NPR Health Blog
Interpreting the results from a genome scan takes a lot of people time. And the databases used to interpret the results aren't infallible.iStockphoto
For more than a decade scientists have been saying that a genomic revolution will transform medicine, making it possible to scan all of a person's DNA to predict risk and customize medical care.
Well, we've got the machines. Where's the revolution?
Getting closer, say researchers at Stanford University, who tested the technology on 12 people. But not quite ready for every doctor's office.
""We were witness to the birth of this idea, and now we feel like we have an unruly teenager on our hands," says Dr. Euan Ashley, an associate professor of medicine and genetics at Stanford, and an author of the study. "It's going to take some tough love."
The study was published Tuesday in JAMA, the journal of the American Medical Association.
Whole-genome scanning uses machines to plow through all of a person's DNA looking for variations that could be associated with disease. Though until now it's been used rarely for diagnosing patients, it's becoming increasingly fast and affordable. Machines are now able to run a whole-genome scan in a day or two, at a cost of just a few thousand dollars.
Quick and affordable, maybe, but not necessarily accurate.
When the Stanford researchers compared whole-genome scans done on two different machines, they found that the results matched up just one-third of the time for genetic variants that could signal a risk of inherited disease.
"That's not good enough; we need to do better than that," Ashley told Shots. But he thinks that's a "solvable problem," especially with a technology that's improving so quickly.
But even if the genome scanners become more accurate, doctors will still have to grapple with what all that data means.back next How Genome Sequencing Works
It used to take hundreds of scientists years and billions of dollars to analyze one genome. Now high-speed sequencing machines can read a genome in weeks.
All genome sequencing machines are designed to make sense out of DNA. DNA is made of two complementary, intertwined strands that fit together like two sides of a zipper.
Each strand is written in a simple language composed of four letters that stand for different nucleic acids: A, T, C and G. The letters always pair the same way: A goes with T; C goes with G.
To decode the letters in a piece of DNA, a sequencing machine figures out what letters stick to the DNA. Here's how one sequencing technique works.
Credits: Michaeleen Doucleff, Stephanie d'Otreppe / NPR
When a mutation is found, geneticists have to comb back through published studies on genes and disease in people and animals, looking for a match. If it's for a disease caused by a single mutation, like cystic fibrosis, that's a cinch. But if it's for something like heart disease, which involves many, many mutations that vary from one person to the next, it's devilishly hard.
And many of the databases used to look for meaning have errors themselves, the researchers say.
One of the 12 people in this study did have a previously-unknown mutation that predisposed her to breast and ovarian cancer. For her, having her genome scanned could be life saving. But for the other 11, there were no revelations.
"You find a lot of stuff that's much harder to determine what do to with," says Dr. W. Gregory Feero, a geneticist and faculty member for the Maine-Dartmouth family medicine program. He wrote an editorial accompanying the Stanford study, titled "Proceed With Care."
With the Stanford volunteers, it took a lot of human effort to try to figure that out. Each had 90 to 127 genetic variants, and it took an average of an hour of expert time to try to figure out what they meant.
Scanning and interpretation cost about $15,000 per person, the Stanford group said.
Still, Ashley says people shouldn't dismiss genomic medicine as mere hype. "The worst thing would be if the hype overcame this, and people said we weren't delivering. There's opportunity here to transform medicine."Copyright 2014 NPR. To see more, visit http://www.npr.org/.
There are only a few more weeks for people to get health coverage on HealthCare.gov and state exchanges.Jon Elswick/AP
With 20 days left for people to sign up for private health coverage under the Affordable Care Act, the number of people who have completed that task rose to 4.2 million through the end of February, the Obama administration reports.
While the 943,000 people who signed up in February through the federal HealthCare.gov site or a state health exchange is slightly less than the original February projection of about 1.3 million, the exchanges have mostly put behind them their very sorry starts, when enrollments were often counted in the tens or hundreds.
"What we're finding is that as more Americans learn just how affordable marketplace insurance can be, more are signing up to get covered," Health and Human Services Secretary Kathleen Sebelius said in a media briefing.i i
The proportion of sign-ups for health insurance by age group on the federal and state exchanges.HHS
Now concern seems to be focused on whether the various health plans will have enough healthy people in their mix of customers to keep premiums stable. And that has everyone looking at the percentage of younger enrollees, particularly those between ages 18 and 34. On average, young people have lower health care costs than older people.
February's numbers looked OK, but not great when gauged that way. Of those signing up for insurance last month, 27 percent were in that coveted young adult demographic. That was up 3 percentage points from the first three months of open enrollment, but the same as January.
As a result, the percentage of young adults who have enrolled in insurance through the exchanges since they opened Oct. 1 remains at 25 percent.
Women are more numerous in the exchanges than men — 55 percent and 45 percent respectively. Some analysts have suggested that could pose a problem, since women tend to use more health care services.
The most popular type of plan remains the silver one, the second lowest of the four tiers defined by the law. The plan's popularity isn't surprising, because coverage is linked to full cost-sharing subsidies for those with incomes under 250 percent of the federal poverty line.
The administration has stepped up its outreach to young people. President Obama even went between the ferns with comedian Zach Galifianakis on FunnyorDie.com to talk about health insurance. "I think it's fair to say I wouldn't be here today if I didn't have something to plug," the president says. "Have you heard of the Affordable Care Act?"
Evidently a lot more people have now. White House health spokeswoman Tara McGuinness tweeted Tuesday afternoon that "FunnyorDie.com is the #1 source of referrals to HealthCare.gov right now." About 19,000 people who watched the video went to HealthCare.gov, the White House said.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
The exam might also include questions about alcohol and drugs.iStockphoto
What can doctors do to help kids stay away from drugs?
There's not much evidence to say one way or the other, it turns out.
The U.S. Preventive Services Task Force, which issues guidelines on what doctors should and shouldn't do, said there aren't enough reliable studies around to come up with any solid advice. So the task force gave the interventions an "I" for insufficient evidence. The kids might call it an incomplete.
We only identified six studies that addressed this question in primary care settings or in ways that were applicable to primary care, says Carrie Patnode, a research associate at Kaiser Permanente Center for Health Research.
Some of the interventions that have been studied include brief counseling sessions during an office visit, sometimes combined with computer-based screening. Other studies looked at computer-based interventions accessed at home.
"Studies on these interventions were limited and the findings on whether interventions significantly improved health outcomes were inconsistent," the task force said in a summary. The review and the task force's conclusions were published in the latest Annals of Internal Medicine.
Patnode, who led the review of the evidence for the USPSTF, tells Shots that clinicians may still want to screen for substance abuse. None of the studies showed any harm in in it. Less than half of pediatricians are doing that now, she says.
The lack of evidence doesn't mean doctors should do nothing. "When there is a lack of evidence, doctors must use their clinical experience and judgment, and many clinicians may choose to talk with an adolescent to prevent or discourage risky behaviors, such as drug use," USPSTF member Susan Curry said in a statement.
But, of course, there's the question of what primary care doctors choose to do during their short visits with children and teens. There are only so many questions a doctor gets to ask.
The American Academy of Pediatrics recommends that pediatricians routinely screen adolescent patients for drug use, including alcohol and tobacco. One tool is a six-question list that asks, among other things, whether the child has ever ridden in car with someone who was on drugs or who had been drinking.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
In a British study of nearly 6,000 students, obesity — or perhaps dealing with the stigma associated with obesity — seemed to reduce academic performance.iStockphoto
Childhood obesity has made it to the forefront of public health issues, both in the United Kingdom and in the United States.
Now researchers at the Universities of Dundee, Strathclyde, Georgia and Bristol say that not only does obesity affect a child's overall health, but it may also lead to poorer school performance among teenage girls. Among boys, the link is less apparent.
Since the 1990s, the U.K has seen childhood obesity rates grow at an alarming rate, says John Reilly, specialist in the prevention of childhood obesity at the University of Strathclyde, and the study's lead author. Today, nearly a quarter of children in U.K. are obese by the time they reach 12.Shots - Health News Adult Obesity May Have Origins Way Back In Kindergarten
Increasingly, researchers in both the U.S. and the U.K. have been interested in how obesity might affect students' academic achievement, but Reilly says few studies have examined the same students over several years, or been able tease out obesity's effects from the influence of social factors, such as socioeconomic status.Health Are Americans Getting Smarter About Obesity?
The current study analyzed data from nearly 6,000 adolescent students in the U.K., comparing their body mass index from ages 11 to 16 with how well they performed in standardized tests during those years. About 71 percent of the students surveyed were of a "healthy weight" at the start, the researchers said, and about 15 percent were obese.
The academic exams, which tested the students' English, math and science abilities, were given three times — at ages 11, 13 and 16. After adjusting for factors like socioeconomic status, IQ and menstruation cycles, the researchers found that, on average, girls who were obese at age 11 performed worse at age 11, 13 and 16 than girls deemed to have a healthy weight. Being obese at 11, the scientists found, was enough "to lower average attainment to a grade D instead of a grade C," by age 16.Shots - Health News When Sizing Up Childhood Obesity Risks, It Helps To Ask About Random Kids
The strength of that effect can mean the difference between passing a class and failing it, says Reilly. He and his colleagues focused on age 16, he says, because that's about the age that "determines whether you will do well after 16 — and whether you will go on in college."
The results were published Tuesday in the International Journal of Obesity.
Though the study followed British teens, Reilly says the findings are likely also applicable to students in the United States, where the proportion of children between the ages 12 and 19 who are obese grew from 5 percent in 1980 to nearly 21 percent by 2012.
"The similarities between the environment, the culture, [and] school systems between the U.S. and the U.K. are more similar than may be obvious," Reilly says.
"There is nothing about this [study] that is specific to the U.K.," agrees David Katz, the director of Yale University's Prevention Research Center, who wasn't involved in the study.
For example, one 2012 study of more than 6,000 boys and girls in elementary school in the U.S. also found that obese students performed worse on math tests.
The reason behind such a link, or why it consistently seems more prevalent among young girls, has yet to be determined, Reilly says. But other studies suggest the stigma of obesity and its effect on mental health in young adults may play a large role.
"Girls are much more affected by obesity in terms of mental health and well-being than boys are," he says, adding that stigma's negative effect on things like self-image, self-esteem and even depression may be lead girls to skip school more often, leading to poorer grades.
"The issue with girls," Katz says, "is that they're much more subject to the peer pressure and ridicule associated with obesity."
The link between obesity and grades likely goes both directions, Katz adds. That is, poor academic achievement also could contribute to obesity.
"If you're rewarded with grades and success, then you're less dependent on fries and cheese doodles, frankly," he says. "And if your [grades] are not good or rewarding, you don't have to be depressed to be frustrated — and for your self-esteem to plummet. And food may be a solution [you turn to]."
But there are a slew of other factors that might also explain the link — including the ways sleep problems in obese teens can impair school performance and brain function, and the findings that peers tend to influence each other's weight.
"We tend to isolate factors," Katz says. "But likely ... everything that happens influences everything else that happens." The best strategy, at least in the U.S., he says, is to address the root causes of obesity from a cultural level.
"We need to make eating well the default," Katz says. "We need to make physical activity a default. And we need to address ... the hypocrisy of a culture where the First Lady is focused on childhood obesity, but we aggressively market French fries and Coca Cola."Copyright 2014 NPR. To see more, visit http://www.npr.org/.
The glasses aren't going to help with your allergies. But some inventors think that a tiny dust-blocking device might.iStockphoto
For the millions of people with allergies, spring can mean months of antihistamines, nasal steroids and avoiding nature.
So we were intrigued when we came across the concept of nasal filters – tiny devices that claim to block pollen and other allergens from ever entering nasal passages.
The devices are sort of like contact lenses you can put up your nose. Some are adhesive, while others clip on to your septum. And though a quick trip to a drug store close to NPR didn't turn up any, several varieties are available online.
These little contraptions even had their 15 minutes of fame when the inventor of an adhesive version was offered $4 million on the reality show "Shark Tank".i i
The Rhinix nasal filter is one of several concepts aimed at combating seasonal allergies. The clip goes under the septum.Courtesy of Rhinix
But do they work? Researchers in Denmark say their version has shown success in a small clinical trial. Their study found that the filters reduce throat irritation and runny noses in allergy sufferers, compared to a filter-less placebo device.
Most people in the study said they stopped noticing the device after wearing it for an hour. And the patients didn't tend to switch to breathing through their mouths while they were wearing the device.
"It needed to have excellent breathability. And it needed to be comfortable to wear," says Peter Sinkjaer Kenney, a medical student at Aarhus University in Denmark and the developer of Rhinix. The results were published in the Journal of Allergy and Clinical Immunology.
But this clinical trial only included 24 patients, and the researcher also plans to sell the devices, so he's hardly a disinterested party.
Still, allergists say the nose filter is an intriguing idea. "I think over all it's a good concept," says Dr. Andy Nish, an allergist from Georgia. Even though the nose filter idea has been floating around since the 1990s, there hasn't been any consensus on their value as a medical treatment, Nish told Shots: "My impression is maybe [these filters are] not quite ready for prime time yet."
Nish says he's never recommended nasal filters to any of his patients. That was true with two other allergists we spoke to as well.
"We don't really use it in our practice," says Dr. Flavia Hoyte, an assistant professor of medicine at National Jewish Health in Denver, Colo. And allergists aren't taught about nasal filters in their training. Hoyte says she'd want to know more before recommending the devices. "But we don't discourage it if patients choose to use it."Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Janelle Arevalo, an insurance agent with Sunshine Life and Health Advisors, makes a house call in Miami to sign up Sandra Berrios (left) for an insurance plan under the Affordable Care Act.Joe Raedle/Getty Images
People who got off to a rough start with Obamacare or haven't picked a plan still have options. But they better hop to it. The open enrollment period ends March 31.
Those who were unable to sign up for a marketplace plan because of the glitches with federal or state websites can receive coverage retroactive to the date they originally applied. There are also retroactive premium tax credits and subsidies, the federal government said in late February.
In addition, some people who gave up on enrolling through their state's balky marketplace and instead bought a plan outside the exchange may be able to switch to a marketplace plan and qualify for retroactive subsidies.
The federal guidance leaves it up to individual states to decide whether they want to offer these options. The federal marketplace has its own process in place to bump back the effective coverage date for people who encountered those problems, says an official at the Centers for Medicare & Medicaid Services.
"This [guidance] raises more questions than it answers," says Sabrina Corlette, project director at Georgetown University's Center on Health Insurance Reforms. "From a consumer perspective, it says nothing about what difficulties you have to have had to qualify or what documentation you have to show."
In addition to difficulties enrolling, some consumers have been tripped up by inaccurate or incomplete information posted online about the benefits or providers available in a particular plan. They, too, may get some relief.Shots - Health News Selling Health Care To California's Latinos Got Lost In Translation Intelligence Squared U.S. Debate: Is The Affordable Care Act Beyond Repair?
According to the federal guidance, if enrollees encounter "benefit display errors," such as inaccurate information about deductibles or coverage, insurers are encouraged to honor the information they displayed.Shots - Health News After January Surge, 3.3 Million Have Enrolled In Obamacare
If the insurer fails to do so, and the misinformation might have affected a consumer's choice of plan, that person will generally be allowed to pick another plan at the same coverage level, offered by the same insurer. If consumers can't find a good substitute with that insurer, they'll have 60 days to select a new marketplace plan, the guidance says.
Similarly, if people have enrolled in a marketplace plan and then discovered that it doesn't include doctors, hospitals or other providers they need, they may switch to another plan at the same level offered by the same insurer, according to the federal rules. However, changes due to provider network issues must be made by March 31.
By the end of February, roughly 4 million people had signed up for a marketplace plan on the federal or state-based exchanges.
Picking a plan is only part of the process of getting coverage. Benefits only take effect when you pay your premium, says Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities. "If you've never paid your premium, your insurer doesn't consider you're covered," she says.
People who haven't enrolled by Mar. 31 may owe a penalty for not having health insurance in 2014.
In the past, people buying coverage directly from an insurer could generally sign up any time during the year as long as they got through the medical underwriting process that insurers used to evaluate applicants.
Not anymore. Consumers who don't sign up during the open enrollment period will generally have to wait until enrollment begins again next fall to sign up or change plans — unless their circumstances change, for instance, if they move, marry, or lose a job, among some of the more common examples.
There are a number of circumstances that may exempt people from penalties for not having insurance. The long list of exemptions covers things like affordability, incarceration and hardships such as being evicted or filing for bankruptcy.Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
A survey taken in early 2014 finds that the uninsured rate has declined. But differences by age remain.Gallup
Since the Affordable Care Act kicked in fully, the percentage of Americans without health coverage has fallen to its lowest point in five years.
In the last quarter of 2013, just before the federal health law took full effect, 17.1 percent of Americans reported they lacked health insurance, according to a Gallup survey.
When the survey was taken (between Jan. 2 and Feb. 28), the rate had dropped to 1.2 percentage points to 15.9 percent.
The findings come from landline and cellphone interviews conducted with more than 28,000 Americans.
More people reported being covered by insurance they purchased themselves or by Medicaid. The percentage who said they were covered by employer plans fell slightly.
"The uninsured rate for almost every major demographic group has dropped in 2014 so far," Gallup said.
The biggest decline in the uninsured rate was seen among people who earned less than $36,000 a year — a drop of 2.8 percentage points to 27.9 percent. Among blacks, another group that saw a big change, the uninsured rate fell 2.6 percentage points to 18 percent.
Medicaid enrollment in states that took advantage of federal funding to expand coverage for low-income people could help explain that decline.
The uptake of insurance among the young was a bit less dramatic. The uninsured rate for 26- to 34-year-olds declined by 1.6 percentage points. Under the Affordable Care Act, adult children can stay on their parents' plans until they turn 26.
The Gallup survey only asks about adults, so it may understate the total number of people being added to the health insurance rolls.
The margin of error for the survey is plus or minus 1 percentage point, so some of the changes seen aren't much greater than the statistical noise.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
The illusion of an out-of-body experience made it harder for people to remember what happened.iStockphoto
Our bodies may help us remember our lives, fixing experiences in place. By using virtual reality, scientists can make people feel like they're outside their own bodies. And when they do, the brain struggles to remember what happened.
The phenomenon is a bit like the disembodied sensation that some people have with post-traumatic stress disorder or schizophrenia, according to Loretxu Bergouignan, a neuroscience researcher at the Karolinska Institute in Stockholm, and lead author of the study. You might even compare it to an extreme form of daydreaming.
"It's a new way to assess what's going on between two intermingled systems, the body and memory," Bergouignan told Shots. "We did not realize that they were so intermingled."i i
A volunteer wearing virtual reality goggles is interviewed by a professor played by Swedish actor Peter Bergared.Courtesy of Staffan Larsson
To create the out-of-body illusion, Bergouignan and her colleagues outfitted volunteers with goggles and headphones that let them see and hear through a camera and microphones positioned elsewhere in the room.
They heightened the illusion by touching the volunteers with a stick while they watched a different stick approach the camera from the same angle. The effect is "very, very strong," Bergouignan says, who tried it many times. "You feel outside your body. You feel where the camera is."
Then the student volunteers were grilled by a particularly demanding professor about information they had studied — surely something they could remember. (Unbeknownst to the students, the professor was played by a Swedish actor who used dialogue based on work of the British playwright Harold Pinter.)
When the students' location was virtually shifted outside their bodies, they had a harder time remembering details of that event a week later, compared to when they didn't feel like their location was shifted. "They did not remember the context," Bergouignan says.
The findings were published Monday in the Proceedings of the National Academy of Sciences.Shots - Health News Our Brains Rewrite Our Memories, Putting Present In The Past
And it looks like the out-of-body students used their brains differently, too. When participants tried to recall the virtual reality sessions, they relied less on the brain's hippocampus, a region involved in creating memories of events, according to MRI scans.
Somehow, it seems, the brain relies on the body to help remember events. That wasn't the case with the emotional context of the encounter with the eccentric professor, or the facts they had to remember.
Knowing about this connection between the body and memory may help better understand PTSD. People who have been traumatized are more apt to have the feeling that they have been disembodied, Bergouignan says. "We know the trauma will change the person. But we don't know what's the effect of stress, and what's the effect of disassociation. Here we show the effect of disassociation alone. It has an effect on memory."
Daydreaming may be a very mild form of this "We can't say what's going on when it's milder, but it's giving hints," she says. "We need to be able to experience something to be able to recall it later."
But Bergouignan says it's too much of a leap to say that experiencing an increasingly virtual world, as we do through computers, phones and cameras, may tinker with memory. "We should not speculate," she says.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
High school students whose friends posted photos of drinking and smoking were about 20 percent more likely to become drinkers or smokers themselves.iStockphoto
Teenagers put a lot of stock in what their peers are doing, and parents are forever trying to push back against that influence. But with the advent of social media, hanging out with the wrong crowd can include not just classmates, but teenagers thousands of miles away on Instagram, Snapchat and Facebook.
"Kids partying, generally two to three in a picture, raising their glasses, cups, or beer cans," says Thomas Valente, a professor of preventive medicine at the University of Southern California, describing a typical photo shared by teenagers.
Valente is trying to figure out how much emotional weight those sorts of online images carry when it comes to risky behaviors. To do that, he and his colleagues surveyed more than 1,500 10th-graders who attended high schools in southern California.Technology Online, Researcher Says, Teens Do What They've Always Done
They asked students how many of their friends posted photos of themselves smoking or drinking. Then they asked students about their own behavior after viewing the images.All Tech Considered Through The Internet, Gay Teens Connected To Larger Community
Students who saw images of partying with comments posted by friends were about 20 percent more likely to become drinkers or smokers themselves over the next few months, the study found. The results were published online in the Journal of Adolescent Health.Author Interviews Today's Bullied Teens Subject To 'Sticks And Stones' Online, Too
That online influence still pales compared to face-to-face influence, Valente says. But unlike more intimate friends, you can have hundreds, even thousands of online friends. And the comments and photos are delivered in seconds.
In years past it would take quite a while for cultures to change, according to Susan Lipkins, a clinical psychologist in Port Washington, N.Y. Not anymore. "Now, because of the Internet we see that worldwide cultures are changing at warp speed."
And teenagers often exaggerate behavior when they imitate it, Lipkins says. "They want to equal it and make it their own by increasing the danger, risk, sexualization, violence, aggression."
That makes it difficult to transmit more gentle values like empathy and compassion, Lipkins says. But bottom line, it's parents who still hold the most influence when it comes to these values.
"I ask parents, when I speak to them, I say 'OK, so there was a car accident; what did you do? Did you stop and help? Did you call 911? Or did you drive by and say; boy I'm glad it's not me?' That's a very mild example of how we teach our kids what to do," she says.
It's equally important to talk with your children about what they view online, Valente says, and put those images in context.
"Know who they're friends with and make sure you have conversations with them about what they're seeing and doing so that they properly interpret it," he says, "so they don't come away from these experiences thinking 'Oh my gosh, if I don't go out partying and drinking heavily every weekend I'm not going to be popular!' "Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Scientists have long sought a way to detect Alzheimer's before symptoms appear.iStockphoto
An experimental blood test can identify people in their 70s who are likely to develop Alzheimer's disease within two or three years. The test is accurate more than 90 percent of the time, scientists reported Sunday in Nature Medicine.
The finding could lead to a quick and easy way for seniors to assess their risk of Alzheimer's, says Dr. Howard Federoff, a professor of neurology at Georgetown University. And that would be a "game changer," he says, if researchers find a treatment that can slow down or stop the disease.
But because there is still no way to halt Alzheimer's, Federoff says, people considering the test would have to decide whether they are prepared to get results that "could be life-altering."Shots - Health News Drugmakers And NIH Band Together To Speed Up Research
The idea of predicting Alzheimer's isn't new. It's already possible to detect signs of the disease long before symptoms like memory loss begin to appear. But the tests require either a spinal tap, which is painful, or an MRI scan, which is time consuming and expensive.
So Federoff and a team of researchers set out to find something better. They took blood samples from 525 people ages 70 and older. Then, he says, they looked to see who developed Alzheimer's in the next five years.
The goal was to find some difference between the blood of people who developed Alzheimer's and the blood of people who remained "cognitively normal," Federoff says. And after sifting through more than 4,000 potential "biomarkers," he says, "We discovered that 10 blood lipids [fats] predicted whether someone would go on to develop cognitive impairment or Alzheimer's."
The results need to be confirmed, and the approach still needs to be tried in people of different ages and from different racial groups, Federoff says. Even so, he says, it raises the possibility that in the not too distant future, many more people will know their risk of Alzheimer's.Shots - Health News Vitamin E Might Help Slow Alzheimer's Early On
That knowledge can be a good thing, says Dr. Jason Karlawish, a professor of medicine, medical ethics and health policy at the University of Pennsylvania. That's been shown among people who chose to be tested for a gene that increases the risk of Alzheimer's, he says.
"Knowing their risk of developing cognitive impairment is very relevant to making plans around retirement and where they live," he says. "So there is certainly a role for knowing that information."
On the other hand, people who have the Alzheimer's gene and know it tend to rate their own memories as worse than people who have the gene but don't know it, he says. Knowing you carry the gene also seems to hurt people's performance on memory tests.
But the biggest concern about Alzheimer's testing probably has to do with questions of stigma and identity, Karlawish says. "How will other people interact with you if they learn that you have this information?" he says. "And how will you think about your own brain and your sort of sense of self?"13.7: Cosmos And Culture Alzheimer's Challenges Notions Of Memory And Identity
The stigma and fear surrounding Alzheimer's may decrease, though, as our understanding of the disease changes, Karlawish says. Right now, people still tend to think that "either you have Alzheimer's disease dementia or you're normal, you don't have it," he says.Shots - Health News For Middle-Aged Women, Stress May Raise Alzheimer's Risk
But research has shown that's not really true, Karlawish says. Alzheimer's is a bit like heart disease. It starts with biological changes that occur years before symptoms appear. And there is no bright line separating healthy people from those in early stages of the disease.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
It's just past midnight on a freezing Saturday night in Washington, D.C.
In the last hour, five ambulances have arrived at the emergency room where I work. A sixth pulls up.
The paramedics wheel out a stretcher carrying a man, 73, strapped to a hard board, a precaution in case his spine is fractured. There's blood around his neck brace and a strong smell of urine.
"We found him by his bed," a paramedic tells me. The patient told the paramedics he slipped. "Reports back pain and some cuts and bruises," one of them adds.
Medical history? None the paramedics could find. Same goes for whatever medications the patient might be taking. The only thing they know is his name and address. Nobody else was at home.
Two nurses undress the patient to rid him of his soiled clothes. They wrap a blood pressure cuff around one arm and start an IV line in the other. A tech shaves his chest before attaching sticky electrodes to check the man's heart.
He swats at us, saying that none of this is necessary. He slipped in the shower. "I was only out for a little while," he says. The paramedics mumble that they found him in the bedroom — not the bathroom.
The patient tells us his full name and says that the year is 1843. "It's 2014," I say, as my medical student looks for his records on a nearby computer.
She shakes her head. He's never been in our hospital. He gives us two phone numbers for his son, but neither works. The patient says his doctor lives in Kansas.
We examine him and find a 1-inch laceration over his eyebrow, a bruise over his right wrist, and scrapes on both knees. He winces when I touch his back. He has good strength in his arms and legs.
I send him for X-rays and a CT scan of his head and spine. There's no bleeding inside his brain and nothing is broken. His laboratory tests come back and show that he has anemia and kidney trouble.
He wants to go home. He pleads with us, saying he hates hospitals. He promises he'll be OK. I try his home phone and his son's numbers again. The resident calls two local hospitals on the chance they've seen him before. No luck.
The year is now 1914, the patient declares. Everyone sighs. We have to admit him. It's the last hospital bed we've got, and the patients who come after him will have to wait through the night in the ER.
The next day, I get a call from the patient's son and daughter-in-law. They're irate. The patient has dementia and frequently falls. That's why the family has arranged for live-in help 18 hours a day.
The man has had anemia and kidney problems for years. His longtime doctor (here in town, not in Kansas) monitors these issues closely. The internist taking care of him say that the man never should have been hospitalized.
My first reaction is defensiveness. Where was his family last night? What would the man's usual doctor have done in my position?
We emergency physicians frequently hear complaints from other doctors about how we order too many tests and admit too many patients. While medical overuse is a problem — and fear of malpractice and financial conflicts of interest sometimes play a role — it's easy to make harsh judgments after the fact.
When caring for patients we don't know and who could have life-threatening illnesses, emergency physicians have to do what is safest and best with the information at hand, sparse as it may be.
In this case, I made the choice to admit the patient. He was confused and had several abnormal test results. We couldn't be sure he'd be safe at home.
As I listen to his family, I also see the other side. I can see how unhappy they are that he was stripped, poked and kept against his wishes. I understand their frustration at our system of sick care: Why don't we have unified electronic medical records? Why aren't there better interventions for coordinating care and keeping people out of hospitals?
I tell them that I'm sorry. Knowing what I know now, I would have made a different decision. I gently suggest that it would be helpful to make sure he carries a document in his wallet with updated phone numbers, medical conditions and wishes for his care.
That day, I'm back in the ER. It's another busy shift, and I see him again. Well, not the same 73-year-old, but another elderly gentleman who also fell. Again, he's confused, and we can't reach his family. He doesn't want to stay, but again we hospitalize him. This time, too, I'm filled with doubt and a desire for a better system to care for my patients.
Dr. Wen is an attending physician and director of patient-centered care research in the Department of Emergency Medicine at George Washington University. She is the author of "When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Care," and founder of Who's My Doctor, a project to encourage transparency in medicine.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
fromKUHFListen to the Story 3 min 40 sec
Nobody plans to wind up in the emergency room, but costly accidents happen — even to healthy young people.Getty Images
At lunchtime on the North Harris campus of Houston's Lone Star Community College, students stream through the lobby of the student services center, plugged into their headphones or rushing to class.
Many walk right past a small information table about the Affordable Care Act.
The table is the brainchild of Megan Franks, a health and fitness professor at Lone Star. She knows that young people may be key to the success of Obamacare. The insurance plans need a mix of ages and a mix of healthy and sick people to balance out the costs for everyone — and young people tend to be healthier.Shots - Health News The Healthy, Not The Young, May Determine Health Law's Fate Shots - Health News Edgy Washington State Ads Urge Young People To Buy Insurance
But, many young people are confused about how to sign up. Others feel like they can't afford insurance, and don't realize there are subsidies available that could help them. Just getting overworked students to stop and learn about the law, Franks says, is tough.
"If you say 'Obamacare,' they know what you're saying. If you say 'Affordable Care Act,' they walk by without any 'ding, ding, ding' (of recognition)," she says. "So then we throw out the word 'penalty.' Zoom! They've never heard that before. Penalty? That really tends to be a hook more than, 'Gee, you really need health care.' "
Franks says many students at Lone Star are low-income. They often work. Some have families to support. Others struggle to find gas money to even get to class.
"I still think so many of them are [in] survival mode: 'Health insurance? Really? You know, I've got to get to work,' " she says.
She could be talking about Adan Castillo. He's 19 and hoping for a career in law enforcement, or maybe the Marines. In addition to his classes, he also works.
Castillo actually used to be insured. He paid his parents $55 a month to keep him on their health plan.
But he says it just felt like throwing money away.Education Why Is College So Expensive?
"I just stopped giving it to them," he says. "There are other important things I have to do, like paying for my college books, classes ... gas. Gas is expensive nowadays."
But Adan's girlfriend, Leslie Gonzalez, says insurance is important. She's an accounting student.
"Well, he needs it," Gonzalez says. "Because what if – let's say he doesn't have it right now and he gets in an accident. He's going to have to pay everything out of pocket, and what if he doesn't have it?"
Gonzalez works part time as a bank teller. She says she will sign up for insurance at work as soon as she is eligible.
The stereotype about young people is that they think they're "invincible," that they don't need insurance because they're young and nothing bad will happen to them for years.
But most young adults don't actually think that way.
Two recent surveys, one from the Kaiser Family Foundation and one from the Commonwealth Fund, reveal that cost is the real issue. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)Shots - Health News Young Doesn't Mean Invincible When It Comes To Strokes
Young people think health insurance is expensive, and they assume they can't afford it. Often, they simply don't know about the subsidized plans offered under the law, or how to get them.
Taylor Castille is a nursing student in her second year at Lone Star. She has logged on to HealthCare.gov, but says her first visit didn't go very well.
"I finally got on the website the other day," Castille explains, "and it was kind of confusing to me because I didn't understand ... if I would have to pay, what would I pay, what I'm not paying. It was really confusing, and I got stressed out all over again just looking at that. So I just left the site and didn't even bother to go back."
“ I have all this debt — and I'm 21. I haven't bought a car, I haven't done anything. I don't have the debt because I was being irresponsible. I have the debt because I was sick.
Castille still wants health coverage. Last fall she suffered a series of fainting spells and seizures. After a few visits to a hospital emergency room, she now has $30,000 in medical debt. And she still doesn't have a diagnosis.
"I have all this debt — and I'm 21," she says. "I haven't bought a car, I haven't done anything. I don't have the debt because I was being irresponsible. I have the debt because I was sick. And I couldn't control that, so now I'm stuck with that."
Castille later visited the campus information table and got a flier on how to sign up for a health plan.
So far, only about 25 percent of adults who have signed up are younger than 34. The federal government is hoping to nudge that proportion closer to 40 percent.
The deadline to enroll — for all ages — is March 31.
This story is part of a reporting partnership with NPR, Houston Public Media and Kaiser Health News.Copyright 2014 KUHF-FM. To see more, visit http://www.kuhf.org.
What is it about bars that brings out bad behavior?iStockphoto
Our post on sexual harassment in bars sure struck a nerve.
Earlier this week we covered a study from the University of Toronto that found that men who were sexually aggressive in bars weren't necessarily drunk, and that their actions usually weren't the result of miscommunication.
The researchers hired and trained young adults to go into bars in the Toronto area and observe people's behavior. They found that 90 percent of the victims of sexual aggression were women being harassed by men — and that the perpetrators' aggressiveness didn't correlate with their level of intoxication.
Bystanders and bar staff rarely intervened, according to the study, which was published in Alcoholism: Clinical & Experimental Research. Two-thirds of the incidents involved nonconsensual touch; in other cases the aggressors threatened contact or verbally harassed their targets.
Hundreds of you weighed in, and the debate was passionate. Several people felt that the study merely confirmed the obvious.
Yep, you don't have to be drunk to be a creep, and just because you are drunk doesn't automatically make you a creep. No surprise there.
But many readers said the focus should be on the aggressors' behavior, not that of victims.
Shifting the focus to the women's behavior suggests that women are able to stop these predators. That is how it becomes victim blaming. Society needs to spend as much time scrutinizing the predatory behavior of men as it does focusing on the behavior of women who encounter them. Without the presence of predatory men the incidents just would not happen.
Mae Flexer, a representative in the Connecticut General Assembly and chair of the Assembly's Task Force on Domestic Violence, called in to point out that we should avoid putting undue blame on both men and women.
"Yes, women being intoxicated makes it easier for predators to act out their aggression against women, but these predators are going to do this anyway, whether women are drunk or sober, and I think that's a very important point to get across," she tells Shots.
"It's also important when we talk about these issues that we're not talking about men in the collective," she says. "We need to show that we recognize that the men who commit these crimes are a very small portion of the population."
Yet other readers pointed out that bad behavior isn't limited to Saturday night.
It should also be noted ... the reason for the men targeting these women in this study was because they were "less able to rebuff them." Think of how often these same men are aggressive and predatory in other situations where women are less able to seek justice! For example, when they are alone with women, when they are supervisors or in positions of power over women, when the woman has a physical or mental handicaps, etc. This kind of harassment isn't limited to bars!
But bars aren't a bad place to start trying to figure out a solution.
We called Lauren Taylor, one of the organizers behind Washington, D.C.'s Safe Bars initiative, and asked her what her group is trying to do.
The initiative's goal, Taylor told Shots, is to educate bystanders on what to do when they see sexual aggression. Taylor says the organization hopes to work with bars in D.C. and train staff to intervene and help victims of aggression.Shots - Health News If He's Sexually Aggressive In Bars, It's Not Because He's Drunk
Bystanders can help in many ways, Taylor says. "For example, you might go up to somebody who is being targeted and say, 'Your friend is calling over there.' " A bystander could also address perpetrators directly and ask them to cut it out, she says.
Her group tries to educate bystanders and staff on how to safely intervene. But she realizes that this goes beyond just how people behave on Saturday night. "Really what we're talking about is changing rape culture," Taylor says. "[Rape culture] is the overall messaging throughout our culture that says this kind of behavior is allowed."
That includes the idea that "boys will be boys," or that women at bars should expect bad behavior at bars, she says. And though most men aren't perpetrators of sexual aggression, the majority of perpetrators are men, Taylor says.
"Men can go out and get drunk, and run a whole bunch of risks including getting in a car accident, blacking out or getting alcohol poisoning," Taylor says. "Women run those same risks. But men never have to think 'I shouldn't get drunk because someone is going to rape me.' "Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Health insurers are banding together to share information about how much new customers are costing health plans. A group of actuaries in Denver will be the first to see the figures, which could be used in calculating future rates.iStockphoto
Now that medical insurers must accept all applicants no matter how sick, what will these new customers cost health plans? And how will their coverage costs affect insurance prices for 2015 and beyond?
Few questions about the Affordable Care Act are more important. How it all plays out will affect consumer pocketbooks, insurance company profits and perhaps the political fortunes of those backing the health law.
A few Denver actuaries, bound to confidentiality, will be the first to glimpse the answers.
Quite a few companies have agreed to give Wakely Consulting Group early information about enrollment and member health in plans for individuals and small businesses sold through the online marketplaces that opened last fall.
The firm will use the data to give insurers the earliest possible estimates of how much they'll pay or receive through a government program designed to distribute risk more evenly among plans. The information will also help insurers set rates for 2015, which are due to regulators relatively soon.
"It's really about, how healthy or sick are these people?" said Ross Winkelman, a Wakely actuary who's running the analysis along with colleague Syed Mehmud. "That's probably the biggest uncertainty in each plan's rate filing."
Wakely is getting information on enrollees' health and demographics far beyond what the Department of Health and Human Services has published. (The data are totaled. Wakely doesn't see member information.) Since the ACA bars insurers from asking about people's health until after they sign up, each carrier is quickly trying to assess its new membership.
But plans aren't affected just by the health of their own members. The new enrollees their competitors sign up can also influence bottom lines. That's because the health law's risk adjustment provisions are designed to shift money from insurers that potentially signed up much healthier members than average to those that enrolled sicker members than average. The program, similar to one for Medicare managed care plans, is supposed to remove incentives for insurers to enroll only the healthy.
Properly accounting for risk adjustment could mean as much as 10 percentage points in costs or revenue for plans accustomed to making 3 percent profit — a huge swing, said Winkelman. But to know what they're getting, insurers need to know how their experience compares to that of their competitors in a given state and what the average risk is for the total market.
That information won't come through normal regulatory channels for many months — long after carriers have to set rates for 2015 and start reporting profits to shareholders.
Instead, and perhaps improbably, Wakely has persuaded insurers in more than 30 states to let it act as a clearinghouse, gathering detailed information from each company, figuring how it fits together and sharing only what's necessary.
Winkelman declined to identify the insurers or which states they're in. But in some states every health plan in the individual and small-group markets agreed to participate, he said. A Wakely website lists companies that said they intended to participate. They include most major insurers.
In October, UnitedHealth Group, which owns the nation's biggest health insurer, said it had signed up for such a study, without identifying Wakely.
"We have absolutely participated with a third party to gather industry information and get some feedback on where we sit," Dan Schumacher, chief financial officer for United's insurer, told stock analysts last fall. "And based on that information, as well as our past experience, we feel very comfortable with our ability to estimate the results [on the risk adjustment program] as we get into 2014."
Some Blue Cross and Blue Shield plans are also participating. Wakely is still recruiting clients — especially community-run co-op health plans created by the federal health law and others new to the individual and small-group business.
"The health plans that are probably least likely to be participating right now are the ones that are new, and they are the ones that could really benefit from it," Winkelman said.
Because of insurers' concerns about confidentiality, Wakely won't be sharing what it learns with the federal government, he said.
Thanks to the health law's new requirements, insurers knew they might get a line of sicker-than-usual customers. They priced this year's plans accordingly. But it was still largely a guess.
Whether they have recruited enough healthy members to balance out costs for the sick and keep premiums from rising substantially for 2015 will be something many people in Washington and CEO suites across the country will want to know.
The folks at Wakely will have a better, earlier idea than anybody else. But don't expect them to put out any announcements.Copyright 2014 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
In only the second documented case of its kind, an infant born with the AIDS virus may have been cured of the infection, thanks to an intensive drug treatment begun just hours after her birth. The baby girl — now 9 months old — from Long Beach, Calif., is still on that regimen of antiretroviral drugs. But researchers who described her case at an AIDS meeting in Boston this week say advanced testing suggests that she is HIV-negative.
While not conclusive, the two cases are "quite promising," says Anthony Fauci, a longtime AIDS researcher who directs the National Institute of Allergy and Infectious Diseases.Alex Wong/Getty Images
The California child's case comes three years after doctors apparently cleared an infant in Mississippi of her HIV infection shortly after she was born. That child is now a healthy 3-year-old who seems to be free of HIV, doctors say, despite having been off the AIDS drugs for almost two years now.
Researchers are eager to determine if the two remarkable cases are rare experiences or a broader sign of hope for the hundreds of HIV-infected babies born each day. To find out, clinical trials involving roughly 60 newborns will begin as early as this April or May, says Dr. Anthony Fauci, who directs the National Institute of Allergy and Infectious Diseases.
Fauci, whose institute funded the research in both cases, sat down on Thursday with NPR's Audie Cornish, for All Things Considered, to talk about the two children, and what their promising experience might mean for the future. Here's an edited excerpt of their conversation:
How is this course of treatment different from what's usually given to babies infected with HIV?
In the usual situation when a baby is born to an infected mother, you don't know at birth, for sure, if the baby is infected. So what you do is you give the baby what's called a preventive type of drug [regimen] — lower dose and [fewer drugs]. When you find out that the baby is ultimately infected, you switch over to the full component of three drugs at the right dose, to start treating them. ... The original Mississippi baby and the baby from California were treated within hours of birth as if they were infected. So instead of giving them the prevention type of drug over a period of a few weeks, they were immediately given the full-blown course of the treatment drugs.
But how did doctors know when to stop treatment in the first case — the little girl born in Mississippi?Shots - Health News Scientists Report First Cure Of HIV In A Child, Say It's A Game-Changer
The doctors would never have just ... stopped drug [treatment] in the baby after several months. The mother was lost to follow up and [she apparently] stopped giving the drug to the baby. And then when [the mother and child] came back, the physician noticed that [the little girl] had been several months off therapy and the virus did not rebound. So a quirk — of the mother's decision, or accident, in not following up with the baby — has actually led to a situation that turned out to be beneficial.Shots - Health News A Toddler Remains HIV-Free, Raising Hope For Babies Worldwide
So that case was accidental. How will doctors know in the future when to stop drug treatment, and is that even ethical?
To just ... stop would not be ethical, and that's the reason why we're sponsoring a clinical trial that will begin sometime at the end of April [or] at the beginning of May, where we're taking a large number of babies ... born of mothers who are infected, [women] who have not received any [anti-HIV] treatment [during pregnancy] at all, and we're going to be treating those babies literally within 48 hours of birth with the full component of the treatment regimen. [We will be] assuming that they are infected, even though they might not be. And then we'll wait for a considerable period of time, and very carefully, in individual babies, stop therapy to see if the virus rebounds.Global Health In Mozambique, A Fight To Keep Babies HIV-Free
Give us some context. Just how big a problem is it — babies born HIV-positive?
In the United States, it's really not a big problem at all only because we have the [prenatal and postnatal] care for the mothers, and almost all mothers who are infected will be started on [antiretroviral drug] therapy. It will be extremely unlikely that the baby will be infected – not impossible but very, very unlikely. However, the situation in the developing world is somewhat different. [There] it's not uncommon that a mother will come into a clinic, in labor, ready to deliver, never having seen a health care provider, and not being on antiviral therapy. Those are the babies that are at the highest risk.
How promising are these findings?
Well, it's quite promising because if it's the second one that we have documented now — and there probably will be others coming along — it really brings up a broader concept. If you have the possibility of truly curing babies at the time of birth, then the risk/benefit ratio of waiting until you document that they're infected ... that really changes the equation.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
Is there anyone who can resist dancing when Pharrell Williams sings "Happy"? Yes, if you're one of the rare few with specific musical anhedonia.Kevin Winter/Getty Images
Surely listening to Pharrell Williams' Oscar nominee "Happy" makes you bounce with joy. Nirvana still makes you want to wail. And old Beatles songs make you feel like everything's going to be all right. But maybe you don't feel anything at all.
Some people lack the ability to get pleasure from music, researchers say, even though they enjoy food, sex and other great joys in life.
Psychologists at the University of Barcelona stumbled upon this while they were screening participants for a study by using responses to music to gauge emotion. They were surprised to find that music wasn't important at all to about 5 percent of the people — they said they didn't bob up and down to tunes they liked, didn't get weepy, didn't get chills. It was like they couldn't feel the music at all.i i
Love, love me do? I will if the Beatles sing to me. Here the Fab Four rehearse for a performance in November 1963.Central Press/Getty Images
People with a disorder called amusia can't hear musical tones. So the Barcelona team tested to see if these people could identify the emotions in different types of music. They could do that; they could hear the music.
Then they asked the participants, who were Spanish university students, to bring in music they liked.i i
"I woke up in my mother's arms." Kurt Cobain of Nirvana sings for MTV Unplugged in 1993.Frank Micelotta/Getty Images
"The first surprise is that some of the participants had trouble bringing music from home," says Josep Marco-Pallares, an associate professor of psychology at the University of Barcelona and senior author of the study. These people didn't have any music — no MP3s, no CDs. No Spotify or Pandora.
Then the 30 volunteers were asked to listen to tunes judged pleasurable by other college students, ranging from Puccini's "Nessun dorma" to Simon & Garfunkel's "Bridge over Troubled Water." The scientists measured participants' heart rate and skin conductance, which are considered physiological measures of emotion.
The people who had said they got no pleasure from music showed no physical response, while the music lovers did. "The other participants reported chills when listening to music," Marco-Pallares told Shots. "With our anhedonic group, they had no chills. They had no real response to music."Deceptive Cadence Who Needs Drugs When You've Got Music?
Well, maybe they're just insensitive boors. But the scientists thought of that, too. They then gave participants a common psychological test with which people can earn monetary rewards. The people who were indifferent to music did just fine, showing faster heart rates and skin response at the prospect of winning.Shots - Health News Turns Out Your Kids Really Did Love That Music You Played
"This suggests that they don't have a global impairment of the reward system," Marco-Pallares says. "This is specific to music." The results were published Thursday in Cell Biology.
So here you have healthy, happy people who just don't get music. Maybe those people who don't dance at weddings aren't wallflowers after all. And maybe if we figure out why a small number of humans have missed out on the thrill of music — Marco-Pallares calls it "specific musical anhedonia" — it will reveal something about why music matters so much to the rest of us.
Marco-Pallares is hoping to find that out. He's continuing the experiment by scanning people in an MRI to see if the brains of people who say "meh" to music respond differently.http://www.npr.org/.
They're both legal. Either, both or none?iStockphoto
While electronic cigarettes may be marketed as alternatives that will keep teenagers away from tobacco, a study suggests that may not be the case.
Trying e-cigarettes increased the odds that a teenager would also try tobacco cigarettes and become regular smokers, the study found. Those who said they had ever used an e-cigarette were six times more likely to try tobacco than ones who had never tried the e-cig.
Researchers from the Center for Tobacco Research and Education at the University of California, San Francisco, analyzed data from the 2011 and 2012 National Youth Tobacco Survey, a federal questionnaire administered to students in grades 6 through 12 in middle and high schools nationwide. It asked teenagers whether they smoked electronic or tobacco cigarettes or both.Shots - Health News Cities Take The Lead In Regulating Electronic Cigarettes
The survey found that students' use of electronic cigarettes doubled from 3.3 percent to 6.8 percent in 2011 and 2012. But the number of smokers declined only slightly, from 5 percent to 2011 to 4 percent in 2012.
Teenagers who smoked were more likely to use e-cigarettes, and vice versa. In 2012, 57 percent of those who had tried cigarettes had also tried e-cigarettes. And 26 percent of current smokers used e-cigs as well. By contrast, 4 percent of teens who had never smoked had tried e-cigs, and 1 percent said they use them currently.
E-cigarettes don't burn tobacco. Instead, a battery heats up liquid nicotine and turns it into a vapor that's inhaled into the lungs.
Director Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, has called the rise of e-cigarette use among teenagers "alarming," because nicotine is still an addictive drug. Frieden also has expressed concern that electronic cigarettes may be a gateway to tobacco cigarettes.Shots - Health News Kids' Use Of Electronic Cigarettes Doubles
"The adolescent human brain may be particularly vulnerable to the effects of nicotine because it is still developing," the authors write. Their study was published Thursday in the journal JAMA Pediatrics.
The study is one of the first to try to get a grip on how e-cigarettes affect tobacco use. It couldn't look at whether e-cig use caused tobacco use, or vice versa, or why teenagers decided to use the products. And it doesn't answer the question of whether teenagers used e-cigarettes in order to avoid tobacco.
Although cigarette makers deny they target teenage customers, researchers say the companies aggressively market glamorous and sexy images that appeal to a teenager's sense of rebellion and tendency toward risky behavior. Those same tactics are now being used for e-cigarette ads, tobacco control advocates say.
The electronic versions also come in a variety of flavors like strawberry, watermelon and licorice. There are far more restrictions on tobacco cigarettes including a ban on offering sweet or fruity flavors, as well as restrictions on advertising and sales to minors. The Food and Drug Administraiton is currently considering whether and how much to regulate electronic cigarettes.Copyright 2014 NPR. To see more, visit http://www.npr.org/.
fromWLRNListen to the Story 4 min 3 sec
Yolanda Madrid of Miami (left) talks with navigator Daniela Campos while signing up for health insurance under the Affordable Care Act in January.Lynne Sladky/AP
For all of California's troubles advertising health care to Latinos, that state has embraced the Affordable Care Act and is spending millions of dollars to get people to sign up. Florida is a different story.
Florida has a high rate of uninsured Latinos - almost 10 percent of all the country's uninsured Hispanics who are eligible for health insurance under the Affordable Care Act live in the state.
But Florida lawmakers rejected the Affordable Care Act from the beginning, even being party to a lawsuit to stop its implementation. When the ACA did become law, the state decided not to run its own exchange, and it has not expanded Medicaid. Governor Rick Scott has come out in favor of Medicaid expansion, but it's unlikely the legislature will go along with it this session.
Florida is not marketing the law to anybody. In the absence of state outreach efforts, it's up to the insurers and other groups to get the word out about Obamacare.
And Florida's Hispanics are a group they really want to reach. They tend to be younger and healthier than the rest of the population, so insurers want them because they may pay into the system more than they use in services. Having healthy young people on their rolls helps insurers balance the books.Shots - Health News Selling Health Care To California's Latinos Got Lost In Translation
Florida Blue, a large insurer, is trying to reach the population with a mix of old and new media. The company has developed a mobile phone app, because research shows that's how many Latinos access the Internet. Florida Blue is also partnering with Spanish-language bloggers and forming a partnership with Navarro, a Hispanic drug store. And they've been working with community health centers where Latinos go to the doctor, since face-to-face interaction is critical to reaching this demographic.Shots - Health News Despite Big Market In Florida, Obamacare Is A Hard Sell
Churches, health centers and advocacy groups from within the Latino community have also been working on a grassroots level.
Spanish-language television is also playing a key role in Florida. Univision is partnering with rival Telemundo for Thursday's town hall with President Obama.
Univision's Stephen Keppel says his network is embedding messages about health care into their variety programming, such as Sábado Gigante and Despierta America.
This story is part of a partnership with NPR, WLRN and Kaiser Health News.Copyright 2014 WLRN Public Radio. To see more, visit http://www.wlrn.org/.
fromKQEDListen to the Story 4 min 32 sec i i Covered California
It's been decades since the advertising industry recognized the need to woo Hispanic consumers. Big companies saw the market potential and sank millions of dollars into ads. The most basic dos and don'ts of marketing to Latinos in the United States have been understood for years.
So when officials started thinking about how to persuade the state's Spanish speakers, who make up nearly 30 percent of California's population, to enroll in health care plans, they should have had a blueprint of what to do. Instead, they made a series of mistakes.
For example, one thing health policy experts love about Obamacare is that no one can be denied coverage for a pre-existing health condition. Covered California, the state's health insurance exchange, made this a selling point in almost all its Spanish ads. But that doesn't resonate with Latinos. Many have never had insurance, never considered it.
Bessie Ramirez is with the Los Angeles-based Santiago Solutions Group, a Hispanic market research firm that has consulted for large health care clients like HealthNet, Cigna and Blue Cross.
She says another problem is that all the early TV ads end with a web address for Covered California in Spanish — no phone number or physical address. She says that completely misses how Hispanics like to shop, especially for a complicated product like health insurance.KQED/YouTube
Grammatically correct, but lacking nuance?
"Hispanics are heavily on the Internet, and they're growing very fast on the Internet, however they're not transacting on the Internet," Ramirez notes. "They transact on a personal basis. Hispanics will wait to go to a 7-Eleven until 11 o'clock [if] at 11 o'clock they know that [their friend] Juan is on duty."
Covered California's biggest mistake was perhaps simply translating ads developed in English into Spanish. Think of Got Milk?, the long-running English-language campaign. At worst, a literal translation into Spanish could be a rude reference to breast milk. At best, it just falls flat. That's what happened with Covered California's first Spanish-language ad.
The ad features a series of people looking directly into the camera saying, in Spanish, "Welcome to a new state of health. Welcome to Covered California."
Ad experts say that was an obvious misstep.
"To say we're in a new state of health for California, it's grammatically correct to translate it literally, but it doesn't have the same nuance or cuteness that it does in English," says Roberto Orci, CEO of Acento Advertising in Santa Monica, Calif.
He found one of the state's follow-up ads just boring — the music, the message and the man in the ad.
"This guy was stiff as a board and ... seco, which in English means dry," he says.
If the product is chicken nuggets or milk, it might not matter to anyone but the company if Latinos buy it. But if Latinos don't buy health insurance, it matters to everyone.
On average, Latinos are younger and healthier than the general population. The premiums they will pay if they sign up help cover the health care costs of older, sicker Californians. That keeps premium costs down for everyone else.
That's why Covered California is sweating the numbers. Just 6 percent of people who enrolled in Covered California health plans last year speak Spanish as their first language. The state is worried how far that number is from the number of Spanish speakers.Shots - Health News Mix Of Young And Old Signing Up For Health Care In California
"We don't think we've done a good enough job yet," says Peter Lee, executive director of Covered California. "Relative to our ambitions and our aspirations we don't stack up well enough yet, and so we're going to be doubling down."
The state spent almost $5 million on its Spanish-language ad campaign last year. It plans to spend more than $8 million in the first three months of this year. Covered California has upped its market research efforts and has vowed to adjust its creative messaging. This time around, it will put a lot of emphasis on ads where people can go to get help in person.
"Even from day one, we thought Spanish speakers would need in-person help," Lee says. "How important that is has really crystallized over the last three months."
The final deadline to sign up for coverage this year is March 31. It's not clear if Covered California can come up with a more effective marketing campaign before then.
This story is part of a reporting partnership among NPR, KQED and Kaiser Health News.Copyright 2014 KQED Public Media. To see more, visit http://www.kqed.org.
Current water-filtering technology is costly, but MIT scientists are testing a simpler and cheaper method that uses wood from white pine trees.Wikimedia Commons
Removing all the dangerous bacteria from drinking water would have enormous health benefits for people around the world.
The technologies exist for doing that, but there's a problem: cost.
Now a scientist at the Massachusetts Institute of Technology thinks he's on to a much less expensive way to clean up water.
MIT's Rohit Karnik is a mechanical engineer who works on water technologies. He says it's relatively easy to make membranes that can filter the bacteria out of water. But making membranes cheaply, he says, is not so easy.Additional Information: Related NPR Stories Water-Filtration Plant Sparks Concern About Impact on Ecology Jan. 30, 2003
One day a few years ago, he was at a meeting on plants and water flow when a light bulb went off in his head. Why not, he thought, use the xylem tissue in plants for water filtration?
Now if you remember your high school biology, you'll know that xylem is the stuff in plants that transports water in the form of sap from the roots to the leaves.
"And the way the water is moved is by evaporation from the leaves," says Karnik.
It's somewhat like what happens when you put a straw into a glass of liquid. Evaporation from the leaves has the same effect as sucking on the straw.
Pulling water up to the leaves this way creates a problem for the plant, but also an opportunity for an inventor.
The plant's problem is something called cavitation, or the growth of air bubbles, which makes it harder for water to reach the leaves. But Karnik says xylem has a way of getting rid of these bubbles.
"The xylem has membranes with pores and other mechanisms by which bubbles are prevented from easily spreading and flowing in the xylem tissue," he says.
And it turns out these same pores that are so good at filtering out air bubbles are just the right size for filtering out nasty bacteria.
To prove it worked, he created a simple setup in his lab. He peeled the bark off a pine branch and took the sapwood underneath containing the xylem into a tube. He then sent a stream of water containing tiny particles through the tube and showed that the wood filter removed them.
"We also flowed in bacteria and showed we could filter out bacteria using the xylem," he says. Karnik estimates the xylem removed 99.9 percent of the bacteria.Around the Nation Here, Drink A Nice Glass Of Sparkling Clear Wastewater
The results were published Wednesday in the journal PLOS ONE.The Salt Recipe For Safer Drinking Water? Add Sun, Salt And Lime
Karnik says what makes wood such an attractive material for water filtration is that it's cheap. So he thinks it's worth trying to work out the technical hurdles to scaling up his system.
But Robert Jackson, an environmental expert at Stanford University, points out that at least as it stands now, the system doesn't do a good enough job at filtering out bacteria. He wrote in an email that filtering out almost all of the nasty bacteria is certainly helpful, "but when you can have hundreds of thousands, even millions, of them in a drop of water, you don't want to rely on something with 99 percent efficiency."
"In a survival or short-term situation this could work," he wrote. "As a longer-term or global solution to the billion people on Earth without access to clean water, call me skeptical."Copyright 2014 NPR. To see more, visit http://www.npr.org/.