NPR Health Blog

Syndicate content Shots - Health News
The NPR Health Blog
Updated: 29 min 27 sec ago

Can Divorced Dad Be Forced To Cover Insurance For Adult Kids?

Tue, 08/12/2014 - 9:53am
Can Divorced Dad Be Forced To Cover Insurance For Adult Kids? August 12, 2014 9:53 AM ET

Partner content from

iStockphoto

When it comes to health insurance for young adults, the Affordable Care Act made it possible for kids to stay on their parents' health plans until they turn 26. It was one of the first provisions of the law to take effect and has proved popular. But what happens when the parents are divorced? Here's a look at that question and a couple of others about coverage issues.

My ex-husband has been responsible for providing health insurance for our kids until the age of majority. My sons are now 21 and almost 18. My ex has family coverage for himself and his new wife, but he wants me to put the kids on my insurance now that they have reached the age of majority. Covering the kids doesn't cost him anything extra, but for me to switch from a single plan to a family plan is an extra $175 a month and I can't afford it. Since the age of majority for health insurance is now 26, is it possible he still is required to keep them on his insurance?

No, he's not obligated to keep them on his health plan. Under the health law, insurers must offer to cover young adults up to age 26, but parents aren't obligated to provide it, says Timothy Jost, a law professor at Washington and Lee University and an expert on the health law.

Further, the requirement to offer coverage isn't related to the age of majority, which is defined by individual states and is generally between 18 and 21, says Randy Kessler, an Atlanta divorce lawyer and past chair of the American Bar Association's family law section.

The health insurance coverage arrangement that you describe is pretty typical, says Kessler. You could go back to court and try to get your child-support payments increased to cover the cost of providing health insurance for the kids, but "it would be unusual for the courts to be helpful," says Kessler. Absent some significant change in your or your ex-husband's finances, or unforeseen and costly medical expenses for your children, in general "you can't have another bite at the apple."

With no legal requirement to compel either of you to cover your kids, it's something the two of you will just have to work out, says Kessler. In addition to covering your children on your own plan or your ex's plan, it's also worth exploring whether they might qualify for subsidized coverage on the state marketplaces or for Medicaid, if your state has expanded coverage to childless adults. If they're in college, student health coverage is worth investigating as well.

My husband was recently in the hospital for a pacemaker implant. He was set to come home but developed a staph infection and a blood clot. He now has to receive an antibiotic infusion for six to eight weeks. Medicare would not pay for home infusion, so he has to travel 30 minutes to the infusion center every day. Is there anything we can do?

Probably not. Infusion therapy means administering drugs intravenously, and although it can be done in settings such as outpatient centers, hospitals or nursing homes, many patients would prefer to receive their drugs at home. But even though most private health plans and some Medicare Advantage managed care plans pay for home infusion, the traditional Medicare fee-for-service program generally doesn't. There's an exception for roughly 30 drugs that must be administered using an IV infusion pump. These are covered under Medicare Part B's durable medical equipment benefit. But Medicare generally won't pick up the tab to intravenously administer other drugs such as antibiotics at home, even though the drugs themselves may be covered under Part D, Medicare's prescription drug benefit.

"It's a basic flaw," says Russ Bodoff, president and CEO of the National Home Infusion Association, a trade group for home infusion providers. "Every site of care is covered except the home." Bodoff's organization is working on legislation that would expand Medicare's coverage of home infusion therapy.

For now, though, if you want your husband to receive his antibiotic IV therapy at home, you may have to pay for the cost of the equipment, supplies and any nursing services on your own.

My wife will be exploring insurance options on the federal exchange in November. In regard to subsidies, we file jointly and most of our income comes from dividends derived from jointly owned assets. I am assuming that her share of that income would be precisely half of the annual total income (in addition to her earned income from part-time work.) Is this a fair assumption?

No, it's not. Premium tax credits are available on the health insurance marketplace to people with incomes between 100 and 400 percent of the federal poverty level (in November that will be $15,730 to $62,920 for a couple). Eligibility is based on household income, not her income alone. If the modified adjusted gross income (MAGI) for the two of you falls within those limits, she could be eligible for a subsidy. Under the health law, MAGI would include your wife's wages and your dividend income, as well as tax-exempt Social Security benefits, tax-exempt interest and tax-exempt foreign income, says Mark Luscombe, a federal tax analyst at Wolters Kluwer, CCH, a provider of tax and accounting information to professionals.

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

A Coping Plan Can Help Fend Off Depression From Vision Loss

Mon, 08/11/2014 - 3:28am
A Coping Plan Can Help Fend Off Depression From Vision Loss August 11, 2014 3:28 AM ET Listen to the Story 3 min 20 sec  

One of the scariest parts of advanced macular degeneration can be losing the ability to read facial expressions.

Maria Pavlova /iStockphoto

When people lose their vision as they get older, they lose a lot of other things, too. They lose their ability to do the things they love.

"You can't read, you can't cook, and you can't socialize — and as a result, you may become demoralized, withdrawn and depressed," says Dr. Barry Rovner, a geriatric psychiatrist at Thomas Jefferson University in Philadelphia.

Rovner is not talking about typical eyesight deterioration as we age. He's talking about a specific condition called age-related macular degeneration, which, in severe cases, afflicts about 2 million older Americans. The macula is the central part of the retina that contains the densest concentration of light-sensing receptors, and it's crucial for making out fine details. Perhaps the scariest part of the loss is that people often can't recognize faces or "read" someone's facial expression.

Shots - Health News Cheap Drug Beats Pricey One In Treating Vision Loss In Elderly

"If you can't see somebody's face, you feel disengaged and frightened," Rovner says. "The consequence is you may withdraw; many people withdraw."

In fact, research suggests about 25 percent of people with macular degeneration in both eyes go on to develop clinical depression. So Rovner decided to test a style of psychological therapy called behavior activation. This treatment helps give patients strategies to build on whatever functional vision they have so they can continue their day-to-day activities and carry on an active social life. Rovner wanted to see if the approach would help people with macular degeneration ward off depression.

He recruited 188 people, mostly women in their early to mid-80s, who had age-related macular degeneration in both eyes and mild depressive symptoms. Each was considered at risk for more severe, clinical depression. Everyone in the study had a therapist come to their house six different times in two months. In half the cases the therapists simply talked to patients for an hour about their vision loss and disability. In the other half, the therapists used the hour to help the patient develop a strategy for coping with the lost vision.

“ My world was stopping. I couldn't do anything anymore.

Marilyn Freedman took part in the study. She's 84 years old and lives in Cherry Hill, New Jersey. Freedman developed macular degeneration in both eyes and, as the condition worsened, she was starting to get depressed.

Many of the things she loved — reading, watching television, driving — were becoming difficult, she says. "My world was stopping. I couldn't do anything anymore."

But the most depressing thing for Freedman was to no longer be able to cook or bake for her big family.

"If I can't read a recipe, I can't bake," she says. "That stopped me right there. I didn't do any more baking."

Freedman was put in the group that was given behavior activation therapy. For Freedman, that meant writing giant-sized recipes with one ingredient on every page.

"One page had a cup of sugar, the next page will be a spoonful of salt, the next page would be three eggs," she says.

It was a simple plan, but it soon got Freedman back in the kitchen. Now she says she's cooking entire dinners again for her family.

Shots - Health News A Question About Aspirin And Age-Related Vision Loss

Each person in the study got different strategies. Some people wanted to get out and socialize again, so their plan included calling a friend at regular set times to schedule an outing. Book lovers were encouraged to update the 30-year-old lighting in their homes and invest in a variety of different magnifiers that enabled them to keep reading. Patients who could no longer recognize faces were encouraged to admit the vision loss to their friends instead of withdrawing out of fear of making a mistake or seeming rude.

The results were dramatic: Patients in the study who created a plan and stuck to it cut their risk of depression by more than half, Rovner says, compared to those who received only the talk therapy.

Vision is the primary way sighted people engage in the world, he says. If you can help someone who is losing their sight come up with coping strategies, there's a good chance you'll keep them engaged — and keep depression at bad.

"People tend to ruminate on what they've lost," says Rovner. "That's why we say, 'Do the plan. Follow the plan, not your feelings.' "

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

Where We Learn That Artificial Eyes Really Aren't Round At All

Mon, 08/11/2014 - 3:27am
Where We Learn That Artificial Eyes Really Aren't Round At All August 11, 2014 3:27 AM ET Listen to the Story 5 min 2 sec  

A prosthetic eye is a work of art custom-crafted for an individual.

Rebecca Davis/NPR

Almost every time reporters go out on assignment, they run across something unexpected that they just can't fit into the story they're working on.

When science correspondent Joe Palca and producer Rebecca Davis were in Boston reporting on a boy with a rare form of cancer, they found themselves in the office of Jahrling Ocular Prosthetics, a business dedicated to making artificial eyes.

Joe and Rebecca spoke with Joyce and Eric Jahrling, two of the four Jahrlings who work at this family firm, and learned some surprising things about making prosthetic eyes — and what it's like to wear them.

What follows is an edited version of their adventure.

================================

Rebecca Davis: Joe gets squeamish when he has to talk about eyes — he says it's something to do with eye surgery he had when he was a small child. So I'm going to jump in when things get what Joe calls "icky."

Joe Palca: And I promise I won't get too icky because I can't handle it. Anyway, we were in Boston to tell the story of a young boy named Noah Shaw. He was born with a rare eye cancer called retinoblastoma, and as part of his treatment he had to have an eye removed.

Noah has needed new prosthetic eyes as he has grown. His remaining eye has changed color from blue to a blue-green.

Courtesy of the Shaw family

Well, that surgery was five years ago. Noah is now a healthy 6-year-old, and wearing a false eye is normal for him — no big deal. But because he's still growing, he has to get a new eye made from time to time.

Rebecca: So we got to go with Noah and his parents, Bryan and Elizabeth Shaw, for the fitting. And the thing that surprised both of us was about the shape of that artificial eye.

Joe: Yeah, I thought that a fake eye would be round!

Joyce Jahrling: That's only in the movies when it rolls down the planks.

Joe: These fake eyes are actually small curved bits of plastic — kind of like a contact lens — and they're slipped under the eyelids of the missing eye. That's how they're held in place.

Rebecca: And watching the Jahrlings make these prosthetics, as they are officially known, is really like watching an artist at work.

Eric Jahrling adds tiny red threads to a prosthetic eye to represent blood vessels.

Rebecca Davis/NPR

Eric Jahrling: I'm making my own acrylic paints. This is a raw plastic.

Rebecca: He's using a fine brush to paint what looks like a near perfect replica of Noah's existing eye.

Joe: When he's done at the workbench he calls Noah over.

Eric: OK, let's take a look at your face, mister. I think you need a little bit more gold in there.

Joe: Eric takes the eye back to his workbench. He's got a bit more painting to do; he wants to make the pupil a little bigger, he wants to add some tiny red threads to that will look like blood vessels.

Rebecca: At an earlier appointment, Eric's sister Joyce took a mold of Noah's actual socket, where his eye used to be.

Joyce: I usually do the impression of the eye socket, like they take impressions of your mouth. Same gel. No flavor. But you don't gag.

Joe: So Eric is done touching up the eye, and Joyce comes over to see how it looks on Noah.

Shots - Health News How Pictures Of Infant Boy's Eyes Helped Diagnose Cancer

Joyce: How's that feel?

Noah: Good.

Joyce: Let me see. Let me see. Chin way up there. Not bad!

Rebecca: Joe, I was really surprised that you asked Joyce how to take the eye back out again.

Joe: Yes, I was pretty proud of myself.

Joyce: You can use your fingers to take it out. You have a suction cup. Or we even say the third method is the wooden mallet to the back of the head.

Shots - Health News Chemist Turns Software Developer After Son's Cancer Diagnosis

Rebecca: We heard a lot of that kind of dark humor when doing this story, especially from Noah's parents!

Joe: Oh that's so true: Noah's parents have these amazing stories about things that happen when your child has a fake eye.

Bryan Shaw: So one of the most common things when we got the first eye is sometimes it would rotate 100 degrees, and so the pupil would be looking like it was staring down below the lid further than you could normally even move your eye, and it would just look creepy. It would look way creepier than if the eye was even gone.

Rebecca: Bryan calls that the 'zombie rotation'. And they also told us that Noah got really good at taking his eye out.

Bryan: He would always take it out when he first got it and chew on it.

Shots - Health News Faith Drives A Father To Create A Test For Childhood Cancer

Rebecca: And he used to play this little game with his mom and dad. They'd put him down for bed, then they'd leave the room. And a few minutes later, Noah would take his eye out and throw it on the ground. It sounded like an M&M hitting the hardwood floor. And then of course, Mom and Dad would go rushing back into the room, which would make Noah terribly happy.

Joe: And then there was the time that Noah took his eye out when they were on a city bus.

Elizabeth Shaw: I didn't realize it until after I got off the bus and looked at him, and I was like, 'Oh my gosh, your eye is gone!'

Bryan: She put an ad on Craigslist. It said 'Lost: Prosthetic Eye.' And then she put in parentheses 'It's not a sphere,' and she held up a picture like the old one.

Elizabeth: I had a picture of what it looked like, and finally I called the MBTA mass transit and I said, 'I think my son's eye might be on your bus.'

Joe: A few days later the mass transit folks knocked on Elizabeth's door and said 'Excuse me, ma'am, is this yours?'

Elizabeth, Samuel, Bryan and Noah Shaw amid Texas bluebonnets on Easter Sunday. Samuel was conceived with in vitro fertilization so he would not suffer from the hereditary cancer that afflicted Noah.

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

Recovery Coach Helps An Addict Resist Heroin's Lure

Sun, 08/10/2014 - 3:06pm
Recovery Coach Helps An Addict Resist Heroin's Lure August 10, 2014 3:06 PM ET

fromWBUR

Listen to the Story 4 min 26 sec  

Among heroin addicts who are able to quit, 40 to 60 percent relapse within the first year — many within the first weeks of release from a treatment program.

Diane Diederich/iStockphoto

The first time Jeremy Wurzburg left a heroin treatment program, he planned to begin Narcotics Anonymous and do all the right things to stay off drugs. But one week later, the skinny, pale young man was hanging out with a guy who was also in early recovery, experiencing what Wurzburg, now 21, has come to realize is a typical turning point for recovering addicts: two guys sitting casually in a car, poised to use drugs again.

"We're not sure whether we're going to use or not," he says, "and someone makes like a half joke – 'We could just go out and drink right now,' or something. And the other one is like, 'Yeah let's do that. Sounds good.' "

From that first drink, Wurzburg was quickly back to heroin, his drug of choice. Most recovery programs don't — and maybe can't — prepare freshly discharged patients to fight that urge on their own, he says.

High Relapse Rate In First Year Of Recovery

"Once I got out of treatment into the real world, it was a big shock," Wurzburg says.

Of patients addicted to heroin who are able to quit their habit, 40 to 60 percent relapse within the first year — often within the first weeks of finishing a treatment program, studies show.

Around the Nation Trouble In Paradise: Opiate Use Spikes On Martha's Vineyard

Wurzburg is now in a new program aimed at young adults. It's a one-year pilot project run by Gosnold, a network of addiction treatment services on Cape Cod.

Shots - Health News Wife And Mother: 'You'd Never Suspect My Junkie Past'

As part of the program, Wurzburg agreed to live in a household that doesn't allow the use of drugs or alcohol. He agreed to attend daily 12-step group meetings and to get individual counseling. Perhaps most importantly, Wurzburg now has help daily — sometimes hourly — from a recovery coach.

Coaches in the Gosnold program get much more involved in the lives of the people they're mentoring than the typical sponsor in a Narcotics Anonymous program would.

The recovery coaches show patients "how to manage their emotions," says Wurzburg's coach, Kristoph Pydynkowski — "how to fill out job applications, how to go to meetings, how to take care of themselves, how to go back to school." Pydynkowski, who also calls himself a "cheerleader, a beacon of hope," quit using heroin seven years ago.

Much More Than A Sponsor

Shots - Health News Today's Heroin Addict Is Young, White And Suburban

Pydynkowski ticks off the list of things he and Wurzburg now do together: visits with Wurzburg's parents, a reunion in Los Angeles with Wurzburg's twin brother, fishing and 6:15 a.m. trips to a coffee shop before attending NA meetings. Pydynkowski helps each of the 10 patients he manages create and follow a weekly recovery treatment plan.

Ray Tamasi, the director at Gosnold, says this aggressively supportive approach is paying off. His evidence? A comparison of medical records collected during the year before the program's inception to records collected in the year after its start. The comparison is striking. Fifty-four young adults (ages 18 to 28) who participated in the coaching program saw an 83 percent reduction in admissions to rehabilitation facilities during their year of intensive coaching. Emergency room admissions also dropped — from 16 in the year before the program, down to one during the year of coaching.

Coaching Costs Save States Money

Because fewer people had to be readmitted to rehab centers, Tamasi says, the program saved the state an estimated 37 percent in total outlay.

"Think about the cost/benefit," he says, "if at 19, you're cycling in and out of treatment, but there's an alternative — going back to school and living life."

The program makes sense economically, he says, "and it makes sense simply from the value we place on the human life."

Shots - Health News In Vermont, A Network Of Help For Opiate-Addicted Mothers

And it may make more sense to state legislators than simply increasing the number of beds in recovery facilities, he says, "because you can't just keep people in beds all the time. They have to come out at some point."

Gov. Deval Patrick's administration is ready to spend $20 million on two dozen initiatives aimed at curbing a surge in addiction to heroin and other opiates in Massachusetts. A task force report recommended more peer support and home-based counseling. Health insurers and state Medicaid leaders have said they will look into funding for recovery coaches, but there is right now no plan in place.

New York and Tennessee pay for peer coaches to help treat addiction through Medicaid — something Massachusetts is taking a look at. The use of coaches is built on the idea that addiction is a disease that patients will deal for life, a disease that will be treated by primary doctors in a general medical setting, not just in rehabilitation facilities.

Pydynkowski is teaching his patients to treat addiction as they would hypertension or diabetes.

It's just like taking insulin, he says, "watching my diet, getting my blood work drawn, going to different appointments, walking on the treadmill — making sure I'm taking care of myself."

This story is part of a reporting partnership among NPR, WBUR and Kaiser Health News.

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

Advice For Dating With Asperger's: Don't Call 100 Times A Week

Sat, 08/09/2014 - 4:54am
Advice For Dating With Asperger's: Don't Call 100 Times A Week August 09, 2014 4:54 AM ET

You think it's romantic. She thinks it's creepy.

Katherine Streeter for NPR

Dating isn't easy, and it's even less so when you've got Asperger's, an autism spectrum disorder that can make it hard to read social cues.

Jesse Saperstein knows that all too well. In his new book, "Getting a Life with Asperger's: Lessons Learned on the Bumpy Road to Adulthood," the 32-year-old tells his fellows on the spectrum that they need to be up front with potential dates that they have Asperger's. And he says they also need to realize that what feels to them like sincere interest can all too often be perceived as creepiness. This is an edited version of our conversation.

You say that some of the traits common in people with Asperger's can make social life especially challenging. Why is that?

I believe my peers and I, we achieve great things by being unrelenting. We don't know when to stop. We can go after things for years. But that relentlessness does not work with humans and human emotions. In adulthood, that translates to full-blown stalking. Sometimes there are legal consequences that could be avoided when the intent is harmless.

Have you been accused of stalking?

You have no idea. I have definitely been accused of that many times. In college I would try to win people over by giving them long hand-written cards. I continued this into adulthood, but it wasn't considered cute. It was considered disturbing.

What did you do to fix that?

Now I tell you, 'I have Asperger's and this is how I communicate. If this bothers you, you just need to tell me so I'll do better in the future.' Ninety-nine percent of the time that works. I sure don't want to miss the people who would love a hand-written card.

The purpose of my book is to help people shave off experiences that cause damage. So they'll know from my experiences that if you call someone 100 times in a week, it may work in the movies but it most likely leads to disaster in reality.

You said online dating was tough to figure out. How so?

It was hard for someone who is not able to let go easily. Online dating is all about letting go, and a lot of hidden signals. You can let go and definitely not get what you want but avoid a lot of consequences.

What kind of consequences?

One of the golden rules is not to invest a lot of money the first or second time you meet someone. I used to think that if I spent a lot of money on a Broadway show or a four-star restaurant it might not make a woman fall in love with me, but it sure would help. That is erroneous.

I think that is one of the things that contributed to my $25,000 credit card debt.

I kind of did it to myself, but at the time it did seem like a really good idea.

How do you deal with rejection?

With dating it does not matter how cruel or sudden the rejection is, when someone demands to be let alone you have to respect that. I'll tell people, contact this person only once a year and see what happens. That may not be appropriate, but it's a lot better than being relentless.

Are you dating someone now?

I'm seeing a woman right now who's a few year younger than me. It's hard due to our very hectic schedules; she's still going to school. What helps is her bringing issues to my attention instead of sitting on them, so I can work through them.

What's the message you want people to remember from your book?

Success with autism or any kind of challenge comes from knowing you have incredible things to offer. Mistakes don't mean you're a loser.

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

Advice For Dating With Asperger's: Don't Call 100 Times A Week

Sat, 08/09/2014 - 4:54am
Advice For Dating With Asperger's: Don't Call 100 Times A Week August 09, 2014 4:54 AM ET

You think it's romantic. She thinks it's creepy.

Katherine Streeter for NPR

Dating isn't easy, and it's even less so when you've got Asperger's, an autism spectrum disorder that can make it hard to read social cues.

Jesse Saperstein knows that all too well. In his new book, "Getting a Life with Asperger's: Lessons Learned on the Bumpy Road to Adulthood," the 32-year-old tells his fellows on the spectrum that they need to be up front with potential dates that they have Asperger's. And he says they also need to realize that what feels to them like sincere interest can all too often be perceived as creepiness. This is an edited version of our conversation.

You say that some of the traits common in people with Asperger's can make social life especially challenging. Why is that?

I believe my peers and I, we achieve great things by being unrelenting. We don't know when to stop. We can go after things for years. But that relentlessness does not work with humans and human emotions. In adulthood, that translates to full-blown stalking. Sometimes there are legal consequences that could be avoided when the intent is harmless.

Have you been accused of stalking?

You have no idea. I have definitely been accused of that many times. In college I would try to win people over by giving them long hand-written cards. I continued this into adulthood, but it wasn't considered cute. It was considered disturbing.

What did you do to fix that?

Now I tell you, 'I have Asperger's and this is how I communicate. If this bothers you, you just need to tell me so I'll do better in the future.' Ninety-nine percent of the time that works. I sure don't want to miss the people who would love a hand-written card.

The purpose of my book is to help people shave off experiences that cause damage. So they'll know from my experiences that if you call someone 100 times in a week, it may work in the movies but it most likely leads to disaster in reality.

You said online dating was tough to figure out. How so?

It was hard for someone who is not able to let go easily. Online dating is all about letting go, and a lot of hidden signals. You can let go and definitely not get what you want but avoid a lot of consequences.

What kind of consequences?

One of the golden rules is not to invest a lot of money the first or second time you meet someone. I used to think that if I spent a lot of money on a Broadway show or a four-star restaurant it might not make a woman fall in love with me, but it sure would help. That is erroneous.

I think that is one of the things that contributed to my $25,000 credit card debt.

I kind of did it to myself, but at the time it did seem like a really good idea.

How do you deal with rejection?

With dating it does not matter how cruel or sudden the rejection is, when someone demands to be let alone you have to respect that. I'll tell people, contact this person only once a year and see what happens. That may not be appropriate, but it's a lot better than being relentless.

Are you dating someone now?

I'm seeing a woman right now who's a few year younger than me. It's hard due to our very hectic schedules; she's still going to school. What helps is her bringing issues to my attention instead of sitting on them, so I can work through them.

What's the message you want people to remember from your book?

Success with autism or any kind of challenge comes from knowing you have incredible things to offer. Mistakes don't mean you're a loser.

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

Preventing HIV With Medicine Can Carry A Stigma

Fri, 08/08/2014 - 4:25pm
Preventing HIV With Medicine Can Carry A Stigma August 08, 2014 4:25 PM ET

from

Listen to the Story 4 min 3 sec  

Truvada, an FDA-approved drug to help prevent HIV infection, is among the AIDS drugs that fill pharmacy shelves at the Whitman-Walker clinic, a Washington, D.C., community health center.

Astrid Riecken/MCT/Landov

Eric McCulley takes daily medicine to help keep from contracting HIV.

Jim Burress/WABE

In order to slow the spread of HIV, certain people who do not have the virus but are at risk should take medicine to prevent becoming infected. That's the recommendation of the Centers for Disease Control and Prevention and, just recently, the World Health Organization.

The preventive treatment is known as PrEP, for pre-exposure prophylaxis.

Eric McCulley made the decision to start PrEP. He's 40, gay and HIV-negative. Outside an Atlanta coffee shop, he pulls out a plastic baggy with a few blue pills.

"They're a decent size, actually," he says. "Some people might call them a horse pill."

The pill is called Truvada, a combination of two drugs used to treat HIV. Despite McCulley's negative HIV status, he's taken the pill daily for the past few months.

After hearing about the treatment and doing extensive research on his own, McCulley made an appointment with his primary care doctor earlier this year.

"He was very supportive about it. He encouraged me to do it," he says. "He gave me a lot of stuff to read, gave me a lot of stuff to think about, and told me I was a good candidate for it. So off we went."

So far, McCulley says, the only change the drug has made in his life is in his attitude.

Goats and Soda New Guidelines For Gay Men: A Daily Anti-HIV Pill

"I have what I was looking for. I have peace of mind. I feel like I've taken responsibility for my health," he says.

Shots - Health News As New York Embraces HIV-Preventing Pill, Some Voice Doubts

But some PrEP users worry that not everybody in the medical community is up to speed. Although Truvada has been on the market for a decade, only recently have prescribing guidelines been available.

Dylan West is a 25-year-old Atlanta resident and works in international aid. He is also gay and recently found out firsthand that not every doctor is as familiar with PrEP as McCulley's is.

Some gastrointestinal problems recently landed West in the emergency department. He'd started PrEP after beginning a relationship with someone who's HIV-positive. One of the doctors in the emergency room noticed that West listed Truvada as a medication he regularly takes.

"She immediately, without asking any questions, just said, 'Well, we should probably test for gonorrhea, syphilis, HIV/AIDS — the list,' " he says.

West thinks that physician made a "rash assumption" about his sexual practices because he was on Truvada. West knew stigma was something he might face. Some people within the lesbian, gay, bisexual and transgender communities have gone as far as to label those on PrEP as "Truvada whores."

Effective New HIV Treatment Makes Researcher 'Hopeful' In Fighting Epidemic 10 min 58 sec   Plotting The American Role In Fighting The AIDS Epidemic 5 min 27 sec  

"The assumption being, you're on Truvada, so you probably run around having sex with whoever you can," he explains.

Dr. Melanie Thompson says she's heard that before. She's the principal investigator of the AIDS Research Consortium of Atlanta, and has long worked in HIV research. She has encountered reluctance from some to prescribe PrEP because of lack of knowledge about it.

"This is an interesting thing to me," she says, "because doctors who say, 'I don't want to prescribe PrEP to somebody who might be at risk for HIV because they might not use condoms' — you know, it's an approach we wouldn't take in other areas of medicine."

Thompson says no doctor would refuse to prescribe cholesterol-lowering statins to patients because they're overweight. Somehow, the conversation around PrEP is different.

"So I think it's a very interesting moralistic attitude that soon will be outdated. But I do think that this is a barrier for some patients," Thompson says. "They feel stigmatized. And honestly, health care providers need to step up their game and do better than that."

A CDC spokeswoman said via e-mail that lack of awareness and knowledge among health care providers is one of the primary challenges to PrEP's success.

But both Thompson and CDC officials hope the new treatment guidelines will help overcome any barriers.

This story is part of a reporting partnership among NPR, WABE and Kaiser Health News.

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

Playing Video Games Can Help Or Hurt, Depending On Whom You Ask

Fri, 08/08/2014 - 1:19pm
Playing Video Games Can Help Or Hurt, Depending On Whom You Ask August 08, 2014 1:19 PM ET

When it comes to the effects of video games, content matters.

Mario Tama/Getty Images

Parents worry that video games are bad for kids, but the evidence on how and why they may be harmful has been confusing.

"Most of popular media puts the most emphasis of concern on aggression," says psychologist Jay Hull from Dartmouth College. "But aggression is just the tip of the iceberg."

So Hull looked at other negative behaviors that could be affected by gaming, including binge drinking, smoking cigarettes and unprotected sex. His study found that teenagers who regularly play violent video games such as Manhunt and the Grand Theft Auto series are more likely to take those risks.

The study was published Monday in the Journal of Personality and Social Psychology.

Previously Hull led a study that looked at the relationship between violent video games and reckless driving habits. Playing games that promote "acting evil" may distort a teen's sense of right and wrong, Hull says. In that study he found that teens who played violent video games were more likely to drive recklessly, such as cutting people off while on the highway. Both studies, he says, conclude that video games alter a teen's sense of self.

"They might think 'I've done much worse things in these games,' " he told Shots. "They're less likely to find things as being wrong that other people would find wrong."

But teenagers who played aggressive games that had noble protagonists were not as likely to engage in risky behaviors, the latest study found. That included Spiderman II, in which the player is a web-slinging vigilante with good motives, rather than a thug for hire.

Humans It's A Duel: How Do Violent Video Games Affect Kids?

In another study published this week, scientists looked at both the negative and positive effects of video games.

One hour or less of video game play per day is associated with children and teenagers ages 10 to 15 being happier and more satisfied than those who do not play at all, a study published Monday in Pediatrics found. But the study also found that kids who played in excess of three hours daily were less satisfied with their lives and had more difficulties both socially and personally than nongamers.

"If there was a magic dose, it would be less than one hour," says Andrew Przybylski, an experimental psychologist from the University of Oxford who led the study. And "if there was a dangerous dose, it would be more than three hours."

His study looked at survey responses from nearly 5,000 children in the Understanding Society UK Household Longitudinal Study. Unlike many studies in this field, this study looked at both the positive and the negative effects of video game playing.

Law High Court OKs Sales Of Violent Video Games To Kids

The impact of video games on a child's social well-being is modest at best, Przybylski says, accounting for only 2 percent of a child's psychological and social function. Other factors, such as family life, play much bigger roles, he says.

Neither study proves that the video games are the cause of changes of behavior or emotions, says James Ivory, an associate professor at Virginia Tech who analyzes the effects of video games. He was not involved in either study.

Rather, he says that both studies support the idea that video-game play can be used to understand a teenager's family and environment. Teens who do not play video games at all may be socially isolated, Ivory says, and parents who allow teens to play violent adult games might be less focused on preventing risky behaviors.

"If a parent is just worried that their kid is playing Grand Theft Auto, and not worried about other factors that influence their kids," Ivory says, "then they're looking the wrong way."

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

Investors Pump Prospects Of Unproven Ebola Treatments

Fri, 08/08/2014 - 12:37pm
Investors Pump Prospects Of Unproven Ebola Treatments August 08, 201412:37 PM ET

Tobacco plants grown at an Owensboro, Ky., biotechnology firm were used to help produce an experimental serum used to treat two Americans infected with Ebola.

AP

Interest in drugs that might be used to treat Ebola virus has hit a fever pitch, but the buzz isn't simply about fear of Ebola, or about saving lives in poor nations of West Africa. It's also about money.

Take, for example, the Canadian drug company Tekmira. It is trying to develop an Ebola drug that's based on a technology called RNAi. This is an intriguing concept, using genetic material rather than conventional drugs to disrupt the Ebola virus. The company says it has a $140 million grant from the U.S. Department of Defense to develop this concept.

Shots - Health News Why Treating Ebola With An Experimental Serum Might Help

But the company also trades on the stock market (NASDAQ:TKMR,TSX:TKM), so — no surprise — there's a fair amount of chatter online by investors pumping up the prospects of the putative Ebola drug and hoping to make a buck.

Tekmira's experimental drug is by no means ready for prime time. In fact, the first tests simply to determine whether it's safe to give to people screeched to a halt earlier this spring, after the U.S. Food and Drug Administration raised concerns.

On Thursday the company announced that the FDA had eased that hold somewhat. The human tests on healthy volunteers are still forbidden, but the company says it now has the option of offering the drug to people who are infected with Ebola and therefore already facing a life-threatening risk.

Shots - Health News Ebola Drug Could Be Ready For Human Testing Next Year

The company didn't say whether it actually plans to do that. And it's not clear whether that drug would be the best option for people in West Africa currently ill with Ebola. There are certainly more conventional options. There's an experimental drug called BCX4430 — based on traditional pharmacology — that, like the Tekmira drug, has protected animals from Ebola and related viruses.

And then there are antibody-based treatments. That's what the two American missionaries who contracted Ebola received. Though these were high-tech antibodies, the concept of using antibodies to treat disease goes back more than a century. The decision to try these antibodies on the missionaries generated huge media attention.

CDC Chief On West African Ebola: 'We Know What To Do, But It's Not Easy'

"The plain fact is we don't know whether that treatment is helpful, harmful or doesn't have any impact," CDC Director Dr. Tom Frieden said Thursday at a congressional hearing. "And we're unlikely to know from the experience of two or a handful of patients whether it works."

The truth is that patients who receive good supportive care can get better — for example, if they get good hydration, or oxygen and treatment for other infections. Frieden noted that when patients with an Ebola-like disease received good treatment in Germany a few years ago, three-quarters of them survived.

Health officials are concerned that all this talk about a breakthrough drug for Ebola is a distraction. Frieden said drugs won't stop the current outbreak. What's needed is an effective campaign in West Africa to identify people who are sick with Ebola, so they can be isolated and given good supportive care. The World Health Organization is hoping to stir a stronger international reaction to put the needed people, facilities and supplies in place.

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

State Abortion Laws Face A New Round Of Legal Challenges

Fri, 08/08/2014 - 10:24am
State Abortion Laws Face A New Round Of Legal Challenges August 08, 201410:24 AM ET

Partner content from

A volunteer escort waits outside a clinic that provides abortions in Milwaukee. Wisconsin is one of many states that have passed laws requiring doctors to have hospital privileges if they perform abortions.

Dinesh Ramde/AP

Even if you're trying, it's tough to keep score of what's happening with various lawsuits challenging some state abortion laws.

States led by anti-abortion governors and legislatures have been passing a broad array of measures over the past few years aimed at making the procedure more difficult for women to obtain.

About two dozen states enacted 70 such measures in 2013, according to the Guttmacher Institute. Those laws range from imposing waiting periods to requiring ultrasounds to limiting the use of the "abortion pill" mifepristone, or RU486.

The latest set of laws to be challenged in court have to do with requiring physicians who perform abortions to have admitting privileges at a nearby hospital.

For example, a federal district court judge in Alabama this week struck down as unconstitutional a portion of state law requiring physicians who perform abortions to have admitting privileges. Last week, a federal appeals court panel struck down a similar law in Mississippi. And a third law of the same type is awaiting a ruling in Wisconsin.

All these laws, as well as a law in Texas that a federal appeals court allowed to take effect last November, have one thing in common: They represent the latest fight over efforts to make abortion either less available (according to one side) or safer (according to the other).

Here are some frequently asked questions about the laws and the lawsuits surrounding them.

What are admitting privileges?

Admitting privileges are the right of a physician to admit patients to a particular hospital and to provide specific services in that facility. For a physician to be granted privileges, a hospital generally checks the individual's medical credentials, license and malpractice history.

Shots - Health News Half Of Texas Abortion Clinics Close After Restrictions Enacted

Many hospitals also require physicians to admit a minimum number of patients to the hospital each year before they will grant or renew privileges. Others require the doctor to live within a minimum distance of the hospital.

How do admitting privilege requirements relate to abortion?

Supporters of the laws say it's about safety. "Once a physician assumes the responsibility for overseeing the provision of a medical procedure, there's an obligation on the physician to follow the care through to its ultimate conclusion," including any emergencies that might occur, says Ovide Lamontagne, general counsel of the anti-abortion group Americans United for Life.

Lamontagne also said the process for doctors to obtain hospital privileges is another safety check. "Admitting privileges are sort of the profession's way of validating the credentials of a provider," he said.

Opponents of the laws, however, say they are more about making abortion less available.

The Two-Way Supreme Court Strikes Down Abortion Clinic 'Buffer Zone' Law

"Admitting-privileges legislation would impose stricter requirements on facilities where abortions are performed than on facilities that perform much riskier procedures," says Jeanne Conry, former president of the American College of Obstetricians and Gynecologists.

"As an example, the mortality rate associated with a colonoscopy is more than 40 times greater than that of abortion," she says, yet gastroenterologists who perform such procedures outside of the hospital setting do not face similar requirements "in the context of safety."

And opponents point out that most abortion providers cannot meet the number-of-admissions standard for gaining privileges because so few of their patients need hospital care.

How many states have passed admitting-privileges laws?

According to the Guttmacher Institute, which tracks reproductive health issues, 15 states require abortion providers "to have some affiliation with a local hospital," while 11 specifically require admitting privileges. Many of those laws are not in effect, however, having either been blocked by courts or being too new (Louisiana and Oklahoma) to have taken effect.

West Virginia's Governor Vetoes Abortion Ban

Americans United for Life counts 12 states with "an enforceable admitting-privileges requirement for abortion providers," and four currently in litigation: Alabama, Mississippi, Texas and Wisconsin.

In some states with admitting-privileges laws, physicians have been able to gain hospital access. In North Dakota, for example, a court case ended earlier this year when physicians at the state's only abortion-providing clinic were granted privileges at one hospital.

What have the courts said about the laws?

Under current Supreme Court precedent, states cannot limit abortion in a way that imposes an "undue burden" on a woman's ability to obtain an abortion.

But different courts have had dramatically different responses to admitting-privileges requirements for abortion providers.

In Texas, a district court judge last fall found the admitting-privileges portion of that state's omnibus abortion restriction law unconstitutional. Then in May, a three-judge panel of the 5th Circuit Court of Appeals reversed that lower court ruling.

Abortions Reportedly Drop To Lowest Rate Since 1970s

"Even if we were to accept that both clinics in the Rio Grande Valley were about to close as a result of the admitting-privileges provision ... this finding does not show an undue burden," said the opinion written by Judge Edith Jones.

The opinion also noted that the lower court's finding that " 'there will be abortion clinics that will close' is too vague."

Since the ruling, the last remaining clinics in the Rio Grande Valley did close. That left San Antonio, which is up to 250 miles away, the closest city where legal abortions can be obtained for women in more than 20 Texas counties.

Texas now has fewer than half as many clinics that provide abortions as it had before the law took effect, and that could drop even further depending on the outcome of a trial that began this week regarding another provision of the Texas law.

That provision requires abortion-providing clinics to meet the same facility standards as "ambulatory surgical centers" that do more complex surgeries. Those standards include such details as minimum door widths and allowable types of materials to be used in floors and ceilings.

In Mississippi, a different set of judges from the 5th Circuit Court of Appeals ruled late last month that the state's admitting-privileges law could not take effect because it would have forced the closure of the last remaining abortion-providing clinic in the state.

"Mississippi may not shift its obligation to respect the established constitutional rights of its citizens to another state," wrote Judge E. Grady Jolly in the opinion.

Meanwhile, Alabama District Court Judge Myron Thompson cited the inability of doctors in the state's abortion-providing clinics to be able to get admitting privileges at nearby hospitals in his Aug. 4 opinion striking down that state law.

"The evidence compellingly demonstrates that the requirement would have the striking result of closing three of Alabama's five abortion clinics," Thompson wrote in his 172-page opinion. "If this requirement would not, in the face of all the evidence in the record, constitute an impermissible undue burden, then almost no regulation, short of those imposing an outright prohibition on abortion, would."

A trial over Wisconsin's admitting privileges requirement ended in June. A decision in that case is expected soon.

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

Interval Training While Walking Helps Control Blood Sugar

Thu, 08/07/2014 - 1:17pm
Interval Training While Walking Helps Control Blood Sugar August 07, 2014 1:17 PM ET Listen to the Story 3 min 53 sec  

Varying speed while walking may make the activity much more effective.

iStockphoto

Lots of high-performance athletes use interval training to maximize their fitness.

From runners to cyclists to boot-camp fanatics the strategy involves alternating between periods of high-intensity and lower-intensity aerobic training.

Shots - Health News Hey, Miss Idaho, Is That An Insulin Pump On Your Bikini?

Now, a study published in the journal Diabetologia finds that interval training may help the millions of people with Type 2 diabetes and prediabetes who are trying to control their blood sugar.

And the type of exercise involved? Taking an hourlong walk each day outdoors or on a treadmill.

As part of the study, researchers enrolled about 30 volunteers with Type 2 diabetes who were in their late 50s and early 60s.

The volunteers were divided into groups. One group was instructed to walk three minutes briskly, followed by three minutes at a more restful pace, and repeat that process for an hour.

Another group walked at a continuous pace for the same amount of time.

A third group, a control group, kept up normal routines, which didn't include daily exercise.

"What we expected to see ... was that both exercising groups would have an improvement in their glucose [or blood sugar] control," says study author Thomas Solomon, an associate professor at the University of Copenhagen who studies how exercise affects glycemic control.

But that's not what happened.

Shots - Health News Why Fat Grizzlies Don't Get Diabetes Like We Do

The interval walkers did improve. Their glucose disposal — the ability to move sugar out of the circulating bloodstream and into parts of the body where it can be used as fuel — improved by 20 percent compared with the nonexercising group. And their hemoglobin A1C levels, a longer-term measure of blood sugar, dipped slightly too.

But the steady-paced walkers saw no improvement at all.

"This was somewhat surprising, considering that they were doing one hour of exercising a day for four months," says Solomon.

So what explains the benefits of interval walking? It's not exactly clear, but there's a leading theory.

"It's this switch between the intensities that we think is critical here," says Solomon. "You're able to work hard, and then rest hard ... rather than just walking at a fixed pace."

And during the high-intensity bursts, your muscles need more fuel in the form of glucose.

"It makes sense that intervals would help people with blood sugar control," says Dr. Tim Church, a professor of preventive medicine at the Pennington Biomedical Research Center in Baton Rouge, La.

Your Health Interval Training: Good Exercise For All Ages

He explains that our muscles are the No.1 consumer of blood sugar in our bodies.

So, when we do things such as short bursts of high-impact aerobic activity, "you're pulling excess sugar out of the blood, which results in healthier blood sugar levels," Church says.

This study is small, but the findings match other research on intervals, which find benefits that seem to go beyond better blood sugar.

In a study published in Diabetes Care in 2013, which also compared interval walkers with continuous-paced walkers, Solomon and his colleagues found that the interval walkers lost more weight and lowered their cholesterol levels.

"There are a number of studies that have shown that when you increase the intensity [of aerobic exercise] in the form of doing intervals, there's additional benefits beyond just the calories burned," Solomon says.

There are still unanswered questions, he adds, such as can interval walking cut the risk of strokes or other health problems that are associated with diabetes?

"We really need to understand how this has an impact on the long-term health of these patients with diabetes," Solomon says.

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

House Calls Keep People Out Of Nursing Homes And Save Money

Thu, 08/07/2014 - 11:08am
House Calls Keep People Out Of Nursing Homes And Save Money August 07, 201411:08 AM ET

When it comes to reining in medical costs, delivering more health care and bringing it right to the patient's home can, for a select group of patients, save money.

“ We prevent crises.

These particular patients are elders struggling with multiple chronic medical conditions, such as congestive heart failure, stroke, diabetes or dementia. They make up just 5 percent of the people on Medicare, but they account for about half of all Medicare spending.

Shots - Health News Americans' Upside-Down View Of Medicare's Problems

In a study conducted by MedStar Washington Hospital Center in Washington, D.C., 722 such patients were provided with home-based health care delivered by a team: a physician, a nurse practitioner, licensed practical nurses and social workers. The visits were frequent, and there was someone on call for urgent situations 24/7.

"We prevent crises," says Dr. K. Eric De Jonge, the chief of geriatrics at MedStar Washington Hospital Center, and the lead author of the study. He says that having a doctor who has access to the patient's electronic medical records on call at all times cuts down on "having to call 911 and going to the emergency room, which often ends up in a hospital admission."

Shots - Health News Getting People Out Of Nursing Homes Turns Out To Be Complicated Shots - Health News Will This Tech Tool Help Manage Older People's Health? Ask Dad

In fact, the study found that patients who received this home-based care had 20 percent fewer ER visits, 9 percent fewer hospitalizations and 27 percent fewer stays in a nursing home than similar Medicare patients in the control group. The death rate among these very vulnerable patients was high, but was about the same for both the study group and the control group.

The bottom line: In a two-year period, Medicare saved $8,477 for each patient getting home-based care.

MedStar Washington Hospital Center is one of 18 facilities nationwide participating in a Medicare demonstration project to gauge the impact of home health care on very frail patients. De Jonge says for such a system to work on a larger scale, Medicare would have to change the way it pays health care providers.

"You have to start paying people for their results," says De Jonge, "as opposed to the volume of how many things you do to the patient. Then this program could really take off."

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