NPR Blogs

Europe's Family Tree Gets A New Branch

NPR Health Blog - 3 hours 54 min ago
Europe's Family Tree Gets A New Branch September 17, 2014 4:47 PM ET

This skull, from the Swedish archaeological site called Motala, is thought to have come from a hunter-gatherer who died there about 8,000 years ago.

Anna Arnberg

For those who eagerly trace their genetic lineage or subscribe online to find their earliest ancestors, there's a new group to consider adding to the furthest reaches of your list. A previously unrecognized population of ancient north Eurasians may be a major third braid in the genetic twist that gave rise to most modern Europeans and their kin.

Scientists have known from previous work that more than 8,000 years ago, a population of dark-haired, light-eyed hunter-gatherers from Western Europe, and a group of dark-haired, brown-eyed farmers from the Near East got together and had kids. But new data suggest a third group from north Eurasia may have swaggered into the ancient party many years later — after agriculture was introduced — contrary to previous thought. These traveling Eurasians are evidence that people were moving into Europe later than expected, scientists now say, after the continent was already densely settled.

The evidence, from a team led by geneticist David Reich, at the Howard Hughes Medical Institute, and Johannes Krause, at the University of Tübingen, in Germany, was published Wednesday in Nature. The scientists analyzed DNA from nine ancient skeletons and from 2,345 modern-day people from across the globe. In particular, you might thank the remains of a 7,000-year-old farmer from Germany and eight 8,000-year-old hunter-gatherers from Luxembourg and Sweden; DNA from their bones or teeth was harvested for science.

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"We were using the whole genome," Reich tells Shots, which means they compared the DNA libraries of each individual, looking for areas in the genome that are variable among different populations. In the end, their statistical analysis found that a computer model incorporating these three very different populations of ancestors seemed to best explain the genetic patterns seen among most Europeans today.

Prior to the study, the third lineage was considered a "ghost population" — thought to exist, based on genetic patterns seen in the genomes of modern Europeans, but without any ancient DNA evidence to confirm that. Interestingly, though Reich's team solved the mystery of one ghost population, they've created another. Their genetic data indicates that there's likely at least one more group whose physical remains haven't yet turned up: "It's a population that split off from all other Eurasian populations before they separated" into the three, Reich says.

"I think the most exciting aspect of this work is that it is a powerful demonstration of how ancient DNA analyses can provide insights into human history that would be difficult, or impossible, to make from genetic data of contemporary individuals alone," says Joshua Akey, a geneticist at the University of Washington School of Medicine. "I suspect this study, and several others recently published, are a harbinger of things to come."

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Kids' Perception Of Parents' Favoritism Counts More Than Reality

NPR Health Blog - 5 hours 28 min ago
Kids' Perception Of Parents' Favoritism Counts More Than Reality September 17, 2014 3:13 PM ET

If a child feels like the odd person out, it could mean more problems in the teenage years, psychologists say.


We all know which kid Mom and Dad liked best, and odds are you're thinking it's not you.

But does that really make a difference? It can, researchers say, but not always the way you might think.

Less-favored children are more likely to be using drugs, alcohol and cigarettes as teenagers, according to researchers at Brigham Young University in Provo, Utah.

But what matters is not how the parents actually treat the children, but how the kids perceive it.

Who's Daddy's girl? Researcher Alex Jensen says he really loves Charlotte, 3, and Olivia, 2, equally. But he couldn't resist staging this photo after researching favoritism in families.

Alex Jensen/BYU

"There's this cultural perception that you need to treat your children the same, or at least fairly," says Alex Jensen, a professor of psychology who led the study, which was published in the August Journal of Family Psychology. "But if kids perceive that it's not fair, that's when issues start to arise."

Earlier studies have found that many if not most parents do have a favorite child. And though parents usually strive to hide that, it's not always successful. That differential treatment has been linked to problems with family relationships and risky behavior in teens.

Jensen (the youngest of six and his mother's favorite, he says), wanted to dig deeper. So he and a colleague tested 282 teenage sibling pairs, ages 12 to 17. He asked each person how parents treated the children overall, who if anyone was favored, and how the family functioned.

They found no correlation between thinking you're the unfavored child and delinquency. There was a correlation between feeling on the outs and substance abuse.

But it's even more complicated than that, the researchers say.

In families that weren't particularly close, the child who felt less favored was more likely to be a substance abuser. The more dramatic the difference they perceived in preferential treatment, the more likely they were to be using.

But when family members were more engaged with each other, the perceived favoritism had less impact, at least when it came to substance abuse.

Obviously there's a chicken-and-egg issue here; teenagers who are more likely to be using substances may just be more likely to see themselves as the odd kid out. Jensen's next task is to try to figure that out.

Parents can try to minimize any ill effects of perceived favoritism by letting the kids know that you really do love them, Jensen says, annoying teenage attitude and all.

"See them as individuals and love them for who they are," he told Shots. "Show them how you love them. Hopefully you do, but try to communicate that love."

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Colorado Tries Hard To Convince Teens That Pot Is Bad For You

NPR Health Blog - 7 hours 40 min ago
Colorado Tries Hard To Convince Teens That Pot Is Bad For You September 17, 2014 1:01 PM ET

Colorado's "don't be a lab rat" campaign tries to make the point that we don't know what marijuana does to the teenage brain.


Colorado's new campaign to deter teen marijuana use tries to make the case that weed is bad for your brain.

One TV ad shows a group of teens lighting up inside a dark car as moody music plays in the background. The commercial cites a Duke University study that found a link between regular marijuana use and a lower IQ.

"Some dispute the study," the PSA admits. "But what if years from now you learn those scientists were right?" The kicker comes as the scene fades to black: "Don't be a lab rat."

The campaign, which launched last month, is designed to target kids in the 12 to 15 age group. It also includes a website with links to news stories about the negative effects of marijuana (including a few on

To further reinforce the message, the agency has installed huge, human-sized rat cages near libraries and skate parks in Denver and at concert venues like Red Rocks Amphitheater. "It's like a big art installation," says Mike Sukle, who runs Sukle, the ad agency the state hired to design the campaign. "It's the coolest thing that we've ever gotten to work on," Sukle says. "But it's a huge challenge."

This human-scale lab rat cage is parked near a skate park in Denver, Colo., to make a point about the lack of science on marijuana.

Richard Feldman Studio/Sukle Advertising and Design

Ever since recreational marijuana was legalized in Colorado in January, public health officials have faced an unprecedented challenge: explaining to teens why they shouldn't smoke weed even though it's legal for their parents to do so.

Surveys and focus groups the state conducted prior to launching the campaign suggest that some teens didn't have a clue that smoking marijuana could hurt them, Sukle says. "Because of medical marijuana, a lot of kids thought it cured cancer. They really started thinking there was no harm to it."

Campaigns against teen drinking and tobacco use have generally focused on the health risks. But while there's no dearth of research that shows tobacco is bad for us, the research on marijuana's effects is still in the preliminary stages. Since marijuana isn't legal in most states, it's been hard for researchers to get federal funding for studies, as well as access to large amounts of the substance. The Colorado campaign depends on small studies that are hardly bulletproof.

Shots - Health News Evidence On Marijuana's Health Effects Is Hazy At Best

"The brains of teen marijuana users show significant abnormalities," the website says. That's technically true — researchers from Northwestern University observed differences in the brains of 20 casual pot users as compared to 20 nonusers. However, the researchers can't say that these differences are caused by marijuana use, and there isn't any evidence to show that these differences are associated with any harm. Plus the number of people in the study is so small it's not reliable.

"A lot of the facts are from studies that are preliminary. And we wanted to be honest with the kids about that," Sukle says. Hence the 'lab rat' theme. "Maybe [marijuana] isn't going to be as bad as it looks," he says, but it could be really damaging. The campaign asks teens whether they want to take that risk.

To be sure, there is a growing body of evidence that shows that marijuana isn't good for the developing brain, says Dr. Herbert Kleber, who directs the Division on Substance Abuse at Columbia University. "The adolescent brain is still maturing," he says, and teens who use marijuana are more likely to become dependent on it than adults.

Plus these days marijuana contains more of the psychoactive ingredient THC than the stuff that John Lennon used to smoke back in the 60s, Kleber says.

The trouble is, those messages aren't quite as specific or compelling as the ones in Colorado's campaign. That's part of the challenge in developing a public health campaign, says Kathleen Kelly, the director of the Center for Marketing and Social Issues at Colorado State University who is not involved in the "lab rat" campaign.

"What you have to be very careful about is that your message is credible and it's believable," Kelly says. "Don't be a lab rat" is a far cry from scare campaigns like Refer Madness, the 1939 anti-marijuana film that has become a camp classic. "They're not positioning the message as this is absolutely fact."

Colorado's approach seems promising, Kelly says. "Colorado is trying to use a strategy that's somewhat similar to what they do with the Truth campaign against cigarettes," she says.

That campaign, which is funded by the nonprofit American Legacy Foundation, aims to expose "Big Tobacco's lies and manipulation" and show kids how the industry tries to tick them into smoking. "The underlying message is don't be made a fool," Kelly says. "Don't let them convince you that this is safe"

In Colorado, Sukle's firm and third-party evaluators are tracking how teenagers are responding to the message. Still, while the campaign may discourage some teens from trying marijuana, it doesn't teach those who are going to use it anyway how to reduce risk.

"The first message we need to get out there is 'Don't use marijuana,' " says Dr. Leslie Walker, chief of the Adolescent Medicine division at Seattle Children's Hospital. "But if you do, don't get behind the wheel."

Researchers and public health officials are still trying to figure out the best ways to talk to teens about the drug, Walker says. "I think we have some more work to do."

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How Catholic Insurance Companies Outsource Contraceptive Coverage

NPR Health Blog - 8 hours 39 min ago
How Catholic Insurance Companies Outsource Contraceptive Coverage September 17, 201412:02 PM ET

Contraceptive coverage has long been required by state laws or sought by nonreligious employers the religious health plans serve.


Catholic and other religious hospitals and universities have been arguing in federal court for much of the past two years that they shouldn't have to offer or facilitate birth control as part of their employee health plans because it violates their religious beliefs.

But what happens when the insurance company is itself Catholic? It turns out that Catholic health plans have for years been arranging for outside firms to provide contraceptive coverage to their enrollees.

That's because such coverage has long been required by state laws or sought by nonreligious employers the religious health plans serve.

The federal health law requires most health insurance plans, including all new plans in the individual and small group markets, to provide contraceptive coverage at no out-of-pocket cost to women.

That divergence between the Catholic court claim that any link to contraceptive coverage is forbidden and the actions of Catholic insurance plans is likely to draw more attention as more large Catholic hospital systems add insurance plans to their portfolios.

Already a bishop in Arkansas is raising questions about one of the insurers in his state.

No one is keeping track of just how many Catholic health plans are entering the insurance market and selling to non-Catholics. The latest entry is Catholic Health Initiatives, the nation's fifth-largest nonprofit health system, with facilities in 18 states.

Juan Serrano, who heads CHI's new insurance subsidiary, Prominence Health, said in an interview that over the next year and a half, Prominence plans to "expand our health plan footprint into additional Catholic Health Initiative markets ... where they make the most sense."

He said that "as relates to the mandated benefits that are required in the marketplace, we are taking the same position that has been taken by other Catholic health plans, and it is to cede or contract with a third-party administrator who will administer the ERD-related benefits in an arm's-length manner."

ERD refers to the Ethical and Religious Directives for Catholic Health Care, a document from the Conference of Catholic Bishops that among other things makes contraception off-limits for Catholic institutions.

While CHI's third-party strategy might please health law advocates, the bishop who heads the Diocese of Little Rock, Ark., raised a red flag when the company purchased QualChoice, its first commercial plan in that state, last spring.

"Having given this matter serious thought and prayer, I am not fully convinced by CHI's reasoning that their acquisition of QualChoice will pose no moral or ethical conflicts," Bishop Anthony Taylor said in a statement.

MergerWatch, a reproductive health advocacy group that tracks deals involving secular and religious health institutions, is keeping a close eye on Catholic plans in the commercial market.

"We're now seeing more and more of these plans moving into the commercial market in a big way," said Lois Uttley, director of the group. "Under the Affordable Care Act, these plans are supposed to be covering contraception. So they have to figure out some way to get that to their enrollees, despite their religious objections to contraception."

MergerWatch has been closely watching how Fidelis Care, a Catholic-owned insurer that this year was the second-most-popular plan on the New York state health exchange, is handling reproductive health services.

Fidelis has arranged for a third party to provide women's reproductive health services, although that's not clear on the plan's website. In its handbook for health care providers Fidelis explains it "has elected not to offer all reproductive and family planning services, including abortion, sterilization, and artificial contraception, as a standard benefit nor to receive premium dollars from the State of New York for such services."

Instead, the company "will inform these same providers that the New York State of Health Marketplace has approved Unified IPA, LLC to provide New York State of Health marketplace-mandated family planning services, independent of Fidelis Care." The online marketplace operates under the health law, offering competing plans to people who generally don't have approved employer-based coverage.

A spokeswoman for Fidelis wrote in an email that health plan members need not worry about getting special access to the outside insurer because "the process is seamless for members. Providers simply bill the outside firm."

Mike Elliott, a principal with Unified IPA, the outside firm, says he contracts with the same health care providers that Fidelis does and works with the same pharmacy benefit firms to ensure that prescriptions are filled without Fidelis having to participate.

"From the member's perspective they're getting to see the same doctor, they have the same benefit package ... and we utilize the same ID number as the health plan," said Elliott, who says he has been providing reproductive health services to religious health plans for nearly three decades.

With Fidelis, that process has not been exactly seamless, says MergerWatch. Uttley said her group called several health plans asking about contraceptive coverage, and the response from Fidelis "was particularly confusing. The customer service woman said, 'Well, Fidelis covers contraception if you need it to regulate yourself,' whatever that means. If you need it for other reasons, you have to call this IPA."

That's troublesome, said Uttley, because "that's confusing even to a sophisticated insurance consumer used to having health insurance, and what we have now coming into the marketplace is a lot of people who have never had insurance. It's enough of a challenge to get them to understand how health insurance works without having this wrinkle in it."

Another problem for the group is that Fidelis, unlike many other nonreligious health plans, refuses to allow Planned Parenthood into its network of covered providers, "not even for prenatal or primary care," Uttley said. "It's not clear to us that women enrolling in Fidelis in New York understand they can't use that coverage at a Planned Parenthood if that's been their primary source of family planning services in the past."

In Arkansas, the bishop's concerns remain unresolved. Taylor sought clarification from the Vatican, and according to diocesan spokesman Dennis Lee, "Bishop Taylor has received a substantive response from the Vatican regarding CHI's acquisition of QualChoice, and he is actively involved in ongoing, private discussions with CHI on how best to comply with the Vatican's response."

The issues are clearer to other Catholic health plans that don't have to meet the needs of non-Catholics in the commercial insurance market. They're arguing in court that any participation with the contraceptive mandate is forbidden.

The Little Sisters of the Poor religious order, which provides long-term-care services with employees insured by Christian Brothers Services, is rejecting the Obama administration's newest policy: allowing religious employers to notify the government, instead of their insurer, that they have a religious objection to providing contraceptive coverage. "Any provision of the Mandate's services through the plan ... would violate the Christian Brothers' and Little Sisters' faith," the lawyers argue.

In the case of Christian Brothers, the administration argues that because it is itself a religious plan, it is exempt from the requirements anyway.

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Top Scientists Suggest A Few Fixes For Medical Funding Crisis

NPR Health Blog - 16 hours 30 min ago
Top Scientists Suggest A Few Fixes For Medical Funding Crisis September 17, 2014 4:11 AM ET Listen to the Story 5 min 49 sec  

Dr. Harold Varmus, a Nobel Prize winner, cancer biologist and director of the National Cancer Institute.

Manuel Balce Ceneta/AP

Many U.S. scientists had hoped to ride out the steady decline in federal funding for biomedical research, but it's continuing on a downward trend with no end in sight. So leaders of the science establishment are now trying to figure out how to fix this broken system.

It's a familiar problem. Biomedical science has a long history of funding ups and downs, and, in the past, the system has always righted itself with the passage of time and plumper budgets.

“ We have to remember that this is a fragile system. 'Do no harm,' the doctor's mantra, is very applicable here.

"You know I lived through those [cycles]; I know what they were like," says cancer biologist Dr. Harold Varmus, whose long research career includes a Nobel Prize. However, he says, the funding challenges "were never, in my experience, anywhere as dramatic as they are now."

Varmus knows the problem well — now head of the National Cancer Institute, he directed the entire National Institutes of Health in 1998, when President Clinton started an ambitious push to double the NIH budget.

"It has to be recognized that we actually weren't asking for that much that fast at that time," Varmus says. "And many voices — including my own — were saying, 'Yes, this is great, and we can spend the money well; but you have to be prepared for what you do at the end of that five years.' "

Doubling the budget, he realized, would, of course, encourage rapid growth — so smaller, continual increases would then be required to keep this bigger enterprise humming.

And the annual budget did grow to an impressive size — surpassing $30 billion. But (adjusting for inflation) today's federal budget for biomedical research has given up much of that gain.

Many scientists say the obvious solution is to give them more money.

"There's no doubt that having a bounce back — an increase in our funding — would be helpful," Varmus says. "But I don't think it's going to solve all the problems at this point."

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There are now deep structural problems in the way research is financed. Scientists and universities alike are thinking less and less about the exciting frontiers of science, and more and more about tactics they can use simply to stay afloat.

"It's difficult to operate, and difficult to operate in an adventurous way," Varmus says. And that's bad not just for the scientists, but for patients and universities hoping to benefit from the fruits of a scientist's labor.

One of the biggest changes is in how NIH money is used. These days, it's not simply for conducting experiments — it's increasingly spent on scientists' salaries and even to repay the loans on new laboratory buildings that sprang up like mushrooms during budget boom times.

"This is a very tricky business," Varmus says, "because we recognize that universities are under tremendous pressures. In states, for example, that have some of the best public universities in the country, the amount of money that can be used to support research activities has declined precipitously."

So the NIH can't simply make bold new rules about how these universities can spend grant dollars. Instead, Varmus and some colleagues have been focusing on gentler changes that might help.

"We have to remember that this is a fragile system, Varmus says. " 'Do no harm,' the doctor's mantra, is very applicable here."

One idea is to reduce the number of young scientists being trained for careers that don't exist, and to instead hire staff scientists to carry out more of the day-to-day lab work that the apprentices now perform.

"Staff scientists don't necessarily have to have Ph.D.'s," Varmus says. "They might have master's degrees. And being a staff scientist these days is quite an appealing way to practice science," because you can concentrate on doing the work, and not get tangled up in the sometimes noxious process of fighting for funding.

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The NIH could also help some scientists avoid the money scramble by following the example of the Howard Hughes Medical Institute, Varmus suggests. This private philanthropy gives generous grants to individual scientists, based on that person's broad ideas and talents, rather than funding a specific research proposal.

Whether scientists can gently solve the structural problems remains to be seen, Varmus says. Last April, he and some colleagues laid out several broad ideas in "Rescuing U.S. biomedical research from its systemic flaws," an avidly read article in the Proceedings of the National Academy of Sciences.

He and his co-authors are hoping to broaden the conversation. "We want to bring together folks who are in government, administration, scientific societies, advocacy groups, students, faculty, even members of Congress," Varmus says.

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One idea, he says, among other possibilities, might be to convene a summit akin to the Asilomar conference in 1975, where scientists gathered to set their own rules for dealing with genetic engineering.

Whatever the ultimate solution, much is at stake.

"We have a system that has worked well in the past, that has made the U.S. the leader in biomedical research worldwide," he says, "and while I don't think we've lost that [edge] yet, we do see a rising tide in lots of places."

Maybe, eventually, the threat of losing this competitive edge will spur the U.S. Congress to address the underlying problems in the way it authorizes funding for biomedical research. But that appears to be a distant prospect. In the meantime, another ancient injunction to doctors, "Physician, heal thyself," seems apt. The research establishment will try to find a way to ease the pain, on its own.

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Breast Cancer Patients Seek More Control Over Research Agenda

NPR Health Blog - Tue, 09/16/2014 - 4:11pm
Breast Cancer Patients Seek More Control Over Research Agenda September 16, 2014 4:11 PM ET Listen to the Story 6 min 51 sec  

Coalitions of patient advocates now help steer research funding toward particular projects.

Lilli Carré for NPR

The federal government has poured more than $3 billion into breast cancer research over the past couple of decades, but the results have been disappointing. The disease remains a stubborn killer of women.

“ We decided we could no longer afford to have the scientists set the agenda, and that we were going to decide what questions need to be answered.

So the National Breast Cancer Coalition is trying something bold: The advocacy group has decided that it's not simply going to lobby for more research dollars. Instead, its leaders are sitting down at the table with scientists studying the disease and telling them how they'd like that money to be spent.

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"We've come to a phase in our lives where we're just sick of losing our friends," says Joy Simha, a member of the coalition's board. "We are looking into the eyes of our children and saying, 'No more! No more! We need a deadline.' "

That deadline is January 2020. The goal is not to eradicate breast cancer by that date, but to have figured out by then how to put an end to the disease.

"There's no question, when we started the National Breast Cancer Coalition we thought naïvely: If we just got enough money to the scientific community, they would get the answers we need," says Fran Visco, president of the NBCC. "And then we came to learn that it is much more complicated than that."

In the old days, an individual scientist would come up with an idea related to one small question regarding breast cancer, get funding and then retreat to his or her lab to run experiments to test the idea. Good ideas have resulted in better understanding of breast cancer and better treatments, but years have turned into decades without a cure.

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"We decided we could no longer afford to have the scientists set the agenda," Visco says, "and that we were going to decide what questions need to be answered, and we were going to bring together the necessary scientific expertise, collaborating with advocates, to answer those questions."

So, three years ago, the coalition started what it calls the Artemis Project. The project asks: If you're going to end breast cancer, what would you need to do? The first answer, the coalition decided, is, "Prevent the disease." A vaccine would be ideal — if someone could figure out how to make one. Next, for women who already have breast cancer, the challenge is to keep it from spreading throughout the body — the process of metastasis.

"If you could figure out how to prevent metastasis so that no one died of breast cancer and no one died of the treatment for breast cancer, we believe we will have achieved the goal."

Should the National Institutes of Health, rather than a nonprofit organization, be sponsoring a collaborative project like this?

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"Yes," Visco says, quietly, but adds, "You know, the goal of the NIH is to fund the scientific community. It is not the mission of the NIH to end breast cancer." She says she's not discounting research initiated by scientists.

"The process by which a scientist comes up with an idea and then wants to pursue it is a process that must continue," Visco says. "We need that process. We need discovery."

The backdrop for this new patient-driven paradigm for treating disease is a quiet crisis in funding for biomedical research. Scientists studying diseases are fighting over a steadily shrinking pool of money for research. But for breast cancer, Visco believes, the problem isn't a shortage of funding — it's how it's being spent.

Dr. H. Kim Lyerly, a professor of surgery at Duke University, is part of the breast cancer coalition's Artemis Project. He likens the collaboration to the highly coordinated Apollo project that put men on the moon.

To succeed with Apollo, he says, scientists needed one team to build the rocket to get the spacecraft to the moon, and also a navigation system. "Scientists and experts in the booster rocket may or may not be the same scientists and experts in the navigation system," he says.

Similarly, many types of medical researchers have been working on breast cancer, Lyerly says, but they haven't been working toward one clear, common goal, as the Apollo engineers and scientists did. He's certainly not promising that the Artemis Project's coordination will enable scientists to figure out breast cancer by January 2020, but he is impressed by this collective approach to medical problem-solving.

"I think that is a remarkable opportunity," he says, "and even that achievement would be one that I think would be a positive for science."

At the National Cancer Institute, director Harold Varmus defends the scientific establishment's current strategy.

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"I would never abandon the opportunity for anybody who's got the spark of genius to make an application to do something that is novel and individual," Varmus says. "I do believe that individual labs still have an important role to play. But people who think that we don't have a lot of collaborative work — team science — are wrong. We've always had that for years, and we continue to support it."

The breast cancer advocates are pushing the medical establishment to make those collaborations much deeper and more ambitious.

"I think the national breast cancer coalition's model is incredibly sophisticated and smart," says Daniel Sarewitz, a science policy researcher at Arizona State University. "They recognize that you can't turn a problem of great social concern — such as women's mortality from breast cancer — over to scientists and expect them to solve the problem."

Sarewitz acknowledges that breast cancer advocacy is sometimes criticized for its single-minded focus, which leads breast cancer to absorb a disproportionate share of research dollars. But he says that success also gives them more leverage to change the system.

"They're in the lead in understanding how difficult the problem is and how science needs to reorganize to address the problem. If they succeed, everyone else will want to be like them."

Fran Visco says this is her best — and last — shot. If the group can't reach its ambitious goal by January of 2020, she plans to end her long, celebrated career of trying to conquer the disease.

"I understand there are people who believe that it's going to take decades, maybe a century, to end breast cancer," she says. "And I wish them a great deal of luck."

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Americans' Waistlines Are Expanding, And That's Not Good Fat

NPR Health Blog - Tue, 09/16/2014 - 4:05pm
Americans' Waistlines Are Expanding, And That's Not Good Fat September 16, 2014 4:05 PM ET

If your belt needs to be let out a notch, you're not alone. The average American waistline is growing even though obesity rates haven't grown. And excess abdominal fat increases the risk of heart disease, diabetes and stroke.

The collective American waistline grew by more than an inch from 1999-2000 to 2011-2012, according to a study published Tuesday in JAMA, the Journal of the American Medical Association.

The study results come at a time when the percentage of Americans who are overweight or obese has stabilized. In short, people haven't been getting fatter, but their waistlines are still increasing.

"We're a little bit puzzled for explanations," Dr. Earl Ford, a medical epidemiologist at the Centers for Disease Control and Prevention and lead author of the study, tells Shots. The two measures are closely related: While body mass index or BMI measures fat overall, waist circumference helps measure fat distribution.

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Stress, hormonal imbalances, environmental pollutants, poor sleep or medications that help pack on abdominal weight are possible causes, health and nutrition researchers speculate. And older adults typically lose muscle as they age, while fat continues to increase.

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Ford and his team used data from the National Health and Nutrition Examination Survey (NHANES), which polled 32,816 adult men and women who were not pregnant. The mean waist circumference of Americans increased from 37.6 inches in 1999-2000 to 38.8 inches in 2011-2012. Men, women, non-Hispanic whites, non-Hispanic blacks and Mexican-Americans showed significant gains.

The prevalence of abdominal obesity (a waist circumference of greater than 40.2 inches or size 44 in men and 34.6 inches or size 12/14 in women) increased from 46.4 percent of the sample in 1999-2000 to 54.2 percent in 2011-2012.

Generally, as waist circumference increases, the amount of belly fat increases, too. But that's not true for everyone. African-Americans tend to have somewhat less abdominal fat for the same waist size than do whites and Hispanics.

Regardless, "people should not only watch their weight, but also their waistline," Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health, tells Shots via email.

Ford believes it's important to continue looking at abdominal obesity to judge how American health is doing.

"I can't really say exactly why BMI has gained favor in our national statistics," he says. "It may have to do that height and weight have been more consistently measured and that waist circumference has been included on some [statistics] but not as many as height and weight have been."

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Colleges Brainstorm Ways To Cut Back On Binge Drinking

NPR Health Blog - Tue, 09/16/2014 - 3:46pm
Colleges Brainstorm Ways To Cut Back On Binge Drinking September 16, 2014 3:46 PM ET Listen to the Story 5 min 22 sec  

Frostburg State University police officer Derrick Pirolozzi conducts a "knock and talk" at a house near campus, reminding students of laws on underage drinking and open containers.

Jennifer Ludden/NPR

It's early Friday night, and Frostburg State University police officer Derrick Pirolozzi is just starting the late shift. At a white clapboard house, he jumps out of his SUV to chat with four students on the front steps.

"S'up guys!" he calls out, assuring them he just wants to chat. All are underage but one, and that one tells Pirolozzi he has a string of alcohol violations from past years. Pirolozzi banters a bit. He tells them to "call anytime," and reminds them not to walk around the street with open containers.

"Think about me when you're having a good time!" he says, laughing as he turns to move on.

Cute, huh? A poster that's part of Frostburg State University's social media campaign.

Courtesy of Frostburg State University

Pirolozzi's presence here is part of a notable turnaround at this campus in Maryland's Appalachian mountains, one others may look to copy as stepped-up scrutiny of campus sexual assault puts more pressure on schools to address the related problem of binge-drinking.

In 2012, an unusual agreement gave Frostburg's campus and city police joint jurisdiction. Now Pirolozzi can patrol off campus, where he can tell who's gearing up for house parties.

"Can you see right there?" He points through a fence to where students are dancing in a back yard. Others hang out on porches. Small clusters stroll the streets, cases of Bud Light in tow.

On this weekend night, the university is also helping to pay overtime costs for a show of force: State, county, city and campus police all circle these blocks. The aim is not to arrest everyone.

"We know there's going to be underage drinking," Pirolozzi says. "We can't card everybody. But we want to make sure everybody does it the right way and safe way."

In other words, he hopes to keep students from doing something stupid so he doesn't have to come back and arrest them later.

"The thing that's so striking to me is that many universities perceive [binge drinking] as an intractable problem and that there's nothing they can do," says Jonathan Gibralter, president of Frostburg State University.

When Gibralter became president in 2006, he says, he found the party scene "out of control." As at other schools, heavy drinking at Frostburg has led to injuries and deaths. It's also linked to poor grades, mental health problems and is a factor in the majority of campus sexual assaults.

FSU is among dozens of schools being investigated for its handling of sexual assault. But Gibralter has also made the school a leader in tackling binge drinking. The joint police patrols are just one of many changes.

There are now more Friday morning classes, to discourage Thursday night drinking. Gibralter led the push for Maryland's recent ban on the sale of grain alcohol, that potent, tasteless drink used in homemade punch. With a state grant, the school formed a coalition that includes not just police but also city officials, parents and businesses to tackle underage drinking across the community.

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"I have met with bar owners where they said nobody would come, and there weren't enough seats in this room," Gibralter says. "I said, 'Hey, guys, we need your help.' "

There's been pushback, of course. The surprise is from whom. Gibralter says his biggest critics are parents and alumni who say they all drank in college and wonder what's so wrong with it.

"When I tell parents that 1,800-plus college students drink themselves to death every year, they are stunned," Gibralter says. "They have no idea."

That number has gone up in the past two decades.

Not all students like the changes, either.

"No matter what they do, it's still gonna happen. It's college," says sophomore Alissa Barlow, speaking between classes. "To be honest, the more rules you put down, it's like if your parents tell you 'No.' You're going to do it anyway most of the time."

A Closer Look At Sexual Assaults On Campus Student Activists Keep Pressure On Campus Sexual Assault

Still, several older students tell me the off-campus house parties are nothing like they used to be.

"I would be walking home from campus and I would see large gatherings outside with tables and kegs, and it was in the middle of an afternoon on a weekday," says senior Sara King. "Now, I don't see that at all."

Some resent the changes and call them heavy-handed. One recent graduate says it felt like trying to party "in a police state."

But since 2006, the share of Frostburg students who binge drink at least once every two weeks has fallen from 57 percent to 41 percent, according to the university. The average number of drinks students have each week has dropped in half, from eight to four.

That's somewhat more in line with the 40 percent of college students who binge drink at least once a month, according to the 2012 National Survey on Drug Use and Health.

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One group of juniors tells me they like the anti-booze efforts, especially the monthly alcohol-free parties at the student center.

"Really good food," says Andrew Bock. His friend likes the iPads and Xboxes given away as door prizes. Another student says she shows up early to beat the crowds.

"What's happened in the last decade is the science around preventing the abuse of alcohol has really improved," says Kevin Kruger, president of Student Affairs Administrators in Higher Education.

He says more colleges are training staff to screen for problem drinkers and are expanding alcohol education efforts. But many effective strategies boil down to changing the culture around drinking and what students consider "normal."

Kruger says this can be as small as getting a liquor store not to sell pingpong balls next to its beer to promote the popular game beer pong.

Rich Godlove, owner of Zen-Shi bar and restaurant in Frostburg, Md., says training paid for by the university has helped his staff recognize sophisticated fake IDs.

Jennifer Ludden/NPR

"It's not like college students can't go find pingpong balls," he says. "But why put it out there for them so it's so easy to do that?"

Frostburg State also has a social marketing campaign, sending regular emails and putting up posters for a campaign it calls "Reality Check." One says: "Not Everyone's Doing It: 36 percent of FSU students reported they did not drink alcohol in the last 30 days." Another shows a young woman bent over a toilet, mouth open, with the caption, "Glamorous, Isn't It?"

Another key strategy is simply making it harder for students to get alcohol, Kruger says, any way you can.

Hamilton College in New York made such a change this fall. Dean of Students Nancy Thompson says the school runs a bus to the nearby town of Clinton. But the only things open there at night are bars, and the return ride would be full of drunken students.

"There was damage to the vehicles," Thompson says, "and disruptive behavior."

So Hamilton has banned underage riders after 10 p.m. on weekends (though anyone already in town can still get a ride back). Thompson says the move has not gone over well with students. But "when we have a chance to sit down and talk with them about our rationale," she says, "it's hard to argue that the college should be in the business of driving students to bars. Especially students who are underage."

At Frostburg State University, students can walk to bars, but the school has made it harder for them to get served. In something of a quid pro quo, it has paid the sheriff's office to carry out monthly undercover compliance checks. The school also pays for training to help bar staff spot the fake IDs students get online these days.

"Honestly, these IDs are so good it's ridiculous," says Rich Godlove, owner of Zen-Shi bar and restaurant. "In fact, as soon as we had the class last year, we came in, probably caught two or three fake IDs and recognized the kids as people we thought were of age."

Far from cutting into business, Godlove says it has worked out well. Last year, his staff, using other strategies learned in the new training, cut off three drunken students one night. The next day they came back to have lunch, and to thank him.

Copyright 2014 NPR. To see more, visit
Categories: NPR Blogs

Farewell, Heating Pad: Physical Therapists Say It Doesn't Help

NPR Health Blog - Tue, 09/16/2014 - 12:19pm
Farewell, Heating Pad: Physical Therapists Say It Doesn't Help September 16, 201412:19 PM ET

The physical therapist will advise, but you're going to have to do the work.


I have fond memories of listening to NPR while lounging at the physical therapist's with a heating pad on my shoulder. Don't do that, the nation's physical therapists' association says.

Heat therapy, electrical stimulation, ultrasound and other "passive physical agents" almost never help, according to a list released Monday by the Choosing Wisely campaign. Instead, they siphon time and money away from what you really want from a physical therapist — an exercise program that will restore strength and mobility.

Well, this is certainly going to make physical therapy less restful.

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But seeing as I've been to several physical therapists over the years and they've all used this stuff, the fact that the American Physical Therapy Association put passive physical agents on top of their list of things not to do seems like big news.

So I called up Tony Delitto, chairman of the department of physical therapy at the University of Pittsburgh, to find out what gives. He was chairman of the group that wrote the "what not to do" list for Choosing Wisely. It's aimed at getting health care professionals and civilians to pick medical treatments that are proven to do good.

Heating pads in the PT's office, alas, are not on the list.

Shots - Health News Doctors Urge Their Colleagues To Quit Doing Worthless Tests

"The evidence for any beneficial effect is almost nil," Delitto told Shots. "When I graduated with my physical therapy degree in 1979, these physical agents were a large part of practice. We've had a hard time getting rid of them."

One reason why, Delitto says, is that insurers continue to pay for passive physical agents. I know my health insurer did. The Choosing Wisely campaign, which is run by the American Board of Internal Medicine Foundation, aims to put pressure on insurers to change their ways, too.

Also on the physical therapists' list:

  • Don't underprescribe exercise for older adults.
  • Don't prescribe bed rest for people with acute deep vein thrombosis once they're properly medicated.
  • Don't use continuous passive motion machines for people who have had knee replacements.
  • Don't use whirlpool baths for wound management.

If you detect a pattern there, you're right. The emphasis is on physical activity, and on doing it yourself with the guidance of a physical therapist so you work hard enough to get stronger and don't get hurt.

Shots - Health News Doctors Think The Other Guy Often Prescribes Unnecessary Care

"You're leaning on the physical therapist's expertise to see what activities you can do and how to carry them out on your own," Delitto says. "What to look for so you don't overdo it, and how to progress."

Many physical therapists are hesitant to give older people challenging exercises, but as a result the exercises don't do any good. "We underestimate what they can do," Delitto says. It's a bit trickier to hit the right balance between challenge and safety, he notes, but "it can be done safely."

Shots - Health News Medical Waste: 90 More Don'ts For Your Doctor

The continuous passive motion machines were thought to prevent stiff knees in people who had knee replacements, but studies have found that they don't help. "It turned out to be a very expensive device that was not adding any quality," Delitto says. "But people make money on the machines."

Physical therapy can be a cost-effective first stop for people, Delitto says, because therapists are trained to recognize when a person needs to see a doctor instead. "We're sort of an inexpensive route for patients."

Without the heating pad, that is. I guess I'm going to have to find another place to listen to NPR.

Copyright 2014 NPR. To see more, visit
Categories: NPR Blogs

Health Law Tempers States' Insurance Mandates

NPR Health Blog - Tue, 09/16/2014 - 11:20am
Health Law Tempers States' Insurance Mandates September 16, 201411:20 AM ET

Partner content from

Is that health service covered?


For decades, states have set rules for health coverage through mandates. These laws require insurers to cover specific types of medical care or services.

The Affordable Care Act aims to curb this piecemeal approach to coverage by establishing minimum standards for insurance coverage in individual and small group plans nationwide and requiring states to pay for mandates that go beyond them.

States, however, continue to pass new mandates, but with a twist: Now they're adding language to sidestep the health law, making it tougher than ever for consumers to know whether they're covered or not.

State mandates vary widely. Some require coverage of broad categories of benefits, such as emergency services or maternity care, or of very specific benefits such as autism services, infertility treatment or cleft palate care. Others require that certain types of providers be covered, such as chiropractors. The requirements may apply to all individual and group plans regulated by the state, or they may be more limited.

While patient advocates view state mandates as a crucial tool in their efforts to address coverage shortcomings, the insurance industry generally opposes mandates, saying they drive up the cost of insurance.

Since the health law established a comprehensive set of "essential health benefits" that individual and small group plans must cover (unless they existed prior to passage of the law in 2010), it was hoped that mandates would no longer be much in demand, says Sabrina Corlette, project director at Georgetown University's Center On Health Insurance Reforms.

Mandates are "not the most rational way to build a benefit package," says Corlette.

To discourage states from passing mandates that go beyond essential health benefits requirements, the law requires states, not insurers, to cover the cost of mandates passed after 2011 that apply to individual and small group plans sold on or off the state health insurance marketplaces. If a mandate increases a plan's premium, states will be on the hook for the additional premium cost that's attributable to the mandate.

The payment requirement is waived until 2016, says Kelly Brantley, a senior manager at Avalere Health.

Rather than forgoing mandates altogether, some states are simply excluding from the mandates plans that the states would have to pay for. The result: Consumers who buy individual or small group plans may not get the mandated benefits that are required in large group plans. (Self-funded plans, used by many large employers to pay employee claims directly rather than buying insurance for that purpose, aren't bound by state mandates.)

That's what's happening with state mandates related to autism coverage, says Lorri Unumb, vice president of state government affairs at Autism Speaks, an advocacy group.

By the group's count, 37 states and the District of Columbia have mandates requiring autism coverage. In 26 states, autism coverage is part of the essential health benefits, typically because coverage was mandated before 2012 and so was included in that state's "benchmark" plan that sets the standard for coverage there.

New mandates are different. "For the most part, the states that have passed autism mandates post Dec. 31, 2011, have excluded ACA-compliant plans from the mandate," Unumb says.

States have taken different approaches to structuring new mandates so they don't have to pay for them, says Justin Giovannelli, a research associate at Georgetown's Center on Health Insurance Reforms. The law may say that the mandate only applies to large group plans, for example, or that it doesn't apply to any plans that are required to provide the essential health benefits. A state may say that if the mandate increases premiums by a certain percentage the provision doesn't apply.

Confused? Policy experts fear consumers will be too.

"Your state has passed a law but everything is so market specific it's hard to know what coverage you're getting," says Katie Keith, research director at the Trimpa Group, a consultant for autism and other advocacy groups.

Copyright 2014 Kaiser Health News. To see more, visit
Categories: NPR Blogs

Too Few University Jobs For America's Young Scientists

NPR Health Blog - Tue, 09/16/2014 - 3:38am
Too Few University Jobs For America's Young Scientists September 16, 2014 3:38 AM ET Listen to the Story 7 min 47 sec  

Victoria Ruiz (left), a postdoctoral fellow in immunology, works with Brianna Delgado, a high school student that she mentors, at the Blaser Lab, inside NYU's Langone Medical Center in New York, NY.

Ramsay de Give for NPR

Imagine a job where about half of all the work is being done by people who are in training. That's, in fact, what happens in the world of biological and medical research.

In the United States, more than 40,000 temporary employees known as postdoctoral research fellows are doing science at a bargain price. And most postdocs are being trained for jobs that don't actually exist.

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Academic institutions graduate an overabundance of biomedical Ph.D.s — and this imbalance is only getting worse, as research funding from the National Institutes of Health continues to wither.

The funding squeeze presents an enormous challenge for young scientists like Vanessa Hubbard-Lucey, who is trying to make a career in biomedical research.

Hubbard-Lucey is 35 years old. After earning her Ph.D. a few years ago, she first worked as a research-technician in a cancer lab, then accepted a postdoc position at New York University's Langone Medical Center on Manhattan's East Side, working for a professor who is trying to understand the causes of inflammatory bowel disease.

Vanessa Hubbard-Lucey is also a post-doc at NYU's Langone Medical Center. She works for a professor studying inflammatory bowel disease.

Richard Harris/NPR

"By definition, a postdoc is temporary, mentored training where you are supposed to acquire professional [experience] in order to pursue a career of your own choosing," Hubbard-Lucey says, "the key word being temporary."

But increasingly these low-paying temporary jobs can stretch on for years. "Many people go on to do many postdocs," she says.

That's because if you want a career in academia, it's almost essential as a postdoc to make a splashy discovery and get the findings published in a top scientific journal. Hubbard-Lucey is working on an experiment that she hopes will be her ticket to a professorship — or at least to an interview for an academic job.

Whether she succeeds or not, she's part of a shadow workforce made up of highly qualified scientists who work long hours for comparatively little pay, considering their level of education: about $40,000 a year.

American science couldn't survive without this shadow labor force of some 40,000 postdocs. But only about 15 percent will get tenure-track jobs, heading a lab like the one where Hubbard-Lucey works today. This was not at all what she expected when she started down this path a decade ago.

"I remember [an adviser] saying, 'You know, funding is kind of tough now, but things are going to be better when you finish graduate school,' " Hubbard-Lucey recalls. She says her adviser assured her that the situation would improve, "so I said OK."

In fact the situation hasn't gotten better. It's worse. Support for biomedical research has declined by more than 20 percent in real dollars over the past decade. And even in good times, postdocs had a raw deal.

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The entire system is built around the false idea that all these scientists-in-training are headed to university professorships.

"That's obviously unsustainable," says Keith Micoli, who heads the postdoc program at the NYU Medical Center. "You can't have one manager training 10 subordinates who think they are all going to take over that boss' position someday. That's mathematically impossible."

"But we've grown so dependent on this relatively cheap, seemingly inexhaustible supply of young scientists who do great work," Micoli says. "From the standpoint of dollars and cents, they're a great investment."

Even the lucky few who do land academic jobs find it increasingly difficult to get federal funding to run a lab. There's simply not enough money to go around, given the number of scientists working in academia today.

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"Why go into an academic career when you know you've little chance of success?" Micoli muses. "Funding gets tighter and tighter. It's diminishing returns."

This is very much on the minds of today's postdocs.

Immunologist Victoria Ruiz grew up in modest circumstances in Brooklyn. She says her dad struggled with health issues for many years, "and I saw how troubling it can be, being a patient and being a patient's family. And I wanted to do something to help."

Victoria Ruiz (center) rides the N Train from Bay Parkway into Manhattan every day for work, a commute of nearly an hour each way. Her dad's long health struggles led her to medical research, she says.

Ramsay de Give for NPR

But after getting a Ph.D. at Brown University, and now working in a top lab, she knows she may not end up working to cure diseases.

"What would I do instead? I would love to work with inner city youth and show them different careers that are available to them," Ruiz says. "I came from a poorer community, so I would love to go back and give back to the community."

But she may not advise them to pursue careers in biomedical research.

Kishore Kuchibhotla still holds out that hope. He's a neuroscientist who landed a lucrative consulting gig after earning his Ph.D. from Harvard. But the job didn't inspire him. So he says he took an 80 percent pay cut to come back to the world of academic research as a postdoc.

Shots - Health News When Scientists Give Up

"We will see if it's a foolhardy decision after a few more years," he says. But passion trumps everything for now.

"I'm very excited about really understanding how brains work, how brain circuits work, both in health and in disease," he says. "Is there a way we can slowly figure that out and unpack that so we can get a better handle on what's up in our skull? ... It's really one of the most fascinating organs to me."

But Kuchibhotla knows the system's stacked against him.

"I sometimes like to think of it like medical residents," he says. "Medical residents do need a few years of training before they can become attending [physicians]. The difference is there's not always a job on the other end" for the postdoctoral researchers.

There actually are jobs – in industry, consulting, government and other fields. Biomedical postdocs rarely end up unemployed. But many can't pursue their academic dreams, and they are often in their late 30s or even older before they realize that.

And despite those long odds, Vannessa Hubbard-Lucey was also holding out hope on the rainy spring day when we first talked.

"You have a Ph.D.," Hubbard-Lucey she told me. "It's supposed to be the highest degree you can get, so you feel like, well I've worked this hard, I've done so much, when am I going to get something good out of this?

"I'm sort of at the point where I'm hopeful that my paper's going to go in and it's going to get published," she says, "and at least I'll have something to show for it."

A published paper, then maybe an interview in academia, she was hoping, and at the end of that rainbow, a job running her own research lab from the honcho's office, not the lab bench.

"The boss occasionally comes out and wants to know what's going on, but he's mostly holed up in his office trying to write grants," she says. That may not sound glamorous, but "I would love to actually be telling other postdocs what to do. That would be the best part!"

The worst part: The boss spends a huge amount of time in his office writing grants because money is so tight these days even many top-flight ideas don't make the cut. Nearly 90 percent of grant proposals get rejected.

"Rejection's a little hard," she admits. "You have to get used to rejection."

That first conversation took place in May. Later in the summer, while Hubbard-Lucey was still working on her scientific paper, she heard about a job where she could make good use of her Ph.D. She wouldn't be running a lab or working in academia. But she would be advancing cancer research at a nonprofit institute. She got the job. And now, she says, she's happy with the new path she's chosen.

Copyright 2014 NPR. To see more, visit
Categories: NPR Blogs

Key Brain Connection Slow To Develop In Kids With ADHD

NPR Health Blog - Mon, 09/15/2014 - 4:36pm
Key Brain Connection Slow To Develop In Kids With ADHD September 15, 2014 4:36 PM ET

Maps of connections in the brain are helping researchers better understand attention deficit hyperactivity disorder.

Courtesy of Chandra Sripada/University of Michigan

Scientists analyzing data from a map of connections inside the human brain have gained new insights into the development of attention deficit hyperactivity disorder.

Past images of brain structures showed that the brains of people with ADHD mature later than those of people without the condition. Now researchers making use of data collected as part of something called the ADHD-200 Initiative (similar to the Human Connectome Project) have found that the growth of connections within and between key brain networks in children with ADHD lags behind what happens in other kids the same age.

The results, published Monday in the Proceedings of the National Academy of Sciences, point to a reduced ability among children with ADHD to turn on and off the networks inside the brain that are involved in control and attention. The brain connections that normally help children focus simply aren't as developed.

"Ultimately the brain is an information processing machine and that process occurs in the connections between regions," University of Michigan psychiatry professor Chandra Sripada, lead author of the study, tells Shots. "So the real test of the maturation hypothesis ... is looking at the connectome rather than structure."

Children's Health Study: Brains in ADHD Kids Mature Later

The researchers used two different databases looking at the connections in brains of 576 children with ADHD and normally developing children. In particular, the scientists assessed 907 known points across the brain and calculated how strongly linked each unique pair was in both groups of children.

They found that one neural network in particular lagged behind when it came to children with ADHD. This area, called the default network, is responsible for your stream of consciousness, or daydreaming. It turns on when you're not actively engaged in tasks and turns off when you're busy.

"The default network is maturing very rapidly between youth and adulthood," says Sripada. "It's neither a hero nor villain — you need to be able to turn it on appropriately and turn it off appropriately." Without this ability, researchers suspect that children can't focus on tasks or think further into the future. Their daydreaming network interrupts the area of their brain working on tasks, causing a loss of attention.

The study "makes a lot of intuitive sense," Philip Shaw, an ADHD researcher at the National Institutes for Health and unaffiliated with the study tells Shots. "We know the connections within the brain are very plastic ... treatments could work by boosting these connections."

Sripada agrees, saying that the research might enable people to identify brain connection patterns earlier and develop treatments to target abnormal circuits.

For the kids who eventually grow out of ADHD, there may even be a future where understanding the brain's connections could lead to better knowledge of how the brain will mature. "You could tell a mom, you've got a kid with ADHD," Sripada says, "and, by the way, our expectation is at a certain point your kid will outgrow this."

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Antibiotics Prescribed For Children Twice As Often As Needed

NPR Health Blog - Mon, 09/15/2014 - 11:40am
Antibiotics Prescribed For Children Twice As Often As Needed September 15, 201411:40 AM ET

Drat those viruses. They're the culprit in the majority of children's colds and sore throats.


When your child has an earache or a bad cold, it's hard to think that there's not much you can offer beyond Tylenol and sympathy. But most of those infections are mostly caused by viruses that don't respond to antibiotics, a study finds.

Just 27 percent of acute respiratory tract infections are caused by bacteria, researchers at Seattle Children's Hospital found. That means that more than two-thirds are viral and antibiotics don't help.

But doctors prescribed antibiotics for children with those infections 57 percent of the time, the study found. In other words, children are taking medication that's not going to help them and can hurt, because of side effects and the increased risk of antibiotic resistance, both for that person and for the larger community.

Shots - Health News Pediatricians Urged To Treat Ear Infections More Cautiously

That adds up to about 11 million potentially needless prescriptions each year.

Cutting back on unnecessary use of antibiotics is a "pressing concern," the authors write in Monday's Pediatrics. More than half of all outpatient antibiotic prescriptions are for respiratory infections, they note, which includes ears, noses and throats.

But some infections were more likely to be caused by bacteria than others. Ear infections were caused by bacteria 65 percent of the time, while strep tests revealed Streptococcus pyogenes bacteria causing that sore throat just 20 percent of the time.

Shots - Health News Despite Many Warnings, Antibiotics Are Still Overprescribed

Last year the American Academy of Pediatrics recommended that doctors use caution when prescribing antibiotics for ear infections. That included giving parents a "contingency" prescription to use if the child doesn't get better in a few days.

To find this out, the researchers combed through studies published between 2000 and 2011. They also looked at doctor-office visits in the National Ambulatory Medical Care Survey to see what medications were prescribed.

There was only one study on sinusitis, bronchitis and upper-respiratory infections that met study criteria, so it doesn't address use of antibiotics for those conditions.

Shots - Health News Why Scientists Are Trying Viruses To Beat Back Bacteria

The big problem is that aside from the strep test, there are no quick, simple ways to test a child to see whether an illness is caused by bacteria or viruses.

So parents and doctors have to guess.

This study does give parents and health-care providers a bit more information on the odds of getting benefits from antibiotics.

For instance, the researchers suggest that bronchitis, upper-respiratory infections, sore throats and ear infections in children over age 2 would be good candidates for waiting a bit before prescribing or offering a prescription if the child gets worse.

Copyright 2014 NPR. To see more, visit
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Patients Vulnerable When Cash-Strapped Scientists Cut Corners

NPR Health Blog - Mon, 09/15/2014 - 4:31am
Patients Vulnerable When Cash-Strapped Scientists Cut Corners September 15, 2014 4:31 AM ET Listen to the Story 8 min 15 sec  

Tom Murphy, 56, in his home in Gainesville, Va., was diagnosed with ALS four years ago. An experimental drug seems to have slowed the progression of his disease, he says, though most ALS patients aren't as lucky.

T.J. Kirkpatrick for NPR

There's a funding crunch for biomedical research in the United States — and it's not just causing pain for scientists and universities. It's also creating incentives for researchers to cut corners — and that's affecting people who are seriously ill.

Take, for example, the futile search for drugs to treat ALS, better known as Lou Gehrig's disease. The progressive, degenerative disease of the brain and nerve cells has been the focus of recent publicity, thanks to the Ice Bucket Challenge.

Four years ago, Tom Murphy went to see his doctor when he started noticing some slight muscle weakness.

"I actually thought I was just getting old," says the 56-year-old resident of Gainesville, Va. "I went to my general practitioner. He asked a few questions and told me to take my shirt off."

The doctor noticed some unusual muscle twitches — and sent Murphy directly to a neurologist. It turns out the news was bad. Murphy had ALS.

Tough News: 'You Won't Be Able To Use Your Hands And Arms'

"They told me I had two to four years," Murphy recalls. " 'Going to be pretty tough living, probably be in a wheelchair soon, won't be able to use your hands and arms.' So that was kind of tough — kind of tough news."

Shots - Health News U.S. Science Suffering From Booms And Busts In Funding

It's been 75 years since baseball great Lou Gehrig was diagnosed with this disease. Surely, Murphy thought, a good treatment has been developed since then. But, no.

Shots - Health News When Scientists Give Up

"I said, 'Are you guys telling me that there's really nothing you can do about this, after so many years?' " Murphy says. "And they said, 'Yeah, unfortunately we don't have anything.' "

The last hope was that Murphy could enroll in a clinical trial — the test of an experimental drug. A few U.S. trials were going on in the East, he learned.

Most patients fade so quickly, they only get one shot at an experimental treatment.

Murphy chose one. It was a long shot, and it turns out the odds were worse than he knew.

Evidence Flimsy For Most Experimental Treatments OF ALS

“ In the rush ... to get a wonderful story out on the street in a journal, and preferably with some publicity to match, scientists can cut corners.

Most of the experimental ALS drugs, it turns out, undergo very perfunctory testing in animals before moving into human tests — based on flimsy evidence.

Story Landis, director of the National Institute of Neurological Disorders and Stroke, says her institute plunked down $20 million to test one of these drugs in more than 400 ALS patients, "and what we discovered in the trial was the particular compound was of no benefit to the patients."

In hopes of figuring out why, scientists went back to take a second look at the mouse experiments that were the basis for the human study, and found them to be meager. Additional, more careful tests found no compelling reason to think the experimental drug would have ever worked.

Shots - Health News By The Numbers: Search NIH Grant Data By Institution

Landis has thought a lot about how those last-chance patients ended up in this untenable situation. There is no single answer, she says, but part of the explanation relates to a growing issue in biomedical science: the mad scramble for scarce research dollars.

"The field has become hypercompetitive," she says.

Many excellent grant proposals get turned down, simply because there's not enough money to go around. So Landis says scientists are tempted to oversell weak results.

"Getting a grant requires that you have an exciting story to tell, that you have preliminary data and you have published," she says. "In the rush, to be perfectly honest, to get a wonderful story out on the street in a journal, and preferably with some publicity to match, scientists can cut corners."

According to a research paper published earlier this year, corner-cutting turned out to be the rule, rather than the exception, in animal studies of ALS.

Stefano Bertuzzi, the executive director of the American Society for Cell Biology, says that's partly because there is little incentive for scientists to take the time to go back and verify results from other labs.

"You want to be the first one to show something," he says — not the one to verify or dispute a finding, "because you won't get a big prize for that."

It's even hard to get funding to run those sorts of confirmatory experiments in this hypercompetitive environment. (You can check here to learn how any and every U.S. university has fared in garnering research money from NIH.)

'Wishful Science' Plagues Testing Of Drug Candidates

Landis says ALS is not the only example of this type of wishful science. Similar problems emerged in the study of a drug being tested to see if it could protect the brain from the damage of a stroke. She says that test, too, showed the drug to be a dismal failure.

"A number of people have gone back and looked at the evidence and discovered that, in fact, there are a number of very straightforward things about the conduct of those studies that made it likely that the drug would fail when it went into people," she says.

Landis has since added new guidelines that scientists must follow before the neurology institute will fund large drug tests on people.

"There are now clinical trials that would have been funded five to seven years ago which won't be funded until the preclinical studies are done in a way that is actually believable," she says.

In principle, this should help scientists focus on more promising therapies. But it is also potentially discouraging for ALS patients like Murphy. In the short run, at least, animal studies are not identifying drugs that are promising candidates for treating ALS.

Shots - Health News Life After Ice Buckets: ALS Group Faces $94 Million Challenge

"Basically everybody says animal studies don't work," Murphy says. "They aren't representative of humans, at least in this disease. It's a really big issue in the ALS world."

Progress in treating the illness will likely require scientists to take a step back to identify better ways of searching for promising drugs. This means more painstaking work, not simply quick, cross-your-fingers studies with animals.

NIH expects to spend about $40 million this year on ALS research; the ALS Association hasn't yet decided how much of the more than $100 million it has raised so far through its wildly successful Ice Bucket Challenge will go to funding research.

One strategy for further research might be to look at the few people — including Murphy — who have done a bit better than average in the drug trials that have otherwise failed. That could simply be luck — or it could be a clue about individual differences in the way the disease plays out.

Whatever the outcome for the particular experimental drug he's getting, Murphy says he's grateful he has at least had the chance to try it.

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Pageant Contestant Felt Helpless Against Domestic Violence

NPR Health Blog - Sun, 09/14/2014 - 5:21am
Pageant Contestant Felt Helpless Against Domestic Violence September 14, 2014 5:21 AM ET

Several contestants in this year's Miss America pageant have chosen domestic violence as their platform topic.

Mel Evans/AP

This year's Miss America competition has involved lots of satin and some excellent ventriloquism by Miss Ohio. But it has also involved a public health issue that's been in the headlines over the past week: domestic violence.

Kira Kazantsev says she isolated herself from her friends when they tried to help her get away from an abusive boyfriend.

Jamie McCarthy/Getty Images

And it's not just because it's in the news. Miss New York, Kira Kazantsev, was in an abusive relationship during college.

Back in college, Kazantsev says that she wasn't aware that there were resources available for victims of domestic violence. "I very well may have Googled it," she says. "But that's not the mindset that you're in when you're in that situation. You just feel alone. You feel helpless. You don't feel like anyone could possibly understand."

The fact that people are asking why Janay Rice stayed with Baltimore Ravens running back Ray Rice after he knocked her unconscious in an elevator shows a lack of understanding of the complex psychology of domestic violence, Kazantsev tells Shots.

"I want people to stop asking 'Why doesn't she just leave?' " Kazantsev says. "Every woman is an expert in her own case, and there are so many extenuating circumstances that lead to a woman staying with her abuser."

The woman in the abusive relationship has to decide for herself that she wants to leave, Kazantsev says. The best thing friends and family can do is offer support.

"I definitely had friends that saw this and tried to help and didn't know what to do," she says. "And at that point I isolated myself. I was completely isolated from any help they were offering me."

The Two-Way Janay Rice Says Assault Video Has Brought A 'Nightmare' To Life

That's one reason that she chose to make domestic violence her "platform" topic for the Miss America pageant, which concludes Sunday. It's also the issue chosen by Miss West Virginia, Paige Madden, and Miss Delaware, Brittany Lewis. Lewis told the Associated Press that her sister had been in an abusive relationship for five years before she was fatally shot in her apartment. The case remains unsolved.

Ray Rice Video Sets Off Barrage Of Conversations

"The main goal is to get people talking about it," says Kazantsev. "If people are willing to talk about it, they're not scared of it, it's not taboo."

The uproar over the video showing Rice's assault on his then-fiancee, which resulted in his being cut from the Baltimore Ravens, seems to have accomplished that goal, at least for this week.

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

Kazantsev is working with Safe Horizon, a domestic violence advocacy group, to steer public conversations about abuse in the right direction.

The fact that Miss America contestants are talking about domestic violence is a good thing, says Barbara Paradiso, director of the Center on Domestic Violence at the University of Colorado Denver.

"I think we still hold on to some of those stereotypical beliefs. When we think about the typical victims of domestic violence, we think of someone who is poor, might not have many resources or is unintelligent," Paradiso says. "When you have someone who has been able to be as successful as a Miss America, that helps us put this in perspective."

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Newly Crowned Miss America Felt Helpless Against Domestic Violence

NPR Health Blog - Sun, 09/14/2014 - 5:21am
Newly Crowned Miss America Felt Helpless Against Domestic Violence September 14, 2014 5:21 AM ET

Several contestants in this year's Miss America pageant chose domestic violence as their platform topic.

Mel Evans/AP

Update at 11:50 p.m. EDT

Kira Kazantsev says she isolated herself from her friends when they tried to help her get away from an abusive boyfriend.

Jamie McCarthy/Getty Images

This year's Miss America competition has involved lots of satin and some excellent ventriloquism by Miss Ohio. But it has also involved a public health issue that's been in the headlines over the past week: domestic violence.

And it's not just because it's in the news. Miss New York, Kira Kazantsev — who was crowned Miss America 2015 in Sunday's ceremony — was in an abusive relationship during college.

Back then, Kazantsev says, she wasn't aware that there were resources available for victims of domestic violence. "I very well may have Googled it," she says. "But that's not the mindset that you're in when you're in that situation. You just feel alone. You feel helpless. You don't feel like anyone could possibly understand."

The fact that people are asking why Janay Rice stayed with Baltimore Ravens running back Ray Rice after he knocked her unconscious in an elevator shows a lack of understanding of the complex psychology of domestic violence, Kazantsev tells Shots.

"I want people to stop asking, 'Why doesn't she just leave?' " Kazantsev says. "Every woman is an expert in her own case, and there are so many extenuating circumstances that lead to a woman staying with her abuser."

The woman in the abusive relationship has to decide for herself that she wants to leave, Kazantsev says. The best thing friends and family can do is offer support.

The Two-Way Janay Rice Says Assault Video Has Brought A 'Nightmare' To Life

"I definitely had friends that saw this and tried to help and didn't know what to do," she says. "And at that point I isolated myself. I was completely isolated from any help they were offering me."

Ray Rice Video Sets Off Barrage Of Conversations

That's one reason that she chose to make domestic violence her "platform" topic for the Miss America pageant. It's also the issue chosen by Miss West Virginia, Paige Madden, and Miss Delaware, Brittany Lewis. Lewis told the Associated Press that her sister had been in an abusive relationship for five years before she was fatally shot in her apartment. The case remains unsolved.

"The main goal is to get people talking about it," says Kazantsev. "If people are willing to talk about it, they're not scared of it, it's not taboo."

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

The uproar over the video showing Rice's assault on his then-fiancee, which resulted in his being cut from the Baltimore Ravens, seems to have accomplished that goal, at least for this week.

Kazantsev is working with Safe Horizon, a domestic violence advocacy group, to steer public conversations about abuse in the right direction.

The fact that Miss America contestants are talking about domestic violence is a good thing, says Barbara Paradiso, director of the Center on Domestic Violence at the University of Colorado Denver.

"I think we still hold on to some of those stereotypical beliefs. When we think about the typical victims of domestic violence, we think of someone who is poor, might not have many resources or is unintelligent," Paradiso says. "When you have someone who has been able to be as successful as a Miss America, that helps us put this in perspective."

Copyright 2014 NPR. To see more, visit
Categories: NPR Blogs

Poets Give Voice To The Toll Of Type 2 Diabetes

NPR Health Blog - Sat, 09/13/2014 - 10:34am
Poets Give Voice To The Toll Of Type 2 Diabetes September 13, 201410:34 AM ET

Young poets Monica Mendoza (clockwise from top left), Erica Sheppard McMath, Obasi Davis and Gabriel Cortez have written about how Type 2 diabetes affects their families and communities.

Courtesy of The Bigger Picture

It may not seem like spoken-word poetry and diabetes have a lot to do with one another, but public health educators in California are using the art form to engage young people about the disease.

"Between growing up in Colón, Panama and a tour in the U.S. army, Grandpa is a proud old soldier marching through a never-ending war," Gabriel Cortez, 24, wrote in his poem "Perfect Soldiers." "At 66, we are scared that another stroke could do what no war ever could and cut him to the ground."

Two of Cortez's grandparents have diabetes. "Half of our neighborhood [looks] like the emergency ward of a hospital," he wrote.

"If you look at our community, you see it, but to have it named, I think, is an important thing," he tells Shots. Writing poetry is "another way of opening up the conversation."

Cortez wrote his poem last year during a workshop run by The Bigger Picture, a project that brings together University of California, San Francisco's Center for Vulnerable Populations and the literary nonprofit Youth Speaks. The goal is to encourage them to talk about diabetes and the risks it poses to the health of young people.

About 95 percent of the 29 million Americans with diabetes have the Type 2 variety, and the number of young adults and children with it is rapidly increasing. The problem is acute in poor, urban neighborhoods and in communities of color. Half of African-American youths and a third of Latino youths born in 2000 are expected to develop Type 2 diabetes at some point in their lives.

Back in 2011, Dr. Dean Schillinger heard Erica Sheppard McMath's poem, "Death Recipe" at a Youth Speaks event. The poem recounts the struggle of McMath, now 22, to stay healthy while much of her family struggles with obesity and diabetes:

It's like knowing most of your family has diabetes

but your still smacking on sour patches

as you're walking your aunt to her dialysis appointment

It's like Auntie Marlow being blind at 32

It's like Grandma Susie dying from a heart attack at 51

It's like cousin Kieara shooting insulin in her nine year old arm

"Young people can be such vocal and articulate revolutionaries in ways that old-fart doctors can't be," Schillinger says. He started the partnership between UCSF and Youth Speaks because he thought poetry could be a way to spark more conversations with young people about Type 2 diabetes.

The collaboration aims to shift the focus of the diabetes epidemic away from people's personal decisions. Schillinger says that Type 2 diabetes needs to be talked about in terms of a social disease.

The Bigger Picture holds workshops for teens and young adults to teach them about diabetes and to help them translate their reactions to the information into poetry.

Some of the best poems have been turned into short films that the organizers see as public service announcements. They've made about 20 so far, ranging from personal stories like McMath's to an over-the-top commercial satire called "Block O' Breakfast."

The Bigger Picture also takes its show on the road, conducting high school assemblies. So far, the team has worked with 40 poets and about 2,500 students in Northern California.

Twenty-nine-year-old José Vadi, who participated in the first Bigger Picture workshop and later facilitated them, now helps direct the project at Youth Speaks. He says that Type 2 diabetes is as much about class and access as it is health and diet.

"If you're traditionally disadvantaged economically, and you don't have the time to prepare a meal with fresh ingredients and whatnot, the idea of ... just putting something in your body to not be hungry, speaks to larger issues of inequality," Vadi says.

The Bigger Picture community also looks at the role food and beverage industries' marketing to minorities has played in the rise of diabetes. In the poem "A Taste of Home," 21-year-old Monica Mendoza says that "dinner has become an expedition where we lick our plates clean and swallow cups of nostalgia — nostalgia that isn't even from our own country. Our tongues have been colonized with the belief that this cup of Coke is home."

Cortez says he hopes the Bigger Picture poems will inspire youth anywhere in the country to write down their own experiences in a poem or a song, or to talk to their parents and friends "in a way they hadn't been able to before."

Lydia Zuraw is Washington, D.C., correspondent for the website Food Safety News.

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Opponents Spar In Court Over Texas Clinics That Do Abortions

NPR Health Blog - Fri, 09/12/2014 - 5:47pm
Opponents Spar In Court Over Texas Clinics That Do Abortions September 12, 2014 5:47 PM ET


Listen to the Story 2 min 24 sec  

Abortion-rights advocates filled the rotunda of the state capitol in July 2013 as Texas senators debated sweeping abortion restrictions. Some of those restrictions are now under federal review.

Tamir Kalifa/AP

A federal appeals court in New Orleans is reviewing whether 11 clinics that provide abortion in Texas must immediately close their doors because they don't comply with a state law requiring that they meet all the standards of an outpatient surgical center.

Shots - Health News Federal Judge Blocks Texas Restriction On Abortion Clinics Shots - Health News A Doctor Who Performed Abortions In South Texas Makes His Case

A three-judge panel heard arguments Friday for more than 90 minutes, first from the Texas solicitor general and then from a lawyer with the Center for Reproductive Rights, which is representing many of the Texas clinics. The questions from the judges centered mainly on what constitutes an "undue burden" when a woman is trying to get an abortion, and what fraction of Texas women would be affected.

Advocates say that about 20 clinics that perform abortions in Texas have already closed in advance of the law; if the court rules in Texas' favor, fewer than 10 clinics that provide abortion would remain in a state with a population of 26 million.

Both sides agreed that if the law is upheld, women in the Rio Grande Valley would have to travel more than 200 miles to San Antonio to get an abortion. But Jonathan Mitchell, the Texas solicitor general, said there was no good evidence that women weren't figuring out how to deal with that, and no evidence that if the abortion rate in Texas had fallen, that it was related to the law.

"An abortion law cannot be enjoined based on conjecture," Mitchell said. Judge Jennifer Elrod questioned him about a clinic's survey of 20 patients, presented at the trial in August. An expert testifying for the clinics said one patient surveyed said she did not get an abortion after the Texas law went into effect.

"He did not report she was unable to get it; he did not report she encountered an undue burden," Mitchell answered. "She could simply have changed her mind."

Supporters and opponents of Texas's controversial abortion law gathered Friday afternoon outside the 5th Circuit Court of Appeals in downtown New Orleans. Emily Horne (left) is a legislative associate with Texas Right to Life, a group that lobbied for the law.

Carrie Feibel/KUHF

Furthermore, patients in El Paso (where another clinic might close because it doesn't meet the standards of an outpatient surgical center) could just travel to New Mexico for an abortion, Mitchell added.

Stephanie Toti, with the Center for Reproductive Rights, argued on behalf of affected clinics such as Whole Woman's Health. She says lots of evidence was presented at the trial that women were facing numerous burdens exercising their constitutional right to an abortion. For example, a San Antonio clinic had offered gas cards and free bus tickets to women in the Rio Grande Valley who were seeking abortions, to help them travel north. But the patients told the clinic it wasn't just the distance and lack of money that made such travel difficult, but also problems with child care, getting time off work, and explaining to family why they needed to travel so far away.

Toti said a health outreach worker testified at the trial that women were experiencing obstacles to getting the procedure legally after clinics closed in the Rio Grande Valley. "She says she personally observed women turning to illegal means to get an abortion," Toti told the judges.

In a rebuttal, Mitchell called that testimony "vague," and said the worker couldn't give specific numbers of women doing that, and couldn't provide evidence that those choices stemmed from restrictions in the Texas law.

The three judges did not indicate when they would render their decision; but if they rule in favor of the state of Texas, the clinics would probably close immediately. The judges could also decide that some of the most isolated clinics could remain open, while others must close.

Federal district Judge Lee Yeakel ruled in August that the surgery center regulation had no health benefit and would place numerous burdens on any woman seeking an abortion, especially if she lived in the Rio Grande Valley or West Texas. Yeakel allowed the noncomplying clinics to remain open, but the state asked for an emergency motion to overrule Yeakel's decision and close them.

Sandy Jones (from left) of Houston, with Amelie Hahn and Michelle Colon, of Mississippi. Hahn and Colon are with Pink House Defenders, a group fighting for the last remaining abortion clinic in Mississippi.

Carrie Feibel/KHUF

Mitchell told the panel the state of Texas has a compelling interest in closing any clinics that it deems unsafe, and that's why the state sought an emergency motion to stay Yeakel's decision.

"If there is a Kermit Gosnell-type clinic in a state, and that's the last clinic in the state, I think everyone could agree that clinic could be shut down," Mitchell said, referring to a notorious doctor who performed abortions and was convicted of murder in Philadelphia last year.

Outside the courtroom, protesters carried signs.

Bethany Van Kampen, a recent law school graduate and board member of the New Orleans Abortion Fund, attended the hearing. She said it seemed that the judges were asking very hard questions of Toti.

"It's a bit discouraging," she said. "It felt very targeted. I felt our line of questioning was harder and more difficult and I think we tried to do our best."

Sandy Jones, an activist with Stop Patriarchy, traveled from Houston to attend. She said it seemed the judges had too narrow a focus.

"These are forces that are determined to criminalize every abortion, every woman, and make it inaccessible to every woman," Jones said. "And birth control, as we know, is not far behind. This is a war on women. This is a state of emergency."

Abortion opponents had also traveled from Austin and Fort Worth to listen.

"It's hard to say how this will go," said Emily Horne, a legislative associate for Texas Right to Life.

She said there was a need for Texas to seek this emergency hearing to shut down the noncomplying clinics right away. "It is a direct safety measure for the health and safety of Texas women, so we think that sooner is better to implement that," Horne said.

She said it was exciting to be there, and important for all states, not just Texas.

"Texas is definitely setting some precedents as far as what states are being allowed to pass," Horne added, "so there is a lot that does hinge on this."

This story is part of a reporting partnership between NPR, Houston Public Media and Kaiser Health News.

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Health Costs Inch Up As Obamacare Kicks In

NPR Health Blog - Fri, 09/12/2014 - 11:44am
Health Costs Inch Up As Obamacare Kicks In September 12, 201411:44 AM ET

Partner content from



Doctors and hospitals treated more patients and collected more payments in the spring as millions gained insurance coverage under the health law, new figures from the government show.

But analysts called the second-quarter increases modest and said there is little evidence to suggest that wider coverage and a recovering economy are pushing health spending growth to the painful levels of a decade ago.

Thursday's results from the Census Bureau's survey of service industries join other recent cost indicators that "are quite a bit lower than what the folks at CMS were projecting," said Charles Roehrig, director of the Center for Sustainable Health Spending at the Altarum Institute, a nonprofit research and consulting outfit. "And they're lower than what we were expecting as well."

CMS is the Centers for Medicare & Medicaid Services, the government's main health care bookkeeper. Last week CMS projected that health-expenditure growth would accelerate to 5.6 percent this year from an estimated 3.6 percent in 2013.

But health and social spending as measured by the Census Bureau grew by only 3.7 percent from the second quarter of 2013 to the same quarter of 2014. Hospital revenue increased 4.9 percent during the same period. Revenue for physician offices barely budged, growing by only 0.6 percent. Medical lab revenue rose 1.9 percent.

The report is far from being the last word. It doesn't include spending on prescription drugs, which has been rising this year thanks to new very expensive medicines for hepatitis C.

And while the Census Bureau's year-over-year results for the second quarter show tame cost trends, the increase from the first quarter to the second was more substantial. Total health and social spending rose at an annual rate of more than 12 percent from first quarter to the next. If sustained, such acceleration would raise alarms and actuaries' blood pressure.

But some who follow costs closely don't think the pace will continue.

First, health spending suffered a mini-crash over the winter, as bad storms kept people away from caregivers. Hospitals and doctors billed less from January to March than they did last fall. Part of the second-quarter recovery may just have been catch-up, analysts said.

At the same time, many people covered through the health law's online marketplaces didn't sign up until close to the deadline at the end of March. Much of the spring increase may represent a one-time surge as those folks sought treatment for previously neglected conditions.

For those reasons, the year-over-year results for the second quarter may give a better indication of longer-term cost trends than the change from the first quarter to the second, Roehrig said.

Estimates vary, but no one disputes the idea that the Affordable Care Act's health insurance marketplaces and expansion of Medicaid for the poor have added millions of previously uninsured people to coverage rosters this year.

History and logic suggest that expanded coverage and an improving economy will boost long-term, national health expenditures from their average growth rate of 3.7 percent during the past five years. (That's spending by everybody — government programs, employer insurance, commercial plans and consumers paying out of pocket.)

But so far the speedup seems nowhere close to the near-double-digit rates in the early 2000s.

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Changing Tack, GOP Candidates Support Over-The-Counter Birth Control

NPR Health Blog - Fri, 09/12/2014 - 3:30am
Changing Tack, GOP Candidates Support Over-The-Counter Birth Control September 12, 2014 3:30 AM ET Listen to the Story 4 min 53 sec  

A string of Republican candidates for Senate are supporting an issue usually associated with Democrats: easier access to contraception.

They're supporting it on the road and in ads, like one from anti-abortion conservative Cory Gardner. In it, he says he believes "the pill ought to be available over the counter, round the clock, without a prescription." Tom Tillis and Ed Gillespie, also anti-abortion conservatives, have made similar statements.


Some of them have been associated with state legislation to restrict abortions or with so-called personhood amendments that would give constitutional rights to fertilized eggs.

So what gives? First of all, Republicans are in a deep hole with female voters, and polls show all voters are less likely to support candidates who restrict women's reproductive rights. Republican strategist Katie Packer Gage says the GOP needed to get out of its defensive crouch.

She says when Republicans saw what happened to Mitt Romney in 2012, "where women's groups very falsely and very aggressively attacked him claiming that he wanted to do away with birth control," the party "started to say, 'Look, we're going to have to play offense on this message because otherwise we're going to be totally misdefined by our opponents.' "

Calling for an over-the-counter pill allows Republicans to support access to birth control while also supporting the right of corporations to avoid covering it. Getting the pill at a pharmacy without a prescription leaves insurers and employers out of the picture altogether.

But some Republicans are having trouble with their new talking points. Colorado Rep. Mike Coffman stumbled on the issue in a recent debate: "I am just pro-life, and I'm proud of that. And, uh, I do not support personhood. But, uh, I support a woman's access to, to, um, certainly to — this Hobby Lobby decision — to uh, to get ... "


At that excruciating moment, Coffman is rescued by the audience, which feeds him the word he's been looking for: "birth control."

The exchange is followed by laughter, but Democrats do not find this the least bit funny.

"It really is quite ironic that suddenly now the Republican Party and candidates, after voting repeatedly to take away birth control access for women, are trying to kind of do this before the November elections," says Cecile Richards, president of Planned Parenthood Federation of America.

"It has no credibility based on their voting records. ... What it demonstrates is how important women's health is as an issue to women voters and how important it will be in this election," she says.

Planned Parenthood is also for over-the-counter birth control. But so far, no drug company has asked the FDA for permission to sell contraception over the counter.

Democratic pollster Celinda Lake says Democrats should respond to Republicans with an argument about cost and fairness because insurers generally do not cover over-the-counter medicine, and the pill can cost $600 a year.

"When voters hear that Republicans support your employer denying coverage for birth control when Viagra is still covered, they're very angry about it," she says. "When we make the argument, it really backfires because women say this is going to cost me $600 and this is a very cynical ploy."

But Republican pollster Kellyanne Conway says Republicans have finally found a way to blunt the Democrats' charge that the GOP is conducting a so-called "war on women."

"What's happened with the over-the-counter birth control issue is that the Democrats didn't see it coming," says Conway. "They think that they've got a monopoly on talking to women from the waist down. Anything that has to do with reproduction and birth control and abortion — they call it women's health, then they call it women's issues. They feel like how dare the loyal opposition go ahead and take them on and really neutralize and defang this issue."

There's no doubt Republicans are trying harder this election year to appeal to women, which is a big difference from the past two cycles when some GOP candidates alienated female voters with comments about rape and unwanted pregnancies. Republicans know they can't eliminate the gender gap altogether; they just hope to shrink it enough to win elections.

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