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"disqusTitle": "A Spike In Liver Disease Deaths Among Young Adults Fueled By Alcohol",
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"content": "\u003cp>Dr. Elliot Tapper has treated a lot of patients, but this one stood out.\u003c/p>\n\u003cp>\"His whole body was yellow,\" Tapper remembers. \"He could hardly move. It was difficult for him to breathe, and he wasn't eating anything.\"\u003c/p>\n\u003cp>The patient was suffering from chronic liver disease. After years of alcohol use, his liver had stopped filtering his blood. Bilirubin, a yellowish waste compound, was building up in his body and changing his skin color.\u003c/p>\n\u003cp>Disturbing to Tapper, the man was only in his mid-30s – much younger than most liver disease patients.\u003c/p>\n\u003cp>Tapper, a liver specialist and assistant professor of medicine at the University of Michigan Medical School, tried to get the patient to stop drinking.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We had long, tearful conversations,\" Tapper says, \"but he continued to struggle with alcohol addiction.\" Since then, the young man's condition has continued to deteriorate and Tapper is not optimistic about his chances of survival.\u003c/p>\n\u003cp>It's patient stories like this one that led Tapper to research liver disease in young people. According to a \u003ca href=\"https://www.bmj.com/content/362/bmj.k2817\" target=\"_blank\" rel=\"noopener\">study published Wednesday\u003c/a> in \u003cem>BMJ\u003c/em> by Tapper and a colleague, fatal liver disease has risen, and young people have been hit the hardest.\u003c/p>\n\u003cp>The study examined the number of deaths resulting from cirrhosis, or scarring of the liver, as well as liver cancer. Data came from the Centers for Disease Control and Prevention and covered the period from 1999 to 2016.\u003c/p>\n\u003cp>The analysis revealed that deaths from liver-related illnesses have increased dramatically, and mortality in young people rose the fastest. Although these illnesses can be caused by several things including obesity and hepatitis C infection, the rise among young Americans was caused by alcohol consumption. The number of 25- to 34-year-olds who died annually from alcohol-related liver disease nearly tripled between 1999 and 2016, from 259 in 1999 to 767 in 2016, an average annual increase of around 10 percent.\u003c/p>\n\u003cp>\"What's happening with young people is dismaying to say the least,\" says Tapper.\u003c/p>\n\u003cp>Certain ethnic groups, like whites and Native Americans, also saw large increases in liver-related deaths in all age groups, while Asian-Americans saw decreases.\u003c/p>\n\u003cp>The rise in alcohol-related deaths overlaps with \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25905846\" target=\"_blank\" rel=\"noopener\">rising rates of binge drinking\u003c/a> from 2002 to 2012 observed across much of the U.S.\u003c/p>\n\u003cp>The authors noted a sharp spike in mortality starting in 2009. The reason for the spike is unclear, but Dr. Neehar Parikh, a liver specialist at the University of Michigan Medical School and Tapper's co-author, has a theory.\u003c/p>\n\u003cp>\"It correlates with the global financial crisis,\" Parikh says. \"We hypothesize that there may be a loss of opportunity, and the psychological burden that comes with that may have driven some of those patients to abusive drinking.\"\u003c/p>\n\u003cp>The increase among younger Americans is particularly troubling, because it kills people in the prime of their life.\u003c/p>\n\u003cp>\"Each young patient that dies is a tragedy,\" says Parikh. \"It's years of life lost.\"\u003c/p>\n\u003cp>The study is the latest to confirm that liver-related illnesses are becoming increasingly prevalent. A report \u003ca href=\"https://www.cdc.gov/nchs/products/databriefs/db314.htm\" target=\"_blank\" rel=\"noopener\">published Tuesday\u003c/a> by the CDC shows that the age-adjusted death rate from liver cancer has increased 43 percent since 2000. And a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26255044\" target=\"_blank\" rel=\"noopener\">recent study of veterans\u003c/a> found that cirrhosis cases nearly doubled between 2001 and 2013.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.mayo.edu/research/faculty/shah-vijay-m-d/bio-00083665\" target=\"_blank\" rel=\"noopener\">Dr. Vijay Shah\u003c/a>, who heads the Division of Gastroenterology and Hepatology at the Mayo Clinic and was not involved with this research, says that the study's emphasis on young Americans is new.\u003c/p>\n\u003cp>\"Alcohol-related liver cirrhosis used to be considered a disease that would happen after 30 years of heavy alcohol consumption,\" Shah says. \"But this study is showing that these problems are actually occurring in individuals in their 20s and 30s.\"\u003c/p>\n\u003cp>\"There has been a shift in the kind of patient we're seeing,\" agrees Dr. Sumeet Asrani, a liver specialist practicing in Dallas who did not contribute to the study. \"It fits with what we see in practice. We're seeing younger and younger patients with alcoholic liver disease.\"\u003c/p>\n\u003cp>Despite the recent increase, cirrhosis remains a relatively minor cause of death for young Americans, accounting for only 1.4 percent of total deaths in the 25-34 age range. But it's much more significant for young Native Americans, accounting for 6.3 percent of deaths.\u003c/p>\n\u003cp>Tapper thinks the problem is only going to get worse. Some conditions that cause liver trouble, like hepatitis C, have been falling. But other risk factors, including obesity, are on the rise. Alcohol consumption and obesity could interact to worsen liver disease, Tapper says.\u003c/p>\n\u003cp>Tapper says he thinks that policy could play a role in addressing the problem. For instance, strategic taxation of alcoholic beverages could deter consumption, just as raising the \u003ca href=\"https://www.npr.org/sections/health-shots/2016/11/10/501589893/cigarette-smoking-in-the-u-s-continues-to-fall\" target=\"_blank\" rel=\"noopener\">taxes on cigarettes has been shown to reduce smoking\u003c/a>. He cites the example of Scotland, which recently set minimum prices for units of alcohol to deter binge drinking. He also points to public health interventions, such as counseling, that help people quit drinking.\u003c/p>\n\u003cp>The good news is that liver disease is often reversible. Many patients can recover if they stop drinking soon enough.\u003c/p>\n\u003cp>\"I've had patients who came to me in a wheelchair,\" Tapper says. \"Three months later, they're shoveling snow and their lab tests are normal. It's always because they made that choice to stop drinking.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Paul Chisholm is an intern with NPR's Science desk.\u003c/em>\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+Spike+In+Liver+Disease+Deaths+Among+Young+Adults+Fueled+By+Alcohol+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Dr. Elliot Tapper has treated a lot of patients, but this one stood out.\u003c/p>\n\u003cp>\"His whole body was yellow,\" Tapper remembers. \"He could hardly move. It was difficult for him to breathe, and he wasn't eating anything.\"\u003c/p>\n\u003cp>The patient was suffering from chronic liver disease. After years of alcohol use, his liver had stopped filtering his blood. Bilirubin, a yellowish waste compound, was building up in his body and changing his skin color.\u003c/p>\n\u003cp>Disturbing to Tapper, the man was only in his mid-30s – much younger than most liver disease patients.\u003c/p>\n\u003cp>Tapper, a liver specialist and assistant professor of medicine at the University of Michigan Medical School, tried to get the patient to stop drinking.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We had long, tearful conversations,\" Tapper says, \"but he continued to struggle with alcohol addiction.\" Since then, the young man's condition has continued to deteriorate and Tapper is not optimistic about his chances of survival.\u003c/p>\n\u003cp>It's patient stories like this one that led Tapper to research liver disease in young people. According to a \u003ca href=\"https://www.bmj.com/content/362/bmj.k2817\" target=\"_blank\" rel=\"noopener\">study published Wednesday\u003c/a> in \u003cem>BMJ\u003c/em> by Tapper and a colleague, fatal liver disease has risen, and young people have been hit the hardest.\u003c/p>\n\u003cp>The study examined the number of deaths resulting from cirrhosis, or scarring of the liver, as well as liver cancer. Data came from the Centers for Disease Control and Prevention and covered the period from 1999 to 2016.\u003c/p>\n\u003cp>The analysis revealed that deaths from liver-related illnesses have increased dramatically, and mortality in young people rose the fastest. Although these illnesses can be caused by several things including obesity and hepatitis C infection, the rise among young Americans was caused by alcohol consumption. The number of 25- to 34-year-olds who died annually from alcohol-related liver disease nearly tripled between 1999 and 2016, from 259 in 1999 to 767 in 2016, an average annual increase of around 10 percent.\u003c/p>\n\u003cp>\"What's happening with young people is dismaying to say the least,\" says Tapper.\u003c/p>\n\u003cp>Certain ethnic groups, like whites and Native Americans, also saw large increases in liver-related deaths in all age groups, while Asian-Americans saw decreases.\u003c/p>\n\u003cp>The rise in alcohol-related deaths overlaps with \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25905846\" target=\"_blank\" rel=\"noopener\">rising rates of binge drinking\u003c/a> from 2002 to 2012 observed across much of the U.S.\u003c/p>\n\u003cp>The authors noted a sharp spike in mortality starting in 2009. The reason for the spike is unclear, but Dr. Neehar Parikh, a liver specialist at the University of Michigan Medical School and Tapper's co-author, has a theory.\u003c/p>\n\u003cp>\"It correlates with the global financial crisis,\" Parikh says. \"We hypothesize that there may be a loss of opportunity, and the psychological burden that comes with that may have driven some of those patients to abusive drinking.\"\u003c/p>\n\u003cp>The increase among younger Americans is particularly troubling, because it kills people in the prime of their life.\u003c/p>\n\u003cp>\"Each young patient that dies is a tragedy,\" says Parikh. \"It's years of life lost.\"\u003c/p>\n\u003cp>The study is the latest to confirm that liver-related illnesses are becoming increasingly prevalent. A report \u003ca href=\"https://www.cdc.gov/nchs/products/databriefs/db314.htm\" target=\"_blank\" rel=\"noopener\">published Tuesday\u003c/a> by the CDC shows that the age-adjusted death rate from liver cancer has increased 43 percent since 2000. And a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26255044\" target=\"_blank\" rel=\"noopener\">recent study of veterans\u003c/a> found that cirrhosis cases nearly doubled between 2001 and 2013.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.mayo.edu/research/faculty/shah-vijay-m-d/bio-00083665\" target=\"_blank\" rel=\"noopener\">Dr. Vijay Shah\u003c/a>, who heads the Division of Gastroenterology and Hepatology at the Mayo Clinic and was not involved with this research, says that the study's emphasis on young Americans is new.\u003c/p>\n\u003cp>\"Alcohol-related liver cirrhosis used to be considered a disease that would happen after 30 years of heavy alcohol consumption,\" Shah says. \"But this study is showing that these problems are actually occurring in individuals in their 20s and 30s.\"\u003c/p>\n\u003cp>\"There has been a shift in the kind of patient we're seeing,\" agrees Dr. Sumeet Asrani, a liver specialist practicing in Dallas who did not contribute to the study. \"It fits with what we see in practice. We're seeing younger and younger patients with alcoholic liver disease.\"\u003c/p>\n\u003cp>Despite the recent increase, cirrhosis remains a relatively minor cause of death for young Americans, accounting for only 1.4 percent of total deaths in the 25-34 age range. But it's much more significant for young Native Americans, accounting for 6.3 percent of deaths.\u003c/p>\n\u003cp>Tapper thinks the problem is only going to get worse. Some conditions that cause liver trouble, like hepatitis C, have been falling. But other risk factors, including obesity, are on the rise. Alcohol consumption and obesity could interact to worsen liver disease, Tapper says.\u003c/p>\n\u003cp>Tapper says he thinks that policy could play a role in addressing the problem. For instance, strategic taxation of alcoholic beverages could deter consumption, just as raising the \u003ca href=\"https://www.npr.org/sections/health-shots/2016/11/10/501589893/cigarette-smoking-in-the-u-s-continues-to-fall\" target=\"_blank\" rel=\"noopener\">taxes on cigarettes has been shown to reduce smoking\u003c/a>. He cites the example of Scotland, which recently set minimum prices for units of alcohol to deter binge drinking. He also points to public health interventions, such as counseling, that help people quit drinking.\u003c/p>\n\u003cp>The good news is that liver disease is often reversible. Many patients can recover if they stop drinking soon enough.\u003c/p>\n\u003cp>\"I've had patients who came to me in a wheelchair,\" Tapper says. \"Three months later, they're shoveling snow and their lab tests are normal. It's always because they made that choice to stop drinking.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Paul Chisholm is an intern with NPR's Science desk.\u003c/em>\u003c/p>\n\u003chr>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=A+Spike+In+Liver+Disease+Deaths+Among+Young+Adults+Fueled+By+Alcohol+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates",
"title": "Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates",
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"content": "\u003cp>To an outsider, the fancy booths at a June health insurance industry gathering in San Diego, Calif., aren't very compelling: a handful of companies pitching \"lifestyle\" data and salespeople touting jargony phrases like \"social determinants of health.\"[contextly_sidebar id=\"79wDHCMXsLwHcrV0uV8lwcSxOMTorwMk\"]\u003c/p>\n\u003cp>But dig deeper and the implications of what they're selling might give many patients pause: a future in which everything you do — the things you buy, the food you eat, the time you spend watching TV — may help determine how much you pay for health insurance.\u003c/p>\n\u003cp>With little public scrutiny, the health insurance industry has joined forces with data brokers to vacuum up personal details about hundreds of millions of Americans, including, odds are, many readers of this story.\u003c/p>\n\u003cp>The companies are tracking your race, education level, TV habits, marital status, net worth. They're collecting what you post on social media, whether you're behind on your bills, what you order online. Then they feed this information into complicated computer algorithms that spit out predictions about how much your health care could cost them.\u003c/p>\n\u003cp>Are you a woman who recently changed your name? You could be newly married and have a pricey pregnancy pending. Or maybe you're stressed and anxious from a recent divorce. That, too, the computer models predict, may run up your medical bills.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Are you a woman who has purchased plus-size clothing? You're considered at risk of depression. Mental health care can be expensive.[contextly_sidebar id=\"bDoTI0AqbPZA0QggUW6RBxclSpZhPjsp\"]\u003c/p>\n\u003cp>Low-income and a minority? That means, the data brokers say, you are more likely to live in a dilapidated and dangerous neighborhood, increasing your health risks.\u003c/p>\n\u003cp>\"We sit on oceans of data,\" said Eric McCulley, director of strategic solutions for \u003ca href=\"https://risk.lexisnexis.com/insurance\" target=\"_blank\" rel=\"noopener\">LexisNexis Risk Solutions\u003c/a>, during a conversation at the data firm's booth. And he isn't apologetic about using it. \"The fact is, our data is in the public domain,\" he said. \"We didn't put it out there.\"\u003c/p>\n\u003cp>Insurers contend that they use the information to spot health issues in their clients — and flag them so they get services they need. And companies like LexisNexis say the data shouldn't be used to set prices. But as a research scientist from one company told me: \"I can't say it hasn't happened.\"\u003c/p>\n\u003cp>At a time when every week brings a new privacy scandal and worries abound about the misuse of personal information, patient advocates and privacy scholars say the insurance industry's data gathering runs counter to its touted, and federally required, allegiance to patients' medical privacy. The \u003ca href=\"https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html\" target=\"_blank\" rel=\"noopener\">Health Insurance Portability and Accountability Act\u003c/a>, or HIPAA, only protects medical information.\u003c/p>\n\u003cp>\"We have a health privacy machine that's in crisis,\" said Frank Pasquale, a professor at the University of Maryland Carey School of Law who specializes in issues related to machine learning and algorithms. \"We have a law that only covers one source of health information. They are rapidly developing another source.\"\u003c/p>\n\u003cp>Patient advocates warn that using unverified, error-prone \"lifestyle\" data to make medical assumptions could lead insurers to improperly price plans — for instance, raising rates based on false information — or discriminate against anyone tagged as high cost. And, they say, the use of the data raises thorny questions that should be debated publicly, such as: Should a person's rates be raised because algorithms say they are more likely to run up medical bills? Such questions would be moot in Europe, where a strict law took effect in May that bans trading in personal data.[contextly_sidebar id=\"d5hHSDi3Hs2EqOb5p8wPiO2juNTZPrbB\"]\u003c/p>\n\u003cp>This year, \u003ca href=\"https://www.propublica.org/series/the-health-insurance-hustle\" target=\"_blank\" rel=\"noopener\">ProPublica and NPR are investigating\u003c/a> the various tactics the health insurance industry uses to maximize its profits. Understanding these strategies is important because patients — through taxes, cash payments and insurance premiums — are the ones funding the entire health care system. Yet the industry's bewildering web of strategies and inside deals often has little to do with patients' needs. As the series' \u003ca href=\"https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills\" target=\"_blank\" rel=\"noopener\">first story\u003c/a> showed, contrary to popular belief, lower bills aren't health insurers' top priority.\u003c/p>\n\u003cp>Inside the San Diego Convention Center, there were few qualms about the way insurance companies were mining Americans' lives for information — or what they planned to do with the data.\u003c/p>\n\u003cp>\u003cstrong>Linking Health Costs to Personal Data\u003c/strong>\u003c/p>\n\u003cp>The sprawling convention center was a balmy draw for one of America's Health Insurance Plans' marquee gatherings. Insurance executives and managers wandered through the exhibit hall, sampling chocolate-covered strawberries, champagne and other delectables designed to encourage deal-making.\u003c/p>\n\u003cp>Up front, the prime real estate belonged to the big guns in health data: The booths of Optum, IBM Watson Health and LexisNexis stretched toward the ceiling, with flat-screen monitors and some comfy seating. (NPR collaborates with IBM Watson Health on national polls about consumer health topics.)\u003c/p>\n\u003cp>To understand the scope of what they were offering, consider Optum. The company, owned by the massive UnitedHealth Group, has collected the medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150 million Americans going back to 1993, according to its marketing materials.(UnitedHealth Group provides financial support to NPR.)\u003c/p>\n\u003cp>The company says it uses the information to link patients' medical outcomes and costs to details like their level of education, net worth, family structure and race. An Optum spokesman said the socioeconomic data is de-identified and is not used for pricing health plans.\u003c/p>\n\u003cp>Optum's marketing materials also boast that it now has access to even more. In 2016, the company filed a patent application to gather what people share on platforms like Facebook and Twitter, and to link this material to the person's clinical and payment information. A company spokesman said in an email that the patent application never went anywhere. But the company's current marketing materials say it combines claims and clinical information with social media interactions.\u003c/p>\n\u003cp>I had a lot of questions about this and first reached out to Optum in May, but the company didn't connect me with any of its experts as promised. At the conference, Optum salespeople said they weren't allowed to talk to me about how the company uses this information.\u003c/p>\n\u003cp>It isn't hard to understand the appeal of all this data to insurers. Merging information from data brokers with people's clinical and payment records is a no-brainer if you overlook potential patient concerns. Electronic medical records now make it easy for insurers to analyze massive amounts of information and combine it with the personal details scooped up by data brokers.\u003c/p>\n\u003cp>It also makes sense given the shifts in how providers are getting paid. Doctors and hospitals have typically been paid based on the quantity of care they provide. But the industry is moving toward paying them in lump sums for caring for a patient, or for an event, like a knee surgery. In those cases, the medical providers can profit more when patients stay healthy. More money at stake means more interest in the social factors that might affect a patient's health.\u003c/p>\n\u003cp>Some insurance companies are already using socioeconomic data to help patients get appropriate care, such as programs to help patients with chronic diseases stay healthy. Studies show social and economic aspects of people's lives play an important role in their health. Knowing these personal details can help them identify those who may need help paying for medication or help getting to the doctor.\u003c/p>\n\u003cp>But patient advocates are skeptical that health insurers have altruistic designs on people's personal information.\u003c/p>\n\u003cp>The industry has a history of boosting profits by signing up healthy people and finding ways to avoid sick people — called \"cherry-picking\" and \"lemon-dropping,\" experts say.\u003c/p>\n\u003cp>Among the classic examples: A company was accused of putting its enrollment office on the third floor of a building without an elevator, so only healthy patients could make the trek to sign up. Another tried to appeal to spry seniors by holding square dances.\u003c/p>\n\u003cp>The Affordable Care Act prohibits insurers from denying people coverage based on pre-existing health conditions or charging sick people more for individual or small group plans. But experts said patients' personal information could still be used for marketing, and to assess risks and determine the prices of certain plans. And the Trump administration is promoting short-term health plans, which do allow insurers to deny coverage to sick patients.\u003c/p>\n\u003cp>Robert Greenwald, faculty director of Harvard Law School's Center for Health Law and Policy Innovation, said insurance companies still cherry-pick, but now they're subtler. The center analyzes health insurance plans to see if they discriminate. He said insurers will do things like failing to include enough information about which drugs a plan covers, which pushes sick people who need specific medications elsewhere. Or they may change the things a plan covers, or how much a patient has to pay for a type of care, after a patient has enrolled. Or, Greenwald added, they might exclude or limit certain types of providers from their networks — like those who have skill caring for patients with HIV or hepatitis C.\u003c/p>\n\u003cp>If there were concerns that personal data might be used to cherry-pick or lemon-drop, they weren't raised at the conference.\u003c/p>\n\u003cp>At the IBM Watson Health booth, Kevin Ruane, a senior consulting scientist, told me that the company surveys 80,000 Americans a year to assess lifestyle, attitudes and behaviors that could relate to health care. Participants are asked whether they trust their doctor, have financial problems, go online, or own a Fitbit and similar questions. The responses of hundreds of adjacent households are analyzed together to identify social and economic factors for an area.\u003c/p>\n\u003cp>Ruane said he has used IBM Watson Health's socioeconomic analysis to help insurance companies assess a potential market. The ACA increased the value of such assessments, experts say, because companies often don't know the medical history of people seeking coverage. A region with too many sick people, or with patients who don't take care of themselves, might not be worth the risk.\u003c/p>\n\u003cp>Ruane acknowledged that the information his company gathers may not be accurate for every person. \"We talk to our clients and tell them to be careful about this,\" he said. \"Use it as a data insight. But it's not necessarily a fact.\"\u003c/p>\n\u003cp>In a separate conversation, a salesman from a different company joked about the potential for error. \"God forbid you live on the wrong street these days,\" he said. \"You're going to get lumped in with a lot of bad things.\"\u003c/p>\n\u003cp>The LexisNexis booth was emblazoned with the slogan \"Data. Insight. Action.\" The company said it uses 442 nonmedical personal attributes to predict a person's medical costs. Its cache includes more than 78 billion records from more than 10,000 public and proprietary sources, including people's cellphone numbers, criminal records, bankruptcies, property records, neighborhood safety and more. The information is used to predict patients' health risks and costs in eight areas, including how often they are likely to visit emergency rooms, their total cost, their pharmacy costs, their motivation to stay healthy and their stress levels.\u003c/p>\n\u003cp>People who downsize their homes tend to have higher health care costs, the company says. As do those whose parents didn't finish high school. Patients who own more valuable homes are less likely to land back in the hospital within 30 days of their discharge. The company says it has validated its scores against insurance claims and clinical data. But it won't share its methods and hasn't published the work in peer-reviewed journals.\u003c/p>\n\u003cp>McCulley, LexisNexis' director of strategic solutions, said predictions made by the algorithms about patients are based on the combination of the personal attributes. He gave a hypothetical example: A high school dropout who had a recent income loss and doesn't have a relative nearby might have higher-than-expected health costs.\u003c/p>\n\u003cp>But couldn't that same type of person be healthy?\u003c/p>\n\u003cp>\"Sure,\" McCulley said, with no apparent dismay at the possibility that the predictions could be wrong.\u003c/p>\n\u003cp>McCulley and others at LexisNexis insist the scores are only used to help patients get the care they need and not to determine how much someone would pay for their health insurance. The company cited three different federal laws that restricted them and their clients from using the scores in that way. But privacy experts said none of the laws cited by the company bar the practice. The company backed off the assertions when I pointed that the laws did not seem to apply.\u003c/p>\n\u003cp>LexisNexis officials also said the company's contracts expressly prohibit using the analysis to help price insurance plans. They would not provide a contract. But I knew that in at least one instance a company was already testing whether the scores could be used as a pricing tool.\u003c/p>\n\u003cp>Before the conference, I'd seen a press release announcing that the largest health actuarial firm in the world, Milliman, was now using the LexisNexis scores.\u003c/p>\n\u003cp>I tracked down Marcos Dachary, who works in business development for Milliman. Actuaries calculate health care risks and help set the price of premiums for insurers. I asked Dachary if Milliman was using the LexisNexis scores to price health plans and he said: \"There could be an opportunity.\"\u003c/p>\n\u003cp>The scores could allow an insurance company to assess the risks posed by individual patients and make adjustments to protect themselves from losses, he said. For example, he said, the company could raise premiums or revise contracts with providers.\u003c/p>\n\u003cp>It's too early to tell whether the LexisNexis scores will actually be useful for pricing, he said. But he was excited about the possibilities. \"One thing about social determinants data – it piques your mind,\" he said.\u003c/p>\n\u003cp>Dachary acknowledged the scores could also be used to discriminate. Others, he said, have raised that concern. As much as there could be positive potential, he said, \"there could also be negative potential.\"\u003c/p>\n\u003cp>\u003cstrong>Erroneous Inferences From Group Data\u003c/strong>\u003c/p>\n\u003cp>It's that negative potential that still bothers data analyst Erin Kaufman, who left the health insurance industry in January. The 35-year-old from Atlanta had earned her doctorate in public health because she wanted to help people, but one day at Aetna, her boss told her to work with a new data set.\u003c/p>\n\u003cp>To her surprise, the company had obtained personal information from a data broker on millions of Americans. The data contained each person's habits and hobbies, like whether they owned a gun, and if so, what type, she said. It included whether they had magazine subscriptions, liked to ride bikes or run marathons. It had hundreds of personal details about each person.\u003c/p>\n\u003cp>The Aetna data team merged the data with the information it had on patients it insured. The goal was to see how people's personal interests and hobbies might relate to their health care costs.\u003c/p>\n\u003cp>But Kaufman said it felt wrong: The information about the people who knitted or crocheted made her think of her grandmother. And the details about individuals who liked camping made her think of herself. What business did the insurance company have looking at this information? \"It was a data set that really dug into our clients' lives,\" she said. \"No one gave anyone permission to do this.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.documentcloud.org/documents/4600083-Aetna-Statement.html\">In a statement\u003c/a>, Aetna said it uses consumer marketing information to supplement its claims and clinical information. The combined data helps predict the risk of repeat emergency room visits or hospital admissions. The information is used to reach out to members and help them and plays no role in pricing plans or underwriting, the statement said.\u003c/p>\n\u003cp>Kaufman said she had concerns about the accuracy of drawing inferences about an individual's health from an analysis of a group of people with similar traits. Health scores generated from arrest records, homeownership and similar material may be wrong, she said.\u003c/p>\n\u003cp>Pam Dixon, executive director of the World Privacy Forum, a nonprofit that advocates for privacy in the digital age, shares Kaufman's concerns. She points to a study by the analytics company SAS, which worked in 2012 with an unnamed major health insurance company to predict a person's health care costs using 1,500 data elements, including the investments and types of cars people owned.\u003c/p>\n\u003cp>The SAS study said higher health care costs could be predicted by looking at things like ethnicity, watching TV and mail-order purchases.\u003c/p>\n\u003cp>\"I find that enormously offensive as a list,\" Dixon said. \"This is not health data. This is inferred data.\"\u003c/p>\n\u003cp>Data scientist Cathy O'Neil said drawing conclusions about health risks on such data could lead to a bias against some poor people. It would be easy to infer they are prone to costly illnesses based on their backgrounds and living conditions, said O'Neil, author of the book \u003cem>Weapons of Math Destruction,\u003c/em> which looked at how algorithms can increase inequality. That could lead to poor people being charged more, making it harder for them to get the care they need, she said. Employers, she said, could even decide not to hire people with data points that could indicate high medical costs in the future.\u003c/p>\n\u003cp>O'Neil said the companies should also measure how the scores might discriminate against the poor, sick or minorities.\u003c/p>\n\u003cp>American policymakers could do more to protect people's information, experts said. In the United States, companies can harvest personal data unless a specific law bans it, although California just passed legislation that could create restrictions, said William McGeveran, a professor at the University of Minnesota Law School. Europe, in contrast, passed a strict law called the \u003ca href=\"https://ec.europa.eu/info/law/law-topic/data-protection/reform/what-does-general-data-protection-regulation-gdpr-govern_en\" target=\"_blank\" rel=\"noopener\">General Data Protection Regulation\u003c/a>, which went into effect in May.\u003c/p>\n\u003cp>\"In Europe, data protection is a constitutional right,\" McGeveran said.\u003c/p>\n\u003cp>Pasquale, the University of Maryland law professor, said health scores should be treated like credit scores. Federal law gives people the right to know their credit scores and how they're calculated. If people are going to be rated by whether they listen to sad songs on Spotify or look up information about AIDS online, they should know, Pasquale said. \"The risk of improper use is extremely high,\" he said. \"And data scores are not properly vetted and validated and available for scrutiny.\"\u003c/p>\n\u003cp>\u003cstrong>A Creepy Walk Down Memory Lane \u003c/strong>\u003c/p>\n\u003cp>As I reported this story I wondered how the data vendors might be using my personal information to score my potential health costs. So, I filled out \u003ca href=\"https://personalreports.lexisnexis.com/access_your_full_file_disclosure.jsp\" target=\"_blank\" rel=\"noopener\">a request on the LexisNexis website\u003c/a> for the company to send me some of the personal information it has on me. A week later, a somewhat creepy, 182-page walk down memory lane arrived in the mail. Federal law only requires the company to provide a subset of the information it collected about me. So that's all I got.\u003c/p>\n\u003cp>LexisNexis had captured details about my life going back 25 years, many that I'd forgotten. It had my phone numbers going back decades and my home addresses going back to my childhood in Golden, Colo. Each location had a field to show whether the address was \"high risk.\" Mine were all blank. The company also collects records of any liens and criminal activity, which, thankfully, I didn't have.\u003c/p>\n\u003cp>My report was boring, which isn't a surprise. I've lived a middle-class life and grown up in good neighborhoods. But it made me wonder: What if I had lived in \"high-risk\" neighborhoods? Could that ever be used by insurers to jack up my rates — or to avoid me altogether?\u003c/p>\n\u003cp>I wanted to see more. If LexisNexis had health risk scores on me, I wanted to see how they were calculated and, more importantly, whether they were accurate. But the company told me that if it had calculated my scores it would have done so on behalf of its client, my insurance company. So, I couldn't have them.\u003c/p>\n\u003chr>\n\u003cp>\u003cem>ProPublica Senior Research Fellow Claire Perlman contributed to this story. \u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>ProPublica is a nonprofit newsroom based in New York. Sign up to get ProPublica's \u003c/em>\u003ca href=\"https://go.propublica.org/bigstorynewsletter-20180717\" target=\"_blank\" rel=\"noopener\">Big Story newsletter\u003c/a>\u003cem> to receive stories like this one in your inbox as soon as they are published. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Health+Insurers+Are+Vacuuming+Up+Details+About+You+%E2%80%94+And+It+Could+Raise+Your+Rates+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>To an outsider, the fancy booths at a June health insurance industry gathering in San Diego, Calif., aren't very compelling: a handful of companies pitching \"lifestyle\" data and salespeople touting jargony phrases like \"social determinants of health.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But dig deeper and the implications of what they're selling might give many patients pause: a future in which everything you do — the things you buy, the food you eat, the time you spend watching TV — may help determine how much you pay for health insurance.\u003c/p>\n\u003cp>With little public scrutiny, the health insurance industry has joined forces with data brokers to vacuum up personal details about hundreds of millions of Americans, including, odds are, many readers of this story.\u003c/p>\n\u003cp>The companies are tracking your race, education level, TV habits, marital status, net worth. They're collecting what you post on social media, whether you're behind on your bills, what you order online. Then they feed this information into complicated computer algorithms that spit out predictions about how much your health care could cost them.\u003c/p>\n\u003cp>Are you a woman who recently changed your name? You could be newly married and have a pricey pregnancy pending. Or maybe you're stressed and anxious from a recent divorce. That, too, the computer models predict, may run up your medical bills.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Are you a woman who has purchased plus-size clothing? You're considered at risk of depression. Mental health care can be expensive.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Low-income and a minority? That means, the data brokers say, you are more likely to live in a dilapidated and dangerous neighborhood, increasing your health risks.\u003c/p>\n\u003cp>\"We sit on oceans of data,\" said Eric McCulley, director of strategic solutions for \u003ca href=\"https://risk.lexisnexis.com/insurance\" target=\"_blank\" rel=\"noopener\">LexisNexis Risk Solutions\u003c/a>, during a conversation at the data firm's booth. And he isn't apologetic about using it. \"The fact is, our data is in the public domain,\" he said. \"We didn't put it out there.\"\u003c/p>\n\u003cp>Insurers contend that they use the information to spot health issues in their clients — and flag them so they get services they need. And companies like LexisNexis say the data shouldn't be used to set prices. But as a research scientist from one company told me: \"I can't say it hasn't happened.\"\u003c/p>\n\u003cp>At a time when every week brings a new privacy scandal and worries abound about the misuse of personal information, patient advocates and privacy scholars say the insurance industry's data gathering runs counter to its touted, and federally required, allegiance to patients' medical privacy. The \u003ca href=\"https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html\" target=\"_blank\" rel=\"noopener\">Health Insurance Portability and Accountability Act\u003c/a>, or HIPAA, only protects medical information.\u003c/p>\n\u003cp>\"We have a health privacy machine that's in crisis,\" said Frank Pasquale, a professor at the University of Maryland Carey School of Law who specializes in issues related to machine learning and algorithms. \"We have a law that only covers one source of health information. They are rapidly developing another source.\"\u003c/p>\n\u003cp>Patient advocates warn that using unverified, error-prone \"lifestyle\" data to make medical assumptions could lead insurers to improperly price plans — for instance, raising rates based on false information — or discriminate against anyone tagged as high cost. And, they say, the use of the data raises thorny questions that should be debated publicly, such as: Should a person's rates be raised because algorithms say they are more likely to run up medical bills? Such questions would be moot in Europe, where a strict law took effect in May that bans trading in personal data.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>This year, \u003ca href=\"https://www.propublica.org/series/the-health-insurance-hustle\" target=\"_blank\" rel=\"noopener\">ProPublica and NPR are investigating\u003c/a> the various tactics the health insurance industry uses to maximize its profits. Understanding these strategies is important because patients — through taxes, cash payments and insurance premiums — are the ones funding the entire health care system. Yet the industry's bewildering web of strategies and inside deals often has little to do with patients' needs. As the series' \u003ca href=\"https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills\" target=\"_blank\" rel=\"noopener\">first story\u003c/a> showed, contrary to popular belief, lower bills aren't health insurers' top priority.\u003c/p>\n\u003cp>Inside the San Diego Convention Center, there were few qualms about the way insurance companies were mining Americans' lives for information — or what they planned to do with the data.\u003c/p>\n\u003cp>\u003cstrong>Linking Health Costs to Personal Data\u003c/strong>\u003c/p>\n\u003cp>The sprawling convention center was a balmy draw for one of America's Health Insurance Plans' marquee gatherings. Insurance executives and managers wandered through the exhibit hall, sampling chocolate-covered strawberries, champagne and other delectables designed to encourage deal-making.\u003c/p>\n\u003cp>Up front, the prime real estate belonged to the big guns in health data: The booths of Optum, IBM Watson Health and LexisNexis stretched toward the ceiling, with flat-screen monitors and some comfy seating. (NPR collaborates with IBM Watson Health on national polls about consumer health topics.)\u003c/p>\n\u003cp>To understand the scope of what they were offering, consider Optum. The company, owned by the massive UnitedHealth Group, has collected the medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150 million Americans going back to 1993, according to its marketing materials.(UnitedHealth Group provides financial support to NPR.)\u003c/p>\n\u003cp>The company says it uses the information to link patients' medical outcomes and costs to details like their level of education, net worth, family structure and race. An Optum spokesman said the socioeconomic data is de-identified and is not used for pricing health plans.\u003c/p>\n\u003cp>Optum's marketing materials also boast that it now has access to even more. In 2016, the company filed a patent application to gather what people share on platforms like Facebook and Twitter, and to link this material to the person's clinical and payment information. A company spokesman said in an email that the patent application never went anywhere. But the company's current marketing materials say it combines claims and clinical information with social media interactions.\u003c/p>\n\u003cp>I had a lot of questions about this and first reached out to Optum in May, but the company didn't connect me with any of its experts as promised. At the conference, Optum salespeople said they weren't allowed to talk to me about how the company uses this information.\u003c/p>\n\u003cp>It isn't hard to understand the appeal of all this data to insurers. Merging information from data brokers with people's clinical and payment records is a no-brainer if you overlook potential patient concerns. Electronic medical records now make it easy for insurers to analyze massive amounts of information and combine it with the personal details scooped up by data brokers.\u003c/p>\n\u003cp>It also makes sense given the shifts in how providers are getting paid. Doctors and hospitals have typically been paid based on the quantity of care they provide. But the industry is moving toward paying them in lump sums for caring for a patient, or for an event, like a knee surgery. In those cases, the medical providers can profit more when patients stay healthy. More money at stake means more interest in the social factors that might affect a patient's health.\u003c/p>\n\u003cp>Some insurance companies are already using socioeconomic data to help patients get appropriate care, such as programs to help patients with chronic diseases stay healthy. Studies show social and economic aspects of people's lives play an important role in their health. Knowing these personal details can help them identify those who may need help paying for medication or help getting to the doctor.\u003c/p>\n\u003cp>But patient advocates are skeptical that health insurers have altruistic designs on people's personal information.\u003c/p>\n\u003cp>The industry has a history of boosting profits by signing up healthy people and finding ways to avoid sick people — called \"cherry-picking\" and \"lemon-dropping,\" experts say.\u003c/p>\n\u003cp>Among the classic examples: A company was accused of putting its enrollment office on the third floor of a building without an elevator, so only healthy patients could make the trek to sign up. Another tried to appeal to spry seniors by holding square dances.\u003c/p>\n\u003cp>The Affordable Care Act prohibits insurers from denying people coverage based on pre-existing health conditions or charging sick people more for individual or small group plans. But experts said patients' personal information could still be used for marketing, and to assess risks and determine the prices of certain plans. And the Trump administration is promoting short-term health plans, which do allow insurers to deny coverage to sick patients.\u003c/p>\n\u003cp>Robert Greenwald, faculty director of Harvard Law School's Center for Health Law and Policy Innovation, said insurance companies still cherry-pick, but now they're subtler. The center analyzes health insurance plans to see if they discriminate. He said insurers will do things like failing to include enough information about which drugs a plan covers, which pushes sick people who need specific medications elsewhere. Or they may change the things a plan covers, or how much a patient has to pay for a type of care, after a patient has enrolled. Or, Greenwald added, they might exclude or limit certain types of providers from their networks — like those who have skill caring for patients with HIV or hepatitis C.\u003c/p>\n\u003cp>If there were concerns that personal data might be used to cherry-pick or lemon-drop, they weren't raised at the conference.\u003c/p>\n\u003cp>At the IBM Watson Health booth, Kevin Ruane, a senior consulting scientist, told me that the company surveys 80,000 Americans a year to assess lifestyle, attitudes and behaviors that could relate to health care. Participants are asked whether they trust their doctor, have financial problems, go online, or own a Fitbit and similar questions. The responses of hundreds of adjacent households are analyzed together to identify social and economic factors for an area.\u003c/p>\n\u003cp>Ruane said he has used IBM Watson Health's socioeconomic analysis to help insurance companies assess a potential market. The ACA increased the value of such assessments, experts say, because companies often don't know the medical history of people seeking coverage. A region with too many sick people, or with patients who don't take care of themselves, might not be worth the risk.\u003c/p>\n\u003cp>Ruane acknowledged that the information his company gathers may not be accurate for every person. \"We talk to our clients and tell them to be careful about this,\" he said. \"Use it as a data insight. But it's not necessarily a fact.\"\u003c/p>\n\u003cp>In a separate conversation, a salesman from a different company joked about the potential for error. \"God forbid you live on the wrong street these days,\" he said. \"You're going to get lumped in with a lot of bad things.\"\u003c/p>\n\u003cp>The LexisNexis booth was emblazoned with the slogan \"Data. Insight. Action.\" The company said it uses 442 nonmedical personal attributes to predict a person's medical costs. Its cache includes more than 78 billion records from more than 10,000 public and proprietary sources, including people's cellphone numbers, criminal records, bankruptcies, property records, neighborhood safety and more. The information is used to predict patients' health risks and costs in eight areas, including how often they are likely to visit emergency rooms, their total cost, their pharmacy costs, their motivation to stay healthy and their stress levels.\u003c/p>\n\u003cp>People who downsize their homes tend to have higher health care costs, the company says. As do those whose parents didn't finish high school. Patients who own more valuable homes are less likely to land back in the hospital within 30 days of their discharge. The company says it has validated its scores against insurance claims and clinical data. But it won't share its methods and hasn't published the work in peer-reviewed journals.\u003c/p>\n\u003cp>McCulley, LexisNexis' director of strategic solutions, said predictions made by the algorithms about patients are based on the combination of the personal attributes. He gave a hypothetical example: A high school dropout who had a recent income loss and doesn't have a relative nearby might have higher-than-expected health costs.\u003c/p>\n\u003cp>But couldn't that same type of person be healthy?\u003c/p>\n\u003cp>\"Sure,\" McCulley said, with no apparent dismay at the possibility that the predictions could be wrong.\u003c/p>\n\u003cp>McCulley and others at LexisNexis insist the scores are only used to help patients get the care they need and not to determine how much someone would pay for their health insurance. The company cited three different federal laws that restricted them and their clients from using the scores in that way. But privacy experts said none of the laws cited by the company bar the practice. The company backed off the assertions when I pointed that the laws did not seem to apply.\u003c/p>\n\u003cp>LexisNexis officials also said the company's contracts expressly prohibit using the analysis to help price insurance plans. They would not provide a contract. But I knew that in at least one instance a company was already testing whether the scores could be used as a pricing tool.\u003c/p>\n\u003cp>Before the conference, I'd seen a press release announcing that the largest health actuarial firm in the world, Milliman, was now using the LexisNexis scores.\u003c/p>\n\u003cp>I tracked down Marcos Dachary, who works in business development for Milliman. Actuaries calculate health care risks and help set the price of premiums for insurers. I asked Dachary if Milliman was using the LexisNexis scores to price health plans and he said: \"There could be an opportunity.\"\u003c/p>\n\u003cp>The scores could allow an insurance company to assess the risks posed by individual patients and make adjustments to protect themselves from losses, he said. For example, he said, the company could raise premiums or revise contracts with providers.\u003c/p>\n\u003cp>It's too early to tell whether the LexisNexis scores will actually be useful for pricing, he said. But he was excited about the possibilities. \"One thing about social determinants data – it piques your mind,\" he said.\u003c/p>\n\u003cp>Dachary acknowledged the scores could also be used to discriminate. Others, he said, have raised that concern. As much as there could be positive potential, he said, \"there could also be negative potential.\"\u003c/p>\n\u003cp>\u003cstrong>Erroneous Inferences From Group Data\u003c/strong>\u003c/p>\n\u003cp>It's that negative potential that still bothers data analyst Erin Kaufman, who left the health insurance industry in January. The 35-year-old from Atlanta had earned her doctorate in public health because she wanted to help people, but one day at Aetna, her boss told her to work with a new data set.\u003c/p>\n\u003cp>To her surprise, the company had obtained personal information from a data broker on millions of Americans. The data contained each person's habits and hobbies, like whether they owned a gun, and if so, what type, she said. It included whether they had magazine subscriptions, liked to ride bikes or run marathons. It had hundreds of personal details about each person.\u003c/p>\n\u003cp>The Aetna data team merged the data with the information it had on patients it insured. The goal was to see how people's personal interests and hobbies might relate to their health care costs.\u003c/p>\n\u003cp>But Kaufman said it felt wrong: The information about the people who knitted or crocheted made her think of her grandmother. And the details about individuals who liked camping made her think of herself. What business did the insurance company have looking at this information? \"It was a data set that really dug into our clients' lives,\" she said. \"No one gave anyone permission to do this.\"\u003c/p>\n\u003cp>\u003ca href=\"https://www.documentcloud.org/documents/4600083-Aetna-Statement.html\">In a statement\u003c/a>, Aetna said it uses consumer marketing information to supplement its claims and clinical information. The combined data helps predict the risk of repeat emergency room visits or hospital admissions. The information is used to reach out to members and help them and plays no role in pricing plans or underwriting, the statement said.\u003c/p>\n\u003cp>Kaufman said she had concerns about the accuracy of drawing inferences about an individual's health from an analysis of a group of people with similar traits. Health scores generated from arrest records, homeownership and similar material may be wrong, she said.\u003c/p>\n\u003cp>Pam Dixon, executive director of the World Privacy Forum, a nonprofit that advocates for privacy in the digital age, shares Kaufman's concerns. She points to a study by the analytics company SAS, which worked in 2012 with an unnamed major health insurance company to predict a person's health care costs using 1,500 data elements, including the investments and types of cars people owned.\u003c/p>\n\u003cp>The SAS study said higher health care costs could be predicted by looking at things like ethnicity, watching TV and mail-order purchases.\u003c/p>\n\u003cp>\"I find that enormously offensive as a list,\" Dixon said. \"This is not health data. This is inferred data.\"\u003c/p>\n\u003cp>Data scientist Cathy O'Neil said drawing conclusions about health risks on such data could lead to a bias against some poor people. It would be easy to infer they are prone to costly illnesses based on their backgrounds and living conditions, said O'Neil, author of the book \u003cem>Weapons of Math Destruction,\u003c/em> which looked at how algorithms can increase inequality. That could lead to poor people being charged more, making it harder for them to get the care they need, she said. Employers, she said, could even decide not to hire people with data points that could indicate high medical costs in the future.\u003c/p>\n\u003cp>O'Neil said the companies should also measure how the scores might discriminate against the poor, sick or minorities.\u003c/p>\n\u003cp>American policymakers could do more to protect people's information, experts said. In the United States, companies can harvest personal data unless a specific law bans it, although California just passed legislation that could create restrictions, said William McGeveran, a professor at the University of Minnesota Law School. Europe, in contrast, passed a strict law called the \u003ca href=\"https://ec.europa.eu/info/law/law-topic/data-protection/reform/what-does-general-data-protection-regulation-gdpr-govern_en\" target=\"_blank\" rel=\"noopener\">General Data Protection Regulation\u003c/a>, which went into effect in May.\u003c/p>\n\u003cp>\"In Europe, data protection is a constitutional right,\" McGeveran said.\u003c/p>\n\u003cp>Pasquale, the University of Maryland law professor, said health scores should be treated like credit scores. Federal law gives people the right to know their credit scores and how they're calculated. If people are going to be rated by whether they listen to sad songs on Spotify or look up information about AIDS online, they should know, Pasquale said. \"The risk of improper use is extremely high,\" he said. \"And data scores are not properly vetted and validated and available for scrutiny.\"\u003c/p>\n\u003cp>\u003cstrong>A Creepy Walk Down Memory Lane \u003c/strong>\u003c/p>\n\u003cp>As I reported this story I wondered how the data vendors might be using my personal information to score my potential health costs. So, I filled out \u003ca href=\"https://personalreports.lexisnexis.com/access_your_full_file_disclosure.jsp\" target=\"_blank\" rel=\"noopener\">a request on the LexisNexis website\u003c/a> for the company to send me some of the personal information it has on me. A week later, a somewhat creepy, 182-page walk down memory lane arrived in the mail. Federal law only requires the company to provide a subset of the information it collected about me. So that's all I got.\u003c/p>\n\u003cp>LexisNexis had captured details about my life going back 25 years, many that I'd forgotten. It had my phone numbers going back decades and my home addresses going back to my childhood in Golden, Colo. Each location had a field to show whether the address was \"high risk.\" Mine were all blank. The company also collects records of any liens and criminal activity, which, thankfully, I didn't have.\u003c/p>\n\u003cp>My report was boring, which isn't a surprise. I've lived a middle-class life and grown up in good neighborhoods. But it made me wonder: What if I had lived in \"high-risk\" neighborhoods? Could that ever be used by insurers to jack up my rates — or to avoid me altogether?\u003c/p>\n\u003cp>I wanted to see more. If LexisNexis had health risk scores on me, I wanted to see how they were calculated and, more importantly, whether they were accurate. But the company told me that if it had calculated my scores it would have done so on behalf of its client, my insurance company. So, I couldn't have them.\u003c/p>\n\u003chr>\n\u003cp>\u003cem>ProPublica Senior Research Fellow Claire Perlman contributed to this story. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>ProPublica is a nonprofit newsroom based in New York. Sign up to get ProPublica's \u003c/em>\u003ca href=\"https://go.propublica.org/bigstorynewsletter-20180717\" target=\"_blank\" rel=\"noopener\">Big Story newsletter\u003c/a>\u003cem> to receive stories like this one in your inbox as soon as they are published. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Health+Insurers+Are+Vacuuming+Up+Details+About+You+%E2%80%94+And+It+Could+Raise+Your+Rates+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Physicists Go Small: Let's Put A Particle Accelerator On A Chip",
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"content": "\u003cp>When people think of particle accelerators, they tend to think of giant structures: tunnels many miles long that electrons and protons race through at tremendous speeds, packing enormous energy.\u003c/p>\n\u003cp>But scientists in California think small is beautiful. They want to build an accelerator on semiconductor chips. An accelerator built that way won't achieve the energy of its much larger cousins, but it could accelerate material research and revolutionize medical therapy.\u003c/p>\n\u003cp>First of all, what is an accelerator?\u003c/p>\n\u003cp>\"An accelerator is a way to add energy to particles,\" says \u003ca href=\"https://web.stanford.edu/~rlbyer/\" target=\"_blank\" rel=\"noopener\">Robert Byer\u003c/a>, a physicist at Stanford University. Once you have those energetic particles, you can do things with them, like irradiate tumors or generate X-rays that scientists use to investigate new materials. An accelerator built this way would bring an accelerator's usefulness within the reach of more researchers.\u003c/p>\n\u003cp>Byer has been trying to shrink the size of particle accelerators for more than 40 years. His idea is to use lasers to add energy to electrons as they zip through a tiny channel in a semiconductor chip. Byer says this is a miniaturized version of what goes on in larger accelerators, but there are big challenges to doing this on such a small scale.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"We need to focus the electrons,\" Byer says. \"We need to bunch them so they surf the wavelength of light right at the crest, so they get the maximum acceleration.\"\u003c/p>\n\u003cp>Byer and his colleagues are working on those challenges in a laboratory in the basement of the Spilker Engineering and Applied Sciences building on the Stanford campus. Byer took me on a tour there.\u003c/p>\n\u003cp>We put on glasses to protect our eyes from the powerful laser light used in the pint-sized accelerator.\u003c/p>\n\u003cp>A big red emergency shut-off button attached to a shelf suggests this is not equipment to trifle with.\u003c/p>\n\u003cp>\u003ca href=\"https://www.laserphysics.nat.fau.eu/person/peter-hommelhoff/\" target=\"_blank\" rel=\"noopener\">Peter Hommelhoff\u003c/a> of the Friedrich-Alexander-Universität Erlangen-Nürnberg in Germany says one of the big challenges is to keep the electrons in the accelerator traveling where you want them to.\u003c/p>\n\u003cp>\"The acceleration channel is very narrow, so you have to generate a very, very narrow electron beam that you can send through the channel,\" Hommelhoff says.\u003c/p>\n\u003cp>\"It's a little like threading an invisible needle,\" says Dylan Black, a Stanford graduate student in physics.\u003c/p>\n\u003cp>Testing their accelerator requires lasers and lenses and pumps scattered around benches in the lab, it takes up a fair amount of space. But this is just a prototype.\u003c/p>\n\u003cp>Black points to a bright circle of light on a monitor's screen.\u003c/p>\n\u003cp>\"That there is a picture of what the electron beam would look like if you put your eye right in front of the beam,\" Black says.\u003c/p>\n\u003cp>\"Which I would not recommend,\" interjects Ken Leedle, a research engineer working on the accelerator-on-a-chip project.\u003c/p>\n\u003cp>I asked \u003ca href=\"https://portal.slac.stanford.edu/sites/ard_public/people/joen/Pages/default.aspx\" target=\"_blank\" rel=\"noopener\">R. Joel England\u003c/a>, a physicist at the SLAC National Accelerator Laboratory who has been working on the accelerator-on-a-chip project, how long it will be before the prototype turns into a working instrument.\u003c/p>\n\u003cp>\"Depending on how much progress gets made, I would say five to 10 years,\" England says. England is enthusiastic about the promise of these small-scale accelerators.\u003c/p>\n\u003cp>\"One of the applications could be to take one of the fairly bulky, 10,000-pound accelerator devices that's used in hospitals for radiation therapy and make that into something that's chip-sized,\" he says.\u003c/p>\n\u003cp>In addition to saving huge costs and space, it might eventually be possible to insert a chip-sized accelerator into a patient's body, where it could directly irradiate a tumor.\u003c/p>\n\u003cp>Even though it may take a decade or more, Robert Byer is convinced smaller accelerators will become a reality. His isn't the only lab working on the idea. And besides, he points out, new technologies often start out bulky. Take the first laser to come on the scene.\u003c/p>\n\u003cp>\"Early on, lasers were big — and they were inefficient and they took all the power and water in your building to operate them,\" Byer says. \"They got more and more efficient because we converted to semiconductor lasers and solid state lasers — and all of a sudden, lasers then became everywhere.\"\u003c/p>\n\u003cp>Even new mobile phones have lasers in them, Byer says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The day of the accelerator on a chip, he believes, is coming.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Physicists+Go+Small%3A+Let%27s+Put+A+Particle+Accelerator+On+A+Chip&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When people think of particle accelerators, they tend to think of giant structures: tunnels many miles long that electrons and protons race through at tremendous speeds, packing enormous energy.\u003c/p>\n\u003cp>But scientists in California think small is beautiful. They want to build an accelerator on semiconductor chips. An accelerator built that way won't achieve the energy of its much larger cousins, but it could accelerate material research and revolutionize medical therapy.\u003c/p>\n\u003cp>First of all, what is an accelerator?\u003c/p>\n\u003cp>\"An accelerator is a way to add energy to particles,\" says \u003ca href=\"https://web.stanford.edu/~rlbyer/\" target=\"_blank\" rel=\"noopener\">Robert Byer\u003c/a>, a physicist at Stanford University. Once you have those energetic particles, you can do things with them, like irradiate tumors or generate X-rays that scientists use to investigate new materials. An accelerator built this way would bring an accelerator's usefulness within the reach of more researchers.\u003c/p>\n\u003cp>Byer has been trying to shrink the size of particle accelerators for more than 40 years. His idea is to use lasers to add energy to electrons as they zip through a tiny channel in a semiconductor chip. Byer says this is a miniaturized version of what goes on in larger accelerators, but there are big challenges to doing this on such a small scale.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We need to focus the electrons,\" Byer says. \"We need to bunch them so they surf the wavelength of light right at the crest, so they get the maximum acceleration.\"\u003c/p>\n\u003cp>Byer and his colleagues are working on those challenges in a laboratory in the basement of the Spilker Engineering and Applied Sciences building on the Stanford campus. Byer took me on a tour there.\u003c/p>\n\u003cp>We put on glasses to protect our eyes from the powerful laser light used in the pint-sized accelerator.\u003c/p>\n\u003cp>A big red emergency shut-off button attached to a shelf suggests this is not equipment to trifle with.\u003c/p>\n\u003cp>\u003ca href=\"https://www.laserphysics.nat.fau.eu/person/peter-hommelhoff/\" target=\"_blank\" rel=\"noopener\">Peter Hommelhoff\u003c/a> of the Friedrich-Alexander-Universität Erlangen-Nürnberg in Germany says one of the big challenges is to keep the electrons in the accelerator traveling where you want them to.\u003c/p>\n\u003cp>\"The acceleration channel is very narrow, so you have to generate a very, very narrow electron beam that you can send through the channel,\" Hommelhoff says.\u003c/p>\n\u003cp>\"It's a little like threading an invisible needle,\" says Dylan Black, a Stanford graduate student in physics.\u003c/p>\n\u003cp>Testing their accelerator requires lasers and lenses and pumps scattered around benches in the lab, it takes up a fair amount of space. But this is just a prototype.\u003c/p>\n\u003cp>Black points to a bright circle of light on a monitor's screen.\u003c/p>\n\u003cp>\"That there is a picture of what the electron beam would look like if you put your eye right in front of the beam,\" Black says.\u003c/p>\n\u003cp>\"Which I would not recommend,\" interjects Ken Leedle, a research engineer working on the accelerator-on-a-chip project.\u003c/p>\n\u003cp>I asked \u003ca href=\"https://portal.slac.stanford.edu/sites/ard_public/people/joen/Pages/default.aspx\" target=\"_blank\" rel=\"noopener\">R. Joel England\u003c/a>, a physicist at the SLAC National Accelerator Laboratory who has been working on the accelerator-on-a-chip project, how long it will be before the prototype turns into a working instrument.\u003c/p>\n\u003cp>\"Depending on how much progress gets made, I would say five to 10 years,\" England says. England is enthusiastic about the promise of these small-scale accelerators.\u003c/p>\n\u003cp>\"One of the applications could be to take one of the fairly bulky, 10,000-pound accelerator devices that's used in hospitals for radiation therapy and make that into something that's chip-sized,\" he says.\u003c/p>\n\u003cp>In addition to saving huge costs and space, it might eventually be possible to insert a chip-sized accelerator into a patient's body, where it could directly irradiate a tumor.\u003c/p>\n\u003cp>Even though it may take a decade or more, Robert Byer is convinced smaller accelerators will become a reality. His isn't the only lab working on the idea. And besides, he points out, new technologies often start out bulky. Take the first laser to come on the scene.\u003c/p>\n\u003cp>\"Early on, lasers were big — and they were inefficient and they took all the power and water in your building to operate them,\" Byer says. \"They got more and more efficient because we converted to semiconductor lasers and solid state lasers — and all of a sudden, lasers then became everywhere.\"\u003c/p>\n\u003cp>Even new mobile phones have lasers in them, Byer says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The day of the accelerator on a chip, he believes, is coming.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Physicists+Go+Small%3A+Let%27s+Put+A+Particle+Accelerator+On+A+Chip&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>CTE has been part of the national lexicon in the U.S. since the 2015 movie \u003cem>\u003ca href=\"http://www.sonypictures.com/movies/concussion/\" target=\"_blank\" rel=\"noopener\">Concussion\u003c/a> \u003c/em>dramatized the discovery of this degenerative brain disease among football players.[contextly_sidebar id=”ehLMKdjS8P8l8PM67KnXRoh4cZnjRNoD”]\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945234/\" target=\"_blank\" rel=\"noopener\">Chronic traumatic encephalopathy\u003c/a> is found among people who’ve had head injuries. Though not everyone with head trauma develops CTE, the group that’s come to be most associated with it is football players, whose brains can be routinely jarred by hard hits. The disease has been linked to depression, dementia and even suicide among those who play the game.\u003c/p>\n\u003cp>But the \u003cem>Journal of Alzheimer’s Disease\u003c/em> published a study Tuesday that helps broaden the understanding of who is potentially affected by CTE to include \u003ca href=\"https://www.npr.org/sections/health-shots/2017/04/05/522613294/do-u-s-troops-risk-brain-injury-when-they-fire-heavy-weapons\" target=\"_blank\" rel=\"noopener\">military personnel\u003c/a>. And, perhaps more significantly, the study represents a step forward in developing a test for the disease in the living.\u003c/p>\n\u003cp>Right now, accurately diagnosing CTE requires the close study of brain tissue during autopsy, to identify the telltale abnormal proteins that kill brain cells. And this is a key reason why knowledge about CTE — who gets it, how widespread it is and the development of treatments — has lagged.\u003c/p>\n\u003cp>“You’ve really got to have a living diagnosis scan in order to make much headway on understanding the disease,” says \u003ca href=\"http://www.protectthebrain.org/Our-Team.aspx\" target=\"_blank\" rel=\"noopener\">Dr. Julian Bailes\u003c/a>, a neurosurgeon at the Chicago area’s NorthShore University HealthSystem, and one of the study’s authors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That diagnostic scan is what researchers have gotten close to in this case.\u003c/p>\n\u003cp>\u003cstrong>A Comparison of Brains\u003c/strong>\u003c/p>\n\u003cp>The small study involved seven military personnel — five veterans and two active duty — who’d had brain injuries and experienced CTE-type symptoms, such as memory loss and mood swings. They were injected with what’s called a molecular tracer — in this case the shorthand name is FDDNP. The FDDNP tracer, which is radioactive, binds with the abnormal proteins in the brain and then appears in neural PET scans.[contextly_sidebar id=”Ndl9rWapqUS4IcPfG65Xr4EsLQn8p0vR”]\u003c/p>\n\u003cp>“The PET scanner functions a bit like a Geiger counter, which measures radioactivity,” says the study’s lead researcher, \u003ca href=\"http://www.bri.ucla.edu/people/gary-w-small-md\" target=\"_blank\" rel=\"noopener\">Dr. Gary Small\u003c/a>, a professor of geriatric psychiatry and biobehavioral sciences at UCLA’s David Geffen School of Medicine. (Small is a co-inventor of the FDDNP marker; he and some other researchers in the project have disclosed a financial interest in Taumark LLC, a company licensed by UCLA to develop the tracer.)\u003c/p>\n\u003cp>Small’s team compared the scans with those of a number of other people: Fifteen retired football players who had suffered brain injuries and exhibited CTE symptoms; two dozen people who had Alzheimer’s dementia and 28 healthy “control” subjects who were cognitively intact.\u003c/p>\n\u003cp>The results: The scans of the military personel showed patterns similar to the retired football players and different from the Alzheimer’s patients and control subjects.\u003c/p>\n\u003cp>And, it should be noted, the former players — all of them professionals who’d played in the NFL — had brain scans consistent with those of people who had died and had autopsies that \u003cem>confirmed\u003c/em> CTE.\u003c/p>\n\u003cp>\u003cstrong>Not Just a Problem for Athletes, Soldiers\u003c/strong>\u003c/p>\n\u003cp>Small says the study paves the way for deeper investigation of CTE’s brain changes.\u003c/p>\n\u003cp>“It could help us not just with people who’ve had head trauma from sports,” he says, “but also from other forms of injury, such as blast injury in the military.” \u003ca href=\"https://www.npr.org/sections/health-shots/2018/05/30/613779769/domestic-violence-s-untold-damage-concussion-and-brain-injury\" target=\"_blank\" rel=\"noopener\">Survivors of domestic violence\u003c/a> are another group believed to be vulnerable to CTE.[contextly_sidebar id=”1oVFhsMiBXNwtZ6trkQG3xEAzXq6oKRy”]\u003c/p>\n\u003cp>Small is quick to caution that the study isn’t definitive.\u003c/p>\n\u003cp>“There are several limitations,” he says. “One is [the small] sample size. Another is that we don’t have a control group of individuals who’ve been subjected to the same degree of head trauma, but are asymptomatic. … And what does that tell us? There may be something else we’re completely unaware of that’s driving the disease.”\u003c/p>\n\u003cp>A reliable test for CTE in living people is still at least a few years away, he estimates. But there already are plans for more research.\u003c/p>\n\u003cp>“We’re still within the scientific process of trying to figure out where this test lands on the scale of being definitive,” Bailes says. The researchers still need to determine “how it correlates with the changes actually seen in the brain when people die,” he explains. “It’s not definitive yet but this paper in a military setting is another piece of the puzzle, we think.”\u003c/p>\n\u003cp>A potentially pivotal piece of the puzzle.\u003c/p>\n\u003cp>“If you can’t diagnose a disease when someone’s alive,” says Bailes, “you really can’t help them. And you really don’t know, in a new and emerging and not completely understood situation like CTE. You don’t know the prevalence of it. You don’t know exactly who gets it and why. You don’t know how it evolves or changes over time and if there’s ever a potential for treatment.”\u003c/p>\n\u003cp>As another football season approaches, CTE will again be a lingering issue. And in some instances, it will be portrayed by some as it has in the past few years — as an “epidemic,” threatening the game’s future.\u003c/p>\n\u003cp>Which Bailes says is wrong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I don’t think it’s an epidemic,” he says, “but whatever the number is, is important. And you have to have living diagnosis in order to be able to tell that.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Scientists+Hunt+For+A+Test+To+Diagnose+Chronic+Brain+Injury+In+Living+People&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>CTE has been part of the national lexicon in the U.S. since the 2015 movie \u003cem>\u003ca href=\"http://www.sonypictures.com/movies/concussion/\" target=\"_blank\" rel=\"noopener\">Concussion\u003c/a> \u003c/em>dramatized the discovery of this degenerative brain disease among football players.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945234/\" target=\"_blank\" rel=\"noopener\">Chronic traumatic encephalopathy\u003c/a> is found among people who’ve had head injuries. Though not everyone with head trauma develops CTE, the group that’s come to be most associated with it is football players, whose brains can be routinely jarred by hard hits. The disease has been linked to depression, dementia and even suicide among those who play the game.\u003c/p>\n\u003cp>But the \u003cem>Journal of Alzheimer’s Disease\u003c/em> published a study Tuesday that helps broaden the understanding of who is potentially affected by CTE to include \u003ca href=\"https://www.npr.org/sections/health-shots/2017/04/05/522613294/do-u-s-troops-risk-brain-injury-when-they-fire-heavy-weapons\" target=\"_blank\" rel=\"noopener\">military personnel\u003c/a>. And, perhaps more significantly, the study represents a step forward in developing a test for the disease in the living.\u003c/p>\n\u003cp>Right now, accurately diagnosing CTE requires the close study of brain tissue during autopsy, to identify the telltale abnormal proteins that kill brain cells. And this is a key reason why knowledge about CTE — who gets it, how widespread it is and the development of treatments — has lagged.\u003c/p>\n\u003cp>“You’ve really got to have a living diagnosis scan in order to make much headway on understanding the disease,” says \u003ca href=\"http://www.protectthebrain.org/Our-Team.aspx\" target=\"_blank\" rel=\"noopener\">Dr. Julian Bailes\u003c/a>, a neurosurgeon at the Chicago area’s NorthShore University HealthSystem, and one of the study’s authors.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That diagnostic scan is what researchers have gotten close to in this case.\u003c/p>\n\u003cp>\u003cstrong>A Comparison of Brains\u003c/strong>\u003c/p>\n\u003cp>The small study involved seven military personnel — five veterans and two active duty — who’d had brain injuries and experienced CTE-type symptoms, such as memory loss and mood swings. They were injected with what’s called a molecular tracer — in this case the shorthand name is FDDNP. The FDDNP tracer, which is radioactive, binds with the abnormal proteins in the brain and then appears in neural PET scans.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“The PET scanner functions a bit like a Geiger counter, which measures radioactivity,” says the study’s lead researcher, \u003ca href=\"http://www.bri.ucla.edu/people/gary-w-small-md\" target=\"_blank\" rel=\"noopener\">Dr. Gary Small\u003c/a>, a professor of geriatric psychiatry and biobehavioral sciences at UCLA’s David Geffen School of Medicine. (Small is a co-inventor of the FDDNP marker; he and some other researchers in the project have disclosed a financial interest in Taumark LLC, a company licensed by UCLA to develop the tracer.)\u003c/p>\n\u003cp>Small’s team compared the scans with those of a number of other people: Fifteen retired football players who had suffered brain injuries and exhibited CTE symptoms; two dozen people who had Alzheimer’s dementia and 28 healthy “control” subjects who were cognitively intact.\u003c/p>\n\u003cp>The results: The scans of the military personel showed patterns similar to the retired football players and different from the Alzheimer’s patients and control subjects.\u003c/p>\n\u003cp>And, it should be noted, the former players — all of them professionals who’d played in the NFL — had brain scans consistent with those of people who had died and had autopsies that \u003cem>confirmed\u003c/em> CTE.\u003c/p>\n\u003cp>\u003cstrong>Not Just a Problem for Athletes, Soldiers\u003c/strong>\u003c/p>\n\u003cp>Small says the study paves the way for deeper investigation of CTE’s brain changes.\u003c/p>\n\u003cp>“It could help us not just with people who’ve had head trauma from sports,” he says, “but also from other forms of injury, such as blast injury in the military.” \u003ca href=\"https://www.npr.org/sections/health-shots/2018/05/30/613779769/domestic-violence-s-untold-damage-concussion-and-brain-injury\" target=\"_blank\" rel=\"noopener\">Survivors of domestic violence\u003c/a> are another group believed to be vulnerable to CTE.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Small is quick to caution that the study isn’t definitive.\u003c/p>\n\u003cp>“There are several limitations,” he says. “One is [the small] sample size. Another is that we don’t have a control group of individuals who’ve been subjected to the same degree of head trauma, but are asymptomatic. … And what does that tell us? There may be something else we’re completely unaware of that’s driving the disease.”\u003c/p>\n\u003cp>A reliable test for CTE in living people is still at least a few years away, he estimates. But there already are plans for more research.\u003c/p>\n\u003cp>“We’re still within the scientific process of trying to figure out where this test lands on the scale of being definitive,” Bailes says. The researchers still need to determine “how it correlates with the changes actually seen in the brain when people die,” he explains. “It’s not definitive yet but this paper in a military setting is another piece of the puzzle, we think.”\u003c/p>\n\u003cp>A potentially pivotal piece of the puzzle.\u003c/p>\n\u003cp>“If you can’t diagnose a disease when someone’s alive,” says Bailes, “you really can’t help them. And you really don’t know, in a new and emerging and not completely understood situation like CTE. You don’t know the prevalence of it. You don’t know exactly who gets it and why. You don’t know how it evolves or changes over time and if there’s ever a potential for treatment.”\u003c/p>\n\u003cp>As another football season approaches, CTE will again be a lingering issue. And in some instances, it will be portrayed by some as it has in the past few years — as an “epidemic,” threatening the game’s future.\u003c/p>\n\u003cp>Which Bailes says is wrong.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“I don’t think it’s an epidemic,” he says, “but whatever the number is, is important. And you have to have living diagnosis in order to be able to tell that.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Scientists+Hunt+For+A+Test+To+Diagnose+Chronic+Brain+Injury+In+Living+People&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Insurers And Government Are Slow To Cover Expensive CAR-T Cancer Therapy",
"title": "Insurers And Government Are Slow To Cover Expensive CAR-T Cancer Therapy",
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"content": "\u003cp>Patients whose blood cancers have failed to respond to repeated rounds of chemotherapy may be candidates for a new type of gene therapy that could send their cancers into remission for years. But the two approved therapies, with price tags of hundreds of thousands of dollars, have roiled the insurance approval process, leading to delays and, in some cases, denials of coverage, clinicians and analysts say.[contextly_sidebar id=\"ReV9Gv0J6j7ADmv2dqbEuegAVdiLN5dE\"]\u003c/p>\n\u003cp>The therapy involves collecting patients' own T cells, a type of white blood cell, genetically modifying them, and then infusing them back into patients, where they hunt down and kill cancer cells. Known as \u003ca href=\"https://www.cancer.gov/about-cancer/treatment/research/car-t-cells\" target=\"_blank\" rel=\"noopener\">CAR-T cell therapy\u003c/a>, it's been characterized as a \"living drug\" by some researchers.\u003c/p>\n\u003cp>Two different CAR-T drugs — \u003ca href=\"https://www.us.kymriah.com/diffuse-large-b-cell-lymphoma-adults/?site=KYDDAY0DTCBR0040&source=01030&gclid=CNDIg4PMpNwCFRj1swod-MwKyw&gclsrc=ds\" target=\"_blank\" rel=\"noopener\">Kymriah\u003c/a> and \u003ca href=\"https://www.yescarta.com/therapy#how-yescarta-is-different\" target=\"_blank\" rel=\"noopener\">Yescarta\u003c/a> — were approved by the FDA last year to treat patients whose blood cancers haven't responded to at least two other rounds of treatment.\u003c/p>\n\u003cp>Kymriah is \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm574154.htm\">approved\u003c/a> for people up to age 25 with a form of acute lymphoblastic leukemia, the most common cancer in children. Kymriah and Yescarta are \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm606540.htm\" target=\"_blank\" rel=\"noopener\">both\u003c/a> \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm581296.htm\" target=\"_blank\" rel=\"noopener\">approved\u003c/a> for adults with advanced lymphomas.\u003c/p>\n\u003cp>Researchers report that some critically ill patients who received the therapy have remained cancer-free for as long as five years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"This is what patients need,\" says \u003ca href=\"https://www.mayo.edu/research/faculty/lin-yi-m-d-ph-d/bio-00092684\" target=\"_blank\" rel=\"noopener\">Dr. Yi Lin\u003c/a>, a hematologist who oversees the CAR-T cell practice and research for the Mayo Clinic. \"With the likelihood of getting patients into durable survival, we don't want to deny them the therapy.\" She says she receives no personal financial support from the drugs' makers.[contextly_sidebar id=\"nsB5Luqi8Mrdsb9vLceD3T77zYYY4sKK\"]\u003c/p>\n\u003cp>But the treatment comes at a cost — the drug treatments are hugely expensive. Kymriah and Yescarta cost $373,000 for a one-time infusion to treat adults with advanced lymphomas, while Kymriah costs $475,000 to treat acute lymphoblastic leukemia in children and young adults. That's the cost of the drug itself; in addition, many patients experience serious side effects that can land them in a hospital intensive care unit for weeks, \u003ca href=\"https://khn.org/news/cascade-of-costs-could-push-new-gene-therapy-above-1-million-per-patient/\" target=\"_blank\" rel=\"noopener\">pushing treatment costs to more than $1 million\u003c/a>.\u003c/p>\n\u003cp>All of this gives government and private insurers pause.\u003c/p>\n\u003cp>Most commercial insurers are covering CAR-T cell therapies now, but they do so on an individual basis, writing single-patient agreements each time, say cancer specialists. Large insurers that are already familiar with complicated therapies like stem-cell transplants are getting speedier at handling requests for CAR-T cell treatment, they say. But that's not always the case at smaller or regional plans, where delays can add weeks to the approval process.\u003c/p>\n\u003cp>\"A request for CAR-T may end up with somebody on the payer authorization team who doesn't understand the technology or the urgency of the request, when somebody has only weeks or months to live,\" says \u003ca href=\"https://www.asbmt.org/about/contact-us\" target=\"_blank\" rel=\"noopener\">Stephanie Farnia\u003c/a>, director of health policy and strategic relations at the American Society for Blood and Marrow Transplantation.\u003c/p>\n\u003cp>Farnia is in contact with many of the more than 50 medical centers that are authorized to provide treatment. The process of getting to a treatment center and evaluated for therapy is involved, she says. \"To then be substantially delayed due to paperwork is incredibly frustrating\" for patients.[contextly_sidebar id=\"mCjXSziNW7nkG4M52QmA48lgOAVmv3eg\"]\u003c/p>\n\u003cp>Medicare and Medicaid often pose greater coverage challenges than do private insurers, according to insurance experts.\u003c/p>\n\u003cp>Some Medicaid programs don't cover the treatment, says \u003ca href=\"AndrewsCAR-TandInsuranceDFedit.docx\" target=\"_blank\" rel=\"noopener\">Dr. Michael Bishop\u003c/a>, director of the cellular therapy program in the hematology/oncology section at the University of Chicago. Medicaid, the state-federal health program, covers children in low-income households and some adults.\u003c/p>\n\u003cp>\"Medicaid has been very tough,\" he says. \"Certain states just deny coverage — even states with balanced budgets.\"\u003c/p>\n\u003cp>States \u003ca href=\"https://icer-review.org/wp-content/uploads/2017/07/ICER_CAR_T_Final_Evidence_Report_032318.pdf\" target=\"_blank\" rel=\"noopener\">have to evaluate the cost as well as the drugs' effectiveness\u003c/a>, says \u003ca href=\"http://medicaiddirectors.org/about/staff/\" target=\"_blank\" rel=\"noopener\">Matt Salo\u003c/a>, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>\"Medicaid is a finite pot of money, and it's stretched threadbare even on a good day,\" he says.\u003c/p>\n\u003cp>People who are on Medicare, the health insurance program for people age 65 and older and some people with disabilities, typically haven't faced coverage denials to date, clinicians say. But the government's reimbursement rates are raising concerns for providers.\u003c/p>\n\u003cp>Last spring, Medicare announced payment rates for providers who administer Yescarta and Kymriah on an outpatient basis. The payments would more than cover the costs of the drugs. Medicare beneficiaries' out-of-pocket costs would be capped at $1,340 plus the beneficiaries' Part B deductible (if that hasn't already been met), the agency says.[contextly_sidebar id=\"zRKGtFwAO4CBGEIycv3lNE5oWVwoZuVf\"]\u003c/p>\n\u003cp>The problem with this plan? Facilities typically provide treatment on an inpatient basis, not outpatient, because of the potential for severe, systemic side effects.\u003c/p>\n\u003cp>\"There's a lot of toxicity and questions about whether it can even be provided in an outpatient setting,\" says Gary Goldstein, the business manager at the blood and marrow transplant program at Stanford Health Care in Stanford, Calif.\u003c/p>\n\u003cp>For inpatient care, \"CAR-T cell therapy ... would be paid at a much lower amount compared to outpatient hospital use,\" according to officials at the Centers for Medicare & Medicaid Services.\u003c/p>\n\u003cp>The agency is considering how to handle payment for inpatient CAR-T care for the fiscal year that starts in October. For now, some medical centers are absorbing whatever Medicare doesn't pay.\u003c/p>\n\u003cp>\"How can you tell a patient who's 66, 'If only you'd gotten lymphoma when you were 64'?\" Goldstein asks.\u003c/p>\n\u003cp>But the current approach can't continue indefinitely, he says.\u003c/p>\n\u003cp>\"Even if there aren't any centers that are making that decision today, if coverage doesn't change for Medicare, it absolutely is going to be a problem tomorrow,\" says Goldstein.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente. Michelle Andrews is on Twitter \u003c/em>\u003ca href=\"https://twitter.com/mandrews110\" target=\"_blank\" rel=\"noopener\">\u003cem>@mandrews110\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Insurers+And+Government+Are+Slow+To+Cover+Expensive+CAR-T+Cancer+Therapy&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Patients whose blood cancers have failed to respond to repeated rounds of chemotherapy may be candidates for a new type of gene therapy that could send their cancers into remission for years. But the two approved therapies, with price tags of hundreds of thousands of dollars, have roiled the insurance approval process, leading to delays and, in some cases, denials of coverage, clinicians and analysts say.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The therapy involves collecting patients' own T cells, a type of white blood cell, genetically modifying them, and then infusing them back into patients, where they hunt down and kill cancer cells. Known as \u003ca href=\"https://www.cancer.gov/about-cancer/treatment/research/car-t-cells\" target=\"_blank\" rel=\"noopener\">CAR-T cell therapy\u003c/a>, it's been characterized as a \"living drug\" by some researchers.\u003c/p>\n\u003cp>Two different CAR-T drugs — \u003ca href=\"https://www.us.kymriah.com/diffuse-large-b-cell-lymphoma-adults/?site=KYDDAY0DTCBR0040&source=01030&gclid=CNDIg4PMpNwCFRj1swod-MwKyw&gclsrc=ds\" target=\"_blank\" rel=\"noopener\">Kymriah\u003c/a> and \u003ca href=\"https://www.yescarta.com/therapy#how-yescarta-is-different\" target=\"_blank\" rel=\"noopener\">Yescarta\u003c/a> — were approved by the FDA last year to treat patients whose blood cancers haven't responded to at least two other rounds of treatment.\u003c/p>\n\u003cp>Kymriah is \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm574154.htm\">approved\u003c/a> for people up to age 25 with a form of acute lymphoblastic leukemia, the most common cancer in children. Kymriah and Yescarta are \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm606540.htm\" target=\"_blank\" rel=\"noopener\">both\u003c/a> \u003ca href=\"https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm581296.htm\" target=\"_blank\" rel=\"noopener\">approved\u003c/a> for adults with advanced lymphomas.\u003c/p>\n\u003cp>Researchers report that some critically ill patients who received the therapy have remained cancer-free for as long as five years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This is what patients need,\" says \u003ca href=\"https://www.mayo.edu/research/faculty/lin-yi-m-d-ph-d/bio-00092684\" target=\"_blank\" rel=\"noopener\">Dr. Yi Lin\u003c/a>, a hematologist who oversees the CAR-T cell practice and research for the Mayo Clinic. \"With the likelihood of getting patients into durable survival, we don't want to deny them the therapy.\" She says she receives no personal financial support from the drugs' makers.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But the treatment comes at a cost — the drug treatments are hugely expensive. Kymriah and Yescarta cost $373,000 for a one-time infusion to treat adults with advanced lymphomas, while Kymriah costs $475,000 to treat acute lymphoblastic leukemia in children and young adults. That's the cost of the drug itself; in addition, many patients experience serious side effects that can land them in a hospital intensive care unit for weeks, \u003ca href=\"https://khn.org/news/cascade-of-costs-could-push-new-gene-therapy-above-1-million-per-patient/\" target=\"_blank\" rel=\"noopener\">pushing treatment costs to more than $1 million\u003c/a>.\u003c/p>\n\u003cp>All of this gives government and private insurers pause.\u003c/p>\n\u003cp>Most commercial insurers are covering CAR-T cell therapies now, but they do so on an individual basis, writing single-patient agreements each time, say cancer specialists. Large insurers that are already familiar with complicated therapies like stem-cell transplants are getting speedier at handling requests for CAR-T cell treatment, they say. But that's not always the case at smaller or regional plans, where delays can add weeks to the approval process.\u003c/p>\n\u003cp>\"A request for CAR-T may end up with somebody on the payer authorization team who doesn't understand the technology or the urgency of the request, when somebody has only weeks or months to live,\" says \u003ca href=\"https://www.asbmt.org/about/contact-us\" target=\"_blank\" rel=\"noopener\">Stephanie Farnia\u003c/a>, director of health policy and strategic relations at the American Society for Blood and Marrow Transplantation.\u003c/p>\n\u003cp>Farnia is in contact with many of the more than 50 medical centers that are authorized to provide treatment. The process of getting to a treatment center and evaluated for therapy is involved, she says. \"To then be substantially delayed due to paperwork is incredibly frustrating\" for patients.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Medicare and Medicaid often pose greater coverage challenges than do private insurers, according to insurance experts.\u003c/p>\n\u003cp>Some Medicaid programs don't cover the treatment, says \u003ca href=\"AndrewsCAR-TandInsuranceDFedit.docx\" target=\"_blank\" rel=\"noopener\">Dr. Michael Bishop\u003c/a>, director of the cellular therapy program in the hematology/oncology section at the University of Chicago. Medicaid, the state-federal health program, covers children in low-income households and some adults.\u003c/p>\n\u003cp>\"Medicaid has been very tough,\" he says. \"Certain states just deny coverage — even states with balanced budgets.\"\u003c/p>\n\u003cp>States \u003ca href=\"https://icer-review.org/wp-content/uploads/2017/07/ICER_CAR_T_Final_Evidence_Report_032318.pdf\" target=\"_blank\" rel=\"noopener\">have to evaluate the cost as well as the drugs' effectiveness\u003c/a>, says \u003ca href=\"http://medicaiddirectors.org/about/staff/\" target=\"_blank\" rel=\"noopener\">Matt Salo\u003c/a>, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>\"Medicaid is a finite pot of money, and it's stretched threadbare even on a good day,\" he says.\u003c/p>\n\u003cp>People who are on Medicare, the health insurance program for people age 65 and older and some people with disabilities, typically haven't faced coverage denials to date, clinicians say. But the government's reimbursement rates are raising concerns for providers.\u003c/p>\n\u003cp>Last spring, Medicare announced payment rates for providers who administer Yescarta and Kymriah on an outpatient basis. The payments would more than cover the costs of the drugs. Medicare beneficiaries' out-of-pocket costs would be capped at $1,340 plus the beneficiaries' Part B deductible (if that hasn't already been met), the agency says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The problem with this plan? Facilities typically provide treatment on an inpatient basis, not outpatient, because of the potential for severe, systemic side effects.\u003c/p>\n\u003cp>\"There's a lot of toxicity and questions about whether it can even be provided in an outpatient setting,\" says Gary Goldstein, the business manager at the blood and marrow transplant program at Stanford Health Care in Stanford, Calif.\u003c/p>\n\u003cp>For inpatient care, \"CAR-T cell therapy ... would be paid at a much lower amount compared to outpatient hospital use,\" according to officials at the Centers for Medicare & Medicaid Services.\u003c/p>\n\u003cp>The agency is considering how to handle payment for inpatient CAR-T care for the fiscal year that starts in October. For now, some medical centers are absorbing whatever Medicare doesn't pay.\u003c/p>\n\u003cp>\"How can you tell a patient who's 66, 'If only you'd gotten lymphoma when you were 64'?\" Goldstein asks.\u003c/p>\n\u003cp>But the current approach can't continue indefinitely, he says.\u003c/p>\n\u003cp>\"Even if there aren't any centers that are making that decision today, if coverage doesn't change for Medicare, it absolutely is going to be a problem tomorrow,\" says Goldstein.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>, a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente. Michelle Andrews is on Twitter \u003c/em>\u003ca href=\"https://twitter.com/mandrews110\" target=\"_blank\" rel=\"noopener\">\u003cem>@mandrews110\u003c/em>\u003c/a>\u003cem>.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Insurers+And+Government+Are+Slow+To+Cover+Expensive+CAR-T+Cancer+Therapy&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Worried About Dementia? You Might Want to Check Your Blood Pressure",
"title": "Worried About Dementia? You Might Want to Check Your Blood Pressure",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Every day, \u003ca href=\"https://www.ninds.nih.gov/About-NINDS/Who-We-Are/Directors-Corner\" target=\"_blank\" rel=\"noopener\">Dr. Walter Koroshetz\u003c/a>, 65, takes a pill as part of his effort to help keep his brain healthy and sharp.[contextly_sidebar id=\"4qBhSsrstKRvTKQK6tvUcmCtY4bzQNtv\"]\u003c/p>\n\u003cp>The pill is his blood pressure medication. And Koroshetz, who directs the National Institute of Neurological Disorders and Stroke, says controlling high blood pressure helps him reduce his risk of dementia.\u003c/p>\n\u003cp>He also keeps his blood pressure down by exercising and paying attention to his weight and diet. \"I'm a believer,\" he says.\u003c/p>\n\u003cp>Koroshetz is urging other people with high blood pressure to follow his lead.\u003c/p>\n\u003cp>He is responsible for the institute's public health campaign called \u003ca href=\"https://mindyourrisks.nih.gov/\" target=\"_blank\" rel=\"noopener\">Mind Your Risks\u003c/a>. Its goal is to let people know that there is a link between high blood pressure, stroke and dementia.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When blood pressure rises, it strains the tiny blood vessels that keep brain cells alive, Koroshetz says.\u003c/p>\n\u003cp>\"With every pulse of your heart, you are pushing blood into these very small blood vessels in the brain,\" he says. And when the heart pushes too hard, as it does when blood pressure is elevated, it can cause damage that can lead to a stroke.[contextly_sidebar id=\"8eq71K4GS69glebb5gMvhBNDaKzdVXhl\"]\u003c/p>\n\u003cp>At least two large studies have revealed an alarming trend among stroke patients, Koroshetz says.\u003c/p>\n\u003cp>\"If you had a stroke, even a small stroke, your risk of dementia within the next two years was greatly magnified,\" he says. \"So there's something about having a stroke that drives a lot of the processes that give rise to dementia.\"\u003c/p>\n\u003cp>The evidence is clearest for a type of dementia called \u003ca href=\"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia\" target=\"_blank\" rel=\"noopener\">vascular dementia\u003c/a>. It occurs when something blocks or reduces the flow of blood to brain cells.\u003c/p>\n\u003cp>But high blood pressure also appears to increase a person's risk of developing Alzheimer's disease, which is associated with the accumulation of plaques and tangles in the brain.\u003c/p>\n\u003cp>If people knew about the link between dementia and high blood pressure, they might be more inclined to do something about it, Koroshetz says.\u003c/p>\n\u003cp>\"Only about 50 percent of people who have hypertension are actually treated,\" he says. \"So I think there's a lot to be said for trying to get high blood pressure under control.\"\u003c/p>\n\u003cp>Koroshetz's campaign is getting some help from the \u003ca href=\"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia\" target=\"_blank\" rel=\"noopener\">Alzheimer's Association\u003c/a>.\u003c/p>\n\u003cp>The group will present new research on blood pressure and Alzheimer's at its annual scientific \u003ca href=\"https://www.alz.org/aaic/about/chicago.asp\" target=\"_blank\" rel=\"noopener\">meeting\u003c/a> in Chicago, which starts July 22. And the group is encouraging people to control high blood pressure.\u003c/p>\n\u003cp>\"The good news is that we can control blood pressure now,\" says Maria Carrillo, the group's chief science officer. \"We can do that with exercise, with lifestyle, with healthy eating and also with medications.\"\u003c/p>\n\u003cp>Koroshetz is using all of these approaches. And he says other people with high blood pressure should follow his lead.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When you get to be my age, you're going to be very grateful that you controlled your blood pressure and exercised,\" he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Worried+About+Dementia%3F+You+Might+Want+to+Check+Your+Blood+Pressure&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "A new public health campaign says controlling high blood pressure is among the best ways to keep your brain sharp. The neurologist in charge aims to lead by example.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Every day, \u003ca href=\"https://www.ninds.nih.gov/About-NINDS/Who-We-Are/Directors-Corner\" target=\"_blank\" rel=\"noopener\">Dr. Walter Koroshetz\u003c/a>, 65, takes a pill as part of his effort to help keep his brain healthy and sharp.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The pill is his blood pressure medication. And Koroshetz, who directs the National Institute of Neurological Disorders and Stroke, says controlling high blood pressure helps him reduce his risk of dementia.\u003c/p>\n\u003cp>He also keeps his blood pressure down by exercising and paying attention to his weight and diet. \"I'm a believer,\" he says.\u003c/p>\n\u003cp>Koroshetz is urging other people with high blood pressure to follow his lead.\u003c/p>\n\u003cp>He is responsible for the institute's public health campaign called \u003ca href=\"https://mindyourrisks.nih.gov/\" target=\"_blank\" rel=\"noopener\">Mind Your Risks\u003c/a>. Its goal is to let people know that there is a link between high blood pressure, stroke and dementia.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When blood pressure rises, it strains the tiny blood vessels that keep brain cells alive, Koroshetz says.\u003c/p>\n\u003cp>\"With every pulse of your heart, you are pushing blood into these very small blood vessels in the brain,\" he says. And when the heart pushes too hard, as it does when blood pressure is elevated, it can cause damage that can lead to a stroke.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At least two large studies have revealed an alarming trend among stroke patients, Koroshetz says.\u003c/p>\n\u003cp>\"If you had a stroke, even a small stroke, your risk of dementia within the next two years was greatly magnified,\" he says. \"So there's something about having a stroke that drives a lot of the processes that give rise to dementia.\"\u003c/p>\n\u003cp>The evidence is clearest for a type of dementia called \u003ca href=\"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia\" target=\"_blank\" rel=\"noopener\">vascular dementia\u003c/a>. It occurs when something blocks or reduces the flow of blood to brain cells.\u003c/p>\n\u003cp>But high blood pressure also appears to increase a person's risk of developing Alzheimer's disease, which is associated with the accumulation of plaques and tangles in the brain.\u003c/p>\n\u003cp>If people knew about the link between dementia and high blood pressure, they might be more inclined to do something about it, Koroshetz says.\u003c/p>\n\u003cp>\"Only about 50 percent of people who have hypertension are actually treated,\" he says. \"So I think there's a lot to be said for trying to get high blood pressure under control.\"\u003c/p>\n\u003cp>Koroshetz's campaign is getting some help from the \u003ca href=\"https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/vascular-dementia\" target=\"_blank\" rel=\"noopener\">Alzheimer's Association\u003c/a>.\u003c/p>\n\u003cp>The group will present new research on blood pressure and Alzheimer's at its annual scientific \u003ca href=\"https://www.alz.org/aaic/about/chicago.asp\" target=\"_blank\" rel=\"noopener\">meeting\u003c/a> in Chicago, which starts July 22. And the group is encouraging people to control high blood pressure.\u003c/p>\n\u003cp>\"The good news is that we can control blood pressure now,\" says Maria Carrillo, the group's chief science officer. \"We can do that with exercise, with lifestyle, with healthy eating and also with medications.\"\u003c/p>\n\u003cp>Koroshetz is using all of these approaches. And he says other people with high blood pressure should follow his lead.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When you get to be my age, you're going to be very grateful that you controlled your blood pressure and exercised,\" he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Worried+About+Dementia%3F+You+Might+Want+to+Check+Your+Blood+Pressure&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Can't cool off this summer? Heat waves can slow us down in ways we may not realize.[contextly_sidebar id=\"vfD9z3obGh2C18mIRbWsth99DmsY1OtQ\"]\u003c/p>\n\u003cp>New research suggests heat stress can muddle our thinking, making simple math a little harder to do.\u003c/p>\n\u003cp>\"There's evidence that our brains are susceptible to temperature abnormalities,\" says \u003ca href=\"https://www.hsph.harvard.edu/joseph-allen/\" target=\"_blank\" rel=\"noopener\">Joe Allen\u003c/a>, co-director of the \u003ca href=\"https://www.hsph.harvard.edu/c-change/\" target=\"_blank\" rel=\"noopener\">Center for Climate, Health and the Global Environment\u003c/a> at Harvard University. And as the climate changes, temperatures spike and \u003ca href=\"https://science2017.globalchange.gov/chapter/6/\" target=\"_blank\" rel=\"noopener\">heat waves are more frequent\u003c/a>.\u003c/p>\n\u003cp>To learn more about how the heat influences young, healthy adults, Allen and his colleagues studied college students living in dorms during a summer heat wave in Boston.\u003c/p>\n\u003cp>Half of the students lived in buildings with central AC, where the indoor air temperature averaged 71 degrees. The other half lived in dorms with no AC, where air temperatures averaged almost 80 degrees.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"In the morning, when they woke up, we pushed tests out to their cellphones,\" explains Allen. The students took two tests a day for 12 consecutive days.\u003c/p>\n\u003cp>One test, which included basic addition and subtraction, measured cognitive speed and memory. A second test assessed attention and processing speed.\u003c/p>\n\u003cp>\"We found that the students who were in the non-air-conditioned buildings actually had slower reaction times: 13 percent lower performance on basic arithmetic tests, and nearly a 10 percent reduction in the number of correct responses per minute,\" Allen explains.\u003c/p>\n\u003cp>The results, \u003ca href=\"http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002605\" target=\"_blank\" rel=\"noopener\">published in PLOS Medicine\u003c/a>, may come as a surprise. \"I think it's a little bit akin to the frog in the boiling water,\" Allen says. There's a \"slow, steady — largely imperceptible — rise in temperature, and you don't realize it's having an impact on you.\"\u003c/p>\n\u003cp>The findings add to a growing body of evidence that documents the effect of heat on mental performance, both in schools and workplaces.\u003c/p>\n\u003cp>For instance, a 2006 study from researchers at the Lawrence Berkeley National Lab found that when office temperatures rise above the mid-70s, \u003ca href=\"https://indoor.lbl.gov/publications/effect-temperature-task-performance\" target=\"_blank\" rel=\"noopener\">workers' performance begins to drop off\u003c/a>. Researchers reviewed multiple studies that evaluated performance on common office tasks\u003cem>.\u003c/em> The study found that worker productivity is highest at about 72 degrees. When temperatures exceeded the mid-80s, worker productivity decreased by about 9 percent.\u003c/p>\n\u003cp>Another, \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0360132316304723\" target=\"_blank\" rel=\"noopener\">more recent study\u003c/a> compared worker performance in green-certified buildings and typical office buildings. They found a dip in cognitive function linked to conditions in the indoor environment, including higher indoor temperatures and poor lighting.\u003c/p>\n\u003cp>And, when it comes to performance in the classroom, a study funded by the Harvard Environmental Economics Program finds that taking a standardized test on a very hot day is\u003ca href=\"https://scholar.harvard.edu/files/jisungpark/files/paper_nyc_aejep.pdf\" target=\"_blank\" rel=\"noopener\"> linked to poorer performance\u003c/a>. The study includes an analysis of test scores from students in New York City who take a series of high-school exams called the Regents Exams.\u003c/p>\n\u003cp>The author, R. Jisung Park, assistant professor at the University of California, Los Angeles, writes that compared with a 72-degree day, \"taking an exam on a 90◦F day leads to a 10.9 percent lower likelihood of passing a particular subject (e.g. Algebra), which in turn affects probability of graduation.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There's still a lot to learn about how our brains and bodies respond to heat. \"We all tend to think we can compensate, we can do just fine\" during heat waves says Allen. But he says the \"evidence shows that the indoor temperature can have a dramatic impact on our ability to be productive and learn.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Heat+Making+You+Lethargic%3F+Research+Shows+It+Can+Slow+Your+Brain%2C+Too&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Can't cool off this summer? Heat waves can slow us down in ways we may not realize.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>New research suggests heat stress can muddle our thinking, making simple math a little harder to do.\u003c/p>\n\u003cp>\"There's evidence that our brains are susceptible to temperature abnormalities,\" says \u003ca href=\"https://www.hsph.harvard.edu/joseph-allen/\" target=\"_blank\" rel=\"noopener\">Joe Allen\u003c/a>, co-director of the \u003ca href=\"https://www.hsph.harvard.edu/c-change/\" target=\"_blank\" rel=\"noopener\">Center for Climate, Health and the Global Environment\u003c/a> at Harvard University. And as the climate changes, temperatures spike and \u003ca href=\"https://science2017.globalchange.gov/chapter/6/\" target=\"_blank\" rel=\"noopener\">heat waves are more frequent\u003c/a>.\u003c/p>\n\u003cp>To learn more about how the heat influences young, healthy adults, Allen and his colleagues studied college students living in dorms during a summer heat wave in Boston.\u003c/p>\n\u003cp>Half of the students lived in buildings with central AC, where the indoor air temperature averaged 71 degrees. The other half lived in dorms with no AC, where air temperatures averaged almost 80 degrees.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"In the morning, when they woke up, we pushed tests out to their cellphones,\" explains Allen. The students took two tests a day for 12 consecutive days.\u003c/p>\n\u003cp>One test, which included basic addition and subtraction, measured cognitive speed and memory. A second test assessed attention and processing speed.\u003c/p>\n\u003cp>\"We found that the students who were in the non-air-conditioned buildings actually had slower reaction times: 13 percent lower performance on basic arithmetic tests, and nearly a 10 percent reduction in the number of correct responses per minute,\" Allen explains.\u003c/p>\n\u003cp>The results, \u003ca href=\"http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002605\" target=\"_blank\" rel=\"noopener\">published in PLOS Medicine\u003c/a>, may come as a surprise. \"I think it's a little bit akin to the frog in the boiling water,\" Allen says. There's a \"slow, steady — largely imperceptible — rise in temperature, and you don't realize it's having an impact on you.\"\u003c/p>\n\u003cp>The findings add to a growing body of evidence that documents the effect of heat on mental performance, both in schools and workplaces.\u003c/p>\n\u003cp>For instance, a 2006 study from researchers at the Lawrence Berkeley National Lab found that when office temperatures rise above the mid-70s, \u003ca href=\"https://indoor.lbl.gov/publications/effect-temperature-task-performance\" target=\"_blank\" rel=\"noopener\">workers' performance begins to drop off\u003c/a>. Researchers reviewed multiple studies that evaluated performance on common office tasks\u003cem>.\u003c/em> The study found that worker productivity is highest at about 72 degrees. When temperatures exceeded the mid-80s, worker productivity decreased by about 9 percent.\u003c/p>\n\u003cp>Another, \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0360132316304723\" target=\"_blank\" rel=\"noopener\">more recent study\u003c/a> compared worker performance in green-certified buildings and typical office buildings. They found a dip in cognitive function linked to conditions in the indoor environment, including higher indoor temperatures and poor lighting.\u003c/p>\n\u003cp>And, when it comes to performance in the classroom, a study funded by the Harvard Environmental Economics Program finds that taking a standardized test on a very hot day is\u003ca href=\"https://scholar.harvard.edu/files/jisungpark/files/paper_nyc_aejep.pdf\" target=\"_blank\" rel=\"noopener\"> linked to poorer performance\u003c/a>. The study includes an analysis of test scores from students in New York City who take a series of high-school exams called the Regents Exams.\u003c/p>\n\u003cp>The author, R. Jisung Park, assistant professor at the University of California, Los Angeles, writes that compared with a 72-degree day, \"taking an exam on a 90◦F day leads to a 10.9 percent lower likelihood of passing a particular subject (e.g. Algebra), which in turn affects probability of graduation.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>There's still a lot to learn about how our brains and bodies respond to heat. \"We all tend to think we can compensate, we can do just fine\" during heat waves says Allen. But he says the \"evidence shows that the indoor temperature can have a dramatic impact on our ability to be productive and learn.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Heat+Making+You+Lethargic%3F+Research+Shows+It+Can+Slow+Your+Brain%2C+Too&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Could the tick that just bit you carry a pathogen that causes Lyme disease or another ailment? If you’re worried, you could ship the offending bug to a \u003ca href=\"https://www.tickreport.com/\" target=\"_blank\" rel=\"noopener\">private testing service\u003c/a> to find out. But between August 2016 and January 2017, you could have gotten a free analysis by sending it to \u003ca href=\"https://www.nietolab.com/\" target=\"_blank\" rel=\"noopener\">Nathan Nieto\u003c/a>‘s lab at Northern Arizona University. You’d get back info on the critter that bit you and, if applicable, a pathology report.[contextly_sidebar id=”vQtnCzXhkQcs89CEeEPJrr32XWz2BjaR”]\u003c/p>\n\u003cp>Nieto’s project wasn’t just a goodwill gesture: It was an unprecedented attempt to include the public in tick research. Nieto, a microbiologist at Northern Arizona University, and his team published \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199644\" target=\"_blank\" rel=\"noopener\">the results\u003c/a> of their brief tick-collecting experiment Thursday in \u003cem>PLOS One\u003c/em>. They say it shows the potential of citizen science to fill in gaps in research—and that data gathered this way could ultimately help form a more proactive public health response when it comes to identifying and preventing tick-borne disease.\u003c/p>\n\u003cp>Public health officials track the number of reported cases of tick-borne diseases, and researchers can study ticks in their local habitats. But when it comes to assessing the risk of potential infection from tick-born pathogens, figuring out which ticks commonly bite humans, what pathogens they carry, and how many people actually get sick from bites, the picture’s always been blurry.\u003c/p>\n\u003cp>Until now. Usually, Nieto says, scientists collect around 100 ticks at a time for local research using surprisingly low-tech methods (such as dragging a long swath of fabric behind a truck, then counting the number of ticks it catches). In this case, researchers received thousands of ticks. Most had been removed from humans or dogs—and there were many more than they originally planned for.\u003c/p>\n\u003cp>“We budgeted for 2,400,” says Nieto. “Then all of a sudden it was over 16,000.” The massive response shows how hungry the public is for information on the ticks that bite them, he says. In the meantime, it fed scientists an unexpectedly large dataset, and information on ticks from 49 states and Puerto Rico.[contextly_sidebar id=”ohPookGuQNsrQ7oV2MNauvfZDjgmSRp5″]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Once ticks made their way into the lab, the team identified them and tested them for four tick-born pathogens, including \u003cem>Borrelia burgdorferi\u003c/em>, the bacterium that causes Lyme disease. They sent information on the pathogen back to the people who submitted ticks and mapped their geographic distribution.\u003c/p>\n\u003cp>Though researchers weren’t on the hunt for new tick-borne pathogens, they did uncover some surprises. Unexpected ticks turned up in unexpected locations, like Lone Star ticks you’d expect to find in the Southeast as far north as Maine and as far west as California. And ticks capable of carrying Lyme disease were reported in 83 counties where they hadn’t been recorded before. A few rare ticks turned up, too, though none of them carried pathogens.\u003c/p>\n\u003cp>For Nieto, the real point was to show how citizens might help fill in a gray area between incidence and risk, documenting human and animal exposure to ticks.\u003c/p>\n\u003cp>“We can use this data to show when risk is actually happening in the system,” says Nieto. “It ends up being predictive.” The data could be lined up to reports of tick-borne disease in a certain geographic area, for example, to show how long it takes for people to report illness or to help public health officials brace for next year’s tick season.\u003c/p>\n\u003cp>The researchers note that gathering data at this scale wouldn’t be possible without citizen scientists — and future studies of this type could help improve understanding of tick-borne disease.[contextly_sidebar id=”clkhy1Xj8UN6TWA04SmgdSJIeSSTp8ZO”]\u003c/p>\n\u003cp>“It’s a great example of using citizen science to ask questions about the ecology of infectious disease,” says \u003ca href=\"https://profiles.stanford.edu/katharine-walter\" target=\"_blank\" rel=\"noopener\">Katharine Walter\u003c/a>, an epidemiologist at Stanford University who has studied the prevalence and spread of tick-borne diseases. Walter, who did not participate in the research, says that a longer-term project could yield real insights not just into disease, but climate change and human impacts on their environment.\u003c/p>\n\u003cp>“That’s the power of science,” says Walter. “I really believe that scientific research shouldn’t be just for scientists.”\u003c/p>\n\u003cp>The study’s authors admit there are some real limitations to their work. They didn’t find out if and where people had traveled before they found the ticks. Since ticks can hang out on the body for days, they could have traveled along with people or animals on the move and resulted in misreporting. Nieto says his team didn’t ask for the data out of privacy concerns and a desire to encourage participation.\u003c/p>\n\u003cp>Another limitation is that people who never hear about a citizen science initiative can’t participate, and the study wasn’t advertised beyond an initial PR campaign conducted by the \u003ca href=\"https://www.bayarealyme.org/\" target=\"_blank\" rel=\"noopener\">Bay Area Lyme Foundation\u003c/a>, which funded the project. Socioeconomic barriers to the internet may also have limited participants, and there’s no way to verify how many participants misreported information about the ticks that bit them.\u003c/p>\n\u003cp>What’s next for the tick collectors? First, says Nieto, they’ll dig deeper into the ticks’ DNA, and hopefully open up another wave of free tick analysis in an attempt to broaden the data even more. From there, says Nieto, it’s up to others to use the dataset for good.\u003c/p>\n\u003cp>“We have this information,” he says. “Now we need some technology or changes in behavior that are going to help us actually prevent infection.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Erin Blakemore is a science writer based in Boulder, Colo. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Researchers+Study+Thousands+Of+Ticks+Collected+By+The+People+They+Bit&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Could the tick that just bit you carry a pathogen that causes Lyme disease or another ailment? If you’re worried, you could ship the offending bug to a \u003ca href=\"https://www.tickreport.com/\" target=\"_blank\" rel=\"noopener\">private testing service\u003c/a> to find out. But between August 2016 and January 2017, you could have gotten a free analysis by sending it to \u003ca href=\"https://www.nietolab.com/\" target=\"_blank\" rel=\"noopener\">Nathan Nieto\u003c/a>‘s lab at Northern Arizona University. You’d get back info on the critter that bit you and, if applicable, a pathology report.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Nieto’s project wasn’t just a goodwill gesture: It was an unprecedented attempt to include the public in tick research. Nieto, a microbiologist at Northern Arizona University, and his team published \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199644\" target=\"_blank\" rel=\"noopener\">the results\u003c/a> of their brief tick-collecting experiment Thursday in \u003cem>PLOS One\u003c/em>. They say it shows the potential of citizen science to fill in gaps in research—and that data gathered this way could ultimately help form a more proactive public health response when it comes to identifying and preventing tick-borne disease.\u003c/p>\n\u003cp>Public health officials track the number of reported cases of tick-borne diseases, and researchers can study ticks in their local habitats. But when it comes to assessing the risk of potential infection from tick-born pathogens, figuring out which ticks commonly bite humans, what pathogens they carry, and how many people actually get sick from bites, the picture’s always been blurry.\u003c/p>\n\u003cp>Until now. Usually, Nieto says, scientists collect around 100 ticks at a time for local research using surprisingly low-tech methods (such as dragging a long swath of fabric behind a truck, then counting the number of ticks it catches). In this case, researchers received thousands of ticks. Most had been removed from humans or dogs—and there were many more than they originally planned for.\u003c/p>\n\u003cp>“We budgeted for 2,400,” says Nieto. “Then all of a sudden it was over 16,000.” The massive response shows how hungry the public is for information on the ticks that bite them, he says. In the meantime, it fed scientists an unexpectedly large dataset, and information on ticks from 49 states and Puerto Rico.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Once ticks made their way into the lab, the team identified them and tested them for four tick-born pathogens, including \u003cem>Borrelia burgdorferi\u003c/em>, the bacterium that causes Lyme disease. They sent information on the pathogen back to the people who submitted ticks and mapped their geographic distribution.\u003c/p>\n\u003cp>Though researchers weren’t on the hunt for new tick-borne pathogens, they did uncover some surprises. Unexpected ticks turned up in unexpected locations, like Lone Star ticks you’d expect to find in the Southeast as far north as Maine and as far west as California. And ticks capable of carrying Lyme disease were reported in 83 counties where they hadn’t been recorded before. A few rare ticks turned up, too, though none of them carried pathogens.\u003c/p>\n\u003cp>For Nieto, the real point was to show how citizens might help fill in a gray area between incidence and risk, documenting human and animal exposure to ticks.\u003c/p>\n\u003cp>“We can use this data to show when risk is actually happening in the system,” says Nieto. “It ends up being predictive.” The data could be lined up to reports of tick-borne disease in a certain geographic area, for example, to show how long it takes for people to report illness or to help public health officials brace for next year’s tick season.\u003c/p>\n\u003cp>The researchers note that gathering data at this scale wouldn’t be possible without citizen scientists — and future studies of this type could help improve understanding of tick-borne disease.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It’s a great example of using citizen science to ask questions about the ecology of infectious disease,” says \u003ca href=\"https://profiles.stanford.edu/katharine-walter\" target=\"_blank\" rel=\"noopener\">Katharine Walter\u003c/a>, an epidemiologist at Stanford University who has studied the prevalence and spread of tick-borne diseases. Walter, who did not participate in the research, says that a longer-term project could yield real insights not just into disease, but climate change and human impacts on their environment.\u003c/p>\n\u003cp>“That’s the power of science,” says Walter. “I really believe that scientific research shouldn’t be just for scientists.”\u003c/p>\n\u003cp>The study’s authors admit there are some real limitations to their work. They didn’t find out if and where people had traveled before they found the ticks. Since ticks can hang out on the body for days, they could have traveled along with people or animals on the move and resulted in misreporting. Nieto says his team didn’t ask for the data out of privacy concerns and a desire to encourage participation.\u003c/p>\n\u003cp>Another limitation is that people who never hear about a citizen science initiative can’t participate, and the study wasn’t advertised beyond an initial PR campaign conducted by the \u003ca href=\"https://www.bayarealyme.org/\" target=\"_blank\" rel=\"noopener\">Bay Area Lyme Foundation\u003c/a>, which funded the project. Socioeconomic barriers to the internet may also have limited participants, and there’s no way to verify how many participants misreported information about the ticks that bit them.\u003c/p>\n\u003cp>What’s next for the tick collectors? First, says Nieto, they’ll dig deeper into the ticks’ DNA, and hopefully open up another wave of free tick analysis in an attempt to broaden the data even more. From there, says Nieto, it’s up to others to use the dataset for good.\u003c/p>\n\u003cp>“We have this information,” he says. “Now we need some technology or changes in behavior that are going to help us actually prevent infection.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Erin Blakemore is a science writer based in Boulder, Colo. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Researchers+Study+Thousands+Of+Ticks+Collected+By+The+People+They+Bit&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Could light one day be used to restore hearing loss?\u003c/p>\n\u003cp>To try to answer that question, a team of German bioengineers surgically installed coiled strips of optical fibers in the ears of deaf gerbils.\u003c/p>\n\u003cp>While they still had their hearing, the gerbils had learned to hurdle a small barrier upon hearing an alarm. Now researchers sent a pulse of blue laser light deep into the animals’ ears. They jumped.\u003c/p>\n\u003cp>The experiment was part of a \u003ca href=\"http://stm.sciencemag.org/content/10/449/eaaq1564\" target=\"_blank\" rel=\"noopener\">study\u003c/a> published Wednesday seeking to improve upon cochlear implants — electronic devices that stimulate auditory neurons to partially restore hearing. Instead of using electrical currents, scientists are trying to determine whether optogenetics, a new field that uses light to control living cells, could one day help improve someone’s sense of hearing.\u003c/p>\n\u003cp>Although it could take decades to use optogenetics-based technologies in humans, researchers are beginning to demonstrate that light, not electricity, may be the best way to convey the rich information contained in sound.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“Through my experience with patients, I’ve recognized the huge potential of cochlear implants,” said Tobias Moser, director of the Institute for Auditory Neuroscience at the University Medical Center Göttingen and lead author of the new study. “At the same time I’ve also witnessed the shortcomings.”\u003c/p>\n\u003cp>Patients with cochlear implants often describe the sound quality through the devices as harsh and tinny. Listening to music or picking out one voice from several others is often impossible. The goal of the new research, said Moser, is to improve the technology and create “a more natural hearing so that patients can recognize the melody in music and speech.”\u003c/p>\n\u003cp>At the most basic level, the act of hearing is transforming sound into electrochemical signals, the language of neurons, that the brain can then interpret.\u003c/p>\n\u003cp>Much of this process occurs in the cochlea, a snail-shaped organ within the inner ear lined with specialized sensory cells called hair cells. When hair cells detect vibration through thin protrusions on their surface, they generate electrical current in neighboring nerve cells that travel to the brain.\u003c/p>\n\u003cp>In people who have dysfunctional or dead hair cells, cochlear implants work by electrically stimulating auditory nerve cells directly.\u003c/p>\n\u003cp>According to Dan Polley, an associate professor at Harvard Medical School and director of the Lauer Tinnitus Research Center who was not involved in the study, the successes and limitations of the cochlear implant are determined by the anatomy of the inner ear.\u003c/p>\n\u003cp>Within the cochlea, hair cells rest on an organic platform known as the basilar membrane that is floppy and wide on one end and narrow and taut on the other. This biomechanical organization causes hair cells to wiggle in response to specific sound frequencies or pitches that are mapped out smoothly from low to high, like keys on a piano.\u003c/p>\n\u003cp>When implanting cochlear implants, Polley explained, surgeons thread electrodes into specific locations along the basilar membrane to target nerves that are sensitive to particular frequencies.\u003c/p>\n\u003cp>With cochlear implants, however, electrical current spreads itself over a large area and activates not only the targeted nerves but also neighboring cells as well. This impercision distorts and muffles sound.\u003c/p>\n\u003cp>Moser and other scientists believe that using light, which can be more finely targeted, will improve the performance of implants.\u003c/p>\n\u003cp>“Using electricity to control neurons is like playing the piano with your elbow,” said Polley. “Whereas light is better. It is more like playing the piano while wearing mittens.”\u003c/p>\n\u003cp>Auditory neurons normally don’t respond to light. However, the rapidly growing field of optogenetics has made this possible. The key is to genetically engineer neurons so that they contain light-sensitive proteins that are found elsewhere in nature including bacteria, algae, and the human eye.\u003c/p>\n\u003cp>Moser and his team of scientists performed this technique in adult Mongolian gerbils instead of mice or rats, which were used in previous studies. Gerbils, in contrast to other rodents, are a better proxy for humans because they hear low frequencies used by the human ear and have relatively large cochleas that are only two-and-a-half times smaller than those of humans.\u003c/p>\n\u003cp>The researchers also used a new version of light-sensitive proteins, called CatCh, to increase how quickly nerve cells could respond to light stimulation. Previous versions of the protein worked sluggishly to move ions in and out of neurons — a critical step in generating electrical signals to the brain conveying the rapidly changing characteristics of sound like loudness and pitch.\u003c/p>\n\u003cp>This really hampers our ability to “capture the dynamics of speech,” said Polley. “If you have to deliver pulses [of light] more slowly, you can’t keep up.”\u003c/p>\n\u003cp>To test how quickly neurons equipped with CatCh could process information, researchers exposed neurons to rapid bursts of laser light, up to 300 flashes per second. They observed that individual neurons and groups of neurons were able to keep pace with the flashes by releasing their own corresponding surges of electrical energy.\u003c/p>\n\u003cp>“This is a big improvement over our previous work, “ said Moser. The response “is quick and approaches physiological performance of normal neurons.”\u003c/p>\n\u003cp>Aside from faster processing, the neurons also showed a graded response to different intensities of light. This suggests that the gerbils could experience an accurate representation of loudness that is proportional to how strongly neurons are activated by light.\u003c/p>\n\u003cp>But how could researchers be sure that all this promising electrical activity was actually creating a sense of hearing in gerbils?\u003c/p>\n\u003cp>Scientists first surgically implanted a loop of optical fibers — a primitive prototype of high-tech cochlear implants that could one day be used in humans — into the gerbils’ inner ear. They then trained the animals to jump over a fence-like obstacle dividing two halves of a box. Once the gerbils learned this behavior, scientists deafened the animals, causing them to become unresponsive to the loudspeaker. However, when researchers pulsed blue laser light through the optic fiber, the gerbils leapt into the air again.\u003c/p>\n\u003cp>“It’s not hearing until you measure behavior,” said Polley. “Because hearing is a psychological property. [This experiment] shows that the animals generalize light stimulation to sound, they treat it as if it were sound.”\u003c/p>\n\u003cp>Despite these dramatic results, Moser is quick to point out that light-based cochlear implants are not ready for human use.\u003c/p>\n\u003cp>The most obvious hurdle is that installing light-sensitive proteins into cells requires genetic engineering. In the case of gerbils, scientists accomplished the feat by injecting viruses carrying specially designed DNA into the animals’ ears. While gene therapy is being used to treat certain diseases in clinical trials — and has been approved for a \u003ca href=\"https://www.statnews.com/2018/03/21/gene-therapy-luxturna-launch/\">rare form of blindness\u003c/a> — it remains a long way from reality for most conditions.\u003c/p>\n\u003cp>“Right now,” said Polley, “ I doubt anyone would suggest that you get this gene therapy instead of cochlear implants.”\u003c/p>\n\u003cp>Even if gene therapy was a proven technology, light-based implants have other restrictions. In humans, bioengineers imagine using tiny light-emitting diodes (LEDs) to stimulate genetically engineered auditory neurons. However these machines consume a lot of power and dissipate heat, making it unclear how patients would wear or operate such a device.\u003c/p>\n\u003cp>“Optogenetics is the most sophisticated way we have to stimulate nerves in the cochlea,” said Adrien Eshraghi, a professor at the Miller School of Medicine and director of the Hearing Research Laboratory at the University of Miami who was not involved with the study. “It is still [in] the early basics of science research, but I think optogenetics has a good future.”\u003c/p>\n\u003cp>Another source of optimism is the power of the brain to adapt to new signaling inputs.\u003c/p>\n\u003cp>In the case of cochlear implants, patients initially experience the human voice as high-pitched and scratchy (think Mickey Mouse) but adapt over time. Although researchers don’t know what light will sound like, they expect a similar adjustment process.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“At the end of the day for engineers,” said Polley, “the brain is the hero … it is one of the best players on their team because they don’t have to perfect the signal, they just have to make it reasonably good, and then the brain can take it the rest of the way.”\u003c/p>\n\u003cdiv> \u003cem>This\u003ca href=\"https://www.statnews.com/2018/07/11/optogenetics-hearing-gerbils-cochlear-implants/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“Through my experience with patients, I’ve recognized the huge potential of cochlear implants,” said Tobias Moser, director of the Institute for Auditory Neuroscience at the University Medical Center Göttingen and lead author of the new study. “At the same time I’ve also witnessed the shortcomings.”\u003c/p>\n\u003cp>Patients with cochlear implants often describe the sound quality through the devices as harsh and tinny. Listening to music or picking out one voice from several others is often impossible. The goal of the new research, said Moser, is to improve the technology and create “a more natural hearing so that patients can recognize the melody in music and speech.”\u003c/p>\n\u003cp>At the most basic level, the act of hearing is transforming sound into electrochemical signals, the language of neurons, that the brain can then interpret.\u003c/p>\n\u003cp>Much of this process occurs in the cochlea, a snail-shaped organ within the inner ear lined with specialized sensory cells called hair cells. When hair cells detect vibration through thin protrusions on their surface, they generate electrical current in neighboring nerve cells that travel to the brain.\u003c/p>\n\u003cp>In people who have dysfunctional or dead hair cells, cochlear implants work by electrically stimulating auditory nerve cells directly.\u003c/p>\n\u003cp>According to Dan Polley, an associate professor at Harvard Medical School and director of the Lauer Tinnitus Research Center who was not involved in the study, the successes and limitations of the cochlear implant are determined by the anatomy of the inner ear.\u003c/p>\n\u003cp>Within the cochlea, hair cells rest on an organic platform known as the basilar membrane that is floppy and wide on one end and narrow and taut on the other. This biomechanical organization causes hair cells to wiggle in response to specific sound frequencies or pitches that are mapped out smoothly from low to high, like keys on a piano.\u003c/p>\n\u003cp>When implanting cochlear implants, Polley explained, surgeons thread electrodes into specific locations along the basilar membrane to target nerves that are sensitive to particular frequencies.\u003c/p>\n\u003cp>With cochlear implants, however, electrical current spreads itself over a large area and activates not only the targeted nerves but also neighboring cells as well. This impercision distorts and muffles sound.\u003c/p>\n\u003cp>Moser and other scientists believe that using light, which can be more finely targeted, will improve the performance of implants.\u003c/p>\n\u003cp>“Using electricity to control neurons is like playing the piano with your elbow,” said Polley. “Whereas light is better. It is more like playing the piano while wearing mittens.”\u003c/p>\n\u003cp>Auditory neurons normally don’t respond to light. However, the rapidly growing field of optogenetics has made this possible. The key is to genetically engineer neurons so that they contain light-sensitive proteins that are found elsewhere in nature including bacteria, algae, and the human eye.\u003c/p>\n\u003cp>Moser and his team of scientists performed this technique in adult Mongolian gerbils instead of mice or rats, which were used in previous studies. Gerbils, in contrast to other rodents, are a better proxy for humans because they hear low frequencies used by the human ear and have relatively large cochleas that are only two-and-a-half times smaller than those of humans.\u003c/p>\n\u003cp>The researchers also used a new version of light-sensitive proteins, called CatCh, to increase how quickly nerve cells could respond to light stimulation. Previous versions of the protein worked sluggishly to move ions in and out of neurons — a critical step in generating electrical signals to the brain conveying the rapidly changing characteristics of sound like loudness and pitch.\u003c/p>\n\u003cp>This really hampers our ability to “capture the dynamics of speech,” said Polley. “If you have to deliver pulses [of light] more slowly, you can’t keep up.”\u003c/p>\n\u003cp>To test how quickly neurons equipped with CatCh could process information, researchers exposed neurons to rapid bursts of laser light, up to 300 flashes per second. They observed that individual neurons and groups of neurons were able to keep pace with the flashes by releasing their own corresponding surges of electrical energy.\u003c/p>\n\u003cp>“This is a big improvement over our previous work, “ said Moser. The response “is quick and approaches physiological performance of normal neurons.”\u003c/p>\n\u003cp>Aside from faster processing, the neurons also showed a graded response to different intensities of light. This suggests that the gerbils could experience an accurate representation of loudness that is proportional to how strongly neurons are activated by light.\u003c/p>\n\u003cp>But how could researchers be sure that all this promising electrical activity was actually creating a sense of hearing in gerbils?\u003c/p>\n\u003cp>Scientists first surgically implanted a loop of optical fibers — a primitive prototype of high-tech cochlear implants that could one day be used in humans — into the gerbils’ inner ear. They then trained the animals to jump over a fence-like obstacle dividing two halves of a box. Once the gerbils learned this behavior, scientists deafened the animals, causing them to become unresponsive to the loudspeaker. However, when researchers pulsed blue laser light through the optic fiber, the gerbils leapt into the air again.\u003c/p>\n\u003cp>“It’s not hearing until you measure behavior,” said Polley. “Because hearing is a psychological property. [This experiment] shows that the animals generalize light stimulation to sound, they treat it as if it were sound.”\u003c/p>\n\u003cp>Despite these dramatic results, Moser is quick to point out that light-based cochlear implants are not ready for human use.\u003c/p>\n\u003cp>The most obvious hurdle is that installing light-sensitive proteins into cells requires genetic engineering. In the case of gerbils, scientists accomplished the feat by injecting viruses carrying specially designed DNA into the animals’ ears. While gene therapy is being used to treat certain diseases in clinical trials — and has been approved for a \u003ca href=\"https://www.statnews.com/2018/03/21/gene-therapy-luxturna-launch/\">rare form of blindness\u003c/a> — it remains a long way from reality for most conditions.\u003c/p>\n\u003cp>“Right now,” said Polley, “ I doubt anyone would suggest that you get this gene therapy instead of cochlear implants.”\u003c/p>\n\u003cp>Even if gene therapy was a proven technology, light-based implants have other restrictions. In humans, bioengineers imagine using tiny light-emitting diodes (LEDs) to stimulate genetically engineered auditory neurons. However these machines consume a lot of power and dissipate heat, making it unclear how patients would wear or operate such a device.\u003c/p>\n\u003cp>“Optogenetics is the most sophisticated way we have to stimulate nerves in the cochlea,” said Adrien Eshraghi, a professor at the Miller School of Medicine and director of the Hearing Research Laboratory at the University of Miami who was not involved with the study. “It is still [in] the early basics of science research, but I think optogenetics has a good future.”\u003c/p>\n\u003cp>Another source of optimism is the power of the brain to adapt to new signaling inputs.\u003c/p>\n\u003cp>In the case of cochlear implants, patients initially experience the human voice as high-pitched and scratchy (think Mickey Mouse) but adapt over time. Although researchers don’t know what light will sound like, they expect a similar adjustment process.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“At the end of the day for engineers,” said Polley, “the brain is the hero … it is one of the best players on their team because they don’t have to perfect the signal, they just have to make it reasonably good, and then the brain can take it the rest of the way.”\u003c/p>\n\u003cdiv> \u003cem>This\u003ca href=\"https://www.statnews.com/2018/07/11/optogenetics-hearing-gerbils-cochlear-implants/\" target=\"_blank\" rel=\"noopener\"> story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "To Repel Ticks, Try Spraying Your Clothes With A Pesticide That Mimics Mums",
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"content": "\u003cp>There's new evidence to support a decades-old strategy for preventing the tick bites that lead to all sorts of nasty diseases, including Lyme disease and Rocky Mountain spotted fever.\u003c/p>\n\u003cp>The remedy involves spraying your clothing with \u003ca href=\"http://npic.orst.edu/factsheets/PermGen.html\" target=\"_blank\" rel=\"noopener\">permethrin\u003c/a> — a pesticide that's chemically similar to extracts of the flowering chrysanthemum plant.\u003c/p>\n\u003cp>Back in the 1980s, the U.S. military conducted several \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/3735345\" target=\"_blank\" rel=\"noopener\">tests\u003c/a> on a synthetic version of the plant-derived pesticide. When it was shown to be effective in preventing the bites of insects and ticks, the military began to purchase uniforms for soldiers that are \u003ca href=\"https://www.army.mil/article/110610/army_launches_website_about_permethrin_treated_acus\" target=\"_blank\" rel=\"noopener\">factory-treated with permethrin\u003c/a>.\u003c/p>\n\u003cp>Now, many outdoor enthusiasts are converts, too.\u003c/p>\n\u003cp>\"I love being outside — whether it's hiking, biking or climbing,\" says Danny Quinteros, who lives in Washington, D.C., and works at REI.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Quinteros is planning a hike of the Appalachian Trail, which cuts through many tick-infested areas. And because of the rise in tick-borne diseases, permethrin has become part of his protection routine.\u003c/p>\n\u003cp>He takes a can and sprays it on a T-shirt. \"You want to stay back about 6 to 8 inches away from the clothing,\" he says. He applies an even coat, then flips the T-shirt over to spray the back.\u003c/p>\n\u003cp>In addition to treating his clothes with permethrin, Quinteros wears a \u003ca href=\"https://www.epa.gov/insect-repellents/deet\">DEET-based\u003c/a> repellent to cover his exposed skin when he's outdoors. Together, he says, these two strategies are very effective.\u003c/p>\n\u003cp>There's scientific evidence to back up Quinteros' observations.\u003c/p>\n\u003cp>\"There are several studies that provide pretty compelling evidence that wearing permethrin-treated clothing has the potential to reduce tick bites,\" says \u003ca href=\"http://wcsu.edu/sigma-xi/neeta-connally/\" target=\"_blank\" rel=\"noopener\">Neeta Connally\u003c/a>, a medical entomologist who oversees the Tickborne Disease Prevention Lab at Western Connecticut State University.\u003c/p>\n\u003cp>The most \u003ca href=\"https://academic.oup.com/jme/advance-article/doi/10.1093/jme/tjy062/4999656\" target=\"_blank\" rel=\"noopener\">recent study\u003c/a>, published in May in the \u003cem>Journal of Medical Entomology,\u003c/em> comes from researchers at the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Researchers purchased 10 different types of permethrin-treated clothing, including T-shirts, socks and pants from \u003ca href=\"https://www.insectshield.com/?mkwid=s1nqM9s0h&pcrid=278970168178&pmt=p&pkw=insect%20shield&pdv=c&slid=&product=&gclid=CjwKCAjwg_fZBRAoEiwAppvp-QZ8hfNLPVdP5uLKhbz9cznj2xFsO6HFT8tuFOEdo9pnQgSudOnGIBoCK_oQAvD_BwE\" target=\"_blank\" rel=\"noopener\">Insect Shield\u003c/a>, a purveyor of pretreated clothing. (\u003ca href=\"http://www.orvis.com/s/insect-repellent-clothing-by-bugsaway-from-orvis/3741\" target=\"_blank\" rel=\"noopener\">Bugsaway\u003c/a> is another brand of permethrin-treated clothing, and Cabela's \u003ca href=\"https://www.cabelas.com/product/cabela-s-men-s-insect-defense-over-the-calf-socks/2194854.uts?Ntk=AllProducts&searchPath=%2Fcatalog%2Fsearch%2F%3FN%3D5100830%26Ne%3D5100830%26Ntk%3DAllProducts%26Ntt%3Dinsect%26Ntx%3Dmode%252Bmatchallpartial%26WT.srch%3D1%26WT.tsrc%3DPPC%26rid%3D20%26WT.mc_id%3DGOOGLE%257Cmec_insect%252Bdefense%252Bclothing_permethrin%257CUSA%26WT.z_mc_id1%3D43700004953223579%26ds_rl%3D1256283%26gclid%3DCj0KCQjwpvzZBRCbARIsACe8vyJMjXM43KEVQge7fUu5cjDJtSMWKuOtBUrolmga-OkYJOhvp9lI49caAhLiEALw_wcB%26gclsrc%3Daw.ds&Ntt=insect&slotId=0\" target=\"_blank\" rel=\"noopener\">sells socks\u003c/a> treated with the insecticide.)\u003c/p>\n\u003cp>The scientists let loose different species of ticks on a bit of treated cloth from each sample — a piece of cloth the size of a playing card.\u003c/p>\n\u003cp>\"We wanted to see how long [the ticks would] have to be in contact with the clothing to be incapacitated and die,\" says Lars Eisen, a research entomologist for the CDC in Fort Collins, Colo., and one of the study's authors.\u003c/p>\n\u003cp>The ticks quickly become irritated after being exposed to the pesticide, Eisen says.\u003c/p>\n\u003cp>\"They essentially start flipping backwards and start rolling off the treated clothing,\" he says.\u003c/p>\n\u003cp>The black-legged tick — also known as the deer tick — which can transmit the bacteria that cause Lyme disease, was one of the species tested.\u003c/p>\n\u003cp>When black-legged nymphs (young ticks that are no bigger than a poppy seed) came into contact with the treated clothing, it took them \"less than a minute\" to receive a dose of permethrin that killed them, Eisen says.\u003c/p>\n\u003cp>And even though the ticks don't die instantly, the permethrin quickly incapacitates them so they're unable to bite.\u003c/p>\n\u003cp>So, if permethrin-treated clothing is so effective, why don't more people use it?\u003c/p>\n\u003cp>For example, in one Lyme \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Peridomestic+Lyme+Disease+Prevention+Connally\" target=\"_blank\" rel=\"noopener\">prevention study\u003c/a> published in 2009 that Connally and her team conducted in Connecticut, less than 1 percent of study participants said they ever wear treated clothing.\u003c/p>\n\u003cp>And even though awareness is growing, she says, a more recent survey \"found that many respondents were uncertain about the effectiveness and safety of treated clothing.\"\u003c/p>\n\u003cp>Permethrin has been registered with the \u003ca href=\"https://www.epa.gov/insect-repellents/repellent-treated-clothing\" target=\"_blank\" rel=\"noopener\">Environmental Protection Agency\u003c/a> since 1979, and the EPA periodically re-evaluates it.\u003c/p>\n\u003cp>It's an EPA-registered product, \"which means it must be studied for safety,\" Connally says.\u003c/p>\n\u003cp>According to \u003ca href=\"https://www.epa.gov/insect-repellents/repellent-treated-clothing#safety%20of%20permethrin\" target=\"_blank\" rel=\"noopener\">the EPA website\u003c/a>, \"All exposure scenarios showed that permethrin factory-treated clothing is unlikely to pose any significant immediate or long-term hazard to people wearing the clothing.\" Using permethrin spray according to directions to treat your own clothes should also pose little risk, the agency says.\u003c/p>\n\u003cp>The National Pesticide Information Center \u003ca href=\"http://npic.orst.edu/factsheets/PermGen.html\">notes\u003c/a> that some people who inadvertently get the insecticide spray on their skin may experience temporary tingling, redness or irritation at that site, but not serious symptoms.\u003c/p>\n\u003cp>Permethrin lotions and creams are also routinely used to treat \u003ca href=\"https://medlineplus.gov/druginfo/meds/a698037.html\" target=\"_blank\" rel=\"noopener\">head lice and scabies\u003c/a> in people 2 months of age and older.\u003c/p>\n\u003cp>\"I absolutely wear permethrin-treated clothing,\" say Connally, who has no financial ties to makers of permethrin or the treated clothes.\u003c/p>\n\u003cp>And she says many of the researchers in her lab wear treated overalls to protect themselves while doing research.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When I think of the potentially serious illnesses that my family members or I could get from a single tick bite, I feel very comfortable wearing treated clothing,\" she says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=To+Repel+Ticks%2C+Try+Spraying+Your+Clothes+With+A+Pesticide+That+Mimics+Mums&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>There's new evidence to support a decades-old strategy for preventing the tick bites that lead to all sorts of nasty diseases, including Lyme disease and Rocky Mountain spotted fever.\u003c/p>\n\u003cp>The remedy involves spraying your clothing with \u003ca href=\"http://npic.orst.edu/factsheets/PermGen.html\" target=\"_blank\" rel=\"noopener\">permethrin\u003c/a> — a pesticide that's chemically similar to extracts of the flowering chrysanthemum plant.\u003c/p>\n\u003cp>Back in the 1980s, the U.S. military conducted several \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/3735345\" target=\"_blank\" rel=\"noopener\">tests\u003c/a> on a synthetic version of the plant-derived pesticide. When it was shown to be effective in preventing the bites of insects and ticks, the military began to purchase uniforms for soldiers that are \u003ca href=\"https://www.army.mil/article/110610/army_launches_website_about_permethrin_treated_acus\" target=\"_blank\" rel=\"noopener\">factory-treated with permethrin\u003c/a>.\u003c/p>\n\u003cp>Now, many outdoor enthusiasts are converts, too.\u003c/p>\n\u003cp>\"I love being outside — whether it's hiking, biking or climbing,\" says Danny Quinteros, who lives in Washington, D.C., and works at REI.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Quinteros is planning a hike of the Appalachian Trail, which cuts through many tick-infested areas. And because of the rise in tick-borne diseases, permethrin has become part of his protection routine.\u003c/p>\n\u003cp>He takes a can and sprays it on a T-shirt. \"You want to stay back about 6 to 8 inches away from the clothing,\" he says. He applies an even coat, then flips the T-shirt over to spray the back.\u003c/p>\n\u003cp>In addition to treating his clothes with permethrin, Quinteros wears a \u003ca href=\"https://www.epa.gov/insect-repellents/deet\">DEET-based\u003c/a> repellent to cover his exposed skin when he's outdoors. Together, he says, these two strategies are very effective.\u003c/p>\n\u003cp>There's scientific evidence to back up Quinteros' observations.\u003c/p>\n\u003cp>\"There are several studies that provide pretty compelling evidence that wearing permethrin-treated clothing has the potential to reduce tick bites,\" says \u003ca href=\"http://wcsu.edu/sigma-xi/neeta-connally/\" target=\"_blank\" rel=\"noopener\">Neeta Connally\u003c/a>, a medical entomologist who oversees the Tickborne Disease Prevention Lab at Western Connecticut State University.\u003c/p>\n\u003cp>The most \u003ca href=\"https://academic.oup.com/jme/advance-article/doi/10.1093/jme/tjy062/4999656\" target=\"_blank\" rel=\"noopener\">recent study\u003c/a>, published in May in the \u003cem>Journal of Medical Entomology,\u003c/em> comes from researchers at the Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>Researchers purchased 10 different types of permethrin-treated clothing, including T-shirts, socks and pants from \u003ca href=\"https://www.insectshield.com/?mkwid=s1nqM9s0h&pcrid=278970168178&pmt=p&pkw=insect%20shield&pdv=c&slid=&product=&gclid=CjwKCAjwg_fZBRAoEiwAppvp-QZ8hfNLPVdP5uLKhbz9cznj2xFsO6HFT8tuFOEdo9pnQgSudOnGIBoCK_oQAvD_BwE\" target=\"_blank\" rel=\"noopener\">Insect Shield\u003c/a>, a purveyor of pretreated clothing. (\u003ca href=\"http://www.orvis.com/s/insect-repellent-clothing-by-bugsaway-from-orvis/3741\" target=\"_blank\" rel=\"noopener\">Bugsaway\u003c/a> is another brand of permethrin-treated clothing, and Cabela's \u003ca href=\"https://www.cabelas.com/product/cabela-s-men-s-insect-defense-over-the-calf-socks/2194854.uts?Ntk=AllProducts&searchPath=%2Fcatalog%2Fsearch%2F%3FN%3D5100830%26Ne%3D5100830%26Ntk%3DAllProducts%26Ntt%3Dinsect%26Ntx%3Dmode%252Bmatchallpartial%26WT.srch%3D1%26WT.tsrc%3DPPC%26rid%3D20%26WT.mc_id%3DGOOGLE%257Cmec_insect%252Bdefense%252Bclothing_permethrin%257CUSA%26WT.z_mc_id1%3D43700004953223579%26ds_rl%3D1256283%26gclid%3DCj0KCQjwpvzZBRCbARIsACe8vyJMjXM43KEVQge7fUu5cjDJtSMWKuOtBUrolmga-OkYJOhvp9lI49caAhLiEALw_wcB%26gclsrc%3Daw.ds&Ntt=insect&slotId=0\" target=\"_blank\" rel=\"noopener\">sells socks\u003c/a> treated with the insecticide.)\u003c/p>\n\u003cp>The scientists let loose different species of ticks on a bit of treated cloth from each sample — a piece of cloth the size of a playing card.\u003c/p>\n\u003cp>\"We wanted to see how long [the ticks would] have to be in contact with the clothing to be incapacitated and die,\" says Lars Eisen, a research entomologist for the CDC in Fort Collins, Colo., and one of the study's authors.\u003c/p>\n\u003cp>The ticks quickly become irritated after being exposed to the pesticide, Eisen says.\u003c/p>\n\u003cp>\"They essentially start flipping backwards and start rolling off the treated clothing,\" he says.\u003c/p>\n\u003cp>The black-legged tick — also known as the deer tick — which can transmit the bacteria that cause Lyme disease, was one of the species tested.\u003c/p>\n\u003cp>When black-legged nymphs (young ticks that are no bigger than a poppy seed) came into contact with the treated clothing, it took them \"less than a minute\" to receive a dose of permethrin that killed them, Eisen says.\u003c/p>\n\u003cp>And even though the ticks don't die instantly, the permethrin quickly incapacitates them so they're unable to bite.\u003c/p>\n\u003cp>So, if permethrin-treated clothing is so effective, why don't more people use it?\u003c/p>\n\u003cp>For example, in one Lyme \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/?term=Peridomestic+Lyme+Disease+Prevention+Connally\" target=\"_blank\" rel=\"noopener\">prevention study\u003c/a> published in 2009 that Connally and her team conducted in Connecticut, less than 1 percent of study participants said they ever wear treated clothing.\u003c/p>\n\u003cp>And even though awareness is growing, she says, a more recent survey \"found that many respondents were uncertain about the effectiveness and safety of treated clothing.\"\u003c/p>\n\u003cp>Permethrin has been registered with the \u003ca href=\"https://www.epa.gov/insect-repellents/repellent-treated-clothing\" target=\"_blank\" rel=\"noopener\">Environmental Protection Agency\u003c/a> since 1979, and the EPA periodically re-evaluates it.\u003c/p>\n\u003cp>It's an EPA-registered product, \"which means it must be studied for safety,\" Connally says.\u003c/p>\n\u003cp>According to \u003ca href=\"https://www.epa.gov/insect-repellents/repellent-treated-clothing#safety%20of%20permethrin\" target=\"_blank\" rel=\"noopener\">the EPA website\u003c/a>, \"All exposure scenarios showed that permethrin factory-treated clothing is unlikely to pose any significant immediate or long-term hazard to people wearing the clothing.\" Using permethrin spray according to directions to treat your own clothes should also pose little risk, the agency says.\u003c/p>\n\u003cp>The National Pesticide Information Center \u003ca href=\"http://npic.orst.edu/factsheets/PermGen.html\">notes\u003c/a> that some people who inadvertently get the insecticide spray on their skin may experience temporary tingling, redness or irritation at that site, but not serious symptoms.\u003c/p>\n\u003cp>Permethrin lotions and creams are also routinely used to treat \u003ca href=\"https://medlineplus.gov/druginfo/meds/a698037.html\" target=\"_blank\" rel=\"noopener\">head lice and scabies\u003c/a> in people 2 months of age and older.\u003c/p>\n\u003cp>\"I absolutely wear permethrin-treated clothing,\" say Connally, who has no financial ties to makers of permethrin or the treated clothes.\u003c/p>\n\u003cp>And she says many of the researchers in her lab wear treated overalls to protect themselves while doing research.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"When I think of the potentially serious illnesses that my family members or I could get from a single tick bite, I feel very comfortable wearing treated clothing,\" she says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=To+Repel+Ticks%2C+Try+Spraying+Your+Clothes+With+A+Pesticide+That+Mimics+Mums&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Family Caregivers Exchange Tips, Share Stories To Ease Alzheimer's Losses",
"title": "Family Caregivers Exchange Tips, Share Stories To Ease Alzheimer's Losses",
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"content": "\u003cp>Vicki Bartholomew started a support group for wives who are caring for a husband with Alzheimer's disease because she needed that sort of group herself.\u003c/p>\n\u003cp>They meet every month in a conference room at a new memory care facility in Nashville, Tenn., called \u003ca href=\"http://nashvillepublicradio.org/post/nashville-dementia-ward-aims-become-hub-memory-care-research#stream/0\" target=\"_blank\" rel=\"noopener\">Abe's Garden\u003c/a>, where Bartholomew's husband was one of the first residents — a Vietnam veteran and prominent attorney in Nashville.\u003c/p>\n\u003cp>\"My husband's still living, and now I'm in an even more difficult situation — I'm married, but I'm a widow,\" she says.\u003c/p>\n\u003cp>These women draw the shades and open up to each other in ways they can't with their lifelong friends.\u003c/p>\n\u003cp>\"They're still wonderful friends, but they didn't know how to handle this. It was hard for them, and as you all know, your friends don't come around as much as they used to,\" Bartholomew says. \"I was in bad shape. I didn't think I was — I did have health problems, and [now] I know I was depressed.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As the numbers of Americans afflicted with Alzheimer's disease continue to swell to an estimated 5.7 million, so do the legions of loved ones caring for friends and family members. The toll on Bartholomew's own mental health is one of the reasons the Alzheimer's Foundation of America focuses on the nation's estimated \u003ca href=\"https://www.alz.org/facts/\" target=\"_blank\" rel=\"noopener\">16 million unpaid caregivers\u003c/a>.\u003c/p>\n\u003cp>With no cure on the horizon, the foundation has been highlighting the necessity of better support for those caregivers through a \u003ca href=\"https://alzfdn.org/afa-educating-america-tour/\">national tour\u003c/a>. It stopped in Nashville earlier this spring, was in Tempe, Ariz., in June and heads to Fairfax, Va., in September; the tour includes at least six more cities in the fall.\u003c/p>\n\u003cp>At the live events, Alzheimer's researchers and clinicians offer guidance on a number of topics, including how to ensure safety for patients at home, care planning and even how to \u003ca href=\"https://alzfdn.org/event/afa-educating-america-tour-tempe/\" target=\"_blank\" rel=\"noopener\">entertain someone\u003c/a> with memory loss.\u003c/p>\n\u003cp>The organization promotes in-person and \u003ca href=\"https://alzfdn.org/alzheimers-foundation-americas-national-toll-free-helpline-expanding-seven-days-week/\" target=\"_blank\" rel=\"noopener\">telephone support groups\u003c/a>, since being a caregiver is often a barrier to getting out of the house alone. But even virtual support systems have shown some effectiveness at reducing loneliness, stress and depression \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668714/\" target=\"_blank\" rel=\"noopener\">in a small 2014 study.\u003c/a>\u003c/p>\n\u003cp>\"We have to do everything we can to educate a caregiver, to provide them with the best practices on caring for somebody,\" says \u003ca href=\"https://alzfdn.org/team_member/charles-j-fuschillo-jr/\" target=\"_blank\" rel=\"noopener\">Charles J. Fuschillo Jr.,\u003c/a> the Alzheimer's Foundation of America's CEO.\u003c/p>\n\u003cp>For example, the AFA \u003ca href=\"https://alzfdn.org/caregiving-resources/fact-sheets-information/\" target=\"_blank\" rel=\"noopener\">recommends\u003c/a> that family members:\u003c/p>\n\u003cul>\n\u003cli>Feed Alzheimer's patients one food at a time. \"A busy plate can be confusing,\" the group says.\u003c/li>\n\u003cli>Mark rooms in the house with signs to avoid unnecessary confusion.\u003c/li>\n\u003cli>Remind a person with Alzheimer's to use the toilet; don't wait for them to ask.\u003c/li>\n\u003cli>When traveling, stick with familiar destinations.\u003c/li>\n\u003cli>Watch for a cough while eating; it can signal a swallowing disorder in people with dementia.\u003c/li>\n\u003cli>Schedule overnight stays at a memory-care facility so the caregiver gets some respite.\u003c/li>\n\u003c/ul>\n\u003cp>Just as important, Fuschillo says, \"We want to do everything we can to avoid caregiver burnout.\"\u003c/p>\n\u003cp>The breaking point sneaks up on even the most committed caregiver, say Alzheimer's advocates, especially as the nights grow more sleepless. Alzheimer's patients can tend to pace, or wake up their partner every few minutes. They can even become violent. Or, perhaps worse, they can leave the house.\u003c/p>\n\u003cp>\"And I've had some issues at night that I had to take care of alone,\" says Pam Hawkins, whose husband has Alzheimer's. \"But I'm not ready to have anyone there at night.\"\u003c/p>\n\u003cp>For now, she says, her husband usually sleeps all night. And if there's a problem, her son-in-law is 15 minutes away.\u003c/p>\n\u003cp>She's had to hire caregivers during the day. Knowing how to find and hire the right person is a shared concern by Alzheimer's family members that has inspired an entire\u003ca href=\"https://www.alz.org/national/documents/topicsheet_homehealth.pdf\" target=\"_blank\" rel=\"noopener\"> checklist\u003c/a> for navigating the process. The tips include these: Interview the aide in the home. Over-share information about the patient. Ask what kind of quality control a supervisor will provide.\u003c/p>\n\u003cp>Hawkins is adamant about keeping her husband at home, whatever the cost.\u003c/p>\n\u003cp>\"He's not going anywhere,\" she says. \"He's staying at our home until he moves to heaven. We made that decision a long time ago.\"\u003c/p>\n\u003cp>But many caregivers have no choice.\u003c/p>\n\u003cp>April Simpkins says tending to her husband became all consuming, and she's young enough that she still needs to keep her job; she works at a local university.\u003c/p>\n\u003cp>\"It was not possible for us to keep Joe at home,\" she says.\u003c/p>\n\u003cp>Simpkins found she'd often have to call her husband's siblings to settle him down over the phone. One night, she had to dial 911 when he kept yelling in the hallways of their condo building.\u003c/p>\n\u003cp>And yet she felt some societal pressure that she wasn't doing enough.\u003c/p>\n\u003cp>\"There's a lot of ... glory given to the whole idea of someone being long-suffering and staying at home and giving up their life, basically, to care for their loved one,\" Simpkins says. \"It makes it harder for people who can't do that.\"\u003c/p>\n\u003cp>Everyone around the table nods in agreement. Whatever stage of illness their loved one is experiencing, these caregivers understand the complicated existence that many have dubbed \"the long goodbye.\"\u003c/p>\n\u003cp>Along with sharing the sorrow, they find a way to share in the humor of it all — one woman says her husband wears a laundry-basket's-worth of shirts and pants because he forgets he's already gotten dressed. Even tips on how to reduce the odor from incontinence are offered with a loving laugh.\u003c/p>\n\u003cp>The support group ends with hugs. Some women head for the parking lot. Others buzz through the locked doors to see their husbands.\u003c/p>\n\u003cp>Simpkins sits down for lunch with Joe, who is a former state employee and a youthful-looking 66 years old. She drapes an arm around his slumping shoulders and assists him as he spears a cold strawberry with his fork.\u003c/p>\n\u003cp>\"You know, there are some days,\" she says, interrupted by a random reflection from Joe. \"Yeah, some days are clearer than others.\"\u003c/p>\n\u003cp>Simpkins tries to stop by to see her husband every day. But it's a wicked kind of blessing, she says, that when she misses a visit, Joe no longer notices.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with Nashville Public Radio and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Nashville Public Radio. To see more, visit \u003ca href=\"http://www.wpln.org/\" target=\"_blank\" rel=\"noopener\">Nashville Public Radio\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Family+Caregivers+Exchange+Tips%2C+Share+Stories+To+Ease+Alzheimer%27s+Losses&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Vicki Bartholomew started a support group for wives who are caring for a husband with Alzheimer's disease because she needed that sort of group herself.\u003c/p>\n\u003cp>They meet every month in a conference room at a new memory care facility in Nashville, Tenn., called \u003ca href=\"http://nashvillepublicradio.org/post/nashville-dementia-ward-aims-become-hub-memory-care-research#stream/0\" target=\"_blank\" rel=\"noopener\">Abe's Garden\u003c/a>, where Bartholomew's husband was one of the first residents — a Vietnam veteran and prominent attorney in Nashville.\u003c/p>\n\u003cp>\"My husband's still living, and now I'm in an even more difficult situation — I'm married, but I'm a widow,\" she says.\u003c/p>\n\u003cp>These women draw the shades and open up to each other in ways they can't with their lifelong friends.\u003c/p>\n\u003cp>\"They're still wonderful friends, but they didn't know how to handle this. It was hard for them, and as you all know, your friends don't come around as much as they used to,\" Bartholomew says. \"I was in bad shape. I didn't think I was — I did have health problems, and [now] I know I was depressed.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As the numbers of Americans afflicted with Alzheimer's disease continue to swell to an estimated 5.7 million, so do the legions of loved ones caring for friends and family members. The toll on Bartholomew's own mental health is one of the reasons the Alzheimer's Foundation of America focuses on the nation's estimated \u003ca href=\"https://www.alz.org/facts/\" target=\"_blank\" rel=\"noopener\">16 million unpaid caregivers\u003c/a>.\u003c/p>\n\u003cp>With no cure on the horizon, the foundation has been highlighting the necessity of better support for those caregivers through a \u003ca href=\"https://alzfdn.org/afa-educating-america-tour/\">national tour\u003c/a>. It stopped in Nashville earlier this spring, was in Tempe, Ariz., in June and heads to Fairfax, Va., in September; the tour includes at least six more cities in the fall.\u003c/p>\n\u003cp>At the live events, Alzheimer's researchers and clinicians offer guidance on a number of topics, including how to ensure safety for patients at home, care planning and even how to \u003ca href=\"https://alzfdn.org/event/afa-educating-america-tour-tempe/\" target=\"_blank\" rel=\"noopener\">entertain someone\u003c/a> with memory loss.\u003c/p>\n\u003cp>The organization promotes in-person and \u003ca href=\"https://alzfdn.org/alzheimers-foundation-americas-national-toll-free-helpline-expanding-seven-days-week/\" target=\"_blank\" rel=\"noopener\">telephone support groups\u003c/a>, since being a caregiver is often a barrier to getting out of the house alone. But even virtual support systems have shown some effectiveness at reducing loneliness, stress and depression \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668714/\" target=\"_blank\" rel=\"noopener\">in a small 2014 study.\u003c/a>\u003c/p>\n\u003cp>\"We have to do everything we can to educate a caregiver, to provide them with the best practices on caring for somebody,\" says \u003ca href=\"https://alzfdn.org/team_member/charles-j-fuschillo-jr/\" target=\"_blank\" rel=\"noopener\">Charles J. Fuschillo Jr.,\u003c/a> the Alzheimer's Foundation of America's CEO.\u003c/p>\n\u003cp>For example, the AFA \u003ca href=\"https://alzfdn.org/caregiving-resources/fact-sheets-information/\" target=\"_blank\" rel=\"noopener\">recommends\u003c/a> that family members:\u003c/p>\n\u003cul>\n\u003cli>Feed Alzheimer's patients one food at a time. \"A busy plate can be confusing,\" the group says.\u003c/li>\n\u003cli>Mark rooms in the house with signs to avoid unnecessary confusion.\u003c/li>\n\u003cli>Remind a person with Alzheimer's to use the toilet; don't wait for them to ask.\u003c/li>\n\u003cli>When traveling, stick with familiar destinations.\u003c/li>\n\u003cli>Watch for a cough while eating; it can signal a swallowing disorder in people with dementia.\u003c/li>\n\u003cli>Schedule overnight stays at a memory-care facility so the caregiver gets some respite.\u003c/li>\n\u003c/ul>\n\u003cp>Just as important, Fuschillo says, \"We want to do everything we can to avoid caregiver burnout.\"\u003c/p>\n\u003cp>The breaking point sneaks up on even the most committed caregiver, say Alzheimer's advocates, especially as the nights grow more sleepless. Alzheimer's patients can tend to pace, or wake up their partner every few minutes. They can even become violent. Or, perhaps worse, they can leave the house.\u003c/p>\n\u003cp>\"And I've had some issues at night that I had to take care of alone,\" says Pam Hawkins, whose husband has Alzheimer's. \"But I'm not ready to have anyone there at night.\"\u003c/p>\n\u003cp>For now, she says, her husband usually sleeps all night. And if there's a problem, her son-in-law is 15 minutes away.\u003c/p>\n\u003cp>She's had to hire caregivers during the day. Knowing how to find and hire the right person is a shared concern by Alzheimer's family members that has inspired an entire\u003ca href=\"https://www.alz.org/national/documents/topicsheet_homehealth.pdf\" target=\"_blank\" rel=\"noopener\"> checklist\u003c/a> for navigating the process. The tips include these: Interview the aide in the home. Over-share information about the patient. Ask what kind of quality control a supervisor will provide.\u003c/p>\n\u003cp>Hawkins is adamant about keeping her husband at home, whatever the cost.\u003c/p>\n\u003cp>\"He's not going anywhere,\" she says. \"He's staying at our home until he moves to heaven. We made that decision a long time ago.\"\u003c/p>\n\u003cp>But many caregivers have no choice.\u003c/p>\n\u003cp>April Simpkins says tending to her husband became all consuming, and she's young enough that she still needs to keep her job; she works at a local university.\u003c/p>\n\u003cp>\"It was not possible for us to keep Joe at home,\" she says.\u003c/p>\n\u003cp>Simpkins found she'd often have to call her husband's siblings to settle him down over the phone. One night, she had to dial 911 when he kept yelling in the hallways of their condo building.\u003c/p>\n\u003cp>And yet she felt some societal pressure that she wasn't doing enough.\u003c/p>\n\u003cp>\"There's a lot of ... glory given to the whole idea of someone being long-suffering and staying at home and giving up their life, basically, to care for their loved one,\" Simpkins says. \"It makes it harder for people who can't do that.\"\u003c/p>\n\u003cp>Everyone around the table nods in agreement. Whatever stage of illness their loved one is experiencing, these caregivers understand the complicated existence that many have dubbed \"the long goodbye.\"\u003c/p>\n\u003cp>Along with sharing the sorrow, they find a way to share in the humor of it all — one woman says her husband wears a laundry-basket's-worth of shirts and pants because he forgets he's already gotten dressed. Even tips on how to reduce the odor from incontinence are offered with a loving laugh.\u003c/p>\n\u003cp>The support group ends with hugs. Some women head for the parking lot. Others buzz through the locked doors to see their husbands.\u003c/p>\n\u003cp>Simpkins sits down for lunch with Joe, who is a former state employee and a youthful-looking 66 years old. She drapes an arm around his slumping shoulders and assists him as he spears a cold strawberry with his fork.\u003c/p>\n\u003cp>\"You know, there are some days,\" she says, interrupted by a random reflection from Joe. \"Yeah, some days are clearer than others.\"\u003c/p>\n\u003cp>Simpkins tries to stop by to see her husband every day. But it's a wicked kind of blessing, she says, that when she misses a visit, Joe no longer notices.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of NPR's reporting partnership with Nashville Public Radio and Kaiser Health News.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Nashville Public Radio. To see more, visit \u003ca href=\"http://www.wpln.org/\" target=\"_blank\" rel=\"noopener\">Nashville Public Radio\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Family+Caregivers+Exchange+Tips%2C+Share+Stories+To+Ease+Alzheimer%27s+Losses&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "For Women Over 30, There May Be A Better Choice Than The Pap Smear",
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"headTitle": "Women’s Health | KQED Future of You | KQED Science",
"content": "\u003cp>For most women under 65, a visit to the gynecologist often includes an unpleasant necessity: a Pap smear to check for cervical cancer risk.\u003c/p>\n\u003cp>The test involves letting a doctor or nurse scrape cells from the back of the cervix, which are visually inspected for signs of abnormality.\u003c/p>\n\u003cp>There's another way to screen for cervical cancer risk, by directly testing for the human papillomavirus, or HPV, which causes 99 percent of cervical cancer. \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.7464\" target=\"_blank\" rel=\"noopener\"> A study published in JAMA\u003c/a> Tuesday suggests that method might be preferable for women age 30 and over.\u003c/p>\n\u003cp>The FDA in 2014 approved the first HPV test, which tests cervical cells for the presence of HPV.\u003c/p>\n\u003cp>HPV testing also can be done on samples of vaginal and cervical secretions that clinicians or women themselves gather with a swab — a less invasive process than the Pap. That process was shown to be accurate in multiple studies but is not yet used in clinical practice in the U.S.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new study, called the HPV FOCAL trial, compared the HPV test with traditional Pap smear screening among 19,000 Canadian women over four years. It adds to a body of research suggesting that HPV testing might be more accurate.\u003c/p>\n\u003cp>\"In our world this study is going to be a pretty big deal, in a good way,\" says \u003ca href=\"https://faculty.mdanderson.org/profiles/kathleen_schmeler.html\" target=\"_blank\" rel=\"noopener\">Dr. Kathleen Schmeler\u003c/a>, a gynecologic oncologist at the University of Texas MD Anderson Cancer Center.\u003c/p>\n\u003cp>Schmeler says that in the U.S., it has been hard to justify replacing the Pap smear with the HPV test because there has not been a head-to-head comparison until now.\u003c/p>\n\u003cp>The issue is not resolved. Some are still skeptical of relying on HPV testing alone, and co-testing, or using both the HPV test and a Pap smear, is still the standard.\u003c/p>\n\u003cp>Cervical cancer screening is essential because nearly \u003ca href=\"https://gis.cdc.gov/Cancer/USCS/DataViz.html\" target=\"_blank\" rel=\"noopener\">13,000 women in the U.S. are diagnosed with cervical cancer\u003c/a> annually. More than 4,000 women die from it, even with screening and treatment.\u003c/p>\n\u003cp>Current screening guidelines from the U.S. Preventive Services Task Force recommend women ages 30 to 65 have a Pap smear every three years, or every five years if an HPV test is done at the same time.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/cervical-cancer-screening2\" target=\"_blank\" rel=\"noopener\">draft recommendations issued last fall by USPSTF\u003c/a> recommended just one or the other — a Pap smear or an HPV test — instead of co-testing for women 30 and up. The organization has yet to issue final guidelines. This new study could prove important in deciding practice guidelines.\u003c/p>\n\u003cp>At the start of the HPV FOCAL trial, some women received HPV testing and some had a Pap smear; those in the Pap smear group who tested negative had a second Pap after two years. Both groups were tested again using both methods after four years.\u003c/p>\n\u003cp>Neither method was foolproof. The final round of co-testing found additional abnormal cells in some women who originally tested negative in both groups. Women who originally had the Pap smear were more than twice as likely to have abnormal cells. Of the women who tested negative on the HPV test only 22 women showed abnormal cells (grade 3 or worse), while from the Pap smear group, 52 women ended up with abnormal cells.\u003c/p>\n\u003cp>\"What our study shows is that by using HPV testing, we detect precancerous lesions earlier,\" says \u003ca href=\"http://www.spph.ubc.ca/person/gina-ogilvie/\" target=\"_blank\" rel=\"noopener\">lead author Dr. Gina Ogilvie\u003c/a>. \"If women have a negative HPV test, they are significantly less likely to have a precancerous lesion four years later, meaning we can extend screening time.\"\u003c/p>\n\u003cp>Ogilvie, a professor of medicine at the University of British Columbia, says this study shows that the real value of co-testing actually comes from the HPV test, not the Pap smear.\u003c/p>\n\u003cp>Studies like this one could lead to a change in guidelines, according to Dr. Chris Zahn, the vice president of practice for the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>\"This study adds evidence to those that evaluated use of HPV as a primary screening modality, and the findings support the use of HPV only as a primary screen,\" he wrote in an email.\u003c/p>\n\u003cp>Even if guidelines do change for women over 30, the Pap smear is still important for women ages 21-29. They can't rely on HPV testing, Schmeler says, because almost everyone in that age group will contract HPV, and in many cases it goes away on its own. If the virus persists until their 30s, that's where problems come in.\u003c/p>\n\u003cp>\"If you tested everyone for HPV in their 20s, they are almost all going to be positive, but there's going to be all of this intervention that's not needed,\" she says.\u003c/p>\n\u003cp>Moving away from co-testing may not be a good idea, says \u003ca href=\"http://www.colposcopycenter.com/MeetDrMarkSpitzer.html\" target=\"_blank\" rel=\"noopener\">Mark Spitzer\u003c/a>, an OB-GYN and past president of American Society for Colposcopy and Cervical Pathology. He wrote in an email that this new study actually shows the small but significant benefit of co-testing. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period.\u003c/p>\n\u003cp>\"In the U.S., co-testing is currently the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together,\" he says.\u003c/p>\n\u003cp>\u003ca href=\"https://medicine.umich.edu/dept/family-medicine/diane-m-harper-md-mph-ms\">Dr. Diane Harper,\u003c/a> a professor of medicine who researches HPV at the University of Michigan, argues that the study was \"extraordinarily well done\" and moving away from co-testing could result in a decrease of false positives.\u003c/p>\n\u003cp>\"The whole reason for [co-testing] is that you get a slight improvement in sensitivity,\" Harper says. \"But your false positive rate blows up. It's up to 30 percent of people [who] are falsely positive.\"\u003c/p>\n\u003cp>Women who have a positive Pap smear generally get a colposcopy, which is an even closer \u003ca href=\"https://www.mayoclinic.org/tests-procedures/colposcopy/about/pac-20385036\" target=\"_blank\" rel=\"noopener\">examination of the cervix, vagina and vulva \u003c/a>for signs of disease.\u003c/p>\n\u003cp>A false positive could mean going through a biopsy during a colposcopy. Biopsies come with risks like bleeding, infection and pelvic pain, according to the Mayo Clinic. Harper says false positives bring unnecessary costs and fears to patients.\u003c/p>\n\u003cp>\"That's a lot of women that are unnecessarily worried,\" she says.\u003c/p>\n\u003cp>Women can get a clear result from a simple HPV test and those who receive a negative result will be able to trust those results for several years, she says.\u003c/p>\n\u003cp>\"It's really amazing — there's no other test that gives us this level of reassurance for that period of time for a cancer,\" Harper says.\u003c/p>\n\u003cp>Pap smears rely on the human eye to get results, she says, and it's far preferable to detect problems on a molecular level.\u003c/p>\n\u003cp>One caution about the study findings, says \u003ca href=\"https://www.uclahealth.org/carol-mangione\" target=\"_blank\" rel=\"noopener\">Dr. Carol Mangione\u003c/a>, a USPSTF task force member and UCLA professor of medicine, is that screening — either kind — is what saves lives. She says the method of testing comes second to being sure that all women, \u003ca href=\"https://www.npr.org/sections/health-shots/2017/10/11/556895389/could-making-cancer-screening-simpler-increase-womens-risk\" target=\"_blank\" rel=\"noopener\">especially high-prevalence groups like black and Hispanic women\u003c/a>, are able to get the testing they need.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"Most cases of cervical cancer happen in women who have not been regularly screened, or who have been screened, but don't have access to appropriate treatment,\" she says. \"When we think about cervical cancer screening, we want to think about it in the framework of how do we get this test in the hands of all women?\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Women+Over+30%2C+There+May+Be+A+Better+Choice+Than+The+Pap+Smear&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>For most women under 65, a visit to the gynecologist often includes an unpleasant necessity: a Pap smear to check for cervical cancer risk.\u003c/p>\n\u003cp>The test involves letting a doctor or nurse scrape cells from the back of the cervix, which are visually inspected for signs of abnormality.\u003c/p>\n\u003cp>There's another way to screen for cervical cancer risk, by directly testing for the human papillomavirus, or HPV, which causes 99 percent of cervical cancer. \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.7464\" target=\"_blank\" rel=\"noopener\"> A study published in JAMA\u003c/a> Tuesday suggests that method might be preferable for women age 30 and over.\u003c/p>\n\u003cp>The FDA in 2014 approved the first HPV test, which tests cervical cells for the presence of HPV.\u003c/p>\n\u003cp>HPV testing also can be done on samples of vaginal and cervical secretions that clinicians or women themselves gather with a swab — a less invasive process than the Pap. That process was shown to be accurate in multiple studies but is not yet used in clinical practice in the U.S.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new study, called the HPV FOCAL trial, compared the HPV test with traditional Pap smear screening among 19,000 Canadian women over four years. It adds to a body of research suggesting that HPV testing might be more accurate.\u003c/p>\n\u003cp>\"In our world this study is going to be a pretty big deal, in a good way,\" says \u003ca href=\"https://faculty.mdanderson.org/profiles/kathleen_schmeler.html\" target=\"_blank\" rel=\"noopener\">Dr. Kathleen Schmeler\u003c/a>, a gynecologic oncologist at the University of Texas MD Anderson Cancer Center.\u003c/p>\n\u003cp>Schmeler says that in the U.S., it has been hard to justify replacing the Pap smear with the HPV test because there has not been a head-to-head comparison until now.\u003c/p>\n\u003cp>The issue is not resolved. Some are still skeptical of relying on HPV testing alone, and co-testing, or using both the HPV test and a Pap smear, is still the standard.\u003c/p>\n\u003cp>Cervical cancer screening is essential because nearly \u003ca href=\"https://gis.cdc.gov/Cancer/USCS/DataViz.html\" target=\"_blank\" rel=\"noopener\">13,000 women in the U.S. are diagnosed with cervical cancer\u003c/a> annually. More than 4,000 women die from it, even with screening and treatment.\u003c/p>\n\u003cp>Current screening guidelines from the U.S. Preventive Services Task Force recommend women ages 30 to 65 have a Pap smear every three years, or every five years if an HPV test is done at the same time.\u003c/p>\n\u003cp>But \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/cervical-cancer-screening2\" target=\"_blank\" rel=\"noopener\">draft recommendations issued last fall by USPSTF\u003c/a> recommended just one or the other — a Pap smear or an HPV test — instead of co-testing for women 30 and up. The organization has yet to issue final guidelines. This new study could prove important in deciding practice guidelines.\u003c/p>\n\u003cp>At the start of the HPV FOCAL trial, some women received HPV testing and some had a Pap smear; those in the Pap smear group who tested negative had a second Pap after two years. Both groups were tested again using both methods after four years.\u003c/p>\n\u003cp>Neither method was foolproof. The final round of co-testing found additional abnormal cells in some women who originally tested negative in both groups. Women who originally had the Pap smear were more than twice as likely to have abnormal cells. Of the women who tested negative on the HPV test only 22 women showed abnormal cells (grade 3 or worse), while from the Pap smear group, 52 women ended up with abnormal cells.\u003c/p>\n\u003cp>\"What our study shows is that by using HPV testing, we detect precancerous lesions earlier,\" says \u003ca href=\"http://www.spph.ubc.ca/person/gina-ogilvie/\" target=\"_blank\" rel=\"noopener\">lead author Dr. Gina Ogilvie\u003c/a>. \"If women have a negative HPV test, they are significantly less likely to have a precancerous lesion four years later, meaning we can extend screening time.\"\u003c/p>\n\u003cp>Ogilvie, a professor of medicine at the University of British Columbia, says this study shows that the real value of co-testing actually comes from the HPV test, not the Pap smear.\u003c/p>\n\u003cp>Studies like this one could lead to a change in guidelines, according to Dr. Chris Zahn, the vice president of practice for the American College of Obstetricians and Gynecologists.\u003c/p>\n\u003cp>\"This study adds evidence to those that evaluated use of HPV as a primary screening modality, and the findings support the use of HPV only as a primary screen,\" he wrote in an email.\u003c/p>\n\u003cp>Even if guidelines do change for women over 30, the Pap smear is still important for women ages 21-29. They can't rely on HPV testing, Schmeler says, because almost everyone in that age group will contract HPV, and in many cases it goes away on its own. If the virus persists until their 30s, that's where problems come in.\u003c/p>\n\u003cp>\"If you tested everyone for HPV in their 20s, they are almost all going to be positive, but there's going to be all of this intervention that's not needed,\" she says.\u003c/p>\n\u003cp>Moving away from co-testing may not be a good idea, says \u003ca href=\"http://www.colposcopycenter.com/MeetDrMarkSpitzer.html\" target=\"_blank\" rel=\"noopener\">Mark Spitzer\u003c/a>, an OB-GYN and past president of American Society for Colposcopy and Cervical Pathology. He wrote in an email that this new study actually shows the small but significant benefit of co-testing. He cites the small group of women who had abnormal cells discovered through a Pap smear at the end of the study period.\u003c/p>\n\u003cp>\"In the U.S., co-testing is currently the recommended gold standard, and neither doctors nor their patients should be willing to give up the added benefit you get from screening with a Pap test and HPV test together,\" he says.\u003c/p>\n\u003cp>\u003ca href=\"https://medicine.umich.edu/dept/family-medicine/diane-m-harper-md-mph-ms\">Dr. Diane Harper,\u003c/a> a professor of medicine who researches HPV at the University of Michigan, argues that the study was \"extraordinarily well done\" and moving away from co-testing could result in a decrease of false positives.\u003c/p>\n\u003cp>\"The whole reason for [co-testing] is that you get a slight improvement in sensitivity,\" Harper says. \"But your false positive rate blows up. It's up to 30 percent of people [who] are falsely positive.\"\u003c/p>\n\u003cp>Women who have a positive Pap smear generally get a colposcopy, which is an even closer \u003ca href=\"https://www.mayoclinic.org/tests-procedures/colposcopy/about/pac-20385036\" target=\"_blank\" rel=\"noopener\">examination of the cervix, vagina and vulva \u003c/a>for signs of disease.\u003c/p>\n\u003cp>A false positive could mean going through a biopsy during a colposcopy. Biopsies come with risks like bleeding, infection and pelvic pain, according to the Mayo Clinic. Harper says false positives bring unnecessary costs and fears to patients.\u003c/p>\n\u003cp>\"That's a lot of women that are unnecessarily worried,\" she says.\u003c/p>\n\u003cp>Women can get a clear result from a simple HPV test and those who receive a negative result will be able to trust those results for several years, she says.\u003c/p>\n\u003cp>\"It's really amazing — there's no other test that gives us this level of reassurance for that period of time for a cancer,\" Harper says.\u003c/p>\n\u003cp>Pap smears rely on the human eye to get results, she says, and it's far preferable to detect problems on a molecular level.\u003c/p>\n\u003cp>One caution about the study findings, says \u003ca href=\"https://www.uclahealth.org/carol-mangione\" target=\"_blank\" rel=\"noopener\">Dr. Carol Mangione\u003c/a>, a USPSTF task force member and UCLA professor of medicine, is that screening — either kind — is what saves lives. She says the method of testing comes second to being sure that all women, \u003ca href=\"https://www.npr.org/sections/health-shots/2017/10/11/556895389/could-making-cancer-screening-simpler-increase-womens-risk\" target=\"_blank\" rel=\"noopener\">especially high-prevalence groups like black and Hispanic women\u003c/a>, are able to get the testing they need.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"tagline": "Art is where you find it",
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"soldout": {
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"info": "The TED Radio Hour is a journey through fascinating ideas, astonishing inventions, fresh approaches to old problems, and new ways to think and create.",
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