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Blind From Birth, But Able To Use Sound To 'See' Faces

Fri, 11/21/2014 - 4:19am
Blind From Birth, But Able To Use Sound To 'See' Faces November 21, 2014 4:19 AM ET Listen to the Story 3 min 39 sec  

A brain area that recognizes faces remains functional even in people who have been blind since birth, researchers say. The finding, presented at the Society for Neuroscience meeting this week, suggests that facial recognition is so important that evolution has hardwired it into the human brain.

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"It's all inborn," says Josef Rauschecker, a professor of neuroscience at Georgetown University Medical Center. "The structures are all there because nature has put them there."

Rauschecker was part of a team that studied the brains of six blind people, including Jeannette Gerrard, a retired government worker who lives in Washington, D.C. Gerrard has always relied on voices to identify people, and says that faces were never that important to her.

"I knew what my face looked like by touch," she says, "and I figured a face was a face."

So she was intrigued when researchers from Georgetown asked her to take part in an experiment that would eventually allow her to see faces using sound.

First, the scientists had Gerrard learn to use a special headset fitted with a small camera. By moving her head, Gerrard could make the camera scan across a drawing.

Additional Information: Seeing With Sound

Blind volunteers used a headset fitted with a small camera to scan various shapes, and listened to a mix of corresponding sounds. Gradually, they learned to associate a specific pattern of sound interplay with a specific contour. The square in the center represents the camera's field of view. So, what you are seeing and hearing is a line moving across the camera's field of view, first from bottom to top and then from left to right.

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Credit: Georgetown University Medical Center

The device produced sounds. And as lines or curves came into the camera's view, those sounds would change. The concept is a bit like tapping your way along a wall to find a stud behind the plaster.

With practice, Gerrard was able to interpret more complex sound patterns that revealed more complicated shapes. Eventually, "I could identify a face by listening to those sounds," Gerrard says.

To find out how Gerrard was doing this, the Georgetown scientists put her in a brain scanner. The idea was to watch Gerrard's brain while she was using sounds to recognize a simplified drawing of a face, says Paula Plaza, who was in charge of the experiment. "Our interest was looking into the brain," she says. "What part of the brain is responsible for this perception?"

The team compared brain scans from the six blind people with the scans from 10 sighted people who were looking at the face drawings with their own eyes. The results were almost identical. In both groups, the image caused lots of activity in the left fusiform face area, a region of the brain "that always lights up when you see a face," Rauschecker says.

In sighted people, the fusiform face area is connected to the brain's visual system, he says. But in blind people it appears to be wired to circuits that process sounds. "So there is substantial reorganization in the brain of the blind," Rauschecker says.

What's remarkable is that despite this reorganization, the brain of a blind person retains the module devoted to facial recognition, Rauschecker says. That strongly suggests that the ability to recognize faces comes more from nature than from nurture, he says.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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What Diabetes Costs You, Even If You Don't Have The Disease

Thu, 11/20/2014 - 3:51pm
What Diabetes Costs You, Even If You Don't Have The Disease November 20, 2014 3:51 PM ET

The costs of diabetes aren't all as obvious as an insulin pump.

iStockphoto

Diabetes is an expensive disease to treat, costing the United States $244 billion in 2012, according to an analysis of the disease's economic burden.

When the loss of productivity due to illness and disability is added in, the bill comes to $322 billion, or $1,000 a year for each American, including those without diabetes. That's 48 percent higher than the same benchmark in 2007; not a healthy trend.

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The increase is being driven by a growing and aging population, the report finds, as well as more common risk factors like obesity, and higher medical costs.

For a person diagnosed with diabetes, the average economic burden was $10,970 a year. Caring for a pregnant woman with gestational diabetes cost $5,800 a year. Undiagnosed diabetes costs $4,030 a case, and prediabetes, or having abnormal blood sugar that doesn't met the diagnostic criteria for diabetes, $510. Those last two reflect the fact that people with undiagnosed diabetes or elevated glucose tend to go to the doctor more often.

Costs were generally higher in older people, not surprising since it can take years for the disease's more devastating complications, like heart attacks, blindness and nerve damage, to develop.

About 29 million people have been diagnosed with diabetes, according to the Centers for Disease Control and Prevention; 8 million of them haven't yet been diagnosed. Another 86 million, or 37 percent of adults, have prediabetes, which is more common as people age. And though the symptoms of gestational diabetes usually recede when a woman gives birth, both she and her child are at higher risk for Type 2 diabetes.

The researchers, at the IHS Life Sciences economic consulting group, combed data from multiple sources, including hospital discharges, private insurers and Medicare to come up with the trend lines. The various data sources vary, so it's hardly the last word. But it provides a solid look at the trend.

UPDATED 2:00 PM 11/21/14: The researchers didn't have the resources to differentiate the costs of Type 1 diabetes, an autoimmune disease, and Type 2, which occurs later in life and is affected by lifestyle choices. But in 2007, they found that Type 1 accounted for 5.7 percent of people with diabetes and 8.6 percent of the economic burden. In other words, the cost per case of Type 1 is higher, but because many more people have Type 2, it's responsible for most of the economic burden. END UPDATE.

The results were published Thursday in Diabetes Care.

The economists crunched the numbers for individual states, too. West Virginia had the highest rate of people diagnosed with diabetes, at 10 percent. Alabama, Arkansas, Delaware, Florida, Kentucky, Louisiana and Mississippi all posted rates over 8 percent.

Alaska had the lowest diabetes rates in 2012, at 4.2 percent, followed by Utah, Colorado,, Montana and Vermont, all under 5 percent.

These grim numbers "underscore the urgency to better understand the cost mitigation potential of prevention and treatment strategies," the authors write.

In other words: We better get cracking.

Here's just one example of how we're failing to help people with diabetes: just 6.8 percent of people diagnosed with diabetes in 2011 or 2012 were given diabetes self-management training, according to another study released Wednesday, this one from the CDC.

That training typically includes getting people up to speed on treatment options; healthy eating and exercise; detecting and treating complications; and "developing personalized strategies for decision making."

For people who weren't prescribed medication to manage their diabetes, not getting diabetes management training "could mean that their diabetes remains essentially untreated," the report finds.

And these were people with health insurance. It's hard to imagine that the numbers could be worse, but they almost certainly would be for people who are uninsured.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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How Well Do Your Apps Protect Your Privacy?

Thu, 11/20/2014 - 11:59am
How Well Do Your Apps Protect Your Privacy? November 20, 201411:59 AM ET Alison Bruzek

Google Maps scored an A on PrivacyGrade.org.

Meredith Rizzo/NPR

When you open up your Skype app to make a call, it's probably no surprise that it's accessing your phone's call history. But would you expect your Nike+ Running app to collect that information too?

If you're like most people, the answer is no.

That's why the Nike+ Running app gets a B on PrivacyGrade, a site for people to figure out what information their apps might be collecting. Right now it only looks at Android apps, but the site already lists hundreds of them from Google Maps to Instagram to WebMD.

We asked on Facebook: What do think of your health apps and how they guard your privacy?

  • Laura Horton: I am worried about mapmyrun and strava compiling maps and publishing that info which basically shows where you live and what time you leave.

  • Erin Itchett: There is nothing quite like learning the calorie count on your favorite smoothie to make you think twice. The location info would creep me out more than the food. I'm pretty sure my grocery store loyalty card is already tracking all that.

  • Miguel Castro: I really don't mind sharing. At one point I think all this gathered data could be used to get a discount on the insurance premiums.

  • Cara Jacobsen: I hope the website gains more public attention, and spawns some legislation for privacy. Forcing apps to display their privacy rating would be a great way to deter them from low scores.

Many of the apps that got graded are for health and fitness.

For instance, What To Expect, a pregnancy app, gets the lowest possible grade, a D, for collecting images you take of your baby bump and potentially using them to offer you targeted ads.

The grades are determined by comparing people's expectations about the information an app might collect with what the app actually collects. For example, people don't expect the Period Tracker (Pink Pad) app to track their location, but it does, so it gets a C. Whereas Google Maps, which everyone expects to track their location, receives an A. (NPR News, by the way, gets a B while NPR One scores an A.)

Researchers at Carnegie Mellon University and Rutgers University created PrivacyGrade based on their studies of people's privacy expectations. They found, unsurprisingly, that when people are informed why their location or other sensitive data might be needed for an app, they're more comfortable giving that information away.

PrivacyGrade specifically looks at the pieces of an app's code called libraries. Libraries are pieces of code provided by companies to help apps connect to their services. Facebook, Twitter and Google all offer libraries for app developers. They allow users to post impressive weight loss gains or long runs to Facebook from within an app, for instance.

But they can also let advertisers learn about an app's users in ways people don't necessarily want – and the developers may not even know it. "One of the big problems we've seen with libraries ... developers don't often know what these libraries are doing," says Jason Hong, one of the developers of PrivacyGrade.

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PrivacyGrade's main limitation is that it looks only at libraries. While it's a good start, any given app could be digging much deeper into your private information on the phone outside of those libraries says Jeremy Gillula, a spokesperson for the Electronic Frontier Foundation.

And right now, there's not enough demand by the public for app developers to use safer libraries or fix their code. People who build apps "don't have a huge incentive," says Gillula. An NPR-Truven Health Analytics poll found that people don't seem to care about health data privacy nearly as much as you might think.

TED Radio Hour Is Too Much Privacy Bad For Your Health?

That's where PrivacyGrade's rating system could help, says Omri Ben-Shahar, law professor at the University of Chicago. He says he was skeptical of the site until he found out about the grades.

Grades or rating systems work. People "don't want to know too much about a restaurant other than its Zagat rating," he says.

For health in particular, Ben-Shahar says there may be more incentive for people to use a site like PrivacyGrade. "Commercializing people's illnesses, medical problems, is something that many people find particularly tasteless. So there might be more demand ... but only to the extent that they get low grades."

He says even people who say in a survey that they want privacy, but when it comes down to it, they aren't willing to put their money where their mouth is.

"It's pretty easy to change settings or to even change service in a way that anonymizes you on your smartphone," says Ben-Shahar. "But people are not buying this form of protection. And so when people really want some kind of protection like insurance, they're willing to pay a lot for it."

So where does that leave a free site like PrivacyGrade? It's too early to tell if it'll catch on, says Ben-Shahar. And the grades should be taken with a grain of salt: "If people already expect the worst ... then [PrivacyGrade] is not going to give them a negative grade."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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A Worry In Theory, Medical Data Privacy Draws A Yawn In Practice

Thu, 11/20/2014 - 11:25am
A Worry In Theory, Medical Data Privacy Draws A Yawn In Practice November 20, 201411:25 AM ET

How concerned are people about the privacy of their medical information? The NPR-Truven Health Analytics Health Poll found worries were low.

NPR

When it comes to health records, how concerned are Americans about what happens to their personal information?

We asked in the latest NPR-Truven Health Analytics Health Poll. And, in a bit of surprise to me, the responses showed that, in general, worries don't run very high.

First, we learned that nearly three-quarters of people see doctors who use electronic medical records. So the chances are good that your medical information is being kept digitally and that it can be served up to lots of people inside your doctor's office and elsewhere.

Health insurers, employers, hospitals and doctors have easier access than ever to our records. Think about the confidentiality waiver you've probably signed that says the doctor's office can share information with your insurance company, for instance.

Is data privacy a problem? Only 11 percent of people have concerns related to their doctors. About 14 percent of respondents had privacy concerns related to hospitals. Privacy worries about health insurers ran highest at 16 percent.

Worries about employers were low — at 10 percent. "Maybe the fact that employers have had this type de-identified information for so many years, employees are finally getting used to it," says Dr. Michael Taylor, chief medical officer for Truven Health Analytics. "Personally, I think it's good," says Taylor, who was previously medical director for wellness programs at Caterpillar Inc. "Most employers with whom I deal want to help their employees be healthier, and they need information."

Still, there was some variation in the responses, with 22 percent of people in households making more than $100,000 a year worried about how employers treat the data.

A recent survey on the broad topic of privacy by the Pew Research Internet Project found that people feel that health details, including medicines they take, is among the most sensitive information they have.

For our part, we wondered how many people have experienced a privacy privacy breach. About 5 percent of people said they'd been told their records had been compromised or accessed without permission.

Research done by the Ponemon Institute, Traverse City, Mich., suggest athat about 1.8 million American households experienced medical record theft in 2013.

Survey work by Ponemon found that people say they are concerned about security and privacy in a general way. But when asked more specifically, medical record privacy usually drops to the lowest quartile of concern, said Larry Ponemon, chairman and founder of the Ponemon Institute.

"People are just not worried about privacy" of their medical records, he told Shots. "They're thinking about other things."

What do people think about some uses of data not directly related to their care?

The NPR-Truven Health poll found that two-thirds of people said they would be willing to share their health information with researchers, as long as it was scrubbed of identifying details.

Finally, would people be willing to let doctors, hospitals and insurers in on their credit card info and social media antics if the information would be used for health improvement? Not a popular idea. A little over three-quarters of people said no way.

The poll questions were posed by cellphone, land line and online during the first half of August. More than 3,000 adults participated. The margin for error was plus or minus 1.8 percentage points.

You can find the list of questions and responses here and find the past polls here.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Sleep's Link To Learning And Memory Traced To Brain Chemistry

Thu, 11/20/2014 - 9:56am
Sleep's Link To Learning And Memory Traced To Brain Chemistry November 20, 2014 9:56 AM ET

Almost a century after the discovery that sleep helps us remember things, scientists are beginning to understand why.

During sleep, the brain produces chemicals that are important to memory and relives events we want to remember, scientists reported this week at the Society for Neuroscience meeting in Washington D.C.

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"One of the most profound effects of a night of sleep is the improvement in our ability to remember things," says Ravi Allada, a sleep researcher at Northwestern University. Yet this connection hasn't been well-understood, he says.

That's changing, thanks to recent research from scientists including Jennifer Choi Tudor from the University of Pennsylvania. At the meeting, Tudor presented a study involving a brain chemical (known as 4EBP2) that is produced during sleep and is thought to play a role in remembering new information.

Previous experiments have shown that sleep-deprived mice have memory problems and lower levels of this chemical. So the team tried injecting the chemical into the brains of mice, then deprived them of sleep. "With the injection, their memory is normal," Tudor says.

To Sleep, Perchance To Learn

Sleep is also a time when old memories can be modified and new memories can be formed, says Karim Benchenane from the National Center for Scientific Research in Paris. Benchenane was part of a team that studied the brains of rats while the rats were awake, as well as during sleep.

When the animals were awake and traveling around their cages, the scientists identified brain cells that became active only when the rats were in a specific location. During sleep, these same cells became active in the same order, indicating that the rats were reliving their travels and presumably strengthening their memories of places they'd been.

Then Benchenane's team set out to change each rat's memory during sleep. They did this by stimulating the pleasure center in the animal's brain each time the brain cell associated with a specific location became active. The idea was to form, in the brain, a positive association with one place in the cage. And sure enough, when the animals woke up, they went straight to that location, looking for a pleasurable reward.

The finding not only shows that new memories can be formed during sleep, Benchenane says — it also suggests a new way to treat people who have post-traumatic stress disorder and often have a negative association with a particular experience. It might be possible to eliminate that negative association during sleep by providing a pleasurable feeling every time they dream about that experience.

The Food-Sleep-Memory Connection

One surprising bit of research at the meeting was a study that suggests a midnight snack can undo the memory benefits usually conferred by getting enough sleep. A team from UCLA found that mice that ate during their normal sleep time scored worse on memory tests than mice that ate during their normal waking hours.

"Those animals show severe deficits in their recall," says neuroscientist Christopher Colwell. And the deficit occurred even if the animals were getting a normal amount of sleep, he says. The finding suggests that people who wake up during the night and want to snack should probably abstain, Colwell says, if they want their memory to work normally the next day.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Gilead Buys Shortcut For FDA Drug Review For $125 Million

Wed, 11/19/2014 - 4:09pm
Gilead Buys Shortcut For FDA Drug Review For $125 Million November 19, 2014 4:09 PM ET Drew Kilb/Duke University's Fuqua School of Business

How much is a fast track for the Food and Drug Administration review of a new drug worth? Try $125 million.

In an auction, Gilead Sciences, a maker of HIV and hepatitis medicines, just bought a coupon good for the accelerated review of a drug of the company's choice from Knight Therapeutics, a Canadian company.

The priority review voucher entitles Gilead to move a drug of its choice through the FDA four months faster than the normal track.

"We're happy with the price we got for it," Jeffrey Kadanoff, chief financial officer for Montreal-based Knight, told Shots. "I'm sure it's worth more than that to Gilead."

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The legal shortcut was created in 2007 as a reward for companies developing drugs for specific neglected tropical diseases. For a potential blockbuster drug, the shortened review made possible by the voucher could be worth many millions of dollars in sales.

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Gilead wouldn't say if it has a drug in mind for the voucher. "There are a number of potential clinical candidates in our pipeline where this could be beneficial," spokesman Nathan Kaiser said in an email to Shots. "We will make the decision to apply the [priority review voucher] in conjunction with ongoing internal pipeline reviews."

Knight got the voucher in March when FDA approved Impavido, a drug to treat the parasitic disease leishmaniasis. About 1.3 million people a year become sick with leishmaniasis, according to the World Health Organization.

But leishmaniasis isn't a real problem in the U.S. where only a handful of cases are seen each year in people who get infected overseas. "Impavido will never be a big drug in the U.S.," Knight's Kadanoff said, because "there are no sand flies that will bite you and give you the disease,"

The real prize for Knight was the voucher, which the company was free to sell to the highest bidder.

Duke health economist David Ridley, one of the intellectual architects behind the voucher law, told Shots that he "was delighted" by the sale. "I think we're much closer to the [true] value of a voucher." Earlier this year, BioMarin sold a voucher it won for approval of drug for Morquio A syndrome, a rare pediatric disease, for $67.5 million.

The higher price paid by Gilead suggests that pharmaceutical companies are becoming more comfortable with the voucher idea. For a drug company manager, the purchase of a voucher could be a career-ender if it doesn't pan out. "It's an unproven concept," Ridley said. But with each sale, he predicted, the worries about controversy or failure will decline.

The Knight sale sends "a great signal to investors in small companies that are developing drugs for neglected diseases," Ridley said. It's becoming easier to put a value on a voucher, he said.

Separately, the Senate Health, Education, Labor and Pensions Committee approved a bill Wednesday to add Ebola to the list of neglected disease for which a voucher could be given to encourage the development of new drugs.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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You Can Monitor Your Baby's Vital Signs 24/7, But Should You?

Wed, 11/19/2014 - 11:18am
You Can Monitor Your Baby's Vital Signs 24/7, But Should You? November 19, 201411:18 AM ET

The Owlet, which is not yet on the market, is designed to measure a baby's heart rate and blood oxygen levels.

Courtesy of Owlet Care

I'm sure I'm not the only parent who has hovered over a newborn's crib, wondering, "Is she breathing?" Tech companies are now offering to help parents manage that anxiety with devices that monitor a baby's vital signs and beam them to a smartphone.

But that might not be such a good idea, according to Dr. David King, a pediatric researcher at the University of Sheffield. He first heard baby vital signs monitors being discussed on the radio, and "I suspected there wasn't much evidence behind it, because I knew cardiovascular monitoring wasn't recommended in SIDS."

The Exmobaby monitor tracks a baby's heart rate and temperature and ports it to a parent's phone.

Courtesy of Exmovere

King is referring to unhappy experiments in the 1980s and 1990s with using monitors in an attempt to prevent sudden infant death syndrome, or SIDS. The monitors failed to reduce SIDS deaths in healthy infants and are no longer recommended by the American Academy of Pediatrics and other medical groups.

The problem, King says, is that there's no research to suggest that the information provided by these new devices provides a reliable indicator of danger, or indeed any reliable information about your child. "It's not a medical device; it's not registered as a medical device. It's just for fun, really," King told Shots. "But if you look at the marketing so far, I don't think that's the message that comes across."

He wrote about his findings in Tuesday's British Medical Journal.

The Mimo, which sells for $199, monitors a baby's breathing, body position, sleep activity and skin temperature through a sensor that attaches to a special onesie. It takes a lot of scrolling through the site's terms of service to find this disclaimer:

The Mimo baby monitor system is not a medical device, is neither regulated nor approved by the U.S. Food and Drug Administration, and is not designed to detect or prevent causes of sudden infant death syndrome (SIDS). The Mimo baby monitor system is intended to help you monitor your baby and is not to be used as a substitute for parenting or other adult supervision. Use of the services and any content is entirely at your own risk.

Still, promotional language for many of the monitors suggests that tracking a healthy baby like she's in the NICU is somehow a good thing. The site for the still-in-development Owlet, a sensor built into a baby bootie, says:

The Owlet Baby Monitor is meant to help you be aware of possible indicators of danger, but your baby's safety is your responsibility.

Call me picky, but isn't keeping babies safe what parents were designed for? And truth to tell, I don't know how I could use data on an infant's heart rate and blood oxygen level to keep her safe. One of the big problems with SIDS monitors was that they gave many false alarms, panicking parents.

The American Academy of Pediatrics has very specific advice for reducing SIDS risk, including putting babies to sleep on their backs and keeping soft bedding out of the crib. "Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS," the academy says, since "there is no evidence that use of such devices decreases the incidence of SIDS."

Science And Medicine Rethinking SIDS: Many Deaths No Longer A Mystery

The developer of Exmobaby, which is being sold in China, is applying for FDA approval to sell its monitor in the United States. "I can tell you that the big healthcare product distributors in the U.S. that I have approached demand at least a 510k clearance from the FDA," David Bychkov, the CEO of Exmobaby, told Shots via email. That allows marketing of devices that are similar to devices already approved by the FDA.

In the case of Exmobaby, that would be an electrocardiogram and temperature sensor.

"The product is helpful for allowing a mom to keep track and record a baby's vital signs as it develops in year one," Bychkov wrote. "Mom can also use the system to log emotional changes and correlate those changes with the baby's underlying temperature and heart rate data."

I vividly remember parsing my newborn's emotional changes; who could ever forget that first smile? But much as I love tech gizmos, I think I'll take a pass on baby ECGs.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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6 Pitfalls To Avoid When Picking Insurance On The Job

Wed, 11/19/2014 - 8:59am
6 Pitfalls To Avoid When Picking Insurance On The Job November 19, 2014 8:59 AM ET

Partner content from

Jay Hancock

You don't get a pass this year on big health insurance decisions because you're not shopping in an Affordable Care Act marketplace. Employer medical plans — where most working-age folks get coverage — are changing too.

Rising costs, a looming tax on rich benefits packages and the idea that people should buy medical treatment the way they shop for cellphones have increased odds that workplace plans will be very different in 2015.

"If there's any year employees should pay attention to their annual enrollment material, this is probably the year," said Brian Marcotte, CEO of the National Business Group on Health, which represents large employers.

In other words, don't blow off the human resources seminars. Ask these questions.

1) Is my doctor still in the network?

Some employers are shifting to plans that look like the HMOs of the 1990s, with limited networks of physicians and hospitals. Provider affiliations change even when companies don't adopt a "narrow network."

Insurers publish directories, but the surest way to see if docs or hospitals take your plan is to call and ask.

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2) Is my employer changing where I get labs and medications?

For expensive treatments — for diseases such as cancer or multiple sclerosis — some companies are hiring preferred vendors. Getting infusions or prescriptions outside this network could cost thousands extra, just as with doctors and hospitals.

3) How will my out-of-pocket costs go up?

It's probably not a question of if. Shifting medical expenses to workers benefits employers because it means they absorb less of a plan's overall cost increases. By lowering the value of the insurance, it also shields companies from the so-called Cadillac tax on high-end coverage that begins in 2018.

Having consumers pay more is also supposed to nudge them to buy thoughtfully — to consider whether procedures are necessary and to find good prices.

"It gets them more engaged in making decisions," said Dave Osterndorf, a benefits consultant with Towers Watson.

How well this will control total costs is very unclear.

Your company is probably raising deductibles — the amount you pay for care before your insurance kicks in. The average deductible for a single worker rose to $1,217 this year, according to the Kaiser Family Foundation. One large employer in three surveyed by Marcotte's group planned to offer only high-deductible plans (at least $2,600 for families) in 2015.

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Employers are also scrapping copayments — fixed charges collected during an office or pharmacy visit.

Once you might have made a $20 copay for a $100 prescription, with the insurance company picking up the other $80. Now you might pay the full $100, with the cost applied against your deductible, Marcotte said.

4) How do I compare medical prices and quality?

Companies concede that they can't push workers to shop around without giving information on prices and quality.

Tools to comparison shop are often primitive. But you should take advantage of whatever resources, usually an online app from the insurance company, are available.

5) Can I use tax-free money for out-of-pocket payments?

Workers are familiar with flexible spending accounts (which aren't that flexible). You contribute pretax dollars and then have to spend them on medical costs before a certain time.

Employers increasingly offer health savings accounts, which have more options. Contribution limits for HSAs are higher. Employers often chip in. There is no deadline to spend the money, and you keep it if you quit the company. So you can let it build up if you stay healthy.

Don't necessarily think of HSAs as money down the drain, says Osterndorf. Think of them as a different kind of retirement savings plan.

6) How is my prescription plan set up?

Drugs are one of the fastest-rising medical costs. To try to control them, employers are splitting pharma benefits into more layers than ever before. Cost-sharing is lowest for drugs listed in formulary's bottom tiers — usually cheap generics — and highest for specialty drugs and biologics.

If you're on a long-term prescription, check how it's covered so you know how much to put in the savings account to pay for it. Also, see if a less-expensive drug will deliver the same benefit.

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

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Outreach Workers Look For Gains In Second Year Of Obamacare

Tue, 11/18/2014 - 5:02pm
Outreach Workers Look For Gains In Second Year Of Obamacare November 18, 2014 5:02 PM ET Jim Burress, WABE, Atlanta Eric Whitney, Montana Public Radio As Heard On Morning Edition 2 min 18 sec  

Lee Ann Johnson, director of the Missoula Indian Center, encourages Native Americans in Montana to enroll in private coverage through Healthcare.gov at an outreach event on Saturday, November 15.

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With the HealthCare.gov website working for consumers much more smoothly than last year, health officials are focused on reaching out to potential customers.

For starters, they want to people who bought insurance last year to take another look at those plans. And, of course, the exchange wants to bring in new customers who didn't need or skipped insurance last year.

Among them, are minority groups that didn't sign up in the numbers that state officials hoped for last year. In Montana and Georgia the minorities differ but face similar challenges.

Native Americans are among the uninsured Montana officials would like to reach. It's a hard sell, since they are actually exempt from the health law's requirement to have insurance coverage. They're eligible for health care through the Indian Health Service since the federal government promised in treaties to provide health care in exchange for tribes giving up their land.

But Montana Sen. Jon Tester, who sits on the Committee for Indian Affairs, says the IHS "is really in tough shape, basically runs out of money about 9 months into the fiscal year. There's a real issue getting health care professionals into Indian country. I mean, it's really in crisis."

The IHS budget crisis means tribal members can often only get health care when they're in immediate danger of losing life or limb, says Lesa Evers, a member of the Turtle Mountain tribe who works for Montana's state health department.

"If you have an individual who really requires knee surgery from trying to play basketball with their kids, or whatever they tried to do, they may never have that opportunity to have that knee surgery," she says.

Buying private health coverage on the exchanges would give them access to more health care providers, and subsidies under the health care law are making insurance affordable for many Indians. But efforts to get them to enroll in private coverage aren't bearing much fruit yet. Fewer than than half a percent of people who enrolled last year in Obamacare plans were Native American.

In Georgia, efforts will focus on getting Asians, Hispanics and African Americans to sign up.

"It's a big undertaking, for sure," says Cindy Zeldin, executive director of the nonprofit Georgians for a Healthy Future.

And, there's a catch for both these states. Neither Montana nor Georgia expanded Medicaid under the Affordable Care Act.

That means it's possible that people will try to sign up for health coverage and find out they earn too little to qualify for a subsidy for an exchange plan, but too much to get covered by Medicaid.

"Until Georgia closes the coverage gap by expanding Medicaid, we are going to continue to have a very large number of people without health insurance," says Zeldin.

Montana navigator Amanda Harrow says she saw it firsthand last year. "There are people that came in here really excited to get health insurance, and we have to tell them that they're not eligible, and they're devastated, and it's just so hard," Harrow says.

An estimated 282,000 Georgians fall into the gap, and about 35,000 people in Montana.

The second group – those who bought last year – are being encouraged to shop again. That includes customers like Michael Lappin and husband John West

They are happy with their coverage, but Lappin says they're back on HealthCare.gov because premiums for their platinum-level Humana plan went up by about 19 percent. Subsidy amounts and available plans will almost certainly change for most people.

Marketing and outreach efforts to all groups this year will focus on affordability and available subsidies. An analysis by Georgia Health News finds insurance premiums were the biggest predictor whether or not someone purchased a policy.

This story is part of a reporting partnership that includes NPR, local member stations and Kaiser Health News.

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

More States Adopt Laws To Ease Access To Experimental Treatments

Tue, 11/18/2014 - 1:51pm
More States Adopt Laws To Ease Access To Experimental Treatments November 18, 2014 1:51 PM ET

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Michelle Andrews

When should a patient in dire condition be allowed to try an experimental treatment?

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On Election Day, Arizona voters approved a referendum that allows terminally ill patients to receive treatment with drugs and devices that haven't been approved by the Food and Drug Administration. Arizona became the fifth state to approve a so-called right-to-try law this year.

Supporters say the laws give patients faster access to experimental, potentially life-saving therapies than the FDA's existing approach, often referred to as "expanded access" or "compassionate use."

But critics of the state laws charge that they're feel-good measures that don't address some of the real reasons patients don't receive experimental treatments in the first place.

Nevertheless, legislatures in Colorado, Louisiana, Michigan and Missouri also passed right-to-try laws this year as part of a nationwide effort spearheaded by the conservative Goldwater Institute, which hopes to get right-to-try laws on the books in all 50 states.

The measures generally permit a patient to get access to an experimental drug or device after it has passed the earliest stage of safety study. This initial testing for drugs, often called phase 1, involves a small group of usually healthy people receiving a medicine to get a first look at its safety and side effects. The testing requirements for devices vary, and initial safety may be explored in small clinical studies or laboratory experiments.

"For people with terminal illness, for whom nothing else has proved effective, they don't have the luxury of waiting four to five months to get through the FDA's compassionate-use program," says Victor Riches, vice president of external affairs at the Goldwater Institute. Riches says the delays come from requirements for a lengthy application by the patient's physician, FDA review and approval of the request, and a federally required review by an institutional review board, a group of medical experts that evaluates the risks and ensures that the patient understands them as well.

Between 2009 and 2013, the FDA received roughly 1,000 expanded-access applications annually and approved virtually all of them. Some patient advocates and policy analysts say that while the FDA process could be sped up, they support the agency's continued oversight because of its critical role in ensuring safety and effectiveness.

Experimental therapies could help some people. But they are also, by definition, unproved, and they may turn out to be ineffective. They may also carry significant risks, not all of which are known before in-depth clinical testing.

Even if the FDA approves a request for an experimental drug or device, the patient might not get it. Drugmakers and device companies aren't obligated to provide a therapy to patients who request it.

Right-to-try laws are no different.

Without any assurance of access to an experimental drug or device, and with no financial support to help patients cover the costs, right-to-try laws give patients false hope, say critics of the laws.

"There's no money in these laws, and no provision for companies to supply anything," says Arthur Caplan, a medical ethicist at NYU Langone Medical Center. Caplan has been a vocal critic of right-to-try laws.

The degree to which insurers cover drugs and medical services under FDA's expanded-access program varies. According to the FDA website, some companies charge patients for the experimental drug, and medical services may or may not be covered.

Critics also voice a broader concern about the potential impact on the drug development process.

How do drugmakers or device companies balance the needs of a sick individual against the potential to introduce the therapy to a broader population? Terminally ill individuals who receive experimental treatment may well suffer serious adverse events, potentially setting back the approval process.

In addition, if more people get access to experimental therapies through right-to-try laws, they may be less likely to participate in the clinical trials that are essential to new drug development.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Doctor Shortage Looming? Maybe Not

Tue, 11/18/2014 - 3:32am
Doctor Shortage Looming? Maybe Not November 18, 2014 3:32 AM ET

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Julie Rovner Listen to the Story 4 min 23 sec  

Victoria Elizabeth Fischer was presented with a white coat by her grandfather, Dr. Christian Van Den Heuvel, at Georgetown University School of Medicine in August. The ceremony marks the start for each new class of medical students.

Lisa Helfert/Courtesy of Georgetown University

The United States is facing a critical shortage of doctors that could seriously jeopardize the ability of a patient to get medical care in the coming years.

Or, at least, that's the message the medical community has been pushing for several years now. And the media (including this reporter) have swallowed the line without much question.

But is the shortage real? Not necessarily, say a growing number of health economists and analysts.

The most widely publicized prediction of a looming crisis comes from the Association of American Medical Colleges , which has said that by 2025, the U.S. will be short roughly 130,000 doctors.

It's not hard to see how the group makes that calculation. Millions of people are getting health insurance for the first time under the federal Affordable Care Act. At the same time, 10,000 baby boomers are qualifying for Medicare every day, says Dr. Atul Grover, chief public policy officer of the AAMC.

“ We don't think we should put patients at risk by saying, 'Let's not train enough doctors just in case everything lines up perfectly and we don't need them.'

"And we know, essentially, with the doubling of the population over the age of 65, over the course of a couple of decades, they're driving the demand for services," Grover says.

Others point out that the shortage isn't just about the absolute numbers of doctors needed. The demographics of the physician workforce are important, too, says Dr. Andrew Bazemore, who studies the primary care workforce for the Robert Graham Center, a think tank created by the American Academy of Family Physicians.

"And that means by their race and ethnicity," Bazemore says, "by their age, by their gender, and backgrounds. Do they actually look like and reflect the populations they are going to serve?"

But, while there may be agreement that the U.S. needs more primary care providers, it's not clear to everyone considering the problem whether all of those people need to be doctors.

"There are a lot of primary care services that can be provided by a lot of people other than primary care doctors," says health economist Gail Wilensky. She and a colleague recently led an expert panel that looked at the funding of advanced training for doctors.

“ The business model of an interest group is to create a sense of crisis and then tell their constituents, 'We can help you.'

Nonphysician primary care providers can include physician assistants, nurse practitioners, pharmacists and social workers, for example — often working together in teams with a medical doctor. Teams are thought to provide more cost-effective care, according to some health policy analysts. And, says Wilensky, more nonphysician health practitioners, each providing a different set of services, might lessen the need for more primary care doctors.

"What will we allow nurses to do — work up to the limits of their license?" Wilensky asks. "Work up to the limits of their training? What will we allow pharmacists to do? Those together would determine how many physicians it would be useful to have around."

Wilensky also points out that past studies predicting shortages of doctors have been laughably wrong.

"We haven't even been directionally correct sometimes," she says. "We thought we were going into a surplus and we ended up in a shortage — or vice versa."

Still, Atul Grover of the medical school association thinks it's better for society to err on the side that the shortage is real. "We don't think we should put patients at risk by saying, 'Let's not train enough doctors just in case everything lines up perfectly and we don't need them,' " Grover said in a recent C-SPAN interview.

But letting more people train to be doctors "just in case" strikes Wilensky and many other health economists as wasteful.

"Are you really serious?" Wilensky asks. "You're talking about somebody who is potentially 12 to 15 years post-high school — to invest in a skill set that we're not sure we're going to need?"

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Training too many doctors could, potentially, jeopardize more than just the bank accounts of those being trained. Dr. Fitzhugh Mullan, a pediatrician and professor at George Washington University, says every doctor added to the health care system also adds cost.

"Training another doctor," he says, "isn't cheap — isn't cheap for the individual doing the training, isn't cheap for the institution providing the education, and ultimately isn't cheap for the health system. Because the more doctors we have, the more activity there will be."

Why, then, do so many physician groups continue to press for more doctors to be trained?

Princeton health economist Uwe Reinhardt says there's at least some self-interest involved.

"The business model of an interest group is to create a sense of crisis," he says, "and then tell their constituents, 'We can help you.' "

There is one element of the debate that just about every expert agrees on — that the U.S. has to stop paying physicians based on the number and type of treatments and procedures they do, and instead base payment on how well they keep patients healthy. That might or might not reduce the need for more medical doctors. But it would almost certainly help close the payment gap between specialists and generalists.

"The physicians are the team drivers of the system," Wilensky says. "If you don't get that part right, either in terms of how they're trained or how they're paid, it's hard to imagine how health reform happens."

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

Are Modafinil's Brain-Boosting Benefits Hype Or Science?

Mon, 11/17/2014 - 4:24pm
Are Modafinil's Brain-Boosting Benefits Hype Or Science? November 17, 2014 4:24 PM ET

Nobody gets enough sleep these days and everyone needs to work harder. Sometimes coffee just doesn't seem like it's enough. Thus the temptation to apply pharmacology to thinking smarter, faster and longer.

One option is modafinil, a prescription drug approved by the Food and Drug Administration to treat narcolepsy. "I feel like a well-oiled machine 5 days a week on 5 hrs a night," one poster who uses modafinil writes on Reddit.

But there's no conclusive evidence that modafinil actually makes people think better.

The problem is, says Ahmed Mohamed, a psychologist at the University of Nottingham's campus in Malaysia, that "we don't really know how this drug is acting on the brain." In a small study published in the current issue of PLOS ONE, Mohammed found that rather than boosting cognition, the modafinil actually seemed to slow volunteers down.

While some small studies in rats and people have suggested that modafinil may improve memory, attention span or other aspects of cognition, other research has found no such link. One intriguing 2005 study suggested that it doesn't help people whose IQ is already high or even average.

The Food and Drug Administration first approved modafinil (brand name Provigil) for excessive sleepiness due to narcolepsy back in 1998. Since then, doctors increasingly have prescribed the drug off-label for everything from multiple sclerosis to depression.

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For his study, Mohamed gathered 64 young, healthy volunteers and had half of them take modafinil, while the others took a placebo pill. He then had all the participants complete reading and sentence completion tests.

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The two groups completed the tests equally well — but people in the group that got modafinil took slightly longer to respond to the questions. "Basically, this suggests that the drug might slow you down without making you smarter," Mohamed says.

The results, though preliminary, make sense, considering that modafinil is designed to promote wakefulness, says Dr. Larissa Mooney, an associate professor of psychiatry at UCLA. "It makes sense that people would feel more alert while taking it," she says. "But that doesn't necessarily mean that they're performing better."

It's unclear how many people use modafinil and other psychostimulant drugs like Adderall and Ritalin as a brain booster, though some public health officials and drug researchers say they are concerned.

Psychiatric patients are asking about the drug more often these days, Mooney says. "And we are getting an increase in requests for prescriptions to enhance performance."

She says she wouldn't recommend modafinil for that purpose, especially for young people, considering that researchers still aren't sure how it might affect brains that are still developing.

Side effects may also be a concern. In 2006, an FDA advisory committee recommended the agency not approve modafinil as a treatment for children with ADHD because it seemed to have caused a potentially fatal reaction called Stevens-Johnson syndrome in some patients.

"It's important to clarify that Provigil is indicated to improve wakefulness in adult patients," says Doris Saltkill, a spokesperson for Teva Pharmaceuticals, which manufactures modafinil under the brand name Provigil. The company doesn't recommend the drug for any other purpose, she says.

Given that there's no conclusive evidence that modafinil does anything to boost brain power, Mooney says, "Why not just have a cup of coffee?"

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

Toxic Tau Of Alzheimer's May Offer A Path To Treatment

Mon, 11/17/2014 - 4:18pm
Toxic Tau Of Alzheimer's May Offer A Path To Treatment November 17, 2014 4:18 PM ET Listen to the Story 3 min 39 sec  

A tangle of protein (green) in this scanning electron micrograph of a brain cell of an Alzheimer's patient lies within the cytoplasm (blue) of the cell. The tangle consists of clumps of a toxic form of tau.

Thomas J. Deerinck/Corbis

After years of setbacks, Alzheimer's researchers are sounding optimistic again. The reason: a brain protein called tau.

At this year's Society for Neuroscience meeting in Washington, D.C., there are more than 100 papers on tau, which is responsible for the tangles that form in the brains of people with Alzheimer's. In the past, tau has received less attention than another protein called amyloid beta, which causes the sticky plaques associated with Alzheimer's.

"Many people focused on amyloid beta for many years," says Julia Gerson, a graduate student in neuroscience at the University of Texas Medical Branch, who presented a paper on tau at the neuroscience meeting. "Now it's coming out that tau might be more important."

“ If we could figure out how to stop that spread, maybe one could limit the disease to just some brain regions, instead of having it go everywhere.

"Clearly both are working together, conspiring if you will, to bring down cell functions and cell survival over the years as the disease unfolds," says Dr. Lennart Mucke, a neurologist who directs the Gladstone Institute of Neurological Disease, a research center affiliated with the University of California, San Francisco.

In the past decade, several promising drugs that merely lower amyloid have failed to stop Alzheimer's. Those failures, Mucke says, helped persuade scientists to take a closer look at tau, which has produced some surprising findings.

"Initially it was thought that tau was purely inside brain cells," he says. "But now we recognize that it can actually exist outside of cells and even transfer from one cell to the next."

The idea that tau can spread from cell to cell like an infection suggests a new way to treat Alzheimer's, Mucke says. "If we could figure out how to stop that spread, maybe one could limit the disease to just some brain regions, instead of having it go everywhere."

Some researchers are already trying to interrupt the process, using the immune system to mop up toxic forms of tau. A similar strategy has proved effective for reducing amyloid.

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The closer look at tau also revealed that the protein comes in different forms. In its most common form, tau actually helps brain cells function, Gerson says. "But in disease, for various reasons that we don't entirely understand yet, it takes on this other, toxic form," she says.

This toxic tau, known as a tau oligomer, occurs not only in Alzheimer's patients but also in people with traumatic brain injury. In both groups, Gerson says, the protein appears to build up over time and lead to memory problems.

To find out more about this process, Gerson and a team of scientists injected tau oligomers from people with Alzheimer's into the brains of healthy mice. Within a week the mice developed memory problems; tissue samples showed toxic tau throughout the animals' brains. "What we believe is happening is that the toxic form [of tau] induces the healthy form in the brains of these mice to take on that toxic conformation," Gerson says.

The new research suggests that treating Alzheimer's will require drugs that affect both tau and amyloid, and perhaps other factors that are less well understood, Mucke says. That means doctors will need a lot of different tools.

"The problem," he says, "has been that the toolbox was nearly empty." Thanks to the sort of research presented at this year's neuroscience meeting, Mucke says, that toolbox is starting to fill up again.

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

In California, That MRI Will Cost You $255 — Or Maybe $6,221

Mon, 11/17/2014 - 4:06pm
In California, That MRI Will Cost You $255 — Or Maybe $6,221 November 17, 2014 4:06 PM ET

fromKQED

Lisa Aliferis Andy Warner/KQED

Prices for common medical tests like mammograms and MRIs are notoriously opaque. Negotiated rates between insurance companies and doctors or hospitals are sealed tight by contract. We know there's price variation, but comparing what one insurance company pays versus another is virtually impossible.

That's why we here at KQED in San Francisco turned to members of our audience to help us find out what medical tests and devices cost.

Together with our collaborators KPCC in Los Angeles and ClearHealthCosts.com, a New York City startup dedicated to health cost transparency, we created an online form to make it easy for people to share what they paid — and to make it easy for you to see apples-to-apples comparisons of prices.

Would people share? Yes! Since we started the project in June, hundreds of people have shared prices, and thousands more have searched our database to look up prices. And on Monday, the journal JAMA Internal Medicine published a viewpoint I wrote to tell doctors about our findings.

How PriceCheck Works

We asked people to share prices for four common medical procedures: mammograms, lower-back MRIs, IUDs and diabetes test strips — although plenty of people shared prices for other procedures, too. Our form can take virtually any share.

We started with mammograms because this test is done more than 38 million times a year across the country. Since screening mammograms are a test that can be scheduled, women can in theory call around and select a facility based on price.

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We thought we would find variation, and indeed we did. In California, commercial insurers paid from $128 to $694 for a screening mammogram. In Los Angeles, one woman's insurer paid $600 more than the lowest-cost screening mammogram reported in the area. "I'm sure every woman who's had a mammogram had the exact same experience I did," this woman said. "It was a friendly technician, but I don't think that's worth maybe 600 extra dollars."

In lower-back MRIs, we found that for CPT code 72148, insurers paid from $467 to $1,567. But when we looked beyond commercial insurers, we found even greater variation — from a low of $255 to a self-pay price of $6,221 at an academic medical center. That $255 MRI was paid by Medicare, and was just a fraction of the facility's charge of $2,450.

But the variation doesn't stop there. Yet another person went to the same facility and was charged $603 for the same procedure, same CPT code. This patient had commercial insurance but paid the entire amount out of pocket, the patient wrote, since "I had not yet met my deductible."

Why Price Matters

Until recently consumers didn't have much incentive to shop on price in health care. They might have paid a small copay; insurance picked up the rest.

But today, many people have high-deductible health plans. So it might matter to you if the price your insurer negotiated at Facility A is hundreds of dollars more than at Facility B.

In the comments on our PriceCheck coverage, people have told of their frustration ("fury" might be a better word):

  • "High deductible so paid the whole thing and then found out I could have had it done for *HALF* the price only blocks away. My first foray into individual insurance and it s***ed. Need to shop around assuming can even get a price quote."
  • "I was told the procedure was $1,850. I have a $7,500 deductible. So I talked to (an employee) who said if I paid up front and agreed not to report the procedure to Blue Cross that it would be $580."

What About Quality?

We received thoughtful and pointed questions on two fronts. First, many people ask about quality. Should people be shopping for health care procedures in the same way they shop for a computer or canned goods?

This is a reasonable question, but the problem is that cost and quality are unfortunately not connected in health care. There's no evidence that getting the most expensive treatment or procedure will yield a better outcome. People are starting to wonder why they're paying dramatically more if that extra money isn't buying better health.

We also hear skepticism about the reliability of crowdsourced data. Yes, these data are crowdsourced and as such may contain errors.

But at PriceCheck, we believe that pushing for cost transparency helps drive quality discussions, too. A new law in Massachusetts requires insurers to make their prices public in advance.

As I wrote in JAMA Internal Medicine:

The money conversation makes the practice of medicine very complicated: the "gotcha" bill and the medication that s not covered challenge the physician-patient relationship. It is time to take off the blindfold and embrace transparency in pricing for medical care and services.

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.
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Controversial Cholesterol Drug Redeemed By Global Clinical Test

Mon, 11/17/2014 - 1:34pm
Controversial Cholesterol Drug Redeemed By Global Clinical Test November 17, 2014 1:34 PM ET

Fresh data show that Vytorin, a combination pill for cholesterol, cuts the risk of heart attack and stroke.

Getty Images/Getty Images

The wheels of drug research grind slowly, but they can grind exceedingly fine.

Merck said Monday that its cholesterol drug Vytorin was vindicated by a nine-year-long clinical study that aimed to find out if adding a drug that blocked the absorption of cholesterol to a statin, long the gold standard for cholesterol care, would help patients at a high risk of heart attack and stroke.

Previous research had raised doubts about Vytorin's effectiveness. In a bit of a surprise, the study, known by the acronym IMPROVE-IT, showed that the drug worked. Still, the effects were modest.

Researchers found that when people took Vytorin (a combination of the statin simvastatin and ezetimibe, the cholesterol blocker) for seven years, their risk of heart attack and stroke was about 2 percentage points lower than patients taking only simvastatin.

All told, 32.7 percent of patients taking Vytorin experienced a heart attack or stroke compared with 34.7 percent of those taking simvastatin alone. In relative terms, Vytorin reduced the chances of a heart attack or stroke by 6.4 percent over seven years. As for side effects, they were about the same for both groups.

"This is a reminder to everybody that all the stuff they've heard about cholesterol is true," Dr. Christopher Cannon, the principal investigator for the study, told Shots in an interview. "Lowering the cholesterol to even lower levels than we had in the past looks to be beneficial," he said.

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The results were presented Monday in Chicago at a scientific meeting of the American Heart Association.

Vytorin and Zetia, which is the brand name for ezetimibe alone, have been on the market for years. In approving them, the Food and Drug Administration relied mainly on data that showed the drugs reduced bad cholesterol rather than on whether the drugs led to fewer heart attacks and strokes among people who took them.

"There's still some uncertainty, but overall it's good news," Yale cardiologist Harlan Krumholz told Shots. "It means that there's another option for treatment that has some evidence behind it."

Using a laboratory measurement, such as bad cholesterol, as a shortcut in clinical research is common.

But a previous study that looked at thickening of the arteries that carry blood to the brain raised doubts about Vytorin and Zetia. The extra drug didn't appear to reduce thickening compared with simvastatin alone. Merck, which bought Vytorin's maker Schering-Plough in 2009, agreed to pay $688 million last year to settle a suit brought by investors who claimed the companies had harmed them by withholding those unflattering data.

IMPROVE-IT looked at patients at a high risk of heart attack and stroke. Would Vytorin and Zetia help patients at lower risk? Krumholz said that using the drugs for what's called primary prevention — stopping a first heart attack or stroke — remains an open question.

Doctors and patients also don't know for sure how effective Zetia is when added to more potent statins, such as atorvastatin (the generic form of Lipitor) and Crestor.

It's unlikely that a study like this one will be extended to those other drugs.

The IMPROVE-IT trial was huge — more than 18,000 patients. And it was expensive. "The exact costs of a trial like IMPROVE-IT are difficult to calculate but are on the order of hundreds of millions of dollars," a Merck spokeswoman said in an email to Shots.

And, speaking of cost, Vytorin isn't cheap. A 30-day supply costs more than $200 at Costco. Atorvastatin, or generic Lipitor, runs $20 or less, depending on the dose.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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What's In His Kiss? 80 Million Bacteria

Mon, 11/17/2014 - 11:46am
What's In His Kiss? 80 Million Bacteria November 17, 201411:46 AM ET Alison Bruzek Listen to the Story 3 min 26 sec  

Credit: Katherine Streeter for NPR

If your partner's kiss is on your lips, his microbes are, too.

A passionate kiss that lasts more than 10 seconds transfers about 80 million bacteria, researchers say. The evidence, published Sunday in the journal Microbiome, comes from 21 couples, ages 17 to 45, who made out for science. (Tough gig.)

Each couple had their mouths swabbed and spit to measure the bacteria in their mouths. Even before kissing, the couples had similar mouth bacteria.

"To our surprise, we found that those people that are intimately related ... share much more of that bacteria on their tongue than unrelated individuals," Remco Kort, a microbiologist at the Netherlands Organisation for Applied Scientific Research in Amsterdam and lead author of the study told NPR's Rob Stein. He believes it may be due to other shared habits among couples, like using a certain toothpaste or smoking.

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To see if kissing transfers microbes from one person to another, the couples then smooched after drinking probiotic yogurt. The researchers focused on Lactobacillus and Bifidobacteria, which together usually make up only about 0.15 percent of the bacteria in human saliva and 0.01 percent of the bacteria on the tongue.

But after the yogurt kiss, the Lactobacillus and Bifidobacteria in the person on the receiving end rose substantially — up to 0.54 percent in saliva and 0.49 percent on the tongue. This led them to the estimate that each smooch carries 80 million bacteria.

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Couples who kissed at least nine times a day were more likely to have similar saliva microbes. Put simply, "kissing affects the microbes living in your mouth," says Kort.

To be clear, we're talking about French kissing here, not a grandmotherly peck.

Kort and colleagues believe this vigorous osculation could be a way to change your microbiome. "There's a number of studies that show that it's healthy to have a high diversity of microorganisms in your mouth," says Kort. And it might be fun to try.

Remco Kort, author of the kissing study, stands near his Kiss-O-Meter developed for the Micropia museum.

Courtesy Micropia

Could changing the microbiome be as simple as a lip lock? "It is provocative to think that we can perhaps donate beneficial microbes by an 'oral microbiome transplant,' " says Joseph Petrosino, a microbiologist at the Baylor College of Medicine who didn't work on the study, in an email to Shots.

Maybe we could transplant the mouth bacteria of a person who doesn't get cavities to one who often does, says Andrea Azcarate-Peril, a microbiologist at the University of North Carolina School of Medicine who did not work on the study. There may even be evolutionary reasons for the swap, she says, like, "when a mom of a newborn kisses a baby, it may actually be sampling the microbiota."

If you'd like to find out how many microbes you and your partner swap, the results of the study have been used to fuel a Kiss-O-Meter at Micropia, billed as "the world's first museum of micro-organisms." Just stand on the stage and pucker up and sensors will detect the type of kiss you're sharing. A readout will tell you how many and what types of microbes you've just shared. But that requires a trip to Amsterdam.

If you really want to know, that is. Some of us just might prefer kissing in the dark.

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

The Power Of Suggestion Could Trigger Asthma — Or Treat It

Mon, 11/17/2014 - 3:41am
The Power Of Suggestion Could Trigger Asthma — Or Treat It November 17, 2014 3:41 AM ET Listen to the Story 4 min 29 sec   Daniel Horowitz for NPR

Lots of things can trigger an asthma attack, but one of the most common causes is odor — anything from the heavy scent of perfume to a household cleaner.

Sondra Justice is a 60-year-old retired postal worker from Philadelphia, and for her, lots of odors are dangerous: aerosol cans, certain charcoals and cleaners, "even mixing bleach in water irritates my throat," she says. If Justice smells any of these things, it can bring on an asthma attack. Her airways constrict, and breathing becomes shallow and difficult. "I'll get a hacking cough, my throat will feel like it's closing up, I'll break out in hives — it's awful when it happens," she says.

“ Perhaps there are smells that could actually make their asthma better.

So life for Justice is a constant worry. She's always on the lookout for any smell that could provoke her asthma.

She's not alone, says Pamela Dalton, senior scientist at the Monell Chemical Senses Center in Philadelphia. "I think people with asthma are probably more at risk of being hypervigilant all the time than mostly anyone else," she says.

And that vigilance can be extreme, to the point where even thinking about a dangerous odor can put them at risk of an attack. Some researchers think this power of suggestion could be used to help stop an asthma attack before it starts.

Dalton studies how people react to odor. She has found that most people are highly suggestive. In one study, two groups of people were given the same thing to smell. One group was told it was a chemical solvent, the other — a rain forest plant. After 15 minutes of smelling the odor, the group that thought they were smelling a chemical reported feeling sick. The group that thought it was a plant felt relaxed and even rejuvenated.

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"When we saw these dramatic effects in normal, healthy people, we decided, 'Well, maybe they'd be even more enhanced in a population like asthmatics who were already afraid of odors,' " says Dalton.

So she conducted a small study. Seventeen people with chronic moderate asthma were divided into two groups. Both were given the same pure rose scent to smell for 15 minutes. One group was told it could help them breathe better. The other was told it might cause breathing problems.

As expected, the "breathe better" group said they liked the odor. The "might cause problems" group didn't like it at all. In fact, they said it made them feel sick. But not only did it make them feel sick, it caused inflammation in their airways — a hallmark of asthma. And the inflammation lasted for 24 hours. Meanwhile, the people who were told the smell could be beneficial experienced no inflammation at all.

"What really surprised us was the simple instruction that the odor might be hazardous caused their airways to increase inflammation," says Dalton.

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This could open up a whole new area of asthma therapy, says Dr. Gailen Marshall, chairman of the department of allergy and immunology at the University of Mississippi Medical Center. If there are smells that could make someone's asthma worse, he says, "perhaps there are smells that could actually make their asthma better."

Take, for example, lavender. Most people think of lavender as a nice, soothing smell. If a sachet of mild lavender could be associated with regular asthma medicine that made patients get better, he says, "after a while it may be that simply smelling the lavender sachet would have the same effect as an inhaler."

And reducing reliance on an inhaler is a good thing, says Marshall, because over time people's lungs get less responsive and the inhaler becomes less effective.

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

They Paid How Much? How Negotiated Deals Hide Health Care's Cost

Sat, 11/15/2014 - 7:48am
They Paid How Much? How Negotiated Deals Hide Health Care's Cost November 15, 2014 7:48 AM ET

fromWLRN

Sammy Mack Listen to the Story 3 min 53 sec  

As Americans begin shopping again for health insurance under the Affordable Care Act on Saturday, they'll be wrestling with premiums, deductibles, out-of-pocket costs and other vague and confusing insurance-speak.

Believe it or not, that's the easy part compared with figuring out what health care actually costs.

Sal Morales found an Obamacare health plan this year that costs him $145 per month — versus the $560 he'd been paying.

Courtesy of The Miami Herald

Sal Morales of Miami bought insurance in March during the ACA's first enrollment period on the HealthCare.gov website.

It felt amazing, he says, to get that insurance card in the mail — "like if I got an American Express Platinum card. That's how I felt."

Morales was unemployed at the time. Money was tight and he knew he needed regular doctor visits to manage his high blood pressure. He diligently researched what he would get for his money before settling on a health insurance plan.

Instead of paying $560 a month for COBRA coverage, Morales discovered he could get an Obamacare plan for $145 per month.

"I have a network deductible of $500," Morales says. "My first three visits to a primary care physician — they're zero dollars. Then it's $5 out of my pocket."

Morales understands his end of the health care equation, but what he sees doesn't necessarily reflect the amount that hospitals and doctors receive to care for him, says Bruce Rueben, president of the Florida Hospital Association.

"That gentleman knows what it costs him, but he may not know what the actual cost of his health care is," Rueben says.

Here's how Rueben breaks it down: "There's one party — the hospital who provides the service. There's a second party — the patient, who receives the service. And there's a third party — the insurance, who pays for the service."

That third part is where health care pricing gets really squirrelly.

“ I am completely sympathetic that it's very confusing. There are at least six different prices for a hospital day. And then there's the cost of actually delivering the service — which, for most of these things, even hospitals don't know.

Every hospital has its own master list of charges for different services. Those charges are different from hospital to hospital.

But insurance companies don't pay those listed charges. The listed charges are almost fiction. Instead, each insurer negotiates for lower prices with each hospital and doctor on every plan. The negotiated prices even can vary within an insurance company depending on which plan a patient has.

All of this means there are about as many price tags for that hypertension checkup as there are insurers and providers.

"For an individual consumer, I am completely sympathetic that it's very confusing," says Dr. Ezekiel Emanuel, who was an adviser to the president during the drafting of the health law and is now a health policy specialist at the University of Pennsylvania. "There are at least six different prices for a hospital day. And then there's the cost of actually delivering the service, which — for most of these things, even hospitals don't know what that is. So when you say, 'What's the price?' it's almost a meaningless question, because there [are] all these different prices."

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Emanuel says there's almost nothing that a consumer can check to gauge the actual prices for their health care before buying health insurance.

Those negotiated rates — the prices insurance companies really pay hospitals — are treated like trade secrets. Insurers and many hospitals don't want their competitors to know what they are paying.

It is only on an individual basis that people can see the prices their insurer paid for their care. And that's only after the care has been delivered — and only if the person is already insured.

The true cost of a treatment or procedure or medical service is buried in a statement called an explanation of benefits. These are the letters from insurers that look like a bill but say "this is not a bill."

Efrain Monzon helps patients interpret those explanations for Florida Blue, the largest insurance company in the state of Florida.

"We're identifying the procedure, we're identifying the provider, the date of service and then making sure the amount — the member responsibility — has to be in there," Monzon says.

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Wedged into that statement (somewhere between the billing code and the member deductible) is a column for the amount paid.

This is the secret number the insurance company and the provider have worked into their contract, says Monzon. The industry often calls that number the "adjusted rate" or the "negotiated rate."

In Florida Blue's explanation of benefits to patients, it's called simply "amount paid."

To get a clearer sense of what health care costs, someone would have to collect enough of those statements from patients at every hospital, and every different type of insurance.

There are companies and crowdsourcing projects trying to do just that around the country. And Massachusetts has a law that says insurers have to disclose some of these prices in a way that is accessible to patients.

But so far, that's not happening in South Florida.

Which is all part of why someone like Sal Morales can know that his health care will cost him about $145 every month — but he won't necessarily know the true price of that care.

This story is part of a reporting partnership with WLRN, the Miami Herald, NPR and Kaiser Health News.

Copyright 2014 WLRN Public Radio. To see more, visit http://www.wlrn.org/.
Categories: NPR Blogs

HealthCare.gov Head Says Site Is Tested And 'Ready To Go'

Fri, 11/14/2014 - 5:11pm
HealthCare.gov Head Says Site Is Tested And 'Ready To Go' November 14, 2014 5:11 PM ET Listen to the Story 4 min 6 sec  

The second open enrollment period for buying health insurance under the federal Affordable Care Act starts Saturday.

Don Ryan/AP

It's being challenged in the Supreme Court. Members of the new Republican Congress want to repeal it. But Obamacare will get a second chance on Saturday, when enrollment opens again in the government-sponsored health exchanges.

The Obama administration is expecting over 3 million new enrollees and almost 6 million return customers. And while the system faces some challenges, the government says it's up to the task.

"We are ready to go," says Kevin Counihan, the new CEO of HealthCare.gov. Counihan headed Connecticut's successful Obamacare exchange and was named to head the federal website in August.

"We have learned a lot from last year," Counihan says. "We've had testing by the insurance companies. We've had independent testing. We've had end-to-end testing. We've had stress testing. We've kicked the tires on this thing."

No one expects a repeat of last year's disastrous launch. And Counihan says there are new features that will make the user experience much better.

"In the past, we had around 76 screens that an applicant had to work through before they could enroll for coverage, and that's now been reduced to 16," he says.

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That should please Katie Garcia, a 33-year-old dentist in Lincoln, Neb. "Last year I remember I tried pretty hard to set up an account and I actually wasn't ever able to," Garcia says.

Her employer doesn't provide coverage. Last year her personal insurance policy was canceled because it didn't meet the Affordable Care Act standards. That's because it didn't cover much. But then, Garcia was allowed to extend it for a year — and she did because it was cheap. Now she regrets it.

"It was a bad call. I ended up requiring two surgeries this year, and I got hammered by medical bills," she says.

She had between $15,000 and $20,000 in out-of-pocket costs. This week Garcia browsed HealthCare.gov.

"I do like the website. I'm impressed by it. I think they've made a lot of nice changes. I like all the links that you can jump around on. Everything's really nice and clean," she says.

Garcia is part of a group the administration hopes will boost Obamacare numbers this year — people whose nonconforming policies were canceled last year, then given an extension by President Obama.

But most of the traffic on the website is likely to be returning customers. A few months ago the administration was touting an automatic re-enrollment feature, which allows current policyholders to continue their coverage without doing anything. But now the administration is urging them to revisit the site.

"Current policyholders should come back to HealthCare.gov, update their income, update any changes in their family status and shop and compare and see if there are any new and better deals out there," Counihan says.

Robert Laszewski of Health Policy and Strategy Associates, who has been a critic of Obamacare, agrees. "There've been so many changes in the plans this year and so many changes in the baseline plan that determine subsidies that people really do need to go in and re-enroll," he says.

“ We have learned a lot from last year. We've had testing by the insurance companies. We've had independent testing. We've had end-to-end testing. We've had stress testing. We've kicked the tires on this thing.

Laszewski points out that most states are seeing changes in the benchmark plans used to calculate subsidies. That means even if your current insurer doesn't raise your premium, your subsidy could go down and you could end up paying more for your health insurance.

Laszewski also points out that while open enrollment extends through Feb. 15, to have your insurance take effect at the beginning of the year, you need to make a decision by Dec. 15 — just 30 days from now.

"We could have 8 million people trying to go through HealthCare.gov in a 30-day period when before we did it over many months. So we could have a problematic open enrollment even if the technology for HealthCare.gov works fairly well," he says.

The administration is confident the system can handle the challenge. One reason for that is that re-enrollees will have to enter just a small amount of new information. And Counihan says the majority of current customers could save money by coming back to the website to do some comparison shopping.

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

More Squash, Less Bacon: Calculating Your Real-Life Heart Risk

Fri, 11/14/2014 - 3:51pm
More Squash, Less Bacon: Calculating Your Real-Life Heart Risk November 14, 2014 3:51 PM ET

Cardiovascular risk calculators usually expect you to know your blood pressure and cholesterol numbers. I have enough trouble remembering my email password.

So this new calculator from the Harvard School of Public Health may be a boon for people like me. It's designed to more accurately gauge risk for people who are in their 40s and 50s, especially women. And it does that by focusing on how lifestyle factors like diet and exercise affect heart disease risk, rather than numbers.

Here's my risk profile. Note the risky red heart due to bacon-eating.

Courtesy of Harvard Public Health

It may be the first data-driven risk predictor based on healthful lifestyle factors.

Indeed, taking the Healthy Heart Score online quiz is more like a conversation with a cheerfully nosy friend than with a doctor. Am I lifting weights these days? Doing yoga? Playing squash? (Squash? OK, Harvard.)

It has an odd fascination with breakfast: Eating oatmeal? High-fiber cereal? Bran? Grits? Juice?

The calculator crunched my numbers, and told me my risk is low. Hooray! But it did note my less-than-slight BMI and somewhat slothful ways.

The only high-risk rating I got out of 10 lifestyle factors was for eating processed meats. What? I never eat processed meats. So I went back to the quiz to check. Oh yes, the bacon. And the Italian sausage.

NPR's economics correspondent John Ydstie also took the quiz and also got dinged for eating processed meats. We looked more closely and realized that while the calculator is willing to grant us the occasional beer or glass or wine, it has a zero tolerance policy when it comes to bacon.

Ydstie and I decided we're willing to sacrifice a few years of life for bacon. But you may be wiser.

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Iimproving these risk factors in midlife can reduce the risk of heart disease and early death by 70 to 80 percent, the study authors note. "The absence of established risk factors at the age of 55 is associated with a lifetime risk of CVD of 5 to 8 percent," they wrote.

The study was published Friday in the Journal of the American Heart Association. It's based on data from 62,025 women in the the Nurses Health Study and 34,478 men in the Health Professionals Follow-Up Study, tracking how they lived and what became of them for up to 24 years.

Because of the large number of people involved and the long time span, it should give a pretty reliable sense of risk and reward when it comes to lifestyle choices.

And that calculator does give practical advice on how to improve your odds.

I think I'll head out for a walk.

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