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"content": "\u003cp>[audio mp3=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/20180327_fa_01.mp3\" autoplay=\"true\"][/audio]\u003c/p>\n\u003cp>When journalist Maya Dusenbery was in her 20s, she started experiencing progressive pain in her joints, which she learned was caused by \u003ca href=\"https://www.npr.org/tags/164632370/rheumatoid-arthritis\" target=\"_blank\" rel=\"noopener\">rheumatoid arthritis.\u003c/a>\u003c/p>\n\u003cp>As she began to research her own condition, Dusenbery realized how lucky she was to have been diagnosed relatively easily. Other women with similar symptoms, she says, \"experienced very long diagnostic delays and felt ... that their symptoms were not taken seriously.\"\u003c/p>\n\u003cp>Dusenbery says these experiences fit into a larger pattern of gender bias in medicine. Her new book, \u003cem>Doing Harm,\u003c/em> makes the case that women's symptoms are often dismissed and misdiagnosed — in part because of what she calls the \"systemic and unconscious bias that's rooted ... in what doctors, regardless of their own gender, are learning in medical schools.\"\u003c/p>\n\u003cp>\"I definitely believe that the fact that medicine has been historically and continues to be mainly run by men has been a source of these problems,\" she says. \"The medical knowledge that we have is just skewed towards knowing more about men's bodies and the conditions that disproportionately affect them.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dusenbery is also the executive editor of \u003ca href=\"http://feministing.com/\" target=\"_blank\" rel=\"noopener\">Feministing\u003c/a>, a website of writing by young feminists about social, cultural and political issues.\u003c/p>\n\u003ch3 class=\"edTag\">\u003cstrong>Interview Highlights\u003c/strong>\u003c/h3>\n\u003cp>\u003cstrong>On how women have been left out of drug trials and medical observational studies\u003c/strong>\u003c/p>\n\u003cp>There was a lot of concern about including women in drug trials, specifically because of concerns about affecting their hypothetical fetuses. So in the '70s the FDA had a policy of prohibiting any woman of childbearing age from participating in early-stage drug trials.\u003c/p>\n\u003cp>But we also see that at that time, women were also excluded from studies that were just observational studies — not just drug trials. In the '90s, when there were congressional hearings about this problem, the public learned that women had been left out of things like a big observational study looking at normal human aging that was ongoing for 20 years. It started in the '50s, and for the first 20 years women had been left out of that.\u003c/p>\n\u003cp>\u003cstrong>On women's recent inclusion in National Institutes of Health studies \u003c/strong>\u003c/p>\n\u003cp>[In] 1993, Congress passed a law saying that women need to be included in NIH-funded clinical research. And in the aggregate, women do make up a majority of subjects in NIH research. However, we still don't know that women are necessarily adequately represented in all areas of research, because the NIH looks at the aggregate numbers, and the outside analyses that have been done show that women are still a little bit underrepresented.\u003c/p>\n\u003cp>More importantly, even though women are usually included in most studies today, it's still not the norm to really analyze results by gender to actually see if there are differences between men and women. So experts have described this to me as an \"add women and stir\" approach. Women are included, but we're still not getting the knowledge we need about ways that their symptoms or responses to treatment might differ from men.\u003c/p>\n\u003cp>\u003cstrong>On why some medicine affects men and women differently — and how that results in women receiving excessive doses of most drugs\u003c/strong>\u003c/p>\n\u003cp>There are a lot of factors that go into these recognized sex differences in drug metabolism and response. ... Percentage of body fat affects it. Hormones, different levels of enzymes — all of these things go into it. But really, probably the most straightforward [factor] is that, on average, men have a higher body weight than women. And yet, even that difference is not usually accounted for. We prescribe drugs based on this one-size-fits-all dosage, but that ends up meaning that, on average, women are being overdosed on most drugs.\u003c/p>\n\u003cp>\u003cstrong>On the difference between how men and women experience heart disease \u003c/strong>\u003c/p>\n\u003cp>Over the last couple of decades, there's been a recognition that for the first 35 years we were studying heart disease, we were really mostly studying it in men. And so there's been a concerted effort to go back and compare women's experiences to men's, which has led to the knowledge that women are more likely to have what are considered to be atypical symptoms. [And] the only reason they're considered \"atypical\" is because the norm has been this male model — so, atypical symptoms, like pain in the neck or shoulder, nausea, fatigue, lightheadedness. ...\u003c/p>\n\u003cp>Partly as a result of those differences in symptoms — which are still not always recognized by health care providers — women (especially younger women) are more likely to be turned away when they're having a heart attack, sent home. One study found it was younger women — so women under 55 — were seven times more likely than the average patient to be sent home mid-heart attack. ... Even if they're not sent home, you see longer delays [for women] to getting [electrocardiograms] and other diagnostic testing or interventions in the ER setting.\u003c/p>\n\u003cp>\u003cstrong>On how the subjective symptom of fatigue is dismissed in women\u003c/strong>\u003c/p>\n\u003cp>One of the most common [symptoms] that really is common across ... [the autoimmune diseases] is fatigue — a really deep, deep fatigue that isn't just being sleep-deprived from staying up too late. That fatigue, comparable to pain, is this very subjective symptom that's hard to communicate to other people. And I think that women are up against this real distrust of their own reports of their symptoms.\u003c/p>\n\u003cp>So conditions like autoimmune diseases that really are marked by these subjective symptoms of pain and fatigue, I think, are very easy to dismiss in women. ... Even though we do know about autoimmune diseases, during that diagnostic delay, women are often told, \"You're just stressed. You're tired.\" And [they] have a really hard time convincing doctors that this fatigue is abnormal.\u003c/p>\n\u003cp>\u003cstrong>On some female patients taking a male relative or spouse with them to doctors' appointments to vouch for them\u003c/strong>\u003c/p>\n\u003cp>I found this to be one of the most disturbing things that I found in my research: how many women reported that as they were fighting to get their symptoms taken seriously, [they] just sort of sensed that what they really needed was somebody to testify to their symptoms, to testify to their sanity, and felt that bringing a partner or a father or even a son would be helpful. And then [they] found that it was [helpful], that they were treated differently when there was that man in the room who was corroborating their reports.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Heidi Saman and Seth Kelley produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Scott Hensley adapted it for the Web.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Fresh Air. To see more, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\" target=\"_blank\" rel=\"noopener\">Fresh Air\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+%27Bad+Medicine%27+Dismisses+And+Misdiagnoses+Women%27s+Symptoms&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When journalist Maya Dusenbery was in her 20s, she started experiencing progressive pain in her joints, which she learned was caused by \u003ca href=\"https://www.npr.org/tags/164632370/rheumatoid-arthritis\" target=\"_blank\" rel=\"noopener\">rheumatoid arthritis.\u003c/a>\u003c/p>\n\u003cp>As she began to research her own condition, Dusenbery realized how lucky she was to have been diagnosed relatively easily. Other women with similar symptoms, she says, \"experienced very long diagnostic delays and felt ... that their symptoms were not taken seriously.\"\u003c/p>\n\u003cp>Dusenbery says these experiences fit into a larger pattern of gender bias in medicine. Her new book, \u003cem>Doing Harm,\u003c/em> makes the case that women's symptoms are often dismissed and misdiagnosed — in part because of what she calls the \"systemic and unconscious bias that's rooted ... in what doctors, regardless of their own gender, are learning in medical schools.\"\u003c/p>\n\u003cp>\"I definitely believe that the fact that medicine has been historically and continues to be mainly run by men has been a source of these problems,\" she says. \"The medical knowledge that we have is just skewed towards knowing more about men's bodies and the conditions that disproportionately affect them.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dusenbery is also the executive editor of \u003ca href=\"http://feministing.com/\" target=\"_blank\" rel=\"noopener\">Feministing\u003c/a>, a website of writing by young feminists about social, cultural and political issues.\u003c/p>\n\u003ch3 class=\"edTag\">\u003cstrong>Interview Highlights\u003c/strong>\u003c/h3>\n\u003cp>\u003cstrong>On how women have been left out of drug trials and medical observational studies\u003c/strong>\u003c/p>\n\u003cp>There was a lot of concern about including women in drug trials, specifically because of concerns about affecting their hypothetical fetuses. So in the '70s the FDA had a policy of prohibiting any woman of childbearing age from participating in early-stage drug trials.\u003c/p>\n\u003cp>But we also see that at that time, women were also excluded from studies that were just observational studies — not just drug trials. In the '90s, when there were congressional hearings about this problem, the public learned that women had been left out of things like a big observational study looking at normal human aging that was ongoing for 20 years. It started in the '50s, and for the first 20 years women had been left out of that.\u003c/p>\n\u003cp>\u003cstrong>On women's recent inclusion in National Institutes of Health studies \u003c/strong>\u003c/p>\n\u003cp>[In] 1993, Congress passed a law saying that women need to be included in NIH-funded clinical research. And in the aggregate, women do make up a majority of subjects in NIH research. However, we still don't know that women are necessarily adequately represented in all areas of research, because the NIH looks at the aggregate numbers, and the outside analyses that have been done show that women are still a little bit underrepresented.\u003c/p>\n\u003cp>More importantly, even though women are usually included in most studies today, it's still not the norm to really analyze results by gender to actually see if there are differences between men and women. So experts have described this to me as an \"add women and stir\" approach. Women are included, but we're still not getting the knowledge we need about ways that their symptoms or responses to treatment might differ from men.\u003c/p>\n\u003cp>\u003cstrong>On why some medicine affects men and women differently — and how that results in women receiving excessive doses of most drugs\u003c/strong>\u003c/p>\n\u003cp>There are a lot of factors that go into these recognized sex differences in drug metabolism and response. ... Percentage of body fat affects it. Hormones, different levels of enzymes — all of these things go into it. But really, probably the most straightforward [factor] is that, on average, men have a higher body weight than women. And yet, even that difference is not usually accounted for. We prescribe drugs based on this one-size-fits-all dosage, but that ends up meaning that, on average, women are being overdosed on most drugs.\u003c/p>\n\u003cp>\u003cstrong>On the difference between how men and women experience heart disease \u003c/strong>\u003c/p>\n\u003cp>Over the last couple of decades, there's been a recognition that for the first 35 years we were studying heart disease, we were really mostly studying it in men. And so there's been a concerted effort to go back and compare women's experiences to men's, which has led to the knowledge that women are more likely to have what are considered to be atypical symptoms. [And] the only reason they're considered \"atypical\" is because the norm has been this male model — so, atypical symptoms, like pain in the neck or shoulder, nausea, fatigue, lightheadedness. ...\u003c/p>\n\u003cp>Partly as a result of those differences in symptoms — which are still not always recognized by health care providers — women (especially younger women) are more likely to be turned away when they're having a heart attack, sent home. One study found it was younger women — so women under 55 — were seven times more likely than the average patient to be sent home mid-heart attack. ... Even if they're not sent home, you see longer delays [for women] to getting [electrocardiograms] and other diagnostic testing or interventions in the ER setting.\u003c/p>\n\u003cp>\u003cstrong>On how the subjective symptom of fatigue is dismissed in women\u003c/strong>\u003c/p>\n\u003cp>One of the most common [symptoms] that really is common across ... [the autoimmune diseases] is fatigue — a really deep, deep fatigue that isn't just being sleep-deprived from staying up too late. That fatigue, comparable to pain, is this very subjective symptom that's hard to communicate to other people. And I think that women are up against this real distrust of their own reports of their symptoms.\u003c/p>\n\u003cp>So conditions like autoimmune diseases that really are marked by these subjective symptoms of pain and fatigue, I think, are very easy to dismiss in women. ... Even though we do know about autoimmune diseases, during that diagnostic delay, women are often told, \"You're just stressed. You're tired.\" And [they] have a really hard time convincing doctors that this fatigue is abnormal.\u003c/p>\n\u003cp>\u003cstrong>On some female patients taking a male relative or spouse with them to doctors' appointments to vouch for them\u003c/strong>\u003c/p>\n\u003cp>I found this to be one of the most disturbing things that I found in my research: how many women reported that as they were fighting to get their symptoms taken seriously, [they] just sort of sensed that what they really needed was somebody to testify to their symptoms, to testify to their sanity, and felt that bringing a partner or a father or even a son would be helpful. And then [they] found that it was [helpful], that they were treated differently when there was that man in the room who was corroborating their reports.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Heidi Saman and Seth Kelley produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Scott Hensley adapted it for the Web.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Fresh Air. To see more, visit \u003ca href=\"http://www.npr.org/programs/fresh-air/\" target=\"_blank\" rel=\"noopener\">Fresh Air\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=How+%27Bad+Medicine%27+Dismisses+And+Misdiagnoses+Women%27s+Symptoms&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "E-Cigarettes May Be Toxic To the Body",
"title": "E-Cigarettes May Be Toxic To the Body",
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"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Many smokers turn to electronic cigarettes and vaporizers as a way to quit their habit, but recent research shows that swapping smoke for vapor might also lead to serious health risks. \u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">'When e-cigarettes first became available there was a lot of hope that they would be better than cigarettes but the more we learn the worse they look.'\u003ccite>Stanton Glantz, UCSF\u003c/cite>\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jordan Hall is taking a break on the rooftop deck above the Vapor Den, an electronic cigarette store in San Francisco. \u003c/span>\u003cspan style=\"font-weight: 400\">While looking out over the city he pulls out a shiny red device. \u003c/span>\u003cspan style=\"font-weight: 400\">The handheld machine, called a vapor mod, converts liquid nicotine into vapor.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After a deep breath, Hall leans back, looks up and exhales a giant cloud of mist. His posture relaxes and he smiles. \u003c/span>\u003c/p>\n\u003cp>“I fell in love with it and I completely stopped smoking cigarettes,\" says Hall through wafts of vapor that smell like watermelon. \"I ended up working for the Vapor Den, and since then I've been helping other people stop smoking as well.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That was five years ago. At the time he was smoking Camel Reds daily. \u003c/span>\u003cspan style=\"font-weight: 400\">\"I hated it,\" says Hall. \"I had been smoking for about eight years.\" \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_440552\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440552\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_4821-e1522276677380-800x512.jpg\" alt=\"\" width=\"800\" height=\"512\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-800x512.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-160x102.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-768x491.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-1020x652.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-1180x755.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-960x614.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-240x154.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-375x240.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-520x333.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380.jpg 1718w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jordan Hall exhales strawberry watermelon menthol flavored mist from a vape mod. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">But he says it was easy to quit when he found vaping. Within a week of switching to electronic cigarettes he says his sleep, stamina and the stench of tobacco no longer lingered on his clothes.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[contextly_sidebar id=\"BowHf9BbnzG3Vig8La9GoeLiPOcjwa6Y\"]Back in the Vapor Den where consumers lounge on couches enjoying e-cigs, Hall pulls out drawer after drawer of clear liquid droppers filled with exotic flavors. \u003c/span>\u003c/p>\n\u003cp>\"We’ve got strawberry parfaits, banana custards, blueberry parfaits, apple juice,\" says Hall. \"And milk and honey for a more savory option.\"\u003c/p>\n\u003cp>\u003cstrong>Flavoring Compounds May Be Toxic\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But \u003ca href=\"https://www.med.unc.edu/cellbiophysio/faculty-old/tarran/images/flori-sassano/view\" target=\"_blank\" rel=\"noopener\">Flori Sassano\u003c/a>, a pharmacologist at the University of North Carolina, worries about all those fruity ingredients.\u003c/span>\u003c/p>\n\u003cp>“Even though they all sound great,\" says Sassano. \"That doesn’t mean they're actually made from that. They’re made from chemicals.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Scientists do not know how the body reacts to inhaling artificial flavors. The Food and Drug Administration has only tested the flavor agents for consumption, that's why Sassano just completed a \u003ca href=\"http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2003904\" target=\"_blank\" rel=\"noopener\">study\u003c/a> on e-liquids. The research was published today\u003c/span>\u003cspan style=\"font-weight: 400\"> in the Journal \u003cem>PLOS Biology\u003c/em>. Sassano's team exposed human cells in test tubes to about 150 of the more than 7,700 commercially available flavored nicotine liquids. \u003c/span>\u003c/p>\n\u003cp>“We found that some of them were very highly toxic to the cells,\" says Sassano. “Not only stopping the growth but also killing them.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The researchers found that results varied widely across the e-liquid products tested, and overall, more ingredients led to increased toxicity. The worst culprits were cinnamaldehyde\u003cem> \u003c/em>and vanillin. \u003c/span>\u003cspan style=\"font-weight: 400\">And it wasn’t just the flavors that were dangerous. Sassano also found that the base ingredients used in e-liquids, propylene glycol and vegetable glycerin, were harmful to the cells.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Potentially Hard on the Heart\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">This worries Stanton Glantz, the director of the \u003ca href=\"https://tobacco.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">Center for Tobacco Control Research and Education\u003c/a> at UCSF.\u003c/span>\u003c/p>\n\u003cp>“When e-cigarettes first became available there was a lot of hope that they would be better than cigarettes but the more we learn the worse they look,\" Glantz says.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He recently presented research at the annual meeting of the Society for Research on Nicotine and Tobacco indicating e-cigarettes might increase your risk of heart attacks. \u003c/span>\u003c/p>\n\u003cp>“If you use e-cigarettes only on a daily basis you have nearly a doubling of your risk of having a heart attack,\" says Glantz. \"When people use an e-cigarette it shuts off normal functioning of their arteries just like a cigarette does.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But other researchers said Glantz's conclusions were premature. The data Glantz used was sourced from surveys conducted by the Centers for Disease Control and Prevention. The agency asked participants whether they vaped and whether they had a heart attack. It did not follow people over time to determine if vaping was the likely cause of the cardiac arrest. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"We don't even know that these people used e-cigarettes before they had the heart attack,\" \u003c/span>\u003cspan style=\"font-weight: 400\">Michael Siegel says, a professor at Boston University's School of Public Health, who \u003ca href=\"http://abc7news.com/health/controversial-ucsf-study-links-e-cigarettes-with-heart-attacks/3145433/\" target=\"_blank\" rel=\"noopener\">spoke\u003c/a> to ABC News. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In other words, the participants could have been life long smokers who had just starting vaping.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> Glantz agrees that more long term studies are needed to know whether e-cigs cause cardiac arrest. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Vaping May Make it Hard to Breathe\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There’s also a growing body of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed?term=tarran%20e-cigarette&holding=ucsflib&otool=cdlotool&cmd=search\" target=\"_blank\" rel=\"noopener\">research\u003c/a> showing that vaping may lead to asthma and lung inflammation. \u003c/span>\u003c/p>\n\u003cp>“The evidence for adverse affects on lungs is that they're actually looking worse than cigarettes,” Glantz says.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Because scientists have only studied vaping for the last five to ten years, conclusive data on it’s health effects isn’t available yet. A recent \u003ca href=\"http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24952\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the National Academies of Science, Engineering and Medicine concluded that e-cigarettes are 'likely far less harmful than conventional cigarettes.' Even so, Glantz and other doctors worry that users are under a false impression that vaping is safe. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The \u003ca href=\"https://www.cnbc.com/2017/09/06/san-francisco-big-tobacco-set-for-a-showdown-over-flavored-products.html\" target=\"_blank\" rel=\"noopener\">issue\u003c/a> goes before San Francisco voters soon. In June, residents will vote on whether to ban all flavored vaping and tobacco products. You can check an online \u003ca href=\"http://www.eliquidinfo.org\" target=\"_blank\" rel=\"noopener\">database\u003c/a> of e-liquid ingredients to determine if your favorite flavor is toxic. \u003c/span>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Many smokers turn to electronic cigarettes and vaporizers as a way to quit their habit, but recent research shows that swapping smoke for vapor might also lead to serious health risks. \u003c/span>\u003c/p>\n\u003caside class=\"pullquote alignright\">'When e-cigarettes first became available there was a lot of hope that they would be better than cigarettes but the more we learn the worse they look.'\u003ccite>Stanton Glantz, UCSF\u003c/cite>\u003c/aside>\n\u003cp>\u003cspan style=\"font-weight: 400\">Jordan Hall is taking a break on the rooftop deck above the Vapor Den, an electronic cigarette store in San Francisco. \u003c/span>\u003cspan style=\"font-weight: 400\">While looking out over the city he pulls out a shiny red device. \u003c/span>\u003cspan style=\"font-weight: 400\">The handheld machine, called a vapor mod, converts liquid nicotine into vapor.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After a deep breath, Hall leans back, looks up and exhales a giant cloud of mist. His posture relaxes and he smiles. \u003c/span>\u003c/p>\n\u003cp>“I fell in love with it and I completely stopped smoking cigarettes,\" says Hall through wafts of vapor that smell like watermelon. \"I ended up working for the Vapor Den, and since then I've been helping other people stop smoking as well.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That was five years ago. At the time he was smoking Camel Reds daily. \u003c/span>\u003cspan style=\"font-weight: 400\">\"I hated it,\" says Hall. \"I had been smoking for about eight years.\" \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_440552\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440552\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_4821-e1522276677380-800x512.jpg\" alt=\"\" width=\"800\" height=\"512\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-800x512.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-160x102.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-768x491.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-1020x652.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-1180x755.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-960x614.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-240x154.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-375x240.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380-520x333.jpg 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_4821-e1522276677380.jpg 1718w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Jordan Hall exhales strawberry watermelon menthol flavored mist from a vape mod. \u003ccite>(Lesley McClurg/ KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">But he says it was easy to quit when he found vaping. Within a week of switching to electronic cigarettes he says his sleep, stamina and the stench of tobacco no longer lingered on his clothes.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003c/p>\u003cp>\u003c/p>\u003cp>Back in the Vapor Den where consumers lounge on couches enjoying e-cigs, Hall pulls out drawer after drawer of clear liquid droppers filled with exotic flavors. \u003c/span>\u003c/p>\n\u003cp>\"We’ve got strawberry parfaits, banana custards, blueberry parfaits, apple juice,\" says Hall. \"And milk and honey for a more savory option.\"\u003c/p>\n\u003cp>\u003cstrong>Flavoring Compounds May Be Toxic\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But \u003ca href=\"https://www.med.unc.edu/cellbiophysio/faculty-old/tarran/images/flori-sassano/view\" target=\"_blank\" rel=\"noopener\">Flori Sassano\u003c/a>, a pharmacologist at the University of North Carolina, worries about all those fruity ingredients.\u003c/span>\u003c/p>\n\u003cp>“Even though they all sound great,\" says Sassano. \"That doesn’t mean they're actually made from that. They’re made from chemicals.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Scientists do not know how the body reacts to inhaling artificial flavors. The Food and Drug Administration has only tested the flavor agents for consumption, that's why Sassano just completed a \u003ca href=\"http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.2003904\" target=\"_blank\" rel=\"noopener\">study\u003c/a> on e-liquids. The research was published today\u003c/span>\u003cspan style=\"font-weight: 400\"> in the Journal \u003cem>PLOS Biology\u003c/em>. Sassano's team exposed human cells in test tubes to about 150 of the more than 7,700 commercially available flavored nicotine liquids. \u003c/span>\u003c/p>\n\u003cp>“We found that some of them were very highly toxic to the cells,\" says Sassano. “Not only stopping the growth but also killing them.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The researchers found that results varied widely across the e-liquid products tested, and overall, more ingredients led to increased toxicity. The worst culprits were cinnamaldehyde\u003cem> \u003c/em>and vanillin. \u003c/span>\u003cspan style=\"font-weight: 400\">And it wasn’t just the flavors that were dangerous. Sassano also found that the base ingredients used in e-liquids, propylene glycol and vegetable glycerin, were harmful to the cells.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Potentially Hard on the Heart\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">This worries Stanton Glantz, the director of the \u003ca href=\"https://tobacco.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">Center for Tobacco Control Research and Education\u003c/a> at UCSF.\u003c/span>\u003c/p>\n\u003cp>“When e-cigarettes first became available there was a lot of hope that they would be better than cigarettes but the more we learn the worse they look,\" Glantz says.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">He recently presented research at the annual meeting of the Society for Research on Nicotine and Tobacco indicating e-cigarettes might increase your risk of heart attacks. \u003c/span>\u003c/p>\n\u003cp>“If you use e-cigarettes only on a daily basis you have nearly a doubling of your risk of having a heart attack,\" says Glantz. \"When people use an e-cigarette it shuts off normal functioning of their arteries just like a cigarette does.”\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But other researchers said Glantz's conclusions were premature. The data Glantz used was sourced from surveys conducted by the Centers for Disease Control and Prevention. The agency asked participants whether they vaped and whether they had a heart attack. It did not follow people over time to determine if vaping was the likely cause of the cardiac arrest. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"We don't even know that these people used e-cigarettes before they had the heart attack,\" \u003c/span>\u003cspan style=\"font-weight: 400\">Michael Siegel says, a professor at Boston University's School of Public Health, who \u003ca href=\"http://abc7news.com/health/controversial-ucsf-study-links-e-cigarettes-with-heart-attacks/3145433/\" target=\"_blank\" rel=\"noopener\">spoke\u003c/a> to ABC News. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In other words, the participants could have been life long smokers who had just starting vaping.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\"> Glantz agrees that more long term studies are needed to know whether e-cigs cause cardiac arrest. \u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Vaping May Make it Hard to Breathe\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There’s also a growing body of \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed?term=tarran%20e-cigarette&holding=ucsflib&otool=cdlotool&cmd=search\" target=\"_blank\" rel=\"noopener\">research\u003c/a> showing that vaping may lead to asthma and lung inflammation. \u003c/span>\u003c/p>\n\u003cp>“The evidence for adverse affects on lungs is that they're actually looking worse than cigarettes,” Glantz says.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Because scientists have only studied vaping for the last five to ten years, conclusive data on it’s health effects isn’t available yet. A recent \u003ca href=\"http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24952\" target=\"_blank\" rel=\"noopener\">report\u003c/a> from the National Academies of Science, Engineering and Medicine concluded that e-cigarettes are 'likely far less harmful than conventional cigarettes.' Even so, Glantz and other doctors worry that users are under a false impression that vaping is safe. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The \u003ca href=\"https://www.cnbc.com/2017/09/06/san-francisco-big-tobacco-set-for-a-showdown-over-flavored-products.html\" target=\"_blank\" rel=\"noopener\">issue\u003c/a> goes before San Francisco voters soon. In June, residents will vote on whether to ban all flavored vaping and tobacco products. You can check an online \u003ca href=\"http://www.eliquidinfo.org\" target=\"_blank\" rel=\"noopener\">database\u003c/a> of e-liquid ingredients to determine if your favorite flavor is toxic. \u003c/span>\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Antibiotic Resistance is Globally On the Rise, Raising Alarms",
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"content": "\u003cp>The development of antibiotics in the middle of the 20th century was one of the greatest achievements of modern medicine. Penicillin and its pharmaceutical cousins \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/\" target=\"_blank\" rel=\"noopener\">saved millions\u003c/a> of lives. But like a magic potion given to the world by a stern fairy, antibiotics come with a catch — If you abuse them, you lose them.\u003c/p>\n\u003cp>For decades, scientists have been \u003ca href=\"https://www.kqed.org/futureofyou/100905/superbugs\" target=\"_blank\" rel=\"noopener\">warning that antibiotic resistance\u003c/a> is on the rise globally because of misuse of the drugs.\u003c/p>\n\u003cp>But a new report makes it clear that the world is not listening.[contextly_sidebar id=\"KJZOa7uMNIN4ArNMyMOA5manjU869PnC\"]\u003c/p>\n\u003cp>Between the year 2000 and 2015 human consumption of antibiotics globally rose 65 percent — to an astounding 42 billion doses a year. \"We wanted to examine global use of antibiotics because once resistance emerges in one place it can spread anywhere,\" says Eili Klein, a fellow at the Center for Disease Dynamics, Economics and Policy in Washington and the lead author of the new report, which was published Monday in the \u003ca href=\"http://www.pnas.org/content/early/2018/03/20/1717295115\" target=\"_blank\" rel=\"noopener\">Proceedings of the National Academy of Sciences\u003c/a>.\u003c/p>\n\u003cp>Along with his colleagues Klein found that there was a dramatic rise in antibiotic use over the last 15 years in low- and middle-income countries.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"A place like India, which has one of the highest populations in the world, saw enormous gains in antibiotic use both overall and on a per capita gain basis,\" says Klein.[contextly_sidebar id=\"SmtZzzk0FHpRcMcZ48thm4EPcrSnAjnT\"]\u003c/p>\n\u003cp>Antibiotic use more than doubled in India between the year 2000 and 2015. It was up 79 percent in China and 65 percent in Pakistan. Some of that increase was due to population growth but it wasn't just that. Overall sales were up.\u003c/p>\n\u003cp>So the report makes it clear that the average person in India, China or Pakistan is taking far more antibiotics now than they were a decade and half ago.\u003c/p>\n\u003cp>Western countries didn't see the sharp rise in antibiotics but they also failed to cut overall consumption.\u003c/p>\n\u003cp>\"In high-income countries reducing inappropriate use has not really ... in most countries ... driven down per capita use rates in the last 15 years,\" Klein says.\u003c/p>\n\u003cp>Lance Price, director of the Antibiotic Resistance Action Center at George Washington University, is concerned about this increase in antibiotic use.[contextly_sidebar id=\"lnBKX8143Mq00xj3zZD6AuQQqZq3rGIR\"]\u003c/p>\n\u003cp>\"The biggest driver for the evolution of superbugs is the use of antibiotics,\" Price says. Every time a bacteria is exposed to an antibiotic but isn't killed by it, it has the potential to develop resistance. The evolutionary math is fairly simple. \"The more we use antibiotics,\" he explains, \"the more we are going to encourage the growth of these bacteria that are resistant to them.\"\u003c/p>\n\u003cp>Hospitals around the world increasingly have been reporting bacterial infections that don't respond to traditional antibiotics.\u003c/p>\n\u003cp>\"Then you have these extreme cases like the woman [in Nevada] just about a year ago who died of an infection that was resistant to 26 different antibiotics,\" Price says. \"So the bacteria are out there that are resistant to everything, and they are becoming more and more prevalent.\"\u003c/p>\n\u003cp>Health officials worry about so much growth in antibiotic use in low- and middle-income countries because these drugs are often available there without a prescription. So the potential for misuse is high. Also Price notes that poor sanitation in impoverished nations adds to the problem. If a superbug develops in a patient who only has access to an outhouse, that bug is far more likely to spread into the local water supply than if that patient had access to a toilet connected to a sewage treatment plant.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So the antibiotic fairy is not happy: If we don't change our ways she's going to slowly make the potion less and less powerful until one day it disappears.\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=Surge+In+Antibiotics+Is+A+Boon+For+Superbugs&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The development of antibiotics in the middle of the 20th century was one of the greatest achievements of modern medicine. Penicillin and its pharmaceutical cousins \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/\" target=\"_blank\" rel=\"noopener\">saved millions\u003c/a> of lives. But like a magic potion given to the world by a stern fairy, antibiotics come with a catch — If you abuse them, you lose them.\u003c/p>\n\u003cp>For decades, scientists have been \u003ca href=\"https://www.kqed.org/futureofyou/100905/superbugs\" target=\"_blank\" rel=\"noopener\">warning that antibiotic resistance\u003c/a> is on the rise globally because of misuse of the drugs.\u003c/p>\n\u003cp>But a new report makes it clear that the world is not listening.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Between the year 2000 and 2015 human consumption of antibiotics globally rose 65 percent — to an astounding 42 billion doses a year. \"We wanted to examine global use of antibiotics because once resistance emerges in one place it can spread anywhere,\" says Eili Klein, a fellow at the Center for Disease Dynamics, Economics and Policy in Washington and the lead author of the new report, which was published Monday in the \u003ca href=\"http://www.pnas.org/content/early/2018/03/20/1717295115\" target=\"_blank\" rel=\"noopener\">Proceedings of the National Academy of Sciences\u003c/a>.\u003c/p>\n\u003cp>Along with his colleagues Klein found that there was a dramatic rise in antibiotic use over the last 15 years in low- and middle-income countries.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"A place like India, which has one of the highest populations in the world, saw enormous gains in antibiotic use both overall and on a per capita gain basis,\" says Klein.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Antibiotic use more than doubled in India between the year 2000 and 2015. It was up 79 percent in China and 65 percent in Pakistan. Some of that increase was due to population growth but it wasn't just that. Overall sales were up.\u003c/p>\n\u003cp>So the report makes it clear that the average person in India, China or Pakistan is taking far more antibiotics now than they were a decade and half ago.\u003c/p>\n\u003cp>Western countries didn't see the sharp rise in antibiotics but they also failed to cut overall consumption.\u003c/p>\n\u003cp>\"In high-income countries reducing inappropriate use has not really ... in most countries ... driven down per capita use rates in the last 15 years,\" Klein says.\u003c/p>\n\u003cp>Lance Price, director of the Antibiotic Resistance Action Center at George Washington University, is concerned about this increase in antibiotic use.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"The biggest driver for the evolution of superbugs is the use of antibiotics,\" Price says. Every time a bacteria is exposed to an antibiotic but isn't killed by it, it has the potential to develop resistance. The evolutionary math is fairly simple. \"The more we use antibiotics,\" he explains, \"the more we are going to encourage the growth of these bacteria that are resistant to them.\"\u003c/p>\n\u003cp>Hospitals around the world increasingly have been reporting bacterial infections that don't respond to traditional antibiotics.\u003c/p>\n\u003cp>\"Then you have these extreme cases like the woman [in Nevada] just about a year ago who died of an infection that was resistant to 26 different antibiotics,\" Price says. \"So the bacteria are out there that are resistant to everything, and they are becoming more and more prevalent.\"\u003c/p>\n\u003cp>Health officials worry about so much growth in antibiotic use in low- and middle-income countries because these drugs are often available there without a prescription. So the potential for misuse is high. Also Price notes that poor sanitation in impoverished nations adds to the problem. If a superbug develops in a patient who only has access to an outhouse, that bug is far more likely to spread into the local water supply than if that patient had access to a toilet connected to a sewage treatment plant.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So the antibiotic fairy is not happy: If we don't change our ways she's going to slowly make the potion less and less powerful until one day it disappears.\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=Surge+In+Antibiotics+Is+A+Boon+For+Superbugs&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "The Juul’s So Cool, Kids Smoke It in School",
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"content": "\u003cp>The students wait eagerly for their teachers to turn their backs.\u003c/p>\n\u003cp>That’s their cue to reach quietly for a small, sleek device they can easily conceal in their palms. It resembles a flash drive, but instead of computer files, this device stores nicotine.\u003c/p>\n\u003cp>They take a hit, sucking on the device as they would a cigarette. Then, “they blow into their backpacks … or into their sweater when the teacher isn’t looking,” said Elijah Luna, 16, a sophomore at Vista del Lago High School in Folsom, Calif., about 30 miles east of Sacramento.[contextly_sidebar id=\"djx30e7WNNg22Lzan6ALRB7cB9P9wBw0\"]\u003c/p>\n\u003cp>The vapor cloud is so small and dissipates so quickly that teachers are usually none the wiser, said Luna, who added he’s never tried it himself.\u003c/p>\n\u003cp>The device is a \u003ca href=\"https://support.juulvapor.com/learn\" target=\"_blank\" rel=\"noopener\">Juul\u003c/a>, a popular electronic cigarette that’s a sensation among teens, especially in wealthier neighborhoods — and a nightmare for school administrators and public health advocates.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I think this is going to be the health problem of the decade,” said Milagros Vascones-Gatski, a substance abuse counselor at Yorktown High School in Arlington, Va. In nearly 17 years working with teens, she said, she’s never seen a tobacco product become so popular so quickly. Three to four students are caught smoking e-cigs on campus each week, usually Juuls, and some are suspended, she said.[contextly_sidebar id=\"V3e6sXL3LUlq4wqn0XrGQuq8Gylvns1F\"]\u003c/p>\n\u003cp>Vascones-Gatski, along with other concerned educators and health care experts, consider “Juuling” more than youthful rebellion. Because it is high in nicotine, they fear the devices are extremely addictive for this vulnerable population.\u003c/p>\n\u003cp>To combat the spread of the devices, some schools have banned \u003ca href=\"http://www.fox29.com/news/upper-dublin-school-district-bans-flash-drives-over-confusion-with-e-cigarette-brand\" target=\"_blank\" rel=\"noopener\">flash drives\u003c/a> as well, to avoid any confusion between the items. Yorktown High even removed the main entrance doors from student bathrooms at the beginning of the school year to dissuade students from vaping inside. Despite these efforts, teens across America continue smoking the stuff in class, in hallways, in restrooms and at school sporting events.\u003c/p>\n\u003cp>Because it’s referred to as Juuling, not smoking or vaping, some students may think what they’re doing is harmless, said Pamela Ling, a professor at the University of California-San Francisco School of Medicine. “They may not even know it contains nicotine.”[contextly_sidebar id=\"sjPlnDQM2v8meizeQlSVKNclM0AfKBCv\"]\u003c/p>\n\u003cp>But it does — and a significant amount. One Juul “pod,” the nicotine cartridge inserted into the smoking device and heated, delivers about 200 puffs, about as much nicotine as a pack of cigarettes, according to the \u003ca href=\"https://support.juulvapor.com/home/learn/faqs/juulpods-juice\" target=\"_blank\" rel=\"noopener\">product website\u003c/a>.\u003c/p>\n\u003cp>Assuming a teen smokes one pod a week, “in five weeks, that’s like 100 cigarettes,” Ling said. “By that point, you’re considered an established smoker.”\u003c/p>\n\u003cp>E-cigarettes, also known as vapes, are battery-operated devices that heat up liquid nicotine to generate an aerosol that users inhale. Smoking e-cigs is more discreet and easier to get away with than traditional cigarettes.[contextly_sidebar id=\"j9qNeDkmKq8G2NE1y8iaUVGnDMNiBfb3\"]\u003c/p>\n\u003cp>In 2016, California increased the minimum age to purchase tobacco products, including e-cigarettes, from 18 to 21. Experts predicted the change would make it harder for teens to get tobacco products from their slightly older friends, and it seems to be working, \u003ca href=\"https://californiahealthline.org/news/after-raising-age-for-tobacco-purchases-state-sees-decreased-sales-to-minors/\" target=\"_blank\" rel=\"noopener\">according to a recent report\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_440500\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440500\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-180088674-800x593.jpg\" alt=\"\" width=\"800\" height=\"593\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-800x593.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-160x119.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-768x569.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-1020x756.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-1920x1424.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-1180x875.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-960x712.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-240x178.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-375x278.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-520x386.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A teenage boy smoking an electronic cigarette. \u003ccite>(iStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But some health care advocates now worry that devices like the Juul could reverse that progress.\u003c/p>\n\u003cp>Although its manufacturer, Juul Labs, said the device is intended exclusively for adult use, it is appealing to youth because it can be easily charged on a laptop, its decal covers come in colorful designs, and the pods are available in flavors such as mango, mint and crème brûlée.\u003c/p>\n\u003cp>The odor Juuls produce is subtle and could easily be mistaken for a lotion or body spray.\u003c/p>\n\u003cp>“It’s stinky and fruity,” said Luna’s friend Cody Maratas, of the smell he encounters inside school restrooms when others are Juuling.\u003c/p>\n\u003cp>In a \u003ca href=\"https://www.reddit.com/r/juul/comments/7xnhzm/juuling_in_school/\" target=\"_blank\" rel=\"noopener\">Reddit forum\u003c/a> dedicated to Juuling in schools, some users who identify themselves as students say school restrooms smell much nicer now as a result.[contextly_sidebar id=\"qf3M4b2Qh9DR7UrVTICkmbOlum92hcXb\"]\u003c/p>\n\u003cp>Other online users describe “craving nicotine” and complain about “fiends” who ask to borrow their Juuls at school. One has solved this by charging freshmen $3 for a hit.\u003c/p>\n\u003cp>An article from Berkeley High School’s \u003ca href=\"http://www.berkeleyhighjacket.com/juuling-popularizes-e-cigarette-use-at-bhs/\" target=\"_blank\" rel=\"noopener\">student newspaper\u003c/a> described students who seek Juuls from others because they “love the head rush.”\u003c/p>\n\u003cp>“That’s a symptom of nicotine addiction,” Ling said.\u003c/p>\n\u003cp>Juul Labs said it wants to help schools get its products off their campuses. Spokeswoman Christine Castro said the company has created a curriculum to educate youth about Juul and nicotine addiction, with input from academics. It’s available for any school that is interested, she said.\u003c/p>\n\u003cp>“This product is solely for adult smokers,” said Castro. “We absolutely condemn kids using our products.”\u003c/p>\n\u003cp>Castro said the company limits online purchases to individuals 21 or older. To browse the site, you need only click on a box pledging you’re of age. But to buy, you must create a profile. Customer information is verified through multiple databases and, if that fails, customers must upload a photo identification, she said.\u003c/p>\n\u003cp>However, Castro conceded that it is harder to control sales on third-party sites like eBay or Craigslist.\u003c/p>\n\u003cp>She urged consumers to report suspicious sales to the company’s \u003ca href=\"mailto:youthprevention@juul.com\" target=\"_blank\" rel=\"noopener\">youthprevention@juul.com\u003c/a> email address. Juul Labs may follow up with secret shopper visits to stores suspected of selling the product to underage customers, she said.\u003c/p>\n\u003cp>If users get through the age-verification process online, they can buy a Juul starter kit, which includes the vaping pen and four pods, for $50. That’s expensive for most high school students — which is why Juuling might be more prevalent in affluent communities. “In order to vape, you need money,” said Vascones-Gatski, noting that most students at her high school either work or receive big allowances.\u003c/p>\n\u003cp>Vince Willmore, vice president of communications at the \u003ca href=\"https://www.tobaccofreekids.org/\" target=\"_blank\" rel=\"noopener\">Campaign for Tobacco-Free Kids\u003c/a>, applauds efforts taken by schools, but he thinks the burden shouldn’t fall solely on educators and parents. The Food and Drug Administration “regulates tobacco products … and we think it’s important that the FDA take action to protect kids from Juul and other e-cigarettes,” he said.\u003c/p>\n\u003cp>Last year, \u003ca href=\"https://www.nytimes.com/2017/07/28/health/electronic-cigarette-tobacco-nicotine-fda.html\" target=\"_blank\" rel=\"noopener\">the agency delayed regulations\u003c/a> that could have yanked many e-cigarette products from the market, possibly including the Juul, while it studies whether these devices might actually help longtime smokers wean off traditional cigarettes. “That basically locked in the products that are in the market for another four years,” Willmore said.\u003c/p>\n\u003cp>Meanwhile, schools continue the battle.\u003c/p>\n\u003cp>At Needham High School in Massachusetts, Principal Aaron Sicotte said e-cigarettes started appearing on his campus last school year, and soon Juul became the most popular brand.\u003c/p>\n\u003cp>The school has alerted staff “so that when these fall out of students’ bags, teachers don’t hand them back,” he said.\u003c/p>\n\u003cp>While the hype surrounding Juul might die down, Sicotte doesn’t expect vaping to go away. “I think this is something that will remain in the fabric of adolescence,” he said. “The access is too easy, the draw is too great, and the push through advertising is too significant.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. \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=When+You+Need+A+Mammogram%2C+Should+You+Get+One+In+%273-D%27%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The students wait eagerly for their teachers to turn their backs.\u003c/p>\n\u003cp>That’s their cue to reach quietly for a small, sleek device they can easily conceal in their palms. It resembles a flash drive, but instead of computer files, this device stores nicotine.\u003c/p>\n\u003cp>They take a hit, sucking on the device as they would a cigarette. Then, “they blow into their backpacks … or into their sweater when the teacher isn’t looking,” said Elijah Luna, 16, a sophomore at Vista del Lago High School in Folsom, Calif., about 30 miles east of Sacramento.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The vapor cloud is so small and dissipates so quickly that teachers are usually none the wiser, said Luna, who added he’s never tried it himself.\u003c/p>\n\u003cp>The device is a \u003ca href=\"https://support.juulvapor.com/learn\" target=\"_blank\" rel=\"noopener\">Juul\u003c/a>, a popular electronic cigarette that’s a sensation among teens, especially in wealthier neighborhoods — and a nightmare for school administrators and public health advocates.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I think this is going to be the health problem of the decade,” said Milagros Vascones-Gatski, a substance abuse counselor at Yorktown High School in Arlington, Va. In nearly 17 years working with teens, she said, she’s never seen a tobacco product become so popular so quickly. Three to four students are caught smoking e-cigs on campus each week, usually Juuls, and some are suspended, she said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Vascones-Gatski, along with other concerned educators and health care experts, consider “Juuling” more than youthful rebellion. Because it is high in nicotine, they fear the devices are extremely addictive for this vulnerable population.\u003c/p>\n\u003cp>To combat the spread of the devices, some schools have banned \u003ca href=\"http://www.fox29.com/news/upper-dublin-school-district-bans-flash-drives-over-confusion-with-e-cigarette-brand\" target=\"_blank\" rel=\"noopener\">flash drives\u003c/a> as well, to avoid any confusion between the items. Yorktown High even removed the main entrance doors from student bathrooms at the beginning of the school year to dissuade students from vaping inside. Despite these efforts, teens across America continue smoking the stuff in class, in hallways, in restrooms and at school sporting events.\u003c/p>\n\u003cp>Because it’s referred to as Juuling, not smoking or vaping, some students may think what they’re doing is harmless, said Pamela Ling, a professor at the University of California-San Francisco School of Medicine. “They may not even know it contains nicotine.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But it does — and a significant amount. One Juul “pod,” the nicotine cartridge inserted into the smoking device and heated, delivers about 200 puffs, about as much nicotine as a pack of cigarettes, according to the \u003ca href=\"https://support.juulvapor.com/home/learn/faqs/juulpods-juice\" target=\"_blank\" rel=\"noopener\">product website\u003c/a>.\u003c/p>\n\u003cp>Assuming a teen smokes one pod a week, “in five weeks, that’s like 100 cigarettes,” Ling said. “By that point, you’re considered an established smoker.”\u003c/p>\n\u003cp>E-cigarettes, also known as vapes, are battery-operated devices that heat up liquid nicotine to generate an aerosol that users inhale. Smoking e-cigs is more discreet and easier to get away with than traditional cigarettes.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In 2016, California increased the minimum age to purchase tobacco products, including e-cigarettes, from 18 to 21. Experts predicted the change would make it harder for teens to get tobacco products from their slightly older friends, and it seems to be working, \u003ca href=\"https://californiahealthline.org/news/after-raising-age-for-tobacco-purchases-state-sees-decreased-sales-to-minors/\" target=\"_blank\" rel=\"noopener\">according to a recent report\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_440500\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440500\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-180088674-800x593.jpg\" alt=\"\" width=\"800\" height=\"593\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-800x593.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-160x119.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-768x569.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-1020x756.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-1920x1424.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-1180x875.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-960x712.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-240x178.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-375x278.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-180088674-520x386.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">A teenage boy smoking an electronic cigarette. \u003ccite>(iStock)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>But some health care advocates now worry that devices like the Juul could reverse that progress.\u003c/p>\n\u003cp>Although its manufacturer, Juul Labs, said the device is intended exclusively for adult use, it is appealing to youth because it can be easily charged on a laptop, its decal covers come in colorful designs, and the pods are available in flavors such as mango, mint and crème brûlée.\u003c/p>\n\u003cp>The odor Juuls produce is subtle and could easily be mistaken for a lotion or body spray.\u003c/p>\n\u003cp>“It’s stinky and fruity,” said Luna’s friend Cody Maratas, of the smell he encounters inside school restrooms when others are Juuling.\u003c/p>\n\u003cp>In a \u003ca href=\"https://www.reddit.com/r/juul/comments/7xnhzm/juuling_in_school/\" target=\"_blank\" rel=\"noopener\">Reddit forum\u003c/a> dedicated to Juuling in schools, some users who identify themselves as students say school restrooms smell much nicer now as a result.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Other online users describe “craving nicotine” and complain about “fiends” who ask to borrow their Juuls at school. One has solved this by charging freshmen $3 for a hit.\u003c/p>\n\u003cp>An article from Berkeley High School’s \u003ca href=\"http://www.berkeleyhighjacket.com/juuling-popularizes-e-cigarette-use-at-bhs/\" target=\"_blank\" rel=\"noopener\">student newspaper\u003c/a> described students who seek Juuls from others because they “love the head rush.”\u003c/p>\n\u003cp>“That’s a symptom of nicotine addiction,” Ling said.\u003c/p>\n\u003cp>Juul Labs said it wants to help schools get its products off their campuses. Spokeswoman Christine Castro said the company has created a curriculum to educate youth about Juul and nicotine addiction, with input from academics. It’s available for any school that is interested, she said.\u003c/p>\n\u003cp>“This product is solely for adult smokers,” said Castro. “We absolutely condemn kids using our products.”\u003c/p>\n\u003cp>Castro said the company limits online purchases to individuals 21 or older. To browse the site, you need only click on a box pledging you’re of age. But to buy, you must create a profile. Customer information is verified through multiple databases and, if that fails, customers must upload a photo identification, she said.\u003c/p>\n\u003cp>However, Castro conceded that it is harder to control sales on third-party sites like eBay or Craigslist.\u003c/p>\n\u003cp>She urged consumers to report suspicious sales to the company’s \u003ca href=\"mailto:youthprevention@juul.com\" target=\"_blank\" rel=\"noopener\">youthprevention@juul.com\u003c/a> email address. Juul Labs may follow up with secret shopper visits to stores suspected of selling the product to underage customers, she said.\u003c/p>\n\u003cp>If users get through the age-verification process online, they can buy a Juul starter kit, which includes the vaping pen and four pods, for $50. That’s expensive for most high school students — which is why Juuling might be more prevalent in affluent communities. “In order to vape, you need money,” said Vascones-Gatski, noting that most students at her high school either work or receive big allowances.\u003c/p>\n\u003cp>Vince Willmore, vice president of communications at the \u003ca href=\"https://www.tobaccofreekids.org/\" target=\"_blank\" rel=\"noopener\">Campaign for Tobacco-Free Kids\u003c/a>, applauds efforts taken by schools, but he thinks the burden shouldn’t fall solely on educators and parents. The Food and Drug Administration “regulates tobacco products … and we think it’s important that the FDA take action to protect kids from Juul and other e-cigarettes,” he said.\u003c/p>\n\u003cp>Last year, \u003ca href=\"https://www.nytimes.com/2017/07/28/health/electronic-cigarette-tobacco-nicotine-fda.html\" target=\"_blank\" rel=\"noopener\">the agency delayed regulations\u003c/a> that could have yanked many e-cigarette products from the market, possibly including the Juul, while it studies whether these devices might actually help longtime smokers wean off traditional cigarettes. “That basically locked in the products that are in the market for another four years,” Willmore said.\u003c/p>\n\u003cp>Meanwhile, schools continue the battle.\u003c/p>\n\u003cp>At Needham High School in Massachusetts, Principal Aaron Sicotte said e-cigarettes started appearing on his campus last school year, and soon Juul became the most popular brand.\u003c/p>\n\u003cp>The school has alerted staff “so that when these fall out of students’ bags, teachers don’t hand them back,” he said.\u003c/p>\n\u003cp>While the hype surrounding Juul might die down, Sicotte doesn’t expect vaping to go away. “I think this is something that will remain in the fabric of adolescence,” he said. “The access is too easy, the draw is too great, and the push through advertising is too significant.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. \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=When+You+Need+A+Mammogram%2C+Should+You+Get+One+In+%273-D%27%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Birth Control Apps Find a Big Market in 'Contraception Deserts'",
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"content": "\u003cp>[audio mp3=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/20180326_me_birth_control_apps_find_a_big_market_in_contraception_deserts_.mp3\" autoplay=\"true\" preload=\"auto\"][/audio]\u003c/p>\n\u003cp>Rachel Ralph works long hours at an accounting firm in Oakland, Calif., and coordinates much of her life via the apps on her phone.\u003c/p>\n\u003cp>So when she first heard several months ago that she could order her usual brand of birth control pills \u003ca href=\"https://www.kqed.org/futureofyou/425267/mobile-app-designed-to-prevent-pregnancy-gets-eu-approval\" target=\"_blank\" rel=\"noopener\">via an app\u003c/a>, and have them delivered to her doorstep in a day or two, it seemed perfect. She was working 12-hour days.[contextly_sidebar id=\"BZOrcpBR3skDDUzwXqFtMkYivLh8tU2K\"]\u003c/p>\n\u003cp>\"Food was delivered, dinner was often delivered,\" Ralph says. \"Anything I could get sent to my house with little effort — the better.\"\u003c/p>\n\u003cp>Ralph ordered a three-month supply of pills via the app of a San Francisco-based company called \u003ca href=\"https://www.nurx.com/\" target=\"_blank\" rel=\"noopener\">NURX\u003c/a>. It's one of several digital ventures, including \u003ca href=\"https://www.mavenclinic.com/\" target=\"_blank\" rel=\"noopener\">Maven\u003c/a> and \u003ca href=\"https://www.lemonaidhealth.com/\" target=\"_blank\" rel=\"noopener\">Lemonaid Health\u003c/a>, that now provide several types of hormonal contraception without requiring a live visit to a doctor or other health care provider.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Women using these services in cities say they like the speed and no-hassle privacy they get by making a purchase through the app. And in some rural areas where women's health clinics are few and far between, being able \u003ca href=\"https://www.newsdeeply.com/water/articles/2018/03/26/report-how-los-angeles-could-source-its-water-locally%20https://www.apnews.com/870b745abdfe41dfa3bb79b49d60f117/Self-taught-rocket-scientist-blasts-off-into-California-sky%20https://www.apnews.com/870b745abdfe41dfa3bb79b49d60f117/Self-taught-rocket-scientist-blasts-off-into-California-sky%20https://www.npr.org/sections/goatsandsoda/2018/03/23/596435463/how-fast-can-an-outbreak-be-detected%20https://khn.org/news/trump-immigration-policies-put-immigrant-caregivers-and-elderly-patients-at-risk/\" target=\"_blank\" rel=\"noopener\">to buy prescription\u003c/a> contraceptives online — starting at around $15 for a month's supply — can be not only much more private, but much more affordable and less time-consuming than driving an hour or more to the closest clinic, or paying for a doctor's appointment.[contextly_sidebar id=\"8UyELd0sdLCUnKJd2rRKJEDknWqS1wDA\"]\u003c/p>\n\u003cp>NURX is now available in 18 states. It's popular in Texas, where many women live in what some health policy analysts call \"\u003ca href=\"https://www.washingtonpost.com/news/monkey-cage/wp/2016/09/26/contraception-deserts-are-what-you-get-when-you-cut-off-this-little-known-federal-program/?utm_term=.2c000aedfece\" target=\"_blank\" rel=\"noopener\">contraception deserts\u003c/a>\" — places that lack easy access to women's health services.\u003c/p>\n\u003cp>The company's process is pretty simple. After users log in to the NURX app, they fill out a questionnaire.\u003c/p>\n\u003cp>\"They tell us about their medical history,\" says Jessica Horowitz, a nurse practitioner with NURX who consults with patients via online chats. \"They give us a blood-pressure check.\"\u003c/p>\n\u003cp>A clinician like Horowitz then reviews the answers and, based on that, makes a suggestion about what type of hormonal contraception might be best for that individual — a pill, a ring or a patch are available, as well as emergency contraception\u003cstrong>.\u003c/strong> If the patient has a question about the product they're considering, they can send an instant message or call to chat with a provider.\u003c/p>\n\u003cp>\"It doesn't matter what time of day it is,\" Horowitz says. \"Someone responds.\"\u003c/p>\n\u003cp>Then NURX sends a prescription to a pharmacy and the drugs are mailed out via priority mail, or faster for emergency contraception. The cost of a month's supply of prescription birth control is often free to the patient, if they have health insurance, Horowitz says, and otherwise starts at $15 out-of-pocket for a month's supply, depending on the brand.[contextly_sidebar id=\"GekufaWZutErmbxmWrMVqC5SIpjD8lih\"]\u003c/p>\n\u003cp>For Claire Hammons, who lives and works in Llano, Texas, about 90 minutes outside of Austin, the low cost of the pills was as important as the convenience.\u003c/p>\n\u003cp>Hammons loves many aspects of life in her small town. \"There is a population of 3,000 people,\" she says. \"But we have a lot going on. We are a huge art town. We have the Llano River. We are surrounded by state parks.\"\u003c/p>\n\u003cp>Still, living there has its drawbacks, she says. There's only one doctor in town and there are no clinics nearby. This means getting health care isn't easy. And for Hammons, the main medicine she needs are birth control pills.\u003c/p>\n\u003cp>\"I've been taking birth control since I was 16 because of endometriosis,\" she explains.\u003c/p>\n\u003cp>If she can't get the pills, Hammons is in a lot of pain every month. A while back, she had a particularly hard time getting a prescription, because she lost her health insurance, and her out-of-pocket cost for a doctor's visit in Llano would have been $140.\u003c/p>\n\u003cp>\"I really did not have — literally — have the money to go to the doctor. Period,\" she says.\u003c/p>\n\u003cp>Hammons says she also couldn't afford to pay out of pocket to pick up the pills every month at a pharmacy.\u003c/p>\n\u003cp>Then, about six months ago, she went online and found NURX. The cost-savings, she says, was \"really amazing and ... saved me a lot.\"[contextly_sidebar id=\"93eYfIv1ZOkr9FnHiToO84fR8I08e0No\"]\u003c/p>\n\u003cp>Texas has become a big market for the app. Dr. Brook Randal, an emergency medicine physician in Austin who works as a provider for NURX, says her patients come from different backgrounds and use the app for different reasons.\u003c/p>\n\u003cp>\"A lot of them are low-income women who may not have a low-cost clinic available to them in the communities where they live,\" she says. \"And so we provide an important service for those women.\"\u003c/p>\n\u003cp>In 2013, the state \u003ca href=\"https://www.kqed.org/futureofyou/440262/landmark-report-concludes-abortion-in-u-s-is-safe\" target=\"_blank\" rel=\"noopener\">passed an abortion\u003c/a> bill that led half of all Texas clinics that performed abortions to close – clinics that often also provided birth control and other medical services to low-income women.\u003c/p>\n\u003cp>\"Many of those women will tell us that they would have had to drive a really long distance in order to get to a clinic where they can get birth control economically,\" Randal says.\u003c/p>\n\u003cp>And their access to birth control got even worse when Texas lawmakers cut funding for the state's family planning program, says \u003ca href=\"https://forabettertexas.org/meetourstaff.html\" target=\"_blank\" rel=\"noopener\">Stacey Pogue\u003c/a>, a health policy analyst with the \u003ca href=\"https://forabettertexas.org/whatwedoandwhy.html\" target=\"_blank\" rel=\"noopener\">Center for Public Policy Priorities\u003c/a> in Austin. The cuts came at a time when the state's population was growing and more women were seeking services, Pogue notes.\u003c/p>\n\u003cp>\"The ability of our safety net system to meet those needs and deliver health care — to actually get health care to women who are looking for contraceptives and well-woman exams — that has certainly been diminished,\" she says.\u003c/p>\n\u003cp>Apps like NURX that give women access to at least some types of contraceptives are definitely helpful, she says. But they aren't a comprehensive solution.\u003c/p>\n\u003cp>Some of the most effective types of birth control — IUDs and implants — aren't available through the apps, Pogue notes, because they require a visit to a health provider. And apps will never substitute for the missing medical clinics — places where, beyond contraception, women could also get life-saving services, such as pap smears, breast exams and cervical cancer screenings.\u003c/p>\n\u003cp>Texas is one of two states (Indiana is the other) where minors can't buy prescription birth control through NURX because of laws restricting minors' access to contraception.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/author/lesleymcclurg\" target=\"_blank\" rel=\"noopener\">\u003cem>Lesley McClurg\u003c/em>\u003c/a>\u003cem> covers mental health and consumer health stories for \u003c/em>\u003ca href=\"https://www.kqed.org/\" target=\"_blank\" rel=\"noopener\">KQED\u003c/a>\u003cem> in San Francisco, Calif. \u003c/em>\u003ca href=\"http://kut.org/people/ashley-lopez\" target=\"_blank\" rel=\"noopener\">\u003cem>Ashley Lopez\u003c/em>\u003c/a>\u003cem> reports on health care and politics for \u003ca href=\"http://kut.org/people/ashley-lopez\" target=\"_blank\" rel=\"noopener\">KUT\u003c/a>\u003c/em>\u003cem>, in Austin, Texas.\u003c/em>\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=Birth+Control+Apps+Find+A+Big+Market+In+%27Contraception+Deserts%27+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Rachel Ralph works long hours at an accounting firm in Oakland, Calif., and coordinates much of her life via the apps on her phone.\u003c/p>\n\u003cp>So when she first heard several months ago that she could order her usual brand of birth control pills \u003ca href=\"https://www.kqed.org/futureofyou/425267/mobile-app-designed-to-prevent-pregnancy-gets-eu-approval\" target=\"_blank\" rel=\"noopener\">via an app\u003c/a>, and have them delivered to her doorstep in a day or two, it seemed perfect. She was working 12-hour days.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"Food was delivered, dinner was often delivered,\" Ralph says. \"Anything I could get sent to my house with little effort — the better.\"\u003c/p>\n\u003cp>Ralph ordered a three-month supply of pills via the app of a San Francisco-based company called \u003ca href=\"https://www.nurx.com/\" target=\"_blank\" rel=\"noopener\">NURX\u003c/a>. It's one of several digital ventures, including \u003ca href=\"https://www.mavenclinic.com/\" target=\"_blank\" rel=\"noopener\">Maven\u003c/a> and \u003ca href=\"https://www.lemonaidhealth.com/\" target=\"_blank\" rel=\"noopener\">Lemonaid Health\u003c/a>, that now provide several types of hormonal contraception without requiring a live visit to a doctor or other health care provider.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Women using these services in cities say they like the speed and no-hassle privacy they get by making a purchase through the app. And in some rural areas where women's health clinics are few and far between, being able \u003ca href=\"https://www.newsdeeply.com/water/articles/2018/03/26/report-how-los-angeles-could-source-its-water-locally%20https://www.apnews.com/870b745abdfe41dfa3bb79b49d60f117/Self-taught-rocket-scientist-blasts-off-into-California-sky%20https://www.apnews.com/870b745abdfe41dfa3bb79b49d60f117/Self-taught-rocket-scientist-blasts-off-into-California-sky%20https://www.npr.org/sections/goatsandsoda/2018/03/23/596435463/how-fast-can-an-outbreak-be-detected%20https://khn.org/news/trump-immigration-policies-put-immigrant-caregivers-and-elderly-patients-at-risk/\" target=\"_blank\" rel=\"noopener\">to buy prescription\u003c/a> contraceptives online — starting at around $15 for a month's supply — can be not only much more private, but much more affordable and less time-consuming than driving an hour or more to the closest clinic, or paying for a doctor's appointment.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>NURX is now available in 18 states. It's popular in Texas, where many women live in what some health policy analysts call \"\u003ca href=\"https://www.washingtonpost.com/news/monkey-cage/wp/2016/09/26/contraception-deserts-are-what-you-get-when-you-cut-off-this-little-known-federal-program/?utm_term=.2c000aedfece\" target=\"_blank\" rel=\"noopener\">contraception deserts\u003c/a>\" — places that lack easy access to women's health services.\u003c/p>\n\u003cp>The company's process is pretty simple. After users log in to the NURX app, they fill out a questionnaire.\u003c/p>\n\u003cp>\"They tell us about their medical history,\" says Jessica Horowitz, a nurse practitioner with NURX who consults with patients via online chats. \"They give us a blood-pressure check.\"\u003c/p>\n\u003cp>A clinician like Horowitz then reviews the answers and, based on that, makes a suggestion about what type of hormonal contraception might be best for that individual — a pill, a ring or a patch are available, as well as emergency contraception\u003cstrong>.\u003c/strong> If the patient has a question about the product they're considering, they can send an instant message or call to chat with a provider.\u003c/p>\n\u003cp>\"It doesn't matter what time of day it is,\" Horowitz says. \"Someone responds.\"\u003c/p>\n\u003cp>Then NURX sends a prescription to a pharmacy and the drugs are mailed out via priority mail, or faster for emergency contraception. The cost of a month's supply of prescription birth control is often free to the patient, if they have health insurance, Horowitz says, and otherwise starts at $15 out-of-pocket for a month's supply, depending on the brand.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>For Claire Hammons, who lives and works in Llano, Texas, about 90 minutes outside of Austin, the low cost of the pills was as important as the convenience.\u003c/p>\n\u003cp>Hammons loves many aspects of life in her small town. \"There is a population of 3,000 people,\" she says. \"But we have a lot going on. We are a huge art town. We have the Llano River. We are surrounded by state parks.\"\u003c/p>\n\u003cp>Still, living there has its drawbacks, she says. There's only one doctor in town and there are no clinics nearby. This means getting health care isn't easy. And for Hammons, the main medicine she needs are birth control pills.\u003c/p>\n\u003cp>\"I've been taking birth control since I was 16 because of endometriosis,\" she explains.\u003c/p>\n\u003cp>If she can't get the pills, Hammons is in a lot of pain every month. A while back, she had a particularly hard time getting a prescription, because she lost her health insurance, and her out-of-pocket cost for a doctor's visit in Llano would have been $140.\u003c/p>\n\u003cp>\"I really did not have — literally — have the money to go to the doctor. Period,\" she says.\u003c/p>\n\u003cp>Hammons says she also couldn't afford to pay out of pocket to pick up the pills every month at a pharmacy.\u003c/p>\n\u003cp>Then, about six months ago, she went online and found NURX. The cost-savings, she says, was \"really amazing and ... saved me a lot.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Texas has become a big market for the app. Dr. Brook Randal, an emergency medicine physician in Austin who works as a provider for NURX, says her patients come from different backgrounds and use the app for different reasons.\u003c/p>\n\u003cp>\"A lot of them are low-income women who may not have a low-cost clinic available to them in the communities where they live,\" she says. \"And so we provide an important service for those women.\"\u003c/p>\n\u003cp>In 2013, the state \u003ca href=\"https://www.kqed.org/futureofyou/440262/landmark-report-concludes-abortion-in-u-s-is-safe\" target=\"_blank\" rel=\"noopener\">passed an abortion\u003c/a> bill that led half of all Texas clinics that performed abortions to close – clinics that often also provided birth control and other medical services to low-income women.\u003c/p>\n\u003cp>\"Many of those women will tell us that they would have had to drive a really long distance in order to get to a clinic where they can get birth control economically,\" Randal says.\u003c/p>\n\u003cp>And their access to birth control got even worse when Texas lawmakers cut funding for the state's family planning program, says \u003ca href=\"https://forabettertexas.org/meetourstaff.html\" target=\"_blank\" rel=\"noopener\">Stacey Pogue\u003c/a>, a health policy analyst with the \u003ca href=\"https://forabettertexas.org/whatwedoandwhy.html\" target=\"_blank\" rel=\"noopener\">Center for Public Policy Priorities\u003c/a> in Austin. The cuts came at a time when the state's population was growing and more women were seeking services, Pogue notes.\u003c/p>\n\u003cp>\"The ability of our safety net system to meet those needs and deliver health care — to actually get health care to women who are looking for contraceptives and well-woman exams — that has certainly been diminished,\" she says.\u003c/p>\n\u003cp>Apps like NURX that give women access to at least some types of contraceptives are definitely helpful, she says. But they aren't a comprehensive solution.\u003c/p>\n\u003cp>Some of the most effective types of birth control — IUDs and implants — aren't available through the apps, Pogue notes, because they require a visit to a health provider. And apps will never substitute for the missing medical clinics — places where, beyond contraception, women could also get life-saving services, such as pap smears, breast exams and cervical cancer screenings.\u003c/p>\n\u003cp>Texas is one of two states (Indiana is the other) where minors can't buy prescription birth control through NURX because of laws restricting minors' access to contraception.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/author/lesleymcclurg\" target=\"_blank\" rel=\"noopener\">\u003cem>Lesley McClurg\u003c/em>\u003c/a>\u003cem> covers mental health and consumer health stories for \u003c/em>\u003ca href=\"https://www.kqed.org/\" target=\"_blank\" rel=\"noopener\">KQED\u003c/a>\u003cem> in San Francisco, Calif. \u003c/em>\u003ca href=\"http://kut.org/people/ashley-lopez\" target=\"_blank\" rel=\"noopener\">\u003cem>Ashley Lopez\u003c/em>\u003c/a>\u003cem> reports on health care and politics for \u003ca href=\"http://kut.org/people/ashley-lopez\" target=\"_blank\" rel=\"noopener\">KUT\u003c/a>\u003c/em>\u003cem>, in Austin, Texas.\u003c/em>\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=Birth+Control+Apps+Find+A+Big+Market+In+%27Contraception+Deserts%27+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When Allison Ruddick was diagnosed with stage 3 colorectal cancer in October 2014, she turned to the world of hashtags.\u003c/p>\n\u003cp>After her initial diagnosis it wasn't clear if the cancer had metastasized, so she was in for a nerve-wracking wait, she says. She wanted outside advice. \"But they don't really give you a handbook, so you search kind of anywhere for answers,\" Ruddick says. \"Social media was one of the first places I went.\"\u003c/p>\n\u003cp>Under the hashtags #colorectalcancer and #nevertooyoung on Facebook, Twitter and Instagram, other patients were sharing a fuller picture of their experience with cancer treatments.[contextly_sidebar id=\"cdQjHydnnhf1qm80VAQ5VOhZ1zDgEbZ8\"]\u003c/p>\n\u003cp>Later she found even more advice on specialized message boards. Patients posted everything from the details of their surgeries to the ice packs they liked best as they recovered. \"These weren't things that my doctor could tell me, and as much as I appreciate their expertise, it's also really limited by the fact that they've never really experienced any of this themselves,\" Ruddick says.\u003c/p>\n\u003cp>Partly because of that experience gap, doctors and drug companies are keen to learn from online communities, too. They're analyzing social networks to get a faster, wider look into how patients react to drugs, sometimes picking up information about side effects that clinical trials missed.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>The Rule of Three\u003c/strong>\u003c/p>\n\u003cp>Stanford University dermatologist \u003ca href=\"https://profiles.stanford.edu/bernice-kwong\">Bernice Kwong\u003c/a> specializes in skin conditions that tag along with cancer treatments. In her practice and on patient message boards, she's constantly on the lookout for symptoms that could be drug reactions.\u003c/p>\n\u003cp>In January 2017, a patient came to Kwong's office with an unusual complaint\u003cstrong>. \u003c/strong>\"I've noticed that when I work out, I just get really hot,\" he told Kwong. \"I don't sweat anymore, and I used to sweat so much.\" He was taking a drug called Tarceva, or erlotinib, that's used against lung cancer.[contextly_sidebar id=\"YV4ALpzrjOrylquldVmESZ1WsJYER2Bg\"]\u003c/p>\n\u003cp>At first, Kwong thought the problem might be hormonal. But soon after, two more of her patients at Stanford on the same drug reported that they'd also stopped sweating. \"Anytime something hits three, I think, OK, I gotta look into this a little bit more,\" she says.\u003c/p>\n\u003cp>But she hadn't seen any reports before of a lack of sweating — hypohidrosis — as a side effect for Tarceva. Her sample size of three patients was small. She'd need more data to figure things out.\u003c/p>\n\u003cp>From talking with patients and perusing online forums, Kwong knew people discussed their treatments and side effects online. In fact, hundreds of thousands of people participate in support groups and communities she'd looked at on the website \u003ca href=\"https://www.inspire.com/\">Inspire\u003c/a>. She partnered with the site with the idea that its trove of patient reports could connect more dots between hypohidrosis and Tarceva.\u003c/p>\n\u003cp>\u003cstrong>A Sharper Data Set\u003c/strong>\u003c/p>\n\u003cp>Inspire's focused groups are filled with patients' experiences with diseases and treatment, so analyzing posts requires less filtering than Facebook or Twitter data would, says \u003ca href=\"https://profiles.stanford.edu/nigam-shah\">Nigam Shah\u003c/a>, a Stanford University bioinformatics specialist who collaborated with Kwong. It also helped that the skin reactions they were interested in are relatively easy for patients to describe.\u003c/p>\n\u003cp>Still, the posts on Inspire's boards are less precise than insurance claims and health records typically used for studies on side effects.\u003c/p>\n\u003cp>Take loss of sweating. Most doctors would refer to that as hypohidrosis, so a records-based study could focus on that phrase. In online message boards there's a lot of variety. One person's \"I can't sweat anymore\" might be another's \"I'm overheating.\"[contextly_sidebar id=\"b60xAgKbNdenisEddidkCVcmMXTjd0Aj\"]\u003c/p>\n\u003cp>Kwong, Shah and their colleagues used a deep learning algorithm to process the phrases surrounding reports of symptoms, basically finding contextual clues to identify the different ways patients referred to side effects.\u003c/p>\n\u003cp>In 8 million posts on Inspire from a 10-year period, 4,909 users mentioned Tarceva, or erlotinib generically. Although clinical reports don't link the drug and hypohidrosis, 23 patients wrote about the medicine and loss of sweating in the same post — a statistically significant connection, Kwong says. The research group's findings \u003ca href=\"https://jamanetwork.com/journals/jamaoncology/article-abstract/2673831?redirect=true\" target=\"_blank\" rel=\"noopener\">were published\u003c/a> in \u003cem>JAMA Oncology\u003c/em> in March.\u003c/p>\n\u003cp>Using the same approach to monitor posts about a different class of immunotherapy cancer drugs, the researchers found mentions of autoimmune blistering that also predated the clinical reports of the side effect.\u003c/p>\n\u003cp>Given the stakes of cancer treatment, Kwong says she's inclined to help patients manage side effects instead of stopping a given drug. But earlier alerts from systems like this could have made a difference in her practice. \"If we had had this program already, I would've been looking out for [blistering] sooner and maybe I would've noticed it earlier in some patients,\" Kwong says.\u003c/p>\n\u003cp>\u003cstrong>How Clinical Trials Miss Side Effects\u003c/strong>\u003c/p>\n\u003cp>From numbers alone, it's no surprise that clinical trials for drugs don't pick up every side effect. The Food and Drug Administration first \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/nda/2004/21-743_Tarceva_StatR.PDF\">approved\u003c/a> Tarceva in 2004 on the basis of a trial that enrolled 731 patients, 488 of whom received the drug. Uncommon effects might not show up in a group that size.\u003c/p>\n\u003cp>On Inspire's message boards, more than 10 times as many patients reported using Tarceva, so it's reasonable to imagine that online posts could include reports of rarer side effects.\u003c/p>\n\u003cp>And while drug trials do collect data on side effects, their overriding goal is to find out whether or not a drug works, says \u003ca href=\"http://bioethics.hms.harvard.edu/person/faculty-members/aaron-kesselheim\">Dr. Aaron Kesselheim\u003c/a>, a professor of medicine at Harvard University. \"After a drug is approved, it is absolutely essential to continue to observe, follow and study the drug rigorously as it's used in a larger population to try to really get a handle on the safety of the drug,\" he says.[contextly_sidebar id=\"JGYGYdpwADzgX2U5wdZePXnIkUOkoc8q\"]\u003c/p>\n\u003cp>Collecting data about a drug from insurance claims and health records typically happens with quite a time lag. So mining the Internet and social media for casual patient reports is tempting, Kesselheim says, because of its potential scale and speed. But the approach also has drawbacks. \"You just get this tidal wave of data, and it's hard to know how to assess it in a rigorous and thoughtful fashion,\" he says.\u003c/p>\n\u003cp>That hasn't stopped drug companies from wading in. Roche has \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29446035\">sampled\u003c/a> mentions of their products from Twitter, Tumblr, Facebook and blogs to learn more about drug safety. GlaxoSmithKline has tried it too, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26798054\">analyzing\u003c/a> millions of mentions of drugs from Twitter and Facebook.\u003c/p>\n\u003cp>Much of the work published so far has focused on drug reactions. But scraping public social media data isn't just a matter of product safety. The company \u003ca href=\"https://www.synthesio.com/social-listening-pharma-healthcare/\">Synthesio\u003c/a> touts its social data services for drugmakers as a way to answer customer questions, conduct market research and influence purchasing.\u003c/p>\n\u003cp>\u003cstrong>Surfing Responsibly\u003c/strong>\u003c/p>\n\u003cp>In terms of extending studies to mine even bigger networks, like Twitter or Facebook, for potential side effects, Kesselheim points to issues of representation and privacy. As with any analysis, a deep learning model like the one Shah used on the Inspire message boards can only make conclusions about the information it \u003cem>sees\u003c/em>.\u003c/p>\n\u003cp>And it's hard to guarantee that message boards and social media represent all patients. In 2012, researchers gave 231 breast cancer patients in rural Michigan and Wisconsin computers, Internet access and training to use an online cancer support group. The researchers \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556823/\">found\u003c/a> that white women were much more likely to log on and post in the group than black women. Younger women were also more likely to post information.\u003c/p>\n\u003cp>While the long-standing approach to post-approval drug studies — using health records and claims data — may be slower, Kesselheim says, they're more established. \"There are methodologies and tools that you can use in claims data to try to make sure that you are making conclusions that can be generalizable across different races and ethnicity and genders and parts of America,\" he says.\u003c/p>\n\u003cp>There's also the issue of privacy — patients' health records are protected by the Health Insurance Portability and Accountability Act of 1996, whereas public data online aren't, Kesselheim says.\u003c/p>\n\u003cp>For Stanford researcher Shah, this wasn't an issue. Inspire's privacy statement tells patients their posts may be used for research if they're not private, and Shah feels comfortable following common sense rules when using public data. \"As in, if somebody did [something] with my data and I would be upset, don't do that with someone else's data,\" he says.\u003c/p>\n\u003cp>But the newness of social media makes Kesselheim wary. \"There are big questions that remain about how patient privacy is upheld in those social media contexts, and I think that's a really big issue to think about moving forward as people are trying to use those outlets to provide insight into drug safety and side effects.\"\u003c/p>\n\u003cp>As a patient, Ruddick isn't bothered by the idea of researchers and pharmaceutical companies studying data from social media and patient message boards, as long as the data are public or there's mention of data sharing in a privacy statement.\u003c/p>\n\u003cp>She works as a communications director in New York City, so she's thought a lot about the nature of information online. \"If I'm putting something out there on the Internet, it's for the Internet. I know the world is going to see it,\" Ruddick says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>She knows other patients might feel differently, but she's optimistic that analyzing patients' interactions online could improve the treatments available. \"It's one thing, being in a lab and developing these drugs,\" she says. \"But it's a completely different thing to see how they're being used out there in the world, and to see how they're affecting somebody's life.\"\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=How+Social+Media+Can+Reveal+Overlooked+Drug+Reactions&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When Allison Ruddick was diagnosed with stage 3 colorectal cancer in October 2014, she turned to the world of hashtags.\u003c/p>\n\u003cp>After her initial diagnosis it wasn't clear if the cancer had metastasized, so she was in for a nerve-wracking wait, she says. She wanted outside advice. \"But they don't really give you a handbook, so you search kind of anywhere for answers,\" Ruddick says. \"Social media was one of the first places I went.\"\u003c/p>\n\u003cp>Under the hashtags #colorectalcancer and #nevertooyoung on Facebook, Twitter and Instagram, other patients were sharing a fuller picture of their experience with cancer treatments.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Later she found even more advice on specialized message boards. Patients posted everything from the details of their surgeries to the ice packs they liked best as they recovered. \"These weren't things that my doctor could tell me, and as much as I appreciate their expertise, it's also really limited by the fact that they've never really experienced any of this themselves,\" Ruddick says.\u003c/p>\n\u003cp>Partly because of that experience gap, doctors and drug companies are keen to learn from online communities, too. They're analyzing social networks to get a faster, wider look into how patients react to drugs, sometimes picking up information about side effects that clinical trials missed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>The Rule of Three\u003c/strong>\u003c/p>\n\u003cp>Stanford University dermatologist \u003ca href=\"https://profiles.stanford.edu/bernice-kwong\">Bernice Kwong\u003c/a> specializes in skin conditions that tag along with cancer treatments. In her practice and on patient message boards, she's constantly on the lookout for symptoms that could be drug reactions.\u003c/p>\n\u003cp>In January 2017, a patient came to Kwong's office with an unusual complaint\u003cstrong>. \u003c/strong>\"I've noticed that when I work out, I just get really hot,\" he told Kwong. \"I don't sweat anymore, and I used to sweat so much.\" He was taking a drug called Tarceva, or erlotinib, that's used against lung cancer.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>At first, Kwong thought the problem might be hormonal. But soon after, two more of her patients at Stanford on the same drug reported that they'd also stopped sweating. \"Anytime something hits three, I think, OK, I gotta look into this a little bit more,\" she says.\u003c/p>\n\u003cp>But she hadn't seen any reports before of a lack of sweating — hypohidrosis — as a side effect for Tarceva. Her sample size of three patients was small. She'd need more data to figure things out.\u003c/p>\n\u003cp>From talking with patients and perusing online forums, Kwong knew people discussed their treatments and side effects online. In fact, hundreds of thousands of people participate in support groups and communities she'd looked at on the website \u003ca href=\"https://www.inspire.com/\">Inspire\u003c/a>. She partnered with the site with the idea that its trove of patient reports could connect more dots between hypohidrosis and Tarceva.\u003c/p>\n\u003cp>\u003cstrong>A Sharper Data Set\u003c/strong>\u003c/p>\n\u003cp>Inspire's focused groups are filled with patients' experiences with diseases and treatment, so analyzing posts requires less filtering than Facebook or Twitter data would, says \u003ca href=\"https://profiles.stanford.edu/nigam-shah\">Nigam Shah\u003c/a>, a Stanford University bioinformatics specialist who collaborated with Kwong. It also helped that the skin reactions they were interested in are relatively easy for patients to describe.\u003c/p>\n\u003cp>Still, the posts on Inspire's boards are less precise than insurance claims and health records typically used for studies on side effects.\u003c/p>\n\u003cp>Take loss of sweating. Most doctors would refer to that as hypohidrosis, so a records-based study could focus on that phrase. In online message boards there's a lot of variety. One person's \"I can't sweat anymore\" might be another's \"I'm overheating.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Kwong, Shah and their colleagues used a deep learning algorithm to process the phrases surrounding reports of symptoms, basically finding contextual clues to identify the different ways patients referred to side effects.\u003c/p>\n\u003cp>In 8 million posts on Inspire from a 10-year period, 4,909 users mentioned Tarceva, or erlotinib generically. Although clinical reports don't link the drug and hypohidrosis, 23 patients wrote about the medicine and loss of sweating in the same post — a statistically significant connection, Kwong says. The research group's findings \u003ca href=\"https://jamanetwork.com/journals/jamaoncology/article-abstract/2673831?redirect=true\" target=\"_blank\" rel=\"noopener\">were published\u003c/a> in \u003cem>JAMA Oncology\u003c/em> in March.\u003c/p>\n\u003cp>Using the same approach to monitor posts about a different class of immunotherapy cancer drugs, the researchers found mentions of autoimmune blistering that also predated the clinical reports of the side effect.\u003c/p>\n\u003cp>Given the stakes of cancer treatment, Kwong says she's inclined to help patients manage side effects instead of stopping a given drug. But earlier alerts from systems like this could have made a difference in her practice. \"If we had had this program already, I would've been looking out for [blistering] sooner and maybe I would've noticed it earlier in some patients,\" Kwong says.\u003c/p>\n\u003cp>\u003cstrong>How Clinical Trials Miss Side Effects\u003c/strong>\u003c/p>\n\u003cp>From numbers alone, it's no surprise that clinical trials for drugs don't pick up every side effect. The Food and Drug Administration first \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/nda/2004/21-743_Tarceva_StatR.PDF\">approved\u003c/a> Tarceva in 2004 on the basis of a trial that enrolled 731 patients, 488 of whom received the drug. Uncommon effects might not show up in a group that size.\u003c/p>\n\u003cp>On Inspire's message boards, more than 10 times as many patients reported using Tarceva, so it's reasonable to imagine that online posts could include reports of rarer side effects.\u003c/p>\n\u003cp>And while drug trials do collect data on side effects, their overriding goal is to find out whether or not a drug works, says \u003ca href=\"http://bioethics.hms.harvard.edu/person/faculty-members/aaron-kesselheim\">Dr. Aaron Kesselheim\u003c/a>, a professor of medicine at Harvard University. \"After a drug is approved, it is absolutely essential to continue to observe, follow and study the drug rigorously as it's used in a larger population to try to really get a handle on the safety of the drug,\" he says.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Collecting data about a drug from insurance claims and health records typically happens with quite a time lag. So mining the Internet and social media for casual patient reports is tempting, Kesselheim says, because of its potential scale and speed. But the approach also has drawbacks. \"You just get this tidal wave of data, and it's hard to know how to assess it in a rigorous and thoughtful fashion,\" he says.\u003c/p>\n\u003cp>That hasn't stopped drug companies from wading in. Roche has \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29446035\">sampled\u003c/a> mentions of their products from Twitter, Tumblr, Facebook and blogs to learn more about drug safety. GlaxoSmithKline has tried it too, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26798054\">analyzing\u003c/a> millions of mentions of drugs from Twitter and Facebook.\u003c/p>\n\u003cp>Much of the work published so far has focused on drug reactions. But scraping public social media data isn't just a matter of product safety. The company \u003ca href=\"https://www.synthesio.com/social-listening-pharma-healthcare/\">Synthesio\u003c/a> touts its social data services for drugmakers as a way to answer customer questions, conduct market research and influence purchasing.\u003c/p>\n\u003cp>\u003cstrong>Surfing Responsibly\u003c/strong>\u003c/p>\n\u003cp>In terms of extending studies to mine even bigger networks, like Twitter or Facebook, for potential side effects, Kesselheim points to issues of representation and privacy. As with any analysis, a deep learning model like the one Shah used on the Inspire message boards can only make conclusions about the information it \u003cem>sees\u003c/em>.\u003c/p>\n\u003cp>And it's hard to guarantee that message boards and social media represent all patients. In 2012, researchers gave 231 breast cancer patients in rural Michigan and Wisconsin computers, Internet access and training to use an online cancer support group. The researchers \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556823/\">found\u003c/a> that white women were much more likely to log on and post in the group than black women. Younger women were also more likely to post information.\u003c/p>\n\u003cp>While the long-standing approach to post-approval drug studies — using health records and claims data — may be slower, Kesselheim says, they're more established. \"There are methodologies and tools that you can use in claims data to try to make sure that you are making conclusions that can be generalizable across different races and ethnicity and genders and parts of America,\" he says.\u003c/p>\n\u003cp>There's also the issue of privacy — patients' health records are protected by the Health Insurance Portability and Accountability Act of 1996, whereas public data online aren't, Kesselheim says.\u003c/p>\n\u003cp>For Stanford researcher Shah, this wasn't an issue. Inspire's privacy statement tells patients their posts may be used for research if they're not private, and Shah feels comfortable following common sense rules when using public data. \"As in, if somebody did [something] with my data and I would be upset, don't do that with someone else's data,\" he says.\u003c/p>\n\u003cp>But the newness of social media makes Kesselheim wary. \"There are big questions that remain about how patient privacy is upheld in those social media contexts, and I think that's a really big issue to think about moving forward as people are trying to use those outlets to provide insight into drug safety and side effects.\"\u003c/p>\n\u003cp>As a patient, Ruddick isn't bothered by the idea of researchers and pharmaceutical companies studying data from social media and patient message boards, as long as the data are public or there's mention of data sharing in a privacy statement.\u003c/p>\n\u003cp>She works as a communications director in New York City, so she's thought a lot about the nature of information online. \"If I'm putting something out there on the Internet, it's for the Internet. I know the world is going to see it,\" Ruddick says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She knows other patients might feel differently, but she's optimistic that analyzing patients' interactions online could improve the treatments available. \"It's one thing, being in a lab and developing these drugs,\" she says. \"But it's a completely different thing to see how they're being used out there in the world, and to see how they're affecting somebody's life.\"\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=How+Social+Media+Can+Reveal+Overlooked+Drug+Reactions&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Abnormal Heartbeat? There's an App for That -- And it Could Be 97 Percent Accurate",
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"headTitle": "Heart health | Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>A mobile app was able to detect irregular heart rhythms with 97 percent accuracy, a finding by UC San Francisco researchers that could lead to life-saving \u003ca href=\"https://www.kqed.org/futureofyou/266349/how-reliable-are-smartphones-and-wearables-for-monitoring-your-heart\" target=\"_blank\" rel=\"noopener\">preventative screenings.\u003c/a>\u003c/p>\n\u003cp>One in four adults over the age of 40 is at risk for a heart condition known as \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624\" target=\"_blank\" rel=\"noopener\">atrial fibrillation\u003c/a> (AF). It's one of the leading causes of stroke and often goes undetected until it's too late.\u003c/p>\n\u003cp>The study, which relied on an app specifically designed for the Apple Watch, is reportedly the first to use a smartwatch to detect abnormal heart rhythms.\u003c/p>\n\u003cp>“By identifying candidates for appropriate anti-coagulation treatment, we might ultimately leverage common wearable devices to reduce ... complications, even death,\" said Gregory Marcus, director of clinical research in the UCSF Division of Cardiology and lead author of the study.\u003c/p>\n\u003cp>AF occurs when electrical impulses in the the upper chambers of the heart become erratic, causing the atrium's walls to quiver as blood passes through, potentially triggering blood clots.[contextly_sidebar id=\"sQ9MJSaMtUHbSJHSKfj37aKsbqwOOxmZ\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Researchers say the findings, published in \u003ca href=\"https://jamanetwork.com/journals/jamacardiology/article-abstract/2675364?redirect=true\" target=\"_blank\" rel=\"noopener\">JAMA Cardiology\u003c/a>, could lead to the development of more effective screenings. And with nearly 6 million people in the U.S. estimated to develop AF by 2050, the app could prevent large numbers of strokes and death.\u003c/p>\n\u003cp>With a 97 percent accuracy rate, the app performed better than a competing \u003ca href=\"http://www.abstractsonline.com/pp8/#!/4496/presentation/41378\" target=\"_blank\" rel=\"noopener\">FDA-approved product sold as Kardia Band.\u003c/a>\u003c/p>\n\u003cp>The UCSF-tested app, designed by Cardiogram, relies on deep neural networks, a type of sophisticated machine-learning algorithm that provides a continuous stream of data. More than 139 million measurements of heart rates and step counts were collected from 9,750 participants. [contextly_sidebar id=\"C27bFTVwLpXMdavOJy6PlXm3e5jXCR7Q\"]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Researchers cited certain limitations to their study, including a number of participants who failed to link their Cardiogram accounts. In addition, researchers focused on those with known AF and did not look into the app's ability to identify undiagnosed conditions.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A mobile app was able to detect irregular heart rhythms with 97 percent accuracy, a finding by UC San Francisco researchers that could lead to life-saving \u003ca href=\"https://www.kqed.org/futureofyou/266349/how-reliable-are-smartphones-and-wearables-for-monitoring-your-heart\" target=\"_blank\" rel=\"noopener\">preventative screenings.\u003c/a>\u003c/p>\n\u003cp>One in four adults over the age of 40 is at risk for a heart condition known as \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624\" target=\"_blank\" rel=\"noopener\">atrial fibrillation\u003c/a> (AF). It's one of the leading causes of stroke and often goes undetected until it's too late.\u003c/p>\n\u003cp>The study, which relied on an app specifically designed for the Apple Watch, is reportedly the first to use a smartwatch to detect abnormal heart rhythms.\u003c/p>\n\u003cp>“By identifying candidates for appropriate anti-coagulation treatment, we might ultimately leverage common wearable devices to reduce ... complications, even death,\" said Gregory Marcus, director of clinical research in the UCSF Division of Cardiology and lead author of the study.\u003c/p>\n\u003cp>AF occurs when electrical impulses in the the upper chambers of the heart become erratic, causing the atrium's walls to quiver as blood passes through, potentially triggering blood clots.\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>Researchers say the findings, published in \u003ca href=\"https://jamanetwork.com/journals/jamacardiology/article-abstract/2675364?redirect=true\" target=\"_blank\" rel=\"noopener\">JAMA Cardiology\u003c/a>, could lead to the development of more effective screenings. And with nearly 6 million people in the U.S. estimated to develop AF by 2050, the app could prevent large numbers of strokes and death.\u003c/p>\n\u003cp>With a 97 percent accuracy rate, the app performed better than a competing \u003ca href=\"http://www.abstractsonline.com/pp8/#!/4496/presentation/41378\" target=\"_blank\" rel=\"noopener\">FDA-approved product sold as Kardia Band.\u003c/a>\u003c/p>\n\u003cp>The UCSF-tested app, designed by Cardiogram, relies on deep neural networks, a type of sophisticated machine-learning algorithm that provides a continuous stream of data. More than 139 million measurements of heart rates and step counts were collected from 9,750 participants. \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Researchers cited certain limitations to their study, including a number of participants who failed to link their Cardiogram accounts. In addition, researchers focused on those with known AF and did not look into the app's ability to identify undiagnosed conditions.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "A Dietary Supplement Makes Old Mice Youthful. Will It Work in People?",
"title": "A Dietary Supplement Makes Old Mice Youthful. Will It Work in People?",
"headTitle": "Future of You | KQED Future of You | KQED Science",
"content": "\u003cp>Transfusing \u003ca href=\"https://www.statnews.com/2018/03/02/young-blood-anti-aging-study/\" target=\"_blank\" rel=\"noopener\">young blood\u003c/a> and freezing heads may get most of the anti-aging and life-extension buzz, but don’t count out the molecule hunters: After setbacks and stumbles and what critics called \u003ca href=\"http://blogs.sciencemag.org/pipeline/archives/2010/01/12/the_sirtris_compounds_worthless_really\" target=\"_blank\" rel=\"noopener\">debacles\u003c/a>, these scientists are figuring out which biochemicals might potentially, possibly be fountains of youth in pill form.[contextly_sidebar id=\"YaFBEqHshnjDvp4XR5pAEiDxJjAI7Fx4\"]\u003c/p>\n\u003cp>In the latest advance, biologists \u003ca href=\"http://www.cell.com/cell/fulltext/S0092-8674(18)30152-1\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on Thursday that a molecule already sold by supplement makers (even as scientists scramble to understand it) restored youthfulness to blood vessels in 20-month-old mice, an age comparable to 70 years in people. The research supports the idea that boosting certain genes and molecules that fade with age could keep people functional, resilient, and even spry well into their 80s, even without living longer.\u003c/p>\n\u003cp>“I think it’s quite an important paper,” said Dr. Eric Verdin, of the California-based Buck Institute for Research on Aging, who was not involved in the\u003ca href=\"https://www.kqed.org/futureofyou/439750/superagers-maintain-memory-into-80s-and-90s\" target=\"_blank\" rel=\"noopener\"> new research\u003c/a>. “It’s probably not the magic pill everyone is looking for, but it’s one more brick in our efforts to understand aging and healthspan,” or how long people can stay biologically young(ish) even as their birthday candles proliferate.[contextly_sidebar id=\"Vl0Meh1Zh9UAHnk3RIGR5S5B5rBQ0sSW\"]\u003c/p>\n\u003cp>Others were more skeptical, calling the advance at best “incremental” (and asking to remain anonymous so as not to antagonize colleagues). And science is littered with examples of compounds that worked in mice but not people. “It’s hard to tell how significant any contribution is until it has been replicated and extended” by other labs, said David Harrison of the Jackson Lab, an expert on the molecular \u003ca href=\"https://www.kqed.org/futureofyou/440080/hearts-get-younger-even-at-middle-age-with-exercise\" target=\"_blank\" rel=\"noopener\">mechanisms of aging.\u003c/a>\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>The new study, in Cell, found that boosting mice’s levels of the naturally occurring molecule NMN, which humans also have, increased levels of another called NAD+. That, in turn, raised levels of a famous anti-aging enzyme called SIRT1, which has been the focus of nearly 30 years of research.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>After two months of NMN, more blood vessels sprouted in the old mice’s muscles. The density of the smallest vessels — capillaries — became comparable to that of young mice. Blood flow increased, and the animals’ endurance, measured by how long they could run on a treadmill before becoming exhausted, was 56 percent to 80 percent greater than that of untreated old mice: 1,400 feet compared to 780 feet.[contextly_sidebar id=\"8Tmsn0Ufo1g8AeUi0b3OJ5Td2G7sq49c\"]\u003c/p>\n\u003cp>The treated mice also benefitted from exercise like mice half their age. In young animals, exercise spurs the creation of new blood vessels and boosts muscle mass, but that effect weakens with age in both people and mice. NMN restored the blood-vessel- and muscle-boosting effects of a good treadmill run, basically “reversing vascular aging in the mice,” said study co-leader David Sinclair of Harvard Medical School.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter wp-image-440373 size-medium\" title=\"iStock\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg\" alt=\"\" width=\"800\" height=\"588\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-160x118.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-768x564.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1020x749.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1920x1411.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1180x867.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-960x705.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-240x176.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-375x275.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-520x382.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Opinions differed on how important that is. One expert on the biology of aging said, “So David’s found another molecule that prevents aging?” (Sinclair was a prominent exponent of resveratrol, a compound that slowed aging in mice but proved disappointing in people.) The Jax’s Harrison questioned whether the inbred mice used in the study were representative of humans, who are genetically diverse.\u003c/p>\n\u003cp>New blood vessels could also be a mixed blessing. They support the growth of tumors, which is why anti-angiogenesis molecules have become cancer drugs. The scientists found no excess cancers in the mice given NMR, but “more study is warranted,” they wrote.[contextly_sidebar id=\"EmvIbKqj3sGiXrLYKODcw1UEPJNlCkZr\"]\u003c/p>\n\u003cp>The blood-vessel benefits of NMN didn’t happen if the mice lacked the SIRT1 gene, probably the brightest star in the anti-aging firmament. In the 1990s, it and the six other genes belonging to the family called sirtuins took aging research by storm, as biologists showed that increasing the genes’ activity extended lifespan in yeast, roundworms, and fruit flies by up to 30 percent. When Massachusetts Institute of Technology’s Leonard Guarente, whose lab was sirtuin central, found that the lifespan-extending effect of drastic caloric restriction works by turning up sirtuin genes, it seemed to point the way to slowing aging: Activate sirtuins with a molecule.\u003c/p>\n\u003cp>That proved easier said than done. Some studies, especially in higher animals, contradicted the simple notion that overexpression of sirtuins translated into longer life. The biggest setback involved resveratrol, a compound found in grapes and wine, which activates the SIRT1 gene. After years of hyperbolic headlines and soaring sales, the resveratrol bubble burst. GlaxoSmithKline bought Cambridge, Mass.-based Sirtris Pharmaceuticals, which Sinclair co-founded in 2004 to develop sirtuin-boosting compounds, for $720 million, but within five years essentially shut it down.[contextly_sidebar id=\"FSd7BTxFEMjJhm2kkUJ0cTaJQITZc3CT\"]\u003c/p>\n\u003cp>“Resveratrol is very, very good [at activating SIRT1 and extending lifespan] if you’re a mouse,” said Guarente, who cheerfully acknowledges buying a 10-year supply of micronized resveratrol. Most of it is still in his basement. “But the human trials were all over the place, which was unsettling,” he said.\u003c/p>\n\u003cp>Those failures led scientists to search for other sirtuin-boosting molecules. In 2014, Guarente co-founded Elysium Health, which, for $40 to $60 per month, sells a dietary supplement that boosts NAD+ levels and activates SIRT1. Since levels of NAD+ fall as people age, the hope is that providing the raw material for it will raise those levels, slowing aging. The pills seem to be safe, Guarente and colleagues \u003ca href=\"https://www.nature.com/articles/s41514-017-0016-9\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year, and additional human studies are underway to test whether they benefit health.\u003c/p>\n\u003cp>Thanks to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188402/\" target=\"_blank\" rel=\"noopener\">negative studies\u003c/a>, the jury is still out on whether anything related to sirtuins will extend lifespan, but the Cell study offers some hope for extending healthspan. If boosting NAD+ promotes blood vessel formation via SIRT1, it might “rescue muscle mass” that otherwise decreases as blood vessels atrophy, Guarente said. That could prevent the bone loss, frailty, and falls that can be fatal in old age.\u003c/p>\n\u003cp>“Anything that contributes to muscle health through vascular health is likely to be quite important,” said the Buck Institute’s Verdin, who takes a daily NAD+ precursor.\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>Sinclair and his team are now studying whether raising NAD+ might also spur the creation of blood vessels in the brain. There and in other organs, said Sinclair, “the lack of oxygen and buildup of waste products” that results from loss of small blood vessels “sets off a downward spiral of disease and disability.” In the brain, that would include vascular dementia.\u003c/p>\n\u003cp>Sinclair takes NMN to boost NAD+ levels. “In someone my age [49], it’s probably harder to see immediate benefits,” he said, though he said he feels sharper and younger on it. After his 78-year-old father began taking NMN “he started climbing mountains and going whitewater rafting and looking forward to the next five years,” Sinclair said. “It might be psychological, but it isn’t hurting.”\u003c/p>\n\u003cp>Only rigorous human research can determine that. Metro International Biotech, a Michigan-based startup for which Sinclair consults, just finished a clinical trial of the safety of a proprietary version of NMN and hopes to start a trial of the molecule’s efficacy this year, Sinclair said.\u003c/p>\n\u003cp>One concern is that boosting sirtuins could backfire. An excess of the molecules, Verdin said, can promote autoimmunity, which causes diseases such as Crohn’s and rheumatoid arthritis.\u003c/p>\n\u003cp>“That should give us pause about broad claims of what they can do,” he cautioned. “I worry sometimes that [with NAD+-boosting pills already on the market] the field is getting ahead of itself.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was originally published by\u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\"> STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Transfusing \u003ca href=\"https://www.statnews.com/2018/03/02/young-blood-anti-aging-study/\" target=\"_blank\" rel=\"noopener\">young blood\u003c/a> and freezing heads may get most of the anti-aging and life-extension buzz, but don’t count out the molecule hunters: After setbacks and stumbles and what critics called \u003ca href=\"http://blogs.sciencemag.org/pipeline/archives/2010/01/12/the_sirtris_compounds_worthless_really\" target=\"_blank\" rel=\"noopener\">debacles\u003c/a>, these scientists are figuring out which biochemicals might potentially, possibly be fountains of youth in pill form.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In the latest advance, biologists \u003ca href=\"http://www.cell.com/cell/fulltext/S0092-8674(18)30152-1\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on Thursday that a molecule already sold by supplement makers (even as scientists scramble to understand it) restored youthfulness to blood vessels in 20-month-old mice, an age comparable to 70 years in people. The research supports the idea that boosting certain genes and molecules that fade with age could keep people functional, resilient, and even spry well into their 80s, even without living longer.\u003c/p>\n\u003cp>“I think it’s quite an important paper,” said Dr. Eric Verdin, of the California-based Buck Institute for Research on Aging, who was not involved in the\u003ca href=\"https://www.kqed.org/futureofyou/439750/superagers-maintain-memory-into-80s-and-90s\" target=\"_blank\" rel=\"noopener\"> new research\u003c/a>. “It’s probably not the magic pill everyone is looking for, but it’s one more brick in our efforts to understand aging and healthspan,” or how long people can stay biologically young(ish) even as their birthday candles proliferate.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Others were more skeptical, calling the advance at best “incremental” (and asking to remain anonymous so as not to antagonize colleagues). And science is littered with examples of compounds that worked in mice but not people. “It’s hard to tell how significant any contribution is until it has been replicated and extended” by other labs, said David Harrison of the Jackson Lab, an expert on the molecular \u003ca href=\"https://www.kqed.org/futureofyou/440080/hearts-get-younger-even-at-middle-age-with-exercise\" target=\"_blank\" rel=\"noopener\">mechanisms of aging.\u003c/a>\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>The new study, in Cell, found that boosting mice’s levels of the naturally occurring molecule NMN, which humans also have, increased levels of another called NAD+. That, in turn, raised levels of a famous anti-aging enzyme called SIRT1, which has been the focus of nearly 30 years of research.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>After two months of NMN, more blood vessels sprouted in the old mice’s muscles. The density of the smallest vessels — capillaries — became comparable to that of young mice. Blood flow increased, and the animals’ endurance, measured by how long they could run on a treadmill before becoming exhausted, was 56 percent to 80 percent greater than that of untreated old mice: 1,400 feet compared to 780 feet.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The treated mice also benefitted from exercise like mice half their age. In young animals, exercise spurs the creation of new blood vessels and boosts muscle mass, but that effect weakens with age in both people and mice. NMN restored the blood-vessel- and muscle-boosting effects of a good treadmill run, basically “reversing vascular aging in the mice,” said study co-leader David Sinclair of Harvard Medical School.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter wp-image-440373 size-medium\" title=\"iStock\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg\" alt=\"\" width=\"800\" height=\"588\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-800x588.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-160x118.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-768x564.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1020x749.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1920x1411.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-1180x867.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-960x705.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-240x176.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-375x275.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-639071970-520x382.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003c/p>\n\u003cp>Opinions differed on how important that is. One expert on the biology of aging said, “So David’s found another molecule that prevents aging?” (Sinclair was a prominent exponent of resveratrol, a compound that slowed aging in mice but proved disappointing in people.) The Jax’s Harrison questioned whether the inbred mice used in the study were representative of humans, who are genetically diverse.\u003c/p>\n\u003cp>New blood vessels could also be a mixed blessing. They support the growth of tumors, which is why anti-angiogenesis molecules have become cancer drugs. The scientists found no excess cancers in the mice given NMR, but “more study is warranted,” they wrote.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The blood-vessel benefits of NMN didn’t happen if the mice lacked the SIRT1 gene, probably the brightest star in the anti-aging firmament. In the 1990s, it and the six other genes belonging to the family called sirtuins took aging research by storm, as biologists showed that increasing the genes’ activity extended lifespan in yeast, roundworms, and fruit flies by up to 30 percent. When Massachusetts Institute of Technology’s Leonard Guarente, whose lab was sirtuin central, found that the lifespan-extending effect of drastic caloric restriction works by turning up sirtuin genes, it seemed to point the way to slowing aging: Activate sirtuins with a molecule.\u003c/p>\n\u003cp>That proved easier said than done. Some studies, especially in higher animals, contradicted the simple notion that overexpression of sirtuins translated into longer life. The biggest setback involved resveratrol, a compound found in grapes and wine, which activates the SIRT1 gene. After years of hyperbolic headlines and soaring sales, the resveratrol bubble burst. GlaxoSmithKline bought Cambridge, Mass.-based Sirtris Pharmaceuticals, which Sinclair co-founded in 2004 to develop sirtuin-boosting compounds, for $720 million, but within five years essentially shut it down.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“Resveratrol is very, very good [at activating SIRT1 and extending lifespan] if you’re a mouse,” said Guarente, who cheerfully acknowledges buying a 10-year supply of micronized resveratrol. Most of it is still in his basement. “But the human trials were all over the place, which was unsettling,” he said.\u003c/p>\n\u003cp>Those failures led scientists to search for other sirtuin-boosting molecules. In 2014, Guarente co-founded Elysium Health, which, for $40 to $60 per month, sells a dietary supplement that boosts NAD+ levels and activates SIRT1. Since levels of NAD+ fall as people age, the hope is that providing the raw material for it will raise those levels, slowing aging. The pills seem to be safe, Guarente and colleagues \u003ca href=\"https://www.nature.com/articles/s41514-017-0016-9\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> last year, and additional human studies are underway to test whether they benefit health.\u003c/p>\n\u003cp>Thanks to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188402/\" target=\"_blank\" rel=\"noopener\">negative studies\u003c/a>, the jury is still out on whether anything related to sirtuins will extend lifespan, but the Cell study offers some hope for extending healthspan. If boosting NAD+ promotes blood vessel formation via SIRT1, it might “rescue muscle mass” that otherwise decreases as blood vessels atrophy, Guarente said. That could prevent the bone loss, frailty, and falls that can be fatal in old age.\u003c/p>\n\u003cp>“Anything that contributes to muscle health through vascular health is likely to be quite important,” said the Buck Institute’s Verdin, who takes a daily NAD+ precursor.\u003c/p>\n\u003caside>\u003c/aside>\n\u003cp>Sinclair and his team are now studying whether raising NAD+ might also spur the creation of blood vessels in the brain. There and in other organs, said Sinclair, “the lack of oxygen and buildup of waste products” that results from loss of small blood vessels “sets off a downward spiral of disease and disability.” In the brain, that would include vascular dementia.\u003c/p>\n\u003cp>Sinclair takes NMN to boost NAD+ levels. “In someone my age [49], it’s probably harder to see immediate benefits,” he said, though he said he feels sharper and younger on it. After his 78-year-old father began taking NMN “he started climbing mountains and going whitewater rafting and looking forward to the next five years,” Sinclair said. “It might be psychological, but it isn’t hurting.”\u003c/p>\n\u003cp>Only rigorous human research can determine that. Metro International Biotech, a Michigan-based startup for which Sinclair consults, just finished a clinical trial of the safety of a proprietary version of NMN and hopes to start a trial of the molecule’s efficacy this year, Sinclair said.\u003c/p>\n\u003cp>One concern is that boosting sirtuins could backfire. An excess of the molecules, Verdin said, can promote autoimmunity, which causes diseases such as Crohn’s and rheumatoid arthritis.\u003c/p>\n\u003cp>“That should give us pause about broad claims of what they can do,” he cautioned. “I worry sometimes that [with NAD+-boosting pills already on the market] the field is getting ahead of itself.”\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 was originally published by\u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\"> STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "As Towns Lose Their Newspapers, Disease Detectives Left Flying Blind",
"title": "As Towns Lose Their Newspapers, Disease Detectives Left Flying Blind",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Maia Majumder was on Twitter earlier this month when she saw a map that terrified her.\u003c/p>\n\u003cp>The map recorded the number of local newspapers in each county across the United States. Large swaths were shaded light pink, denoting a county that had no local newspaper at all. As a record of the decline of the American newspaper industry, it was disconcerting.\u003c/p>\n\u003cp>But Majumder, a scientist who specializes in mathematical modeling, saw something different in the splotches of light pink: a disaster for infectious disease surveillance.\u003c/p>\n\u003cp>Epidemiologists rely on all kinds of data to detect the spread of disease, including reports from local and state agencies and social media. But local newspapers are critical to identifying outbreaks and forecasting their trajectories.\u003c/p>\n\u003caside class=\"pullquote alignright\">'“Local media is the bedrock of internet surveillance.’ \u003ccite>John Brownstein, Healthmap\u003c/cite>\u003c/aside>\n\u003cp>On the map, Majumder saw every county without a local newspaper as a community where health officials and disease researchers could be flying blind.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We rely very heavily on local news. And I think what this will probably mean is that there are going to be pockets of the U.S. where we’re just not going to have a particularly good signal anymore,” said Majumder, a Ph.D. candidate at the Massachusetts Institute of Technology.\u003c/p>\n\u003cp>Majumder is a computational epidemiology research fellow at HealthMap, a 12-year-old disease detection project run by researchers from Boston Children’s Hospital. The website uses nontraditional data sources — reports from local news outlets and social media platforms among them— to track global infectious disease activity in real time.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-295309 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2050/12/newspapers-800x533.gif\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-800x533.gif 800w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-160x107.gif 160w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-768x512.gif 768w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1020x680.gif 1020w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1920x1280.gif 1920w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1180x787.gif 1180w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-960x640.gif 960w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-240x160.gif 240w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-375x250.gif 375w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-520x347.gif 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">The information HealthMap gathers is used not only by public health authorities, but by researchers around the world who are studying things like the changing geographic distribution of diseases — think Zika — and the impact of climate change on disease patterns, said John Brownstein, one of the co-founders of the site.\u003c/p>\n\u003cp>“Local media is the bedrock of internet surveillance — the kind of work that we do in terms of scouring the web looking for early signs of something taking place in a community,” explained Brownstein, chief innovation officer at Boston Children’s and a pioneer in the field of using sources other than public health data to do this type of work.\u003c/p>\n\u003cp>He pointed to the 2009 H1N1 influenza pandemic as an example of a case in which local reporting helped to bring an emerging disease threat to global attention.\u003c/p>\n\u003cp>\u003cstrong>Tracking an Outbreak\u003c/strong>\u003cbr>\nThe Centers for Disease Control and Prevention was the first agency to detect that two young children in California had been infected with a flu strain circulated in pigs. As officials were trying to figure out if the cases were blips or part of something bigger, however, disease detectives began crawling through recent media reports to determine whether unusual numbers of people with flu-like illness in Mexico had also been sickened by the new virus. It turned out they had been. The new virus was spreading.[contextly_sidebar id=\"eRWHDjM3IMP7OEH2GlfugYXA5fly6vp3\"]\u003c/p>\n\u003cp>“It makes sense that if we see a reduction in local reporting, you’re not going to have that early signaling of something in a community,” Brownstein said.\u003c/p>\n\u003cp>Without local reporting, it’s also harder to follow an outbreak and assess its progress. Majumder used the example of the massive 2016-2017 mumps outbreak in northwestern Arkansas to illustrate the point.\u003c/p>\n\u003cp>She and colleagues were trying to figure out why the outbreak was so large — nearly 3,000 cases all told. Had the virus simply found its way into an area with lots of unvaccinated children? Or was something else driving transmission?\u003c/p>\n\u003cp>That’s the kind of information that is hugely helpful to public health authorities struggling to control an outbreak. But Majumder found she couldn’t easily get her hands on key data; the Arkansas Department of Public Health issued regular updates, but the agency did not archive previous updates on its website. Getting access to official data can be a time-consuming process.\u003c/p>\n\u003cp>“There is a lot of red tape to get data sharing privileges, even around something as simple as cumulative case counts over time,” she said.\u003c/p>\n\u003cp>The Northwest Arkansas Democrat-Gazette, however, was covering the outbreak closely, and its coverage provided important context for Majumder’s research. Some of the paper’s stories noted that the vaccine refusal rate in that region was higher than anywhere else in the state; others made clear disease was spreading in a local community of people from the Marshall Islands who had been vaccinated.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-440343 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">Both those factors proved key in helping public health officials better understand what was driving the outbreak, Majumder said.\u003c/p>\n\u003cp>The World Health Organization urges countries to augment their official disease surveillance efforts — which draw information from networks of doctor’s offices, hospitals, and public health laboratories — with what’s known as “event-based surveillance,” said Dr. Larry Madoff, editor of ProMED, the Program for Monitoring Emerging Diseases. The internet-based outbreak reporting system — which reports on human, animal, and plant disease outbreaks — operates under the auspices of the International Society for Infectious Diseases.\u003c/p>\n\u003cp>Event-based surveillance is more informal and relies on systems that pick up on media reports, rumors on social media, and the like. That’s the way news of the 2003 SARS outbreak emerged. Internet chatter about a disease that was sickening and killing people in China made its way to the WHO before Chinese authorities eventually disclosed the existence of an outbreak that had been raging for several months.[contextly_sidebar id=\"pHkMIHqxoK7nvOZ2Rw6M77aUOBH1WSHD\"]\u003c/p>\n\u003cp>“It is well-known that event-based surveillance depends on healthy, local journalism,” said Madoff, who is also director of the Massachusetts Department of Health’s division of epidemiology and immunization. “So it would be a reasonable assumption that the loss of local sources would increase the time required to discover an outbreak.”\u003c/p>\n\u003cp>Like HealthMap, ProMED casts its net globally. In some countries, there are not many local media sources, or if there are, those news sources aren’t available on the internet. In those places, ProMED has to rely on word-of-mouth — which may become the case in parts of the U.S. as local news outlets are shuttered, Madoff said.\u003c/p>\n\u003cp>He’s not sure if ProMED is starting to miss things because of the shrinking number of local news sources. “There’s a huge volume of information and we get what we get. So it’s hard to say what we’re missing, necessarily. But I can easily imagine that we might,” he said.\u003c/p>\n\u003cp>\u003cstrong>Social Media\u003c/strong>\u003c/p>\n\u003cp>Newspapers, of course, aren’t the only source of local news. But a town that can’t support a newspaper may not have radio and television stations either. Radio and TV stations may not archive their reports online, or those reports may not be archived in print form, meaning their archives are harder to search, Majumder said.\u003c/p>\n\u003cp>Social media cannot fill the gap created by the declining local news coverage, she and others involved in this type of research argued. “With Twitter … you are picking up a signal, but that signal might not be precise,” said Alessandro Vespignani, a professor at Northeastern University whose research focuses on modeling of epidemics. And social media reports can be simply wrong, he said — either by accident or design. News coverage “anchors” the signals picked up on social media, Vespignani said.[contextly_sidebar id=\"67Do4Phey2ezXlhxwIvDAmFbf798Cd3r\"]\u003c/p>\n\u003cp>“When you combine data from multiple data sources … including data collected from news alerts, we can gain a better handle on the situational awareness in a given community or country,” agreed Mauricio Santillana, an assistant professor at Harvard Medical School whose research focuses on use of novel data sources to track and forecast disease outbreaks.\u003c/p>\n\u003cp>Majumder said she and colleagues would like to look at whether the growth of “news deserts” — communities without local news sources — has already had an impact on the amount of data HealthMap has been harvesting from under-covered parts of the United States.\u003c/p>\n\u003cp>One of the reasons the news desert map scared her, she said, was because she realized many of the places without local papers are also places where voters have been complaining of being left behind.\u003c/p>\n\u003cp>“What that means is they lose access to news which is very, very vital for knowing what’s going on in your town,” Majumder said. “But also from the public health surveillance point of view, we’re losing access to knowing what they need.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2018/03/20/news-deserts-infectious-disease/\" target=\"_blank\" rel=\"noopener\">story\u003c/a> was originally published by \u003ca href=\"https://www.statnews.com/\" target=\"_blank\" rel=\"noopener\">STAT, \u003c/a>an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Maia Majumder was on Twitter earlier this month when she saw a map that terrified her.\u003c/p>\n\u003cp>The map recorded the number of local newspapers in each county across the United States. Large swaths were shaded light pink, denoting a county that had no local newspaper at all. As a record of the decline of the American newspaper industry, it was disconcerting.\u003c/p>\n\u003cp>But Majumder, a scientist who specializes in mathematical modeling, saw something different in the splotches of light pink: a disaster for infectious disease surveillance.\u003c/p>\n\u003cp>Epidemiologists rely on all kinds of data to detect the spread of disease, including reports from local and state agencies and social media. But local newspapers are critical to identifying outbreaks and forecasting their trajectories.\u003c/p>\n\u003caside class=\"pullquote alignright\">'“Local media is the bedrock of internet surveillance.’ \u003ccite>John Brownstein, Healthmap\u003c/cite>\u003c/aside>\n\u003cp>On the map, Majumder saw every county without a local newspaper as a community where health officials and disease researchers could be flying blind.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We rely very heavily on local news. And I think what this will probably mean is that there are going to be pockets of the U.S. where we’re just not going to have a particularly good signal anymore,” said Majumder, a Ph.D. candidate at the Massachusetts Institute of Technology.\u003c/p>\n\u003cp>Majumder is a computational epidemiology research fellow at HealthMap, a 12-year-old disease detection project run by researchers from Boston Children’s Hospital. The website uses nontraditional data sources — reports from local news outlets and social media platforms among them— to track global infectious disease activity in real time.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-295309 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2050/12/newspapers-800x533.gif\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-800x533.gif 800w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-160x107.gif 160w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-768x512.gif 768w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1020x680.gif 1020w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1920x1280.gif 1920w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-1180x787.gif 1180w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-960x640.gif 960w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-240x160.gif 240w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-375x250.gif 375w, https://ww2.kqed.org/app/uploads/sites/13/2050/12/newspapers-520x347.gif 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">The information HealthMap gathers is used not only by public health authorities, but by researchers around the world who are studying things like the changing geographic distribution of diseases — think Zika — and the impact of climate change on disease patterns, said John Brownstein, one of the co-founders of the site.\u003c/p>\n\u003cp>“Local media is the bedrock of internet surveillance — the kind of work that we do in terms of scouring the web looking for early signs of something taking place in a community,” explained Brownstein, chief innovation officer at Boston Children’s and a pioneer in the field of using sources other than public health data to do this type of work.\u003c/p>\n\u003cp>He pointed to the 2009 H1N1 influenza pandemic as an example of a case in which local reporting helped to bring an emerging disease threat to global attention.\u003c/p>\n\u003cp>\u003cstrong>Tracking an Outbreak\u003c/strong>\u003cbr>\nThe Centers for Disease Control and Prevention was the first agency to detect that two young children in California had been infected with a flu strain circulated in pigs. As officials were trying to figure out if the cases were blips or part of something bigger, however, disease detectives began crawling through recent media reports to determine whether unusual numbers of people with flu-like illness in Mexico had also been sickened by the new virus. It turned out they had been. The new virus was spreading.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It makes sense that if we see a reduction in local reporting, you’re not going to have that early signaling of something in a community,” Brownstein said.\u003c/p>\n\u003cp>Without local reporting, it’s also harder to follow an outbreak and assess its progress. Majumder used the example of the massive 2016-2017 mumps outbreak in northwestern Arkansas to illustrate the point.\u003c/p>\n\u003cp>She and colleagues were trying to figure out why the outbreak was so large — nearly 3,000 cases all told. Had the virus simply found its way into an area with lots of unvaccinated children? Or was something else driving transmission?\u003c/p>\n\u003cp>That’s the kind of information that is hugely helpful to public health authorities struggling to control an outbreak. But Majumder found she couldn’t easily get her hands on key data; the Arkansas Department of Public Health issued regular updates, but the agency did not archive previous updates on its website. Getting access to official data can be a time-consuming process.\u003c/p>\n\u003cp>“There is a lot of red tape to get data sharing privileges, even around something as simple as cumulative case counts over time,” she said.\u003c/p>\n\u003cp>The Northwest Arkansas Democrat-Gazette, however, was covering the outbreak closely, and its coverage provided important context for Majumder’s research. Some of the paper’s stories noted that the vaccine refusal rate in that region was higher than anywhere else in the state; others made clear disease was spreading in a local community of people from the Marshall Islands who had been vaccinated.\u003c/p>\n\u003cp>\u003cimg class=\"size-medium wp-image-440343 aligncenter\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/iStock-691796746-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">Both those factors proved key in helping public health officials better understand what was driving the outbreak, Majumder said.\u003c/p>\n\u003cp>The World Health Organization urges countries to augment their official disease surveillance efforts — which draw information from networks of doctor’s offices, hospitals, and public health laboratories — with what’s known as “event-based surveillance,” said Dr. Larry Madoff, editor of ProMED, the Program for Monitoring Emerging Diseases. The internet-based outbreak reporting system — which reports on human, animal, and plant disease outbreaks — operates under the auspices of the International Society for Infectious Diseases.\u003c/p>\n\u003cp>Event-based surveillance is more informal and relies on systems that pick up on media reports, rumors on social media, and the like. That’s the way news of the 2003 SARS outbreak emerged. Internet chatter about a disease that was sickening and killing people in China made its way to the WHO before Chinese authorities eventually disclosed the existence of an outbreak that had been raging for several months.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“It is well-known that event-based surveillance depends on healthy, local journalism,” said Madoff, who is also director of the Massachusetts Department of Health’s division of epidemiology and immunization. “So it would be a reasonable assumption that the loss of local sources would increase the time required to discover an outbreak.”\u003c/p>\n\u003cp>Like HealthMap, ProMED casts its net globally. In some countries, there are not many local media sources, or if there are, those news sources aren’t available on the internet. In those places, ProMED has to rely on word-of-mouth — which may become the case in parts of the U.S. as local news outlets are shuttered, Madoff said.\u003c/p>\n\u003cp>He’s not sure if ProMED is starting to miss things because of the shrinking number of local news sources. “There’s a huge volume of information and we get what we get. So it’s hard to say what we’re missing, necessarily. But I can easily imagine that we might,” he said.\u003c/p>\n\u003cp>\u003cstrong>Social Media\u003c/strong>\u003c/p>\n\u003cp>Newspapers, of course, aren’t the only source of local news. But a town that can’t support a newspaper may not have radio and television stations either. Radio and TV stations may not archive their reports online, or those reports may not be archived in print form, meaning their archives are harder to search, Majumder said.\u003c/p>\n\u003cp>Social media cannot fill the gap created by the declining local news coverage, she and others involved in this type of research argued. “With Twitter … you are picking up a signal, but that signal might not be precise,” said Alessandro Vespignani, a professor at Northeastern University whose research focuses on modeling of epidemics. And social media reports can be simply wrong, he said — either by accident or design. News coverage “anchors” the signals picked up on social media, Vespignani said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“When you combine data from multiple data sources … including data collected from news alerts, we can gain a better handle on the situational awareness in a given community or country,” agreed Mauricio Santillana, an assistant professor at Harvard Medical School whose research focuses on use of novel data sources to track and forecast disease outbreaks.\u003c/p>\n\u003cp>Majumder said she and colleagues would like to look at whether the growth of “news deserts” — communities without local news sources — has already had an impact on the amount of data HealthMap has been harvesting from under-covered parts of the United States.\u003c/p>\n\u003cp>One of the reasons the news desert map scared her, she said, was because she realized many of the places without local papers are also places where voters have been complaining of being left behind.\u003c/p>\n\u003cp>“What that means is they lose access to news which is very, very vital for knowing what’s going on in your town,” Majumder said. “But also from the public health surveillance point of view, we’re losing access to knowing what they need.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "New Diabetes Monitors Require Fewer Pricks, Less Guessing",
"title": "New Diabetes Monitors Require Fewer Pricks, Less Guessing",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003ch3>\u003cem>Continuous glucose monitors have been around for over a decade, but reductions in cost and improvements in quality have enticed more patients and doctors to try them out.\u003c/em>\u003c/h3>\n\u003cp>For Melissa Lee, the worst part of diabetes isn’t pricking her finger to check her glucose level or changing her diet to keep her blood sugar in check. Rather, it’s the constant worry and mental calculations.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a perfect world, everybody with diabetes would benefit from some form of this technology.'\u003ccite>Kathleen Dungan, Ohio State University\u003c/cite>\u003c/aside>\n\u003cp>“You have to think about what did I eat last, how much insulin did I take for that, where is my blood sugar now, which direction is it trending, and then based on that, what am I going to eat?” she says. “You’re making these educated guesses about how much of a really volatile hormone [insulin] to take, and that is mentally exhausting.”\u003c/p>\n\u003cp>Lee, 38, who was diagnosed with Type 1 diabetes when she was 10, recounts ruined dates, missed flights and abandoned excursions, all because she was worried about her glucose level or forgot to bring a replacement for her insulin pump.\u003c/p>\n\u003cp>“You can go from being okay to being really not okay in a moment’s notice,” says Lee, who lives in Milpitas, California and works as the director of community relations at Bigfoot Biomedical.\u003c/p>\n\u003cp>To relieve some of the burden for the estimated 9.3 million people who use insulin to regulate diabetes, medical device makers have introduced new ways to monitor glucose and administer insulin.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Better Glucose Management\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_440097\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"wp-image-440097 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg\" alt=\"FreeStyle Libre\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee displays the components of the FreeStyle Libre, her blood glucose monitor. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Continuous glucose monitors, or CGMs, have been around for over a decade, but poor quality and high costs have been barriers to use, says Irl Hirsch, who holds the Diabetes Treatment and Teaching Chair at the University of Washington School of Medicine. But improvements on both fronts lead him to believe that CGMs will soon become the standard of care. At his own clinic, 60 percent of patients use one.\u003c/p>\n\u003cp>“The financial impact and the insurance coverage is not the barrier that it used to be,” Hirsch says. What’s more, “The quality and the accuracy of these things have just gotten better.”\u003c/p>\n\u003cp>CGMs measure glucose levels not in blood but in the interstitial fluid, which surrounds the cells just underneath the skin. A sensor sticks onto the body, typically on the upper arm or abdomen, with a small, flexible needle that penetrates the skin. The sensor takes a reading every 5 to 15 minutes and transmits that information to a separate receiver or a smartphone app, which patients can check at any time. The reading shows their current glucose level and a trend graph for the last eight hours. If the number is high and rising, the patient can bring their glucose down using insulin; if it’s low and dropping, they need to eat some sugar, fast.\u003c/p>\n\u003cp>“It's very exciting technology. I think it's really revolutionizing diabetes care,” says Kathleen Dungan, an associate professor of medicine at Ohio State University who runs the school’s endocrine clinical trials unit. “In a perfect world, everybody with diabetes would benefit from some form of this technology.”\u003c/p>\n\u003cp>\u003cstrong>Too Little Insulin\u003c/strong>\u003c/p>\n\u003cp>Every time you eat, your pancreas pumps out insulin to help your cells extract glucose from the blood and use it for fuel. In Type I diabetes, the pancreas stops producing insulin, while in Type II the cells can’t utilize the hormone properly. In either case, too little insulin causes excessive blood glucose levels. Chronic high blood sugar, or hyperglycemia, can lead to heart disease, kidney disease, stroke, nerve damage, blindness and loss of limbs.\u003c/p>\n\u003cfigure id=\"attachment_440099\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"size-full wp-image-440099\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg\" alt=\"Melissa Lee, who was diagnosed with type one diabetes at 10 years old, models the FreeStyle Libre in Hayward, Calif.\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee, who was diagnosed with Type 1 diabetes at 10 years old, models the FreeStyle Libre, \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In contrast, too much insulin results in low blood sugar, or hypoglycemia, which can cause weakness, dizzy spells, seizures, shaking, fainting and even death.\u003c/p>\n\u003cp>Patients typically use blood glucose meters that measure sugar levels in a drop of blood to determine if they need to take more insulin or not. However, having to prick your finger and draw blood to check your glucose level can be a major hurdle for maintaining normal blood sugar. Some patients may have aversions to needles, while others may have difficulty creating a sterile environment in which to take a reading.\u003c/p>\n\u003cp>\u003cstrong>Popular CGMs\u003c/strong>\u003c/p>\n\u003cp>CGMs aim to ease that pain and inconvenience. Dexcom and Abbott are two of the largest producers of CGMs, with Abbott’s FreeStyle Libre the newest device approved by the FDA, in September 2017.\u003c/p>\n\u003cp>The Libre sensors last for 10 days and cost $59 each. Sensors for Dexcom’s G4 or G5 system are $350 for a pack of four and have to be replaced every seven days. Patients also have to purchase a receiver, about $60 for the Libre versus $465 for the Dexcom G5. Finally, Dexcom requires a separate transmitter to send the glucose information to the receiver, another $595. Both companies’ devices are covered by major insurance providers and Medicare, so the actual cost to patients varies.\u003c/p>\n\u003cfigure id=\"attachment_440100\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-440100\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg\" alt=\"Ken Reutell of Petaluma, Calif. displays his MiniMed 670G\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell of Petaluma, Calif. displays his MiniMed 670G. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Libre is the only monitor that doesn’t have to be calibrated daily with a traditional blood glucose reading, meaning patients never have to prick their fingers.\u003c/p>\n\u003cp>Studies show that patients who use a CGM have \u003ca href=\"http://care.diabetesjournals.org/content/40/Supplement_1/S48\" target=\"_blank\" rel=\"noopener\">better control over their diabetes\u003c/a> than patients who use traditional blood glucose tests. Doctors recommend patients check their glucose between \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628\" target=\"_blank\" rel=\"noopener\">4 and 10 times per day\u003c/a>, but in reality, only \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/14999899\" target=\"_blank\" rel=\"noopener\">one-third of patients\u003c/a> test themselves as often as they should. Abbott says patients using its device easily exceed this standard, checking on average 16 times a day.\u003c/p>\n\u003cp>Lee, who uses the FreeStyle Libre, says being able to easily check her blood glucose helps her know how it's affected by her diet. “You suddenly have this insight into how actions you took actually affected some kind of diabetes outcome,” she says.\u003c/p>\n\u003cp>Another Type 1 diabetes patient, Lisa Trahan, 33, yses the Dexcom G4 and says it’s “terrific.” Trahan, a clinical psychologist based in San Marcos, Texas, says the frequent readings provide her with more peace of mind, especially before exercising or eating. However, she still doesn’t trust the device enough to forego pricking her finger to double check the numbers.\u003c/p>\n\u003cfigure id=\"attachment_440101\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440101\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0816-800x533.jpg\" alt=\"A man's hand holds a small gaget.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell's MiniMed 670G means he spends less time pricking himself to monitor his blood glucose levels. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I can trust the CGM reading of my Dexcom G4 to be within 20 percent in either direction of my actual blood sugar reading,” she explains. But, she says, that range can make a big difference when tinkering with blood sugar or insulin. “I use the alert as a suggestion to check my blood sugar and go from there.”\u003c/p>\n\u003cp>\u003cstrong>Smarter Insulin Pumps\u003c/strong>\u003c/p>\n\u003cp>Besides checking blood sugar, the other part of managing diabetes is taking insulin, either with an injection or an insulin pump.\u003c/p>\n\u003cp>Traditional insulin pumps are preset to deliver different doses at certain times of the day. However, it can be difficult to match the correct dose to fluctuations in glucose levels that occur naturally throughout the day or because of diet or exercise. A patient or doctor can adjust the levels manually, but it requires complex calculations and typically isn’t done every day.\u003c/p>\n\u003cp>Medtronic’s MiniMed 670G, the first integrated CGM-insulin pump system approved by the FDA in 2016, aims to solve that problem. The 670G can vary the amount of insulin it delivers as often as every five minutes, in response to input from an integrated glucose monitor.\u003c/p>\n\u003cp>The only calculation patients have to make is to manually deliver a boost of insulin every time they eat that is proportionate to the number of carbohydrates in the meal. They also need to prick their fingers three times a day to calibrate the system.\u003c/p>\n\u003cp>Despite the excitement over the 670G, the price can be prohibitive, running between $6,000 and $9,000. Medtronic says some of the cost is covered by insurance.\u003c/p>\n\u003cp>\u003cstrong>A Debate Over Alarms\u003c/strong>\u003c/p>\n\u003cp>Because low glucose levels can be so dangerous, most monitors have built-in alarms that go off when a patient’s glucose has dropped too low. However, Abbott’s FreeStyle Libre does not. Hirsch, the diabetes expert from the University of Washington, says because of this he recommends Dexcom’s CGM, even though the Libre is less expensive and easier to use.\u003c/p>\n\u003cp>The MiniMed 670G also has an alarm, and to patient Ken Reutell, 67, from Petaluma, California, this is a great feature. In the past he’s had to call 911 and has even passed out because his blood sugar had dropped so low. He's used the 670G for six months and says the alarm alerts him well before he gets to that point. Other users, however, have \u003ca href=\"https://www.reddit.com/r/diabetes_t1/comments/7sjpsi/just_placed_on_order_for_the_medtronic_790/dt5oh0l/\" target=\"_blank\" rel=\"noopener\">complained\u003c/a> that the 670G’s alarm is loud and goes off too frequently.\u003c/p>\n\u003cp>And while the device can alert a patient to a dangerously low glucose level, it can’t do anything about it because it doesn’t administer glucose.\u003c/p>\n\u003cp>“(W)hen you get too low, your liver starts pumping out more glucose. That’s something that insulin pumps don’t do yet,” Reutell laments.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Something for the next generation of devices, perhaps.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003ch3>\u003cem>Continuous glucose monitors have been around for over a decade, but reductions in cost and improvements in quality have enticed more patients and doctors to try them out.\u003c/em>\u003c/h3>\n\u003cp>For Melissa Lee, the worst part of diabetes isn’t pricking her finger to check her glucose level or changing her diet to keep her blood sugar in check. Rather, it’s the constant worry and mental calculations.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a perfect world, everybody with diabetes would benefit from some form of this technology.'\u003ccite>Kathleen Dungan, Ohio State University\u003c/cite>\u003c/aside>\n\u003cp>“You have to think about what did I eat last, how much insulin did I take for that, where is my blood sugar now, which direction is it trending, and then based on that, what am I going to eat?” she says. “You’re making these educated guesses about how much of a really volatile hormone [insulin] to take, and that is mentally exhausting.”\u003c/p>\n\u003cp>Lee, 38, who was diagnosed with Type 1 diabetes when she was 10, recounts ruined dates, missed flights and abandoned excursions, all because she was worried about her glucose level or forgot to bring a replacement for her insulin pump.\u003c/p>\n\u003cp>“You can go from being okay to being really not okay in a moment’s notice,” says Lee, who lives in Milpitas, California and works as the director of community relations at Bigfoot Biomedical.\u003c/p>\n\u003cp>To relieve some of the burden for the estimated 9.3 million people who use insulin to regulate diabetes, medical device makers have introduced new ways to monitor glucose and administer insulin.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Better Glucose Management\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_440097\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"wp-image-440097 size-full\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg\" alt=\"FreeStyle Libre\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29282_LIBRE_020718_002-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee displays the components of the FreeStyle Libre, her blood glucose monitor. \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Continuous glucose monitors, or CGMs, have been around for over a decade, but poor quality and high costs have been barriers to use, says Irl Hirsch, who holds the Diabetes Treatment and Teaching Chair at the University of Washington School of Medicine. But improvements on both fronts lead him to believe that CGMs will soon become the standard of care. At his own clinic, 60 percent of patients use one.\u003c/p>\n\u003cp>“The financial impact and the insurance coverage is not the barrier that it used to be,” Hirsch says. What’s more, “The quality and the accuracy of these things have just gotten better.”\u003c/p>\n\u003cp>CGMs measure glucose levels not in blood but in the interstitial fluid, which surrounds the cells just underneath the skin. A sensor sticks onto the body, typically on the upper arm or abdomen, with a small, flexible needle that penetrates the skin. The sensor takes a reading every 5 to 15 minutes and transmits that information to a separate receiver or a smartphone app, which patients can check at any time. The reading shows their current glucose level and a trend graph for the last eight hours. If the number is high and rising, the patient can bring their glucose down using insulin; if it’s low and dropping, they need to eat some sugar, fast.\u003c/p>\n\u003cp>“It's very exciting technology. I think it's really revolutionizing diabetes care,” says Kathleen Dungan, an associate professor of medicine at Ohio State University who runs the school’s endocrine clinical trials unit. “In a perfect world, everybody with diabetes would benefit from some form of this technology.”\u003c/p>\n\u003cp>\u003cstrong>Too Little Insulin\u003c/strong>\u003c/p>\n\u003cp>Every time you eat, your pancreas pumps out insulin to help your cells extract glucose from the blood and use it for fuel. In Type I diabetes, the pancreas stops producing insulin, while in Type II the cells can’t utilize the hormone properly. In either case, too little insulin causes excessive blood glucose levels. Chronic high blood sugar, or hyperglycemia, can lead to heart disease, kidney disease, stroke, nerve damage, blindness and loss of limbs.\u003c/p>\n\u003cfigure id=\"attachment_440099\" class=\"wp-caption aligncenter\" style=\"max-width: 539px\">\u003cimg class=\"size-full wp-image-440099\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg\" alt=\"Melissa Lee, who was diagnosed with type one diabetes at 10 years old, models the FreeStyle Libre in Hayward, Calif.\" width=\"539\" height=\"360\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi.jpg 539w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/RS29281_LIBRE_020718_001-sfi-520x347.jpg 520w\" sizes=\"(max-width: 539px) 100vw, 539px\">\u003cfigcaption class=\"wp-caption-text\">Melissa Lee, who was diagnosed with Type 1 diabetes at 10 years old, models the FreeStyle Libre, \u003ccite>(Lauren Hanussak/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In contrast, too much insulin results in low blood sugar, or hypoglycemia, which can cause weakness, dizzy spells, seizures, shaking, fainting and even death.\u003c/p>\n\u003cp>Patients typically use blood glucose meters that measure sugar levels in a drop of blood to determine if they need to take more insulin or not. However, having to prick your finger and draw blood to check your glucose level can be a major hurdle for maintaining normal blood sugar. Some patients may have aversions to needles, while others may have difficulty creating a sterile environment in which to take a reading.\u003c/p>\n\u003cp>\u003cstrong>Popular CGMs\u003c/strong>\u003c/p>\n\u003cp>CGMs aim to ease that pain and inconvenience. Dexcom and Abbott are two of the largest producers of CGMs, with Abbott’s FreeStyle Libre the newest device approved by the FDA, in September 2017.\u003c/p>\n\u003cp>The Libre sensors last for 10 days and cost $59 each. Sensors for Dexcom’s G4 or G5 system are $350 for a pack of four and have to be replaced every seven days. Patients also have to purchase a receiver, about $60 for the Libre versus $465 for the Dexcom G5. Finally, Dexcom requires a separate transmitter to send the glucose information to the receiver, another $595. Both companies’ devices are covered by major insurance providers and Medicare, so the actual cost to patients varies.\u003c/p>\n\u003cfigure id=\"attachment_440100\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003cimg class=\"size-large wp-image-440100\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg\" alt=\"Ken Reutell of Petaluma, Calif. displays his MiniMed 670G\" width=\"640\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0829-520x347.jpg 520w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell of Petaluma, Calif. displays his MiniMed 670G. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Libre is the only monitor that doesn’t have to be calibrated daily with a traditional blood glucose reading, meaning patients never have to prick their fingers.\u003c/p>\n\u003cp>Studies show that patients who use a CGM have \u003ca href=\"http://care.diabetesjournals.org/content/40/Supplement_1/S48\" target=\"_blank\" rel=\"noopener\">better control over their diabetes\u003c/a> than patients who use traditional blood glucose tests. Doctors recommend patients check their glucose between \u003ca href=\"https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628\" target=\"_blank\" rel=\"noopener\">4 and 10 times per day\u003c/a>, but in reality, only \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/14999899\" target=\"_blank\" rel=\"noopener\">one-third of patients\u003c/a> test themselves as often as they should. Abbott says patients using its device easily exceed this standard, checking on average 16 times a day.\u003c/p>\n\u003cp>Lee, who uses the FreeStyle Libre, says being able to easily check her blood glucose helps her know how it's affected by her diet. “You suddenly have this insight into how actions you took actually affected some kind of diabetes outcome,” she says.\u003c/p>\n\u003cp>Another Type 1 diabetes patient, Lisa Trahan, 33, yses the Dexcom G4 and says it’s “terrific.” Trahan, a clinical psychologist based in San Marcos, Texas, says the frequent readings provide her with more peace of mind, especially before exercising or eating. However, she still doesn’t trust the device enough to forego pricking her finger to double check the numbers.\u003c/p>\n\u003cfigure id=\"attachment_440101\" class=\"wp-caption alignright\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-440101\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/03/IMG_0816-800x533.jpg\" alt=\"A man's hand holds a small gaget.\" width=\"800\" height=\"533\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-160x107.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1020x680.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1920x1280.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-960x640.jpg 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-240x160.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-375x250.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/03/IMG_0816-520x347.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ken Reutell's MiniMed 670G means he spends less time pricking himself to monitor his blood glucose levels. \u003ccite>(Danielle Venton/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“I can trust the CGM reading of my Dexcom G4 to be within 20 percent in either direction of my actual blood sugar reading,” she explains. But, she says, that range can make a big difference when tinkering with blood sugar or insulin. “I use the alert as a suggestion to check my blood sugar and go from there.”\u003c/p>\n\u003cp>\u003cstrong>Smarter Insulin Pumps\u003c/strong>\u003c/p>\n\u003cp>Besides checking blood sugar, the other part of managing diabetes is taking insulin, either with an injection or an insulin pump.\u003c/p>\n\u003cp>Traditional insulin pumps are preset to deliver different doses at certain times of the day. However, it can be difficult to match the correct dose to fluctuations in glucose levels that occur naturally throughout the day or because of diet or exercise. A patient or doctor can adjust the levels manually, but it requires complex calculations and typically isn’t done every day.\u003c/p>\n\u003cp>Medtronic’s MiniMed 670G, the first integrated CGM-insulin pump system approved by the FDA in 2016, aims to solve that problem. The 670G can vary the amount of insulin it delivers as often as every five minutes, in response to input from an integrated glucose monitor.\u003c/p>\n\u003cp>The only calculation patients have to make is to manually deliver a boost of insulin every time they eat that is proportionate to the number of carbohydrates in the meal. They also need to prick their fingers three times a day to calibrate the system.\u003c/p>\n\u003cp>Despite the excitement over the 670G, the price can be prohibitive, running between $6,000 and $9,000. Medtronic says some of the cost is covered by insurance.\u003c/p>\n\u003cp>\u003cstrong>A Debate Over Alarms\u003c/strong>\u003c/p>\n\u003cp>Because low glucose levels can be so dangerous, most monitors have built-in alarms that go off when a patient’s glucose has dropped too low. However, Abbott’s FreeStyle Libre does not. Hirsch, the diabetes expert from the University of Washington, says because of this he recommends Dexcom’s CGM, even though the Libre is less expensive and easier to use.\u003c/p>\n\u003cp>The MiniMed 670G also has an alarm, and to patient Ken Reutell, 67, from Petaluma, California, this is a great feature. In the past he’s had to call 911 and has even passed out because his blood sugar had dropped so low. He's used the 670G for six months and says the alarm alerts him well before he gets to that point. Other users, however, have \u003ca href=\"https://www.reddit.com/r/diabetes_t1/comments/7sjpsi/just_placed_on_order_for_the_medtronic_790/dt5oh0l/\" target=\"_blank\" rel=\"noopener\">complained\u003c/a> that the 670G’s alarm is loud and goes off too frequently.\u003c/p>\n\u003cp>And while the device can alert a patient to a dangerously low glucose level, it can’t do anything about it because it doesn’t administer glucose.\u003c/p>\n\u003cp>“(W)hen you get too low, your liver starts pumping out more glucose. That’s something that insulin pumps don’t do yet,” Reutell laments.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Something for the next generation of devices, perhaps.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Landmark Report Concludes Abortion in U.S. is Safe",
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"content": "\u003cp>Abortions in the United States are safe and have few complications, according to a landmark new study by the National Academies of Sciences, Engineering and Medicine.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.nap.edu/catalog/24950/the-safety-and-quality-of-abortion-care-in-the-united-states\">report\u003c/a>, called \"The Safety and Quality of Abortion Care in the United States,\" examined the four major methods used for abortions — medication, aspiration, dilation and evacuation, and induction — and examined women's care from before they had the procedure through their follow-up care.[contextly_sidebar id=\"jMTkDIjBqWWCgCakps1aEu2Qa7NrZakX\"]\u003c/p>\n\u003cp>\"I would say the main takeaway is that abortions that are provided in the United States are safe and effective,\" says \u003ca href=\"http://www.coloradotrust.org/content/ned-calonge-md-mph\" target=\"_blank\" rel=\"noopener\">Ned Calonge\u003c/a>, the co-chair of the committee that wrote the study. He is an associate professor of family medicine and epidemiology at the University of Colorado and CEO of \u003ca href=\"http://www.coloradotrust.org/\" target=\"_blank\" rel=\"noopener\">The Colorado Trust\u003c/a>.\u003c/p>\n\u003cp>Calonge says the researchers found that about 90 percent of all abortions happen in the first 12 weeks of pregnancy. And complications for all abortions are \"rare,\" the report says.\u003c/p>\n\u003cp>But the report did find that state laws and regulations can interfere with safe abortions.[contextly_sidebar id=\"zTJU1sTa18fez3ecDq44jqN6KfYhyHGL\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Abortion-specific regulations in many states create barriers to safe and effective care,\" the report says.\u003c/p>\n\u003cp>Calonge says those rules often have no basis in medical research.\u003c/p>\n\u003cp>\"There are some requirements that require clinicians to misinform women of the health risks, that say you have to inform a woman that an abortion will increase her risk of breast cancer,\" he says.\u003c/p>\n\u003cp>There is no evidence that breast cancer follows abortion, for example, but \u003ca href=\"https://www.guttmacher.org/gpr/2006/10/misinformed-consent-medical-accuracy-state-developed-abortion-counseling-materials\">five states\u003c/a> require doctors to tell women there is a link, according to the Guttmacher Institute, a research group that focuses on reproductive and sexual health.\u003c/p>\n\u003cp>\"There are policies that mandate clinically unnecessary services like pre-abortion ultrasounds, separate inpatient counseling. There are required waiting periods,\" Calonge says.\u003c/p>\n\u003cp>According to Guttmacher, 27 states make women wait at least 24 hours for an abortion and 11 states require women to have an ultrasound before they can terminate their pregnancy.\u003c/p>\n\u003cp>And there are state laws that dictate who can perform abortions and where they can do them. Some require all abortions to happen in the equivalent of a hospital or surgery center. Others require a doctor to have admitting privileges at a nearby hospital.\u003c/p>\n\u003cp>The National Academies report says waiting periods and requirements for unnecessary tests can result in long delays because women may have to travel to get care and have trouble getting appointments.\u003c/p>\n\u003cp>\"Delays put the patient at greater risk of an adverse event,\" the report says.\u003c/p>\n\u003cp>Hal Lawrence, the CEO of the American College of Obstetricians and Gynecologists, says the report settles the debate over abortion-restricting laws and regulations.\u003c/p>\n\u003cp>\"Those sorts of laws have been totally debunked,\" he says.\u003c/p>\n\u003cp>He says the study shows most of those laws do nothing to improve women's health.\u003c/p>\n\u003cp>\"Abortion is safer when it's performed earlier in gestation,\" Lawrence says. \"And so delaying and making people wait and go through hoops of unnecessary, extra procedures does not improve the safety. And actually by having them delay can actually worsen the safety.\"\u003c/p>\n\u003cp>The U.S. Supreme Court in 2016 voided some state abortion laws when it ruled that Texas' strict rules around abortion facilities impose an undue burden on women. But other laws remain in place even without any backing in medical research.\u003c/p>\n\u003cp>Still, Donna Harrison says there are good reasons for the requirements.\u003c/p>\n\u003cp>\"The tendency to look at abortion as though it were not a serious medical procedure is irresponsible. I mean, we all know that the fetus is killed during an abortion but women can be harmed by irresponsible medical care,\" says Harrison, the executive director of the \u003ca href=\"http://aaplog.org/\" target=\"_blank\" rel=\"noopener\">American Association of Pro-Life Obstetricians and Gynecologists\u003c/a>.\u003c/p>\n\u003cp>She says data on complications from abortion is incomplete because doctors and patients don't always report it accurately, or at all.\u003c/p>\n\u003cp>\u003cem>\"\u003c/em>There is no good data collection — and when you have garbage in, and you have garbage out,\" she says.\u003c/p>\n\u003cp>And she says waiting periods are important so that women can give fully informed consent before they undergo what she says is a sometimes dangerous, surgical procedure.\u003c/p>\n\u003cp>The new report — which runs more than 200 pages — addresses most aspects of abortion care, including the use of the abortion pill \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20687lbl.htm\" target=\"_blank\" rel=\"noopener\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>For example, it concludes that the strict requirements on how doctors can administer mifepristone may need review. The researchers say the rules may be erecting unnecessary barriers.\u003c/p>\n\u003cp>The report also says nurse practitioners and physician assistants can perform abortions just as safely as physicians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Also, abortions have no long-term consequences on women's physical and mental health, the report says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Landmark+Report+Concludes+Abortion+In+U.S.+Is+Safe+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Abortions in the United States are safe and have few complications, according to a landmark new study by the National Academies of Sciences, Engineering and Medicine.\u003c/p>\n\u003cp>The \u003ca href=\"https://www.nap.edu/catalog/24950/the-safety-and-quality-of-abortion-care-in-the-united-states\">report\u003c/a>, called \"The Safety and Quality of Abortion Care in the United States,\" examined the four major methods used for abortions — medication, aspiration, dilation and evacuation, and induction — and examined women's care from before they had the procedure through their follow-up care.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"I would say the main takeaway is that abortions that are provided in the United States are safe and effective,\" says \u003ca href=\"http://www.coloradotrust.org/content/ned-calonge-md-mph\" target=\"_blank\" rel=\"noopener\">Ned Calonge\u003c/a>, the co-chair of the committee that wrote the study. He is an associate professor of family medicine and epidemiology at the University of Colorado and CEO of \u003ca href=\"http://www.coloradotrust.org/\" target=\"_blank\" rel=\"noopener\">The Colorado Trust\u003c/a>.\u003c/p>\n\u003cp>Calonge says the researchers found that about 90 percent of all abortions happen in the first 12 weeks of pregnancy. And complications for all abortions are \"rare,\" the report says.\u003c/p>\n\u003cp>But the report did find that state laws and regulations can interfere with safe abortions.\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>\"Abortion-specific regulations in many states create barriers to safe and effective care,\" the report says.\u003c/p>\n\u003cp>Calonge says those rules often have no basis in medical research.\u003c/p>\n\u003cp>\"There are some requirements that require clinicians to misinform women of the health risks, that say you have to inform a woman that an abortion will increase her risk of breast cancer,\" he says.\u003c/p>\n\u003cp>There is no evidence that breast cancer follows abortion, for example, but \u003ca href=\"https://www.guttmacher.org/gpr/2006/10/misinformed-consent-medical-accuracy-state-developed-abortion-counseling-materials\">five states\u003c/a> require doctors to tell women there is a link, according to the Guttmacher Institute, a research group that focuses on reproductive and sexual health.\u003c/p>\n\u003cp>\"There are policies that mandate clinically unnecessary services like pre-abortion ultrasounds, separate inpatient counseling. There are required waiting periods,\" Calonge says.\u003c/p>\n\u003cp>According to Guttmacher, 27 states make women wait at least 24 hours for an abortion and 11 states require women to have an ultrasound before they can terminate their pregnancy.\u003c/p>\n\u003cp>And there are state laws that dictate who can perform abortions and where they can do them. Some require all abortions to happen in the equivalent of a hospital or surgery center. Others require a doctor to have admitting privileges at a nearby hospital.\u003c/p>\n\u003cp>The National Academies report says waiting periods and requirements for unnecessary tests can result in long delays because women may have to travel to get care and have trouble getting appointments.\u003c/p>\n\u003cp>\"Delays put the patient at greater risk of an adverse event,\" the report says.\u003c/p>\n\u003cp>Hal Lawrence, the CEO of the American College of Obstetricians and Gynecologists, says the report settles the debate over abortion-restricting laws and regulations.\u003c/p>\n\u003cp>\"Those sorts of laws have been totally debunked,\" he says.\u003c/p>\n\u003cp>He says the study shows most of those laws do nothing to improve women's health.\u003c/p>\n\u003cp>\"Abortion is safer when it's performed earlier in gestation,\" Lawrence says. \"And so delaying and making people wait and go through hoops of unnecessary, extra procedures does not improve the safety. And actually by having them delay can actually worsen the safety.\"\u003c/p>\n\u003cp>The U.S. Supreme Court in 2016 voided some state abortion laws when it ruled that Texas' strict rules around abortion facilities impose an undue burden on women. But other laws remain in place even without any backing in medical research.\u003c/p>\n\u003cp>Still, Donna Harrison says there are good reasons for the requirements.\u003c/p>\n\u003cp>\"The tendency to look at abortion as though it were not a serious medical procedure is irresponsible. I mean, we all know that the fetus is killed during an abortion but women can be harmed by irresponsible medical care,\" says Harrison, the executive director of the \u003ca href=\"http://aaplog.org/\" target=\"_blank\" rel=\"noopener\">American Association of Pro-Life Obstetricians and Gynecologists\u003c/a>.\u003c/p>\n\u003cp>She says data on complications from abortion is incomplete because doctors and patients don't always report it accurately, or at all.\u003c/p>\n\u003cp>\u003cem>\"\u003c/em>There is no good data collection — and when you have garbage in, and you have garbage out,\" she says.\u003c/p>\n\u003cp>And she says waiting periods are important so that women can give fully informed consent before they undergo what she says is a sometimes dangerous, surgical procedure.\u003c/p>\n\u003cp>The new report — which runs more than 200 pages — addresses most aspects of abortion care, including the use of the abortion pill \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/label/2000/20687lbl.htm\" target=\"_blank\" rel=\"noopener\">mifepristone\u003c/a>.\u003c/p>\n\u003cp>For example, it concludes that the strict requirements on how doctors can administer mifepristone may need review. The researchers say the rules may be erecting unnecessary barriers.\u003c/p>\n\u003cp>The report also says nurse practitioners and physician assistants can perform abortions just as safely as physicians.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Also, abortions have no long-term consequences on women's physical and mental health, the report says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Landmark+Report+Concludes+Abortion+In+U.S.+Is+Safe+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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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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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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