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Eyeing That BB Gun For Christmas? Don't Go There, Doctors Say

Fri, 11/28/2014 - 9:03am
Eyeing That BB Gun For Christmas? Don't Go There, Doctors Say November 28, 2014 9:03 AM ET

In the 1983 movie A Christmas Story, all Ralphie wanted was a BB gun.

The Kobal Collection/MGM/UA

If you've seen the classic movie A Christmas Story, you know that Ralphie really, really wanted that BB gun. And you know that his mother, his teacher, even the department store Santa all said: "You'll shoot your eye out."

They're right, the nation's ophthalmologists say. And though BB guns still top the eye doctors' list of way-too-dangerous toys, each year there are new contenders for that dubious prize.

Like the Air Storm Firetek Bow, which makes it possible to shoot glowing brands across a darkened room. Am I alone in thinking that this sounds like tons of fun?

"At short range it packs a punch," says Dr. Jane Edmond, a pediatric ophthalmologist at Texas Children's Hospital and a spokeswoman for the American Academy of Ophthalmology. "It can cause bleeding, cataracts, retinal detachment."

That doesn't sound good. The foam on the Air Storm arrows isn't enough to prevent injury, Edmond explains.

That's why the Air Storm bow ended up at the top of the "10 worst toys" list for WATCH, a nonprofit promoting toy safety.

The original steel Jarts — fun, but ultimately just too dangerous.

Courtesy of Walnut Street Antiques

Truth be told, my family abandoned our all-out Nerf gun battles after a suction-cup dart nailed my husband right in the eye. Luckily he had glasses on; they stopped the dart. Otherwise he might have been on the way to the ER, too.

"Parents need to weigh in and use their common sense," Edmond says. Wearing polycarbonate glasses or goggles will shield eyes against projectiles. But they don't come with the Air Storm Firetek Bow or indeed any toy I can think of.

For toys like a BB gun or a trampoline, the sense of danger is part of what makes it such exhilarating fun. As a child, I loved throwing heavy steel Jarts across the yard with my brothers.

But Jarts were banned in 1988, after thousands of children were seriously injured by the projectiles. Some were killed. In 2012, the American Academy told parents not to buy home trampolines because of the high injury count.

So I keep weighing thrill vs. caution in the toy aisle. I've let my daughter shoot a BB gun and go hang gliding. But I'm resisting the trampoline, despite serious kid pressure.

This is one Christmas when there won't be a glowing crossbow under the tree, either.

Zing Toys/YouTube

Who wouldn't want to shoot glowing arrows in the dark? But doctors say projectile toys like this pose a danger to eyes.

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How Dogs Understand What We Say

Fri, 11/28/2014 - 4:06am
How Dogs Understand What We Say November 28, 2014 4:06 AM ET Listen to the Story 3 min 43 sec  

Do you want to go to the park? Mango Doucleff, of San Francisco, responds to her favorite command by perking up her ears and tilting her head.

Michaeleen Doucleff/NPR

Scientists — and anyone who lives with a canine — know that dogs pay close attention to the emotion in our voices. They listen for whether our tone is friendly or mean, how the pitch goes up or down and even the rhythms in our speech.

But what about the meaning of the words we say?

Sure, a few studies have reported on super smart dogs that know hundreds of words. And Chaser, a border collie in South Carolina, even learned 1,022 nouns and commands to go with them.

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But otherwise, there's little evidence that dogs differentiate between speech with meaningful words from sounds that contain only inflections, says neurobiologist Attila Andics, at the MTA-ELTE Comparative Ethology Research Group in Budapest.

"We know quite a bit about how much dogs get about how we say things, Andics says, "but we know quite little about how much dogs get about what we say to them."

That's about to change.

Psychologists reported Wednesday in the journal Current Biology that dogs do pay attention to the meaning of words. And they process that information in a different part of the brain than where they process emotional cues in speech.

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To figure all that out, graduate student Victoria Ratcliffe at the University of Sussex in England set up a clever experiment.

She brought 250 dogs into the lab. And then for each one, Ratcliffe put a speaker on either side of the dog's head.

Then she played the command "to come" out of both speakers, at the same time. At first, the command sounded normal. It had both meaningful words and emotional cues in it.

Then Ratcliffe started to manipulate the speech in the command. In some instances, she removed all the inflections in the speaker's voice. In other instances, she kept the inflections in the speaker's voice but removed the words (or replaced the words with gibberish).

For each command, Ratcliffe recorded which way the dogs turned their heads — toward the left speaker or toward the right speaker. Even though both speakers were playing the same sounds, a clear pattern emerged.

When the dogs heard commands that still had meaningful words in them, about 80 percent of the animals turned to the right. When they heard commands, with just emotional cues in them, most dogs turned to the left.

That result sounds simple. But Andics, who wasn't involved in the study, says the findings show something surprising: "That dogs are able to differentiate between meaningful and meaningless sound sequences."

The study also suggests that a dog's brain breaks up speech into two parts: the emotional cues and the meaning of the words. Then it processes these two components on opposite sides of the brain: emotional cues on the right, meaning of words on the left. (Yes, it's opposite to the way the dogs turned.)

That's a bit similar to how we humans process speech. We also break up speech into several parts, such as the meaning of the words, clues about the speaker and emotional cues.

"But with humans, it's trickier," Andics says. "We believe the human brain processes various aspects of human speech in different stages and in many different parts of the brain."

Still though, Andics says the new study offers one way that people may be able to communicate better with their best friends: Pick the ear you use carefully.

"Tell all the emotional things to the dog in his left ear," Andics says. "For commands that you want a dog to get clearly and precisely, tell them in right ear."

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Your Adult Siblings May Be The Secret To A Long, Happy Life

Thu, 11/27/2014 - 9:03am
Your Adult Siblings May Be The Secret To A Long, Happy Life November 27, 2014 9:03 AM ET Robin Marantz Henig Katherine Streeter for NPR

Somehow we're squeezing 16 people into our apartment for Thanksgiving this year, with relatives ranging in age from my 30-year-old nephew to my 90-year-old mother. I love them all, but in a way the one I know best is the middle-aged man across the table whose blue eyes look just like mine: my younger brother Paul.

Paul and I kind of irritated each other when we were kids; I would take bites out of his precisely made sandwiches in just the spot I knew he didn't want me to, and he would hang around the living room telling jokes when he knew I wanted to be alone with the boy on the couch.

“ Most sibling relationships are close — two-thirds of people in one large study said a brother or sister was one of their best friends.

But as adults, we've always had each other's backs, especially when it comes to dealing with our mother's health crises, which have become more frequent in the past few years. Paul is the first person I want to talk to when there's something that worries me about Mom; I know he'll be worried, too.

There's probably a biological explanation for the intensity of the sibling bond. Siblings share half their genes, which evolutionary biologists say should be motivation enough for mutual devotion. ("I would lay down my life," British biologist J.B.S. Haldane once said, applying the arithmetic of kin selection, "for two brothers or eight cousins.") Siblings are a crucial part of a child's development, too, teaching one another socialization skills and the rules of dominance and hierarchy, all part of the eternal struggle for parental resources.

“ One thing that can scuttle closeness in adulthood is a parent who played favorites in childhood; this sense of resentment can last a lifetime.

When psychologists study siblings, they usually study children, emphasizing sibling rivalry and the fact that brothers and sisters refine their social maneuvering skills on one another. The adult sibling relationship has only sporadically been the subject of attention. Yet we're tethered to our brothers and sisters as adults far longer than we are as children; our sibling relationships, in fact, are the longest-lasting family ties we have.

Most such relationships are close — two-thirds of people in one large study said a brother or sister was one of their best friends. One thing that can scuttle closeness in adulthood is a parent who played favorites in childhood; this sense of resentment can last a lifetime.

Jill Suitor, a sociologist at Purdue University, and her colleagues polled 274 families with 708 adult children (ages 23 to 68) in 2009 and found that the majority had good feelings toward their siblings. Most didn't remember much favoritism when they were kids, but those who did reported feeling less loved and cared for by their siblings. It didn't matter whether they felt themselves to be the favored or the unfavored child. The simple perception of parental favoritism was enough to undermine their relationship.

“ During middle age and old age, indicators of well-being – mood, health, morale, stress, depression, loneliness, life satisfaction – are tied to how you feel about your brothers and sisters.

That's one thing Paul and I have going for us: We're pretty sure our parents treated us the same when we were growing up. Yet we're very different people. Paul is gregarious while I'm shy, funny while I'm not, a terrific amateur saxophonist while I can't read music or carry a tune. This isn't unusual. In families with more than one child, every sibling seems to get a label in contrast to every other sibling.

So if your kid sister is the queen bee in any social gathering, you might get labeled "the quiet one" even if you're not especially quiet, just quiet in comparison. And if you're a bright child who always gets good grades, you might not get much credit for that if your big brother is a brilliant child with straight As. There's only room for one "smart one" per family — you'll have to come up with something else. (I was smart, but Paul was smarter; I ended up being the "good one.")

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The very presence of siblings in the household can be an education. When a new baby is born, writes psychologist Victor Cicirelli in the 1995 book Sibling Relationships Across the Life Span, "the older sibling gains in social skills in interacting with the younger" and "the younger sibling gains cognitively by imitating the older."

They learn from the friction between them, too, as they fight for their parents' attention. Mild conflict between brothers and sisters teaches them how to interact with peers, co-workers and friends for the rest of their lives.

The benefits can carry into old age. The literature on sibling relationships shows that during middle age and old age, indicators of well-being — mood, health, morale, stress, depression, loneliness, life satisfaction — are tied to how you feel about your brothers and sisters.

In one Swedish study, satisfaction with sibling contact in one's 80s was closely correlated with health and positive mood — more so than was satisfaction with friendships or relationships with adult children. And loneliness was eased for older people in a supportive relationship with their siblings, no matter whether they gave or got support.

“ Because of the particular intensity of sibling relationships, conflict cuts to the bone. People grieve for the frayed ties to their siblings as though they've lost a piece of themselves.

That's why it's so sad when things between siblings fall apart. This often happens when aging parents need care or die — old feelings of rivalry, jealousy and grief erupt all over again, masked as petty fights ostensibly over who takes Mom to the doctor or who calls the nursing home about Dad.

Many families get through their parents' illnesses just fine, establishing networks where the workload is divided pretty much equally. So far, Paul and I have done fine, too. But about 40 percent of the time, according to one study, there is a single primary caregiver who feels like she (and it's almost always a she) is not getting any help from her brothers and sisters, which can lead to serious conflict.

And because of the particular intensity of sibling relationships, such conflict cuts to the bone. People grieve for the frayed ties to their siblings as though they've lost a piece of themselves.

So let this all percolate as you sit down to turkey with your sometimes-complicated family. And remember the immortal words of folksinger Loudon Wainwright III, in a song called Thanksgiving. It's about spending the holiday with a brother and a sister he rarely sees but still has intense feelings about:

"On this auspicious occasion, this special family dinner/If I argue with a loved one, Lord, please make me the winner."

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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Millennial Doctors May Be More Tech-Savvy, But Is That Better?

Thu, 11/27/2014 - 3:49am
Millennial Doctors May Be More Tech-Savvy, But Is That Better? November 27, 2014 3:49 AM ET

fromKERA

Lauren Silverman Listen to the Story 5 min 5 sec  

Medical residents including Dr. Amy Ho (bottom right) helped with first aid at the Pitchfork Music Festival in Chicago.

Courtesy Amy Ho

The University of Texas Southwestern class of 2014 is celebrating graduation. Class vice president Amy Ho has shed her scrubs for heels and a black dress. She says with modern technology, med school really wasn't too hard.

"If you want to do the whole thing by video stream, you can," she says. "I would wake up at 10 a.m., work out for an hour or so, get some lunch and then video stream for 6 hours and then go to happy hour. It actually was not that bad."

Millennial physicians like Ho are taking over hospital wards and doctors' offices, and they're bringing new ideas about life-work balance and new technologies.

One time, a patient asked Ho if it was OK if he recorded her performing a minor surgical procedure.

"He Instagram-videoed the entire procedure," she says. "It's not that a senior physician couldn't do it — I think that they might not have the comfort level."

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She means comfort with technology. Millennial doctors want offices that are high-tech. Many have never worked with paper charts and they don't read dusty medical journals — they look at them online.

"We absolutely consult Wikipedia, not the library to find the most up-to-date medical research," she explains.

When young docs meet with patients, it's a safe bet they'll be behind a laptop or at least glancing at their smartphones.

This is a big change from prior generations.

"I think the physician patient relationship has suffered," says Dr. Rick Snyder, a cardiologist from the baby boom generation and past president of the Dallas County Medical Society.

He worries that what's happening with young doctors is like what happened to young soldiers during Vietnam — yes, that's the analogy he used — when fighters became too reliant on technology and lost their dogfighting skills.

"We as physicians, that's our dogfighting skills: talking to a patient, interacting with a patient," he says. "We really are required to spend more time with technology and our computers than we are with a patient."

The old guard, Snyder says, well, they just worked more.

"Your job came first. It was your family life; your personal life was second. You were supposed to sacrifice that. The newer generation, they're more willing to ask the question, 'Well, how much vacation time do I have? How much time do I have with my family?' Where, in my day, that could be a killer," he says.

In the 1980s, residents spent so much time training at hospitals, Snyder says, that some med schools would talk about the divorce rate among med students as a badge of honor. Thirty-hour shifts were standard. Now, first-year residents aren't allowed to work more than 16-hour shifts.

This reflects a larger trend of doctors working fewer hours and in teams.

Dr. Sadi Raza with his wife, Dr. Samreen Raza.

Courtesy Sadi Raza

Dr. Sadi Raza has a lot in common with Dr. Snyder — they work in the same office, and both have wives who are also cardiologists. But Raza is a millennial.

"My generation of physicians, when they come out of training, they are far less likely to go into solo practice," says Raza.

Raza says virtually no one wants to be like the iconic doctor Marcus Welby — yeah, I had to look that up, too — working alone and making house calls. Millennial physicians are choosing hospital teams and group practices.

"In some ways you go home with your work, but you're also working less hours and it's less stressful because your burden isn't on you exclusively, because of the team approach. There are people you can share management of a patient with," he says.

The number of physicians employed by hospitals, rather than going solo, has doubled over the past decade, according to Dr. Robert Kocher, who wrote an article in the New England Journal of Medicine.

Sharing patients, working less — the hope is that physicians won't burn out so fast. But some baby boomer doctors say practicing medicine with this kind of "sharing economy" approach could be bad for patients' health.

Among them is Dr. Karen Sibert, an anesthesiologist in Los Angeles.

"If you are having too many handoffs of care between one physician and another physician, and another physician, it's almost like the game you play when you were a kid — that you whisper a sentence in a circle, and see how screwed up it gets at the end of the game. It's like that, only way more dangerous," says Sibert.

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She bristles at the thought of working part time or less than 10 hour days. But working fewer hours doesn't mean millennials aren't out to change the world. After all, they are millennials.

Take Amy Ho. Like many young doctors, she's combining patient care with policy work to reform the health care system. In addition to practicing emergency medicine, Ho is on the board of directors for the American Medical Association's Political Action Committee (AMPAC).

And she has a message for patients worried about the next generation of doctors: "Regardless, there's one thing that I think holds true for every generation," she say. "Everyone is there to try and take care of you. Everyone is there because they want to take care of patients."

Whether it's with a pen or a quill or a smartphone, she says, you'll still be in good hands.

Copyright 2014 KERA Unlimited. To see more, visit http://www.kera.org/.
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Those Phone-Obsessed Teenagers Aren't As Lonely As You Think

Wed, 11/26/2014 - 1:58pm
Those Phone-Obsessed Teenagers Aren't As Lonely As You Think November 26, 2014 1:58 PM ET

A recent dinner with my friends went something like this:

"Wait, who is going to take a Snapchat of all of us when our drinks arrive?"

"Oh no, I can't! My phone is dying."

"Guys, this is such a stereotypical millennial conversation. I am totally tweeting about this."

So I guess I understand why older folk fret that youngsters these days are losing out on authentic social connections because of social media.

But it looks like the kids are going to be all right, researchers say. High school students in 2012 reported lower levels of loneliness than their counterparts in 1991, according to a study published Monday in the Personality and Social Psychology Bulletin.

Researchers from the University of Queensland in Australia arrived at that conclusion after analyzing data from the Monitoring the Future Project, which surveys about 50,000 American high school students annually. The survey gauged loneliness by explicitly asking students how lonely they felt, and by assessing how included and supported they felt among friends.

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Though the researchers didn't find any dramatic changes, the survey results suggest that loneliness has been declining — slowly and ever so slightly — for the past 30 years. The report also found that teens these days may have fewer close confidants — but they also feel less of a need to make more friends.

"This was a bit unexpected," says David Clark, a Ph.D. candidate at the University of Queensland's department of psychology, who led the study.

It could be that young people today are more individualistic than they used to be; they may not need as much social interaction to feel satisfied, Clark notes. But at this point, researchers can't explain what is responsible for these trends.

"More than anything, this shows that things aren't as bad as people might think," he says.

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It also shows that while the Internet has changed the way we communicate, it hasn't necessarily changed much else, says Kali Trzesniewski, a social and developmental psychologist at the University of California, Davis who wasn't involved in the research.

There's a lot researchers still don't understand about the impact of social media on mental health, and it's clear that some ways of using social media are healthier than others, Trzesniewski says. But it's unlikely that Facebook and Twitter are fundamentally altering human nature.

Despite their penchant for selfies, on average the teens of "Generation Me" aren't any more egotistical or self-assured than teens of generations past, according to a study Trzesniewski led in 2010.

"There's been a lot of concern that the social media is harming people's social lives," she says. "But the research shows that overall the Internet and social networking don't seem to be having a negative impact."

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If Supreme Court Strikes Federal Exchange Subsidies, Health Law Could Unravel

Wed, 11/26/2014 - 12:28pm
If Supreme Court Strikes Federal Exchange Subsidies, Health Law Could Unravel November 26, 201412:28 PM ET

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Julie Rovner

Supreme Court police stand guard during a storm in March.

Michael Reynolds/EPA/Landov

Exactly what would happen to the Affordable Care Act if the Supreme Court invalidates tax credits in three dozen states where the federal government runs the program?

Legal scholars say a decision like that would deal a potentially lethal blow to the law because it would undermine the government-run insurance marketplaces that are its backbone, as well as the mandate requiring most Americans to carry coverage.

In King v. Burwell, the law's challengers argue that Congress intended to limit federal tax credits to residents of states running their own insurance exchanges. Currently only 13 states and the District of Columbia operate exchanges on their own; another 10 are in some sort of partnership with the federal government. Federal officials run the rest.

Should the justices find that subsidies in federal exchanges are not allowed, "I don't think there are any rosy scenarios," said Timothy Jost, a law professor at Washington and Lee University and a supporter of the law. "It's a complete disaster."

The immediate impact would be that the Internal Revenue Service would stop paying subsidies to those in federally run exchanges.

In 2014, more than 4.6 million people were getting those subsidies but the number is projected to grow to as many as 13 million by 2016.

Most of those who lose subsidies would no longer be required to have insurance, because they would fall into an exemption in the law for those who have to pay more than 8 percent of family income for premiums.

"Since a lot of people can't afford insurance without the tax credits, you're looking at a lot of people shedding coverage," says Nicholas Bagley, a law professor at the University of Michigan.

Those who hang onto their coverage and pay the premium without help "are likely to be sicker on average than the people who shed their coverage because they're the ones who need insurance the most," he says.

Indeed, the insurance industry argued in a legal brief for a related case that elimination of the federal exchange subsidies could seriously undermine those markets, creating an insurance death spiral.

"A sicker pool of consumers results in higher premiums, which causes an additional relatively healthy subset of participants to drop out, which in turn results in a further increase in premiums," the group's trade group, America's Health Insurance Plans, said in its brief.

Eliminating subsidies also would undermine the so-called employer mandate that seeks to require larger firms to provide coverage. That's because it requires employers to pay a fine if their employees obtain subsidies on the exchange. If there are no subsidies, there are no employer fines and thus effectively, no mandate.

So what could be done? Some have argued that states that rely on the federal government to run their exchanges could establish their own marketplaces. But legal experts believe that's problematic as well.

"The practical obstacle is that creating an exchange is not child's play," says Bagley. "They've got to be able to carry out a variety of functions," including working with consumer assistance groups and overseeing plan's compliance with the laws.

While some have suggested that states could create a "virtual" exchange on paper and then contract with the federal government to run it, Bagley says the law on the subject is pretty explicit. "States would have to do more than just the bare minimum," he said.

Timing and financing would also pose practical problems. The final deadline for states to apply for federal funding to establish an exchange has passed. And a Supreme Court decision is likely to come in late June of next year, which is after another deadline (June 15) for states to use their own funds to establish an exchange in time for the 2015-16 open enrollment season.

The political obstacles are potentially even bigger.

In six states, even if a governor wanted to establish an exchange, the state legislature has specifically taken that authority away, according to the National Conference of State Legislatures. Georgia became the seventh state earlier this year.

That means state legislatures will have to get involved, said Bagley.

And many "are full of new members after the mid-term elections who specifically campaigned against the ACA."

Still, not everyone is convinced all this would spell the ACA's end.

"Congress will step in," predicts health economist Tom Miller of the conservative American Enterprise Institute.

"We're going to have the kind of political give and take which was abbreviated and artificially truncated when the law was passed," he said. "It's not a pretty process, but that's why we have a government and we elect people."

Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.

Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Patient Safety Journal Finds Violations, Tightens Standards After Scandal

Wed, 11/26/2014 - 9:30am
Patient Safety Journal Finds Violations, Tightens Standards After Scandal November 26, 2014 9:30 AM ET

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Marshall Allen

The aftershocks of what some have called the patient safety movement's first scandal continue to reverberate in the medical community, most recently in the current issue of the Journal of Patient Safety.

The journal's editorial team reviewed 10 articles by Dr. Chuck Denham, the publication's previous editor, and said nine had potential conflicts of interest, five of them undisclosed. Though it's unlikely the articles resulted in patient harm, the editorial said, they may have hurt the journal's credibility.

The review is the latest turn in a rapid fall from grace for Denham, whose business dealings and patient advocacy came under scrutiny this year after a Justice Department kickback settlement.

A year ago, Denham was a golden figure in the burgeoning patient safety movement, a smooth-talking advocate who brought Hollywood pizzazz to the cause with his connection to actor Dennis Quaid and commitment to filmmaking.

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As ProPublica reported, Denham also served in other prominent patient safety posts — most notably as co-chairman of a committee that set guidelines for the National Quality Forum, a nonprofit group that endorses best practices that are widely adopted throughout the healthcare community.

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He ran a nonprofit patient safety organization and a for-profit consulting business, but Denham wasn't a practicing physician and didn't have strong academic credentials.

The scandal started when the Justice Department accused Denham of taking $11.6 million in kickbacks from CareFusion, a pharmaceutical company that makes the surgical antiseptic ChloraPrep. Denham wasn't a defendant in the civil case, which the company settled for $40 million. But prosecutors claimed he was paid to influence recommendations of the Quality Forum in favor of the drug.

Denham has denied the allegations. He didn't return a call for comment about this story.

On Jan. 28, ProPublica reported that Denham hadn't disclosed that his for-profit company had been paid by CareFusion while he led the Quality Forum's Safe Practices committee and advocated for ChloraPrep's formulation. The Quality Forum ended up endorsing the formulation, excluding other antiseptics, in its guidelines. Other experts on the panel told ProPublica that hadn't been their intent.

The Quality Forum cut its ties with Denham, as did the Journal of Patient Safety.

A new editorial board was appointed in Denham's wake. The editors wrote in their review that they were surprised when Denham was named editor in February 2011. They hadn't been consulted, there was no formal search process and Denham had previously published only 17 academic articles.

A spokeswoman for Wolters Kluwer Health, the company that publishes the Journal of Patient Safety, told ProPublica that Denham was appointed because he was a prominent member of the editorial board who had been recommended by the previous editor.

The Denham articles that editors reviewed included no direct references to ChloraPrep. But the articles contained numerous references to the Quality Forum's Safe Practices guidelines. That was a potential conflict of interest given that the company that could have benefitted from Denham's control of the guidelines, the editors concluded.

"This is a clear violation of the standards of the Journal," the editors wrote.

Dr. Albert Wu, an associate editor with the journal and a professor in the Johns Hopkins Bloomberg School of Public Health, said it was clear when Denham's ties to CareFusion became public that a review of his published work would be necessary.

Wu said the Denham controversy has helped the patient safety movement grow up by showing that the world of quality improvement presents opportunities for industry to corrupt medical practice.

People are becoming as wary and aware of the influence of money on patient safety as they have been in the world of medical devices and pharmaceuticals, he said.

"We're now much more aware that we need to be more vigilant," Wu said.

The Journal of Patient Safety launched in 2005 and hadn't adopted some of the conflict-of-interest standards of the International Council of Medical Journal Editors. Now conflict-of-interest forms will be published with articles, and editors will publish disclosure statements and recuse themselves from decisions where they have conflicts.

The new editors should be commended for airing their dirty laundry because the openness will build trust, said Eric Campbell, a professor of medicine at Harvard Medical School.

"The reputation of a journal is all it has," said Campbell, a sociologist who studies conflicts of interest.

Campbell said the controversy opened the eyes of many in the patient safety field to the notion that money could corrupt, "even something as awesome and great for society as patient safety."

Have you or a loved one been harmed while undergoing medical care? ProPublica wants to hear your story. Please complete the ProPublica Patient Harm Questionnaire.

Copyright 2014 ProPublica. To see more, visit http://www.propublica.org/.
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Administration Warns Employers: Don't Dump Sick Workers From Plans

Tue, 11/25/2014 - 4:16pm
Administration Warns Employers: Don't Dump Sick Workers From Plans November 25, 2014 4:16 PM ET

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As employers try to minimize expenses under the health law, the Obama administration has warned them against paying high-cost workers to leave the company medical plan and buy coverage elsewhere.

Such a move would unlawfully discriminate against employees based on their health status, three federal agencies said in a bulletin issued in early November.

Brokers and consultants have been offering to save large employers money by shifting workers with expensive conditions such as hepatitis or hemophilia into insurance marketplace exchanges established by the health law, Kaiser Health News reported in May.

The Affordable Care Act requires exchange plans to accept all applicants at pre-established prices, regardless of existing illness.

Because most large employers are self-insured, moving even one high-cost worker out of the company plan could save a company hundreds of thousands of dollars a year. That's far more than the $10,000 or so it might give an employee to pay for an exchange plan's premiums.

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"Rather than eliminating coverage for all employees, some employers ... have considered paying high-cost claimants relatively large amounts if they will waive coverage under the employer's plan," Lockton Cos., a large brokerage, said in a recent memo to clients.

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The trend concerns consumer advocates because it threatens to erode employer-based coverage and drive up costs and premiums in the marketplace plans, which would absorb the expense of the sick employees. The burden would fall on consumers buying the plans and taxpayers subsidizing them.

Administration officials approached independent lawyers about the practice in May, saying, "We don't like this, but how can we address this?" said Christopher Condeluci, principal at CC Law & Policy, a legal firm. This month's guidance, he said, "is the first time that they've come out explaining how and why the administration believes it violates the law."

The Affordable Care Act itself doesn't block companies from paying sick workers to find coverage elsewhere, lawyers said. But other laws do, including the Health Insurance Portability and Accountability Act and the Public Health Service Act, according to three federal agencies.

Specifically, paying a sick worker to leave the company plan violates those statutes' restrictions on discriminating against employees based on medical status, the departments said in their bulletin.

"If you were to cherry-pick your high-cost individuals and offer them money to send them over to the exchange ... this would be a violation of HIPAA," according to the regulators, said Amy Gordon, a benefits lawyer with McDermott Will & Emery.

The agencies publishing the guidance were the departments of Labor, Treasury and Health and Human Services.

Starting next year, the health law requires large employers to provide medical insurance to most workers or face fines.

How many companies have offered to pay workers with chronic conditions to find coverage elsewhere is unclear.

"I know there are some brokers out there that were pushing this, but it was a limited number that I had heard about," Condeluci said. Even so, he added, the attitude of the administration was: "We don't want it to become widespread. Let's nip it in the bud now."

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

Drugged Marshmallows Can Keep Urban Raccoons From Spreading Disease

Tue, 11/25/2014 - 2:50pm
Drugged Marshmallows Can Keep Urban Raccoons From Spreading Disease November 25, 2014 2:50 PM ET Alison Bruzek

Does this little guy look familiar? Clean up his feces in your yard to avoid infection from his parasites.

iStockphoto

The masked garbage crusaders of the night can be more than just a nuisance. Raccoons also can be bad news for human health, carrying diseases such as rabies and roundworms.

And because raccoons have happily colonized cities and suburbs, a particular roundworm called Baylisascaris procyonis that the critters often carry can make its way into humans. The parasite's eggs are carried in raccoon poop.

When ingested, the eggs release the worm, which can burrow into the eyes and brain causing blindness or even death, in rare cases.

Shots - Health News Risky Raccoon Roundworms Found In Pet Kinkajous

Don't freak out. There have only been 30 reported cases of severe or fatal human infection in the U.S. over the past 30 years. And while researchers believe that many of the infections aren't reported, they say most infections are likely subtle and go unnoticed.

Small children face a higher risk, because they're more likely to stick a fistful of dirt into their mouth from the backyard or playground. Raccoons often use the areas around decks, patios and playhouses as bathrooms.

But if you can't beat 'em, it turns out you can bait 'em. Putting baits containing worm medicine in the raccoon poop zones can keep the animals from spreading the parasite, according to a study published in the December issue of Emerging Infectious Diseases.

The researchers, led by Kristen Page, an ecologist at Wheaton College in Illinois, got down and dirty, studying raccoon hangouts at about 60 sites around Chicago. They wanted to know if there were practical solutions for keeping city folks safe from the critter's parasite.

They tested raccoon poop from each site and found about 13 percent of the droppings contained roundworm eggs. However, after baiting monthly for a year with a delicious mix of marshmallow creme laced with pyrantel pamoate (a drug used to deworm dogs and cats), only 3 percent of the feces from the baited sites contained worm eggs.

"If you deworm the raccoons once a month, then the worms never mature enough to produce eggs," Page tells Shots.

The baiting is a more environmentally friendly way to get rid of the parasites. Current methods use a blowtorch to burn the land. "The eggs are really resistant to temperature change," says Page. "[A] Midwestern summer won't kill them and certainly our winters won't kill them." We don't know how long the eggs last in the wild, she says, but it's upwards of 10 years.

As Shots has reported before, you can keep yourself and your kids safe by checking the yard once a month for raccoon feces. You should wear gloves to pick up any feces and put it in the garbage. If you're worried there may be roundworms still lurking, pour boiling water over the spot to ensure the eggs are dead.

Otherwise, use common sense: "Keep raccoons away from your home, monitor your children ... wash your hands, wear gloves when you work outside," says Sarah Sapp, a Ph.D. student at the University of Georgia who is studying the raccoon parasite.

And if you're thinking about an exotic pet raccoon, you might think again. The same worms are found in cute pet kinkajous, or, if you happen to be in China, the variety found in the local zoological garden.

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

Treatment For HIV Runs Low In U.S., Despite Diagnosis

Tue, 11/25/2014 - 1:16pm
Treatment For HIV Runs Low In U.S., Despite Diagnosis November 25, 2014 1:16 PM ET

A pharmacist pours Truvada pills, an HIV treatment, back into the bottle at Jack's Pharmacy in San Anselmo, Calif.

Justin Sullivan/Getty Images

About two-thirds of Americans who are infected with the virus that causes AIDS aren't getting treated for it.

The finding comes from an analysis just released by the Centers for Disease Control and Prevention showing that more needs to be done to make sure people infected with the human immunodeficiency virus get proper treatment.

"For people living with HIV, it's not just about knowing you're infected — it's also about going to the doctor for medical care," says CDC Director Dr. Tom Frieden.

The analysis, published in the latest issue of the CDC's Morbidity and Mortality Weekly Report, looked at nationwide data collected in 2011.

Shots - Health News HIV Treatment Lags In U.S., Guaranteeing More Infections

Of the 1.2 million people living with HIV in the United States, about 86 percent had been diagnosed and 40 percent were receiving some kind of medical care, according to the report.

Shots - Health News Cost Of Treatment Still A Challenge For HIV Patients In U.S.

Thirty-seven percent were prescribed antiviral drugs, which suppressed the virus for 30 percent of patients, the report said.

Antiviral drugs can help people who are HIV-positive to live years, sometimes decades, after they are infected. The drugs also reduce the chances they will spread the virus to someone else.

About two-thirds of those whose virus was out of control had been diagnosed but were no longer receiving care, the researchers found. That finding highlights the need to make sure people getting treated for HIV continue to receive care, Frieden says.

Young HIV-positive people were especially unlikely to have their infection under control, the researchers found. That's probably because younger people are the least likely to know they are infected.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.
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How Can Vultures Eat Rotten Roadkill And Survive?

Tue, 11/25/2014 - 11:24am
How Can Vultures Eat Rotten Roadkill And Survive? November 25, 201411:24 AM ET Listen to the Story 3 min 22 sec  

You might wonder why 48 million Americans get food poisoning every year, yet there are some animals that seem to be immune from even the nastiest germs.

We're talking here about vultures, which feast on rotting flesh that is chockablock with bacteria that would be deadly to human beings. In fact, vultures have a strong preference for that kind of food.

"The real question is how can they actually stand eating things like this," says Lars H. Hansen, a professor of molecular microbial ecology at Aarhus University in Denmark.

Hansen started chewing over this question in a conversation with colleagues who study bacteria that form ecosystems within animal intestines. Maybe, they thought, vultures have some helpful bacteria in their guts to help them tolerate these otherwise deadly germs.

They turned to Michael Roggenbuck at the University of Copenhagen because he studies communities of intestinal bacteria.

"When Lars told me about this study I was very, very interested in that one," Roggenbuck tells NPR. "I thought, wow, a vulture! That would be very exciting."

Roggenbuck was working on his Ph.D. at the time. He set to work examining the guts of 50 turkey vultures and black vultures that had been trapped and killed near Nashville.

He expected to see a huge variety of bacteria in the gut, as you'd find inside human intestines. Instead, he found an ecosystem dominated by two species of bacteria, both well-known poisons: fusobacteria, which can cause blood infections; and Clostridium, which produces deadly botulism toxins.

So why didn't the vultures get sick from a gut full of nasty germs? "There are several possibilities," Roggenbuck says.

They could have developed immunity to these toxins as they evolved to eat their everyday diet. Also, other disease-causing germs are likely killed in the stomach, before they even get into the intestine, Hansen suggests. He says vulture stomach acid is 10 to 100 times stronger than human stomach acid, "so it seems like the stomach itself is a very harsh environment."

"Another hypothesis could be that they're actually using the bacteria in the stomach as some sort of probiotics," Hansen says. By having a gut full of a few tolerable species of bacteria, it's possible that those would crowd out other deadly microbes.

Hansen, Roggenbuck and their colleagues published their results Tuesday in the journal Nature Communications.

Hansen is looking for larger lessons from this trip into the secret lives of vultures.

"I think it's mind-boggling that organisms that are perceived as very bad for you seem to be very useful for other biological creatures, such as the vultures," he says. "So I think that's amazing."

Wildlife biologists say vultures aren't alone in being resistant to botulism toxins. Tonie Rocke at the USGS's National Wildlife Health Center in Madison, Wis., says lots of birds seem to handle botulism spores just fine. But vultures have to cope with massive amounts of deadly germs.

"They're very hardy beasts, I would say so," Rocke says. "But given that, they've also suffered their share of mortality."

Vultures can be poisoned, for example, by lead, or by ibuprofenlike drugs given to cattle in Asia. Curiously, those drugs, while deadly to vultures, are safe for human consumption.

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

Turning 21? Here's How To Avoid A Big Hike In Health Premiums

Tue, 11/25/2014 - 9:52am
Turning 21? Here's How To Avoid A Big Hike In Health Premiums November 25, 2014 9:52 AM ET

Partner content from

Michelle Andrews

For young people, turning 21 is generally a reason to celebrate.

If they're insured through the federal health insurance marketplace that operates in about three-dozen states, however, their birthday could mean a whopping 58 percent jump in their health insurance premium in 2015, according to an analysis by researchers at the Center on Budget and Policy Priorities.

Many 21-year-olds who qualify for premium subsidies will be able to sidestep the rate increase if they re-evaluate their coverage options on the federal marketplace before Feb. 15, when the annual open enrollment period ends.

If they don't, they'll generally be automatically renewed into the same plan and with the same premium tax credit they had in 2014.

"If they don't come back to the marketplace, they're going to get a premium tax credit that's based on their age rating as a child, and that premium difference is going to hit them," says Judith Solomon, a vice president for health policy at the budget center.

Families with federal marketplace plans whose now 21-year-old children are covered as dependents will face a premium jump as well.

Under the health law, insurers can no longer base premiums on people's health or pre-existing medical conditions. Instead, insurers are permitted to apply just four premium rating factors in their calculations: age, where someone lives, how many people are going to be covered and whether someone uses tobacco.

The law also prohibits premiums for older adults from being more than three times higher than those for younger adults.

Because of age rating, premiums for most adults will rise slightly every year as they get older. But with children, it's different. Insurers apply the same age-rating factor to all children when computing their premiums. When people turn 21, however, the insurer begins to compute their premiums based on an adult age-rating factor, which results in that 58 percent premium increase.

Young people who go back to the marketplace to shop for a 2015 plan can generally avoid any age-related premium increases. They likely qualify for premium tax credits that are available to people with incomes between 100 and 400 percent of the federal poverty level ($11,670 to $46,680 for an individual). If they return to the marketplace, their premium tax credit will be adjusted to cover the higher age-related premium for their 2015 coverage.

"We've been encouraging everyone to update their profiles on HealthCare.gov so they can ensure that they have a tax credit that reflects what they should be getting," says Jen Mishory, executive director at Young Invincibles, an advocacy group for young people.

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

Vitamin D Tests Aren't Needed For Everyone, Federal Panel Says

Mon, 11/24/2014 - 5:05pm
Vitamin D Tests Aren't Needed For Everyone, Federal Panel Says November 24, 2014 5:05 PM ET

People can make vitamin D when exposed to sunshine. But many people in North America never get enough sun to do that.

iStockphoto

Should you get a blood test to see if you're deficient in vitamin D? It sounds like such a good idea, seeing as how most people don't get enough sunshine to make vitamin D themselves. And the tests are becoming increasingly popular.

But there are problems with making vitamin D tests a standard part of preventive medicine, a federal panel said. The U.S. Preventive Services Task Force said Monday there's not enough evidence of benefits or harms to recommend vitamin D testing for all.

Shots - Health News Panel Questions Benefits Of Vitamin D Supplements

And even though some studies have associated low levels of vitamin D with a long list of ills, including a higher risk of fractures, falls, heart disease, colorectal cancer, diabetes, depression, thinking problems and death, scientists who evaluated studies for the USPSTF say there is no direct evidence that universal screening would reduce those risks.

"The effect of vitamin D levels on health outcomes is difficult to evaluate," the recommendation statement says.

Well, that's certainly uncertain. But if you've been following the controversy over vitamin D, you know that it's far from the only uncertainty.

As the USPSTF report notes:

  • There's no agreement on what's considered a vitamin D deficiency. Different professional societies set different minimum levels, ranging between 20 and 30 nanograms per milliliter of blood.
  • Test results can be hard to interpret, because there are lots of different types of tests and no internationally recognized reference standard.
  • Ethnicity may make a difference in vitamin D levels; African-Americans typically have lower levels, but it's not known if that's deficient or OK.
Shots - Health News How A Vitamin D Test Misdiagnosed African-Americans

And then there's the fact that the blood test can be expensive, running $50 to $220. Since vitamin D supplements are cheap, some doctors say it's easier just to tell people to take supplements rather than mess around with a blood test.

Shots - Health News Fewer Americans Need Vitamin D Supplements Under New Guidelines

In 2010, the Institute of Medicine issued a report saying that vitamin D is vital for bone health, but other than that there isn't evidence that low levels of vitamin D cause disease. It recommended that adults up to age 70 get 600 milligrams of D a day, with 800 milligrams for people over 70.

So, to test or not to test? Probably up to you, based on your health concerns, especially your risk of osteoporosis.

But one thing's for sure: This latest recommendation is not the last word on you'll hear on who should be taking extra vitamin D, and why.

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

Merck Partners With NewLink To Speed Up Work On Ebola Vaccine

Mon, 11/24/2014 - 12:01pm
Merck Partners With NewLink To Speed Up Work On Ebola Vaccine November 24, 201412:01 PM ET

A 26-year-old man receives an injection in September of an experimental Ebola vaccine being tested by the National Institute of Allergy and Infectious Diseases and GlaxoSmithKline.

NIAID

It's now Goliath versus Goliath in the quest for an Ebola vaccine.

Until now, the two leading candidates for a vaccine to protect against the Ebola virus were being led by global pharmaceutical giant GlaxoSmithKline on the one hand, and a tiny company in Ames, Iowa, that was virtually unknown, on the other.

Today, the David in that scenario, NewLink Genetics, said it has made a deal with drugmaker Merck, to research, develop, manufacture and distribute the experimental Ebola vaccine. That move will put the two leading Ebola vaccine programs on more equal footing.

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The NewLink vaccine is a based on a harmless virus that has been genetically engineered to incorporate bits of the Ebola virus. The Canadian government developed the vaccine and then licensed it to this small biotech company. The U.S. Defense Department has provided development funding to NewLink.

Still, NewLink has struggled to keep pace with the vaccine being developed by GlaxoSmithKline. (Johnson & Johnson also has an experimental Ebola vaccine in the works, but that effort is lagging the others).

"Merck's vaccine development expertise, commercial leadership and history of successful strategic alliances make it an ideal partner to expedite the development of [the experimental vaccine] and, if demonstrated to be efficacious and well-tolerated, to make it available to individuals and communities at risk of Ebola virus infection around the world," said NewLink CEO Charles Link, in a statement.

Both of these vaccines are being given to a handful of volunteers in the US, Europe and Africa, to see whether they are safe. The World Health Organization hopes that the vaccines will be ready early next year to be tested in people who are at high risk of contracting Ebola, such as healthcare workers in West Africa.

Health officials say an effective vaccine could help slow the spread of Ebola, but they say the epidemic will only end through old-fashioned public health measures: identifying and isolating everyone who is infected with the virus.

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

Upfront Costs Of Going Digital Overwhelm Some Doctors

Mon, 11/24/2014 - 3:40am
Upfront Costs Of Going Digital Overwhelm Some Doctors November 24, 2014 3:40 AM ET

fromAPTI

Annie Feidt Listen to the Story 3 min 23 sec  

Dr. Oliver Korshin says he's just a few years from retirement and can't afford the flurry of technology upgrades the federal government expects him to make.

Annie Feidt/Alaska Public Media

Dr. Oliver Korshin practices ophthalmology three days a week in the same small office in east Anchorage, Alaska, he's had for three decades. Many of his patients have aged into their Medicare years right along with him.

For his tiny practice, which employs just one part-time nurse, putting all his patients' medical records in an online database just doesn't make sense, Korshin says. It would cost too much to install and maintain — especially considering that he expects to retire in just a few years.

“ There's no economy of scale. I can't share these expenses with anybody.

"No possible business model would endorse that kind of implementation in a practice situated like mine," he says. "It's crazy."

But starting next year the federal government will penalize Korshin and other doctors for not using electronic health records; Medicare will withhold 1 percent of his payments. What's more, Korshin will lose an additional 1.5 percent for failing to enroll in a federal program that requires doctors to digitally keep track of (and report) quality data about how their patients fare under their care.

And then there's the new coding system, also set to take effect in the the fall of 2015 — an overhaul of the standard method of classifying diseases and conditions. Medicare and other insurers require the proper use of these codes if doctors want to get paid for the treatments and procedures they perform. A cost study sponsored by the American Medical Association earlier this year estimated that depending on "variable factors such as specialty, vendor and software," implementing the new coding system alone could cost a small medical practice between $56,639 and $226,105.

“ There won't be some flashing neon sign we ever see that says X number of doctors have left. It's a very quiet process. And that, for me, is the scary part.

All these technological initiatives are designed to improve medicine — to bring it into the digital age. But Korshin and many other doctors with small practices say they feel overwhelmed and can't keep up.

"This flurry of things one has to comply with means that unless you work for a large organization, like a hospital, that can devote staff and time to dealing with these issues, there's no economy of scale," Korshin laments. "I can't share these expenses with anybody."

Korshin may seem like an outlier — close to retirement with a very small practice. But he has lots of company, says Mike Haugen of the Alaska State Medical Association.

"Most practices in Alaska are small practices," Haugen says. "They're one-, two- and three-doctor practices. The number of really large practices — and that's relative in Alaska — you can probably count them on one hand."

Haugen says he hears a lot of complaints from doctors, and worries the burden is forcing many — especially older physicians — to consider retiring early.

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"There won't be some flashing neon sign we ever see that says X number of doctors have left," he says. "It's a very quiet process. And that, for me, is the scary part. Because you take a look at the medical association membership a year or two from now, and it may be smaller. And access to care in this state is a real issue."

Rebecca Madison thinks a lot of doctors would decide to stay in practice if they had help with the transition to electronic health records. That's Madison's job as executive director of Alaska eHealth Network — she wants to make it as easy as possible for providers to make the switch.

She tries to sell doctors on the benefits. She reminds them electronic records can make their offices more efficient and give them better data on the care they're providing. The systems can also lower billing costs, she explains.

"We work with providers to ensure that they have the best experience they can, going into an electronic health record," she says, "because it really is changing your entire practice. It's not easy."

This story is part of a reporting partnership that includes NPR, Alaska Public Media and Kaiser Health News

Copyright 2014 Alaska Public Telecommunications Inc.. To see more, visit http://www.alaskapublic.org.
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Africa Inspires A Health Care Experiment In New York

Mon, 11/24/2014 - 3:38am
Africa Inspires A Health Care Experiment In New York November 24, 2014 3:38 AM ET Listen to the Story 6 min 59 sec  

Norma Melendez, a community health worker with City Health Works, walks along Second Avenue on her way to meet a client. City Health Works is an organization that is attempting to bring an African model of health care delivery to the United States.

Bryan Thomas for NPR

There's a project in the neighborhood of Harlem in New York that has a through-the-looking-glass quality. An organization called City Health Works is trying to bring an African model of health care delivery to the United States. Usually it works the other way around.

If City Health Works' approach is successful, it could help change the way chronic diseases are managed in poverty-stricken communities, where people suffer disproportionately from HIV/AIDS, obesity and diabetes.

One of the people behind the experiment, which builds on the public-health technique of community outreach, is Manmeet Kaur. Kaur is a native New Yorker who grew up in Queens.

About a decade ago, just after she graduated from college, she spent time in Cape Town, South Africa. While there, she worked with a community health group called Mamelani Projects that tried to tackle some of the chronic health problems in the poor neighborhoods of Cape Town, especially HIV infection and AIDS. The organization had an interesting way of tackling those problems.

"They hired people from the community as peer health educators," she says. These weren't people with medical backgrounds. They were just local residents — people who were willing to help out.

One of the people Kaur was most impressed by was a woman named Thandi. "What was most powerful was her ability to draw from the life experiences of people she worked with to help them make better informed decisions," says Kaur. "No amount of training can help you do that when you don't have the same life experience of the people you're working with."

Manmeet Kaur and Prabhjot Singh in their neighborhood in Harlem.

Courtesy of Elsa Haag /City Health Works

When she returned from Africa, her thoughts kept straying back to Thandi and how effective she was in helping people with their medical issues.

Skip forward to 2011. Now Kaur is married and living in Harlem, another poor neighborhood where people have a lot of chronic health problems, including HIV infection and diabetes.

Her husband was training to be a doctor. As part of his training, he worked at a clinic that treats people with diabetes. "As I watched my husband begin residency, it just seemed to me he had an extremely short amount of time to talk to somebody," she says.

She felt all he was really doing was telling his patients to take their pills and watch their diet, and then sending them on their way.

"I was slightly aghast at seeing this revolving door of people coming in and out of the clinics but then going back to the same neighborhoods that have the conditions that shape why they were sick in the first place," says Kaur.

She thought "maybe a system of peer educators like Thandi in Cape Town could help here in America."

That's how the idea for City Health Works was born. Kaur's husband, Dr. Prabhjot Singh, partnered with Kaur to get the project off the ground. The pair raised about a million dollars from three sources: the Robert Wood Johnson Foundation (also a supporter of NPR), the Robin Hood Foundation and Mount Sinai Hospital, where Singh works.

“ We really need an ambassador, somebody that really understands the clinical environment but is deeply embedded in the community

Singh says a lot of the people he sees in his clinic at Mount Sinai are in really bad shape. "People you'd expect to see in the hospital. People you couldn't imagine are in such a late stage of illness," he says.

It's this population that City Health Works really wants to help. The idea is to get patients to the clinic before they get so sick, and then help them stay out of the clinics going forward.

"We really need an ambassador," he says. "Somebody that really understands the clinical environment but is deeply embedded in the community."

City Health Works hires people like Norma Melendez to be those ambassadors. Melendez does not have a medical background. She's what City Health Works calls a health coach. Her job is to work with patients after they've visited the clinic. She goes to their homes, makes sure they have the medicine, makes sure they take it, and shows them how to stay on a diet their doctor has ordered. These may seem like easy tasks, but they aren't, especially when you don't have a lot of money.

Norma Melendez (left), a community health worker with City Health Works, visits a client at home in Harlem.

Bryan Thomas for NPR

"I live in this immediate neighborhood, so I can relate to a lot of the people who live in my community," says Melendez. "I've faced many of the similar barriers once upon a time, or someone I know has faced these similar barriers."

Hiring people like Melendez, people "deeply embedded in the community," as Singh puts it, is one of the things that sets City Health Works apart from other programs that use community health workers. "This is an opportunity for a much more intimate relationship, much faster," says Paul Tarini, senior project officer at the Robert Wood Johnson Foundation. Such relationships should yield better health outcomes.

On the day I met Melendez, she was visiting a woman in one of the housing projects near the hospital. We went along with the understanding that health privacy laws prevented our using any of her clients' full names. The woman we met that day introduced herself as Mrs. T. She was diagnosed with diabetes 15 years ago. Now she lives alone, and for a long time she wasn't doing a good job controlling her disease. "I was stupid," she says. "I've let myself go so much. And I don't have anybody else."

Tears drip from Mrs. T's eyes as she describes all the people she's lost in recent years. "My mother died, my ex-husband died, my sister died, my brother died and my dog died. And I buried everybody! I'm tired of burying people."

A doctor seeing Mrs. T at a clinic can't know how Mrs. T's emotional distress makes it hard to do what she knows she should do to control her diabetes. But a community health worker like Norma Melendez can see all this and can help. Even a kind word can do the trick.

"I see her sometimes in the street and I'm like, yay!" says Mrs. T. "So it's somebody who's here. It's not somebody that I go to an office to see that lives in mid-Manhattan."

And there's an economic reality at work here. If City Health Works coaches can keep people like Mrs. T healthy and out of the clinic, that would dramatically reduce the cost of her care.

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Dr. Singh says there's another benefit to using health coaches. He says they can help build ties between doctors and the local community — something that could be really important in dealing with a medical crisis like Ebola.

Coaches like Melendez who don't have any medical training wouldn't have any direct role in caring for sick patients, "but they have an important role in building trust between the community and the health care system if a situation does arise," says Singh. "They have an extremely important role in identifying people that might not feel comfortable going to the health care system."

Just getting sick people to a clinic early could stop an outbreak in its tracks.

City Health Works doesn't intend to rely on foundation grants to keep operating. It is gathering data in order to prove to health insurers that it has a cost-effective method of solving some of the problems that plague health care for the poor in this country. And if it works, it would be ironic that a country with the most sophisticated medical care in the world could learn a thing or two from countries that get by on a shoestring.

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

What Microbes Lurked In The Last Public Restroom You Used?

Sun, 11/23/2014 - 5:52am
What Microbes Lurked In The Last Public Restroom You Used? November 23, 2014 5:52 AM ET Katherine Harmon Courage

Even cleaning a bathroom daily didn't much affect the make-up of the community of microbes living there, scientists say.

Claire Eggers/NPR

The invisible world of the bathroom isn't pretty — unless you're a microbe. After scanning the microbial zoo of four public restrooms recently, a team of researchers found a diverse swarm of characters that persisted for months despite regular cleaning of the facilities.

The goal of the study, published in the December issue of Applied and Environmental Microbiology, was to better understand how communities of bacteria and viruses can shift in these very public places across a couple of months.

To get their down-and-dirty readings, the researchers selected four bathrooms at San Diego State University (in the North Life Sciences building, in case you're in the neighborhood, and want to plan accordingly).

“ All human environments contain pathogens — your bedroom, the phone you're talking on, even the bugs inside of you could turn pathogenic at any time. But we desperately need them in our lives.

They checked two women's restrooms and two men's restrooms (a high-traffic and a low-traffic bathroom for each gender). The bathrooms were thoroughly cleaned at the study's start with bleach solution, which killed any existing germ communities.

Then, during the following hours, days, weeks and months of human use, the researchers periodically swabbed soap dispensers, floors and toilet seats in all four restrooms for microbe samples. Because some microscopic organisms won't grow in petri dishes (especially those evolved for life in the human gut), the researchers used genetic sequencing technology to get a more comprehensive roll call.

Within one hour of sterilization, the bathrooms were completely recolonized with microbes — just as plants rapidly arrive and populate a newly emerged island. Fecal bacteria dominated, including on toilet seats and on soap dispensers — about 45 percent of the bacteria there were of fecal origin.

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In all, the scientists found genetic traces of more than 77,000 distinct types of bacteria and viruses. (At least some of those species were likely dead or dormant, the scientists add; genetic testing detects them all, whatever their status.)

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Patterns of regrowth and succession, as some species waned and others replaced them, were surprisingly similar from bathroom to bathroom; within just five hours the population mix in each room stabilized.

When the team tried growing cultures from different surfaces in each room, they found one set of live bacteria in overwhelming abundance: Staphylococcus.

"They are true survivors," says Jack Gilbert, a microbial ecologist at Argonne National Laboratory, and coauthor of the new study. Even after some of the bathrooms were closed, these human-generated communities of microbes continued to thrive.

Staph's persistence in these studies points to its power as a potential pathogen, Gilbert says. Various versions are common on human skin and inside the nose and other orifices; they generally cause no problems, or trigger only minor skin infections. But staph infections can be serious, or even kill, if the bacteria get into bloodstream, joints, bones, lungs or heart. And one version of S. aureus bacteria that is resistant to common antibiotics — MRSA — can be very dangerous.

Goats and Soda Globe-Trotting Virus Hides Inside People's Gut Bacteria

Gilbert notes that none of the live Staph strains detected in the San Diego bathrooms showed signs of being antibiotic resistant. They were instead relatively harmless "skin bugs that happened to have lost their skin," he says. The team did find genes from MRSA hiding on the floor, as well as traces of some troublemaker viruses, including HPV and herpes virus.

Interestingly, although restrooms that were left open for use for up to two months were cleaned regularly with soap and water, the communities of microbes found there remained relatively unchanged for the full eight weeks of the study.

No need to be scared or grossed out by that finding, Gilbert says. He actually finds it a little reassuring. You just have to think about it in ecological terms.

"All human environments contain pathogens — your bedroom, the phone you're talking on, even the bugs inside of you could turn pathogenic at any time," Gilbert tells Shots. "But we desperately need them in our lives."

Having a healthy community of good — or even just neutral — microbes can crowd out the bad ones. As we've learned from using broad-spectrum antibiotics in the human body, "sterilization is not necessarily good," he says. "Bacteria come back right away, and they might come back perturbed. Maybe a restroom is an ideal place to put in a rich, ideal ecosystem."

Does that mean probiotic cleaning products for your bathroom? Companies are already working on that, Gilbert says.

In the meantime, his take-away from the findings: "It's good to have good hygiene. Don't lick the bathroom floor."

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

What Microbes Lurked In The Last Public Restroom You Used?

Sun, 11/23/2014 - 5:52am
What Microbes Lurked In The Last Public Restroom You Used? November 23, 2014 5:52 AM ET Katherine Harmon Courage

Even cleaning a bathroom daily didn't much affect the make-up of the community of microbes living there, scientists say.

Claire Eggers/NPR

The invisible world of the bathroom isn't pretty — unless you're a microbe. After scanning the microbial zoo of four public restrooms recently, a team of researchers found a diverse swarm of characters that persisted for months despite regular cleaning of the facilities.

The goal of the study, published in the December issue of Applied and Environmental Microbiology, was to better understand how communities of bacteria and viruses can shift in these very public places across a couple of months.

To get their down-and-dirty readings, the researchers selected four bathrooms at San Diego State University (in the North Life Sciences building, in case you're in the neighborhood, and want to plan accordingly).

“ All human environments contain pathogens — your bedroom, the phone you're talking on, even the bugs inside of you could turn pathogenic at any time. But we desperately need them in our lives.

They checked two women's restrooms and two men's restrooms (a high-traffic and a low-traffic bathroom for each gender). The bathrooms were thoroughly cleaned at the study's start with bleach solution, which killed any existing germ communities.

Then, during the following hours, days, weeks and months of human use, the researchers periodically swabbed soap dispensers, floors and toilet seats in all four restrooms for microbe samples. Because some microscopic organisms won't grow in petri dishes (especially those evolved for life in the human gut), the researchers used genetic sequencing technology to get a more comprehensive roll call.

Within one hour of sterilization, the bathrooms were completely recolonized with microbes — just as plants rapidly arrive and populate a newly emerged island. Fecal bacteria dominated, including on toilet seats and on soap dispensers — about 45 percent of the bacteria there were of fecal origin.

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In all, the scientists found genetic traces of more than 77,000 distinct types of bacteria and viruses. (At least some of those species were likely dead or dormant, the scientists add; genetic testing detects them all, whatever their status.)

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Patterns of regrowth and succession, as some species waned and others replaced them, were surprisingly similar from bathroom to bathroom; within just five hours the population mix in each room stabilized.

When the team tried growing cultures from different surfaces in each room, they found one set of live bacteria in overwhelming abundance: Staphylococcus.

"They are true survivors," says Jack Gilbert, a microbial ecologist at Argonne National Laboratory, and coauthor of the new study. Even after some of the bathrooms were closed, these human-generated communities of microbes continued to thrive.

Staph's persistence in these studies points to its power as a potential pathogen, Gilbert says. Various versions are common on human skin and inside the nose and other orifices; they generally cause no problems, or trigger only minor skin infections. But staph infections can be serious, or even kill, if the bacteria get into bloodstream, joints, bones, lungs or heart. And one version of S. aureus bacteria that is resistant to common antibiotics — MRSA — can be very dangerous.

Goats and Soda Globe-Trotting Virus Hides Inside People's Gut Bacteria

Gilbert notes that none of the live Staph strains detected in the San Diego bathrooms showed signs of being antibiotic resistant. They were instead relatively harmless "skin bugs that happened to have lost their skin," he says. The team did find genes from MRSA hiding on the floor, as well as traces of some troublemaker viruses, including HPV and herpes virus.

Interestingly, although restrooms that were left open for use for up to two months were cleaned regularly with soap and water, the communities of microbes found there remained relatively unchanged for the full eight weeks of the study.

No need to be scared or grossed out by that finding, Gilbert says. He actually finds it a little reassuring. You just have to think about it in ecological terms.

"All human environments contain pathogens — your bedroom, the phone you're talking on, even the bugs inside of you could turn pathogenic at any time," Gilbert tells Shots. "But we desperately need them in our lives."

Having a healthy community of good — or even just neutral — microbes can crowd out the bad ones. As we've learned from using broad-spectrum antibiotics in the human body, "sterilization is not necessarily good," he says. "Bacteria come back right away, and they might come back perturbed. Maybe a restroom is an ideal place to put in a rich, ideal ecosystem."

Does that mean probiotic cleaning products for your bathroom? Companies are already working on that, Gilbert says.

In the meantime, his take-away from the findings: "It's good to have good hygiene. Don't lick the bathroom floor."

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

To Stay Energy Efficient As You Age, Keep On Running

Fri, 11/21/2014 - 3:13pm
To Stay Energy Efficient As You Age, Keep On Running November 21, 2014 3:13 PM ET Katherine Hobson

People use energy less efficiently as they age. Running seems to help prevent that slowdown.

iStockphoto

Walking is a simple thing that becomes really, really important as we age. Being able to get around on our feet for extended periods of time not only makes everyday life easier, it's linked to fewer hospitalizations and greater longevity. As we get older, though, the body takes about 15 to 20 percent more energy to cover the same terrain.

And that can be a problem, says Justus Ortega, a kinesiologist at Humboldt State University in Arcata, Calif. "If people have more fatigue, they have less desire to participate" in walking, he tells Shots.

It's easy to see how this becomes a downward spiral of feeling too tired while walking, then not walking and getting even more out of shape.

Here's something that can prevent that slide: running. Older people who regularly ran for exercise had "walking economy" similar to much younger people, according to a study by Ortega and colleagues at Humboldt State and the University of Colorado, Boulder.

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Older people who walked for exercise, however, while they were undoubtedly reaping the other benefits of walking, had walking economy similar to older, sedentary adults. In other words, the walking didn't beget more efficient walking, while running did.

The study, published Thursday in PLOS ONE, took 15 men and 15 women with an average age of 69 who were already consistent runners or walkers. Participants walked on special treadmills at three different speeds and had their oxygen consumption and carbon dioxide production measured during their sessions.

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The runners consumed 7 to 10 percent less energy than the walkers. Importantly, there weren't any apparent biomechanical differences between the groups, such as differences in stride time or stride frequency that might account for the results.

"If your car is using more gas to get down the road, you check to see if your brakes are rubbing, or if there's anything mechanical that might explain what we're seeing," explains Justus.

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So the brakes aren't rubbing. The next question is, "What is it about the engine using the fuel?" he says. One hypothesis is that the runners were more efficient at the cellular process that turns oxygen into ATP, the chemical form of energy that fuels the muscle fibers to move. "There's evidence to show that process is impaired with natural aging," says Justus. And research suggests that aerobic exercise can counteract that process.

It's not 100 percent clear that's what's going on here. Another possible factor is muscle co-activation: older adults tend to use more muscles to perform the same movement than do younger people, perhaps to stabilize the joints. It's quite possible that runners, who are used to spending more time on one foot, use fewer muscles to perform a given movement than the walkers. That might contribute to their lower use of energy, says Justus.

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So the next step, he says is to analyze their data to see how muscle co-activation might be a factor. Other future experiments might look at other activities that are also more aerobically intense than regular walking, such as cycling or even very fast walking, to see if they might offer some protection.

It's really important to mention that this research can't prove that running actually caused the better walking economy. Study subjects were already doing their preferred form of exercise before they entered the study, and it's possible that the runners had greater walking efficiency for some other reason.

And by no means should this turn anyone off walking, says Ortega. "The health and social benefits you reap from walking are enormous," he says. But older folks who run may be getting a leg up on at least one element of walking performance.

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

In The Hospital, There's No Such Thing As A Lesbian Knee

Fri, 11/21/2014 - 12:06pm
In The Hospital, There's No Such Thing As A Lesbian Knee November 21, 201412:06 PM ET Kelli Dunham Maria Fabrizio for NPR

When my partner Cheryl was dying from respiratory complications related to treatment for Hodgkin's lymphoma, she was in so much physical distress she couldn't bear to be touched.

The only contact she could stand — one of the few ways I could share my love with her — was for me to rub her feet. As I stood at the foot of her hospital bed doing just that, a scrub-clad figure we had never seen before poked her head in the door, curled her lip and demanded: "What is your relationship?"

The question was clearly directed at me, but my girlfriend reached through her drug-induced, hypoxic haze to respond with her New Yorker tough-girl attitude: "Really? Whose feet do you rub like this? What the hell are you, the relationship police?"

The Scrub Clad Phantom scampered away and we never saw her again.

“ Although a curled lip seems to be the universal sign for "You disgust me," we weren't at all sure that the question was motivated by homophobia.

Although a curled lip seems to be the universal sign for "You disgust me," we weren't at all sure that the question was motivated by homophobia. Scrub-clad figures poking their heads into hospital rooms and asking random questions without so much as a word of introduction isn't a problem just for people in the LGBT community. If you've been hospitalized, you've probably had a similar experience.

But LGBT people have been so systematically discriminated against, misunderstood, and (at best) ignored within the health system that when we walk into a practitioner's office or a hospital room we don't assume that we're starting at neutral in the interaction, because we know better. Consider the stories just within my social circle:

  • A friend's butch lesbian partner was so traumatized by past gynecological care she refused pap exams for 25 years and was diagnosed with cervical cancer in the emergency room, much too late for treatment.
  • A trans woman left behind her family in the rural South and moved to Boston where she thought HIV/AIDS care would be more accessible, only to have each clinic visit prefaced with "Are you sure you're not using crystal meth?" This was from allegedly trans-sensitive providers who saw the face of an HIV-positive trans woman and automatically assumed substance abuse.
  • A woman from my queer widow support group was refused entrance to her dying partner's hospital room.
  • A trans man of color who had persistent and dangerously heavy vaginal bleeding for months had to jump through hoop after hoop to receive appropriate care; medical professionals accused him of exaggerating his condition to get insurance to cover transition-related surgery. Other professionals said there was nothing to worry about because "women of color often have unusual periods." He was later diagnosed with stage II uterine cancer.

It's possible that because I was the caregiver to two partners who died of cancer (I know, I know; don't stand next to me in a lightning storm) and because I am a nurse in our very underserved communities I am exposed to more of these types of stories than the average person.

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But even though the federal government just recently admitted "oops, yeah, we should have been keeping data on you people," we do know that significant health disparities exist: lesbian and bisexual women are less able to get health care due to cost; gay men, especially gay men of color, are still disproportionately at risk of HIV/AIDS. Bisexual women have lower rates of appropriate breast cancer screening and cervical cancer screening than straight women or lesbians. In a recent study from Massachusetts, one in five transgender/gender non-conforming respondents reported postponing or not using health care in the previous year because of prior experiences of mistreatment in health care settings.

Additionally, much of the community carries with us the trauma of the early years of the AIDS crisis, when the American government and much of the American healthcare system ignored — or was even overtly hostile to — a community in the midst of a devastating crisis of health.

Not exactly a condition conducive to trust.

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It would take the systematic dismantling of entrenched societal, institutional and familial homophobia, biphobia and transphobia in order to completely address the health disparities that the LGBT community faces, which I suppose is a bit of a tall order for a Friday afternoon. So the Association of American Medical Colleges' report earlier this month urging integration of culturally competent LGBT health care across the med school curriculum is a great start.

“ What if providers asked every patient if they had a preferred gender pronoun, or if they had a name a rather than the one on the insurance card that they'd prefer to go by?

Even if the guidelines are universally adopted it will be years before we'll see their impact on practice, but some of the simple yet important changes the report is championing could easily be put to work today.

What if providers asked every patient if they had a preferred gender pronoun, or if they had a name a rather than the one on the insurance card that they'd prefer to go by?

While this is an important safety concern, especially for people of trans experience, many people experience discomfort using their legal name. My grandma cringed at hearing her given name Viola while in the hospital, rather than the name she was known as at home. (Though after she had a beloved grandchild named after her she didn't mind so much.)

“ There is no such thing as a lesbian knee, or a lesbian armpit or a lesbian neck — at least I've never dated one — but each human being comes to health care with a context and a story, and they both are vitally important.

And even beyond being inclusive, isn't "Who do you have to support you?" a much more relevant question in health care than asking what kind of romantic partnership a patient is involved in?

When the uninformed wonder why LGBT people need "special health care" with lines such as "Is there such a thing as a lesbian knee?", they've misunderstood not so much the LGBT community but the nature of health care.

There is no such thing as a lesbian knee, or a lesbian armpit or a lesbian neck — at least I've never dated one — but each human being comes to health care with a context and a story, and they both are vitally important.

Kelli Dunham is a nurse, stand-up comic, LGBT health advocate and author of five books, including the recent tragicomic collection Freak of Nurture (Topside Press, 2013).

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