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Debate Grows Over Employer Health Plans Without Hospital Benefits

Fri, 09/26/2014 - 10:58am
Debate Grows Over Employer Health Plans Without Hospital Benefits September 26, 201410:58 AM ET

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There's just one catch: hospital care isn't covered.

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Lance Shnider is confident Obamacare regulators knew exactly what they were doing when they created an online calculator that gives a green light to new employer coverage without hospital benefits.

"There's not a glitch in this system," said Shnider, president of Voluntary Benefits Agency, an Ohio firm working with some 100 employers to implement such plans. "This is the way the calculator was designed."

Timothy Jost is pretty sure the whole thing was a mistake.

"There's got to be a problem with the calculator," said Jost, a law professor at Washington and Lee University and health-benefits authority. Letting employers avoid health-law penalties by offering plans without hospital benefits "is certainly not what Congress intended," he said.

As companies prepare to offer medical coverage for 2015, debate has grown over government software that critics say can trap workers in inadequate plans while barring them from subsidies to buy fuller coverage on their own.

At the center of contention is the calculator — an online spreadsheet to certify whether plans meet the Affordable Care Act's toughest standard for large employers, the "minimum value" test for adequate benefits.

The software is used by large, self-insured employers that pay their own medical claims but often outsource the plan design and administration. Offering a calculator-certified plan shields employers from penalties of up to $3,120 per worker next year.

Many insurance professionals were surprised to learn from a recent Kaiser Health News story that the calculator approves plans lacking hospital benefits and that numerous large, low-wage employers are considering them.

Although insurance sold to individuals and small businesses through the health law's marketplaces is required to include expensive hospital benefits, plans from large, self-insured employers are not.

Many policy analysts, however, believed it would be impossible for coverage without hospitalization to pass the minimum-value standard, which requires insurance to pay for at least 60 percent of the expected costs of a typical plan.

And because calculator-approved coverage at work bars people from buying subsidized policies in the marketplaces that do offer hospital benefits, consumer advocates see such plans as doubly flawed.

Kaiser Health News asked the Obama administration multiple times to respond to criticism that the calculator is inaccurate, but no one would comment.

Calculator-tested plans lacking hospital benefits can cost half the price of similar coverage that includes them.

While they don't include inpatient care, the plans offer rich coverage of doctor visits, drugs and even emergency-room treatment with low out-of-pocket costs.

Who will offer such insurance? Large, well-paying employers that have traditionally covered hospitalization are likely to keep doing so, said industry representatives.

"My members all had high-quality plans before the ACA came into existence, and they have these plans for a reason, which is recruitment and retention," said Gretchen Young, a senior vice president at the ERISA Industry Committee, which represents very large employers such as those in the Fortune 200. "And you're not going to get very far with employees if you don't cover hospitalization."

But companies that haven't offered substantial medical coverage in the past — and that will be penalized next year for the first time if they don't meet health-law standards — are very interested, benefits advisors say.

They include retailers, hoteliers, restaurants and other businesses with high worker turnover and lower pay. Temporary staffing agencies are especially keen on calculator-tested plans with no hospital coverage.

"We've got many dozens of staffing-firm clients," said Alden Bianchi, a benefits lawyer with Mintz Levin in Boston. "All of them are using these things."

Advisors and brokers declined to identify employers sponsoring the plans, citing client confidentiality.

Benefits administrators offering the insurance say it makes sense not only for employers trying to comply with the law at low cost but for workers who typically have had little if any job-based health insurance.

"This is a stepping-stone to bring in employers who have never [offered] coverage and now they're willing to come forward and do something," said Bruce Flunker, president of Wisconsin-based EBSO, a benefits firm.

The plans are an upgrade for many workers at retailers, staffing agencies and similar companies, he said.

"OK, if I go to the hospital I don't have coverage," he said. "But I don't have [hospital] coverage now. And what I get is a doctor. I can go to a specialist. I get a script filled at the pharmacy. I get real-life coverage."

Companies considering such plans include a restaurant chain with 1,000 workers, a trucking firm with 500 employees and dependents, a delicatessen, a fur farm and firms working the oil boom in upper Midwest, Flunker said.

Employer interest in the plans "is definitely picking up pretty quickly," said Kevin Schlotman, director of benefits at Benovation, an Ohio firm that designs and administers health coverage. "These are organizations that are facing a significant increase in expenses. They're trying to do their best."

Because hospital admissions are rare, plans paying for routine care are more valuable to low-wage workers than coverage of expensive surgery and other inpatient costs, say consultants offering them.

Such plans come with deductibles as low as zero for doctor visits and prescriptions and co-pays of only a few dollars, they say. Emergency-room visits cost members in the $250 or $400 range, depending on the plan.

By contrast, health-law-approved insurance with inpatient benefits often includes deductibles — what members pay for all kinds of care before the insurance kicks in — of $6,000 or more.

Generous coverage of routine care is "what these people want," said Shnider. "They want to be able to go to the doctor. Take care of their kids, go to the emergency room."

In some cases, employers sponsoring calculator-approved plans without hospital coverage also offer "fixed indemnity" coverage that does pay some hospital reimbursement, advisors say. But the benefits are typically a small fraction of hospital costs, leaving members with the likelihood of large bills if they are admitted.

Concerned for their reputations, larger administrators are wary of managing benefits without hospitalization, even if they do pass the calculator.

"Our self-funded customers hand out insurance cards to their employees with Blue Cross all over it," said Michael Bertaut, health care economist at BlueCross BlueShield of Louisiana, which has no plans to handle such coverage. "Do we really want someone to present that card at a hospital and get turned away?"

There are two health-law coverage standards that large employers must meet to avoid paying a penalty.

One, for "minimum essential coverage," merely requires some kind of employer medical plan, no matter how thin, with a potential penalty next year of up to $2,080 per worker. Many low-wage employers are meeting that target with "skinny" plans that cover preventive care and not much else, say brokers and consultants.

The calculator tests the health law's second, more exacting standard — to offer a "minimum value" plan at affordable cost to workers. Failure to do so triggers the second penalty, of up to $3,120 per worker.

The argument over the calculator is whether plans carving out such a large chunk of benefits — hospitalization — can mathematically cover 60 percent of expected costs of a standard plan.

They probably can't, Washington and Lee professor Jost said. The fact that the calculator gives similar, passing scores to plans with hospital benefits and plans costing half as much without hospital benefits suggests that it's flawed, he said. Plans with similar scores should have similar costs, he said.

On the other hand, others ask, why did the administration make a calculator that allows designers to leave out inpatient coverage? Why didn't the law and regulations require hospital coverage for self-insured employers — as they do for commercial plans sold through online marketplaces?

"The law and calculator were purposely designed as they are!" Fred Hunt, past president of the Society of Professional Benefit Administrators, said in an email widely circulated among insurance pros. "No 'glitch' or unintended loophole."

"That's baloney," said Robert Laszewski, a consultant to large insurers and a critic of the health law. "Nobody said we're going to have health plans out there that don't cover hospitalization. That was never the intention ... I think they just screwed up."

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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To Predict Nobel Winners, Skip Vegas And Check The Fine Print

Thu, 09/25/2014 - 4:47pm
To Predict Nobel Winners, Skip Vegas And Check The Fine Print September 25, 2014 4:47 PM ET

Molecular biologist Randy Sheckman, who shared the 2013 Nobel Prize in physiology or medicine, acknowledges applause after receiving his prize during the ceremony in Stockholm last December.

Pascal Le Segretain/Getty Images

Some people like to bet on horses. Others wager on football games. And while there may not be any money in picking the next Nobel Prize winner, that's no reason not to have a little fun trying.

On Monday Oct. 6, a scientist or two, or maybe even three, will get called from Sweden with good news about the Nobel Prize for physiology or medicine. Who will it be?

Some folks at Thomson Reuters have some ideas. They've essentially pored over the footnotes in scientific papers to figure out whose work has been referenced the most often in influential journals.

The analysis was a little bit more complicated than that. They crunched the numbers in databases of citations to figure out how many times possible winners got their papers cited. They also compared that number with how many times average scientists in the field got their papers cited.

The analysts, working in Thomson Reuters' intellectual property and science unit, went beyond these numbers: They handicapped the work subjectively. They gave credit to research that overturned dogma or has already made a big difference in science or medicine. As you would expect, the Nobel committee often likes that type of research.

The analysts also considered whether a Nobel has been awarded in the last couple of years for work in the same general area. If so, it's likely the prize committee would wait a while to recognize even worthy research.

Who are the scientists to watch?

A drum roll, please, for this year's Citation Laureates, as Thomson Reuters calls them, for physiology or medicine. Consider it the research Daily Racing Form.

For fundamental discoveries concerning eukaryotic transcription and gene regulation:

James E. Darnell Jr., Rockefeller University, New York

Robert G. Roeder, Rockefeller University, New York

Robert Tjian, University of California, Berkeley, and president of the Howard Hughes Medical Institute

"These are real giants of molecular biology," says David Pendlebury, an analyst with Thomson Reuters. They helped unravel details about how and when cells turn on genes. That is, how cells know when to synthesize RNA using the DNA, so it can make proteins. "You scratch your head: Why didn't these guys win already?" Pendelbury tells Shots.

For elucidating molecular mechanism of pain sensation:

David Julius, University of California, San Francisco

The work, begun in the 1990s, used capsaicin, the chemical that makes peppers hot. "It's fundamental science," Pendlebury says, but researchers in academia and industry are already making use of the insights to come up with potential new therapies for pain, anxiety and depression.

For their discovery of large-scale copy number variation and its association with specific disease:

Charles Lee, Jackson Laboratory for Genomic Medicine, Farmington, Conn.

Stephen W. Scherer, The Hospital for Sick Children and University of Toronto

Michael H. Wigler, Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y.

Each of us has about 20,000 genes on our chromosomes. But large stretches of our genome can get duplicated or even copied several times. The specific number of copies, at each location, can vary quite a bit from person to person.

"Most of the time [this variation] has no effect," Pendlebury says. But Scherer and Wigler have been exploring the association between these genetic duplications and some diseases, such as autism, schizophrenia and even cancer. The work has helped overturn dogma that held individual genetic variation was relatively small.

Since Thomson Reuters began naming Citation Laureates in 2002, 35 of the 211, or 17 percent, have gone on to win Nobel Prizes. When it comes to picking the winners for any given year, it's pretty tough. Pendlebury says the yearly calls have been exactly right five times.

"What we're really doing is saying that our indicators tell us that this person is of Nobel class," he says. "We would expect they'd be a strong contender."

There are somewhere in the neighborhood of 200 to 300 people nominated for each Nobel, he says, so there are always more people of prize caliber than actually win.

"These researchers deserve public recognition, and they don't often get it," Pendlebury says. The Citation Laureate is one way to do it.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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To Prevent Repeat Hospitalizations, Talk To Patients

Thu, 09/25/2014 - 3:23am
To Prevent Repeat Hospitalizations, Talk To Patients September 25, 2014 3:23 AM ET

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Kevin Wiehrs is a nurse in Savannah, Ga. But instead of giving patients shots or taking blood pressure readings, his job is mostly talking with patients like Susan Johnson.

Kevin Wierhs and Susan Johnson confer about what works and what doesn't in managing diabetes.

Sarah McCammon/Georgia Public Broadcasting

Johnson, 63, is a retired restaurant cook who receives Medicare and Medicaid. She has diabetes, and has already met with her doctor. Afterward, Wiehrs spends another half-hour with Johnson, talking through her medication, exercise and diet.

"So it sounds like you cut back on your sweets, things that have a lot of sugars in them. What about vegetables, your portions of food?" Wiehrs asks Johnson. "Have you made any changes with that?"

"A little bit," Johnson says. "Ain't gonna lie — a little bit."

Wierhs, 51, was a hospice nurse for 15 years and a social worker before that. Now he is one of five new care coordinators at Memorial Health, a medical system based in Savannah. He was hired to pay special attention to patients with poorly controlled chronic conditions like diabetes and heart disease.

"Some of these patients have fought with their diabetes for many years and get very complacent with the whole situation and feel that, 'No matter what I do, it's not going to make a difference,' " he says. "But it does."

It's hard to persuade people to change, Wiehrs says. And patients are sometimes skeptical about his role in their care. He says they often approach him and say, "I've been coming to this office before; I've seen these physicians. And now you're somebody new. What are you doing, and why do you want to talk to me?"

Getting these patients to trust Wiehrs is an important part of the hospital's strategy for dealing with rising costs. Memorial is investing $500,000 a year in care coordination, in the belief that the program will save money in the long run and improve the quality of care.

Memorial CEO Maggie Gill wants Wiehrs to teach patients to care for themselves.

By improving the management of medical conditions outside the hospital, Gill says, "you can help people prevent crises from happening."

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She says Memorial provides about $30 million in free care each year. Because Georgia is not among the states that have chosen to expand Medicaid under the Affordable Care Act, the hospital is going to continue to give a lot of free care to people who have low income and are uninsured, Gill says. On top of that, Medicare is penalizing hospitals (via lower reimbursements) when patients have to be admitted repeatedly for some specific conditions. Gill hopes Wiehrs can prevent some of those repeat visits.

Gill recalls one Memorial care coordinator who helped with a particularly difficult case — another patient with diabetes who tended to show up in the emergency department two or three times a year. Working with the patient's wife until she felt comfortable measuring her spouse's insulin levels, and comfortable delivering insulin, made a big difference.

"They avoided at least two emergency department visits by having that resource," Gill says.

On a typical day, Wiehrs meets with three or four patients and calls people who have just been released from the hospital.

He says patients end up trusting him. He makes sure they're feeling well, taking their medication and that they know when to come in for a follow-up. Wiehrs gives them his direct phone number so they don't have to hassle with the front office. And for those who can't afford their medications, Wiehrs says, he'll call drug companies or do research online to help find discount drug programs.

"Sometimes you have to get creative and you have to spend the extra time to see what might be available," he says. "That's the benefit of me being a care coordinator and having the experience that I have. I know how to navigate the health care system."

Wiehrs says he's encouraged by the results he's seeing already — like the patient who practically bounded into his office recently, breathing easier thanks to new asthma inhalers.

The hope is that lots of little improvements like that will add up to big savings to the health system — and will improve the health of patients.

This story is part of a reporting partnership that includes Georgia Public Broadcasting, NPR and Kaiser Health News.

Copyright 2014 Georgia Public Broadcasting. To see more, visit http://www.gpb.org/.
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Research Institutions Will Have To Identify 'Dual-Use' Pathogens

Wed, 09/24/2014 - 3:11pm
Research Institutions Will Have To Identify 'Dual-Use' Pathogens September 24, 2014 3:11 PM ET

Biohazard suits used to handle dangerous microbes hang in a laboratory at the U.S. Army Medical Research Institute of Infectious Diseases in Fort Detrick, Md.

Patrick Semansky/AP

Any research institution that receives federal funding will soon have to screen certain kinds of scientific experiments to see if the work could potentially be misused to endanger the public.

The new policy will take effect next year, and it's the latest effort by the U. S. government to come to grips with so called "dual-use" biological research—legitimate medical or public health studies that could reveal how to make already-worrisome germs or toxins even more destructive.

Only a small number of experiments are expected to raise this type of concern; one official said a recent review of already-funded research found only a handful of projects. But some of this research, including a lab-altered bird flu virus, has proven hugely contentious, with scientists sharply divided on whether it should even be done.

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Research institutions have long had "biosafety" review boards charged with making sure that infectious agents and toxins will stay safely contained within labs. The new policy means that universities and other federally-funded science organizations will have to consider whether certain kinds of experiments might generate knowledge that could provide a recipe for a weapon or attack.

The required review covers work that involves a list of 15 nasty toxins and pathogens, such as Ebola and anthrax, and seven categories of sensitive experiments that scientists sometimes call "the Seven Deadly Sins." These include studies that could make a germ more deadly or contagious, or that would let it evade existing treatments or diagnostic tests.

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The new policy for research institutions is similar to another one issued in March of 2012 that requires government funding agencies like the National Institutes of Health (NIH) to screen proposed research projects for potential dual-use dangers before issuing grants.

"It's a complementary process," says Amy Patterson, associate director for biosecurity and biosafety policy at the NIH. "I think it is important for institutions and investigators to also gain expertise in the mind-set." As a project is underway, she adds, "They are going to have to be mindful as well of whether dual-use issues emerge during the conduct of the science."

All of this regulatory action came in the wake of a high-profile controversy over two experiments that made a kind of highly-pathogenic bird flu more contagious in ferrets, the lab stand-in for humans. Critics said that the researchers had created super-flus that could cause a pandemic in people, if they ever fell into the wrong hands or got out of the lab.

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The government put a special review process in place for this type of flu research, but scientists are still arguing about the wisdom of conducting research intended to give pathogens new properties, sometimes called "gain-of-function" work.

"The U. S. government's approach to gain-of-function studies is definitely an area that we are actively discussing," says Andrew Hebbeler, assistant director for biological and chemical threats at the White House Office of Science and Technology Policy.

He says officials want advice on gain-of-function studies from a government advisory committee called the National Science Advisory Board for Biosecurity.

That committee reviewed the controversial bird flu experiments back in 2011 and 2012. But the government has not convened this advisory group for almost two years. Federal officials recently appointed a slew of new members and have scheduled a meeting for next month.

"One of the agenda items will include thinking through risks and benefits associated with gain-of-function studies," says Hebbeler. "As these discussions advance within the government, we hope to have more to share with you in the future."

The National Academies of Sciences is also planning to wade into the debate soon, with a symposium that could be held later this year.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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When Cigarettes Cost More, People Drink Less. Except For Wine

Wed, 09/24/2014 - 12:46pm
When Cigarettes Cost More, People Drink Less. Except For Wine September 24, 201412:46 PM ET

Either we smoke or we drink or we break up.

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For those who count Don Draper among their TV loves (or love-to-hates), it comes as no surprise that drinking and smoking go hand in hand. Public health researchers have long known that smokers tend to drink, drinkers tend to smoke, and heavy smokers (see: nearly anyone on Mad Men) tend to drink even more heavily.

We've also known that increasing state taxes on cigarettes actually reduces smoking and helps people break the habit.

Raising cigarette taxes also lowers the amount of drinking, the most recent analysis finds. The study, published Wednesday in Alcoholism: Clinical & Experimental Research, highlights the tie between the vices.

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"It seems logical that as smoking decreases due to these policies that drinking might also decrease," Melissa Krauss, a data analyst at the Washington University School of Medicine and one of the authors of the study, tells Shots.

However, the beneficial effect only applied to beer and spirits, not wine. Wine drinkers, the authors say, are more likely to have healthier lifestyle habits than beer or spirits drinkers. As Krauss says: "[The results] made sense to us because prior research shows that wine drinkers are less likely to smoke." (Granted, this doesn't explain Betty Draper's propensity to light up.)

The Salt Seeking Proof For Why We Feel Terrible After Too Many Drinks

Krauss and her fellow researchers analyzed U.S. data between 1980 and 2009, looking at how much alcohol was consumed per state, per person; each state's price for a pack of cigarettes; and their smoke-free air policies.

Controlling for other variables like income, unemployment rate and religious affiliation, they saw the price of cigarettes (a median of just $1.76 per pack in 1980, compared to $5.68 in 2009) and adoption of smoke-free policies increase, while alcohol consumption dropped. States that showed the highest tax increases per pack also showed the greatest reduction in drinking — 26 percent, compared to just 5 percent in states with low cigarette price increases.

The Salt Key Chain Blood-Alcohol Testing May Make Quantified Drinking Easy

The researchers suggest it's possible to kill two birds with one stone; a 20 percent increase in cigarette price would correlate to a nearly 2 percent reduction in per capita drinking.

"We already know that strengthening tobacco policies has great benefit in reducing smoking prevalence," says Krauss. "This shows that there are unintended consequences that are having good public health benefits as well."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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After The NIH Funding 'Euphoria' Comes The 'Hangover'

Wed, 09/24/2014 - 11:54am
After The NIH Funding 'Euphoria' Comes The 'Hangover' September 24, 201411:54 AM ET

When Richard Larson co-wrote a scientific paper about the perils of up-and-down funding for the National Institutes of Health, he noted that the research cycled between states of "euphoria," and a "hangover" far greater than you'd expect.

The editors of the journal Service Science at first argued that those labels were inflammatory, says Larson who is an engineering professor at the Massachusetts Institute of Technology. But he successfully argued that the wording was spot on.

It turns out there's a natural amplifier in the NIH grant-funding system. It leads to higher highs and lower lows when budgets rise and fall. And Larson's analysis offers lessons for avoiding the pain of boom-and-bust funding that is currently causing some scientists to spend more time writing grant proposals than they spend conducting research.

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The key ingredient in this surprise budget problem is that most grants given out to scientists are promised for four years. One-quarter of the funding is given out in four consecutive years.

One consequence of that system is that in any given year, three-quarters of the budget goes to pay for grants approved in the three previous years. The remaining quarter — for grants that have run their four-year course — is available for new projects.

This formula works fine when funding is the same year to year. But Larson looked at what happens in a year when there's a big increase. It turns out a 20 percent increase in funding for one year leads to a whopping 80 percent increase in money available for new grants. That's a huge jump.

How so? Well, existing grants don't require any more funding than before, so the entire increase goes to new projects. If funding increases from $10 billion to $12 billion, for example, existing grants require three-quarters of the $10 billion — $7.5 billion. That leaves $4.5 billion for new grants. That's a huge jump from the previous year, where new grants garnered $2.5 billion.

That's the "euphoria" part of this equation. But wait. A "hangover" is on the way.

In the case of the real NIH budget, funding doubled between 1998 and 2003. After that, the funding flattened out. Naturally, the existing grants given out during the time of budget increases required a lot more money to support. And as a result, the amount of money available for new grants took a huge tumble.

In fact, money for new grants plunged by more than 35 percent in a single year, according to Larson's simplified mathematical model, even though the overall budget was simply flat.

That's a bad hangover.

"Once you see it in black and white you say, 'Oh my God, it's obvious'," Larson tells Shots. "It's very simple mathematics, but the implications for policy are profound."

Scientists who had the bad fortune of having their grants expire in a hangover year were in big trouble. The chances of getting renewed fell through the floor.

As Larson and his colleagues at MIT and Ohio State University ran the numbers, they found a simple mathematical solution to this. The NIH could have avoided the worst of the hangover by holding back some of the largess, and spreading it out over several years. That's what a prudent business could have done. Not so the NIH. "By federal law they have to spend everything. They can't carry over," he says.

Larson says the NIH can use other techniques to limit funding shocks for scientists. For example, they can adjust the length of grants, so some run three years, some go for four and others go for five. That would reduce the euphoria and hangovers. But it may give some scientists headaches, since they tend to think in terms of four-year funding blocks, and they plan their research accordingly.

Sally Rockey, the NIH Deputy Director for Extramural Research, says the institute is acutely aware of these mathematical quirks, and takes steps to minimize them.

For example, last year the federal budget sequester removed $1.5 billion from the NIH budget, so the agency reduced the number of grants — but also took the extraordinary step of reducing the size of grants that had previously been approved.

This year, congress returned about $1 billion to the NIH budget it had withheld from the sequester, and that enabled NIH to increase the number of new grants approved by 500 to 600, Rockey says. The NIH contemplated the future commitments involved in new grants when deciding how many more to fund. And of course, NIH doesn't know what lies in store for future grants.

"Obviously it would be a lot easier if our budget was on some sort of stable trajectory, if we had something that gave us more predictability and a little growth each year," she tells Shots.

Larson can relate. He's hoping to explore other solutions to the NIH problem — that is, if he can get fresh funding. His four-year NIH grant to study this issue has expired.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Hearing That Things Can Change Helps Teens Dodge Depression

Wed, 09/24/2014 - 10:17am
Hearing That Things Can Change Helps Teens Dodge Depression September 24, 201410:17 AM ET

Depression is common in teenagers, with 11 percent being diagnosed by age 18, and many more having depressive symptoms. Social and academic stress can trigger depression, and rates of depression tend to peak in adolescence around the age of 16.

It doesn't help that stressed-out teens often fall into hopelessness, says David Yeager, an assistant professor of psychology at the University of Texas at Austin. "When kids have hard things happen to them, they think it'll be like that way into the future."

Researchers started noticing back in the 1980s that many teens felt that social and personality traits were immutable — that someone who is once a loser is always a loser.

So what if we could convince kids that things can change for the better — would that help mitigate the high rates of depression? Yeager tested that out. The results of his latest study, published Monday in Clinical Psychological Science, suggests that it does.

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The study divided 600 ninth-graders into two groups. Half participated in a brief intervention program designed to help them understand that people and circumstances can change. These teenagers were shown several articles, including one about brain plasticity, and another about how neither bullies nor victims of bullying are intrinsically bad.

"We didn't want to say something to teenagers that wasn't believable," Yeager says. "We just wanted to inject some doubt into that problematic world view that people couldn't change."

The students also read advice from older students reassuring them that high school gets better, and they were asked to draw from their own experience and write about how personalities can change.

Nine months later, the researchers checked up on all the students. Among those who didn't participate in the intervention, rates of depression symptoms such as feeling constantly sad and feeling unmotivated rose from 18 percent to 25 percent — about what the researchers expected, Yeager says. The group that participated in this intervention showed no increase in depressive symptoms, even if they said they were bullied.

Of course this is a fairly small study. And the intervention doesn't treat clinical depression. At most, it helps kids who may be prone to depression cope better.

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"I would say the research is at an early stage," says Gregory Walton, an assistant professor of psychology at Stanford University who wasn't involved in the study. "But this is a fairly promising start."

For one, the intervention is pretty easy to start and scale up, Walton says.

And Yeager's previous research indicates that the intervention also helps with aggression and general health. Other researchers have found that similar interventions help teens do better academically.

Like teens, many adults tend to feel that people and circumstances don't change, Walton says. "But adolescence might be a good window of opportunity to target that belief."

Anything that could help prevent the onset of depression in teens is worth testing and trying out, he says. "Depression is a recurrent disorder. Kids who have an episode of depression in adolescence are likely to have another episode as adults," he notes. So intervening early could make a huge impact in a teenager's future.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Insurance Brokers Key To Kentucky's Obamacare Success

Tue, 09/23/2014 - 5:20pm
Insurance Brokers Key To Kentucky's Obamacare Success September 23, 2014 5:20 PM ET

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David Combs, an insurance broker in Kentucky, wound up benefiting from the Affordable Care Act, even though early on he had figured the law would put brokers out of business.

Jenny Gold/Kaiser Health News

David Combs has been a health insurance broker in London, Ky., for more than 15 years. When the Affordable Care Act became law, he read it, from cover to cover. Then he sold his agency.

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The mainstay of his business had been selling insurance coverage to small companies, and, the way he saw it, here was the government, stepping in and offering to sell it online instead. Combs and many others thought brokers would go the way of travel agents, no longer needed in a do-it-yourself online marketplace.

But he started to think about the law in a new way once he learned that brokers could still earn a commission for selling coverage through the exchange

"I knew there was going to be a massive change in our industry, and anytime there's a massive change, there's opportunity," says Combs. So he started a new agency in 2013.

Some of the states that were most successful in enrolling consumers via the exchanges embraced brokers. In California, 39 percent of people who signed up for a private exchange plan enrolled with a broker; in Kentucky the number reached 44 percent.

Combs' key insight was that many of his small-business clients could do better dropping their small group coverage and helping their workers sign up for individual insurance on the exchange. The law allows companies with fewer than 50 full-time workers not to offer insurance.

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Frisch's Big Boy, a bustling franchise diner off the highway in London, is the kind of small business where Combs always sold insurance. The restaurant's policy was available only to full-time workers, and, in the past, it was expensive — costing the company and the workers each $150 a month per person. On top of that, they were facing an 86 percent rate increase in 2014.

Before the federal health law offered new options, few of the restaurant's workers who were eligible to buy insurance policies through Frisch's actually did so. Given the new options of Obamacare, "it didn't make sense for [the restaurant] to continue to offer health insurance," explains Combs. "It was actually a detriment to their employees."

Here's why: Because most of the restaurant's employees were low-income, they would qualify for free or low-cost coverage on Kynect — Kentucky's state health insurance exchange. Switching everybody over to the exchange was win-win-win: cheaper for the restaurant, cheaper for the employees; plus, more people got coverage, including some part-time workers.

"I thought to some degree it was too good to be true, what people were paying," says the franchise diner's co-owner Herman Hatfield. "But it worked out to where a lot of people got better care for less money."

Mary Gray bought health insurance through Combs. Gray qualified for subsidies under the Affordable Care Act and is paying a lot less than she did for last year's policy.

Jenny Gold/Kaiser Health News

Combs earns a commission of $20 per month for each person he enrolls, including spouses and children. That commission is paid by the insurer and is already built into premiums. Combs enrolled all the employees at Hatfield's London, Ky., diner in just two days.

Before the advent of Obamacare, waitress Mary Gray was one of only 12 people at the restaurant who bought her health insurance — the old, expensive policy – through Frisch's. This year, she enrolled in a silver plan through Kynect that was completely subsidized, so she pays nothing toward her premium. She is one of the 28 employees at Frisch's whom Combs helped enroll in a private Kynect plan; most of the rest of the 60 full- and part-time employees at the London restaurant qualified for Medicaid, while a few had employer-sponsored coverage through a spouse or parent.

Virtually all the small businesses Combs had sold coverage to in the past were eligible to make a transition similar to the one the London diner made. "We're running into an industry as many of our fellow brokers are running out," he says, because instead of signing up small companies, the other brokers are signing up individual people, one at a time. If you take that approach, Combs says, "you'll go broke."

But brokers' roles are not so significant everywhere. In Kentucky, 44 percent of consumers who bought private health plans bought them through brokers; that compares with just 8 percent nationwide, according to a survey from the Kaiser Family Foundation.

In many states, brokers fought against the health law and against navigators (the government workers who help people sign up for Obamacare). But in Kentucky, Kynect's director, Carrie Banahan, set up a special committee for brokers and navigators that got them talking.

"It was contentious at first," Banahan admits. "But once they got to know each other, they built a level of trust and they get along very well."

If brokers want to survive, Combs says, they have to embrace the federal health law, even if they don't like it. "The ones that don't want to get into it and educate themselves about health reform — I think they are going to become kind of a dinosaur fairly soon," he says.

But those brokers who can evolve have a huge opportunity, Combs believes. By December 2014, he expects his new agency to hit $1 million in revenue — the most business he's done in his 15 years as a broker in Kentucky.

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

More Women Skip Some Prenatal Tests After Learning About Risks

Tue, 09/23/2014 - 4:08pm
More Women Skip Some Prenatal Tests After Learning About Risks September 23, 2014 4:08 PM ET

Is it time for a test?

iStockphoto

For decades, OB-GYNs have offered prenatal tests to expectant moms to uncover potential issues, including Down syndrome, before they give birth. However, some tests, such as amniocentesis and chorionic villus sampling, carry health risks, including miscarriage. For some women, the risks can be greater than the potential benefits from information they would gain.

Evidence now suggests that women who are well-informed about the pros and cons are more likely to decline testing, even when the tests are free, indicating that the average mother-to-be might not have all the facts.

In a study published in JAMA, the Journal of the American Medical Association, researchers worked with 710 women at medical centers around San Francisco. Half of them received standard care, including a focus on testing for women over age 35. The others were offered a computerized guide to prenatal testing and presented with the choice of having prenatal tests free of charge.

Are Fetal DNA Tests A Key To Pandora's Box? 3 min 58 sec   Shots - Health News Blood Test Provides More Accurate Prenatal Testing For Down Syndrome

The guide, complete with bilingual narrator, talked through the information about the tests, including screenings such as blood tests and ultrasounds that don't carry a physical risk. The guide also covered diagnostic tests like amniocentesis that do.

The guide was personalized for each woman, using her birthday and expected delivery day to say which tests were still available for that stage of pregnancy and what the risk of Down syndrome was (the risk increases with maternal age).

The guide also highlighted a choice that women frequently overlooked: opting out. "We already knew that a lot of women do not understand that the screening tests are optional," says Miriam Kuppermann, professor of obstetrics and gynecology at the University of California, San Francisco School of Medicine and lead author of the study. "We told them it was totally reasonable to have no testing at all," she tells Shots. "It's not a medical question — it's really a values question."

The guide pushed women to think about their values, asking whether they wanted to be tested, whether they would want screenings before the more invasive testing, and which tests in particular they were interested in. All of the women in the study were quizzed on their knowledge of prenatal tests.

The researchers found that only 5.9 percent of women who used the guide underwent invasive testing, while 12.3 percent of the normally treated group did. The group that got a personalized guide was also more likely to avoid testing altogether, knew more about the risks of invasive testing and had a better handle on their likelihood of carrying a fetus with Down syndrome.

Reproductive geneticist Debbie Driscoll, at the Hospital of the University of Pennsylvania in Philadelphia, says having women think about their values and beliefs is important before diving in. She tells Shots there's variability across the country among women who choose prenatal screenings. Those differences, she says, are "probably not so surprising when you think about people's political and religious beliefs."

Kuppermann says prenatal testing can be a wonderful thing, particularly with advances in safer blood tests that can give definitive answers. However, she says the millions of women having babies each year in the U.S. need to understand what they're signing up for. The women should make the decision, she says, not their doctors. "I'm not trying to get women to test, and I'm not trying to get women to not test," says Kuppermann. "My goal is to have all women get the information they need."

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

Insurers Cautious As Proton Beam Cancer Therapy Gains Popularity

Tue, 09/23/2014 - 2:09pm
Insurers Cautious As Proton Beam Cancer Therapy Gains Popularity September 23, 2014 2:09 PM ET

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Proton beam therapy can precisely target tumors to avoid harming surrounding tissue, advocates say.

Blythe Bernhard/St. Louis Post-Dispatch/MCT/Landov

Everyone seems to agree that proton beam therapy — a type of radiation treatment that can target cancerous tumors while generally sparing the surrounding tissue — is an exciting technology with a lot of potential.

But some insurers and medical specialists say that coverage shouldn't be routine, until there's better evidence that proton therapy is more effective at treating various cancers than traditional, less expensive radiation treatment.

That cautious approach doesn't sit well with proponents, some of whom say that insurance coverage is needed for research on the controversial therapy's uses.

Meanwhile, the number of proton therapy centers, which can cost more than $200 million to build, continues to increase. Fourteen are in operation in the United States and a dozen more are under development, according to Leonard Arzt, executive director of the National Association for Proton Therapy.

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Critics assert that the rush to build the centers is putting a very large cart before the horse.

In general, "the evidence has failed to demonstrate that there is a significant improvement in outcomes with proton beams," says J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society.

A 2012 study published in the journal Radiotherapy and Oncology, for example, found proton beam therapy to be superior to traditional radiation therapy for some childhood cancers affecting the central nervous system as well as large cancers of the eye and tumors at the base of the skull. In the case of prostate and liver cancers, there was evidence that the therapy worked, but not that it was superior to traditional treatment, according to the study.

The use of proton beam therapy has accelerated rapidly in recent years as medical centers have raced to capitalize on its clinical and financial potential. At the same time, those efforts have drawn criticism from some consumer and health care advocates who suggest that the therapy is a clear illustration of how new technology can drive costs higher for consumers and insurers without necessarily improving care. For some types of cancer, such as prostate cancer, costs can run three to six times higher than conventional radiation.

But there are signs of trouble. Last month, the proton beam center at the University of Indiana, one of the country's first, said it was closing. Among the reasons were the center's aging equipment, the large number of newly designed facilities and falling insurance reimbursements.

Insurance coverage for proton beam therapy varies widely. Some insurers, such as Cigna, cover proton therapy only for cancer of the eye. Others, including UnitedHealthcare, cover the therapy for additional conditions, including skull-based tumors and arteriovenous malformations in the brain as well as some pediatric illnesses.

Although Medicare doesn't have a national coverage policy for proton therapy, the therapy is generally covered with few limitations, according to a spokesman for the Centers for Medicare & Medicaid Services.

Some advocates for proton beam therapy say insurers need to provide more support for the clinical trials that they believe will show the treatment is superior.

Steven Frank, the medical director of the proton therapy center at the MD Anderson Cancer Center in Houston, is trying to recruit patients for a randomized clinical trial to test proton therapy against traditional radiation therapy in head and neck cancer.

"The biggest struggle we're coming up against is that the insurers don't want to pay for it," he says.

Under the health law, most insurers are required to cover routine patient costs associated with participating in approved clinical trials for cancer or other life-threatening conditions.

So if a patient suffers side effects or other medical problems during the trial, insurers are responsible for covering those costs, among others. But they don't have to pay for costs related to the investigational part of the trial, in this case the pricey proton beam therapy.

Some say this situation is no different than testing a cancer drug: The insurer covers the routine costs, but the drug manufacturer is often responsible for providing the drug and testing it.

"Drugs should prove whether they are equal or superior to an existing treatment," says Lichtenfeld. "Why should proton beam be any different?"

Proton beam therapy proponents counter that it is different because they already know the therapy works.

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

To Make Interval Training Less Painful, Add Tunes

Tue, 09/23/2014 - 12:39pm
To Make Interval Training Less Painful, Add Tunes September 23, 201412:39 PM ET

This may be the most efficient way to get in shape, but it may also be the least fun.

Li Zhongfei/iStockphoto

There's increasing evidence that interval training, which involves alternating short bursts of harder exercise with easier recovery periods, delivers more health benefits than exercising at a steady rate.

But if you've tried it, you may have decided that exercising quite hard, even for short periods of time, is about as much fun as peeling off your toenails one by one. At its most intense, "people may say it's pretty aversive," said Matthew Stork, a Ph.D. student in kinesiology at McMaster University in Hamilton, Ontario.

While high-intensity interval training is never going to feel like a stroll in the park, doing intervals while listening to some favorite tunes made participants work out harder and increased their reported enjoyment, according to a study by Stork and his colleagues.

The study, published online in Medicine & Science in Sports & Exercise, took 20 healthy, moderately active adults and taught them to do a particularly tough form of interval training — four 30-second "all-out" sprints on a stationary bicycle with four minutes of rest in between — both with and without a personalized playlist of self-selected songs.

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The exercisers had higher peak and average power outputs while listening to music than when not. They also reported more enjoyment with the music, and that enjoyment increased over time. Differences in participants' feelings (from "very good" to "very bad") and motivation weren't statistically significant. (They might have been if the study had included more participants, said Stork.) All of the participants said they'd listen to music again if they were doing this type of interval training.

The study is generally in line with other research in this area, says Costas Karageorghis, a sport and exercise psychologist at Brunel University London who studies the role of music in improving athletic performance. In general, research suggests that in endurance activities like running or cycling, music can make exercisers produce more power, improve energy efficiency and increase enjoyment.

In lower-intensity exercise, like walking or a Zumba class, it also seems to "block some of the neural messages from muscles to the brain, which makes us feel like we're working less hard," says Karageorghis.

At high intensities, music doesn't make the task feel easier, but it can boost enjoyment nonetheless. "It can't influence what we feel, but how we feel it, he says. The goal is to make an exercise bout feel more enjoyable toward the end of the session, so you're more likely to do it again another day."

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And that may be especially useful when the form of exercise is not so enjoyable.

Karageorghis said there might have been a larger effect seen in this study if music had been selected for exercisers based on tempo, lyrics, personal tastes and other factors rather than allowing exercisers to pick their own tracks.

Stork said future research in this vein might evaluate the influence of music on milder versions of interval training that don't require an all-out effort.

Indeed, Karageorghis warned that the type of high-intensity interval training used in the study is tough by design, and is unlikely to appeal to beginners or keep them engaged for the long term – even if Kelly Clarkson is singing in your ear. It's more likely to attract people who already exercise and enjoy pushing themselves, he said.

My own running playlists include plenty of Jock Jams-esque tunes that I'd rather not admit to. (Okay, I'll cop to EMF's "Unbelievable.") If you need some new tunes in your rotation, check out NPR's Ultimate NPR Workout mix.

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

Death Cuts Short The Life Of An Alzheimer's Research Volunteer

Tue, 09/23/2014 - 3:34am
Death Cuts Short The Life Of An Alzheimer's Research Volunteer September 23, 2014 3:34 AM ET Listen to the Story 1 min 49 sec  

Justin McCowan poses for a portrait outside of his house in Santa Monica, Calif., on Aug. 14.

Benjamin B. Morris for NPR

If you're a regular Shots reader or Morning Edition listener, you may remember a recent story about Justin McCowan, a man with Down syndrome who wanted to help researchers find a treatment for Alzheimer's disease. McCowan died in his sleep on Thursday at his home in Santa Monica, Calif. He was 40.

Shots - Health News People With Down Syndrome Are Pioneers In Alzheimer's Research

Alzheimer's researchers have become interested in Down syndrome because most people with the genetic condition develop Alzheimer's by the time they reach 60. A drug that delays or prevents Alzheimer's in people with Down syndrome will probably also work in the general population, scientists say.

McCowan volunteered for a monthlong study of an experimental Alzheimer's drug at the University of California, San Diego. He decided he was willing to undergo the brain scans and blood tests involved because he saw it as a way to help his friend Maria, who also has Down syndrome and had developed Alzheimer's. "I feel very sad about Maria because she doesn't remember anything," McCowan said.

In a small way, McCowan did help his friend, says Michael Rafii, a researcher who oversees the study. "People with Down syndrome have a huge amount to contribute to the research world," he says, adding that researchers from UCSD will be among those attending McCowan's funeral.

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

Avoid The Rush! Some ERs Are Taking Appointments

Tue, 09/23/2014 - 3:27am
Avoid The Rush! Some ERs Are Taking Appointments September 23, 2014 3:27 AM ET

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Listen to the Story 4 min 10 sec  

Michael Granillo and his wife Sonia await treatment at an emergency room in Northridge, Calif.

Anna Gorman, Kaiser Health News

Three times in one week, 34-year-old Michael Granillo returned to the emergency room of the Northridge Hospital Medical Center in Southern California, seeking relief from intense back pain. Each time, Granillo waited a little while and then left the ER without ever being seen by a doctor.

"I was in so much pain, I wanted to be taken care of 'now,' " says Granillo. "I didn't want to sit and wait."

But on a recent Wednesday morning, he woke up feeling even worse. This time, Granillo's wife, Sonya, tried something different. Using a new service offered by the hospital, she was able to make an ER appointment online, using her mobile phone.

When they arrived at the hospital, he was seen almost immediately.

"The minute I told her who he was and why we were here, she opened the door and let him in," says Sonia Granillo. "That was a relief ... because I thought he was going to say, 'Let's go, let's go. I can't wait.' "

“ We're in a crisis right now with a shortage of access to primary care. I think this emergency room is probably taking advantage of that need.

Hospitals around the country are competing for newly-insured patients, and one way to increase patient satisfaction, they figure, might be to reduce the frustratingly long wait times in the ER. To that end, Northridge and its parent company Dignity Health started offering online appointments last summer; since then, more than 22,000 patients have reserved spots at emergency rooms in California, Arizona and Nevada.

Recently, Dignity stepped up its marketing — with billboards, print advertisements and online and radio spots. One online ad features a woman sitting in a hospital waiting room, and then cuts to her on a living room couch with a dog, as the words on the screen read, "Wait for the ER from home."

Dr. Stephen Jones, who heads the Northridge ER, explains that the system isn't meant to be used during real emergencies — like chest pain or trouble breathing.

"If they have those signs or symptoms, they should pick up the phone and dial 911," Jones says. When patients with appointments get to the hospital, they still may be bumped in favor of people who are more seriously ill.

But hospital executives say the approach makes business sense for hospitals because it gives medical staff a better sense of who will be coming through the door, and it makes patients more comfortable.

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Patients want to get access to health care the same way they get services in other industries, such as retail or travel, says Chris Song, a spokesman for InQuicker, a Nashville-based company that offers the online scheduling in California and 25 other states.

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"When is the last time someone bought plane tickets at the gate?" Song says.

Still, some critics say the online check-in system may be convenient, but is not necessarily cost-effective. If the country wants to decrease the costs of health care, patients need to be treated at the right place at the right time, says Dr. Del Morris, president of the California Academy of Family Physicians. Patients who can make appointments should do so at their doctors' offices, he argues.

"Emergency rooms are there to take care of people who have emergencies," Morris says.

People with non-life-threatening conditions should make an appointment to see their doctor instead of going to the ER, he says. "We're in a crisis right now with a shortage of access to primary care. I think this emergency room is probably taking advantage of that need."

Jones, the medical director for the emergency room, says some patients who come in through the appointment service probably should be seen by a primary care doctor, but either don't have one or can't get a timely appointment.

"I think this represents a reasonable alternative for patients who are concerned they may have an emergency condition," he says.

On the day of his appointment at Northridge Hospital Medical Center, Granillo winced and shifted uncomfortably in the ER exam room.

After a CT scan, doctors told the couple that Granillo has a very serious condition – lymphoma, a type of cancer. Jones says Sonya was right to insist her husband come in for care.

"She was really worried about his condition and rightfully so," Jones says.

Sonya Granillo says if she hadn't made an appointment, her husband might still not know about his diagnosis.

"Over five days, I have been trying to get him into the ER, and that was my last resort." She says. "And it worked."

Dignity Health also offers the online reservations at urgent care centers and at doctors' offices.

Page West, chief nursing officer for Dignity Health, says she hopes that the new service will minimize wait times and boost patient satisfaction scores — under the Affordable Care Act, Medicare's reimbursement payments to hospitals are tied to results on patient surveys.

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

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

In California, Less Water Means More West Nile Virus

Mon, 09/22/2014 - 1:54pm
In California, Less Water Means More West Nile Virus September 22, 2014 1:54 PM ET

fromKQED

Low water levels, like at this reservoir near Gustine, Calif., bring birds and mosquitoes together and help transmit West Nile virus to humans.

Rich Pedroncelli/AP

California's historic drought is partly to blame for the recent rise in West Nile virus infections, public health officials say. There have been 311 cases reported so far, double the number of the same time last year, and the most of any state in the country.

West Nile virus is spread by mosquitoes. They contract the virus when they feed on infected birds, then spread it to the birds they bite next. A shortage of water can accelerate this cycle.

"When we have less water, birds and mosquitoes are seeking out the same water sources, and therefore are more likely to come in to closer proximity to one another, thus amplifying the virus," says Vicki Kramer, chief of vector-borne diseases at the state Department of Public Health.

Also, the water sources that do exist are more likely to stagnate. Stagnant water creates an excellent habitat for mosquitoes to breed.

Around the Nation Despite California's Drought, Taps Still Flowing In LA County

"It makes more mosquitoes, and it makes them faster," says Roger Nasci, chief of the arboviral diseases branch at the Centers for Disease Control and Prevention.

High temperatures contribute as well, and can be especially bad when it doesn't cool down at night. That's been the case in Orange County this year. It has logged the highest number of West Nile cases in humans in the state: 116.

Local officials have been waiting for the right weather conditions to spray pesticides to kill mosquitoes and have been surveying the region by plane for backyard pools and birdbaths that have stagnated. High foreclosure rates in the region led to an increase in abandoned pools in recent years, and continue to be a factor in the current elevated rates of West Nile, Kramer says.

The Salt California Drought Has Wild Salmon Competing With Almonds For Water

While case numbers are high in Orange and Los Angeles counties, some counties in Northern California have a higher concentration of cases. Glenn County north of Sacramento has the highest incidence of West Nile at 35 cases per 100,000 people. Orange County's incidence is just 4 per 100,000.

"There's a broader type of habitat available for mosquitoes in the Sacramento Valley compared to Bay Area counties, for instance," Kramer says.

As a result, the area draws two types of mosquitoes to the region: rural mosquitoes that breed in the rice fields, and urban mosquitoes in surrounding towns.

"So those two mosquitoes working together will further amplify the virus," she says.

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The majority of people infected with West Nile virus show no symptoms. Twenty percent get flu-like aches and fever, and only 1.5 percent develop the most severe neuroinvasive form of the disease. Ten percent of those who get very sick, die.

So far this year, 12 people in California have died, mainly the elderly and people with underlying conditions like diabetes or high blood pressure. In total, California has the most reported cases of West Nile in the country — 311 cases as of last Friday. Texas is second with 98 cases, and Louisiana is third with 78, according to CDC data.

Nasci warned that the season for West Nile has yet to peak. Temperatures and infection rates are still rising.

"There's still a substantial period of the year left," he says. "How long that risk persists will depend on how many more mosquitoes are produced, how much longer they're going to live, how many birds are susceptible."

Public health officials recommend that people protect themselves from infection by wearing long sleeves and long pants, and using insect repellent.

This story was produced by State of Health, KQED's health blog.

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

NFL Looks To Training To Prevent Domestic Violence By Players

Mon, 09/22/2014 - 3:33am
NFL Looks To Training To Prevent Domestic Violence By Players September 22, 2014 3:33 AM ET Listen to the Story 5 min 10 sec  

No amount of training can undo the violence someone experienced at home as a child, but it can help break the cycle.

Pamela Albin Moore/iStockphoto The Two-Way NFL Commissioner: 'We Will Get Our House In Order'

On Friday, NFL Commissioner Roger Goodell broke a week of silence following the release of a video that showed former Baltimore Ravens running back Ray Rice assaulting his then-fiancee.

Goodell apologized for his role in the NFL's handling of the matter.

He also vowed that the NFL will mandate trainings on preventing abuse for all players and staff. What the trainings will entail remains to be seen. But researchers say that to truly cut back on violence among players, the NFL should address at least one major risk factor: a culture of acceptance in professional sports.

Of course, the type of people who engage in domestic violence is disturbingly diverse — some accountants, judges, even clergymen hit their partners.

But lately the question has been: Why the NFL? Especially when the vast majority of NFL players will never abuse their wives or beat their children.

“ The most startling finding was that the highest rate of domestic violence in the Unites States Army was not in the combat infantry or special forces. It was those people who worked in supply.

"Football is not even the most violent sport," says Richard Gelles, a professor of social policy at the University of Pennsylvania. "Why aren't we hearing about wrestlers or boxers? You know the old joke: 'I went to a fight and a hockey game broke out.' "

Gelles has been studying domestic violence since the 1970s. He has done a lot of research on sports, but he also has looked into family violence among members of the military: combat infantry soldiers, trained to kill an enemy.

The U.S. Army brought in Gelles to conduct an internal study in the 1990s. It wanted to find out if men trained to kill were more likely to beat their wives or hit their kids. Gelles found that rates of domestic violence in the Army were slightly higher than in the general population. "But the most startling finding was that the highest rate of domestic violence in the Unites States Army was not [in] combat infantry or Special Forces," he says. "It was those people who worked in supply."

"Supply" — as in ordering things and receiving them. Restocking for missions.

"So the training of people to be violent, and violence as part of your work culture, is not a sufficient explanation for what's going on in the NFL," Gelles says.

It's challenging to measure rates of domestic violence, because most incidents are not reported to the police, or anyone else; but Gelles is not convinced that rates in the NFL are significantly higher than in the general population.

He also notes that, even when aggression is the goal, it's quite difficult to train people to be violent: "In World War II, only about 30 percent of combat infantry actually fired their weapons."

So where do people who abuse their partners and children learn the behavior? How far-reaching should these NFL trainings be?

Rowell Huesmann, a psychologist at the University of Michigan, has spent his career trying to figure out what makes some people violent. Much of his research points to childhood experiences.

The Two-Way Hannah Storm, A Pro, Fan And Mother, Gives NFL An Earful

"Children are great imitators," Huesmann says. Children who grow up with physical abuse and domestic violence are learning that "this is a way you deal with other people when you want to make them bend to your will," he says. "You hit them."

Adrian Peterson, the Minnesota Vikings running back recently indicted by a grand jury on a child abuse charge for his method of disciplining his son, says his own father whipped him as a child. Peterson even chose the same instrument his father used to discipline him: a switch cut from a tree.

No NFL training can change what players experienced as children. But that sort of education can address the biggest risk factor for committing acts of violence: having committed such an act before. Researchers say it's much easier to be violent if you're getting a message that violence is acceptable. The NFL has, at least indirectly, and until very recently, been sending that message for decades.

It doesn't just reach players, says Jackson Katz, a violence prevention educator. It trickles down to fans — even the youngest ones.

"Millions of boys across the United States have big posters of football players on their wall," says Katz. "You can bet that they know what's going on here."

Katz works with NFL players in a program called MVP, Mentors in Violence Prevention — a training program that's just the sort Goodell promised Friday to mandate for all NFL players. (In August, NPR reported on MVP and how it's used with high school boys to prevent sexual assault.)

Katz has trained players in the NFL for almost 15 years. But, except for consistent work with one team, the New England Patriots, he's been brought in only occasionally, he says.

"It's never been systematic in the NFL," Katz says. "We've argued for years that we could do so much more if they wanted us, and wanted to make it happen."

He hasn't gotten a call from the NFL about the new mandate. But in order to make a difference in players' behavior, he says, the trainings will have to go beyond a one-shot presentation.

"What we're talking about here is culture change," Katz says. "We're talking about setting a tone where abusive behavior is seen as completely unacceptable."

In the meantime, Richard Gelles says that even the delayed reaction to Ray Rice's abusive behavior is progress.

This year, Gelles says, "is the first time that I have seen a professional athlete really rung up and sanctioned for domestic violence."

Gelles can rattle off a long list of baseball players, basketball players and football players who were not arrested, and who were allowed to keep playing, even after particularly brutal assaults of their wives and girlfriends.

But he suspects those days in professional sports might be coming to an end, because "what has been private is now becoming public," he says, in the form of YouTube videos and the cascade of public opinion that follows.

That's something institutions like the NFL can no longer ignore.

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

The Biology Of Altruism: Good Deeds May Be Rooted In The Brain

Mon, 09/22/2014 - 3:32am
The Biology Of Altruism: Good Deeds May Be Rooted In The Brain September 22, 2014 3:32 AM ET Listen to the Story 3 min 36 sec   Rob Donnelly for NPR

Four years ago, Angela Stimpson agreed to donate a kidney to a complete stranger.

"The only thing I knew about my recipient was that she was a female and she lived in Bakersfield, Calif.," Stimpson says.

It was a true act of altruism — Stimpson risked pain and suffering to help another. So why did she do it? It involved major surgery, her donation was anonymous, and she wasn't paid.

"At that time in my life, I was 42 years old. I was single, I had no children," Stimpson says. "I loved my life, but I would often question what my purpose is."

Angela Stimpson smiles before surgery to donate a kidney on Sept. 22, 2010, at Weill-Cornell Hospital in New York.

Courtesy of Angela Stimpson

When she read about the desperate need for kidneys, Stimpson, a graphic artist who lives in Albany, N.Y., says she found her purpose. She now blogs about her experience and encourages others to become donors.

People like Stimpson are "extraordinary altruists," according to Abigail Marsh. She's an associate professor of psychology at Georgetown University and one of the country's leading researchers into altruism.

Marsh herself was the beneficiary of extraordinary altruism when she was 20. She got into a freak highway accident and ended up stalled in the fast lane facing oncoming traffic. A man dodged traffic to come to her aid and help get her car started. He saved her life, she says, then disappeared before she could ask his name.

Marsh wanted to know more about this type of extraordinary altruism, so she decided to study the brains of people who had donated a kidney to a stranger. Of the 39 people who took part in the study, 19 of them, including Angela Stimpson, were kidney donors.

Marsh took structural images to measure the size of different parts of their brains and then asked the participants to run through a series of computer tests while their brains were being scanned using functional MRI. In one test, they were asked to look at pictures of different facial expressions, including happiness, fear, anger, sadness and surprise.

Most of the tests didn't find any differences between the brains of the altruistic donors and the people who had not been donors. Except, Marsh says, for a significant difference in a part of the brain called the amygdala, an almond-shaped cluster of nerves that is important in processing emotion.

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The amygdala was significantly larger in the altruists compared to those who had never donated an organ. Additionally, the amygdala in the altruists was extremely sensitive to the pictures of people displaying fear or distress.

These findings are the polar opposite to research Marsh conducted on a group of psychopaths. Using the same tests as with the altruists, Marsh found that psychopaths have significantly smaller, less active amygdalas. More evidence that the amygdala may be the brain's emotional compass, super-sensitive in altruists and blunted in psychopaths, who seem unresponsive to someone else's distress or fear.

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

Best To Not Sweat The Small Stuff, Because It Could Kill You

Mon, 09/22/2014 - 3:30am
Best To Not Sweat The Small Stuff, Because It Could Kill You September 22, 2014 3:30 AM ET Listen to the Story 4 min 33 sec   Keith Negley for NPR

Chronic stress is hazardous to health and can lead to early death from heart disease, cancer and of other health problems. But it turns out it doesn't matter whether the stress comes from major events in life or from minor problems. Both can be deadly.

And it may be that it's not the stress from major life events like divorce, illness and job loss trickled down to everyday life that gets you; it's how you react to the smaller, everyday stress.

The most stressed-out people have the highest risk of premature death, according to one study that followed 1,293 men for years.

"People who always perceived their daily life to be over-the-top stressful were three times more likely to die over the period of study than people who rolled with the punches and didn't find daily life very stressful," according to Carolyn Aldwin. She directs the Center for Healthy Aging Research at Oregon State University and led the study, which is scheduled for publication in the journal Experimental Gerontology.

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Some people get frantic sitting in bumper-to-bumper traffic, worried about being late or not being able to do what they hoped in a timely manner. Others simply take the time to sit back, listen to music and appreciate the break as some quiet time.

Now, getting upset in traffic once is no big deal. But if things like that happen all the time and the response is always getting really upset, then the harmful effects of stress can become toxic.

"There are a number of ways chronic stress can kill you," says Aldwin. That includes increased levels of cortisol, often referred to as the stress hormone. Elevated cortisol levels interfere with learning and memory, lower immune function and bone density, and increase blood pressure, cholesterol and heart disease.

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If you are one of those chronically upset worriers, Dr. Robert Waldinger, a psychiatrist at Massachusetts General Hospital and Harvard University, has a prescription for you: exercise.

"If you could give one magic pill that would improve physical health, mood, reduce weight," this would be it, Waldinger says. Federal health officials recommend 30 minutes of moderate aerobic activity every day.

When it comes to fighting stress, Waldinger says, that's enough. "When they do studies particularly of the mood benefit, they find that more than 30 minutes a day is not necessary — you don't get any boost. So if you think just in terms of stress relief and antidepressant effect, 30 minutes is enough."

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Another option would be to add meditation to your daily routine. For many people, that can make a big difference, Waldinger says, "because what you do is watch your mind spin out anxiously over trivia, and eventually it settles down and you begin to have more perspective."

Breathing may be the simplest and most immediate fix, Aldwin says. "Take a step back when you feel yourself getting upset, step back psychologically and even physically," she recommends. "And then watch your breathing; people who get upset a lot breathe very rapidly and shallowly, and it creates more anxiety." Breathing slowly from the abdomen helps slow the stress response, she says.

And finally, Waldinger says here's something not to do: Don't overdo alcohol. "It feels in the moment like having that extra drink at night eliminates stress because it relaxes you, but it turns out that alcohol disturbs sleep." And it also acts as a depressant.

Some stress is inevitable for everyone, Waldinger says. But stress-related disease doesn't have to be.

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

Terminally Ill, But Constantly Hospitalized

Sun, 09/21/2014 - 5:38am
Terminally Ill, But Constantly Hospitalized September 21, 2014 5:38 AM ET

fromWNYC

The place: Beth Israel Hospital in Manhattan.

The diagnosis: fast-growing, small-cell lung cancer.

The patient: Paula Faber, unrepentant, life-long smoker.

The choice: treat it aggressively to extend life, but probably not cure the disease, or manage the pain and focus on the quality of life.

It was September 2012 and it was Paula Faber's third cancer in a decade, but she did not hesitate.

"She was going to fight it every inch of the way," says her husband Ron Faber.

By August 2013 after much fighting, Paula Faber died at age 72. Ron Faber now regrets the intervening 11 months of chemotherapy, radiation, painkillers and side effects that reduced his wife to 67 pounds of frayed nerves.

"I would have rather have had a really OK four-and-a half months than this endless set of treatments," the stage actor said.

As they confronted Paula's terminal diagnosis, the decision the Fabers made is among the most difficult anyone can make. But it turns out that in the New York metropolitan region, patients opt for aggressive treatment much more often than other Americans.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-wnyc-hospitals-state', 'http://apps.npr.org/dailygraphics/graphics/wnyc-hospitals-state/child.html', {} ); });

"New York City continues to lag in serious ways with regards to providing patients with the environment that they want at the end of life," says Dr. David Goodman, who studies end-of-life care at Dartmouth College's Geisel School of Medicine.

The reasons they do this are many, but most experts agree that it has less to do with the unique characteristics and desires of people in New York and New Jersey than the health care system and culture that has evolved here.

At the end of life, all this translates to more people dying in the hospital, often in an intensive care unit on a ventilator or feeding tube; more doctor visits leading to tests, treatments and drug prescriptions; and more money being spent by the government, private insurers and patients themselves.

Specialists at the Dartmouth Healthcare Atlas maintain that one of the main drivers of this phenomenon is quantity: People end up in hospitals here so often, they say, because this region simply has a lot of hospital beds.

"One of the truisms of health care is that whatever resources are available, or whatever beds are built, they tend to get filled," Goodman says.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-table-wnyc-hospice', 'http://apps.npr.org/dailygraphics/graphics/table-wnyc-hospice/child.html', {} ); });

A second driver is that every region has its own medical "culture," and the one in New York is built around highly trained specialists and sub-specialists who see it as their job to cure illness. Dr. Diane Meier says that means, "that if there's a cancer it needs chemotherapy, that if there's heart failure, it needs a procedure."

Meier is a geriatric specialist at Mount Sinai and the director of the Center to Advance Palliative Care

She says also driving the culture of heavy treatment is the high proportion of specialists and sub-specialists who constantly refer patients to each other — both because that is how they were trained and because it is good for business.

"If I'm an endocrinologist, if I refer to the cardiologist, the cardiologist will refer back to me for endocrine problems," says Meier. "It's like a cottage industry."

At Mt. Sinai, the chair of surgery now demands his staff discuss hospice alternatives with terminally ill patients — and make an electronic note of the conversation that can be tracked. If it does not happen, he demands to know why. Meier said every hospital doctor should follow this example.

"All of medicine needs to be willing to say, 'Why did this person with end-stage dementia have three or four hospitalizations in the last three months of life and die in the intensive care unit? This was a terrible experience for the patient and family. A lot of unnecessary suffering. Over a million dollars cost to the taxpayer. How did that happen?' " she says.

Ron Faber is still asking that question.

A year after his wife Paula died, he still believes her oncologist at Beth Israel Hospital was strangely optimistic about her prospects. Faber acknowledges it was Paula's decision to fight the cancer "every inch of the way," but he thinks she might not have, if her doctors had told her more about the upsides of palliative care and the downsides of aggressive treatment.

"I think they sold her on it," he says. "She was so afraid of death that she was ready to buy, and they knew it. And I think it happens a lot."

Hospice had come up before as an option, but the Fabers thought of that only as a place to go and die, and no one had told them otherwise. Then a social worker explained that hospice is something that can happen at home, too. Belatedly, Faber said, the couple chose that option, and hospice workers from the Visiting Nurse Service of New York came to their apartment in Greenwich Village.

"Once they arrived, it was like putting everything together," he said. "And from that moment on, everything was right."

It turned out to be the Fabers' final five days together, after almost 50 years.

This story is part of a reporting partnership with NPR, WNYC and Kaiser Health News. Special thanks to WNYC's Data Team.

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

Terminally Ill, But Constantly Hospitalized

Sun, 09/21/2014 - 5:38am
Terminally Ill, But Constantly Hospitalized September 21, 2014 5:38 AM ET

fromWNYC

Listen to the Story 6 min 7 sec  

Paula and Ron Faber walk their dog Millie in 2009, between cancer diagnoses.

Shelley Seccombe/Shelley Seccombe

The place: Beth Israel Hospital in Manhattan.

The diagnosis: fast-growing, small-cell lung cancer.

The patient: Paula Faber, unrepentant, life-long smoker.

The choice: treat it aggressively to extend life, but probably not cure the disease, or manage the pain and focus on the quality of life.

It was September 2012 and it was Paula Faber's third cancer in a decade, but she did not hesitate.

"She was going to fight it every inch of the way," says her husband Ron Faber.

By August 2013 after much fighting, Paula Faber died at age 72. Ron Faber now regrets the intervening 11 months of chemotherapy, radiation, painkillers and side effects that reduced his wife to 67 pounds of frayed nerves.

"I would have rather have had a really OK four-and-a half months than this endless set of treatments," the stage actor said.

As they confronted Paula's terminal diagnosis, the decision the Fabers made is among the most difficult anyone can make. But it turns out that in the New York metropolitan region, patients opt for aggressive treatment much more often than other Americans.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-wnyc-hospitals-state', 'http://apps.npr.org/dailygraphics/graphics/wnyc-hospitals-state/child.html', {} ); });

"New York City continues to lag in serious ways with regards to providing patients with the environment that they want at the end of life," says Dr. David Goodman, who studies end-of-life care at Dartmouth College's Geisel School of Medicine.

The reasons they do this are many, but most experts agree that it has less to do with the unique characteristics and desires of people in New York and New Jersey than the health care system and culture that has evolved here.

At the end of life, all this translates to more people dying in the hospital, often in an intensive care unit on a ventilator or feeding tube; more doctor visits leading to tests, treatments and drug prescriptions; and more money being spent by the government, private insurers and patients themselves.

Specialists at the Dartmouth Healthcare Atlas maintain that one of the main drivers of this phenomenon is quantity: People end up in hospitals here so often, they say, because this region simply has a lot of hospital beds.

"One of the truisms of health care is that whatever resources are available, or whatever beds are built, they tend to get filled," Goodman says.

$(function() { var pymParent = new pym.Parent( 'responsive-embed-table-wnyc-hospice', 'http://apps.npr.org/dailygraphics/graphics/table-wnyc-hospice/child.html', {} ); });

A second driver is that every region has its own medical "culture," and the one in New York is built around highly trained specialists and sub-specialists who see it as their job to cure illness. Dr. Diane Meier says that means, "that if there's a cancer it needs chemotherapy, that if there's heart failure, it needs a procedure."

Meier is a geriatric specialist at Mount Sinai and the director of the Center to Advance Palliative Care

She says also driving the culture of heavy treatment is the high proportion of specialists and sub-specialists who constantly refer patients to each other — both because that is how they were trained and because it is good for business.

"If I'm an endocrinologist, if I refer to the cardiologist, the cardiologist will refer back to me for endocrine problems," says Meier. "It's like a cottage industry."

At Mt. Sinai, the chair of surgery now demands his staff discuss hospice alternatives with terminally ill patients — and make an electronic note of the conversation that can be tracked. If it does not happen, he demands to know why. Meier said every hospital doctor should follow this example.

"All of medicine needs to be willing to say, 'Why did this person with end-stage dementia have three or four hospitalizations in the last three months of life and die in the intensive care unit? This was a terrible experience for the patient and family. A lot of unnecessary suffering. Over a million dollars cost to the taxpayer. How did that happen?' " she says.

Ron Faber is still asking that question.

A year after his wife Paula died, he still believes her oncologist at Beth Israel Hospital was strangely optimistic about her prospects. Faber acknowledges it was Paula's decision to fight the cancer "every inch of the way," but he thinks she might not have, if her doctors had told her more about the upsides of palliative care and the downsides of aggressive treatment.

"I think they sold her on it," he says. "She was so afraid of death that she was ready to buy, and they knew it. And I think it happens a lot."

Hospice had come up before as an option, but the Fabers thought of that only as a place to go and die, and no one had told them otherwise. Then a social worker explained that hospice is something that can happen at home, too. Belatedly, Faber said, the couple chose that option, and hospice workers from the Visiting Nurse Service of New York came to their apartment in Greenwich Village.

"Once they arrived, it was like putting everything together," he said. "And from that moment on, everything was right."

It turned out to be the Fabers' final five days together, after almost 50 years.

This story is part of a reporting partnership with NPR, WNYC and Kaiser Health News. Special thanks to WNYC's Data Team.

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

Fair-Trade Condoms: Latex That Lets You Love The World

Sat, 09/20/2014 - 8:37pm
Fair-Trade Condoms: Latex That Lets You Love The World September 20, 2014 8:37 PM ET

Finding the right condom just got a little bit more like finding a good cabbage.

Picky shoppers might notice labels on condom boxes these days that say fair trade, non-GMO and all natural.

Condoms don't just fall off trees, but most of them do start there. The major ingredient in most condoms is natural latex, which comes from rubber trees. A lot has to happen to make tree sap into a Jimmy hat. A number of companies are trying to make that process more ethical, from tree to ... well, you know.

There are Sir Richard's, GLYDE, Fair Squared, Condomi, L. Condoms, French Letter and now Sustain, which hit U.S. stores this summer.

Some of these condoms are certified by the Fair Rubber Association, others by Green America. A PETA sticker ensures that the product hasn't been tested on animals. Many have non-GMO labels. Some claim to have eliminated nitrosamines, a class of carcinogens that's regulated in rubber nipples for baby bottles and pacifiers, but not in condoms.

Rubber drips from a tree into a bucket.

Faisal Akram/Flickr

For all-natural folk, some companies use dyes derived from red cabbage and carrots; some have natural licorice flavoring. For vegans, there are rubbers with something like thistle extract instead of casein, a milk protein that's a common condom ingredient.

All this might leave you wondering how, exactly, a condom is made.

For millennia, the answer was: with whatever's available. "They were made out of fish guts, lamb intestine, beef intestine, and linen," says Aine Collier, who wrote a book about the history of the condom. "The ancient Egyptians used papyrus. The Japanese used extremely fine leather, and they even used a kind of shell that could be pounded. So, latex was a huge step forward, both for comfort and for safety."

Condoms are still made from lamb intestines. But polyurethane, natural rubber and a synthetic rubber called polyisoprene are also used.

These days, step one for a latex condom is to go to a rubber tree plantation in South Asia, armed with a bucket and knife. Getting rubber out of a tree is a little like tapping for maple syrup.

Rubber tappers wake up in the wee hours of the morning to get to the sap before it congeals in the heat of the day. They make incisions in the bark to get it flowing, place a bucket below and let the milky sap bleed.

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"And this is the raw material for balloons, football bladders, household gloves, baby bottle teats and condoms," says Martin Kunz, founder of the Fair Rubber Association. The liquid travels to a factory, often near the plantation, then to another to be formed, tested and packaged. Kunz estimates that one tree can produce enough rubber to make about 100,000 condoms.

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From tree to package, most of the human labor that goes into making a condom happens on the plantation. As with tea and coffee, rubber that's certified fair trade costs more — about 25 cents extra for each pound of rubber. The money goes toward better housing and education, access to electricity, clean drinking water and health care for plantation workers.

The good deeds abroad are sometimes packaged with benefits at home. For every paraben-free love sock that L. Condoms sells, the company donates another to public health partners in sub-Saharan Africa.

Collier says while fair trade certifications may be valuable, in the grand history of condoms, eco-condoms aren't particularly revolutionary. "I think what we're seeing now, this sort of eco-twist to it, doesn't really represent anything fantastic as far as research and development. Fair trade rubber is still rubber."

In the end, Collier says, it may be just one more phase in the condom's long history of creative packaging. A 17th-century sheath might have come with a pink ribbon. In the 1920s and 1930s, condom tins came with flapper silhouettes. Others sold then appealed to people's fascination with Egypt.

"It wasn't about the quality of the condom. Many were absolute crap. But people were buying them with the eye," says Collier. "They loved the packaging, because it fit the lifestyle they were trying to lead. And I think that's exactly what this fair trade, biodegradable, green, vegan condom sales thing is all about. It's just marketing."

Regardless, condoms are still the most effective way to keep sex safe.

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