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Feds Say It's Time To Cut Back On Fluoride In Drinking Water

Mon, 04/27/2015 - 2:48pm
Feds Say It's Time To Cut Back On Fluoride In Drinking Water April 27, 2015 2:48 PM ET Listen to the Story 3 min 55 sec   iStockphoto

Federal health officials Monday changed the recommended amount of fluoride in drinking water for the first time since 1962, cutting by almost half the maximum amount of fluoride that should be added to drinking supplies.

The Department of Health and Human Services recommended 0.7 milligrams of fluoride per liter of water instead of the long-standing range of 0.7 to 1.2 milligrams.

"The change is recommended because now Americans have access to more sources of fluoride, such as toothpaste and mouth rinses, than they did when fluoridation was first introduced in the United States," Dr. Boris Lushniak, the deputy surgeon general, told reporters during a conference call.

As a result, many Americans are getting too much fluoride, which is causing a big increase in a condition known as fluorosis that causes very faint white marks on people's teeth.

"The new recommended level will maintain the protective decay prevention benefits of water fluoridation and reduce the occurrence of dental fluorosis," Lushniak says.

But opponents of fluoridation and even some scientists maintain the new standard doesn't go nearly far enough. They say there's evidence that overexposure to fluoride might increase the risk for other health issues, including possibly thyroid problems, attention deficit hyperactivity disorder and even lower IQs.

"Due to the importance of having the best possible brains in the future, I think that that would suggest that we be careful about the amount of fluoride that we deliver to the population in drinking water," says Dr. Philippe Grandjean at the Harvard T.H. Chan School of Public Health.

Because fluoride is so readily available, critics argue people should be able to decide for themselves whether to use fluoride and how they get it.

"In our view it's high time for the United States to start following the approach taken by most of the Western world and stop fluoridating its water," says Michael Connett of the group Fluoride Action Network.

"It makes far more sense for those people who want to use fluoride to brush it on their teeth, spit it out and that way you apply fluoride to the only tissue in the body that stands to benefit," he says. "And you don't expose every other tissue in the body."

But the decision was welcomed by groups such as the American Dental Association. Federal health officials dismiss concerns that fluoride might cause other health problems.

"The only documented risk of water fluoridation is fluorosis, and it is primarily a cosmetic risk," says Barbara Gooch, a dentist at the Centers for Disease Control and Prevention. "Fluorosis in the milder form is not a health risk."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Chemical Change In Synthetic Marijuana Suspected Of Causing Illnesses

Mon, 04/27/2015 - 11:53am
Chemical Change In Synthetic Marijuana Suspected Of Causing Illnesses April 27, 201511:53 AM ET Angus Chen

Dried plants dosed with psychoactive chemicals is marketed as K2 or spice.

Kelley McCall/AP

Over the past three weeks, people have been tumbling into emergency rooms across the country, seriously ill after using a synthetic drug known as K2 or spice.

Hundreds of cases have been reported in states including Alabama, Mississippi and New York, where state health departments have warned people to stay away from the drug. New York City alone saw over 120 emergency cases in a single week in April.

Several people have died, and emergency room physicians have been seeing K2 users showing up with severe symptoms: high blood pressure, clenched muscles, seizures, hallucinations and psychosis.

"We have to chemically restrain and physically restrain them because they become violent and very strong. It takes four to five personnel to restrain them on a gurney," says Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City. One patient last week ended up in the ICU. "He was combative and required sedation in the ER."

The Two-Way 3 Kings Holiday Cake Laced With Synthetic Drugs Makes Dozens Hallucinate

Although different variations of synthetic marijuana have been circulating on the street for about five years, Glatter says there's likely something unusual about the K2 behind this sudden surge in ER visits.

It's simple for manufacturers to modify the molecular structure of the mind-altering chemicals that producers spray onto dried plant material, which is then smoked. Not only does this make K2 difficult to identify and study, but the psychoactive effects become more unpredictable.

"Chemists are getting more and more creative in designing these structures," says Marilyn Huestis, the chief of a research division at the National Institute for Drug Abuse. That's a big selling part for the drug, which is marketed as a "safe" alternative to marijuana. Changing the molecular structure makes it more difficult to detect in drug screens.

Her division is working on creating tests for several synthetic cannabinoids. But it takes time. "It's like taking a 1,000-piece jigsaw puzzle and throwing it up in the air and piecing it together without a picture," Huestis says. "So here we are in the hospital or police lab, and they have no idea what to look for."

The Salt How Marijuana Highjacks Your Brain To Give You The Munchies

In New York City, Glatter says that this most recent batch of K2 has its users surprised. Many of his patients were longtime users who said they never had to come to the ER because of problems with K2 before now. "They called themselves K-heads and said they'd been doing this for years. I asked one guy, 'What happened?' And he was like, 'I dunno, I use this a lot. I've never had this reaction.' "

If there has been a change in the chemical composition, then Glatter thinks that might account for one striking difference in this outbreak. The high lasts a lot longer. "I had many patients in the ER for four to six hours, which was just unusual. Usually one to two hours and they're ready to go," he says.

"The newer synthetic cannabinoids will have a similar picture to what you're smoking with THC or marijuana," says Dr. David Lee, associate chair of emergency medicine and a toxicologist at North Shore University Hospital in New York. "But if they change the structure, we don't know what else can happen with the newly designed drug."

He says urine samples from this outbreak match at least one known synthetic cannabinoid — a molecule called XLR-11, which caused severe kidney damage to several patients in 2012. But there might be more ingredients that are still unknown, he says. "A few months ago, we had a patient who said he smoked K2 and spice. This patient was very sick, and he had the product with him. We sent it to a laboratory to analyze, and they'd never seen this chemical before. "

Parallels A Chinese Chemical Company And A 'Bath Salts' Epidemic

In the past few years, laboratories analyzing K2 have found synthetic cannabinoids alongside other compounds. Some sellers spray the synthetic marijuana onto cannabis buds or other psychoactive plants like St. John's wort.

And now they're finding synthetic cannabinoids mixed with synthetic cathinones, a stimulant sold as "bath salts," Huestis says. That includes synthetic versions of piperazine, a medication use to treat pinworm infections that's sometimes used as a cheap substitute for the club drug ecstasy, as well as opioids and benzodiazepines, which are sedatives.

The result is a rapidly evolving product that's chemically far more than just synthetic marijuana. It's like a cocktail of an unknown potency, and consumers can't know what they're getting or how it will affect them. Huestis adds: "What's in it today isn't going to be what's in it tomorrow."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Maybe You Should Rethink That Daily Aspirin

Mon, 04/27/2015 - 5:23am
Maybe You Should Rethink That Daily Aspirin April 27, 2015 5:23 AM ET Listen to the Story 1 min 45 sec  

For all the good aspirin can do in preventing second heart attacks and strokes, taking it daily can boost some risks, too — of ulcers, for example, and of bleeding in the brain or gut.

iStockphoto

We've all heard that an aspirin a day can keep heart disease at bay. But lots of Americans seem to be taking it as a preventive measure, when many probably shouldn't.

In a recent national survey, more than half the adults who were middle age or older reported taking an aspirin regularly to prevent a heart attack or stroke. The Food and Drug Administration only recommends the drug for people wh have already experienced such an event or are at extremely high risk.

"The vast majority of people in America who take aspirin for prevention are what I like to call the 'worried well.' "

The survey, published in the American Journal of Preventive Medicine, found that 52 percent of people ages 45 to 75 are taking aspirin daily or every other day. And 47 percent are taking it even though they have never had a heart attack or stroke.

"That's very controversial in the medical community," says Craig Williams, a pharmacologist at Oregon State University, who led the study.

Aspirin thins the blood and can help prevent blood clots that can clog blood vessels and cause strokes and heart attacks. But long-term use of the drug also increases the risk of ulcers, gastrointestinal bleeding and bleeding in the brain.

"Everyone agrees that for people who have already had a cardiac event, the benefits outweigh the risk," Williams says.

Shots - Health News Higher Blood Pressure At 18 Means Hardening Arteries At 40

But for most other people, the chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects, research suggests.

The American Heart Association says aspirin should be used only for prevention when someone's risk for heart disease is especially high.

And Williams says that the U.S. Preventive Services Task Force is in the process of revising its recommendation, which currently holds that older men and women should generally take aspirin if their risk for heart attack outweighs the risk of bleeding due to the medication.

Shots - Health News What Somebody's Mummy Can Teach You About Heart Disease

In the survey by Williams' team, about 43 percent of people said they were taking the drug for prevention without having consulted a physician. That's a bad idea, says Steve Nissen, a cardiologist at the Cleveland Clinic who wasn't involved in the study.

Shots - Health News Best To Not Sweat The Small Stuff, Because It Could Kill You

"The vast majority of people in America who take aspirin for prevention are what I like to call the 'worried well,' " Nissen says. "They are perfectly healthy. They may not even have a lot of risk factors. But they're very health conscious. And somebody told them that aspirin was good for preventing heart attacks, so they just started taking it."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Drop-In Chefs Help Seniors Stay In Their Own Homes

Mon, 04/27/2015 - 4:32am
Drop-In Chefs Help Seniors Stay In Their Own Homes April 27, 2015 4:32 AM ET Listen to the Story 4 min 50 sec   Maria Fabrizio for NPR

A healthy diet is good for everyone. But as people get older, cooking nutritious food can become difficult and sometimes physically impossible. A pot of soup can be too heavy to lift. And there's all that time standing on your feet. It's one of the reasons that people move into assisted living facilities.

But a company called Chefs for Seniors has an alternative: They send professional cooks into seniors' homes. In a couple of hours they can whip up meals for the week.

Chef Sina Sundby cooks delicious, nutritious meals in Jim Schulz's home in a suburb of Madison, Wis.

Ina Jaffe/NPR

For more than a year, Chef Sina Sundby's been doing just that for 85-year-old client Jim Schulz, who lives in a suburb of Madison, Wis. Her starched white chef's jacket tops a pair of blue jeans, while her strawberry blond hair is tucked under the traditional floppy chef's hat. She's a blur, chopping and mixing while pans sizzle on the stove.

Schulz watches, but doesn't interfere.

"We chatter a lot when it's just the two of us," says Schulz. "And even if I don't say anything, she just keeps talking."

Schulz and Sundby both laugh. They know this story.

"I stepped out of the room once and I heard her talking and I said, 'Who are you talking to?' " Schulz says. "And she said, 'I'm talking to the food.' "

"I do talk to the food," says Sundby, proudly.

Schulz says his diet was "lousy" before Sundby started cooking for him.

Ina Jaffe/NPR

Schulz's conclusion: "That's what makes it so good, it listens to her."

The food is also good because Sundby knows what Schulz likes.

So this week's dinners will be Salisbury steak with mushroom gravy, crab cakes with remoulade sauce and asparagus, chicken divan with fresh spinach and chicken pot pie with vegetables. And a twist.

"Jim likes biscuits," explains Sundby. "So instead of the pie dough, we're gonna do biscuits."

Schulz never made this kind of stuff for himself. When it comes to the kitchen, he's mastered the art of boiling water. His wife was a good cook, he says. But she died 14 years ago. So he ate whatever he could buy frozen and shove in the microwave.

"I was anemic, I'd lost a lot of weight, and it was [because] my diet was lousy," he says.

But Schulz says that according to his doctor, that's no longer a problem. "The last time I saw him was three months ago," says Schulz. "And he said, 'We can go a lot longer [between appointments], you're doing so well.' "

According to some estimates, there are hundreds of thousands, maybe even a million seniors living in their own homes who are malnourished. In long-term care facilities, up to 50 percent may suffer from malnutrition. This leads to increased risk for illness, frailty and falls.

The number of seniors out there who aren't eating properly is shocking.

"The number of seniors out there who aren't eating properly is shocking to me," says Barrett Allman, co-founder of Chefs for Seniors, which is based in Madison.

He's been a chef for 22 years, running everything from a seafood place on the Oregon coast to a restaurant in a small town near Madison that specialized in Wisconsin-style comfort food, or as he puts it, "anything with cheese in it."

The inspiration for Chefs for Seniors was Allman's wife's grandmother. When she could no longer cook for herself, the family decided she had to enter assisted living. That was 10 years ago.

The Salt Why Hungry Seniors Aren't Getting Enough To Eat

"She's still there, and not happy," Allman says.

The family didn't take it lightly, either. If only there had been a way for her to have the food she needed and remain in her home, they thought.

Then, about two years ago, the Allmans' 21-year-old son Nathan, a University of Wisconsin student, turned his family's longing into a business.

He entered the idea for Chefs for Seniors into the University's Burrill Business Plan Competition.

And he won his category.

"That's how we received our startup funds," he says: $1,000, plus mentoring.

Enough, says Nathan Allman, that "the next week my dad quit his job and we were off and running."

The Salt Eating To Break 100: Longevity Diet Tips From The Blue Zones

Part of the business plan is keeping the service affordable. In addition to the cost of the food, the client pays $30 an hour for the chef's time. That's usually a couple of hours a week of cooking and cleaning up the kitchen. There's also a $15 charge for grocery shopping. So clients pay on average $45 to $75 a week.

And while there are lots of personal chefs out there and services that deliver meals for seniors there are few services specifically for older adults that prepare food in their homes.

Chefs for Seniors now has 50 to 60 clients and employs around 10 chefs. They talk about expanding their territory. They talk about franchising. But right now, Barrett Allman still consults personally with every new client and is there the first time the client and the chef meet. He cooks for the most challenging cases himself: the people with severe disabilities or people in hospice care.

The Salt Nuts For Longevity: Daily Handful Is Linked To Longer Life

"I can't solve all the problems in that senior's life, but as a chef, the least I can do is make them food," Allman says.

Less than two hours after arriving at Jim Schulz's house, Sina Sundby is packing the food she made into single-portion containers, ready for the microwave. Aromas of chicken, mushrooms, biscuits, asparagus and chocolate chip cookies linger.

"When she leaves, I'm exhausted," says Schulz.

But he's got a week's worth of nourishing dinners to build up his strength for his chef's next visit.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Would Doctors Be Better If They Didn't Have To Memorize?

Sun, 04/26/2015 - 5:36am
Would Doctors Be Better If They Didn't Have To Memorize? April 26, 2015 5:36 AM ET

from

John Henning Schumann Katherine Streeter for NPR

Poor old Dr. Krebs. His painstaking Nobel-winning work on cellular metabolism, called the Krebs cycle, has made him the symbol for what's ailing medical education.

"Why do I need to know this stuff?" medical students ask me.

"How many times have you used the Krebs Cycle lately?" senior doctors jokingly reminisce.

For decades, first-year medical students have had to cram the details of the Krebs cycle into their heads. Now the biomedical model of educating doctors, based largely on a century-old document called The Flexner Report, is coming under fire.

From one end, our long-standing medical education model is attacked as out of tune with the information age. By some estimates, our entire body of medical knowledge doubles every three or four years.

Shots - Health News Medical Schools Reboot For 21st Century

Critics say med students can't possibly master so much information, which quickly becomes outdated anyway. Instead, the new theory goes, students should be taught and evaluated on their ability to find, assess and synthesize knowledge. And they should be educated in teams to help prepare them for what goes on in the real world.

From another angle, critics of the Flexner model correctly point out that Flexner himself, an educational theorist with no medical training, was silent on issues such as poverty, housing, nutrition and other factors that we now call the social determinants of health.

We now know these factors collectively affect our overall health more than even the $3 trillion health care industry.

Many times I've seen patients and found the tools I was trained to use aren't nearly enough to provide help. No physical exam or X-ray can find a homeless person a bed. No lab test or medication can provide a laid-off worker with job training or education.

It took more than a decade for me to learn to ask patients about hunger. I found out that many of the people I've cared for suffer from food insecurity – not knowing where their next meal will come from.

"But what can I do about those problems?" my students ask. "Isn't that just social work?"

The answer may surprise you.

In my role as a medical educator, I attended the Beyond Flexner conference in Albuquerque, N.M., in early April. The main theme of the meeting, sponsored by the W.K. Kellogg Foundation and others, was this question: "What is the social mission of medical education?"

The conference came about as an outgrowth of a 2010 paper that ranked medical schools by their social commitment rather than their research dollars or U.S. News and World Report scores. It began as something of a shot across the bow to organized medicine, challenging orthodoxy, such as making students memorize the Krebs cycle.

Over the years since then, more research has shed light on the economic and health impact of social determinants. The media has caught on to this as well.

Nearly 400 medical educators, activists, policymakers and students turned up to share ideas, hash out strategy and plan a road map for changing medical education.

Our hosts from the University of New Mexico demonstrated that medical schools that are serious about community engagement build strong partnerships that take social determinants into account. We heard how community health workers and a re-imagination of the agricultural extension model for health education are improving the health of New Mexicans.

To me, the most surprising aspect of the meeting was just how many medical schools are now getting serious about the importance of social determinants.

Many of the sessions at the conference explored obstacles that stand in the way of a culture change in medical education. At the top of the list: How to deal with a payment system that still prioritizes the quantity of medical care over quality? A decision by Medicare earlier this year to base a large proportion of future payments on quality and value has convinced many of us that the health system is on the path of change.

I left the conference with new ideas and fresh energy. I also was left wondering what will replace the Krebs cycle in the medical education pantheon.

My bet? It will be a team of students finding ways to break the vicious cycle of poverty that contributes to so much suffering, illness and early loss of life.

John Henning Schumann is a writer and doctor in Tulsa, Okla. He was recently named interim president of the University of Oklahoma, Tulsa. He also hosts Public Radio Tulsa's Medical Matters. He's on Twitter: @GlassHospital

Copyright 2015 KWGS-FM. To see more, visit http://www.kwgs.org.
Categories: NPR Blogs

Would Doctors Be Better If They Didn't Have To Memorize?

Sun, 04/26/2015 - 5:36am
Would Doctors Be Better If They Didn't Have To Memorize? April 26, 2015 5:36 AM ET

from

John Henning Schumann Katherine Streeter for NPR

Poor old Dr. Krebs. His painstaking Nobel-winning work on cellular metabolism, called the Krebs cycle, has made him the symbol for what's ailing medical education.

"Why do I need to know this stuff?" medical students ask me.

"How many times have you used the Krebs Cycle lately?" senior doctors jokingly reminisce.

For decades, first-year medical students have had to cram the details of the Krebs cycle into their heads. Now the biomedical model of educating doctors, based largely on a century-old document called The Flexner Report, is coming under fire.

From one end, our long-standing medical education model is attacked as out of tune with the information age. By some estimates, our entire body of medical knowledge doubles every three or four years.

Shots - Health News Medical Schools Reboot For 21st Century

Critics say med students can't possibly master so much information, which quickly becomes outdated anyway. Instead, the new theory goes, students should be taught and evaluated on their ability to find, assess and synthesize knowledge. And they should be educated in teams to help prepare them for what goes on in the real world.

From another angle, critics of the Flexner model correctly point out that Flexner himself, an educational theorist with no medical training, was silent on issues such as poverty, housing, nutrition and other factors that we now call the social determinants of health.

We now know these factors collectively affect our overall health more than even the $3 trillion health care industry.

Many times I've seen patients and found the tools I was trained to use aren't nearly enough to provide help. No physical exam or X-ray can find a homeless person a bed. No lab test or medication can provide a laid-off worker with job training or education.

It took more than a decade for me to learn to ask patients about hunger. I found out that many of the people I've cared for suffer from food insecurity – not knowing where their next meal will come from.

"But what can I do about those problems?" my students ask. "Isn't that just social work?"

The answer may surprise you.

In my role as a medical educator, I attended the Beyond Flexner conference in Albuquerque, N.M., in early April. The main theme of the meeting, sponsored by the W.K. Kellogg Foundation and others, was this question: "What is the social mission of medical education?"

The conference came about as an outgrowth of a 2010 paper that ranked medical schools by their social commitment rather than their research dollars or U.S. News and World Report scores. It began as something of a shot across the bow to organized medicine, challenging orthodoxy, such as making students memorize the Krebs cycle.

Over the years since then, more research has shed light on the economic and health impact of social determinants. The media has caught on to this as well.

Nearly 400 medical educators, activists, policymakers and students turned up to share ideas, hash out strategy and plan a road map for changing medical education.

Our hosts from the University of New Mexico demonstrated that medical schools that are serious about community engagement build strong partnerships that take social determinants into account. We heard how community health workers and a re-imagination of the agricultural extension model for health education are improving the health of New Mexicans.

To me, the most surprising aspect of the meeting was just how many medical schools are now getting serious about the importance of social determinants.

Many of the sessions at the conference explored obstacles that stand in the way of a culture change in medical education. At the top of the list: How to deal with a payment system that still prioritizes the quantity of medical care over quality? A decision by Medicare earlier this year to base a large proportion of future payments on quality and value has convinced many of us that the health system is on the path of change.

I left the conference with new ideas and fresh energy. I also was left wondering what will replace the Krebs cycle in the medical education pantheon.

My bet? It will be a team of students finding ways to break the vicious cycle of poverty that contributes to so much suffering, illness and early loss of life.

John Henning Schumann is a writer and doctor in Tulsa, Okla. He was recently named interim president of the University of Oklahoma, Tulsa. He also hosts Public Radio Tulsa's Medical Matters. He's on Twitter: @GlassHospital

Copyright 2015 KWGS-FM. To see more, visit http://www.kwgs.org.
Categories: NPR Blogs

CDC Warns More HIV, Hepatitis C Outbreaks Likely Among Drug Users

Fri, 04/24/2015 - 2:19pm
CDC Warns More HIV, Hepatitis C Outbreaks Likely Among Drug Users April 24, 2015 2:19 PM ET Listen to the Story 2 min 22 sec  

The Centers for Disease Control and Prevention warns that the U.S. epidemic of opioid abuse could lead to more severe outbreaks of HIV and hepatitis C nationally, much like the outbreak now seen in Indiana. A health advisory the agency released Friday outlines steps that state health departments and medical providers should take to minimize the risk of that happening.

A public health emergency has been in effect in southern Indiana's Scott County since late March. According to the Indiana State Department of Health, 142 people have been diagnosed with HIV since December. Prior to the outbreak, the rural county hadn't recorded more than five cases of HIV in a given year, and in many years it recorded none.

Indiana's current HIV outbreak has been linked to the intravenous injection of oxymorphone, an oral painkiller sold under the brand name Opana. Abuse of the prescription opioid has been a common problem in southern Indiana for years and has affected many communities across the U.S.

Shots - Health News Indiana's HIV Spike Prompts New Calls For Needle Exchanges Statewide

A CDC report, released at a press conference Friday, shows that 85 percent of patients newly diagnosed with HIV in Scott County also have hepatitis C, which can be hugely expensive to treat.

Around the Nation Indiana Governor Extends Public Health Emergency To Fight HIV Outbreak

The report also indicates that 75 percent of the infected patients are men, and about 25 percent of infected women are commercial sex workers.

Entire families are sometimes using the prescription opioids, the report notes — "with as many as three generations of a family and multiple community members injecting together."

The Indiana State Department of Health says it has developed a multipronged plan for dealing with the current outbreak. It includes a public education campaign, a facility that offers immunizations, and programs that connect patients with addiction treatment centers and job training.

Right now, that approach also includes a controversial needle exchange program, which has reportedly distributed thousands of needles to more than 80 injection drug users. The exchange program became possible when Indiana Gov. Mike Pence temporarily suspended an Indiana law that bans needle exchange programs. Some politicians have called for the ban to be lifted permanently. Neighboring Kentucky approved the use of needle exchange programs last month.

In addition to the recent HIV and hepatitis C outbreaks in Indiana, CDC data have shown a 150 percent increase across four years nationally in new hepatitis C infections. Hepatitis C infections often increase among users of injected drugs; the CDC is asking states to take a closer look at their own health data, to help identify communities that could be at risk for unrecognized clusters of hepatitis and HIV infections.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

To Weather Criticism, It Helps To Think Of The Big Picture

Fri, 04/24/2015 - 10:28am
To Weather Criticism, It Helps To Think Of The Big Picture April 24, 201510:28 AM ET

Think back to the last time you got negative feedback — like when your doctor suggested you lay off the cigarettes or when your mother advised you to get rid of that ridiculous goatee.

Though we all understand the value of constructive criticism, we don't like hearing that we've done something wrong. And the knee-jerk reaction is to act defensive.

But if you focus on the big picture and future goals, you may be able to trick your mind into being a bit more receptive.

That's what researchers at the Ohio State University discovered in a study published Friday in the Personality and Social Psychology Bulletin.

The researchers tried a couple of experiments. First, they divided 85 undergraduate students into two groups. They encouraged half the students think about broad ideas — for example, "sodas are a type of drink." They asked the other half to consider: "A Coke is a type of soda."

Shots - Health News Men And Women Use Different Scales To Weigh Moral Dilemmas

Then they told everyone about the dangers of skin cancer and suggested that students who don't already do so should wear sunscreen and avoid tanning.

The group that was asked to think broadly was more receptive to the suggestions, and said they were more likely to feel motivated to give up tanning.

When people are thinking big, they have an easier time realizing a single critique doesn't define them, says Jennifer Belding, the doctoral student in social psychology who led the study. "It helps them step back, and realize that the person giving them that feedback is just trying to help," she explains.

"But when people are thinking about the nitty-gritty details and they have a narrow mindset, it's easy for them to get caught up in the moment," Belding says. "Instead of focusing on how the feedback can help them in the long run, they think about how much that information is hurting them."

"Every time I submit a research paper to a journal, it invariably comes back with tons of edits and feedback. And every time, it's easy to feel disappointed or even angry."

Believing that change is possible is important as well. In a second experiment, Belding and her colleagues divided 133 students into several groups. Some were asked to think broadly about the importance of maintaining good health, while others were told to think about what they could do in the immediate future to stay healthy. And then, while some read about how skin cancer is easily preventable, others read that it was genetic.

Those who not only thought broadly about their health but also believed that cancer was preventable were the most motivated. This group spent, on average, five extra minutes reading about how to avoid sun damage.

It's all about perspective, says Daniel Molden, a social psychologist at Northwestern University who wasn't involved in the study.

"For most people, the immediate response to criticism is emotional. They might feel threatened or hurt," Molden says. "And people don't like to feel hurt, so they'll try to deflect or undermine the critiques."

A growing body of research suggests that taking a broad perspective helps people deal with perceived threats, Molden notes.

When you're on the receiving end of criticism, Molden's advice is to take a few minutes to think about your long-term goals. And to think about how criticism is simply a part of life.

Shots - Health News Can A Computer Change The Essence Of Who You Are?

"I can tell you, as someone in academia, I deal with negative feedback all the time," Molden says. "I've been doing this for 15 years. And every time I submit a research paper to a journal, it invariably comes back with tons of edits and feedback. And every time, it's easy to feel disappointed or even angry."

Molden says he copes by letting himself feel frustrated for a few minutes. "And then I step back and reflect on how this feedback could be beneficial."

If you're the one delivering negative feedback, before launching into what someone has done wrong, you might want to start with a general statement about what you think of him or her overall, Molden says.

"This is relevant when it comes to public health campaigns as well," Molden notes. People tend to avoid screenings for cancer or sexually transmitted diseases because they don't want to risk hearing bad news. But they might be persuaded by campaigns that encourage screenings as part of a broader plan for staying healthy.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Couples Counseling Catches On With Tech Co-Founders

Thu, 04/23/2015 - 2:56pm
Couples Counseling Catches On With Tech Co-Founders April 23, 2015 2:56 PM ET

from

April Dembosky Listen to the Story 3 min 28 sec  

Work partners Jon Chintanaroad (left) and Mike Prestano are all smiles now, but founding a tech startup together threatened their friendship — and their business.

April Dembosky/KQED

Startups fail for a lot of reasons: bad product, wrong timing. But sometimes, it's just you.

Relationship problems between co-founders are among the biggest reasons companies don't make it. Increasingly in Silicon Valley, business partners are looking for help before things go downhill — they're signing up for couples counseling.

"It's good to do this work while it's actually unfolding in the organizations, and set these things right before they go horribly wrong."

"It felt like a marriage," Jon Chintanaroad says of his business partnership with his friend, Mike Prestano. They launched a tech recruiting startup, Aspire Recruiting, in 2013.

"My joke was, during the day, Mike was my wife No. 1, and my girlfriend was my wife No. 2," Chintanaroad says. "I would see her at night, and I see him all day."

The two were friends for four years before they went into business together. Chintanaroad says their work styles really complemented one another.

"I'm very transactional-based," Chintanaroad says. "I'm kind of a Type-A personality — I just want to get it done, whereas Mike will listen to their whole life story and really cultivate that relationship. When we had both, we started to win over new clients and things went from there."

The business took off right away, and the money came rolling in. But a year into it, they hit some rough patches. They missed some key customer acquisitions. Revenues dipped.

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That's when their differences became less complementary and more problematic.

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"It's like any sports team," Prestano says. "If you lose: 'You should have scored this touchdown.' 'You should have scored that basket.' 'You should have passed to here instead of there.' Those aren't easy conversations."

They started fighting a lot. Mike thought Jon spent too much money. Jon thought Mike wasn't pulling his weight.

Prestano says they worried the business problems were starting to threaten their friendship.

"I think we both agree ... no matter what happens with the business," Prestano says, "if we keep doing it, or it stops, we still keep our friendship."

They decided to try couples counseling — though most therapists who work with co-founders call it "partnership coaching."

It's something more and more startup founders are doing. Jonathan Horowitz is a psychologist with offices in San Francisco and San Mateo. He says the number of requests he gets for co-founder counseling has doubled in the last year. A lot of times, people call when things have already gotten really ugly.

"The company's dead, something went horribly wrong in the relationship, and they're picking up the pieces afterwards," Horowitz says.

Many startups, especially in the tech industry, are founded by young guys — friends who met in college, got an apartment together and started working on their laptops around-the-clock to get a business off the ground. When things go well, co-founders can suddenly find themselves in complicated business situations with a lot of money — and power — on the line. They have to decide who's going to be CEO. They have to answer to investors. These pressures test the relationship.

Most of the time, it's usually lawyers who get called in to mediate heated disputes or to force one of the founders out of the company. Or to help the partners declare bankruptcy, if the business failed.

"It's good to do this work while it's actually unfolding in the organizations," Horowitz says, "and set these things right before they go horribly wrong."

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He says in a lot of business partnerships, there's often one founder who is more dominant, even domineering. "You have the other founder who might not feel like they're being heard or respected. An imbalance like that can be insidious."

In cases like that, good ideas get dismissed; opportunities are lost. Horowitz says his job is to help build trust, communication and empathy.

"All those things are important if you're going to run a business with someone for years and years," he says, "just like [in] a marriage."

It's not just startups that have picked up on the idea. Couples counselors say larger companies like Cisco and Google have hired them to work with managers who aren't getting along. Stanford Business School offers a group therapy course, where required reading includes The Seven Principles for Making Marriage Work. The students call it the "touchy-feely" class.

For Jon Chintanaroad and Mike Prestano, a few sessions with a therapist made them both feel like they had permission to talk about their feelings.

"I think, overall, it resulted in both of us being more aware as people, and balanced," Chintanaroad says.

Chintanaroad worked on listening more. Prestano learned when to speak up if something was bothering him.

"Those things that were bottling up, I talked to Jon about it, expressed how I feel, and he took no offense," Prestano says. "And, actually, he's shown some compassion."

Their tech recruiting business is back on track — and that leaves more energy for social recruiting. After a couple drinks on Friday, Chintanaroad asks Prestano to help him scout for a new girlfriend.

"He can be my wingman," Chintanaroad says.

The sales psychology they use at the office, Prestano says, works just as well at the bar.

Copyright 2015 KQED Public Media. To see more, visit http://www.kqed.org.
Categories: NPR Blogs

Thoughts Can Fuel Some Deadly Brain Cancers

Thu, 04/23/2015 - 12:13pm
Thoughts Can Fuel Some Deadly Brain Cancers April 23, 201512:13 PM ET Listen to the Story 4 min 10 sec  

A color-enhanced cerebral MRI showing a glioma tumor.

Scott Camazine/Science Source

The simple act of thinking can accelerate the growth of many brain tumors.

That's the conclusion of a paper in Cell published Thursday that showed how activity in the cerebral cortex affected high-grade gliomas, which represent about 80 percent of all malignant brain tumors in people.

"This tumor is utilizing the core function of the brain, thinking, to promote its own growth," says Michelle Monje, a researcher and neurologist at Stanford who is the paper's senior author.

In theory, doctors could slow the growth of these tumors by using sedatives or other drugs to reduce mental activity, Monje says. But that's not a viable option because it wouldn't eliminate the tumor and "we don't want to stop people with brain tumors from thinking or learning or being active."

Even so, the discovery suggests other ways to slow down some of the most difficult brain tumors, says Tracy Batchelor, who directs the neuro-oncology program at Massachusetts General Hospital and was not involved in the research.

Dr. Michelle Monje wanted to figure out how tumors hijacked the myelination process.

Steve Fisch/Courtesy of Stanford School of Medicine

"We really don't have any curative treatments for high-grade gliomas," Batchelor says. The discovery of a link between tumor growth and brain activity "has opened up a window into potential therapeutic interventions," he says.

The discovery came from a team of scientists who studied human glioma tumors implanted in mouse brains. The scientists used a technique called optogenetics, which uses light to control brain cells, to increase the activity of cells near the tumors.

The team wanted to know whether this high level of activity would make the glioma grow more quickly. "And it turns out that it did,"

The discovery of a link between tumor growth and brain activity is a byproduct of Monje's career-long quest to help to help children with a rare and deadly form of brain cancer.

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The cancer is called diffuse intrinsic pontine glioma, or DIPG. Monje saw her first case when she was still in medical school. "I cared for a little girl who had diffuse intrinsic pontine glioma and I was just so struck by our failure to treat this disease," she says.

DIPG strikes about 200 children a year, often at around age 6. It can't be treated with surgery because the tumor cells become entwined with healthy cells in the brain stem. Children with DIPG typically live about nine months after they are diagnosed.

"This is a disease with a terrible prognosis," Monje says. "And it's one that unfortunately we haven't been able to touch with interventions for decades."

Monje wanted to change that. So after receiving her M.D. and Ph.D. from Stanford in 2004, she began studying DIPG tumor cells as well as the part of the brain in which they grow, the brain stem.

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She began to suspect that this cancer was somehow hijacking a process called myelination, which happens in the brains of healthy kids. Myelination creates a layer of insulation around nerve fibers, which allows them to carry signals more quickly and efficiently.

Last year, Monje and a team of researchers showed that the cells responsible for myelination began to grow rapidly in response to high levels of brain activity. "That was an intriguing finding and it was consistent with our idea that activity in the brain, thinking, planning, using your brain, might be promoting the cancer arising within it," she says.

The mouse experiment confirmed Monje's suspicion. Another experiment showed that the glioma cells were indeed growing in response to the chemical signals that usually lead to myelination.

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One striking finding, though, was that the link between brain activity and tumor growth wasn't limited to DIPG, the rare childhood tumor Monje had been studying since medical school. Her team found that a range of deadly gliomas grow faster when they're near highly active nerve cells.

"This work has much broader implications for brain tumors," says Batchelor. "It's not just pediatric tumors, it's pediatric and adult. And it's not just one particular type of glioma. This has potential implications across the entire family of gliomas in the brain."

Batchelor says Monje's research suggests a new way to slow down these tumors — by interrupting the pathways linking brain activity to tumor growth.

Monje says she is encouraged that her work has led to a better understanding of DIPG and other deadly childhood tumors. But she says it's still hard to feel gratified.

"It will be gratifying when we make some difference for these kids," she says.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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More Whistleblowers Say Health Plans Are Gouging Medicare

Thu, 04/23/2015 - 5:08am
More Whistleblowers Say Health Plans Are Gouging Medicare April 23, 2015 5:08 AM ET Fred Schulte

Privately run Medicare plans, fresh off a lobbying victory that reversed proposed budget cuts, face new scrutiny from government investigators and whistleblowers who allege that plans have overcharged the government for years.

Federal court records show at least a half dozen whistleblower lawsuits alleging billing abuses in these Medicare Advantage plans have been filed under the False Claims Act since 2010, including two that just recently surfaced. The suits have named insurers from Columbia, S.C., to Salt Lake City to Seattle, and plans that have together enrolled millions of seniors. Lawyers predict more whistleblower cases will surface. The Justice Department also is investigating Medicare risk scores.

Though specific allegations vary, the whistleblower suits all take aim at these risk scores. Medicare uses the scores to pay higher rates for sicker patients and less for people in good health. But officials were warned as early as 2009 that some plans claim patients are sicker than they actually are to boost their payments.

Privately run Medicare Advantage plans have signed up more than 17 million members, about a third of the people eligible for Medicare, and are poised to get bigger. Earlier this month, the industry overturned proposed cuts sought by the Obama administration for a third straight year, instead winning a modest raise in payment rates for the programs.

Medicare Advantage resonates with many seniors for its low out-of-pocket costs. It's also winning favor with some health policy experts who argue these managed care plans can offer higher quality care than standard Medicare, which pays doctors and hospitals on a fee-for-service basis.

Karen Ignagni, the chief executive officer of America's Health Insurance Plans, the industry's trade group, called the government's change of heart "a notable step to provide stable funding."

"It shows the incentives provided for whistleblowers are working well, and all the other controls and detection systems are failing miserably."

But the whistleblower suits argue that it's too easy for health plans to gouge the government.

Malcolm Sparrow, a health care fraud expert at Harvard's John F. Kennedy School of Government, said the number of these cases suggests government oversight is too lax.

"It shows the incentives provided for whistleblowers are working well, and all the other controls and detection systems are failing miserably," Sparrow wrote in an email.

Ray Thorn, a spokesman for the federal Centers for Medicare and Medicaid Services, disagreed. He said CMS "is taking steps to protect taxpayers, Medicare beneficiaries and the Medicare program." Thorn cited an increase in CMS audits and said health plans have identified overpayments and given back about $1.1 billion to the government.

Still, critics want to step up accountability as the health plans bite off bigger chunks of Medicare business. Annual taxpayer costs for Medicare Advantage exceed $150 billion

"CMS could save billions of dollars by improving the accuracy of its payments to Medicare Advantage programs."

"CMS could save billions of dollars by improving the accuracy of its payments to Medicare Advantage programs," the Government Accountability Office wrote in its just-released 2015 annual report.

On another front, the Justice Department is widening the scope of an investigation into whether exaggerated risk scores are jacking up costs improperly.

Humana Inc., based in Louisville, Ky., which counts more than 3 million seniors in its plans, wrote in a March Securities and Exchange Commission filing that the investigation "includes a number of Medicare Advantage plans, providers and vendors."

On April 14, DaVita Healthcare Partners Inc., headquartered in Denver, disclosed that it had received a Justice Department subpoena. Investigators sought Medicare Advantage billing data and other records.

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In the latest lawsuit to surface, a pair of whistleblowers allege that Blue Cross of South Carolina submitted inflated claims between 2006 and 2010, then "acted to cover up and hide the false submissions so that they would be able to retain the wrongly paid reimbursements," according to an April 3 filing.

The South Carolina suit also names the Deseret Mutual Insurance Co., a Utah plan formed by the Church of Jesus Christ of Latter-day Saints, which contracted with Blue Cross to process Medicare Advantage billings.

"We deny the allegations and are vigorously defending the case," responded Blue Cross of South Carolina spokeswoman Patti Embry-Tautenhan.

Deseret Mutual could not be reached despite repeated calls and emails to the health plan's Utah office and its South Carolina attorney.

The suit was filed by Catherine Brtva, a former Blue Cross computer billing specialist, and Jerald R. Conte, a former contractor.

The case targets flaws in computer programs that Blue Cross says were used to submit to Medicare millions of health insurance claims by hundreds of thousands of members.

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In court filings, Blue Cross does not deny that some overcharges occurred. But it says underpayments also happened and that it worked with CMS to correct the problems.

The whistleblowers argue that the plans set out to repay only about $2 million in overpayments — just 10 percent of what they actually owed. CMS officials declined to discuss the matter.

Several attorneys said in interviews they expect more cases to surface, particularly as Medicare Advantage grows. Risk scoring fraud "has popped up on our radar," said Joseph E.B. White, a Philadelphia lawyer specializing in whistleblower cases.

One suit, which the Center for Public Integrity only recently discovered, was filed in 2012 by Lisa Parker, a former clinic supervisor at The Polyclinic in Seattle, who sued the clinic and Essence Healthcare, a Medicare Advantage plan.

Parker cited a 2010 memo that asked doctors' staff to talk hundreds of elderly people into coming in for a medical visit. The clinic was to receive about $250,000 to $500,000 in 2011 from increased risk scores from the visits.

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The lawsuit alleges the visits "were not dictated by patient concern, nor for the treatment or diagnosis of specific illnesses, symptoms, complaints or injuries, but were designed and performed to maximize the opportunity to bill Medicare."

Joel Andersen, vice president of marketing for Essence Healthcare, said in an email statement: "The government did not find any wrongdoing or any cause to intervene and thus the case was quickly dismissed. We consider the matter closed and have no additional commentary to add. We strongly advise that this matter not be characterized in any other fashion than a frivolous lawsuit based on unfounded claims."

Tracy Corgiat, vice president of marketing and development at The Polyclinic, said that CMS requires that a patient's "clinical history and medical diagnoses be newly documented each year during an in-person visit." The Polyclinic has a "rigorous process for validating the diagnoses of our patients and we are fully confident in that process," she said.

At least one doctor was taken aback.

"Let me see if I've got this right. In order to get more $$$ for the Polyclinic, we have to bring patients in for a visit they didn't need or initiate?" the doctor, Scott Stevens, wrote in an email that's part of the court file.

"They would get more from a movie and popcorn!" Stevens wrote.

This piece comes from the Center for Public Integrity, a nonpartisan, nonprofit investigative news organization. To follow CPI's investigations into Medicare and Medicare Advantage waste, fraud and abuse, go here. Or follow the organization on Twitter.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Critics Lash Out At Chinese Scientists Who Edited DNA In Human Embryos

Thu, 04/23/2015 - 5:06am
Critics Lash Out At Chinese Scientists Who Edited DNA In Human Embryos April 23, 2015 5:06 AM ET Listen to the Story 3 min 39 sec   iStockphoto

For the first time, scientists have edited DNA in human embryos, a highly controversial step long considered off limits.

Junjiu Huang and his colleagues at the Sun Yat-sen University in Guangzhou, China, performed a series of experiments involving 86 human embryos to see if they could make changes in a gene known as HBB, which causes the sometimes fatal blood disorder beta-thalassemia.

The report, in the journal Protein & Cell, was immediately condemned by other scientists and watchdog groups, who argue the research is unsafe, premature and raises disturbing ethical concerns.

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"No researcher should have the moral warrant to flout the globally widespread policy agreement against modifying the human germline," Marcy Darnovsky of the Center for Genetics and Society, a watchdog group, wrote in an email to Shots. "This paper demonstrates the enormous safety risks that any such attempt would entail, and underlines the urgency of working to forestall other such efforts. The social dangers of creating genetically modified human beings cannot be overstated."

George Daley, a stem cell researcher at Harvard, agreed.

"Their data reinforces the wisdom of the calls for a moratorium on any clinical practice of embryo gene editing, because current methods are too inefficient and unsafe," he wrote in an email. "Further, there needs to be careful consideration not only of the safety but also of the social and ethical implications of applying this technology to alter our germ lines."

Scientists have been able to manipulate DNA for years. But it's long been considered taboo to make changes in the DNA in a human egg, sperm or embryo because those changes could become a permanent part of the human genetic blueprint. One concern is that it would be unsafe: Scientists could make a mistake, which could introduce a new disease that would be passed down for generations. And there's also fears it this could lead to socially troubling developments, such as "designer babies," in which parents can pick and choose the traits of their children.

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The Chinese researchers say they tried this to try to refine a new technique called CRISPR/Cas9, which many scientists are excited about it because it makes it much easier to edit DNA. The procedure could enable scientists to do all sorts of things, including possibly preventing and curing diseases. So the Chinese scientists tried using CRISPR/Cas9 to fix a gene known as the HBB gene, which causes beta thallasemia.

The work was done on 86 very early embryos that weren't viable, in order to minimize some of the ethical concerns. Only 71 of the embryos survived, and just 28 were successfully edited. But the process also frequently created unintended mutations in the embryos' DNA.

"Taken together, our data underscore the need to more comprehensively understand the mechanisms of CRISPR/Cas9-mediated genome editing in human cells, and support the notion that clinical applications of the CRISPR system may be premature at this stage," the Chinese scientists wrote.

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Rumors about this research have been circulating for weeks, prompting several prominent groups of scientists to publish appeals for a moratorium on doing this sort of thing.

In the wake of the report from the Chinese scientists, several of these researchers reiterated their call for a moratorium. Some said they hoped the difficulties that Huang and his colleagues encountered might discourage other scientists from attempting anything similar.

"The study simply underscores the point that the technology is not ready for clinical application in the human germline," Jennifer Doudna, the University of California, Berkeley, scientist who developed CRISPR, wrote in an email. "And that application of the technology needs to be on hold pending a broader societal discussion of the scientific and ethical issues surrounding such use."

But there are already reports that Huang's group and possibly others in China continue to try editing the genes in human embryos.

"We should brace for a wave of these papers, and I worry that if one is published with a more positive spin, it might prompt some IVF clinics to start practicing it, which in my opinion would be grossly premature and dangerous," Daley says.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Why Do Mosquitoes Like To Bite You Best? It's In Your Genes

Wed, 04/22/2015 - 4:08pm
Why Do Mosquitoes Like To Bite You Best? It's In Your Genes April 22, 2015 4:08 PM ET Listen to the Story 3 min 3 sec  

Mmm. Smells just like your identical twin.

iStockphoto

A study that asked a few dozen pairs of twins to brave a swarm of hungry mosquitoes has revealed another clue to the cluster of reasons the insects are more attracted to some people than others: Genes matter.

"Twins that were identical were very similar in their level of attractiveness to mosquitoes, and twins that were [not identical] were very different in their level of attractiveness," says James Logan, a medical entomologist at the London School of Hygiene & Tropical Medicine who led the study. "So it suggests that the trait for being attractive or unattractive to mosquitoes is genetically controlled."

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It's long been known that female mosquitoes, which need the proteins in a blood meal to make their eggs, are more drawn to certain people than others, and that various factors are involved.

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Women who are pregnant seem to attract the insects more than women who aren't, for example, and people infected with the malaria parasite seem to be most attractive during the period when the parasite is most transmissible.

In their own previous research, Logan and his colleagues found that people who are bitten less frequently seem to "smell differently to mosquitoes." It's almost as if they produce a natural repellent, he says.

The most recent study, published Wednesday in the journal PLOS ONE, indicates that there are likely specific genes behind those differences in people — genes that affect the way each person smells to the insects.

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To figure that out, the researchers brought 18 pairs of identical twins and 19 pairs of fraternal twins into the lab. Each person stuck a hand in one of the short arms of a Y-shaped plexiglass tube, as air was blown past the hand, toward 20 female Aedes aegypti mosquitoes clustered at the long end of the Y. Once released, the insects could choose between the twins — to fly upwind, along either side of the Y, presumably following the odor of the person they were most attracted to. (The scientists used a new batch of hungry mosquitoes in each trial, and also compared the results to trials that involved "clean air" and nobody's hand.)

There was essentially no difference in the mosquitoes' response to genetically identical twins, the scientists found, but quite a bit of difference in their response to fraternal twins, who are as genetically different from each other as any other pair of siblings. Logan now wants to try to identify which genes exactly influence attractiveness.

"If we could work out which genes are involved, we could develop new repellents," Logan says — which could be much more than a boon to backyard barbeques. Mosquitoes spread lots of terrible diseases.

"The mosquito tested here, Aedes aegypti, is the main transmitter of the yellow fever virus, and the dengue virus, and some other infectious agents," says Richard Pollack, a public health entomologist at the Harvard School of Public Health. "So the more we learn about what causes a mosquito to find a person, the better we'll be able to design better strategies to protect people."

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Can A Person With Dementia Consent To Sex?

Wed, 04/22/2015 - 3:34pm
Can A Person With Dementia Consent To Sex? April 22, 2015 3:34 PM ET Listen to the Story 3 min 40 sec   iStockphoto

Sexual relationships in long-term care facilities are not uncommon. But the long-term care industry is still grappling with the issue.

There's no greater evidence of that than a criminal case in Iowa. On Wednesday, a jury in Iowa found a 78-year-old man not guilty of raping his wife, who had Alzheimer's disease. Henry Rayhons' wife lived in a nursing home. The staff there told Rayhons that because of her dementia, his wife was no longer capable of consenting to sex. He had been charged with sexual assault for allegedly having sex with her after that.

But at the Hebrew Home in Riverdale, N.Y., the fact that some people with dementia still have sex lives isn't news. That facility has had a written policy to help staff manage such relationships for 20 years.

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"It was controversial in 1995 and it's controversial today," says Daniel Reingold, the CEO of RiverSpring Health, the nonprofit that runs the Hebrew Home.

"We knew that there was intimacy occurring, and we considered it to be a civil right and a legal right," says Reingold. "We also felt that intimacy was a good thing, that touch is one of the last pleasures we abandon and lose as we age."

Reingold says the policy protects residents from unwanted sexual contact. And he argues that people with dementia are indeed capable of giving consent.

"People who have Alzheimer's disease or dementia are asked on a daily basis to make decisions about their desires," says Reingold, "from what they eat to activities they may want to engage in," including intimacy with another person.

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But even with a written policy, it's not that easy for nursing homes to figure out when consent to sex is really valid, says Evelyn Tenenbaum, a professor of law at Albany Law School and bioethics professor at Albany Medical College.

"For example, suppose you have a couple and the woman believes that the man she's seeing is her husband," says Tenenbaum. "Then she consents to a sexual relationship. Is that really consent if she doesn't understand who he is and that she's not married to him?"

Sometimes in such cases, nursing homes will defer to the wishes of the resident's family, says Tenenbaum.

"On the other hand, nursing homes are required to take care of the psychosocial needs of their residents," says Tenenbaum. "Whether psychosocial needs would include sexual relationships is a question."

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And it's a question with no commonly accepted answer. The American Health Care Association, a trade group representing the majority of nursing homes, only suggests that its member facilities develop their own policies. Patricia Bach, a geriatric psychologist, says when she started looking into the topic she didn't find much.

"There was very, very little empirical evidence, little data, few research studies and it really was a lower priority issue for long-term care providers," she says.

So with a colleague, Bach surveyed members of the American Medical Directors Association, which represents physicians who work in long-term care facilities.

Bach found that "only 25 to 30 percent actually had formal training in the area of intimacy and sexuality, as it would pertain to older adults. Thirty percent had no training at all." The survey also found that only about 30 percent of nursing homes where the respondents worked had formal policies.

That's something that needs to change, and fast, says Reingold.

"We are dealing with the arrival of my fellow baby boomers," he says. They've "grown up in an environment where sexuality was a much more open conversation and activity."

And there's no reason to think that will change, Reingold says, even when those boomers are in long-term care.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Why Many Doctors Don't Follow 'Best Practices'

Wed, 04/22/2015 - 12:14pm
Why Many Doctors Don't Follow 'Best Practices' April 22, 201512:14 PM ET Listen to the Story 3 min 33 sec  

For all their talk about evidence-based medicine, a lot of doctors don't follow the clinical guidelines set by leading medical groups.

Consider, for example, the case of cataract surgery. It's a fairly straightforward medical procedure: Doctors replace an eye's cloudy lens with a clear, prosthetic one. More than a million people each year in the U.S. have the surgery — most of them older than 65.

"The procedure itself is relatively painless and quick," says Dr. Catherine Chen, an anesthesiologist and researcher at the University of California, San Francisco. She calls it the "prototypical low-risk surgery."

And since at least 2002, Chen says, clinical guidelines have stipulated that no preoperative testing is needed before cataract surgery. A large study showed that procedures like chest X-rays, blood tests and EKGs — tests sometimes recommended when older people undergo more complicated surgeries — do not benefit someone who is simply having a cataract removed.

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But Chen noticed that a lot of patients are having these preoperative tests done anyway. How many? Digging into the numbers, she discovered that half the ophthalmologists who performed cataract surgery on Medicare patients in 2011 ordered unnecessary tests. That's the same percentage as in 1995.

"In about 20 years, nothing has really changed in terms of physician performance," Chen says. She recently published those findings in the New England Journal of Medicine.

Dr. Steven Brown, a professor of family medicine at the University of Arizona, has studied doctors' reasons for ordering unnecessary tests before a scheduled surgery. A lot of it has to do with perceived safety, he says.

"They think, somehow, that this is going to make the patient more likely to do well in surgery," he says. "It's not."

Brown says some doctors don't know the latest guidelines, which is somewhat understandable, since there can be hundreds to follow.

But often, he says, doctors order extra tests because they think someone down the line — another surgeon or anesthesiologist — will require them.

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"[It becomes] this game of tag," he says, "where you're doing something because you think somebody else wants it, even if you don't really want it."

So, even in the midst of good science and a clear consensus on what should be done, a lot of physicians don't follow the "best practice" guidelines.

Now, imagine what happens when the science isn't clear.

That was the case Monday, when the U.S. Preventive Services Task Force updated its guidelines for breast cancer screening. After analyzing the best studies, the influential panel now suggests most women get a mammogram every other year, beginning at age 50. Guidance from this task force largely determines which tests will be covered by Medicare, Medicaid and insurance companies.

Meanwhile, the American Cancer Society and the American College of Radiology still recommend annual screening mammograms for women beginning at age 40.

"There's really a lot more ambiguity about what is the right thing — what's appropriate [and] what's not appropriate," says Dr. Albert Wu, an internist and professor at the Johns Hopkins Bloomberg School of Public Health.

In cases like these, Wu says, doctors are more likely to follow their gut instincts. And when that happens, fear often comes into play.

Imagine, for example, that a healthy, 40-year-old woman walks into your office and asks about a mammogram.

"If that woman were to develop breast cancer or to have breast cancer, you can imagine what might happen to you if you didn't order the test," Wu says. "Maybe you'd get sued."

Doctors often hear stories like this, he says, and that can affect their judgment.

"Emotion and recent events do influence our decision-making," he says. "We are not absolutely rational, decision-making machines."

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Is It Time To Make Medical And Family Leave Paid?

Wed, 04/22/2015 - 7:56am
Is It Time To Make Medical And Family Leave Paid? April 22, 2015 7:56 AM ET

Partner content from

Michelle Andrews

It's been more than 20 years since passage of the landmark Family and Medical Leave Act, which allows workers to take up to 12 weeks of unpaid time off for medical or family reasons without losing their jobs.

Some workers' advocates and politicians say it's time to plug a big hole in the law by requiring that workers get paid while they're on leave. But the change faces stiff opposition from some small business and other groups that argue that it would be too expensive and an unnecessary government intrusion.

Saying the reality for many families is that both parents must work, President Obama has pushed for paid family leave, calling it an "economic necessity" in his State of the Union address. He proposed $2.2 billion in next year's federal budget to help five states get paid leave programs up and running, and an additional $35 million for states to conduct planning and startup activities.

The Two-Way Obama Shifts Federal Sick-Leave Rules, Urges Congress To Follow

Meanwhile, Democrats have reintroduced the Family and Medical Insurance Leave Act that would create a national paid leave program to cover two-thirds of people's wages for up to 60 days a year. With Republicans in control of Congress, however, there's little chance it will pass.

Supporters say that many workers can't afford to take unpaid leave and others aren't eligible for leaves because they work for small employers. The law allows workers to take time off to care for a newborn or adopted child, or if they or family members have a serious health condition. But it doesn't apply to companies with fewer than 50 workers, and workers have to have worked for at least a year and logged at least 1,250 hours in the previous year to qualify for the benefit.

Only 13 percent of workers had access to paid family leave in 2013, according to the Department of Labor's 2014 national compensation survey. Meanwhile, 59 percent of workers were eligible for unpaid leave under the FMLA in 2012.

Four states have implemented paid family leave programs, and their experience may provide guidance for a national paid family leave law.

Three of them — California, New Jersey and Rhode Island — fund the programs entirely by withholding employee wages. The programs are administered by states' unemployment insurance agencies in conjunction with temporary disability insurance programs, according to human resources consultant Mercer. (Washington state has a paid leave program on the books, but it has never been implemented because legislators haven't approved funding.)

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California's program is well established after more than a decade. It allows workers up to six weeks of leave annually at 55 percent of their weekly pay, up to a cap of $1,104 weekly in 2015.

When Allison Guevara's children, now aged 5 and 2, were born, she twice took paid time off from her half-time job as a field representative for the American Federation of Teachers-affiliated union that represents librarians and lecturers at the University of California.

Guevara, 36, says that getting just 55 percent of her salary might have been problematic, but she was able to negotiate with her employer to use accrued vacation and sick time to make up the other 45 percent of her pay.

Altogether, she took off at least three months with pay for each baby. Her husband, who works for the city of Santa Cruz, was not so lucky. The law typically doesn't apply to public sector employees.

"The time off was very necessary," says Guevara. In addition to bonding with her kids, "breastfeeding was very difficult with my first one, it took eight weeks to get that going."

Guevara stumbled upon the information about her paid leave options by accident. That's not surprising. A survey conducted last fall for the California Center for Research on Women and Families found that just 36 percent of Californians knew about the state's paid leave program, a decline from three years earlier when 43 percent said they knew about the law.

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"Those who know about it are those who disproportionately work for employers who already do it," says Vicki Shabo, a vice president at the National Partnership for Women and Families. "That leaves out many lower-paid workers."

California employers are generally positive about the paid family leave law, according to a study prepared for the U.S. Department of Labor last year. Ninety percent of employers in a 2010 survey said the law had either a positive effect on productivity, profit and morale, or it had no effect.

California, New Jersey and Rhode Island have built their programs around existing short-term paid disability program infrastructures; only five states have such disability programs in place, says Catherine Stamm, a senior consultant at Mercer.

"It's not as difficult or momentous for these employers," Stamm says.

Under the Democrats' bill, workers and employers would split the cost of the program, which would be administered by the Social Security administration.

But that's a problem for small business owners, says Jack Mozloom, national media director for the National Federation of Independent Business, a trade group. Many of their members have fewer than 10 employees, Mozloom says, and if someone's out on leave, it's likely that they have to hire a temporary worker or pay someone overtime to do the job.

Financing a paid leave program would "represent a real expense that some of them cannot absorb," he says. "When it's mandated, it puts them in a hole."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Screening Tests For Breast Cancer Genes Just Got Cheaper

Tue, 04/21/2015 - 3:54pm
Screening Tests For Breast Cancer Genes Just Got Cheaper April 21, 2015 3:54 PM ET Listen to the Story 3 min 26 sec   iStockphoto

A new California company announced Monday it is offering a much cheaper and easier way for women to get tested for genetic mutations that increase their risk for breast and ovarian cancer.

Color Genomics of Burlingame, Calif., has begun selling a $249 test that it says can accurately analyze a saliva sample for mutations in the breast cancer genes BRCA1 and BRCA2, as well as check for 17 other genetic variants that have been associated with a somewhat increased risk for cancer of the breast or ovaries.

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"Color's goal is to democratize access to genetic testing, starting with breast and ovarian cancer risk testing," says Elad Gil, one of the company's co-founders.

But the announcement has sparked mixed reactions, with some scientists and patient advocates praising the option of cheaper genetic testing, while others say it might not be useful, and could be harmful.

Until now, such testing has typically cost thousands of dollars. Gil says his company slashed the cost in a variety of ways, including using the latest technology to automate much of the process. The firm also recruited software engineers from leading companies, including Google and Twitter, to develop computer programs that streamline the analysis. In addition, Gil tells Shots, the company saves money by making the price so low that women don't need to get their insurance companies involved.

Test-kit-in-a-box, from Color Genomics.

Color Genomics

People interested in taking the test can either ask their doctor to order it for them or can contact the company directly through its website, so that Color Genomics can arrange for a physician to place the order. A test kit containing a small plastic tube will then arrive in the mail; the patient just spits into the tube and mails it back to the company, which then analyzes the DNA from cells in the saliva.

The company validated the accuracy of its test in a variety of ways, Gil says, including using it to analyze about 500 samples provided by leading breast cancer researchers. Color Genomics published the results on its website and plans to submit them to a peer-reviewed journal, Gil says.

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The announcement produced mixed reactions. Some researchers welcome the new test as a way for more women to get tested. Currently, only women with a family history of cancer of the breast or ovaries are routinely urged to get a BRCA test, and typically only these women can get their insurance company to pay for it. But Mary-Claire King, a University of Washington geneticist who discovered BRCA1, says many more women carry one of the mutations in BRCA1 and BRCA2 that significantly increase their risk for cancer.

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"We need to be able to offer all women the opportunity to be sequenced for BRCA1 and BRCA2 — and, indeed, their sister genes — when a woman is young enough to make a plan if [it turns out] she does have the misfortune of having a mutation," says King, who is an unpaid advisor to the Color Genomics.

Still, some other geneticists, cancer researchers and women's health advocates are alarmed by the new test. They question whether the results have been studied enough to provide women with reliable information. The test, they say, may produce ambiguous or misleading results that frighten women into taking drastic action that may be unnecessary, such as getting mastectomies or having their ovaries removed

"I worry it will give women information that we really don't know what it means — and that women will make very difficult choices that turn out to be incorrect," says Frances Visco of the National Breast Cancer Coalition.

"If we have more women who believe they are at increased risk," Visco says, "we will have more women removing healthy body parts. We really do not have enough information to base this kind of expansion of this kind of testing."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Young Adults With Autism More Likely To Be Unemployed, Isolated

Tue, 04/21/2015 - 2:31pm
Young Adults With Autism More Likely To Be Unemployed, Isolated April 21, 2015 2:31 PM ET

The transition to adulthood marks a big turning point in life for everyone, but for young people on the autism spectrum that transition can be really tough.

Young adults with autism had lower employment rates and higher rates of complete social isolation than people with other disabilities, according to a report published Tuesday by the A.J. Drexel Autism Institute.

Additional Information: Disconnection after high school

Percentage of young adults with autism who never worked or continued education after graduating high school.

Credit: NPR; Source: National Longitudinal Transition Study-2/A.J. Drexel Autism Institute

Two-thirds of young people with autism had neither a job nor educational plans during the first two years after high school. For over a third of young adults with autism, this continued into their early 20s, the report found.

And 20-somethings with autism were less likely to be employed than their peers with other disabilities, with 58 percent employed. In comparison, 74 percent of young people with intellectual disabilities, 95 percent with learning disabilities, and 91 percent with a speech impairment or emotional disturbance were employed in their early 20s.

The results are based on data gathered for two large longitudinal studies: the National Longitudinal Transition Study-2, which followed young people in special education programs; and the Pathways survey of children with physical, developmental, mental and behavioral disorders.

"We don't really know at this point why that's happening," says Paul Shattuck an associate professor at Drexel University's School of Public Health, who led the study.

The economic shift in the United States to more service sector jobs hasn't helped, he notes. "Starting in the early to mid-1970s, there's been a historic shift in the balance of jobs in the manufacturing sector to the service sector. And those types of jobs, which require lots of social interaction, are exactly the types of jobs that people with autism have difficulty with."

At the end of high school there's also what Shattuck refers to as the "services cliff." Though the 12th grade, public school students with autism can get tutoring, mental health services and other support through their school's special education program.

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"Then, all of a sudden, when you graduate high school, the special ed services go away. What you're left with is a hodgepodge patchwork of different public services that are pretty difficult to access," Shattuck says. Community programs for adults with autism generally have the capacity to help only the most severely impaired.

"Federal law for special education requires that high schools help students and families develop a transition plan," Shattuck adds. But that doesn't always happen. Only 58 percent of high school students with autism had a transition plan by age 14, as required by federal law. "That's a big accountability problem," Shattuck says.

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Further complicating the issue, he says, is the fact that many people with autism also have an intellectual disability, a seizure disorder or mental health issues. "Although the core of the disability is an inability to relate easily to other people, the majority of people on the spectrum do have some amount of social appetite," Shattuck says.

But many of them lack social support. The study found that 1 in 4 young people with autism was completely isolated — meaning he or she had not seen or spoken with friends in the past year.

Most autism research is focused on children with autism or on preventing the development of autism, he adds. "But autism doesn't go away when people turn 18. We need to figure out how to help adults on the spectrum as well."

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Californians Can Now Pay Cash For Health Insurance At 7-Eleven

Tue, 04/21/2015 - 11:06am
Californians Can Now Pay Cash For Health Insurance At 7-Eleven April 21, 201511:06 AM ET

Partner content from

Sarah Varney

The largest publicly run health plan in the nation, L.A. Care, will allow customers who do not have traditional bank accounts to pay their health insurance premiums with cash.

One in four Americans who were previously uninsured and eligible for federal insurance subsidies don't have a bank account, relying instead on prepaid debit cards, money orders and cash to pay bills, according to a study by Jackson Hewitt Tax Service.

After advocates for low-income consumers raised concerns to the Department of Health and Human Services over how so-called unbanked households would pay their monthly insurance premiums, the Obama administration ordered health plans to accept payment methods that didn't require a credit card or checking account.

"It's as quick as buying a Slurpee."

Starting this week, customers of L.A. Care Covered, one of the health plans for sale on Covered California, the state's insurance marketplace, can pay monthly premiums in cash at more than 680 locations, including 7-Eleven and Family Dollar stores. At the register, customers scan a bar code sent to their smartphone and hand over their cash. The payment posts to L.A. Care within 24 hours, and the service is free to customers.

"It's as quick as buying a Slurpee," said Danny Shader, the founder and CEO of PayNearMe, the for-profit company that established the electronic cash transaction network.

L.A. Care, like most health insurers around the country, pays fees to Visa, MasterCard and banks to process debit and credit card transactions. Laura Jaramillo, director of commercial and group plan operations at L.A. Care, said the health plan negotiated a similar surcharge to PayNearMe for cash payments.

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"It should not increase our administrative costs," Jaramillo said. L.A. Care estimates that up to 25 percent of its marketplace customers mail in money orders each month. Now, members who don't have a bank account can pay in cash, said Jaramillo, "instead of sending us money orders."

Some low- and moderate-income households shun bank accounts because checking account and overdraft fees can wreak havoc on their precarious finances. These same households, however, rely heavily on cellphones — 68 percent of unbanked households have mobile phones.

L.A. Care is the first health plan to use the PayNearMe network, although the company's method of cash collection is already in use in other ways elsewhere. In Nebraska, parents can use the network to pay child support. Pittsburgh water customers and bike share riders in Philadelphia can pay cash at local convenience stores to settle their bills.

"What goes in is cash, and what comes out is an electronic payment," said Shader. "We think everybody ought to do it."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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What's At Stake If Supreme Court Eliminates Your Obamacare Subsidy

Tue, 04/21/2015 - 3:56am
What's At Stake If Supreme Court Eliminates Your Obamacare Subsidy April 21, 2015 3:56 AM ET

from

Jeff Cohen Listen to the Story 5 min 40 sec  

Carlton Scott pays $266.99 per month for his subsidized health insurance plan. He worries he and his neighbors would lose their insurance without the subsidy.

Jeff Cohen/WNPR

The Affordable Care Act requires all Americans to get health insurance or pay a penalty. To help coax people to buy a health plan, the federal government now subsidizes premiums for millions of Americans.

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In just a couple of months, the Supreme Court will rule on a major case concerning those subsidies. The question to be decided is whether the law authorized that financial help nationwide or just in the minority of states that set up their own insurance exchanges. A decision to take away those subsidies could leave millions without insurance.

Attorney Tom Goldstein, who runs SCOTUSblog, has closely followed the case and says the law is ambiguous. "This is a real, serious question," he says. "The law doesn't tell you whether Congress wanted to limit the subsidies only to those states where the state itself went to the trouble of setting up the exchange, or whether Congress wanted everybody who needed the help to be able to get the subsidies."

In my home state of Louisiana, a lot of people could be affected by the upcoming court decision. About 186,000 people there have used HealthCare.gov to buy insurance, and nearly 90 percent of them get subsidies. Here are the stories of a few of the people I spoke with.

Carlton Scott

Carlton Scott: "You never know what's going to happen to you."

Carlton Scott is 63. Sitting at the kitchen table of his home in Prairieville, La., near Baton Rouge, Scott tells me he worked at a chemical plant for 30 years before he retired. Last fall his company let him know it was scaling back his retirement benefits.

"Around October," he says, "they wrote me a letter saying [that] in December we'll no longer be covered."

Those reduced benefits included Scott's health insurance, which he was really counting on.

"I thought they would take me to my grave," he says. "I really thought the company would take me to my grave."

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He was deeply angry, and in a bind. At 63, Scott is too young for Medicare, and Louisiana hasn't expanded Medicaid. Obamacare, he says, was a good option for him.

He pays $266.99 per month, "to the penny," for his plan from BlueCross BlueShield of Louisiana. Like a lot of people I spoke with, Scott could rattle off the exact amount. Money is tight and people track their expenses carefully.

If Scott loses his subsidy, he may eventually lose his health insurance, too. He could pay more for a little while if he has to, he says. He gets $2,600 a month between Social Security and his pension. But he worries about friends who don't make as much.

"I got a friend of mine ... down the street," Scott says. "He gets Social Security and pension too. But it's not as much as mine — not half as much."

When asked about the case soon to be decided by the justices of the Supreme Court, Scott laughs.

"They all got insurance, too," he says. "I guarantee you that. They all got insurance."

He thinks the court should "leave it like it is. I mean, what are people going to do? Get sick, go to the hospital [and say], 'I don't have insurance. Won't you please help me anyway?' " It just won't happen, he says.

LaTasha Perry

LaTasha Perry says she couldn't afford the health plan offered by the community health center where she works. But with a subsidized plan, she has insurance and money left over "to buy food for my kids."

Jeff Cohen/WNPR

LaTasha Perry is at the other end of her career. She's 31 and works at the front desk of a community health center in Plaquemine, La. She's healthy and rarely needs a doctor, she says, but bought coverage under Obamacare because it was cheaper than paying the penalty.

Perry's children have Medicaid as their health coverage. Her job offers health insurance, but she doesn't buy it. Like a lot of people who work but don't make a lot of money, she says she can't afford the insurance her company offers.

"I would pay at least $100 a month for the insurance here," Perry says. "With my subsidy, I pay $13."

That leaves her money for other necessities, she says. "Food for my kids. I'm a single parent. It's hard."

Charles Dalton

Retired paramedic Charles Dalton is now disabled. He pays $149 each month for his subsidized health insurance. "If you get a helping hand," he says, "the last thing you need is for it to be snatched out from under you."

Jeff Cohen/WNPR

Charles Dalton: "Losing my insurance is not an option."

Charles Dalton, of Shreveport, was very glad to get Obamacare coverage. He's 64, and after retiring as a paramedic he didn't have any health insurance. Then he got sick.

"I'm disabled," Dalton says. "But I would be totally incapacitated without seeing this doctor."

Before the Affordable Care Act became law, insurance companies could take a person's health status into account when setting the price of the monthly premium and even refuse an applicant for health reasons. That used to make insurance unavailable or unaffordable for many sick people. And now — with subsidies — Dalton says he pays $149 a month. He hopes the Supreme Court doesn't touch the subsidies.

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"They're just going to make a difficult situation more difficult," Dalton says. The Affordable Care Act, he says, has helped make his existence "more livable."

"You're not asking for a handout," Dalton says. "But if you get a helping hand, the last thing you need is for it to be snatched out from under you."

Attorney Goldstein says the Supreme Court justices have a particularly tough job, trying to balance the specifics of the law with its human dimensions.

"The consequences are so real and so powerful," Goldstein says, "that, if the challengers win here — and maybe they deserve to win, maybe it's what Congress intended — but it's hard to avoid the conclusion that millions of people would lose access to health insurance."

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

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