices For 70 Health Care Procedures Now Online!

Thu, 02/26/2015 - 9:10am
Attention, Shoppers: Prices For 70 Health Care Procedures Now Online! February 26, 2015 9:10 AM ET

Partner content from

Jay Hancock

Shopping for an MRI scan? Guroo.org, won't yet show you what your local hospital or radiologist charges, but it will reveal the average cost of the test in your area.

iStockphoto

Buying health care in America is like shopping blindfolded at Macy's and getting the bill months after you leave the store, Princeton economist Uwe Reinhardt likes to say.

Shots - Health News How Much Is That MRI, Really? Massachusetts Shines A Light

But an online tool that went live Wednesday is supposed to help change that, giving patients in most parts of the country a small peek at the prices of medical tests and procedures before they open their wallets.

Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?

A website called Guroo.com shows the average local cost for 70 common diagnoses and medical tests in most states. It's showing the real cost — not the published charges, which often get marked down — based on a giant database of what insurance companies actually pay.

OK, this isn't like Priceline.com for knee replacements. What Guroo hopes to do for consumers is still limited.

It won't reflect costs for particular hospitals or doctors, although officials say that's coming, in some cases. And it doesn't yet have much to say about the quality of care.

Still, consumer advocates say Guroo should shed new light on the nation's opaque, complex and maddening medical bazaar.

Shots - Health News 'America's Bitter Pill' Makes Case For Why Health Care Law 'Won't Work' Shots - Health News In California, That MRI Will Cost You $255 — Or Maybe $6,221

"This has the potential to be a game changer," said Katherine Hempstead, who analyzes health insurance for the Robert Wood Johnson Foundation. "It's good for uninsured people. It's good for people with high deductibles. It's good for any person [who is] kind of wondering: If I go to see the doctor for such-and-such, what might happen next?"

Guroo is produced by the nonprofit and nonpartisan Health Care Cost Institute, working with three big insurance companies: UnitedHealthcare, Aetna and Humana. (A fourth, insurance firm, Assurant, will soon join the consortium.) The idea is to eventually let members of these health plans use a companion website to see how differing prices set by each provider affect copayments.

Known for its cost and utilization reports, HCCI receives some industry funding, but is governed by an independent board. This is its first tool for consumers.

Consumer advocates praise Guroo, but caution that the movement toward "transparency" in medical prices is still in its very early stages. Data on insurer, employer or government websites are often limited or inaccurate. Consumer information from Fair Health, which manages another huge commercial insurance database, is organized by procedure code.

Even on Guroo.org, "the average user may not have a good sense of what they're looking at and what they're supposed to do with the resulting price," said Lynn Quincy, a health care specialist at Consumers Union.

BlueCross BlueShield of North Carolina recently set a high standard for disclosure by posting prices — doctor by doctor and hospital by hospital — based on its reimbursement rates, Quincy says. Guroo doesn't do that.

HCCI says, so far, its prices detail what insurers pay for about 70 common tests and "bundles" of services, all described in understandable terms so patients don't need a medical textbook to figure out what they are. Users get the average (as well as a range) for local and national prices.

Your Money When Nonprofit Hospitals Sue Their Poorest Patients

That's not the same as seeing provider-specific prices online, of course. But within a year, HCCI expects to let members of UnitedHealthcare, Aetna, Assurant and Humana use a companion site to track spending, and check how switching caregivers might lower their out-of-pocket costs.

Information about the quality of the care provided — essential to helping patients make smart choices — is still to come, as well, Newman says. And at this point Guroo still lacks information on prices in Alabama, Michigan and several other states.

But given its size, influence and openness, Guroo could become a dominant portal for health care prices, says Hempstead.

"Their stance as a neutral broker," she says, "and the amount of data that they have and the amount of data that they're going to have really puts them in a different place."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

Attention, Shoppers: Prices For 70 Health Care Procedures Now Online!

Thu, 02/26/2015 - 9:10am
Attention, Shoppers: Prices For 70 Health Care Procedures Now Online! February 26, 2015 9:10 AM ET

Partner content from

Jay Hancock

Shopping for an MRI scan? Guroo.org, won't yet show you what your local hospital or radiologist charges, but it will reveal the average cost of the test in your area.

iStockphoto

Buying health care in America is like shopping blindfolded at Macy's and getting the bill months after you leave the store, Princeton economist Uwe Reinhardt likes to say.

Shots - Health News How Much Is That MRI, Really? Massachusetts Shines A Light

But an online tool that went live Wednesday is supposed to help change that, giving patients in most parts of the country a small peek at the prices of medical tests and procedures before they open their wallets.

Got a sore knee? Having a baby? Need a primary-care doctor? Shopping for an MRI scan?

A website called Guroo.com shows the average local cost for 70 common diagnoses and medical tests in most states. It's showing the real cost — not the published charges, which often get marked down — based on a giant database of what insurance companies actually pay.

OK, this isn't like Priceline.com for knee replacements. What Guroo hopes to do for consumers is still limited.

It won't reflect costs for particular hospitals or doctors, although officials say that's coming, in some cases. And it doesn't yet have much to say about the quality of care.

Still, consumer advocates say Guroo should shed new light on the nation's opaque, complex and maddening medical bazaar.

Shots - Health News 'America's Bitter Pill' Makes Case For Why Health Care Law 'Won't Work' Shots - Health News In California, That MRI Will Cost You $255 — Or Maybe $6,221

"This has the potential to be a game changer," said Katherine Hempstead, who analyzes health insurance for the Robert Wood Johnson Foundation. "It's good for uninsured people. It's good for people with high deductibles. It's good for any person [who is] kind of wondering: If I go to see the doctor for such-and-such, what might happen next?"

Guroo is produced by the nonprofit and nonpartisan Health Care Cost Institute, working with three big insurance companies: UnitedHealthcare, Aetna and Humana. (A fourth, insurance firm, Assurant, will soon join the consortium.) The idea is to eventually let members of these health plans use a companion website to see how differing prices set by each provider affect copayments.

Known for its cost and utilization reports, HCCI receives some industry funding, but is governed by an independent board. This is its first tool for consumers.

Consumer advocates praise Guroo, but caution that the movement toward "transparency" in medical prices is still in its very early stages. Data on insurer, employer or government websites are often limited or inaccurate. Consumer information from Fair Health, which manages another huge commercial insurance database, is organized by procedure code.

Even on Guroo.org, "the average user may not have a good sense of what they're looking at and what they're supposed to do with the resulting price," said Lynn Quincy, a health care specialist at Consumers Union.

BlueCross BlueShield of North Carolina recently set a high standard for disclosure by posting prices — doctor by doctor and hospital by hospital — based on its reimbursement rates, Quincy says. Guroo doesn't do that.

HCCI says, so far, its prices detail what insurers pay for about 70 common tests and "bundles" of services, all described in understandable terms so patients don't need a medical textbook to figure out what they are. Users get the average (as well as a range) for local and national prices.

Your Money When Nonprofit Hospitals Sue Their Poorest Patients

That's not the same as seeing provider-specific prices online, of course. But within a year, HCCI expects to let members of UnitedHealthcare, Aetna, Assurant and Humana use a companion site to track spending, and check how switching caregivers might lower their out-of-pocket costs.

Information about the quality of the care provided — essential to helping patients make smart choices — is still to come, as well, Newman says. And at this point Guroo still lacks information on prices in Alabama, Michigan and several other states.

But given its size, influence and openness, Guroo could become a dominant portal for health care prices, says Hempstead.

"Their stance as a neutral broker," she says, "and the amount of data that they have and the amount of data that they're going to have really puts them in a different place."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

Infections With Dangerous Gut Microbe Still On The Rise

Wed, 02/25/2015 - 5:00pm
Infections With Dangerous Gut Microbe Still On The Rise February 25, 2015 5:00 PM ET

An overgrowth of Clostridium difficile bacteria can inflame the colon with a life-threatening infection.

Dr. David Phillips/Getty Images/Visuals Unlimited

A potentially life-threatening gastrointestinal infection is more common than previously estimated, federal health officials reported Wednesday.

The infection, caused by a bacterium known as Clostridium difficile, or C-diff, causes nearly 500,000 illnesses in the United States each year and kills about 29,000, according to the federal Centers for Disease Control and Prevention.

Shots - Health News Deaths From Dangerous Gut Bacteria Hit Historic Highs

The estimate, based on an analysis of data collected at 10 geographic areas in 2011, is higher than any previous year, say CDC officials who published the data Wednesday in The New England Journal of Medicine.

The new estimate underscores a growing concern among doctors and health officials about the infection. C-diff produces a powerful toxin that can cause terrible diarrhea and is very difficult to treat, in part because many such infections are caused by strains of the bacteria that have become resistant to standard antibiotics.

Some patients end up having to have part of the colon removed to finally eradicate a C-diff infection. And even in those cases the infections frequently recur repeatedly — which can be severely debilitating and eventually fatal.

"This is very severe illness that causes tremendous suffering and death," Michael Bell, deputy director of the CDC's Division of Healthcare Quality Promotion at the National Center for Emerging and Zoonotic Infectious Diseases, told reporters during a Wednesday briefing.

Shots - Health News Hospitals Struggle To Beat Back Serious Infections Shots - Health News Frozen Poop Pills Fight Life-Threatening Infections

Bell stressed that the new numbers underscore the need to use antibiotics more sparingly; use of the drugs can upset the normal balance of bacteria in a person's digestive system, allowing C-diff to proliferate in some cases. Research shows C-diff infections often occur after patients have received antibiotics for some other reason.

The findings, the CDC says, also underscore the need for hospitals, nursing homes and other health care facilities to do a better job of preventing the spread of C-diff spores from one patient to the next (paying careful attention to frequent hand-washing and other hygiene protocols, for example, and offering infected patients a private room where possible). Many of these difficult infections emerge in a patient who is being treated for some other condition.

Increasingly, some doctors are trying to treat C-diff infections with a procedure known as a fecal transplant, which uses feces from a healthy donor to restore a healthy bacterial balance in the ill recipient.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Infections With Dangerous Gut Microbe Still On The Rise

Wed, 02/25/2015 - 5:00pm
Infections With Dangerous Gut Microbe Still On The Rise February 25, 2015 5:00 PM ET

An overgrowth of Clostridium difficile bacteria can inflame the colon with a life-threatening infection.

Dr. David Phillips/Getty Images/Visuals Unlimited

A potentially life-threatening gastrointestinal infection is more common than previously estimated, federal health officials reported Wednesday.

The infection, caused by a bacterium known as Clostridium difficile, or C-diff, causes nearly 500,000 illnesses in the United States each year and kills about 29,000, according to the federal Centers for Disease Control and Prevention.

Shots - Health News Deaths From Dangerous Gut Bacteria Hit Historic Highs

The estimate, based on an analysis of data collected at 10 geographic areas in 2011, is higher than any previous year, say CDC officials who published the data Wednesday in The New England Journal of Medicine.

The new estimate underscores a growing concern among doctors and health officials about the infection. C-diff produces a powerful toxin that can cause terrible diarrhea and is very difficult to treat, in part because many such infections are caused by strains of the bacteria that have become resistant to standard antibiotics.

Some patients end up having to have part of the colon removed to finally eradicate a C-diff infection. And even in those cases the infections frequently recur repeatedly — which can be severely debilitating and eventually fatal.

"This is very severe illness that causes tremendous suffering and death," Michael Bell, deputy director of the CDC's Division of Healthcare Quality Promotion at the National Center for Emerging and Zoonotic Infectious Diseases, told reporters during a Wednesday briefing.

Shots - Health News Hospitals Struggle To Beat Back Serious Infections Shots - Health News Frozen Poop Pills Fight Life-Threatening Infections

Bell stressed that the new numbers underscore the need to use antibiotics more sparingly; use of the drugs can upset the normal balance of bacteria in a person's digestive system, allowing C-diff to proliferate in some cases. Research shows C-diff infections often occur after patients have received antibiotics for some other reason.

The findings, the CDC says, also underscore the need for hospitals, nursing homes and other health care facilities to do a better job of preventing the spread of C-diff spores from one patient to the next (paying careful attention to frequent hand-washing and other hygiene protocols, for example, and offering infected patients a private room where possible). Many of these difficult infections emerge in a patient who is being treated for some other condition.

Increasingly, some doctors are trying to treat C-diff infections with a procedure known as a fecal transplant, which uses feces from a healthy donor to restore a healthy bacterial balance in the ill recipient.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Eyelashes Grow To Just The Right Length To Shield Eyes

Wed, 02/25/2015 - 1:56pm
Eyelashes Grow To Just The Right Length To Shield Eyes February 25, 2015 1:56 PM ET Poncie Rutsch

A calf sports platinum blonde lashes.

Mike Horrocks/Flickr

Attaching fake eyelashes might make give you a few extra millimeters to bat at your date, but they could also be channeling dust into your eyes. That's because the ideal eyelash length is about one third the width of an eye. And that goes for 22 different animals, not just humans.

A group of researchers at Georgia Tech found the ideal eyelash ratio after measuring pelts at the American Museum of Natural History. "They take great pride in their preservation of the pelt, all the hair and all the fur," says Guillermo Amador, a doctoral student in fluid mechanics at Georgia Tech and the lead author of the study, published Wednesday in the Journal of the Royal Society Interface.

One of his collaborators carefully measured the width of each eye and the length of the eyelashes on 22 different mammals, including species of camel, kangaroo, panda and armadillo.

The mammals measured included rabbit, goat, elephant, warthog, possum, elephant shrew, Baird's tapir, red kangaroo, leopard and porcupine.

So what happens when a fluid mechanics lab embarks on an eye study? They salvage the fan from a desktop computer and use it to build an adjustable wind tunnel, of course! "We used two different airflows that are right in the range that animals will experience when they're just walking at cruising speed in the air," Amador tells Shots.

To see how quickly an eye dries out, the researchers measured the mass of a small eye-sized dish to see how quickly water evaporates.

For the dust test, they added fluorescent dye to a humidifier and measured how much dye landed on an eye-sized piece of absorbent paper.

Camel lashes angle downward, presumably to protect from desert sand and sun.

iStockphoto

They tested false eyelashes and a porous mesh, and found that they both behaved the same way. Then they tested varying lengths of mesh to determine how the length of an animal's eyelashes affects how fast the eye dries out and how much dust gets in.

"As [the eyelashes] get longer you get less evaporation and less deposition," says Amador. This means wetter, cleaner eyes. "But if they get too long they start to channel more airflow towards the eye and that increases the evaporation and increases the deposition of the particles."

The curvature of the eyelashes doesn't seem to matter as much. Animal eyelashes vary greatly: camel lashes, for instance, angle downward, almost parallel to the surface of the eye. Amador and his colleagues measured length perpendicular to the surface of the eye to control for these differences.

But don't go trying to extend or trim your eyelashes to the perfect length. "Nature's kind of taken care of that for us," says Amador.

Eyelashes allow animals to keep their eyes open when they need to watch for predators or prey, so it makes sense that most eyelashes would reach a perfect length to minimize drying and dust.

"If women use false eyelashes they could actually dry out their eyes a little faster and have to blink more frequently," Amador says. Maybe all the flirtatious eyelash-batters of the world just have seriously dry eyes.

Still, Amador is enthusiastic about the potential applications of his findings for people with madarosis, which means loss of eyelashes due to health problems. "They do get eye infections more often," he says. In this case, donning false eyelashes could help. "It would give them a kind of protection from the elements."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Eyelashes Grow To Just The Right Length To Shield Eyes

Wed, 02/25/2015 - 1:56pm
Eyelashes Grow To Just The Right Length To Shield Eyes February 25, 2015 1:56 PM ET Poncie Rutsch

A calf sports platinum blonde lashes.

Mike Horrocks/Flickr

Attaching fake eyelashes might make give you a few extra millimeters to bat at your date, but they could also be channeling dust into your eyes. That's because the ideal eyelash length is about one third the width of an eye. And that goes for 22 different animals, not just humans.

A group of researchers at Georgia Tech found the ideal eyelash ratio after measuring pelts at the American Museum of Natural History. "They take great pride in their preservation of the pelt, all the hair and all the fur," says Guillermo Amador, a doctoral student in fluid mechanics at Georgia Tech and the lead author of the study, published Wednesday in the Journal of the Royal Society Interface.

One of his collaborators carefully measured the width of each eye and the length of the eyelashes on 22 different mammals, including species of camel, kangaroo, panda and armadillo.

The mammals measured included rabbit, goat, elephant, warthog, possum, elephant shrew, Baird's tapir, red kangaroo, leopard and porcupine.

So what happens when a fluid mechanics lab embarks on an eye study? They salvage the fan from a desktop computer and use it to build an adjustable wind tunnel, of course! "We used two different airflows that are right in the range that animals will experience when they're just walking at cruising speed in the air," Amador tells Shots.

To see how quickly an eye dries out, the researchers measured the mass of a small eye-sized dish to see how quickly water evaporates.

For the dust test, they added fluorescent dye to a humidifier and measured how much dye landed on an eye-sized piece of absorbent paper.

Camel lashes angle downward, presumably to protect from desert sand and sun.

iStockphoto

They tested false eyelashes and a porous mesh, and found that they both behaved the same way. Then they tested varying lengths of mesh to determine how the length of an animal's eyelashes affects how fast the eye dries out and how much dust gets in.

"As [the eyelashes] get longer you get less evaporation and less deposition," says Amador. This means wetter, cleaner eyes. "But if they get too long they start to channel more airflow towards the eye and that increases the evaporation and increases the deposition of the particles."

The curvature of the eyelashes doesn't seem to matter as much. Animal eyelashes vary greatly: camel lashes, for instance, angle downward, almost parallel to the surface of the eye. Amador and his colleagues measured length perpendicular to the surface of the eye to control for these differences.

But don't go trying to extend or trim your eyelashes to the perfect length. "Nature's kind of taken care of that for us," says Amador.

Eyelashes allow animals to keep their eyes open when they need to watch for predators or prey, so it makes sense that most eyelashes would reach a perfect length to minimize drying and dust.

"If women use false eyelashes they could actually dry out their eyes a little faster and have to blink more frequently," Amador says. Maybe all the flirtatious eyelash-batters of the world just have seriously dry eyes.

Still, Amador is enthusiastic about the potential applications of his findings for people with madarosis, which means loss of eyelashes due to health problems. "They do get eye infections more often," he says. In this case, donning false eyelashes could help. "It would give them a kind of protection from the elements."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

May I Move My Son Off My Insurance So He Can Buy On The Exchange?

Wed, 02/25/2015 - 9:58am
May I Move My Son Off My Insurance So He Can Buy On The Exchange? February 25, 2015 9:58 AM ET

Partner content from

Michelle Andrews

Some people are trying to figure out how to become eligible for coverage on the health insurance marketplaces. Others are wondering how the Affordable Care Act may affect coverage they buy for their children under previously established state programs.

I am covered by my employer's health plan, but I'm not happy with it. My son is 21 and currently covered under my plan. While I realize that I am not eligible for Obamacare, I am curious if I can terminate my son's policy so that he might be eligible.

Since the open enrollment period to sign up for coverage on the state marketplaces ended Feb. 15, in general, people can't enroll in a marketplace plan until next year's open enrollment period rolls around.

If you drop your son from your employer plan, however, his loss of coverage could trigger a special enrollment period that allows him to sign up for a marketplace plan. Whether he's entitled to a special enrollment period depends on whether his loss of coverage is considered voluntary, say officials at the Centers for Medicare & Medicaid Services. In general, voluntarily dropping employer-sponsored coverage doesn't trigger a special enrollment period for individuals or their family members. But if you drop your son's coverage on his behalf without his consent, his loss of coverage wouldn't be considered voluntary and your son could qualify, according to CMS.

Whether he'll be eligible for tax credits to make marketplace coverage more affordable is another matter, says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

If you claim him as your dependent, he generally won't be eligible. If you don't claim him as your dependent, he would have to qualify for subsidies based on his own income.

I received a notice from the Pennsylvania Children's Health Insurance Program that says they are eliminating CHIP coverage for participants who pay full-cost CHIP because it isn't compliant with the Affordable Care Act. They are forcing us onto the marketplace where the premiums are higher and our deductibles are higher. I believe the state is using the ACA to dismantle its CHIP plan. What can we do?

You should be able to keep your full-cost CHIP coverage after all because state and federal officials reached an agreement on the issue, say consumer advocates in Pennsylvania.

CHIP offers coverage to children in families that earn too much to qualify for Medicaid, the joint federal-state health program for low-income people. But in six states – including Pennsylvania – the program allows families that earn too much to qualify for CHIP under its guidelines to enroll their kids if they pay the full cost of coverage.

The federal government, however, determined that, among other things, the CHIP buy-in program didn't comply with the health law because plans had annual limits on certain types of coverage, such as behavioral health and physical therapy, that aren't allowed, says Ann Bacharach, special projects director at the Pennsylvania Health Law Project. That meant that the families of roughly 3,600 kids in the program would face penalties because the kids wouldn't be considered to have "minimum essential coverage."

But after notifying families that the full-cost CHIP coverage was ending, Pennsylvania Gov. Tom Wolf earlier this month said that his administration had reached an agreement with the federal government so that coverage could continue without penalties. Insurers, meanwhile, will work to bring the plans into compliance with the health law over the coming months.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

May I Move My Son Off My Insurance So He Can Buy On The Exchange?

Wed, 02/25/2015 - 9:58am
May I Move My Son Off My Insurance So He Can Buy On The Exchange? February 25, 2015 9:58 AM ET

Partner content from

Michelle Andrews

Some people are trying to figure out how to become eligible for coverage on the health insurance marketplaces. Others are wondering how the Affordable Care Act may affect coverage they buy for their children under previously established state programs.

I am covered by my employer's health plan, but I'm not happy with it. My son is 21 and currently covered under my plan. While I realize that I am not eligible for Obamacare, I am curious if I can terminate my son's policy so that he might be eligible.

Since the open enrollment period to sign up for coverage on the state marketplaces ended Feb. 15, in general, people can't enroll in a marketplace plan until next year's open enrollment period rolls around.

If you drop your son from your employer plan, however, his loss of coverage could trigger a special enrollment period that allows him to sign up for a marketplace plan. Whether he's entitled to a special enrollment period depends on whether his loss of coverage is considered voluntary, say officials at the Centers for Medicare & Medicaid Services. In general, voluntarily dropping employer-sponsored coverage doesn't trigger a special enrollment period for individuals or their family members. But if you drop your son's coverage on his behalf without his consent, his loss of coverage wouldn't be considered voluntary and your son could qualify, according to CMS.

Whether he'll be eligible for tax credits to make marketplace coverage more affordable is another matter, says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

If you claim him as your dependent, he generally won't be eligible. If you don't claim him as your dependent, he would have to qualify for subsidies based on his own income.

I received a notice from the Pennsylvania Children's Health Insurance Program that says they are eliminating CHIP coverage for participants who pay full-cost CHIP because it isn't compliant with the Affordable Care Act. They are forcing us onto the marketplace where the premiums are higher and our deductibles are higher. I believe the state is using the ACA to dismantle its CHIP plan. What can we do?

You should be able to keep your full-cost CHIP coverage after all because state and federal officials reached an agreement on the issue, say consumer advocates in Pennsylvania.

CHIP offers coverage to children in families that earn too much to qualify for Medicaid, the joint federal-state health program for low-income people. But in six states – including Pennsylvania – the program allows families that earn too much to qualify for CHIP under its guidelines to enroll their kids if they pay the full cost of coverage.

The federal government, however, determined that, among other things, the CHIP buy-in program didn't comply with the health law because plans had annual limits on certain types of coverage, such as behavioral health and physical therapy, that aren't allowed, says Ann Bacharach, special projects director at the Pennsylvania Health Law Project. That meant that the families of roughly 3,600 kids in the program would face penalties because the kids wouldn't be considered to have "minimum essential coverage."

But after notifying families that the full-cost CHIP coverage was ending, Pennsylvania Gov. Tom Wolf earlier this month said that his administration had reached an agreement with the federal government so that coverage could continue without penalties. Insurers, meanwhile, will work to bring the plans into compliance with the health law over the coming months.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

Gerbils Likely Pushed Plague To Europe in Middle Ages

Tue, 02/24/2015 - 4:53pm
Gerbils Likely Pushed Plague To Europe in Middle Ages February 24, 2015 4:53 PM ET Listen to the Story 2 min 22 sec  

Gerbils are a beloved classroom pet, but they might also be deadly killers. A study now claims that gerbils helped bring bubonic plague to Medieval Europe and contributed to the deaths of millions.

Plague is caused by bacteria (Yersinia pestis) found in rodents, and the fleas that live on rodents. The rodent that's usually Suspect Zero is the rat.

"I like rats," says Nils Christian Stenseth, an evolutionary ecologist at the University of Oslo. "But there is a myth around rats that they are evil."

"If you get your gerbil at a pet store ... you have nothing to worry about."

He says the rat story doesn't add up: If rats carried plague to Europe, and Europe is still full of rats today, then plague should also be found in European cities. But it isn't.

Stenseth suspects that the plague came to Europe multiple times from Asia, where it still exists today. The rodents that carry plague in Asia include the cutest of infectious hosts: the gerbil.

"What we are suggesting is that it was gerbils in Central Asia and the bacterium in gerbils that eventually came to Europe," Stenseth says. The scientists used climate records to check their theory, and they found a tentative link. When the climate in Asia was good, gerbils are thought to have thrived; but when it went bad, the population crashed. And about 15 years after each boom and bust, a plague outbreak erupted in Europe. The theory is that fleas carrying plague jumped from dead gerbils to pack animals and human traders, who then brought it to European cities. The research team's results appear in the current issue of the Proceedings of the National Academy of Sciences.

Goats and Soda Shades Of The Middle Ages: The Plague Popped Up In China And Colorado Shots - Health News Decoded DNA Reveals Details Of Black Death Germ

Stenseth isn't alone in his belief. Ken Gage, who studies plague for the Centers for Disease Control and Prevention, says more and more evidence is pointing to Asian rodents as the source of European plague. Rats aren't entirely blameless, he notes – they've been linked to a number of plague outbreaks, including the original outbreak that brought the disease to America at the start of the 20th century.

But Gage says he's beginning to think that rats should be at least partially exonerated.

"When you see the old textbooks and descriptions of plague and the Black Death, it's all rats and rat fleas," he says. "That story got going and it's persisted for a long time."

He says gerbils and other Asian rodents look like the real threat. Gage adds that the CDC isn't worried about the domestic gerbils Americans keep as pets.

"If you get your gerbil at a pet store ... you have nothing to worry about," Gage says.

Pet gerbils aren't exposed to plague, and hopefully they don't have the fleas needed to carry it either.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Gerbils Likely Pushed Plague To Europe in Middle Ages

Tue, 02/24/2015 - 4:53pm
Gerbils Likely Pushed Plague To Europe in Middle Ages February 24, 2015 4:53 PM ET Listen to the Story 2 min 22 sec  

Gerbils are a beloved classroom pet, but they might also be deadly killers. A study now claims that gerbils helped bring bubonic plague to Medieval Europe and contributed to the deaths of millions.

Plague is caused by bacteria (Yersinia pestis) found in rodents, and the fleas that live on rodents. The rodent that's usually Suspect Zero is the rat.

"I like rats," says Nils Christian Stenseth, an evolutionary ecologist at the University of Oslo. "But there is a myth around rats that they are evil."

"If you get your gerbil at a pet store ... you have nothing to worry about."

He says the rat story doesn't add up: If rats carried plague to Europe, and Europe is still full of rats today, then plague should also be found in European cities. But it isn't.

Stenseth suspects that the plague came to Europe multiple times from Asia, where it still exists today. The rodents that carry plague in Asia include the cutest of infectious hosts: the gerbil.

"What we are suggesting is that it was gerbils in Central Asia and the bacterium in gerbils that eventually came to Europe," Stenseth says. The scientists used climate records to check their theory, and they found a tentative link. When the climate in Asia was good, gerbils are thought to have thrived; but when it went bad, the population crashed. And about 15 years after each boom and bust, a plague outbreak erupted in Europe. The theory is that fleas carrying plague jumped from dead gerbils to pack animals and human traders, who then brought it to European cities. The research team's results appear in the current issue of the Proceedings of the National Academy of Sciences.

Goats and Soda Shades Of The Middle Ages: The Plague Popped Up In China And Colorado Shots - Health News Decoded DNA Reveals Details Of Black Death Germ

Stenseth isn't alone in his belief. Ken Gage, who studies plague for the Centers for Disease Control and Prevention, says more and more evidence is pointing to Asian rodents as the source of European plague. Rats aren't entirely blameless, he notes – they've been linked to a number of plague outbreaks, including the original outbreak that brought the disease to America at the start of the 20th century.

But Gage says he's beginning to think that rats should be at least partially exonerated.

"When you see the old textbooks and descriptions of plague and the Black Death, it's all rats and rat fleas," he says. "That story got going and it's persisted for a long time."

He says gerbils and other Asian rodents look like the real threat. Gage adds that the CDC isn't worried about the domestic gerbils Americans keep as pets.

"If you get your gerbil at a pet store ... you have nothing to worry about," Gage says.

Pet gerbils aren't exposed to plague, and hopefully they don't have the fleas needed to carry it either.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Gerbils Likely Pushed Plague To Europe in Middle Ages

Tue, 02/24/2015 - 4:53pm
Gerbils Likely Pushed Plague To Europe in Middle Ages February 24, 2015 4:53 PM ET Listen to the Story 2 min 22 sec  

Gerbils are a beloved classroom pet, but they might also be deadly killers. A study now claims that gerbils helped bring bubonic plague to Medieval Europe and contributed to the deaths of millions.

Plague is caused by bacteria (Yersinia pestis) found in rodents, and the fleas that live on rodents. The rodent that's usually Suspect Zero is the rat.

"I like rats," says Nils Christian Stenseth, an evolutionary ecologist at the University of Oslo. "But there is a myth around rats that they are evil."

"If you get your gerbil at a pet store ... you have nothing to worry about."

He says the rat story doesn't add up: If rats carried plague to Europe, and Europe is still full of rats today, then plague should also be found in European cities. But it isn't.

Stenseth suspects that the plague came to Europe multiple times from Asia, where it still exists today. The rodents that carry plague in Asia include the cutest of infectious hosts: the gerbil.

"What we are suggesting is that it was gerbils in Central Asia and the bacterium in gerbils that eventually came to Europe," Stenseth says. The scientists used climate records to check their theory, and they found a tentative link. When the climate in Asia was good, gerbils are thought to have thrived; but when it went bad, the population crashed. And about 15 years after each boom and bust, a plague outbreak erupted in Europe. The theory is that fleas carrying plague jumped from dead gerbils to pack animals and human traders, who then brought it to European cities. The research team's results appear in the current issue of the Proceedings of the National Academy of Sciences.

Goats and Soda Shades Of The Middle Ages: The Plague Popped Up In China And Colorado Shots - Health News Decoded DNA Reveals Details Of Black Death Germ

Stenseth isn't alone in his belief. Ken Gage, who studies plague for the Centers for Disease Control and Prevention, says more and more evidence is pointing to Asian rodents as the source of European plague. Rats aren't entirely blameless, he notes – they've been linked to a number of plague outbreaks, including the original outbreak that brought the disease to America at the start of the 20th century.

But Gage says he's beginning to think that rats should be at least partially exonerated.

"When you see the old textbooks and descriptions of plague and the Black Death, it's all rats and rat fleas," he says. "That story got going and it's persisted for a long time."

He says gerbils and other Asian rodents look like the real threat. Gage adds that the CDC isn't worried about the domestic gerbils Americans keep as pets.

"If you get your gerbil at a pet store ... you have nothing to worry about," Gage says.

Pet gerbils aren't exposed to plague, and hopefully they don't have the fleas needed to carry it either.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Younger Women Hesitate To Say They're Having A Heart Attack

Tue, 02/24/2015 - 4:26pm
Younger Women Hesitate To Say They're Having A Heart Attack February 24, 2015 4:26 PM ET

Each year more than 15,000 women under the age of 55 die of heart disease in the United States. And younger women are twice as likely to die after being hospitalized for a heart attack as men in the same age group.

It doesn't help that women tend to delay seeking emergency care for symptoms of a heart attack such as pain and dizziness, says Judith Lichtman, an associate professor of epidemiology at the Yale School of Public Health. "We've known that for a while," she says.

In a small study published Tuesday in Circulation: Cardiovascular Quality and Outcomes, Lichtman and her colleagues looked into why women delay getting help. The researchers conducted in-depth interviews with 30 women, ages 30 to 55, who had been hospitalized after a heart attack.

Shots - Health News In Women, Heart Attacks Often Strike Without Chest Pain

It turned out that many had trouble recognizing that they were having symptoms of a heart attack. "A lot of them talk about not really experiencing the Hollywood heart attack," Lichtman tells Shots.

A heart attack doesn't necessarily feel like a sudden painful episode that ends in collapse, she notes. And women are more likely than men to experience vague symptoms like nausea or pain down their arms.

"Women may experience a combination of things they don't always associate with a heart attack," Lichtman says. "Maybe we need to do a better job of explaining and describing to the public what a heart attack looks and feels like."

But even when women suspected that they were having a heart attack, many said they were hesitant to bring it up because they didn't want to look like hypochondriacs.

"We need to do a better job of empowering women to share their concerns and symptoms," Lichtman says.

Shots - Health News Diabetes Raises Women's Risk Of Heart Disease More Than For Men

And medical professionals may need to do a better job of listening, she adds. Several women reported that their doctors initially misdiagnosed the pain, assuming that the women were suffering from acid reflux or gas.

Doctors should pay special attention to women who have high blood pressure or cholesterol, as well as those with a family history of heart disease, Lichtman says.

This is just a preliminary study. Lichtman has already started working on a much larger study investigating why women have a higher risk of dying from heart disease than men.

But the findings aren't too surprising, says Dr. Nisha Parikh, a cardiologist at the University of California, San Francisco who wasn't involved in the research.

"I take care of young women who have heart disease, and this story is very common," she says.

Part of the issue is that most of the research on heart disease has focused on men, since the condition is more common among men. As a result, the diagnostic tools that doctors use to identify heart disease aren't always well suited for female patients.

Cardiologists are just beginning to rethink how to best recognize and treat heart attacks in women, Parikh notes.

Heart disease is the third leading cause of death for women ages 35 to 44, and it's the second leading cause of death for women 45 to 54, according to the Centers for Disease Control and Prevention. (Cancer is the No. 1 cause.)

"Historically we thought of heart disease as sort of a man's disease," Parikh says. "But that's not the case."

This study also highlights the importance of empowering women to speak up about their worries, says. Dr. Jennifer Tremmel, a cardiologist at Stanford University.

"It's interesting because the whole idea of female hysteria dates back to ancient times," Tremmel says. "This is an ongoing issue in the medical field, and we all have to empower women patients, so they know that they need to not be so worried about going to the hospital if they're afraid there's something wrong."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Younger Women Hesitate To Say They're Having A Heart Attack

Tue, 02/24/2015 - 4:26pm
Younger Women Hesitate To Say They're Having A Heart Attack February 24, 2015 4:26 PM ET

Each year more than 15,000 women under the age of 55 die of heart disease in the United States. And younger women are twice as likely to die after being hospitalized for a heart attack as men in the same age group.

It doesn't help that women tend to delay seeking emergency care for symptoms of a heart attack such as pain and dizziness, says Judith Lichtman, an associate professor of epidemiology at the Yale School of Public Health. "We've known that for a while," she says.

In a small study published Tuesday in Circulation: Cardiovascular Quality and Outcomes, Lichtman and her colleagues looked into why women delay getting help. The researchers conducted in-depth interviews with 30 women, ages 30 to 55, who had been hospitalized after a heart attack.

Shots - Health News In Women, Heart Attacks Often Strike Without Chest Pain

It turned out that many had trouble recognizing that they were having symptoms of a heart attack. "A lot of them talk about not really experiencing the Hollywood heart attack," Lichtman tells Shots.

A heart attack doesn't necessarily feel like a sudden painful episode that ends in collapse, she notes. And women are more likely than men to experience vague symptoms like nausea or pain down their arms.

"Women may experience a combination of things they don't always associate with a heart attack," Lichtman says. "Maybe we need to do a better job of explaining and describing to the public what a heart attack looks and feels like."

But even when women suspected that they were having a heart attack, many said they were hesitant to bring it up because they didn't want to look like hypochondriacs.

"We need to do a better job of empowering women to share their concerns and symptoms," Lichtman says.

Shots - Health News Diabetes Raises Women's Risk Of Heart Disease More Than For Men

And medical professionals may need to do a better job of listening, she adds. Several women reported that their doctors initially misdiagnosed the pain, assuming that the women were suffering from acid reflux or gas.

Doctors should pay special attention to women who have high blood pressure or cholesterol, as well as those with a family history of heart disease, Lichtman says.

This is just a preliminary study. Lichtman has already started working on a much larger study investigating why women have a higher risk of dying from heart disease than men.

But the findings aren't too surprising, says Dr. Nisha Parikh, a cardiologist at the University of California, San Francisco who wasn't involved in the research.

"I take care of young women who have heart disease, and this story is very common," she says.

Part of the issue is that most of the research on heart disease has focused on men, since the condition is more common among men. As a result, the diagnostic tools that doctors use to identify heart disease aren't always well suited for female patients.

Cardiologists are just beginning to rethink how to best recognize and treat heart attacks in women, Parikh notes.

Heart disease is the third leading cause of death for women ages 35 to 44, and it's the second leading cause of death for women 45 to 54, according to the Centers for Disease Control and Prevention. (Cancer is the No. 1 cause.)

"Historically we thought of heart disease as sort of a man's disease," Parikh says. "But that's not the case."

This study also highlights the importance of empowering women to speak up about their worries, says. Dr. Jennifer Tremmel, a cardiologist at Stanford University.

"It's interesting because the whole idea of female hysteria dates back to ancient times," Tremmel says. "This is an ongoing issue in the medical field, and we all have to empower women patients, so they know that they need to not be so worried about going to the hospital if they're afraid there's something wrong."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Will Vaping Reignite The Battle Over Smoking On Airplanes?

Tue, 02/24/2015 - 3:37pm
Will Vaping Reignite The Battle Over Smoking On Airplanes? February 24, 2015 3:37 PM ET Poncie Rutsch

Those were the days: A stewardess lights a cigar for a passenger aboard an American Airlines flight in 1949.

Bettmann/CORBIS

My biggest concern while flying is whether my legs will fall victim to deep vein thrombosis from being crammed in the sardine can we call an airplane seat. But on the bright side, at least I'm not increasing my risk of lung cancer, emphysema and bronchitis because of secondhand smoke.

Wednesday marks the 25th anniversary of the ban on smoking on almost all domestic flights in the United States.

Getting clean air aloft wasn't easy. Flights attendants started pushing for a tobacco-free work environment in the 1960s, joined by public health advocates and airline pilots. In 1972, after polls showed that 60 percent of airline passengers were bothered by smoke in cabins, the Civil Aeronautics Board mandated separate sections for smokers and non-smokers.

But the smoking sections created huge enforcement problems for airline staff and didn't appease passengers or crew. Despite the unhappiness, regulators dithered.

A 1986 report from the National Research Council "unanimously and forcefully" called for a ban of smoking on all commercial flights. The council found that flight attendants were exposed to secondhand smoke equivalent to living with a pack-a-day smoker.

Is it still necessary to say "this flight is non-smoking" on flights?

— Ryan Gaynor (@rpgaynor) February 23, 2015

Congress approved a ban of smoking on flights of less than two hours in 1987; flight attendants, health and consumer groups continued to push for a complete ban. A study published in the Journal of the American Medical Association in 1989 found that passengers in non-smoking sections often were exposed to as much smoke as those in the smoking section.

In 1990, the ban was extended to include all domestic flights of six hours or less. It took another decade of lawsuits, studies, ad campaigns and fines, but in 2000 Congress passed a law banning smoking on every single flight entering or leaving the country.

That all seems so long ago. But human nature being what it is, not everyone is willing to bid adieu to lighting up.

In 2007, singer Amy Winehouse spent half of an hour-long flight from London to Glasgow smoking on the plane's toilet. A diplomat from Qatar decided to light a pipe on a plane from Washington, D.C., to Denver in 2010. A plane traveling from Halifax, Nova Scotia, to the Dominican Republic was forced to land after a family allegedly smoked in a bathroom, then got into an altercation with flight attendants.

Flight attendant just announced that there's "no smoking or vapin on this flight."

Categories: NPR Blogs

Will Vaping Reignite The Battle Over Smoking On Airplanes?

Tue, 02/24/2015 - 3:37pm
Will Vaping Reignite The Battle Over Smoking On Airplanes? February 24, 2015 3:37 PM ET Poncie Rutsch

Those were the days: A stewardess lights a cigar for a passenger aboard an American Airlines flight in 1949.

Bettmann/CORBIS

My biggest concern while flying is whether my legs will fall victim to deep vein thrombosis from being crammed in the sardine can we call an airplane seat. But on the bright side, at least I'm not increasing my risk of lung cancer, emphysema and bronchitis because of secondhand smoke.

Wednesday marks the 25th anniversary of the ban on smoking on almost all domestic flights in the United States.

Getting clean air aloft wasn't easy. Flights attendants started pushing for a tobacco-free work environment in the 1960s, joined by public health advocates and airline pilots. In 1972, after polls showed that 60 percent of airline passengers were bothered by smoke in cabins, the Civil Aeronautics Board mandated separate sections for smokers and non-smokers.

But the smoking sections created huge enforcement problems for airline staff and didn't appease passengers or crew. Despite the unhappiness, regulators dithered.

A 1986 report from the National Research Council "unanimously and forcefully" called for a ban of smoking on all commercial flights. The council found that flight attendants were exposed to secondhand smoke equivalent to living with a pack-a-day smoker.

Is it still necessary to say "this flight is non-smoking" on flights?

— Ryan Gaynor (@rpgaynor) February 23, 2015

Congress approved a ban of smoking on flights of less than two hours in 1987; flight attendants, health and consumer groups continued to push for a complete ban. A study published in the Journal of the American Medical Association in 1989 found that passengers in non-smoking sections often were exposed to as much smoke as those in the smoking section.

In 1990, the ban was extended to include all domestic flights of six hours or less. It took another decade of lawsuits, studies, ad campaigns and fines, but in 2000 Congress passed a law banning smoking on every single flight entering or leaving the country.

That all seems so long ago. But human nature being what it is, not everyone is willing to bid adieu to lighting up.

In 2007, singer Amy Winehouse spent half of an hour-long flight from London to Glasgow smoking on the plane's toilet. A diplomat from Qatar decided to light a pipe on a plane from Washington, D.C., to Denver in 2010. A plane traveling from Halifax, Nova Scotia, to the Dominican Republic was forced to land after a family allegedly smoked in a bathroom, then got into an altercation with flight attendants.

Flight attendant just announced that there's "no smoking or vapin on this flight."

Categories: NPR Blogs