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Health Organizations Call For A Ban On E-Cigarettes Indoors

Tue, 08/26/2014 - 11:45am
Health Organizations Call For A Ban On E-Cigarettes Indoors August 26, 201411:45 AM ET

A woman smokes an electronic cigarette at a store in Miami.

Joe Raedle/Getty Images

Tobacco control advocates disagree on whether e-cigarettes are a useful tool to get smokers off tobacco, or just a sleeker form of one of the world's deadliest addictions.

A lot of that discord comes from the fact that there's just not enough science to know the risks and benefits of e-cigarettes, which deliver nicotine in a vapor rather than through tobacco smoke. And it could take years to find out if vaping causes cancer and other deadly diseases.

But that lack of certainty means that people need more protection, not less, according to a report released Tuesday by the World Health Organization. The global health organization called for a ban on indoor use of e-cigarettes in workplaces, restaurants and other public spaces.

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The vapors "pose a serious health threat to adolescents and fetuses," the report says, "and increase exposure of nonsmokers and bystanders to nicotine and a number of toxicants." Some studies have found that bystanders absorb more nicotine from vapor than from tobacco smoke, the report says.

One of the biggest selling points for e-cigarettes — that they can help people quit tobacco — hasn't been systematically tested, the WHO report finds. E-cigarettes are probably less toxic for smokers who switch completely, the report says. "The amount of risk reduction, however, is presently unknown."

Advertising of e-cigarettes should be banned, the report says, to reduce the risk to children and teenagers. The liquid used in the devices is often candy flavored.

And e-cigarettes don't necessarily deter young people from smoking tobacco, according to a study from the Centers for Disease Control and Prevention published Monday. Earlier studies have found a modest deterrent effect. But this study found that 44 percent of those who used e-cigarettes say they plan to try tobacco cigarettes in the next year, compared with 22 percent of those who haven't tried e-cigs.

Shots - Health News FDA Moves To Regulate Increasingly Popular E-Cigarettes

The number of teenagers who had never smoked a cigarette but used electronic cigarettes more than tripled in three years, the study found, rising from 79,000 in 2011 to more than 263,000 in 2013. The results were published in Nicotine and Tobacco Research.

And if that's not enough, the American Heart Association issued its first policy statement on e-cigarettes, saying that the devices should be regulated like tobacco products by state and local governments, including them in smoke-free laws and taxing them to discourage use by teenagers.

In April, the Food and Drug Administration issued proposed regulations for e-cigarettes, but final rules are the focus of intense lobbying by tobacco control advocates and the tobacco industry.

Both the WHO and AHA reports voiced fears that rather than help get rid of tobacco forever, e-cigarettes could make smoking culturally acceptable once again.

The reports were issued in advance of a global health meeting in Moscow in October, where regulation of e-cigarettes will be debated.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Federal Officials Order Medicaid To Cover Autism Services

Tue, 08/26/2014 - 11:01am
Federal Officials Order Medicaid To Cover Autism Services August 26, 201411:01 AM ET

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State Medicaid programs now have to cover a range of treatments for autism.

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When Yuri Maldonado's 6-year-old son was diagnosed with autism four years ago, she learned that getting him the therapy he needed from California's Medicaid plan for low-income children was going to be tough.

Medi-Cal, as California's plan is called, does provide coverage of autism services for some children who are severely disabled by the disorder, in contrast to many states that offer no autism coverage. But Maldonado's son was approved for 30 hours a week of applied behavioral analysis, a type of behavior modification therapy that has been shown to be effective with autistic children, and she was worried that wasn't enough.

So she and her husband, neither of whose jobs offered health insurance, bought an individual private policy for their son, with a $900 monthly price tag, to get him more of the comprehensive therapy.

"I don't know any family that can really afford that," says Maldonado. "We made some sacrifices."

That should be changing soon. In July, the Centers for Medicare & Medicaid Services said comprehensive autism services must be covered for children under all state Medicaid and Children's Health Insurance Program plans, another federal-state partnership that provides health coverage to lower-income children.

The new coverage guidelines apply to children with autism spectrum disorder, a group of developmental conditions including autistic disorder and Asperger's syndrome. Roughly 1 in 68 children has an autism spectrum disorder, according to the Centers for Disease Control and Prevention. The Association of Maternal Child Health Programs estimates that just over a third of them get coverage through Medicaid or CHIP.

Although coverage of applied behavioral analysis, which uses positive reinforcement and other techniques to encourage behavior change, isn't explicitly required, advocates expect it will be covered.

"Since ABA is the most accepted, effective treatment that isn't experimental and investigational, you can't just exclude it entirely," says Daniel Unumb, executive director of Autism Speaks' legal resource center.

"It's going to help a ton," says Maldonado. "We'll be able to pay our rent on time, and we'll be able to pay some bills that we have."

In a July coverage bulletin, CMS said that state Medicaid programs must cover a full range of autism services under the "early and periodic screening, diagnostic and treatment services" provision of the law. The EPSDT benefit, as it's called, covers any services that are medically necessary to correct or ameliorate physical or behavioral conditions in children and young people up to age 21.

Some states are concerned about the new requirement, says Matt Salo, executive director of the National Association of Medicaid Directors. "The nexus of covering a lot of kids and a fairly unknown condition and treatment for that condition, combined with EPSDT, anytime you get that, you get states a bit concerned because there's very little way to control costs in that arena," Salo says.

Like California, some states have provided limited coverage to certain age groups, for example, or up to a specified dollar amount. But the new policy is important because it requires mandatory coverage for everybody under 21, says Kristin Jacobson, co-founder and president of Autism Deserves Equal Coverage, a Burlingame, Calif.-based advocacy group.

In California, to get coverage under the state's Medicaid waiver program, children need to be substantially disabled and have a full autistic disorder diagnosis, says Jacobson.

"It doesn't cover people with Asperger's syndrome or other forms of autism spectrum disorder," she says, leaving children with language or certain functional abilities unable to get services.

Jacobson estimates that up to 6,000 new children in California who are currently ineligible under the waiver program may qualify for autism services under CMS' new guidance. "For them it's going to be a huge deal," she says.

The new coverage rules went into effect July 7 when the federal guidance was issued, although many states are still setting up procedures. More than a dozen states have contacted Unumb about implementing the new policy, he says.

Advocates across the country in recent years have been working to build support for better insurance coverage of autism services, including Medicaid coverage. The federal government's announcement followed a number of recent court cases, including federal circuit decisions in Florida and Ohio, affirming that applied behavioral analysis services were required under the Medicaid EPSTD benefit. Those decisions bolstered advocates' long campaign to get such services covered, Unumb says.

In addition, 37 states and the District of Columbia have passed laws that require private plans to cover autism treatment, according to Autism Speaks.

"It reached that boiling point where CMS had to step in and issue this guidance," says Unumb.

Caring for someone with autism costs an estimated $3.2 million over a lifetime, according to a 2007 study published in the Archives of Pediatrics and Adolescent Medicine.

Advocates argue that early intervention, even pricey applied behavioral analysis that may cost more than $50,000 annually, can save money in the long run. Nearly half of children who receive early interventions such as applied behavioral analysis can achieve mainstream status, according to a 2005 study published in the American Journal of Mental Retardation.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Pediatricians Say School Should Start Later For Teens' Health

Mon, 08/25/2014 - 1:18pm
Pediatricians Say School Should Start Later For Teens' Health August 25, 2014 1:18 PM ET

About 40 percent of high schools start before 8 a.m., which contributes to chronic sleep deprivation among teens, according to the American Academy of Pediatrics.

Chris Waits/Flickr

Many parents have pushed for a later start to the school day for teenagers, with limited success. But parents just got a boost from the nation's pediatricians, who say that making middle and high schoolers start classes before 8:30 a.m. threatens children's' health, safety and academic performance.

"We want to promote safety with kids," says Dr. Cora Breuner, an adolescent medicine specialist at Seattle Children's Hospital. "We truly believe that our teenagers are getting six to seven hours of sleep a night, and they need eight to 10."

On Monday, the American Academy of Pediatrics issued a policy statement calling on school districts to move start times to 8:30 a.m. or later for middle and high schools, so that students can get at least 8 1/2 hours of sleep a night.

"It's making a very powerful statement about the importance of sleep to health," says Dr. Judith Owens, a sleep researcher at Children's National Medical Center in Washington, D.C., who wrote a review of the scientific evidence on teen sleep needs that accompanied the recommendation. "School start time is a cost-effective way to address this public health issue."

Shots - Health News Parents Of Sleep-Deprived Teens Push For Later School Start Times

But it's a change that most school districts have yet to embrace. Right now just 15 percent of high schools start at 8:30 or later, and 40 percent start before 8 a.m.

The doctors know they're leaping into an already tense conflict between parents and school districts. "It's been fraught with controversy," Breuner tells Shots. "It's horrifically challenging to move these start schedules up and back."

Letting teenagers sleep later typically means an earlier start for elementary schools, and sets off a cascade of adjustments. Teachers have to change their schedules, times shift for after-school activities and jobs, and older siblings who sit younger ones might no longer get home first.

But this is one area of health where the evidence is unequivocal, the pediatricians say. As children become teenagers, their sleep-wake cycle shifts two hours later, so it's difficult, if not impossible, for them to go to sleep before 10:30 p.m.

As a result, a National Sleep Foundation poll found that 59 percent of middle schoolers and 87 percent of high schoolers are getting less than the recommended 8 1/2 to 9 1/2 hours of sleep a night.

"There's a price to pay for that," Owens says. Studies have found that lack of sleep in teenagers increases the risk of traffic accidents, and makes them more vulnerable to depression and obesity. Teens who get more sleep do better academically, with better standardized test scores and better quality of life.

Caffeinating to get through the day or sleeping more on weekends doesn't make up for the sleep deficits, the doctors note. "It's not simply about getting teenagers to go to bed early or removing electronics from the bedroom," Owens says. "Those are important things, but the biology trumps a lot of these environmental factors. The average teenager can't fall asleep at 11."

As someone who had to rouse a bleary-eyed middle schooler at 6:20 Monday morning, I'm praying that our school district will reconsider its recent decision to punt on later start times. I know that science doesn't necessarily sway policy. But how about a nice bump in standardized test scores?

"Hopefully this policy statement will get the dialogue started in those school districts that haven't started, and be ammunition for those that are in the throes of making the decision," Owens says.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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People With Down Syndrome Are Pioneers In Alzheimer's Research

Mon, 08/25/2014 - 3:25am
People With Down Syndrome Are Pioneers In Alzheimer's Research August 25, 2014 3:25 AM ET Listen to the Story 4 min 43 sec  

Justin McCowan, 39, has Down syndrome and lives at home with his parents in Santa Monica, Calif.

Benjamin B. Morris for NPR

When researchers at the University of California, San Diego wanted to study an experimental Alzheimer's drug last year, they sought help from an unlikely group: people with Down syndrome.

"I had a CAT scan on my head, and I was in a special machine. It's called an MRI," says Justin McCowan, 39, whose parents drove him 125 miles from Santa Monica so he could participate in the study. McCowan also took brain function tests and spent hours with a needle in his arm so researchers could monitor levels of certain chemicals in his blood.

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Alzheimer's researchers are increasingly interested in people like McCowan because "people with Down syndrome represent the world's largest population of individuals predisposed to getting Alzheimer's disease," says Michael Rafii, director of the Memory Disorders Clinic at UCSD.

Down syndrome is a genetic disorder that's best known for causing intellectual disability. But it also causes Alzheimer's. "By the age of 40, 100 percent of all individuals with Down syndrome have the pathology of Alzheimer's in their brain," Rafii says.

Down syndrome is caused by the presence of an extra copy of chromosome 21. And one of the genes on chromosome 21 happens to control the production of amyloid, the substance that forms the sticky plaques associated with Alzheimer's.

Signature log shows how dementia degraded a woman's ability to write her own name.

UCSD

Because their bodies produce extra amyloid, most people with Down syndrome develop problems with thinking and memory by the time they reach 60. Rafii has chronicled the decline of one of his patients, a woman named Irma, by collecting her signatures from medical forms over the years.

The first one is from 1999, when Irma was in her mid-50s. "You can see her signature is on the line, it's clear, she wrote it in script," Rafii says. By 2005, though, she has switched to large block letters. By 2009, Irma is misspelling her name. By 2011, "there are only a few characters written that resemble letters," Rafii says. "And in the very last year it's completely blank."

People like Irma used to be rare because the medical problems associated with Down syndrome meant they rarely lived long enough to get dementia. Today, though, better medical treatments mean people with the disorder often live into their 60s.

And that has created a huge opportunity for Alzheimer's research, says William Mobley, chairman of the neuroscience department at UCSD. "This is the one group in the world that you could argue would benefit most by the institution of early therapy," he says.

Early therapy means starting people on drug treatment years before the symptoms of Alzheimer's appear. The approach has been hard to test because, in the general population, there's no good way to know who is going to develop Alzheimer's. But for people with Down syndrome, it's a near certainty.

Justin and his mother, Annamarie McCowan, make a salad together.

Benjamin B. Morris for NPR

Finding a drug that prevents Alzheimer's in people with Down syndrome could help millions of people who don't have the disorder, Mobley says. "This approach to treating Alzheimer's disease might apply to all of us," he says. "Imagine someday a drug that we all start taking when we're 25 so we never get Alzheimer's disease."

That's a long-term goal. But already, people with Down syndrome are making a difference in Alzheimer's research. Early work with Down patients helped confirm the importance of amyloid. More recently, people with the disorder helped test an eye exam that may offer a simple way to screen for Alzheimer's.

And then there's the study that Justin McCowan signed up for. It involves a drug from Transition Therapeutics called ELND005 that, in mice, can prevent the brain changes associated with Alzheimer's. Scientists hope the drug can do the same thing in people, including those with Down syndrome.

McCowan says he volunteered for the study because he wants to help other people, especially a friend of his named Maria, who also has Down syndrome. "I feel very sad about Maria because she doesn't remember anything," McCowan says.

His parents, Don and Annamarie McCowan, say their son's memory is still sharp. They hope that what scientists are learning from people like Justin will keep it that way.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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California Trees Nailed As The Source Of Mystery Infections

Fri, 08/22/2014 - 3:32pm
California Trees Nailed As The Source Of Mystery Infections August 22, 2014 3:32 PM ET

A false-color electron microscope image of the fungus Cryptococcus gatii, which can cause fatal illnesses in humans. The yellow areas are spores.

Microbial Pathogenesis/Duke University

A fungus called Cryptococcus gattii can cause life-threatening infections, especially in people with compromised immune systems. One-third of AIDS-related deaths are thought to be caused by the fungus.

But though people in Southern California have been getting sick from C. gatti for years, nobody knew how.

Eucalyptus trees were a prime suspect, since they harbor the fungus in Australia. But even though eucalyptus trees grow like crazy in Southern California, the fungus hasn't been found on eucalyptus there.

A different form of the fungus has been making people sick in the Pacific Northwest, where it grows on Douglas fir trees. But there are no Doug firs in Los Angeles.

"We had a good idea that the fungus was going to be associated with trees," says Deborah Springer, a postdoctoral fellow at Duke University who studies C. gatti. "We just didn't know what trees."

And she didn't have the time to find out.

But someone did: Elan Filler, a 7th grader who was looking for a science fair project. Her dad, Dr. Scott Filler, an infectious disease specialist at the University of California, Los Angeles, ran into Dr. Joseph Heitman, Springer's advisor, at a conference, and told him about Elan. Heitman told Springer.

Elan Filler at the LA County Science and Engineering Fair with her project on Cryptococcus gattii.

Anne Maben/Courtesy of LA County Science & Engineering Fair Health Fungal Disease Spreads Through Pacific Northwest

Elan Filler and Springer connected on email and figured out a plan. Soon Elan was making her way around greater Los Angeles, swabbing tree trunks and growing out the fungus in Petri dishes. None of the eucalyptus trees in the first batch she gathered tested positive for C. gattii, so she expanded her tests to include more types of trees.

Springer analyzed the genetic fingerprints of fungi in the samples that Elan sent to North Carolina.

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Bingo! C. gattii from three trees, Canary Island pine, New Zealand pohutukawa and American sweet gum, matched almost exactly with C. gattii from infected patients. And the tree samples matched not just those from recent patients but from people who were sick 10 to 12 years ago. Thus this strain of C. gattii has been causing health problems in California for at least that long.

The results were published Thursday in PLOS Pathogens.

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People living or traveling in California should be aware of the risk of cryptococcosis from C. gattii, Springer tells Shots, especially if they have HIV/AIDS, cancer, or other illnesses that can suppress the immune system. "When you travel and you're exposed to these reservoirs, you have the potential to be vulnerable to these infections."

Early treatment helps reduce the risk of death or disability, according to the Centers for Disease Control and Prevention.

Elan Filler is named as an author on the study; not a bad credit for someone who just turned 16. "I was very lucky that she was interested in doing this and that she did a fantastic job," Springer says of her junior colleague.

Indeed. This spring Filler, now a high school junior, won the Los Angeles County science fair for another project on pathogenic fungi, and attended the big daddy of science fairs, the Intel International Science and Engineering Fair.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Insurers Refuse To Cover Some Contraceptives, Despite Health Law

Fri, 08/22/2014 - 9:16am
Insurers Refuse To Cover Some Contraceptives, Despite Health Law August 22, 2014 9:16 AM ET

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The NuvaRing contraceptive ring can be used monthly to prevent pregnancy.

Sandy Huffaker/Getty Images

How much leeway do employers and insurers have in deciding whether they'll cover contraceptives without charge and in determining which methods make the cut?

Not much, as it turns out, but that hasn't stopped some from trying.

People still write in regularly describing battles they're waging to get birth control coverage they're entitled to under the Affordable Care Act.

In one of those messages recently, a woman said her insurer denied free coverage for the NuvaRing. This small plastic device, which is inserted into the vagina monthly, works by releasing hormones like the ones in birth control pills.

She said her insurer told her she would be responsible for her contraceptive expenses unless she chose a generic birth control pill. The NuvaRing costs between $15 and $80 a month, according to Planned Parenthood.

Under the health law, health plans have to cover the full range of birth control methods approved by the Food and Drug Administration without any cost sharing by women.

There are some exceptions if the plan falls into a limited number of categories that are excluded. One is if the plan is grandfathered under the law. Those plans were around since March 23, 2010, or before, and haven't changed much. If your plan is grandfathered, it has to disclose that status to you.

The other exception is if the plan is offered by a religious employer or house of worship. Following the recent Supreme Court decision in the Hobby Lobby case, some private employers that have religious objections to providing birth control coverage as a free preventive benefit will also be excused from the requirement.

In addition, the federal government has given plans some flexibility by allowing them to use "reasonable medical management techniques" to keep their costs under control. So if there is both a generic and a brand-name version of a birth control pill available, for example, a plan could decide to cover only the generic version without cost to the patient.

As for the NuvaRing, even though they may use the same hormones, the pill and the ring are different methods of birth control. As an official from the Department of Health and Human Services said in an email, "The pill, the ring and the patch are different types of hormonal methods. ... It is not permissible to cover only the pill, but not the ring or the patch."

Guidance from the federal government clearly states that the full range of FDA-approved methods of birth control must be covered as a preventive benefit without cost sharing. That includes birth control pills, the ring or patch, intrauterine devices and sterilization, among others.

But despite federal guidance, "we've seen this happen, plenty," says Adam Sonfield, a senior public policy associate at the Guttmacher Institute, a reproductive health research and education organization. "Clearly insurance companies think things are ambiguous enough that they can get away with it."

If you are denied coverage, your defense is to appeal the decision and get your state insurance department involved.

"The state has the right and responsibility to enforce this law," says Sonfield.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Vision Problems Increase The Risk Of Early Death In Older People

Thu, 08/21/2014 - 4:26pm
Vision Problems Increase The Risk Of Early Death In Older People August 21, 2014 4:26 PM ET

Seeing better can mean living longer because it helps people remain independent.

iStockphoto

An eye exam may be the ticket to a longer life, researchers say, because good vision is essential for being able to shop, manage money and live independently. And maintaining independence in turn leads to a longer life.

Researchers have known for years that people who have vision problems as they get older are more likely to die sooner than those who still see well. But they weren't sure why that was so.

To answer that question, scientists looked at data from the Salisbury Eye Evaluation, which tracked the vision and health of people ages 65 to 84 living in Salisbury, Md., from 1993 through 2003.

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People's visual problems at the start of the study or their loss of vision didn't directly predict an increased death risk, the researchers found. Instead, the vision loss made it less likely that people could pay their bills, do housework and otherwise manage their lives.

People who lost visual acuity equivalent to one letter on an eye chart each year had a 16 percent increase in mortality risk over eight years, and that was due to the loss in independent living abilities, the researchers said.

"An individual who's remaining relatively stable in their visual acuity in their older years is not seeing this subsequent difficulty in functionality," says Sharon Christ, an assistant professor of human development and family studies at Purdue University and the lead author of the study. It was published Thursday in JAMA Ophthalmology.

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The researchers did look at whether other factors, including physical illness, race, sex, depression, smoking, alcohol use and obesity, could be causing the increased mortality risk. But they found that the correlation between vision loss and instrumental activities of daily living was the strongest.

Reducing the risk may be as simple as getting an eye exam and new glasses or contact lenses, Christ told Shots. "It's really important to deal with impairment and make sure you're getting the eye care that you need."

People with vision problems that can't be corrected should get help with tasks of everyday life, Christ says, and be encouraged to remain physically active, postponing those functional declines for as long as possible.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Would A Prize Help Speed Development Of Ebola Treatments?

Thu, 08/21/2014 - 3:34pm
Would A Prize Help Speed Development Of Ebola Treatments? August 21, 2014 3:34 PM ET

Dr. Bruce Ribner, medical director of Emory University Hospital's infectious disease unit, embraces Dr. Kent Brantly (left) who was treated with an experimental Ebola medicine and released from the Atlanta hospital Thursday.

John Bazemore/AP

The human toll of the Ebola epidemic in West Africa is becoming clearer by the day. The virus has killed at least 1,350 people, making this the largest outbreak of the disease ever.

There's no Ebola cure, and only a few experimental treatments are in the works.

One called ZMapp, which contains antibodies against the Ebola virus, was used to treat two Americans who fell ill, a Spanish priest and three health care workers in Liberia, despite the fact that the medicine hadn't been safety tested for humans.

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

While the World Health Organization has said it's ethical to use unapproved treatments and vaccine in this unprecedented Ebola outbreak, there aren't many options. And supplies of ZMapp "are now exhausted," WHO said Thursday.

The World Health Organization Says Yes To An Experimental Ebola Drug

What would it take to make Ebola drugs a clinical reality? Financial incentives might help.

Shots - Health News FDA Dangles Golden Ticket To Spur Drugs For Neglected Diseases

Even now, Ebola isn't the most appealing business proposition for drugmakers. While devastating to the people infected, Ebola hasn't, thankfully, been a widespread illness since it was first identified in 1976. Before the current outbreak, fewer than 3,000 people had reportedly died from the disease.

In the U.S., drugs to treat rare diseases have become lucrative, thanks to tax incentives, special regulatory protection and a willingness by insurers and governments to pay for life-saving treatments.

But Ebola, like many other diseases that are mainly a threat in less-developed countries, have been largely neglected by drugmakers.

Dr. Marie-Paule Kieny, WHO's assistant director-general, said last week that the lack of an approved Ebola drug is a "market failure" because the disease typically strikes "poor people in poor countries where there is no market."

Most Ebola drug research has been financed by the U.S. government, she said, with Canada also pitching in.

For Ebola, there may need to be more financial help to get research started and a reward for success. "As an investor, your expectation is that in the future very few people will have this disease and very few will be in rich countries," says Duke health economist David Ridley. "Should you pay money up front for clinical trials, or should you dangle a sufficiently big prize? It's both."

Ridley is one of the architects of an idea to encourage the development of drugs for neglected tropical diseases that has become U.S. law. Companies that get Food and Drug Administration approval for a drug to treat one of 16 neglected diseases disease get a voucher that moves any drug of their choice to the head of the line for agency review. The fast-track voucher can be sold to another drugmaker that's willing to pay for a shortcut.

Earlier this year, Knight Therapeutics, a Canadian firm, won a voucher when FDA approved its leishmaniasis drug, just the sort of medicine WHO's Kieny wants to see more of. Knight is now trying to cash in its leishmaniasis prize by selling the priority voucher to the highest bidder.

Funding by the Defense Department and National Institutes of Health has provide a push for Ebola research, Ridley says. "An extra pull, like the voucher, would be a great move," he says.

Ebola isn't on the list of neglected tropical diseases that automatically qualify for an FDA voucher. But Ridley says that would be easy to fix. The secretary of Health and Human Services can amend the voucher regulation to cover "any other infectious disease for which there is no significant market in developed nations and that disproportionately affects poor and marginalized populations."

That sounds like Ebola, doesn't it?

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Mental Health Meets 'Moneyball' In San Antonio

Thu, 08/21/2014 - 12:05pm
Mental Health Meets 'Moneyball' In San Antonio August 21, 201412:05 PM ET

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Leon Evans, director of the community mental health system for Bexar County and San Antonio, broke through barriers that had hindered care.

Jenny Gold/Kaiser Health News

The jails aren't overflowing in San Antonio anymore. People with serious mental illnesses have a place to go for treatment and the city has saved $10 million a year on. How did it happen?

"You know Brad Pitt in the movie Moneyball?" asks Gilbert Gonzalez, Director for the Bexar County Mental Health Department. "Well, the success in that movie was based on the data and analytics. We needed to do the same thing."

Gonzalez's task was to look at all the money San Antonio was spending on mental health in one way or another.

Just eight years ago, the jails, hospitals, courts, police and mental health department in Bexar County all worked separately.

Each part of the system was encountering the same people with serious illnesses, but the people were just cycling through, not getting better. Gonzalez found that the city was spending enormous sums of money while taking care of people with mental illness poorly.

So Leon Evans, director of the community mental health system for Bexar County and San Antonio, got everyone talking. That turned out to be the most challenging piece of the puzzle.

"If you think law enforcement and mental health workers have anything in common, we don't," says Evans. "We speak a different language. We have different goals. There's not a lot of trust there."

Shots - Health News Mental Health Cops Help Reweave Social Safety Net In San Antonio Its Mental Health Treatment System Saves San Antonio Millions 7 min 0 sec  

But once the decision-makers saw what could be done if they pooled their resources, every sector chipped in and the county built a single, integrated system where people with mental illnesses could actually get better.

Among other things, the San Antonio center has a 48-hour inpatient psychiatric unit, outpatient primary care and psychiatric services, help with substance abuse, housing for people with mental illnesses and job training. More than 18,000 people pass through the Restoration Center each year.

"San Antonio is ahead of what's a growing trend across the country to try to build a non-hospital alternative for people who are experiencing a psychiatric emergency, often with co-occurring alcohol or other drug abuse," says Dr. Mark Munetz, a psychiatrist and professor at Northeast Ohio Medical University who toured the Restoration Center last year.

But he says the San Antonio model might not work everywhere. The Restoration Center and homeless shelter, he says, felt like "a psychiatric oasis, removing the people from the most central part of the city. It felt a little like segregating people in that part of the city, especially with the homeless shelter next door. I'm not sure how that would fly in other parts of the country."

Nonetheless, the rest of the country has started to notice. City officials say every state in the country has sent delegates to San Antonio to see if they can model their own mental health systems after this one.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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What Kids' Drawings Say About Their Future Thinking Skills

Wed, 08/20/2014 - 9:23am
What Kids' Drawings Say About Their Future Thinking Skills August 20, 2014 9:23 AM ET

Researchers asked 4-year-olds to draw a child. Here's a sample of their artwork.

Twins Early Development Study/King's College in London

At age 4, many young children are just beginning to explore their artistic style.

The kid I used to babysit in high school preferred self-portraits, undoubtedly inspired by the later works of Joan Miro. My cousin, a prolific young artist, worked almost exclusively on still lifes of 18-wheelers.

These early works may be good for more than decorating your refrigerator and cubicle, researchers say. There appears to be an association, though a modest one, between how a child draws at 4 and her thinking skills at 14, according to a study published in the journal Psychological Science.

The findings don't mean parents should worry if their little ones aren't producing masterpieces early on. But the study suggests that intellectual and artistic skills may be related to each other in a way that reveals something about the influence of our genes.

Researchers from King's College London enlisted 7,700 pairs of 4-year-old identical and fraternal twins in England to draw pictures of a child. The researchers scored each drawing on a scale of 0 to 12, based on how many body parts were included. All of the kids also took verbal and nonverbal intelligence tests at 4 and 14.

Kids with higher drawing scores tended to do better on the intelligence tests, though the two were only moderately linked. And that was expected, says Rosalind Arden, a cognitive geneticist who led the study while at the King's College Institute of Psychiatry. The drawing test researchers used was first developed in the 1920s to measure children's cognition. And studies have shown the test to be useful but not always accurate.

In a surprise to the researchers, the drawings and the test results from identical twins (who share all their genes) were more similar to one another than those from fraternal twins (who share only half their genes). "We had thought any siblings who were raised in the same home would be quite similar," Arden tells Shots. The findings add to the growing body of evidence that suggests genes can play a role in both artistic and cognitive ability, she says.

This doesn't mean that a child's genetic predisposition necessarily hurts his or her chances of succeeding in artistic and intellectual endeavors, Arden says. As previous studies have shown, countless factors affect a person's abilities — and genes are only one of them.

How would Jackson Pollock and Mark Rothko have done on the drawing test when they were kids? Arden says she and her colleagues are trying to figure out whether judging the children's art in some other way (maybe based on creativity instead of accuracy) would reveal something different about their intelligence.

But we shouldn't assume that these abstract masters couldn't draw realistically, Arden says. Picasso was a prodigy, who could draw everything from birds to busts with amazing accuracy at a young age. In fact, the artist famously said he easily learned to draw like Raphael when he was young, but it took him a lifetime to learn to draw like a child.

The most amazing thing about the drawings collected for this study is that they represent such a range of both ability and style, Arden says. "I had a fantastic time looking through them."

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