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Heavy Screen Time Rewires Young Brains, For Better And Worse

Sat, 11/19/2016 - 8:07am
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November 19, 20168:07 AM ET Heard on Weekend Edition Saturday Ippei Naoi/Getty Images

There's new evidence that excessive screen time early in life can change the circuits in a growing brain.

Scientists disagree, though, about whether those changes are helpful, or just cause problems. Both views emerged during the Society for Neuroscience meeting in San Diego this week.

The debate centered on a study of young mice exposed to six hours daily of a sound and light show reminiscent of a video game. The mice showed "dramatic changes everywhere in the brain," said Jan-Marino Ramirez, director of the Center for Integrative Brain Research at Seattle Children's Hospital.

"Many of those changes suggest that you have a brain that is wired up at a much more baseline excited level," Ramirez reported. "You need much more sensory stimulation to get [the brain's] attention."

So is that a problem?

On the plus side, it meant that these mice were able to stay calm in an environment that would have stressed out a typical mouse, Ramirez explained. But it also meant they acted like they had an attention deficit disorder, showed signs of learning problems, and were prone to risky behavior.

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Overall, the results add to the evidence that parents should be very cautious about screen time for young children, Ramirez said. "I would minimize it."

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A more optimistic interpretation came from Leah Krubitzer, an evolutionary neurobiologist at the University of California, Davis. "The benefits may outweigh the negative sides to this," Krubitzer said, adding that a less sensitive brain might thrive in a world where overstimulation is a common problem.

The debate came just weeks after the American Academy of Pediatrics relaxed its longstanding rule against any screen time for kids under two. And it reflected an evolution in our understanding of how sensory stimulation affects developing brains.

Researchers learned many decades ago that young brains need a lot of stimulation to develop normally. So, for a long time parents were encouraged to give kids as many sensory experiences as possible.

"The idea was, basically, the more you are exposed to sensory stimulation, the better you are cognitively," Ramirez said.

Then studies began to suggest that children who spent too much time watching TV or playing video games were more likely to develop ADHD. So scientists began studying rats and mice to see whether intense audio-visual stimulation early in life really can change brain circuits.

Studies like the one Ramirez presented confirm that it can. The next question is what that means for children and screen time.

"The big question is, was our brain set up to be exposed to such a fast pace," Ramirez said. "If you think about nature, you would run on the savanna and you would maybe once in your lifetime meet a lion."

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In a video game, he said, you can meet the equivalent of a lion every few seconds. And human brains probably haven't evolved to handle that sort of stimulation, he said.

Krubitzer, and many other scientists, said they aren't so sure. It's true this sort of stimulation may desensitize a child's brain in some ways, they said. But it also may prepare the brain for an increasingly fast-paced world.

"Less than 300 years ago we had an industrial revolution and today we're using mobile phones and we interact on a regular basis with machines," Krubitzer said. "So the brain must have changed."

Krubitzer rejected the idea that the best solution is to somehow turn back the clock.

"There's a tendency to think of the good old days, when you were a kid, and [say], 'I didn't do that and I didn't have TV and look how great I turned out,' " Krubitzer said.

Gina Turrigiano, a brain researcher at Brandeis University, thinks lots of screen time may be fine for some young brains, but a problem for others.

"Parents have to be really aware of the fact that each kid is going to respond very, very differently to the same kinds of environments," she said.

Copyright 2016 NPR. To see more, visit NPR.
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In Depressed Rural Kentucky, Worries Mount Over Medicaid Cutbacks

Sat, 11/19/2016 - 6:00am

Freida Lockaby says she has benefited from access to health care coverage through Medicaid.

Phil Galewitz/Kaiser Health News

For Freida Lockaby, an unemployed 56-year-old woman who lives with her dog in an aging mobile home in Manchester, Ky., one of America's poorest places, the Affordable Care Act was life altering.

The law allowed Kentucky to expand Medicaid in 2014 and made Lockaby – along with 440,000 other low-income state residents – newly eligible for free health care under the state-federal insurance program. Enrollment gave Lockaby her first insurance in 11 years.

"It's been a godsend to me," said the former Ohio school custodian who moved to Kentucky a decade ago.

Lockaby finally got treated for a thyroid disorder that had left her so exhausted she'd almost taken root in her living room chair. Cataract surgery let her see clearly again. A carpal tunnel operation on her left hand eased her pain and helped her sleep better. Daily medications brought her high blood pressure and elevated cholesterol level under control.

But Lockaby is worried her good fortune could soon end. Her future access to health care now hinges on a controversial proposal to revamp the program that her state's Republican governor has submitted to the Obama administration.

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Next year will likely bring more uncertainty when a Trump administration and a GOP-controlled Congress promise to consider Obamacare's repeal, including a potential reduction in the associated Medicaid expansion in 31 states and the District of Columbia that has led to health coverage for an estimated 10 million people.

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Kentucky Gov. Matt Bevin, who was elected in 2015, has argued his state can't afford Medicaid in its current form. Obamacare permitted states to use federal funds to broaden Medicaid eligibility to all adults with incomes at or below 138 percent of the federal poverty level, now $11,880 for individuals. Kentucky's enrollment has doubled since late 2013 and today almost a third of its residents are in the program. The Medicaid expansion under Obamacare in Kentucky has led to one of the sharpest drops in any state's uninsured rate, to 7.5 percent in 2015 from 20 percent two years earlier.

Kentucky's achievement owed much to the success of its state-run exchange, Kynect, in promoting new coverage options under the health law. Kynect was launched under Bevin's Democratic predecessor, Steve Beshear, and dismantled by Bevin this year.

Bevin has threatened to roll back the expansion if the Obama administration doesn't allow him to make major changes, such as requiring Kentucky's beneficiaries to pay monthly premiums of $1 to $37.50 and require nondisabled recipients to work or do community service for free dental and vision care.

Budget pressures are set to rise next year in the 31 states and the District of Columbia where Medicaid was expanded as the federal government reduces its share of those costs. States will pick up 5 percent next year and that will rise gradually to 10 percent by 2020. Under the health law, the federal government paid the full cost of the Medicaid expansion population for 2014-2016.

In a state as cash-strapped as Kentucky, the increased expenses ahead for Medicaid will be significant in Bevin's view — $1.2 billion from 2017 to 2021, according to the waiver request he's made to the Obama administration to change how Medicaid works in his state.

Trump's unexpected victory may help Bevin's chances of winning approval. Before the election, many analysts expected federal officials to reject the governor's plan by the end of the year on the grounds that it would roll back gains in expected coverage.

A Trump administration could decide the matter differently, said Emily Beauregard, executive director of Kentucky Voice for Health, an advocacy group that opposes most waiver changes because they could reduce access to care.

"I think it's much more likely that a waiver could be approved under the Trump administration," she said. "On the other hand, I wonder if the waiver will be a moot point under a Trump administration, assuming that major pieces of the [Affordable Care Act] are repealed."

Lockaby is watching with alarm: "I am worried to death about it."

Life already is hard in her part of Kentucky's coal country, where once-dependable mining jobs are mostly gone.

In Clay County where Lockaby lives, 38 percent of the population live in poverty. A fifth of the residents are disabled. Life expectancy is eight years below the nation's average.

Clay's location places it inside an area familiar to public health specialists as the South's diabetes and stroke belt. It's also in the so-called "Coronary Valley" encompassing the 10-state Ohio/Mississippi valley region.

About 60 percent of Clay County's 21,000 residents are covered by Medicaid, up from about a third before the expansion. The counties uninsured rate for nonelderly adults has fallen from 29 percent to 10 percent.

Still, the increase in insurance coverage hasn't made Clay's people healthier yet. Local health officials here say achieving that will take a decade or more. Instead, they cite progress in smaller steps: more cancer screenings, more visits to mental health professionals and more prescriptions getting filled. Harder lifestyle changes that are still ahead — such as eating better, quitting smoking and regular exercise — will take more than a couple years to happen, said Aaron Yelowitz, associate professor of economics at the University of Kentucky.

At the Grace Community Health Center in Manchester, Ky., psychologist Joan Nantz meets with patient Ramiro Salazar, who gained Medicaid under the expansion.

Phil Galewitz/Kaiser Health News

One hopeful spot is the Grace Community Health Center in downtown Manchester, where patient visits are up more than 20 percent since 2014. Those without insurance pay on a sliding scale, which can mean a visit costs $50 or more.

That was too much for Ramiro Salazar, 47, who lives with his wife and two children on a $733 monthly income. With Medicaid, he sees a doctor for his foot and ankle pain, meets regularly with a psychologist for anxiety and gets medications — all free to him. Medicaid even covers his transportation costs to doctors, vital because a specialist can be 40 miles away.

Salazar is worried about Bevin's plans, especially the additional costs. "I probably couldn't afford it as I'm unemployed," he said. "It would hurt me pretty bad."

Any development that could take away health coverage from people with mental health issues worries Joan Nantz, a psychologist who works part time at Grace and whose appointment calendar is booked three weeks out because of patient demand. More than 90 percent of her clients are on Medicaid.

"If something happens to this program, I can't begin to think what impact it would have on society," she said. Without counseling, people with mental health issues will resort to illegal drugs and be more likely to commit crimes and domestic violence, Nantz said.

Just five primary care doctors in Manchester treat adults in Clay and surrounding counties. Manchester Memorial Hospital has tried to recruit more without success.

"We had a painful primary care shortage here five years ago and now it's worse," said Dr. Jeffrey Newswanger, an emergency room physician and chief medical officer at the hospital. "Just because they have a Medicaid card doesn't mean they have doctors."

The emergency room is busier than ever seeing patients for primary care needs, he said.

Newswanger sees both sides to the debate over Medicaid. The hospital gained because more patients are now covered by insurance, and the ER's uninsured rate dropped to 2 percent from 10 percent in 2013.

"Eliminating the expansion altogether would be painful for the hospital and a disaster for the community," he said.

But, Newswanger also appreciates some of Bevin's proposals.

"No one values something that they get for free," he said, and incentives are needed to make people seek care in doctors' offices instead of expensive ERs.

Christie Green, public health director of the Cumberland Valley District Health Department that covers Clay County, said making the poor pay more or scrapping Medicaid's expansion would be a setback to improving people's health.

Last year, Green helped Manchester build a three-mile trail along a park and install a swinging bridge across a small creek. Both additions were intended to promote physical fitness in a place where more than a third smoke — both far above national averages.

Progress is slow. The path is used regularly. But drug addicts congregate daily by the bridge and it rarely gets traffic.

"There is a lot to overcome here," Green said.

This story was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health care policy research organization. You can follow Phil Galewitz on Twitter: @philgalewitz.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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Deaths Involving Fentanyl Rise As Curbing Illicit Supply Proves Tough

Fri, 11/18/2016 - 3:27pm
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November 18, 20163:27 PM ET Heard on All Things Considered


Anthony Salemi, of Everett, Mass., holds a photo of his brother Joe, who died from an overdose of fentanyl-laced heroin earlier this year.

Jesse Costa/WBUR

In mid-August, an affable, 40-year-old man from Everett, Mass., overdosed at his mom's home after almost 25 years of heroin use. Joe Salemi had overdosed before, but this time couldn't be revived. Salemi's brother, Anthony, says he was pretty sure when his brother died that there must have been something besides heroin in the syringe. The medical examiner later confirmed it.

"I knew, deep in my mind, it was going to be the stuff that everyone's talking about now — fentanyl," Anthony says. "Because I never thought straight heroin would kill him."

Anthony Salemi was familiar with fentanyl. He'd been prescribed the powerful painkiller after surgery in 2006. Anthony had warned his younger brother about reports that dealers were adding an illicit version of the drug to heroin, sometimes promising a more intense high. Fentanyl is more than 50 times more potent than heroin, according the Centers for Disease Control and Prevention.

But people like Joe rarely know for sure if there is fentanyl in the tiny plastic bags of illegal powder they buy — or how much. Just a few grains of pure fentanyl, doctors say, is enough to kill most users. In Massachusetts, 75 percent of the people who overdosed this year tested positive for the drug.

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"It just seems like the dealers and the drugs are ravaging the whole country, says Anthony Salemi. "The supply just keeps coming in, no matter how many cops you put at the border, it just keeps coming in. This is scary."

The Obama administration agrees that the increasing supply of fentanyl on the street is a major challenge and says agencies are doing a lot. But reducing the supply is complicated.

Fentanyl is a synthetic opioid, constructed with lab chemicals — unlike heroin or morphine, which start with the opium sap of a poppy plant. Drug enforcement agents say clandestine labs across China are the main source of the illegally sold fentanyl.

Producers then ship the drug to Mexico, where drug cartels mix it into heroin or press it into blue, pink or white tablets that look like prescription pills for anxiety or pain. The powder or pills are delivered to dealers, or directly to users, via the Internet or darknet, an online area used for illegal purchases.

"Synthetic drugs are a real winner because they are easy to make, and they're cheap to produce," says Kara McDonald, director of policy, planning and coordination at the international narcotics and law enforcement bureau of the U.S. Department of State.

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"They're not dependent on a season or the weather like a plant-based drug," McDonald says. "And with the distribution system — through mail order — they can be delivered directly to the door in some cases. Like a pizza."

The profit margin is huge, says Drug Enforcement Administration spokesperson Russ Baer. He says it costs from $3,000 to $4,000 to produce a kilo — 2.2 pounds — of fentanyl. The fentanyl is then cut with cheap fillers to make pills, or mixed into bags and fraudulently sold as pure heroin.

"Drug traffickers involved in the wholesale distribution of those products can yield close to $1.5 million off that one kilogram," says Baer.

The DEA has six agents who operate out of Beijing and work closely with China's Ministry of Public Security, Baer says. Chinese officials established controls on 116 new chemicals last year, including 19 that have much the same molecular structure as fentanyl. Baer says that helped reduce the supply of some of these designer analogs of the drug. (Though each analog drug has a slightly different chemical structure from fentanyl, they work much the same way in the body.)

And in September, the DEA moved to declare another fentanyl analog called U-47700 illegal. But the producers always seem to be one step ahead of enforcement agencies, Baer says.

"Once we control a substance, whether here in the U.S. or in China, for example," he says, "the drug manufacturers simply change a molecule, tweak a molecule, in an attempt to circumvent the law."

Keeping up with the inventive chemists sounds nearly impossible.

"We're identifying one to two new synthetic substances every week," Baer says.

If a drug compound is similar to fentanyl, or if it produces the same physiological effect, the DEA can file trafficking charges here in the U.S. But these variations are not illegal in many countries. McDonald says the State Department is working, through the United Nations and with individual nations, to make sure police everywhere can identify new drugs and prosecute dealers.

The international control system is only able to detect, process and outlaw about 10 new psychoactive substances a year, McDonald says. "It doesn't take a mathematician to identify that we have a real challenge here."

To get in front of production, the State Department and a group of U.S. senators asked the United Nations in October to add to the list of tightly controlled substances two key ingredients used to make fentanyl. A decision is expected next year.

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McDonald and Baer at the DEA say slowing demand for illicit uses of fentanyl and other opioids has become an urgent priority. The office of the U.S. Surgeon General this week also issued a report on the growing problem of substance abuse and the need for more widespread implementation of well-recognized, evidence-based treatment programs to address the problem.

In an interview with NPR's Steve Inskeep on Morning Edition Thursday, Surgeon General Vivek Murthy called addiction "a chronic disease of the brain."

"We need to treat it with the same urgency and compassion that we do any other illness," Murthy told Inskeep.

But some lawmakers, physicians and families who've lost loved ones say the Obama administration has done too little too late to tackle the epidemic.

U.S. Sen. Ed Markey, a Democrat from Massachusetts, says it's time to make the illegal production and trafficking of fentanyl the top policy issue in relations with China and Mexico.

"Many more people are going to die from this than [from] any threat from nuclear weapons or any devastation that's caused by an imbalance in trade," Markey says.

Baer says trying to stop the supply of opioids is part of the solution, but so is tackling demand by addressing addiction as a disease.

"The community needs to embrace these folks, create treatment opportunity," Baer says. "We need to educate the public. It's the No. 1 priority and it represents a public health crisis that all of us must work together to try to resolve."

The CDC offers a sobering perspective. While about 78 Americans will die today after an overdose, another 580 will try heroin — or what they think is heroin — for the first time.

This story is part of NPR's reporting partnership with WBUR and Kaiser Health News.

Copyright 2016 WBUR. To see more, visit WBUR.
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Will Legal Marijuana Lead To More People Smoking Tobacco?

Fri, 11/18/2016 - 11:36am

Is marijuana a gateway drug to smoking cigarettes?

PhotoAlto/Katarina Sundelin/Getty Images

California's decision to legalize marijuana was touted as a victory for those who had argued that the state needed a system to decriminalize, regulate and tax it.

But the new law, approved by voters on Nov. 8, also could be a boon to the tobacco industry at a time when cigarette smoking is down and cigarette companies are looking for ways to expand their market, according to researchers in Los Angeles County and around the state.

They warn that unless the state proceeds carefully, the legalization of marijuana for recreational use could roll back some of the gains California has made in reducing the use of tobacco.

"There is a concern that there could be a potential renormalization of smoking," says Michael Ong, an associate professor at UCLA's David Geffen School of Medicine.

Ong says it will depend on how the initiative is implemented, whether officials follow through on the regulation, and how involved public health officials are with it. "It will be important to make sure that we don't have a setback in terms of what we have done for clean air in California ... and what we have done to reduce tobacco's harms," he says.

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Ethan Nadelmann, executive director of the Drug Policy Alliance, which supports marijuana legalization, defended the measure, saying there is no evidence that legalization leads to increased cannabis consumption — or tobacco smoking.

California's adult smoking rate is the second-lowest in the country, at 11.6 percent, according to the California Department of Public Health. The smoking rate dropped by more than 50 percent between 1988 and 2014, cutting health care costs and reducing tobacco-related diseases, according to the department.

The headway against smoking over the past few decades is due to a combination of factors, including tobacco taxes, laws restricting where people can smoke, and broad-based media campaigns and programs to help people quit. Despite the decline in smoking, the use of e-cigarettes has increased dramatically over the past few years, with nearly 10 percent of adults ages 18 through 24 now using them, according to the department.

Another ballot initiative passed by voters last week could push the smoking rate even lower. Prop. 56 will add $2 per pack to the tax on cigarettes and increases taxes on electronic cigarettes that contain nicotine and other tobacco products. The money will help pay for health care and increase funding for tobacco control and prevention.

The marijuana initiative, Prop. 64, allows adults ages 21 and over to grow, buy and possess small amounts of marijuana for personal use. It also regulates recreational marijuana businesses and imposes taxes that will help pay for drug education and prevention programs.

Bonnie Halpern-Felsher, a pediatrics professor at the Stanford University School of Medicine, says she is concerned that there may not be enough education and prevention written into the proposition, especially targeted at youth.

Marijuana is already the most widely used illegal drug among adolescents. Many young people consider marijuana and blunts, which are marijuana rolled with a tobacco leaf wrapper, to be more socially acceptable and less risky than cigarettes, according to a recent study co-authored by Halpern-Felsher. The study also found that youths who saw messages about the benefits of marijuana were more likely to use it.

Blunts are particularly worrisome because they contain nicotine as well as marijuana, Halpern-Felsher says. Many young people may not understand the risk of blunts or marijuana, she notes, and once they start thinking that smoking one product is acceptable, they may believe it's OK to smoke other things as well. "That's my concern," she says. "I do think people are going to generalize."

From the tobacco industry's point of view, marijuana could serve as a "smoke inhalation trainer," and thus become a gateway to tobacco use, says Robert K. Jackler, a professor at the Stanford School of Medicine who researches tobacco advertising. He says tobacco and marijuana are marketed in similar ways — as products to help people relax and ease their stress. "There is tremendous overlap potential," he says.

Tobacco companies could easily try to exploit that similarity to enter the marijuana market, Jackler says. They already have enormous influence on state laws and regulations, and could try to set up small dispensaries and make marijuana another one of their products.

"The tobacco industry is always looking for replacement products because, at least in America, smoking is down," he says. "This will give them a new entry into the market. They are best equipped to exploit this market opportunity."

In fact, the tobacco industry considered getting into the marijuana market in the 1960s and 70s and could easily do so, says Stanton Glantz, a professor at University of California, San Francisco School of Medicine. Glantz believes that even as the newly approved tobacco tax reduces California's smoking rate further, legalized marijuana will help sustain the tobacco market. He says he expected to see mass marketing and branding of marijuana over time.

Along with some therapeutic benefits of marijuana, there are also health risks, Glantz says. "The likely costs that are going to be incurred by all the marijuana-induced diseases don't come close to being covered by the taxes that are written into Prop. 64," he warns.

The initiative should have included higher taxes, graphic warning labels, provisions to keep demand low and a broad-based education campaign like there is on tobacco, Glantz argues. "The ideal situation is where it's legal so nobody is thrown in jail, but nobody wants to buy it."

Election Buzz: Recreational Marijuana On The Ballot Legalizing Marijuana: It Changes Policing, But May Leave Racial Disparities

Legalization supporters said they don't believe the tobacco industry will get involved in the marijuana market until and unless federal prohibition ends. Marijuana is still illegal under federal law.

Nadelmann, of the pro-marijuana Drug Policy Alliance, says it is misguided to conflate the two products. Young people can distinguish between the effects of cigarettes and marijuana, he says.

"Teenagers are actually smarter than most of the adult propaganda," Nadelmann says. "They know smoking cigarettes is really stupid and that smoking marijuana is not such a major issue."

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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Texas Parents Have Unanswered Questions About School Vaccination Rates

Fri, 11/18/2016 - 9:59am

When Georgia Moore (second from left) was diagnosed with leukemia in 2010, her parents, Trevor and Courtney Moore, worried about the germs her younger sister, Ivy, would bring home from school.

Courtesy of the Moore family/Kaiser Health News

Georgia Moore was diagnosed with leukemia the day after her 10th birthday. The fourth-grader began an intense chemotherapy regimen, which left her immune system vulnerable and kept her from attending her small, private Montessori school in Austin, Texas.

But her younger sister Ivy was in kindergarten at the same school, where a handful of families opted out of vaccinating their children. That meant 6-year-old Ivy might bring home germs that could pose a risk to Georgia.

"She would go to school, come home and immediately we'd put clothes in the washer to keep a healthy environment," the girls' mother, Courtney Moore, said of the family's after-school routine.

Georgia, now 16, had very few hospitalizations during the course of her treatment and is now cancer-free, five years out from treatment. But Georgia's battle against cancer made Courtney Moore a vocal advocate for immunizations in Texas — where an increasing number of parents are opting against vaccinating their children.

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After Georgia Moore (left) was diagnosed with leukemia, she underwent chemotherapy that depressed her immune system. She had to stay home from her small, private school in 2010, when the photo was taken.

Courtesy of the Moore family/Kaiser Health News

Texas is one of 18 states that allow nonmedical exemptions to the vaccines required for school attendance. California had a similar law allowing nonmedical exemptions, until last year when it enacted a law that has one of the strictest requirements in the country after a 2014 outbreak of measles traced to the Disneyland theme park infected more than 100 people around the country.

Many of the parents opting out of the immunizations, which are widely recommended by doctors, say they fear a link between the vaccines and health problems such as autism. But studies that they cite have been widely debunked by public health officials.

"Year after year we've seen a steady increase in the number of students with a conscientious exemption from vaccination in Texas," said Christine Mann, a spokeswoman for the Texas Department of State Health Services. "But overall, the numbers are small."

Even though statewide levels of vaccinations remain high, at over 98 percent, what concerns public health officials are the growing geographic clusters of geographic areas with high rates of unvaccinated children. Texas went from just 2,314 "conscientious exemptions" in 2003 to 44,716 this year, according to the Texas Department of State Health Services.

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Data about the number of unvaccinated kids in individual public schools aren't available. Currently, exemption rates are available for individual private and charter schools, but only districtwide for public schools.

Some parents are pressing state officials to let them know how many of their children's peers are unvaccinated.

Jinny Suh, who has a 4-year-old son, is helping spearhead a petition drive asking legislators to change state law so that the number of school exemptions is public. As a parent, there are lots of things that people get very passionate about," Suh said. "But for some reason, in my experience, vaccinations remain an almost taboo topic besides a few passionate people."

At least two bills were introduced during the past legislative session that would require Texas schools to notify parents about vaccination rates at the school level, but none were approved.

As is the case across the country, areas where kids aren't receiving vaccinations in Texas tend to be places with more highly educated and higher-income residents. The school with the highest percentage exemption rate in the state is the Austin Waldorf School, where more than 40 percent of students are unvaccinated and tuition exceeds $13,000 a year. Regents Academy, a private school in east Texas, was the second-highest exemption rate, at almost 38 percent of the school.

"If one of those kids is incubating an infectious disease and the other kids aren't vaccinated, then it's going to spread like wildfire," said Catherine Troisi, an infectious disease epidemiologist at the University of Texas Health Science Center at Houston.

Shots - Health News Vaccination Gaps Helped Fuel Disneyland Measles Spread

Troisi explains that for a disease like measles, you want "herd immunity" to be at 95 percent to prevent an outbreak. If healthy children aren't receiving vaccines, they are putting children who are too young to receive the vaccine and people with compromised immune systems at a much greater risk of infection.

Dr. Peter Hotez, a professor in the department of pediatrics and molecular virology and microbiology at the Baylor College of Medicine in Houston, called the growing numbers "extremely troubling" in a commentary last month in the PLOS Medicine, an online journal. He noted that some counties were getting close to that 95 percent marker, such as Gaines County in the western part of the state where the exemptions are now at 4.83 percent and Briscoe County in the Texas Panhandle with 3.55 percent. And Hotez, who has an adult daughter with autism, highlighted the situation in Austin, where the public school rate for exemptions is 2 percent but many of the private schools exceed 20 percent.

The American Academy of Pediatrics in September issued a policy statement encouraging pediatricians to be more vocal about the importance of vaccines for children healthy enough to receive them.

But some parents are leery of the public health efforts on vaccinations. "We believe parents should make medical decisions for their children, not the state," said Jackie Schlegel, director of Texans for Vaccine Choice, a political action committee that was formed partially in opposition to 2015 legislation to do away with the state's nonmedical vaccine exemptions.

"We campaigned, we block-walked and we'll do it again for anyone else who would like to trample on our parental rights," said Schlegel. When asked if she supported a parent's right to know the number of unvaccinated children at a given public school, Schlegel said "informed consent and privacy are very big concerns and need to be evaluated on both sides of the coin."

As a mother who has seen the issue up close, Moore says she hopes parents understand how their decision not to vaccinate their children could have far-reaching consequences.

"It's a very personal decision ..." Moore said. "But you have to recognize that if you choose not to [vaccinate], there's a good possibility that that personal decision will impact a lot of people."

An earlier version of this story ran on Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, and The Texas Tribune.

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

Chemists Re-Create Deadly Frog Poison In The Lab

Thu, 11/17/2016 - 2:02pm
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November 17, 20162:02 PM ET Heard on All Things Considered

The skin of the golden poison dart frog, Phyllobates terribilis, secretes a deadly poison that might lead to a better understanding of how to treat malfunctions of the human nervous system.

Tambako the Jaguar/Getty Images

The golden poison dart frog is about an inch long and banana yellow. By some estimates, the skin of one little frog contains enough toxin to kill 10 adult men.

"Oh yeah, it's one of the more lethal poisons on the planet," says Justin Du Bois, a synthetic chemist at Stanford University.

The substance is called batrachotoxin (buh-TRAK-uh-TOX-in), and tiny amounts of it can be deadly if it makes it into a victim's bloodstream. It's what some indigenous groups in Colombia's lowland rain forest would use to tip their blow darts.

And, as Du Bois and his colleagues write Thursday in the journal Science, they figured out how to make it in the lab in 24 steps. Why on Earth would anyone want to do that?

"Well, it turns out it's a fantastic research tool for figuring out how nerves conduct electricity," Du Bois says, "and we're very interested in that fundamental process."

Once inside a victim, the compound embeds itself in certain proteins that are responsible for conducting electrical impulses through the nerves and muscles, including the heart. By disrupting that process, it can cause paralysis and a heart attack. But studying the poison's mode of action could also lead to a deeper understanding of the role electrical impulses play in fundamental processes like heart function and the sensation of pain.

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"There are very few molecules like this that we're aware of," Du Bois says, "and we would like to really understand how it works."

And maybe — just maybe — some version could be developed into a useful drug. Du Bois points out a few rare diseases that involve malfunction in the same proteins that this toxin acts on; one such disorder prevents a person from feeling any pain at all.

"You could literally run a knife through their hand and they wouldn't feel a thing," Du Bois says. Some of the same proteins are involved in a condition that's sometimes called "Man on Fire syndrome," because people who have it experience frequent pain and burning.

"Molecules like batrachotoxin are essentially a key into mechanisms of how our nervous system works," says Toto Olivera, a biochemist and neuroscientist with the Howard Hughes Medical Institute who is based at the University of Utah. The more specific the compound is, and the more potent, he says, then "sometimes, the greater the insight that you can gain."

Shots - Health News Snail Venom Yields Potent Painkiller, But Delivering The Drug Is Tricky

There's a long list of nasty toxins that, with a few tweaks in the lab, have proved useful for human health, Olivera points out. Take curare, for example. The poison from tropical plants is now used as a muscle relaxant during some kinds of surgeries.

Olivera's lab found that the venom that certain sea snails — Conus magus — use to paralyze fish also acts on an important mechanism in the human body's communication of pain. That led to the development of a painkiller that is now used in patients who have become tolerant to morphine.

"Sometimes, you can add one atom to a compound and totally change how it acts," says Becca Tarvin, a doctoral student in evolutionary biology at the University of Texas, Austin. She studies the toxins of poison dart frogs and just got back from a trip to Colombia.

Tarvin says the various species of poison dart frogs contain at least 500 different toxins. She knows firsthand how some of these toxins feel once they're in your system; she and a field assistant once licked a few of the milder frogs, to see how they differed.

"One just tasted like sushi, like raw fish," she says. "The other one had kind of a bitter flavor that stayed in your mouth. But the last one I tasted, it tasted bitter at first. And then I could tell on my tongue the area that had touched the frog and the feeling kept spreading until my mouth was kind of numb."

Out of those 500 toxins, scientists know the biological activity of about 60.

"So, being able to synthesize any of these compounds is super important in figuring out how they work and how they could be developed as drugs," Tarvin says.

But another reason it's important to synthesize these compounds, the scientists say, is that they are getting harder and harder to find in nature. A lot of these frogs are endangered.

"Because of that," Tarvin says, "our chances of finding these toxins and these frogs before they're gone is low."

Copyright 2016 NPR. To see more, visit NPR.
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Surgeon General Murthy Wants America To Face Up To Addiction

Thu, 11/17/2016 - 5:14am
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November 17, 20165:14 AM ET Heard on Morning Edition

Addiction to opioids and heroin is a major public health problem, but so is alcohol abuse.

Toby Talbot/AP

In 1964, the U.S. surgeon general released a report on the health impacts of smoking, and it shaped the public and government's attitudes toward tobacco for years to come. On Thursday, another surgeon general's report was issued, this time tackling a much broader issue: addiction and the misuse and abuse of chemical substances. The focus isn't just one drug, but all of them.

Though little in the report is new, it puts impressive numbers to the problem, and some surprising context: More people use prescription opioids than use tobacco. There are more people with substance abuse disorders than people with cancer. One in five Americans binge drink. And substance abuse disorders cost the U.S. more than $420 billion a year.

Dr. Vivek Murthy, who is closing in on his second year as surgeon general, told NPR's Steve Inskeep Thursday on Morning Edition that he hopes putting all the data together will help Americans understand that these problems share a common solution. And it starts with kids. Their conversation has been edited for length and clarity.

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On the prevalence of substance abuse in the United States

U.S. Surgeon General Vivek Murthy says there is evidence for what works to prevent substance abuse, but it's often not applied.

Charles Dharapak/AP

An estimated 20.8 million people in our country are living with a substance use disorder. This is similar to the number of people who have diabetes, and 1.5 times the number of people who have all cancers combined. This number does not include the millions of people who are misusing substances but may not yet have a full-fledged disorder. We don't invest nearly the same amount of attention or resources in addressing substance use disorders that we do in addressing diabetes or cancer, despite the fact that a similar number of people are impacted. That has to change.

We now know from solid data that substance abuse disorders don't discriminate. They affect the rich and the poor, all socioeconomic groups and ethnic groups. They affect people in urban areas and rural ones. Far more people than we realize are affected. It's important for us to bring people out from the shadows, and get them the help that they need.

On the economic impact of substance use disorders

The impact this is having on the health and well being of our country, as well as our economy, is quite staggering. These substance use disorders cost over $420 billion a year in the form of health care costs, lost economic productivity, and cost to the criminal justice system. We measure numbers like this for other illnesses, too, and the cost for substance abuse disorders far exceeds the cost of diabetes.

On shifting views of substance disorders

For far too long people have thought about substance abuse disorders as a disease of choice, a character flaw or a moral failing. We underestimated how exposure to addictive substances can lead to full blown addiction.

Opioids are a good example.

Now we understand that these disorders actually change the circuitry in your brain. They affect your ability to make decisions, and change your reward system and your stress response. That tells us that addiction is a chronic disease of the brain, and we need to treat it with the same urgency and compassion that we do with any other illness.

The opioid crisis has certainly received a lot of attention, and it is certainly tearing apart families and costing us in terms of lives lost and health care dollars. But in terms of actual cost, we lose the most lives and suffer the most costs from alcohol related disorders and alcohol related addiction. In 2015, about 66 million people reported that they'd engaged in at least one episode of binge drinking in the previous month. That's a pretty astounding number. And in 2015, roughly 28 million people reported that they had driven under the influence of drugs and alcohol.

On what we can do to curb the addiction epidemic

There are prevention strategies and treatment strategies that can address multiple substance use disorders. Some of these programs are school-based, college-campus-based, and community-based, some online and some in person. Many — particularly the school-based programs — teach children how to manage stress in a healthy way, because stress is one of the reasons people turn to substances like alcohol, illicit drugs and prescription painkillers. The programs also teach them about substances of misuse, and teach them how to refuse tobacco and alcohol and other illicit substances when they're offered.

The problem that we have right now is that we're not implementing many of these evidence-based interventions.

While we're calling people's attention to some pretty stark statistics, I also want to recognize that there are reasons to be hopeful. All across our country we have examples of communities that are starting to step up and implement prevention programs and treatment programs. And peoples' lives are changing as a result of that. We've been dealing with substance disorders for centuries. What's different now is that we have solutions that work.

On continuing this work under the Trump administration

People on both sides of the aisle state clearly and in unequivocal terms that substance use disorders are a problem that we have to address now, because they are tearing apart our communities. So I am hopeful that we are all on the same page when it comes to addressing this crisis — and addressing it urgently. I'm looking forward to working with the next administration to do so.

Copyright 2016 NPR. To see more, visit NPR.
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A Growing Group Of Doctors Are Big-Money Prescribers In Medicare

Thu, 11/17/2016 - 5:00am
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The number of doctors who each prescribe millions of dollars of medications annually in Medicare's drug program has soared, driven by expensive hepatitis C treatments and rising drug prices overall, federal data obtained by ProPublica show.

The number of providers who topped the $5 million mark for prescriptions increased more than tenfold, from 41 in 2011 to 514 in 2015. The number of prescribers — mostly physicians but also nurse practitioners — exceeding $10 million in drug costs jumped from two to 70 over the same time period, according to the data.

Most of the doctors atop the spending list prescribed Harvoni or Sovaldi, relatively new drugs that cure hepatitis C. Other providers on the list prescribed pricey drugs to treat cancer, multiple sclerosis and rheumatoid arthritis.

Medicare's drug program, known as Part D, covers more than 41 million seniors and disabled people. In 2015, it accounted for $137.4 billion in drug spending, before factoring in rebates from drug companies. That was up from $121.5 billion a year earlier.

"The trends in this space are troubling and don't show any signs of abating," said Tim Gronniger, deputy chief of staff at the Centers for Medicare and Medicaid Services, the federal agency that runs Medicare. "It's going to be a pressure point for patients and the program for the foreseeable future."

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During the recent presidential campaign, both Hillary Clinton and Donald Trump pledged to tackle the rising costs of prescription drugs. Since his election, however, President-elect Trump's transition agenda for health care hasn't featured the topic, a shift The Los Angeles Times reported.

Medicare has released top-level data on drug spending for 2015, including the number of doctors who prescribed medications worth more than $1 million. But the agency has only published data on individual doctors up to 2014.

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Dr. Ben Thrower, medical director of the Multiple Sclerosis Institute at the Shepherd Center in Atlanta, was near the top of the list in 2014. He prescribed medications costing $11.5 million that year, mostly for multiple sclerosis drugs. "We get that it's very expensive," Thrower said. "I think all the MS providers working in the U.S. would like to see the costs go down."

But prices have climbed steadily in recent years for drugs used to treat the neurological condition, including medicines that have been on the market for quite a while.

Most of the spending on Thrower's prescriptions — $8.5 million — was for MS drugs Tecfidera and Copaxone, which can slow progression of the neurological disease and reduce the chance of relapse. Thrower has received payments from the makers of those and other MS drugs, but said he cut ties with the companies in January of this year.

"It was kind of exciting when the first one came out," Thrower said. "The problem we've seen is the cost for these drugs has just gone up and up and up."

Thrower said he no longer prescribes Tecfidera to new patients because it can lower white blood cell counts, putting them at risk for infections.

Just because a doctor prescribes costly drugs doesn't mean he or she has done anything wrong, Gronniger said. "It's much more about drug pricing ... than it is about the behavior of any individual physician, many of whom are equally concerned about the price of these products as we are."

Today, ProPublica is updating its Prescriber Checkup online tool, which allows you to look up your doctor and see how his or her prescribing in Medicare Part D compares to others in the same specialty and state. Our tool covers the year 2014. You can compare the percentage of each doctor's prescriptions that were for brand-name medications, the average cost per prescription and the average number of prescriptions per patient, among other things.

Allyson Funk, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, an industry trade group, said Medicare's figures leave out important context.

"It is important to note physicians' prescribing patterns are dynamic and based on individual patient needs," she said in a statement. "When looking at Medicare Part D, government data on spending at the point of sale does not include the substantial rebates for brand name medicines negotiated between manufacturers and plans and therefore does not accurately reflect actual prescribing dollars or program spending."

These rebates are confidential by law, but Medicare said this week that the average rebate for brand-name drugs in 2014 was 17.5 percent.

The new data on high-spending prescribers is the latest indication of the burden of drug prices on government health programs.

In the past couple years, Medicare's drug tab has surged, in large part because it picks up the vast majority of the cost of drugs once enrollees exceed a certain threshold each year. In 2015, beneficiaries over the limit, which was $4,700, spent $51.3 billion on drugs. In 2013, the figure was $27.7 billion, government data shows. (Taxpayers, through Medicare, pick up 80 percent of the cost of this so-called catastrophic benefit.) The Associated Press first reported the ballooning cost in July.

Another sign could be seen in a drug dashboard released by Medicare this week. It showed that 1 percent of drugs prescribed in the Part D program accounted for more than one-third of the program's cost in 2015 (before rebates). Some drugs were incredibly expensive. The drug H.P. Acthar Gel, used to treat several conditions, such as multiple sclerosis relapses and a rare kidney disease, cost an average of $162,371 for each of its 3,104 users—a higher per-user cost than any other drug in the program. That's up significantly from several years ago, when ProPublica flagged the drug's expense.

Gilead Sciences' Harvoni can cure hepatitis C, but the drug costs a fortune.

Lloyd Fox/Baltimore Sun/TNS via Getty Images

Harvoni, used by more than 75,000 people, cost an average of $92,847 per person, for a total cost of $7 billion (also before any rebates).

Michael Chernew, a professor of health care policy and director of the Healthcare Markets and Regulation Lab at Harvard Medical School, said the number of high-dollar prescribers in Medicare doesn't surprise him. Given the increased cost of prescription drugs and the latest treatment advances, "the entire distribution is shifting to the right."

Chernew said that, in the long term, Medicare and insurance companies have to examine the total cost of caring for patients with certain diseases, taking into account drugs, hospital visits, medical tests and more. Only then can anyone tell if certain expenses, such as a pricey new drug, are justified.

For now, he said, "How do we know what's good or bad?"

Physicians say their top priority must be the patients in front of them, not the costs to the system.

Dr. Bruce Bacon, a liver specialist at St. Louis University, had the highest total Part D drug costs in 2014, $22.7 million. He was a frequent prescriber of Sovaldi and Olysio, another expensive hepatitis C medication.

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Bacon didn't return a call for comment for this story. In a 2015 interview, he said he did not realize his prescriptions were so costly to Medicare.

"I really don't think about the cost," he said. "I think about taking care of the patients. Should I not take care of the patients because the cost is expensive?"

Thrower, the multiple sclerosis specialist, said the high cost of drugs frustrates him and his colleagues, but ultimately the successful treatment of patients comes first.

"On one hand, we get that," he said. "On the other hand, when you're sitting in the exam room and looking someone in the eye, you can't say, 'I'm not going to treat you because of the cost.' "

ProPublica is a nonprofit investigative reporting newsroom based in New York.

Copyright 2016 ProPublica. To see more, visit ProPublica.
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Bellevue Hospital Pioneered Care For Presidents And Paupers

Wed, 11/16/2016 - 4:37pm
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November 16, 20164:37 PM ET Heard on All Things Considered

Opened in 1816 on the old Bel-Vue estate bordering the East River, the so-called Bellevue Establishment was the largest and most expensive building project in the city's history to date, containing an almshouse, an orphanage, a lunatic asylum, a prison and an infirmary. An infectious disease hospital would be added in 1826.

Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday

When he was growing up in New York, All Things Considered host Robert Siegel always knew that Bellevue Hospital was a city institution.

But it wasn't until he read David Oshinsky's book Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital, that he realized the hospital was a pioneering institution for all of American medicine.

The hospital, which grew out of an almshouse founded in 1736, has been in the forefront of many innovations in medicine in the U.S. Advances that started at Bellevue included ambulances, a maternity ward, nursing school, a children's clinic and forensic pathology.

Siegal talked with Oshinsky, a professor of history at New York University, about the hospital and how it reflects the advances and failures of medicine. The interview has been edited for length and clarity.

In 1876, O.G. Mason, Bellevue's official photographer, took a carefully staged photograph of a blood transfusion in progress.

Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday

On Bellevue's origins in colonial New York

Bellevue's first class of interns, top, circa 1856. At bottom, America's first professional nursing school opened at Bellevue in 1873. Preferring single, literate, religious women from cultivated families, it rejected most applicants on account of "bad breeding."

Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday; Courtesy of Bellevue Hospital Center Archive/Doubleday

Bellevue in the 18th century was really both a poorhouse and a pest house. It was a place you came to die. It really began with the great yellow fever epidemics of the 1790s. At that time the Bel-Vue estate, which became the hospital, was located on the East River, about two miles away from where most of New York was located down by the Battery. And you would send people who really had no chance of recovering.

On hospitals not being very good at saving lives in the first half of Bellevue's history

Most physicians at Bellevue and elsewhere believed in the miasma theory — that clouds of bad air caused all kinds of disease. They had no concept that an invisible organism could cause so much damage, and that was what germ theory was about. Belluevue physicians were really on the forefront, particiularly the younger physicians, in pushing germ theory forward.

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You also had a hospital where there was no anesthesia until the 1840s, and once anesthesia comes, postoperative infections are still extraordinarily high. It's only when you have professional nursing and germ care and the coming of X-ray machines and the kind of pathology where you can actually do lab work within a hospital that makes a hospital better at saving a person's life.

Applying the lessons he learned as a medical administrator in the Civil War, Edward Dalton organized the nation's first civilian ambulance corps at Bellevue in 1869. Here, a Bellevue ambulance surgeon provides assistance to an injured New Yorker.

Courtesy of the Lillian and Clarence de la Chapelle Medical Archives at NYU/Doubleday

On Bellevue doctors who treated two presidents — James Garfield and Grover Cleveland — with very different outcomes

Garfield was hit by two bullets, neither of which was fatal, but the lead surgeon was Frank Hamilton from Bellevue. And Hamilton came down to Washington and he put his finger into Garfield's wound, and put dirty probes into Garfield's wound. He didn't die from the bullets, he died of the kind of infection was brought about by physicians who didn't believe in germ theory.

About 15 or 20 years later, Grover Cleveland had a mass in his mouth which turned out to be cancerous. It was during the Great Panic of 1893, a serious economic depression. Cleveland did not want to alert his critics. So they hired a yacht with a number of Bellevue surgeons and physicians. They sailed up the East River to a very, very calm piece of water and they removed this mass from Cleveland's mouth in a one and a half hour operation using every imaginable antiseptic technique available. Cleveland survived the operation and died of a heart attack many, many years later.

During the 1918-19 influenza pandemic, which killed upwards of 50 million people worldwide, patients at Bellevue slept in corridors, closets, and on beds of straw on the floors. No one was turned away.

Courtesy of Bellevue Hospital Center Archive/Doubleday

How Bellevue's response to AIDS epitomizes its ethos

Because it was the place that turned no one away, it dealt with anything that came through New York City: cholera with the Irish in the 1930s, tuberculosis with the Jews and the Italians about the turn of the century, the great influenza epidemics. Bellevue treated more AIDS patients than any hospital in the country, and more AIDS patients died at Bellevue than at any hospital in the country. Bellevue was really in crisis mode at that time.

AIDS was one of the big issues at Bellevue and hospitals across the country. Doctors were wary. There were studies done where even a percentage of young interns thought they had the right to determine whether they would treat these patients or not. In the end, and this is the important point, Bellevue prevailed. The Bellevue message prevailed. The ethos that we treat everybody, regardless of their disease, regardless of their social standing. And they did. And I think that people look back at that era with great pride.

Copyright 2016 NPR. To see more, visit NPR.
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Want To Prevent The Flu? Skip The Supplements, Eat Your Veggies

Wed, 11/16/2016 - 12:02pm

Eating healthy will do more for your immune system than megadoses of supplements.

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Flu season is upon us, which means it's time for the wave of advertisements promoting $8 juices or even more expensive supplements to "boost your immunity" or "support immune function."

But those are marketing terms, not scientific ones. And there's no proof that those products are going to keep you from getting sick.

When you're exposed to a virus like the influenza virus, a number of factors determine whether you actually get sick, and if so, how severely. One is pre-existing immunity, either from being previously exposed to a similar strain or through a vaccine, says Gregory Poland, a spokesman for the Infectious Diseases Society of America and a professor of medicine at the Mayo Clinic. Just last week, a paper published in Science reported that the flu strain you were first exposed to can affect your protection against new strains that jump from animals to humans.

Your immune status also matters; people who have untreated HIV or have recently received a bone marrow transplant, for example, cannot fight off infections like healthier people can.

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Age, too, is a factor, with the very young and the very old suffering worse bouts of the flu.

And yes, what you eat does matter. "We know for a healthy immune system you need a healthy diet," says Joan Salge Blake, a registered dietitian nutritionist and clinical associate professor at Boston University. You need protein as well as micronutrients including vitamins C, A, and E and zinc, she says.

The ideal way to get those nutrients, however, is to eat a healthful, varied diet, including sufficient protein and a variety of fruits and vegetables, says Poland. If you're already doing that, it's unlikely that you have major nutritional deficiencies. One exception is vitamin D, which is necessary for bone health and can be hard to get from food alone, though there's not a consensus on the cutoff for a vitamin D deficiency.

Even those who aren't eating the most healthful diet (i.e. most of us) are likely getting a lot of nutrients through fortified packaged foods like cereal. Nutrient deficiency does happen, but it's relatively uncommon in the U.S. According to the Centers for Disease Control, less than 10 percent of the population is deficient in micronutrients, though Poland says certain groups of people are at risk, including vegans who are not careful about their food choices and older people who eat scant, unvaried diets.

"If you are malnourished, your immune system is going to suffer," says Salge Blake.

If you are not nutrient deficient or malnourished, though, taking megadoses of vitamins is not going to supercharge your immune system or prevent you from catching the flu or other respiratory viruses. Vitamin C, often touted as a way to stay healthy in the winter, doesn't seem to reduce the incidence of colds, though there is some evidence it may cut their duration and it might be helpful for people who experience short periods of heavy physical activity, according to a 2013 Cochrane review.

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Juices sound attractive; after all, they are made from real foods. But Salge Blake says the best way to get the nutrients supplied by fruits and vegetables is to actually eat the fruits and vegetables themselves. That way you get the fiber, which slows the absorption of natural sugars and carries its own health benefits.

Drinking juices also makes it easy to consume too many calories, and obesity suppresses immune function.

What can the average person do who wants to make sure their immune system is as healthy as possible? In addition to a healthful diet and sufficient sleep, Poland recommends exercise, staying up to date on flu and pertussis vaccinations, staying away from people who are obviously sick, and washing your hands.

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She's on Twitter: @katherinehobson.

Copyright 2016 NPR. To see more, visit NPR.
Categories: NPR Blogs

To Get Disability Help In Kansas, Thousands Face A 7-Year Wait

Wed, 11/16/2016 - 10:04am

Nick Fugate (center) with his parents, Julie and Ron, has been adjusting to life on Kansas' waiting list to get life-assistance services through Medicaid.

Alex Smith/KCUR

For 22 years, Nick Fugate washed dishes at a local hotel near his home in Olathe, Kan.

"There was nothing easy," he says, and chuckles. "I just constantly had to scrape the dishes off to get them clean."

Fugate recalls minor annoyances like the long days and the hot kitchen. The work did sometimes get tedious, he says, but he didn't really mind.

"Just as long as I got the job done, it was fine," he says.

Nick's father, Ron Fugate, says the job was the key to the self-reliance he's wanted for his son ever since Nick was born with an intellectual disability 42 years ago.

"From our perspective," Ron says, "having a job, being independent, participating in the community, paying taxes, being a good citizen — that's a dream parents have for their children in general."

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But things got tough last year when Nick lost his job and his health insurance. For the first time, he enrolled in Medicaid. He got his basic medical care covered right away, but in Kansas, there's now a long waitlist — a 7-year wait — for people with intellectual disabilities to get the services they need. Decades ago, Fugate might have been institutionalized, but Medicaid now provides services to help people remain independent — including job coaching, help buying groceries, food preparation and transportation. These are the services Nick is eligible for but must wait to receive through Medicaid.

In the months since losing his employment, Nick has had to pay around $1,000 a month out of pocket for help buying groceries, career coaching and transportation. Those expenses are quickly burning through his life savings.

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This year, families like the Fugates have been speaking out about that long waitlist and about other Medicaid problems at public forums like one held at the Jack Reardon Convention Center, in Kansas City, Kan., in May.

In a basement meeting room hundreds of people with disabilities, their families and caseworkers railed against KanCare — the state Medicaid program. Some even heckled the moderator. The state has been gathering feedback because it needs the federal government's permission to continue running KanCare.

In 2013 Republican Gov. Sam Brownback put KanCare under the management of three private companies that promised to improve services, cut waste and save enough money to end the long waits for the kind of services Nick needs.

Two-and-a-half years later, many families say they've seen few signs of improvement, especially in terms of shortening the waitlist. In fact, it's actually grown by a few hundred names to about 3,500. And, except in emergency situations, the wait to get treatment averages seven years.

But an end is in view, insists Brandt Haehn, commissioner for Home and Community Based Services, part of the agency that oversees KanCare.

"I think everybody in the system is doing the best job they can do to provide the people services," Haehn says.

In August, the department announced it had eliminated a different waiting list — the one for getting physical disability services. That claim has been challenged by advocates, who say many people were dropped from the list without notice.

But state officials say the progress that's been made in speeding up the start of services for KanCare applicants who have physical disabilities demonstrates that the agency can get results.

Haehn does acknowledge that cases like Nick Fugate's, of developmental disability, are more expensive and complicated than physical disability cases. It will take time, he says, to come up with $1.5 billion — the state's share of a $2.6 billion program — that's needed to make sure that, at least through 2025, everyone qualified for these important services can get them without having to wait.

"Nothing would make me happier than to write a check and give all these people services, but that's just not reality," Haehn says. "So I have to deal with what reality is and try to use the money that I have to effect positive change in the most people."

But Ron Fugate says KanCare had its chance. "We're not treading water, we're drowning," he says. Families like his are quickly losing lifelong savings, he says, and their life situations are getting worse while they wait for the state to provide services.

"It's not getting any better," he says. "We've got to start taking some serious action on this and get it addressed. We've kicked the can down the road too long."

The U.S. Department of Justice is investigating the waiting lists, although it declined to comment for this story.

The ability of the state of Kansas to act may be limited. Gov. Brownback's tax cuts, which he initiated to boost the economy, have instead blown a hole in the state's budget, leaving little money to apply to something like reducing the length of the KanCare waitlist.

Meanwhile, Ron Fugate and other advocates have been studying the ways Missouri recently eliminated its waiting list for similar services, in hopes of persuading Kansas legislators to adopt the same strategy.

Ron and his wife are both in their 70s, and say they're now watching their carefully laid plans for their son's future slip away.

"After 22 years, it looked like he was going to be able to complete a career," Ron says, "and it didn't happen that way. All of this comes at a time in our lives where we're in the waning seasons. We did not anticipate this kind of a challenge at this point."

Kansas submits its application the federal government to reauthorize KanCare this month.

This story is part of NPR's reporting partnership with KCUR and Kaiser Health News.

Copyright 2016 KCUR-FM. To see more, visit KCUR-FM.
Categories: NPR Blogs

Biomedical Researchers Ponder Future After Trump Election

Tue, 11/15/2016 - 3:22pm

The federal government spends more than $30 billion a year to fund the National Institutes of Health. What changes are in store under a new administration?


What could the world of medical research look like under a Trump administration?

It's hardly an idle question.

The federal government spends more than $30 billion a year to fund the National Institutes of Health. That's the single largest chunk of federal research funding spent outside the Pentagon's sphere of influence.

Policy insiders confronted that question — albeit with an acute shortage of actual data — Monday at a meeting of health advocates in New York City.

The biotech and pharmaceutical companies, which are at the end of the drug-development pipeline, see encouraging signs for their enterprises. The stock market didn't swoon. Oft-mentioned tax breaks could conceivably encourage drugmakers that have been harboring hundreds of billions of dollars in profits overseas, to bring some of that money back to the U.S.

And the Trump campaign's anti-regulation rhetoric also rings as good news in the ears of Big Pharma.

Hillary Clinton's campaign to rein in prescription drug prices also looks to be on the ropes, which may be more welcome news for companies than for consumers who have been shocked by rapid price increases.

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At the Partnering for Cures meeting, Kay Holcombe, senior vice president of the Biotechnology Innovation Organization, a trade group, said she hoped Clinton's drug-price campaign would fade. Holcombe told attendees that she prefers "a nonshrieking environment."

What's good for the pharmaceutical and biotech industry may not necessarily appeal to President-elect Donald Trump's supporters, however. It doesn't translate to rapid gains for struggling workers in the Rust Belt.

And there are fewer tea leaves to read when it comes to Trump's support for universities and other government-funded parts of the nation's biomedical enterprise. His campaign said little about research and development in general, or health research in particular.

"The fact that he did not take an ideological position may be a positive thing," said Tanisha Carino, vice president for U.S. public policy at U.K.-based GlaxoSmithKline. Perhaps there's a blank slate that can be influenced by people who care deeply about these issues.

She noted that science is an international endeavor (her company alone operates in 150 countries), and it could be harmed if isolationism were to hit medical research and related industries.

Antibiotic resistance, for example, is a global problem, with drug-resistant germs emerging and spreading all over the world. "We as a country can't solve that," she said.

And Keith Yamamoto, vice chancellor for science policy at the University of California, San Francisco, said he hopes there's an opening to remind the Trump administration and its supporters in Congress that NIH research dollars are spent in their districts and support robust economies.

He also said he'd argue that bolstering basic biomedical research could speed up innovation and reduce the expense of drug development. "Let's get back to the basics," Yamamoto said. "That's the kind of message that I would try to send."

Yamamoto is among a group of prominent scientists who had drawn up policy plans for the next administration. Yamamoto acknowledged that he wasn't exactly expecting to have the conversation with the Trump transition team.

There is at least one person close to Trump who has long been an advocate for a significant cash infusion for medical research: Newt Gingrich. He's on some shortlists for a position that could direct his attention elsewhere. Even so, people at the advocates' meeting in New York nodded in ready agreement when someone suggested that he's one key person to watch.

You can contact Richard Harris with comments:

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A Twist On 'Involuntary Commitment': Some Heroin Users Request It

Tue, 11/15/2016 - 1:16pm
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November 15, 20161:16 PM ET Heard on All Things Considered


A police officer holds a bag of heroin that was confiscated as evidence in Gloucester, Mass., in March. Massachusetts is one of 38 states that allow civil commitment for substance abuse.

John Moore/Getty Images

Inpatient treatment programs for heroin and opioid dependence can be so difficult to get into in some parts of the country that drug users who want to quit are voluntarily asking judges to lock them up — just to guarantee they'll get help.

In Massachusetts, that's happening via a 46-year-old law that was designed for family members to commit their loved ones to a locked facility when they are deemed "a danger to themselves or others" because of drug or alcohol abuse. But as more people struggling with addiction are actually requesting this sort of lockup, some are questioning whether "voluntary" court-ordered commitment for treatment of substance abuse is a good idea.

On a bench outside a Springfield, Mass., courtroom recently, a 33-year-old man looked more alert than you might expect for someone coming off a heroin binge. He'd previously been clean for two months, he said, but couldn't maintain it.

"Now I'm probably doing two bags," he said, "and it's getting me high as a kite." He still very much wants to quit, he said. NPR agreed not to disclose his name.

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The man said he has been spending $1,000 a week on heroin, scaring his family and scaring himself. They're all worried he'll overdose. That's why, even though it would mean giving up his liberty for up to 90 days, he was in court that day to ask the judge to lock him away — inside a treatment program that he wouldn't be allowed to leave, far away from his dealers.

"If I don't do this, I'm going to lose my freedom eventually anyway," he explained. "Eventually, I'm going to get enough charges to the point where I go to jail anyway."

Massachusetts is one of 38 states that allow civil commitment for substance abuse.

"Basically, it's a good way to get clean," the heroin user in Springfield explained. "Because, if you try getting into these five- or six-day [detoxification programs], it takes forever. It takes a month to get into the place, and if you don't have the right insurance, they don't want you."

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Officially, under the law, you're not allowed to ask for your own commitment. Someone else — a close relative, a probation officer or emergency room doctor, for example — must petition the court on your behalf. But if you agree not to oppose that sort of petition, the judge is likely to approve it.

In the Springfield courtroom of Judge Michele Ouimet-Rooke, that day, the man requesting to be committed stood tall, respectful of the judge.

His sister was the official petitioner. A forensic psychologist testified that the man was, indeed, a danger to himself and others because of his heroin use. Then his attorney spoke.

"My client is in agreement to go to the treatment program in Brockton," Maria Puppolo told the judge. That facility is the Men's Addiction Treatment Center in Brockton, Mass., a locked-down, privately run intervention program, exclusively for men who have been mandated to go there by the civil courts.

"He understands the seriousness of his addiction and he wants to get the help," the attorney added.

The judge agreed.

"Very good, sir," Ouimet-Rooke said. "I do find there is a basis for the commitment."

As a court officer led the man away in handcuffs, the man smiled at his family and looked relieved. That same afternoon, the judge committed three other heroin users to detox programs, all of them willing.

In most such cases, these drug users hope to be assigned to a privately run treatment center like the one in Brockton. But if there's no room there, some men will end up at a more bare-bones program at the state prison. (Women who are committed to mandatory treatment in these civil proceedings in Massachusetts go exclusively to privately run treatment centers.)

This year, about 8,000 people will be committed to substance abuse treatment in Massachusetts, officials estimate — that's up 40 percent from five years ago. It's not clear how many of those commitments are voluntary.

Jennifer Flanagan, a Democrat and Massachusetts state senator representing Worcester and Middlesex, led an investigation in 2014 into this trend — partly to understand why people addicted to drugs were trying to get committed. She says she found that many just couldn't find or afford treatment outside the courts.

"If you're an addict and you finally decide, 'Today is the day I want to go,' you may not necessarily go through the hassle of calling every place and trying to get a bed, and calling your insurance company," Flanagan says. It some ways it's easier just to ask a judge for voluntary commitment, she says, "because you're mandated a bed."

That's a bed in an inpatient program that the state has to pay for if insurance doesn't — and the length of treatment is often longer than most insurance policies would cover. While Flanagan calls that a "misuse of the system," others say that's what the system is for.

Judge William Mazanec III presides over the Greenfield District Court in Greenfield, Mass. He considers it part of his job to help some people who have become physically and emotionally dependent on opioids — people who see the courts as their last resort in being able to quit the drugs.

"They're asking for me to use that process to force them into a situation where they can't just walk out of treatment," Mazanec said. "You have a window of opportunity where they're recognizing this. You have to act quickly."

Still, the process doesn't always run smoothly. Sometimes drug users want to find out where they're likely to be sent — a private treatment center or a prison program — before agreeing to go. If it's prison, because there aren't enough beds open at the private center, some try to stop the commitment process after it starts.

That puts court officials in a bind — and frustrates some state officials, including Flanagan.

The law was designed, Flanagan said, "to get someone out of imminent danger. If you're in danger, you're in danger."

In the past year, more detox inpatient facilities have opened across Massachusetts, and that may reduce the requests for civil commitment. But advocates for people battling substance abuse say that until someone can reliably pick up the phone and get help right away, the courts will remain a key part of the treatment chain.

Copyright 2016 WFCR-FM. To see more, visit WFCR-FM.
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GOP Health Insurance Alternatives May Wind Up Using Penalties Like The Mandate

Tue, 11/15/2016 - 11:32am

To keep health insurance solvent, the pool of covered people needs to include the well and the sick.

Gary Waters/Ikon Images/Getty Images

The Affordable Care Act's requirement that people have health insurance or pay a fine is one of the least popular provisions of the law, and one that Republicans have pledged to eliminate when they repeal and replace Obamacare.

But take a look at some of the replacement proposals that are floating around and it becomes clear that the "individual mandate," as it's called, could still exist, but in another guise.

First, though, the health law's mandate doesn't actually require people to have insurance. Instead, it imposes a tax penalty on most people if they don't have coverage. In 2016, the penalty is the greater of $695 per person or 2.5 percent of household income.

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Unpopular as the tax penalty is, it's ultimately what makes possible the very popular provision of the law that prohibits insurers from turning people down for coverage because they have preexisting medical conditions that might make them expensive to insure. The mandate is designed to make sure healthy people buy coverage so that insurers aren't left only with customers who are sick.

President-elect Donald Trump has signaled that he would like to find a way to keep the ban on preexisting conditions. But requiring insurers to accept all comers means they need a way to coax people into buying and keeping insurance before they develop expensive conditions like diabetes or cancer. In other words, they need a mandate.

Health policy wonks point out that the individual mandate was originally a Republican idea, advocated by academics and conservative thinkers as a way to avoid a government-run single-payer system. "The purpose of it was to round up the stragglers who wouldn't be brought in by subsidies," said Mark Pauly, a University of Pennsylvania economist, in a 2011 interview. He co-authored a Health Affairs study in 1991 that aimed to persuade then-President George H.W. Bush to adopt a universal health care requirement.

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The drafters of Obamacare incorporated the individual mandate concept because they hoped to get Republicans on board, said Sara Rosenbaum, a professor of health law and policy at George Washington University in Washington, D.C.

Republicans generally accept that some sort of incentive is necessary to help stabilize the insurance market in whatever system they propose as an alternative to the health law. In a policy paper released last summer, House Speaker Paul Ryan proposed creating a one-time open enrollment period during which people could sign up for coverage regardless of their health. As long they stay enrolled in coverage in the individual or group market, they wouldn't be charged higher rates if they get sick. If they don't sign up during that open enrollment period, though, those protections don't apply, and people could face higher premiums and health care costs if they were to buy insurance.

"It's a soft mandate," said Douglas Holtz-Eakin, president of the American Action Forum, a conservative think tank. "You must get in now to get this treatment."

But health policy analysts say that a one-time open enrollment period, whether it's one month or three months in length, isn't enough.

"Such stringent limits on open enrollment ignore the complexities of individuals' lives," said Linda Blumberg, a senior fellow at the Urban Institute's Health Policy Center. People lose their jobs, get into car accidents, and they may not understand the implications of dropping coverage for a while. "The penalty on these folks would potentially be enormous," she said.

Another option to nudge people to get insurance is to impose a penalty on premiums if they don't sign up at a designated time, for example, when they turn 26 and no longer qualify for their parents' coverage.

This option would be similar to the rules for Medicare Parts B and D that cover outpatient services and prescription drugs, respectively. People who don't sign up for Medicare Part B when they're first eligible, for example, are charged an additional 10 percent of the premium for every year that they could have enrolled but didn't.

But Medicare is different in important ways from the individual insurance market, said Sabrina Corlette, research professor at Georgetown University's Center on Health Insurance Reforms. When people sign up for Medicare, they're generally enrolling for the rest of their lives. In contrast, people may move in and out of the individual market a number of times over their lives as they change jobs or leave the Medicaid program, for example.

"It's much more difficult to determine what their first opportunity to sign up was," Corlette said.

There are ways to get people to sign up using a carrot rather than a stick, including increasing the subsidies people receive for coverage, said Corlette.

But Trump has not yet signaled much about his replacement plan, including the extent to which subsidies or other financial assistance would be available under a new health care program.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter:@mandrews110.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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WATCH: Mantis Shrimp's Incredible Eyesight Yields Clues For Detecting Cancer

Tue, 11/15/2016 - 9:01am
KQED Deep Look YouTube

Mantis shrimp, a group of aggressive, reef-dwelling crustaceans, take more than one first-place ribbon in the animal kingdom. Outwardly, they resemble their somewhat larger lobster cousins, but their colorful shells contain an impressive set of superpowers.

Now, scientists are finding that one of those abilities — incredible eyesight — has implications for people with cancer that are potentially lifesaving.

"They have these ridiculous eyes that sense so many things at once," says Sam Powell, a doctoral student in computer science and engineering at Washington University in St. Louis. "It's been very interesting figuring out what we can do with that, that helps out humans."

Powell is part of a collaborative team of engineers and wildlife biologists, co-led by Viktor Gruev at the University of Illinois at Urbana-Champaign. They're working on a set of imaging technologies inspired by the ability of the mantis shrimp to detect polarized light. With the camera the team is developing, Gruev says, cancer surgeons might one day be able to much more clearly see the margins of the tumors they need to remove.

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Mantis shrimp come in two varieties. There are the "smashers" and the "spearers," named for their attack modes when hunting prey. With their spring-loaded, weaponized legs, these predators can crack a snail shell or harpoon a passing fish in a single punch.

One kind of mantis shrimp impales its prey with legs that have serrated edges.


The speed of these attacks has earned the mantis shrimp a world record: fastest strike in the animal kingdom. At 30 times faster than the blink of an eye, the attack is so swift that it can vaporize nearby water molecules, producing bubbles where no bubbles should be.

The mantis shrimp's powerful punch is aided by its world-class eyesight. Like the eyes of most crustaceans and insects, the mantis shrimp's are made up of thousands of light-trapping facets — picture a fly's eye — known as ommatidia.

What's unique to the mantis shrimp is the way the ommatidia of each eye are divided into three sections, each moving independently. That means mantis shrimp vision is able to triangulate distance using up to six images in the brain.

"That's important for an animal that makes its living smashing and spearing things," says Roy Caldwell, a mantis shrimp specialist in the integrative biology department at the University of California, Berkeley.

But the power of the mantis shrimp eye doesn't end there. Mantis shrimp can perceive an attribute of light that eludes our naked eyes: polarization.

Sunlight is messy — a jumble of wavelengths moving in all directions at once. But some surfaces — say, the scale of a fish, or a pair of polarized sunglasses — have a way of changing the light they reflect or transmit, organizing it so it moves in a single plane.

Mantis shrimp eyes can tell where polarized light is and where it isn't, which helps them detect fish scales, crabs and other prey in seawater.


We humans can't really tell this is happening. But the mantis shrimp eye has extra sensors that let it analyze the angle of the light wave. That means the shrimp is able to make out where in its neighborhood light is being polarized, and where it isn't. So the polarizing surfaces of fish, crabs and other potential prey look more vivid against the less polarized backdrop of water.

This ability to detect and visually capitalize on polarized light "is very common in animals," says Thomas Cronin, a research biologist and professor at the University of Maryland, Baltimore County. "In fact, we're among the few that don't use polarized light very much, if at all."

What's unique to some mantis shrimp is their ability to perceive yet another, much more rare variety of polarized light. This "circular" polarized light moves not in a flat plane, but in a twisted one that spins through space like a helix.

Circular polarized light is part of what makes 3-D glasses and DVD technology work. Mantis shrimp not only see this kind of polarization, they broadcast it. Parts of the male's body function as a circular-polarizing surface, flashing a secret code that's only visible within the species.

"It gives them an incredibly private channel of communication that no other animal can see," says Caldwell.

Males display these body parts during courtship to attract females. Other research has shown that adult males flash their polarizing parts to alert other males to their presence inside a burrow, a warning that the homeowner is armed and dangerous.

A male mantis shrimp reflects a particular type of polarized light from the surface of parts of its body. That reflected light serves as a secret signal that only other shrimp can see.


Inspired by the mantis shrimp's superlative eyesight, the group of researchers are collaborating to build polarization cameras that could be used to help diagnose and remove cancerous tumors.

Doctors have long known that, at the cellular level, fast-growing cancer cells are disorganized in comparison with healthy cells. Because of the structural differences, it turns out, some diseased tissues also reflect polarized light differently from healthy tissue.

These differences can show up early with cancer — before other symptoms or signs.

"Looking at nature can help us design better and more sensitive imaging techniques," Gruev says. His team's cameras, which are small enough for endoscopic use, can see polarization patterns on the surfaces of human and animal tissue.

In one study, Gruev and his team tested their polarization cameras in mice, looking for signs of colon cancer. Traditional colonoscopy techniques employ black-and-white images to look for abnormal shapes, such as polyps. But sometimes, cancerous tissue in the colon is flat, blending in with healthy tissue.

Gruev's camera, in contrast, successfully converted polarization data into color images in real time in the mice studies, revealing where the healthy tissue ended and the diseased tissue began.

Interestingly, different types of cancer cells have different polarization signatures, Gruev says, while healthy tissues have a consistent profile.

"The polarization structure makes the cancer apparent," he says. Clinical trials with human breast cancer patients are now underway.

At this point, doctors have no way to confirm during the operation that they've completely removed a tumor. One day, Gruev believes, polarization imaging will be part of every surgical oncologist's toolkit, bringing the power of a mantis shrimp's eye to the operating room.

"It's kind of the cancer moonshot," Gruev says of his hopes for the diagnostic technology. "Right now, we are still detecting cancer way too late in the game."

This post and video were produced by our friends at Deep Look, a wildlife video series from KQED and PBS Digital Studios that explores "the unseen at the very edge of our visible world." KQED's Elliott Kennerson is a digital media producer for the series.

Copyright 2016 KQED Public Media. To see more, visit KQED Public Media.
Categories: NPR Blogs

Spanking Young Children Declines Overall But Persists In Poorer Households

Mon, 11/14/2016 - 3:44pm
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November 14, 20163:44 PM ET Heard on All Things Considered

He's more likely to get a timeout than a spanking.

narvikk/Getty Images

The share of U.S. mothers who spank their young children or endorse physical discipline has declined significantly over the past two and a half decades, according to an analysis of four national surveys.

The findings, out Monday in the journal Pediatrics, came from an analysis of data from 1988 to 2011. Researcher found that 21 percent of median-income mothers of kindergarten-aged children endorsed physical discipline at the end of that period — down from 46 percent at the start.

"There's been a substantial decrease in the share of parents who are reporting having spanked their child in the last week," says Rebecca Ryan, a psychologist at Georgetown University who led the analysis. "And there's a been substantial decrease in the share of parents who say they would spank or hit their child in response to misbehavior."

In a surprise, the drop in spanking occurred regardless of family income. "We're the first to report that across all income levels there's been this big reduction," Ryan says.

For example, about 40 percent of the most affluent parents reported they would use physical punishment in 1988. In 2011, that dropped to 12 percent. Among the poorest mothers, about half of parents endorsed physical punishment in 1988, compared to 30 percent in 2011.

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"In could be that parents are realizing that physical discipline may be less effective than some of the alternatives," Ryan says.

In fact, the proportion of mothers endorsing nonphysical forms of discipline, such as timeouts, increased during the same period, the researchers found.

In 1988, about half of the most affluent parents said they would use timeouts. That increased to 85 percent in 2011. Among the poorest mothers, only 45 percent said they would use time-out in 1988. That rose to 71 percent by 2011.

"These are really big increases," Ryan says. "The majority of parents now are reporting that they are using alternatives to physical discipline like timeouts where it was the minority in 1988."

The finding are being welcomed by researchers.

"I think it's good news for the families of America," says Heidi Feldman, a developmental pediatrician at Stanford University. She wrote a commentary accompanying the study.

Research has shown that nonphysical forms of discipline are more effective, she says. "Nonphysical forms of discipline can actually teach children what they need to understand to be better children and students and citizens eventually," she says.

In contrast, physical discipline like spanking encourages children to be violent, she says. But Feldman noted spanking still remains too common, especially among the lower-income parents.

Ryan acknowledged that one possible shortcoming of her study is that it relies on parents admitting that they spank their children. But she noted that reports of child abuse also fell during this period, making her more confident in the findings.

"Spanking is not the same as physical abuse, but the reduction in official physical abuse reports suggests the changes in physical discipline endorsement reported here reflect changes in actual behavior," she wrote in an email.

Copyright 2016 NPR. To see more, visit NPR.
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'Minibrains' Could Help Drug Discovery For Zika And For Alzheimer's

Sun, 11/13/2016 - 6:01pm
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November 13, 20166:01 PM ET Heard on Morning Edition

This image is from lab-grown brain tissue — a minibrain — infected by Zika virus (white) with neural stem cells in red and neuronal nuclei in green.

Courtesy of Xuyu Qian and Guo-li Ming

Some tiny clusters of brain cells grown in a lab dish are making big news at this week's Society for Neuroscience meeting in San Diego.

Known as "minibrains," these rudimentary networks of cells are small enough to fit on the head of a pin, but already are providing researchers with insights into everything from early brain development to Down syndrome, Alzheimer's and Zika.

At a Sunday press conference at the neuroscience meeting, researchers said minibrains are helping them figure out how the Zika virus can disrupt human brain formation in the early stages of fetal development.

Minibrains are highly organized structures that actually start out as human skin cells. They are then coaxed in the lab to become neural stem cells, then to differentiate into some of the different types of cells found in a real brain.

What makes these lab-grown structures so useful is that they replicate part of the cell diversity and connectivity of the human brain, said Dr. Thomas Hartung, a researcher and experimental toxicologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

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"These cells are communicating," Hartung said. "These neurons are talking to each other."

As a result, the minibrains can help researchers answer questions that couldn't be answered by studying animal brain tissue. "We need human systems to tell us about humans, and that's why this is such a big step forward," Hartung said.

The first minibrains were developed a few years ago by scientists in Europe. Since then, researchers at a handful of institutions around the world have begun cranking out these experimental structures.

At Johns Hopkins, Hongjun Song has been working to streamline the process and make minibrains that are closer to the real thing in the way they respond to viruses, for example.

When I visited Song's lab recently, he took me to a small, windowless room at Hopkins that has a powerful air filtration system, to show me the result of his team's effort. He opened an incubator the size of a dorm fridge and pointed to a device inside that was only slightly larger than a cell phone.

The device contains a complete factory for these organoids, he said; the system was built by three high school interns using a 3-D printer.

The lower half looks like a miniature muffin pan with a dozen separate compartments. "We can grow up to 10 minibrains in each one," Song said.

The top half resembles a mechanized Lego project. A small motor powers gears connected to a dozen plastic shafts. They gently stir a precise mixture of cells, nutrients, and growth factors in each compartment.

The minibrains that emerge after several months in the incubator are barely big enough to see with the naked eye, said Dr. Guo-Li Ming, a professor of neurology at Hopkins who is married to Song and collaborates with him on this research.

"It's basically like a ball of cells clustering together," she said. "But if you open it up you really see something very similar to the early embryonic brain."

Though it has only a tiny fraction of the number of cells of an actual brain, a minibrain grows much the way a real brain does during early pregnancy. And that has helped researchers solve a medical mystery involving the Zika virus.

When Zika began making headlines last year, scientists suspected the virus could interfere with brain development in the womb. "But you can't study that in a mouse," Ming said, because mice have very few of the developing brain cells that are most vulnerable to Zika infection.

A student suggested that Ming and Song use minibrains to figure out what was happening. So the couple contacted Hengli Tang, a research biologist they knew at Florida State University, who was studying the Zika virus.

That call led to studies of minibrains that showed precisely how the infection was attacking certain neural cells, especially at a point in development equivalent to the first trimester of pregnancy. "It was turning [these cells] into a viral factory," Song said.

As a result, the minibrains infected with the virus early in their development actually decreased in size, which may help explain why a human fetus infected with the Zika virus early in pregnancy sometimes develops into a baby with a very small brain.

Members of the Hopkins team are presenting details of their Zika findings this week at the neuroscience meeting, and are already planning minibrain studies of other disorders, including autism, schizophrenia and Alzheimer's.

Elsewhere during the neuroscience meeting, scientists are presenting minibrain research as a model in brain cancer and in developmental disorders, including Down syndrome and Rett syndrome.

Minibrains' greatest potential, though, may be for testing new drugs for brain disorders, Hartung said. Drug testing with animals has often proved misleading because animal brains just aren't like human brains, he explained.

"One company after the other failed on things like stroke, multiple sclerosis, [and] also neurodegenerative diseases like Alzheimer's and Parkinson's," Hartung said.

Those failures involved drugs that worked when tested in animals, but failed on people, Hartung said. So he has begun working with pharmaceutical companies to see whether minibrains might offer a better model.

One obstacle to the widespread use of minibrains in research may be public acceptance of the idea that scientists should be growing "brains" in the lab. But people would be less concerned, Hartung said, if they understood the differences between these very small, lab-grown structures and a real brain.

For one thing, minibrains stop growing when they still have only about 20,000 cells. A human brain has many billions. And these clumps of cells, he explained, have no way of learning or becoming conscious.

Copyright 2016 NPR. To see more, visit NPR.
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Safety Of Painkiller Celebrex Affirmed In New Study

Sun, 11/13/2016 - 4:46pm
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November 13, 20164:46 PM ET Heard on Morning Edition

Pfizer's Celebrex fared well in a safety study that compared the pain reliever with ibuprofen and naproxen.

Daniel Acker/Bloomberg via Getty Images

A large study has produced reassuring evidence about a drug that millions of people use to alleviate pain from arthritis and other ailments.

The study found no evidence that the drug Celebrex, or generically, celecoxib, poses any greater risk for causing heart attacks and strokes than two other widely used pain relievers.

"What we found was surprising," says Steven Nissen, a cardiologist at the Cleveland Clinic who reported the results Sunday at an American Heart Association meeting in New Orleans.

Doctors have been concerned about Celebrex for more than a decade because it is very similar to another pain reliever, Vioxx, which was pulled from the market in 2004 after being linked to heart attacks and strokes.

Celebrex "didn't share the risks that were seen with Vioxx," says Nissen, whose findings were also published online by the New England Journal of Medicine.

Nissen and other heart specialists cautioned that Celebrex can increase the chance of cardiovascular complications. But it doesn't appear to boost those odds nearly as much as Vioxx, or even as much as other painkillers thought to be safer. Both Vioxx and Celebrex are so-called Cox-2 inhibitors, which act by blocking an enzyme involved in inflammation.

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Moreover, the study suggests Celebrex may be less risky than other so-called nonsteroidal anti-inflammatory drugs, or NSAIDs, in other ways. For example, Celebrex appears to pose less of a risk of causing kidney problems.

"It is very reassuring," says Milton Packer, a cardiologist at Baylor University who was not involved in the study. "I think what we'll see is a greater confidence in the use of drugs like Celebrex. I think people will turn to it now more frequently."

But others cautioned that all the drugs tested remain risky, especially for people with heart disease. "It's reassuring that it's not as bad as Vioxx, but it's not a recommendation to take the medication," says Dr. Mary Norine Walsh, the president-elect of the American College of Cardiology.

After Vioxx came on the market in 1999, it quickly became a blockbuster used by millions of people because it was designed to cause fewer gastrointestinal complications than existing NSAIDs.

The Food and Drug Administration allowed continued sales of Celebrex even though it was very similar. But the agency ordered Pfizer Inc., the company marketing Celebrex, to study the drug's safety. In 2005, however, Pfizer withdrew Bextra, another Cox-2 inhibitor, at the FDA's request.

Celebrex is used by an estimated 2 million Americans each year for arthritis, menstrual cramps and other aches and pains.

The new study involved 24,081 patients with osteoarthritis or rheumatoid arthritis. One-third of the patients took Celebrex. One-third took prescription doses of ibuprofen. The remaining third took prescription naproxen.

Ibuprofen is sold over the counter in much lower doses as a generic and under a variety of brand names, including Advil and Motrin. Naproxen, also generic, is sold over the counter with various names, like Aleve and Naprosyn.

Higher, prescription doses of ibuprofen and naproxen were more likely than Celebrex to cause digestive system problems, such as ulcers and bleeding, the researchers found.

Specifically, naproxen had a 1.5 percent risk of gastrointestinal complications, ibuprofen had a 1.6 percent risk, and Celebrex had a 1.1 percent risk in a 30-month period.

That wasn't a surprise. Celebrex and Vioxx were designed to be easier on the digestive system than the existing NSAIDs. But some other risks were surprising, Nissen says.

Compared with Celebrex, patients taking ibuprofen were more likely to experience kidney problems, including kidney failure and the need for dialysis.

Specifically, there was a 1.1 percent risk of kidney complications among those taking ibuprofen for 30 months, versus a 0.7 percent risk among those taking Celebrex and a 0.9 percent risk among those taking naproxen, the researchers report.

All these drugs are known to carry some risks to kidney function, but the risk from ibuprofen was higher than expected, Nissen says.

There was also a hint that naproxen and ibuprofen may pose more of a risk of causing cardiovascular complications that Celebrex. Nissen stresses, however, that that finding was only borderline-statistically significant for ibuprofen.

In addition, there was an even weaker hint that naproxen might increase the risk for death for any reason, compared with Celebrex. But that wasn't statistically significant either.

It means those risks could have been statistical flukes. But they do warrant further investigation, he says.

"What is so surprising about it is that most authorities have believed that if there was a drug that was the safest, it was naproxen," Nissen says. "So we were pretty surprised that there was this borderline significant increase in all-cause mortality with naproxen."

Celebrex turned out to be the least likely of the three drugs to increase the risk for cardiovascular complications. The risk of dying, suffering a stroke or having a heart attack among patients taking Celebrex was 2.3 percent during a 30-month period, compared to 2.5 percent for naproxen and 2.7 percent for ibuprofen.

Nissen stresses that all the patients in the study took doses of these drugs available in the prescription formulation — not the much lower doses most people take when they buy them without a prescription and use them occasionally.

The maximum recommended over-the-counter dose of ibuprofen is typically 1,200 milligrams daily. The study used 600 milligrams of ibuprofen three times a day, or 1,800 milligrams daily. Naproxen tablets are sold over the counter at a dose of 220 milligrams, and are taken twice a day. The study used doses between 375 and 500 milligrams taken twice a day.

"I don't want the public to think that if you take an occasional ibuprofen or naproxen that you're going to have kidney failure or you're going to die," Nissen says. "We didn't study that. We studied daily doses in arthritis patients [taking] ... high doses of these drugs."

But the findings should encourage people who need pain relief to take the lowest dose of the drugs for the shortest time possible.

"If you twist your knee and you hurt, I want people to take medicines for pain relief," Nissen says. "But when they're better, try to get off the drugs and not take them every day and not take them in very high doses."

Other doctors agreed.

"There's probably a risk of all of these drugs, especially at high doses," Packer says. "The question is: If you need these drugs for pain, which is the safest? Right now, based on this study, it appears Celebrex has advantages."

Several experts pointed out that the study has some flaws. The dose of Celebrex tested was relatively low, for example, and a significant number of subjects dropped out of the study, which raises questions about the reliability of the findings.

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DNA Is Not Destiny When It Comes To Heart Risk

Sun, 11/13/2016 - 4:01pm

Yes, getting exercise and eating right can significantly cut your risk of developing heart disease, a study finds, even if you inherited genes that predispose you to the illness.

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You can't choose your parents, so you can't help it if you're born with genes that increase your risk of heart disease. But a study finds that you can reduce that risk greatly with a healthful lifestyle.

Scientists have been wondering whether that's the case. To find out, one international consortium looked at data from four large studies that had isolated genetic risk factors for heart disease.

They identified genetic markers that seem to put people at nearly twice the risk for heart disease.

The scientists then dug further into their data to look at behavior that helps the heart, as well as at the influence of obesity. Specifically, they looked at smoking habits, obesity, diet and exercise. People who were healthy — based on at least three of those criteria — were considered, for the purposes of the study, to be following a healthful lifestyle.

The scientists were pleased to discover that the benefits of those good habits were strong, even for people who carried genetic traits that raised their risk. (Healthful habits actually benefited everyone, regardless of inherited risk.)

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People with unlucky genes, heart-wise, but good health habits were half as likely to develop coronary artery disease as those with unlucky genes and an unhealthful lifestyle, according to the study.

The New England Journal of Medicine published the results online Sunday to coincide with a presentation of the findings at the American Heart Association's scientific sessions in New Orleans.

"At least for heart attack it's pretty clear that DNA is not destiny," senior author Dr. Sekar Kathiresan, who heads the Center for Human Genetic Research at Massachusetts General Hospital, told Shots. "You have pretty good control over your own health."

Kathiresan and colleagues in the United States and Sweden based their conclusion on four big studies, involving more than 55,000 people. Two of those studies have been following people for more than 20 years, including the Atherosclerosis Risk in Communities study in the United States, and a similar study in Sweden.

People with unlucky genes were at about twice the risk of getting heart disease as a group, the scientists found. But those with healthful habits basically cut that risk in half.

Participants in the study who had an increased genetic risk and poor health habits had a 10 percent chance of having a heart attack or similar event over the course of 10 years. And those with unlucky genes and good health habits had a 5 percent chance.

That 5 percent risk was within the same ballpark of many people who had a comparatively good genetic profile, Kathiresan told Shots.

The genetic test of heart risk that the researchers used "is not a test that a physician can order," he said. But materials published online along with the paper identify approximately 50 gene variants that, collectively, increase a person's risk of heart disease. And if you're determined to see how you rank in terms of genetic risk relative to the general population, a test from 23 and Me does scan these genes.

Alternatively, Kathiresan said, you can assume you may have inherited a risk factor for heart disease if a parent or a sibling died young as a result of heart disease.

One limitation of this study, the scientists note, is that most of the participants were white, so the results may not apply to every group. Researchers hope to soon expand their research to include a more racially diverse population.

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Name Of A Vietnam Veteran Killed By Hepatitis C Added To 'The Wall'

Sat, 11/12/2016 - 6:30am

Army Specialist Jim McGough with members of his unit in 1971. Then 19, he was photographed by a columnist from The Des Moines Register.

Gordon Gammack/The Des Moines Register

The Vietnam War ended more than 40 years ago, but it continues to claim military lives. Nearly every spring new names are etched into the black granite walls of the Vietnam Veterans Memorial in Washington, D.C., which pays tribute to the more than 58,000 service members who lost their lives.

Jim McGough is one of them. As a 19-year-old infantry soldier in 1971, Army Specialist McGough was with members of his unit near the Laotian border when came under fire. A grenade exploded nearby, tearing apart his feet and lower legs. McGough was taken by medevac to Okinawa, where he underwent surgery, including a transfusion to replace the blood he had lost. Unable to wear army boots after the injury, he was shipped back to the United States, where he married his high school sweetheart, Sheryl Isaacson. They settled down near their hometown of Fort Dodge, Iowa.

Twenty years passed before McGough, who worked in magazine advertising sales, learned that he had hepatitis C, a bloodborne viral infection that attacks the liver and can cause scarring, called cirrhosis, as well as liver cancer. The virus only was discovered in 1989, and routine testing of the blood supply began shortly afterward. It was about that time that McGough, a regular blood donor, learned he had been infected. He'd never used intravenous drug or gotten tattoos — common routes of infection — so the McGoughs figured Jim must have contracted the virus when he had the blood transfusion in Japan.

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Veterans are more than twice as likely to have hepatitis C as members of the general population, studies have found. The virus is significantly more common among Vietnam era veterans than those of any other service era.

McGough went to a liver specialist, who found no damage. The standard treatment at the time, a combination of the drugs interferon and ribavirin, had debilitating side effects. So Jim and Sheryl decided not to do anything about his infection.

"We were having a great time," says Sheryl, now 62. "We're going, 'No big deal.' When you're young, you're invincible."

But in his late 40s, Jim started to show signs of liver damage. About that time, he and Sheryl took a trip to the nation's capital, and visited the Vietnam Veterans Memorial. He thought it was magnificent, Sheryl remembers, and told her, "If this thing kills me, I want to get my name added."

McGough on a visit to the Vietnam Veterans Memorial, in Washington, D.C., when he was in his late 40s. McGough died in 2014 of liver cancer that doctors traced to a hepatitis C infection he'd contracted from a blood transfusion during his military service in the Vietnam War.

Courtesy of Sheryl Issacson McGough

In January 2014, the virus did kill him. Jim had gone through the interferon treatment by then, but couldn't shake the disease. He finally succumbed to liver cancer.

In order to have their names added to "The Wall," Vietnam veterans must meet criteria established by the Department of Defense. Many of the 376 names that have been added since the memorial was completed in 1982 are people who died during the war or shortly afterward but whose records were misplaced, for example, or who were overlooked for other reasons. Their deaths generally must be the result of injuries sustained during the war in Vietnam or a defined combat zone. A number of causes of death don't qualify, including exposure to the defoliant Agent Orange or similar chemicals, illness or suicide related to post-traumatic stress disorder, diabetes, cancer and heart attack.

"They reject far more than they accept," says Tim Tetz, director of outreach for the Vietnam Veterans Memorial Fund, which founded the memorial and is responsible for adding new names to it.

In McGough's case, at the bottom of a box in the family's basement, Jim and Sheryl found a handwritten note from a nurse in Okinawa, ordering a blood transfusion for Jim the day after he was wounded. That was the documentation they needed to prove his disease was service-related, so he could qualify for veteran's disability benefits. Eventually, after a lengthy application and evaluation, the approval to add McGough's name to the memorial was granted.

In addition to Jim McGough, seven names were inscribed in 2016. There's not much room left to add more names, Tetz says, at least not long ones. There's space for one more long name, he says, fewer than 20 medium-length names and many more short ones. It's an issue that the National Park Service is wrestling with, according to Tetz.

In 2013, the first of a number of pricey new drugs was approved by the Food and Drug Administration that cure hepatitis C in as little as eight weeks with relatively few side effects. Yet the price tags for a course of treatment, which can exceed $84,000 created financial challenges for programs like the Veterans Health Administration.

Jim and his wife Sheryl Isaacson McGough, on their 40th wedding anniversary in 2012.

Courtesy of Sheryl Issacson McGough

After additional financial support from Congress, the VHA has been able to treat many more veterans; the number of those who are eligible and still waiting for treatment has dropped in the past year from 145,000 to 71,000, says Dr. David Ross, director of the HIV, Hepatitis, and Public Health Pathogens Programs at Department of Veterans Affairs.

It was all too late for McGough, though, who died just weeks before the first of these drugs came on the market.

"I can hardly bear to watch those commercials," said Sheryl Isaacson McGough. "It's just heartbreaking."

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter:@mandrews110.

Copyright 2016 Kaiser Health News. To see more, visit Kaiser Health News.
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