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Why don't we do that?' \"\u003c/p>\n\u003cp>But some physicians and health policy analysts question whether such genetic information is necessary to provide good primary care and whether handling such testing is feasible for many primary care physicians.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The new clinical program builds on a research biobank and genome-sequencing initiative called \u003ca href=\"https://www.geisinger.org/precision-health/mycode\" target=\"_blank\" rel=\"noopener\">MyCode\u003c/a> that Geisinger started in 2007 to collect and analyze its patients' DNA. That effort has enrolled more than 200,000 people.\u003c/p>\n\u003cp>Like MyCode, the new clinical program will be based on \"\u003ca href=\"https://ghr.nlm.nih.gov/primer/testing/sequencing\" target=\"_blank\" rel=\"noopener\">whole exome\u003c/a>\" sequencing, analyzing the roughly 1 percent of the genome that provides instructions for making proteins, where most known disease-causing mutations occur.\u003c/p>\n\u003cp>Using this analysis, clinicians could tell Geisinger patients whether they have a genetic variant associated with \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\" target=\"_blank\" rel=\"noopener\">Lynch syndrome\u003c/a>, for example, which leads to an \u003ca href=\"https://www.cancer.net/cancer-types/lynch-syndrome\" target=\"_blank\" rel=\"noopener\">increased risk of cancer of the colon\u003c/a> and some other cancers. Or doctors could offer guidance to patients found to have an increased risk for \u003ca href=\"https://medlineplus.gov/ency/article/000392.htm\" target=\"_blank\" rel=\"noopener\">familial hypercholesterolemia\u003c/a>, which can result in high cholesterol levels and heart disease at a young age.[contextly_sidebar id=\"CCPlmcc1p0X8Yive8TtLHVBcfOHoTLcq\"]\u003c/p>\n\u003cp>Still other patients who undergo the exome sequencing might learn they have an increased susceptibility to \u003ca href=\"https://ghr.nlm.nih.gov/condition/malignant-hyperthermia\" target=\"_blank\" rel=\"noopener\">malignant hyperthermia\u003c/a>, because of a gene variant that causes a severe reaction to certain medications used during anesthesia; the reaction can be fatal.\u003c/p>\n\u003cp>Geisinger spokesperson Wendy Wilson says that what the company plans is very different from direct-to-consumer services like 23andMe — which tests customers' saliva to determine their genetic risk for several diseases and traits, only some of which are medically actionable, and makes the results available in an online report.\u003c/p>\n\u003cp>\"Geisinger is prescribing DNA sequencing to patients and putting DNA results in electronic health records and actually creating an action plan,\" Wilson says. \"We are preventing disease from happening.\"\u003c/p>\n\u003cp>Geisinger says its program will work like this: Samples of a patient's blood or spit will be used to get a DNA sample. After analysis, the results will be sent to the patient's primary care doctor.\u003c/p>\n\u003cp>The doctor will then take a 30-minute online continuing education tutorial to review genetic testing and get more information on whatever specific susceptibilities have turned up in that patient's results.\u003c/p>\n\u003cp>After that, the patient will be informed and invited to meet with the primary care provider, along with a genetic counselor if desired. At that point the doctor and patient can discuss treatment and prevention options, including any particular lifestyle changes that might reduce the risk of developing the disease or condition.\u003c/p>\n\u003cp>About 3.5 percent of the people who have already been tested through Geisinger's research program had a genetic variant that could result in a medical problem for which clinicians can recommend helpful steps to influence their health, Feinberg says.\u003c/p>\n\u003cp>In the clinical program, only actionable mutations will be communicated to patients. The health care team, for example, won't inform patients if they have a variant of the\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726719/\" target=\"_blank\" rel=\"noopener\"> APOE gene \u003c/a>that somewhat increases their risk for getting Alzheimer's disease, because that information wouldn't change anything about their medical treatment. (Geisinger is developing a policy for how to handle these results if \u003ca href=\"https://www.npr.org/sections/health-shots/2012/08/16/158919471/grappling-with-the-uncertainty-of-alzheimers-testing\" target=\"_blank\" rel=\"noopener\">patients ask for them\u003c/a>.)\u003c/p>\n\u003cp>Insurance companies typically don't cover DNA sequencing and do limit a patient's coverage for adult genetic tests for specific mutations, such as those related to the \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing\" target=\"_blank\" rel=\"noopener\">breast cancer susceptibility genes BRCA1 or BRCA2\u003c/a>, unless the patient has a family history of the condition or other indications they're at high risk. For each of the patients it tests, Geisinger will absorb the estimated $300 to $500 testing cost.\u003c/p>\n\u003cp>\"Most of the medical spending in America is done after people have gotten sick,\" says Feinberg. \"We think this will decrease spending on a lot of care.\"\u003c/p>\n\u003cp>But some clinicians and academics outside Geisinger aren't so sure. One of them is \u003ca href=\"http://tdi.dartmouth.edu/about/our-people/directory/h-gilbert-welch-md-mph\" target=\"_blank\" rel=\"noopener\">Dr. H. Gilbert Welch\u003c/a>, a professor at the Dartmouth Institute for Health Policy and Clinical Practice who has written books about the hazards of \u003ca href=\"https://www.penguinrandomhouse.com/books/243193/less-medicine-more-health-by-dr-h-gilbert-welch/9780807077580/\" target=\"_blank\" rel=\"noopener\">overdiagnosis and overscreening\u003c/a>, including, \u003cem>Less Medicine, More Health\u003c/em>.\u003c/p>\n\u003cp>He credits Geisinger with carefully targeting the mutations in which it looks for actionable mutations, instead of taking an all-encompassing approach. And he acknowledges that for some conditions, like Lynch syndrome, people with certain genetic mutations would benefit from being followed closely. But he questions the value of DNA sequencing to identify some other susceptibilities, such as some of the genetic variants related to cardiovascular disease.\u003c/p>\n\u003cp>\"What are we really going to do differently for those patients?\" he asks. \"We should all be concerned about heart disease. We should all exercise; we should eat real food.\"\u003c/p>\n\u003cp>Welch says he's also concerned about the cascading effect of expensive and potentially harmful medical treatment when a genetic risk is identified.\u003c/p>\n\u003cp>\"Doctors will feel the pressure to do something — start a medication, order a test, make a referral,\" he warns. \"You have to be careful. Bad things happen.\"\u003c/p>\n\u003cp>Other clinicians question primary care physicians' comfort with and time for incorporating DNA sequencing into their practices.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1548?journalCode=hlthaff\" target=\"_blank\" rel=\"noopener\">survey published\u003c/a> this month in the journal \u003cem>Health Affairs\u003c/em> queried nearly 500 primary care providers in the New York City area and found that, in the past year, only a third of them had ordered a genetic test, given patients a genetic test result or referred someone for genetic counseling.\u003c/p>\n\u003cp>Only a quarter of the survey respondents said they felt prepared to work with patients who had genetic testing for common diseases or were at high risk for genetic conditions. Just 14 percent reported they were confident they could interpret genetic test results.\u003c/p>\n\u003cp>\"Even though they had training, they felt unprepared to incorporate genomics into their practice,\" says \u003ca href=\"https://www.sharecare.com/user/dr-carol-horowitz\" target=\"_blank\" rel=\"noopener\">Dr. Carol Horowitz\u003c/a>, an internist and professor at the Icahn School of Medicine at Mount Sinai in New York, who co-authored the study.\u003c/p>\n\u003cp>A busy primary care practitioner herself, Horowitz questions the feasibility of adding genomic medicine to regular office visits.\u003c/p>\n\u003cp>\"Geisinger is a very well-resourced health system and they've made a decision to incorporate that into their practices,\" she says, adding that in Harlem, where she practices, it could be a daunting challenge. \"Our plates are already overflowing, and now you're going to dump a lot more on our plate.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News,\u003c/em>\u003c/a>\u003cem> a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation and not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Routine+DNA+Screening+Moves+Into+Primary+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you have a genetic mutation that increases your risk for a treatable medical condition, would you want to know? For many people the answer is yes. But typically such information has not been a part of routine primary care.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>For patients at \u003ca href=\"https://www.geisinger.org/precision-health/our-promise\" target=\"_blank\" rel=\"noopener\">Geisinger Health System\u003c/a>, that could soon change. Starting in the next month or so, the Pennsylvania-based system will offer DNA sequencing to 1,000 patients, with the goal of eventually extending the offer to all 3 million Geisinger patients.\u003c/p>\n\u003cp>The health system's test will look for mutations in at least 77 genes. Many have been associated with medical conditions — dozens of them, ranging from heart disease to cancer. Others have been linked to variability in how people respond to certain medicines based on heredity.\u003c/p>\n\u003cp>\"We're giving more precision to the very important decisions that people need to make,\" says \u003ca href=\"https://www.geisinger.org/about-geisinger/leadership/leadership-team/david-feinberg\" target=\"_blank\" rel=\"noopener\">Dr. David Feinberg\u003c/a>, Geisinger's president and CEO. In the same way that primary care providers currently suggest checking someone's cholesterol, he says, \"we would have that discussion with patients: 'It looks like we haven't done your genome. Why don't we do that?' \"\u003c/p>\n\u003cp>But some physicians and health policy analysts question whether such genetic information is necessary to provide good primary care and whether handling such testing is feasible for many primary care physicians.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The new clinical program builds on a research biobank and genome-sequencing initiative called \u003ca href=\"https://www.geisinger.org/precision-health/mycode\" target=\"_blank\" rel=\"noopener\">MyCode\u003c/a> that Geisinger started in 2007 to collect and analyze its patients' DNA. That effort has enrolled more than 200,000 people.\u003c/p>\n\u003cp>Like MyCode, the new clinical program will be based on \"\u003ca href=\"https://ghr.nlm.nih.gov/primer/testing/sequencing\" target=\"_blank\" rel=\"noopener\">whole exome\u003c/a>\" sequencing, analyzing the roughly 1 percent of the genome that provides instructions for making proteins, where most known disease-causing mutations occur.\u003c/p>\n\u003cp>Using this analysis, clinicians could tell Geisinger patients whether they have a genetic variant associated with \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\" target=\"_blank\" rel=\"noopener\">Lynch syndrome\u003c/a>, for example, which leads to an \u003ca href=\"https://www.cancer.net/cancer-types/lynch-syndrome\" target=\"_blank\" rel=\"noopener\">increased risk of cancer of the colon\u003c/a> and some other cancers. Or doctors could offer guidance to patients found to have an increased risk for \u003ca href=\"https://medlineplus.gov/ency/article/000392.htm\" target=\"_blank\" rel=\"noopener\">familial hypercholesterolemia\u003c/a>, which can result in high cholesterol levels and heart disease at a young age.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Still other patients who undergo the exome sequencing might learn they have an increased susceptibility to \u003ca href=\"https://ghr.nlm.nih.gov/condition/malignant-hyperthermia\" target=\"_blank\" rel=\"noopener\">malignant hyperthermia\u003c/a>, because of a gene variant that causes a severe reaction to certain medications used during anesthesia; the reaction can be fatal.\u003c/p>\n\u003cp>Geisinger spokesperson Wendy Wilson says that what the company plans is very different from direct-to-consumer services like 23andMe — which tests customers' saliva to determine their genetic risk for several diseases and traits, only some of which are medically actionable, and makes the results available in an online report.\u003c/p>\n\u003cp>\"Geisinger is prescribing DNA sequencing to patients and putting DNA results in electronic health records and actually creating an action plan,\" Wilson says. \"We are preventing disease from happening.\"\u003c/p>\n\u003cp>Geisinger says its program will work like this: Samples of a patient's blood or spit will be used to get a DNA sample. After analysis, the results will be sent to the patient's primary care doctor.\u003c/p>\n\u003cp>The doctor will then take a 30-minute online continuing education tutorial to review genetic testing and get more information on whatever specific susceptibilities have turned up in that patient's results.\u003c/p>\n\u003cp>After that, the patient will be informed and invited to meet with the primary care provider, along with a genetic counselor if desired. At that point the doctor and patient can discuss treatment and prevention options, including any particular lifestyle changes that might reduce the risk of developing the disease or condition.\u003c/p>\n\u003cp>About 3.5 percent of the people who have already been tested through Geisinger's research program had a genetic variant that could result in a medical problem for which clinicians can recommend helpful steps to influence their health, Feinberg says.\u003c/p>\n\u003cp>In the clinical program, only actionable mutations will be communicated to patients. The health care team, for example, won't inform patients if they have a variant of the\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726719/\" target=\"_blank\" rel=\"noopener\"> APOE gene \u003c/a>that somewhat increases their risk for getting Alzheimer's disease, because that information wouldn't change anything about their medical treatment. (Geisinger is developing a policy for how to handle these results if \u003ca href=\"https://www.npr.org/sections/health-shots/2012/08/16/158919471/grappling-with-the-uncertainty-of-alzheimers-testing\" target=\"_blank\" rel=\"noopener\">patients ask for them\u003c/a>.)\u003c/p>\n\u003cp>Insurance companies typically don't cover DNA sequencing and do limit a patient's coverage for adult genetic tests for specific mutations, such as those related to the \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing\" target=\"_blank\" rel=\"noopener\">breast cancer susceptibility genes BRCA1 or BRCA2\u003c/a>, unless the patient has a family history of the condition or other indications they're at high risk. For each of the patients it tests, Geisinger will absorb the estimated $300 to $500 testing cost.\u003c/p>\n\u003cp>\"Most of the medical spending in America is done after people have gotten sick,\" says Feinberg. \"We think this will decrease spending on a lot of care.\"\u003c/p>\n\u003cp>But some clinicians and academics outside Geisinger aren't so sure. One of them is \u003ca href=\"http://tdi.dartmouth.edu/about/our-people/directory/h-gilbert-welch-md-mph\" target=\"_blank\" rel=\"noopener\">Dr. H. Gilbert Welch\u003c/a>, a professor at the Dartmouth Institute for Health Policy and Clinical Practice who has written books about the hazards of \u003ca href=\"https://www.penguinrandomhouse.com/books/243193/less-medicine-more-health-by-dr-h-gilbert-welch/9780807077580/\" target=\"_blank\" rel=\"noopener\">overdiagnosis and overscreening\u003c/a>, including, \u003cem>Less Medicine, More Health\u003c/em>.\u003c/p>\n\u003cp>He credits Geisinger with carefully targeting the mutations in which it looks for actionable mutations, instead of taking an all-encompassing approach. And he acknowledges that for some conditions, like Lynch syndrome, people with certain genetic mutations would benefit from being followed closely. But he questions the value of DNA sequencing to identify some other susceptibilities, such as some of the genetic variants related to cardiovascular disease.\u003c/p>\n\u003cp>\"What are we really going to do differently for those patients?\" he asks. \"We should all be concerned about heart disease. We should all exercise; we should eat real food.\"\u003c/p>\n\u003cp>Welch says he's also concerned about the cascading effect of expensive and potentially harmful medical treatment when a genetic risk is identified.\u003c/p>\n\u003cp>\"Doctors will feel the pressure to do something — start a medication, order a test, make a referral,\" he warns. \"You have to be careful. Bad things happen.\"\u003c/p>\n\u003cp>Other clinicians question primary care physicians' comfort with and time for incorporating DNA sequencing into their practices.\u003c/p>\n\u003cp>A \u003ca href=\"https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1548?journalCode=hlthaff\" target=\"_blank\" rel=\"noopener\">survey published\u003c/a> this month in the journal \u003cem>Health Affairs\u003c/em> queried nearly 500 primary care providers in the New York City area and found that, in the past year, only a third of them had ordered a genetic test, given patients a genetic test result or referred someone for genetic counseling.\u003c/p>\n\u003cp>Only a quarter of the survey respondents said they felt prepared to work with patients who had genetic testing for common diseases or were at high risk for genetic conditions. Just 14 percent reported they were confident they could interpret genetic test results.\u003c/p>\n\u003cp>\"Even though they had training, they felt unprepared to incorporate genomics into their practice,\" says \u003ca href=\"https://www.sharecare.com/user/dr-carol-horowitz\" target=\"_blank\" rel=\"noopener\">Dr. Carol Horowitz\u003c/a>, an internist and professor at the Icahn School of Medicine at Mount Sinai in New York, who co-authored the study.\u003c/p>\n\u003cp>A busy primary care practitioner herself, Horowitz questions the feasibility of adding genomic medicine to regular office visits.\u003c/p>\n\u003cp>\"Geisinger is a very well-resourced health system and they've made a decision to incorporate that into their practices,\" she says, adding that in Harlem, where she practices, it could be a daunting challenge. \"Our plates are already overflowing, and now you're going to dump a lot more on our plate.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener\">\u003cem>Kaiser Health News,\u003c/em>\u003c/a>\u003cem> a nonprofit news service, is an editorially independent program of the Kaiser Family Foundation and not affiliated with Kaiser Permanente.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Routine+DNA+Screening+Moves+Into+Primary+Care&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sticker Shock Jolts Foot Patient: $15,076 For 4 Tiny Screws",
"title": "Sticker Shock Jolts Foot Patient: $15,076 For 4 Tiny Screws",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Sherry Young just wanted to be able to walk without pain.\u003c/p>\n\u003cp>About three years ago, she began to experience sharp pain in her left foot. Her big toe had become crooked and constantly rubbed up against the adjacent toe, making it painful to run, walk or even stand. \"I could not walk without intense pain unless I had a pad underneath my toes for cushioning,\" Young said.\u003c/p>\n\u003cp>An orthopedic surgeon told her that he could fix her problem for good. \"He thought my foot was hitting the ground too hard and causing pain,\" said Young. \"That's what he was trying to correct.\"\u003c/p>\n\u003cp>Though Young had had several orthopedic surgeries, she had always had good insurance and never scrutinized her bills.\u003c/p>\n\u003cp>At the time of her foot surgery, Young of course knew nothing about hospital charges for surgical screws, medical saws and other hardware used in the operating room.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Then the bill came.\u003c/p>\n\u003cp>\u003cstrong>Patient: \u003c/strong>Sherry Young, 57, a retired librarian on disability and a mother of two in Lawton, Okla.\u003c/p>\n\u003cp>\u003cstrong>Total bill:\u003c/strong> $115,527 for a three-day hospital stay, including $15,076 for four tiny screws — measuring 2.8 millimeters wide and no more than 14 millimeters long — placed in the two middle toes of her left foot.\u003c/p>\n\u003cp>\u003cstrong>Service provider:\u003c/strong> OU Medical Center, located at the University of Oklahoma Health Science Center in Oklahoma City\u003c/p>\n\u003cp>\u003cstrong>Medical treatment:\u003c/strong> Young underwent two operations on the same day in June 2017. One surgeon addressed an injury in Young's shoulder, caused by arthritis and overuse. A second surgeon performed several procedures on her foot, including removing a \u003ca href=\"https://www.footeducation.com/page/great-toe-cheilectomy-bone-spur-removal\" target=\"_blank\" rel=\"noopener\">bone spur.\u003c/a> To better align Young's middle toes, the doctor removed a slice of bone from the center of each toe, and then reconnected the two ends with surgical screws made by \u003ca href=\"https://www.arthrex.com/\" target=\"_blank\" rel=\"noopener\">Arthrex,\u003c/a> a medical device manufacturer based in Naples, Fla.\u003c/p>\n\u003cp>\u003cstrong>What gives:\u003c/strong> Two weeks after surgery, Young received a letter from her insurance plan, BlueCross BlueShield of Oklahoma, stating that it had not approved her hospital stay. Staying overnight was not \"medically necessary,\" according to the letter, because foot and shoulder surgery are typically performed as outpatient procedures.\u003c/p>\n\u003cp>The letter \"put me in a panic,\" said Young, who was suddenly worried that she would have to pay the entire $115,000 bill herself. That's about how much her home is worth, and five times her annual income.\u003c/p>\n\u003cp>Faced with the astronomical cost, Young asked for an itemized copy of her bill and began checking every charge.\u003c/p>\n\u003cp>She was floored by the price of the screws, each of which cost more than a high-end computer.\u003c/p>\n\u003cp>\"Unless the metal [was] mined on an asteroid, I do not know why it should cost that amount,\" Young said.\u003c/p>\n\u003cp>She repeatedly asked officials at OU Medical Center for part numbers for the screws, so she could find out how much they cost the hospital. Hospital officials never provided the information, Young said.\u003c/p>\n\u003cp>John Schmieding, senior vice president and general counsel for Arthrex, declined to tell Kaiser Health News exactly how much his company charges hospitals for the type of screws implanted in Young's foot. But he did offer ballpark figures: \"Our sale price for screws used in foot and ankle procedures would be below $300 per screw, with the most expensive around $1,000.\"\u003c/p>\n\u003cp>As for what the hospital charges, Schmieding said, \"We do not direct or control how a facility bills for their procedure.\" Based on the numbers Schmieding provided, the hospital markup on Young's screws could range from roughly 275 percent to upwards of 1,150 percent.\u003c/p>\n\u003cp>\"It's mind-boggling,\" said Dr. James Rickert, an orthopedic surgeon in Bedford, Ind., and president of the Society for Patient Centered Orthopedics, which advocates for affordable health care. \"We are talking about little pieces of metal.\"\u003c/p>\n\u003cp>Yet such steep markups are common at hospitals, said Rickert, who was not involved in Young's care.\u003c/p>\n\u003cp>Clearly, the screws used in Young's surgery are more sophisticated than those sold at the local hardware store. Many of the screws in Arthrex's online catalog are made of titanium, which is popular for surgery because it's strong and durable. The screws are also hollow, designed to fit over a guidewire so that doctors can place them in precisely the right place.\u003c/p>\n\u003cp>Surgical device manufacturers also must comply with strict regulations, said Steve Lichtenthal, vice president of business development at the Orthopaedic Implant Co., based in Reno, Nev., which makes surgical supplies.\u003c/p>\n\u003cp>But even the fanciest screw is still pretty simple, Lichtenthal said. Tiny screws cost only about $30 to manufacture, and the technology hasn't changed much in decades, he said. About half the cost of a surgical implant goes toward paying sales and marketing staff, who develop close relationships with doctors and sometimes even attend surgery, Lichtenthal said.\u003c/p>\n\u003cp>Screws weren't the only expensive devices figuring into Young's bill. A drill bit, used for making holes in bone, carried a charge of $4,265; a tool for removing and cauterizing tissue was $5,047; a saw blade, $619.\u003c/p>\n\u003cp>While screws can be used only once, there's no reason that other surgical equipment, such as saw blades, should be disposable, Rickert said. Hospitals routinely sterilize tools such as scalpels and scissors, then use them again.\u003c/p>\n\u003cp>A hospital spokesman declined to comment on the specifics of Young's bill, as did the surgeon who operated on her foot.\u003c/p>\n\u003cp>OU Medical Center issued a statement that said: \"OU Medical Center provides the highest-quality patient care. We are focused on acquiring the latest tools, treatments and technology, while diligently making sure we have the resources to maintain this commitment our patients deserve. We strive to keep costs down and focus investment on where it really matters — our patients.\"\u003c/p>\n\u003cp>In the statement, OU Medical Center said few patients pay the full price. Instead, insurance companies typically negotiate discounts with hospitals, allowing them to pay less than the amount on the list of charges.\u003c/p>\n\u003cp>Yet, as Young learned, people who are uninsured — or whose insurance plan refuses to pay — get no discount.\u003c/p>\n\u003cp>\u003cstrong>Resolution:\u003c/strong> Young is now off the hook. In a statement in response to a reporter's questions, BlueCross BlueShield of Oklahoma said it never actually denied Young's insurance claim but simply needed \"additional information from the provider in order to process it correctly.\"\u003c/p>\n\u003cp>According to Young's most recent billing statement from OU Medical Center, she does not owe anything for her hospital stay. However, her latest statement from the hospital includes a $413 charge for an \"appeal denied.\"\u003c/p>\n\u003cp>Surgery relieved the chronic pain in her shoulder and alleviated some but not all of the pain in her foot, Young said.\u003c/p>\n\u003cp>\u003cstrong>The takeaway:\u003c/strong> Companies can charge big prices for small surgical supplies, and hospitals can mark them up at will.\u003c/p>\n\u003cp>If you want to know exactly why your bill is so high, ask for an itemized list of charges. Since patients have no ability to shop around for different screws before the surgery, it's important to complain loudly to the hospital, your insurer and your employer if you see charges that seem outrageous.\u003c/p>\n\u003chr>\n\u003cp>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003cem> is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Jane Greenhalgh produced and edited the interview with Elisabeth Rosenthal for broadcast. Jackie Fortier from StateImpact Oklahoma reported from Lawton, Okla. Member station KGOU is part of StateImpact Oklahoma, a multistation reporting collaboration. KGOU is owned by the University of Oklahoma, which also owns and operates OU Medical Center.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Sticker+Shock+Jolts+Oklahoma+Patient%3A+%2415%2C076+For+4+Tiny+Screws&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Sherry Young just wanted to be able to walk without pain.\u003c/p>\n\u003cp>About three years ago, she began to experience sharp pain in her left foot. Her big toe had become crooked and constantly rubbed up against the adjacent toe, making it painful to run, walk or even stand. \"I could not walk without intense pain unless I had a pad underneath my toes for cushioning,\" Young said.\u003c/p>\n\u003cp>An orthopedic surgeon told her that he could fix her problem for good. \"He thought my foot was hitting the ground too hard and causing pain,\" said Young. \"That's what he was trying to correct.\"\u003c/p>\n\u003cp>Though Young had had several orthopedic surgeries, she had always had good insurance and never scrutinized her bills.\u003c/p>\n\u003cp>At the time of her foot surgery, Young of course knew nothing about hospital charges for surgical screws, medical saws and other hardware used in the operating room.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Then the bill came.\u003c/p>\n\u003cp>\u003cstrong>Patient: \u003c/strong>Sherry Young, 57, a retired librarian on disability and a mother of two in Lawton, Okla.\u003c/p>\n\u003cp>\u003cstrong>Total bill:\u003c/strong> $115,527 for a three-day hospital stay, including $15,076 for four tiny screws — measuring 2.8 millimeters wide and no more than 14 millimeters long — placed in the two middle toes of her left foot.\u003c/p>\n\u003cp>\u003cstrong>Service provider:\u003c/strong> OU Medical Center, located at the University of Oklahoma Health Science Center in Oklahoma City\u003c/p>\n\u003cp>\u003cstrong>Medical treatment:\u003c/strong> Young underwent two operations on the same day in June 2017. One surgeon addressed an injury in Young's shoulder, caused by arthritis and overuse. A second surgeon performed several procedures on her foot, including removing a \u003ca href=\"https://www.footeducation.com/page/great-toe-cheilectomy-bone-spur-removal\" target=\"_blank\" rel=\"noopener\">bone spur.\u003c/a> To better align Young's middle toes, the doctor removed a slice of bone from the center of each toe, and then reconnected the two ends with surgical screws made by \u003ca href=\"https://www.arthrex.com/\" target=\"_blank\" rel=\"noopener\">Arthrex,\u003c/a> a medical device manufacturer based in Naples, Fla.\u003c/p>\n\u003cp>\u003cstrong>What gives:\u003c/strong> Two weeks after surgery, Young received a letter from her insurance plan, BlueCross BlueShield of Oklahoma, stating that it had not approved her hospital stay. Staying overnight was not \"medically necessary,\" according to the letter, because foot and shoulder surgery are typically performed as outpatient procedures.\u003c/p>\n\u003cp>The letter \"put me in a panic,\" said Young, who was suddenly worried that she would have to pay the entire $115,000 bill herself. That's about how much her home is worth, and five times her annual income.\u003c/p>\n\u003cp>Faced with the astronomical cost, Young asked for an itemized copy of her bill and began checking every charge.\u003c/p>\n\u003cp>She was floored by the price of the screws, each of which cost more than a high-end computer.\u003c/p>\n\u003cp>\"Unless the metal [was] mined on an asteroid, I do not know why it should cost that amount,\" Young said.\u003c/p>\n\u003cp>She repeatedly asked officials at OU Medical Center for part numbers for the screws, so she could find out how much they cost the hospital. Hospital officials never provided the information, Young said.\u003c/p>\n\u003cp>John Schmieding, senior vice president and general counsel for Arthrex, declined to tell Kaiser Health News exactly how much his company charges hospitals for the type of screws implanted in Young's foot. But he did offer ballpark figures: \"Our sale price for screws used in foot and ankle procedures would be below $300 per screw, with the most expensive around $1,000.\"\u003c/p>\n\u003cp>As for what the hospital charges, Schmieding said, \"We do not direct or control how a facility bills for their procedure.\" Based on the numbers Schmieding provided, the hospital markup on Young's screws could range from roughly 275 percent to upwards of 1,150 percent.\u003c/p>\n\u003cp>\"It's mind-boggling,\" said Dr. James Rickert, an orthopedic surgeon in Bedford, Ind., and president of the Society for Patient Centered Orthopedics, which advocates for affordable health care. \"We are talking about little pieces of metal.\"\u003c/p>\n\u003cp>Yet such steep markups are common at hospitals, said Rickert, who was not involved in Young's care.\u003c/p>\n\u003cp>Clearly, the screws used in Young's surgery are more sophisticated than those sold at the local hardware store. Many of the screws in Arthrex's online catalog are made of titanium, which is popular for surgery because it's strong and durable. The screws are also hollow, designed to fit over a guidewire so that doctors can place them in precisely the right place.\u003c/p>\n\u003cp>Surgical device manufacturers also must comply with strict regulations, said Steve Lichtenthal, vice president of business development at the Orthopaedic Implant Co., based in Reno, Nev., which makes surgical supplies.\u003c/p>\n\u003cp>But even the fanciest screw is still pretty simple, Lichtenthal said. Tiny screws cost only about $30 to manufacture, and the technology hasn't changed much in decades, he said. About half the cost of a surgical implant goes toward paying sales and marketing staff, who develop close relationships with doctors and sometimes even attend surgery, Lichtenthal said.\u003c/p>\n\u003cp>Screws weren't the only expensive devices figuring into Young's bill. A drill bit, used for making holes in bone, carried a charge of $4,265; a tool for removing and cauterizing tissue was $5,047; a saw blade, $619.\u003c/p>\n\u003cp>While screws can be used only once, there's no reason that other surgical equipment, such as saw blades, should be disposable, Rickert said. Hospitals routinely sterilize tools such as scalpels and scissors, then use them again.\u003c/p>\n\u003cp>A hospital spokesman declined to comment on the specifics of Young's bill, as did the surgeon who operated on her foot.\u003c/p>\n\u003cp>OU Medical Center issued a statement that said: \"OU Medical Center provides the highest-quality patient care. We are focused on acquiring the latest tools, treatments and technology, while diligently making sure we have the resources to maintain this commitment our patients deserve. We strive to keep costs down and focus investment on where it really matters — our patients.\"\u003c/p>\n\u003cp>In the statement, OU Medical Center said few patients pay the full price. Instead, insurance companies typically negotiate discounts with hospitals, allowing them to pay less than the amount on the list of charges.\u003c/p>\n\u003cp>Yet, as Young learned, people who are uninsured — or whose insurance plan refuses to pay — get no discount.\u003c/p>\n\u003cp>\u003cstrong>Resolution:\u003c/strong> Young is now off the hook. In a statement in response to a reporter's questions, BlueCross BlueShield of Oklahoma said it never actually denied Young's insurance claim but simply needed \"additional information from the provider in order to process it correctly.\"\u003c/p>\n\u003cp>According to Young's most recent billing statement from OU Medical Center, she does not owe anything for her hospital stay. However, her latest statement from the hospital includes a $413 charge for an \"appeal denied.\"\u003c/p>\n\u003cp>Surgery relieved the chronic pain in her shoulder and alleviated some but not all of the pain in her foot, Young said.\u003c/p>\n\u003cp>\u003cstrong>The takeaway:\u003c/strong> Companies can charge big prices for small surgical supplies, and hospitals can mark them up at will.\u003c/p>\n\u003cp>If you want to know exactly why your bill is so high, ask for an itemized list of charges. Since patients have no ability to shop around for different screws before the surgery, it's important to complain loudly to the hospital, your insurer and your employer if you see charges that seem outrageous.\u003c/p>\n\u003chr>\n\u003cp>\u003ca href=\"http://khn.org/\">Kaiser Health News\u003c/a>\u003cem> is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Jane Greenhalgh produced and edited the interview with Elisabeth Rosenthal for broadcast. Jackie Fortier from StateImpact Oklahoma reported from Lawton, Okla. Member station KGOU is part of StateImpact Oklahoma, a multistation reporting collaboration. KGOU is owned by the University of Oklahoma, which also owns and operates OU Medical Center.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Sticker+Shock+Jolts+Oklahoma+Patient%3A+%2415%2C076+For+4+Tiny+Screws&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Michael Pollan Embraces The 'New Science' Of Psychedelics",
"title": "Michael Pollan Embraces The 'New Science' Of Psychedelics",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Author Michael Pollan had always been curious about psychoactive plants, but his interest skyrocketed when he heard about a \u003ca href=\"https://www.npr.org/sections/health-shots/2016/12/03/504136736/how-a-psychedelic-drug-helps-cancer-patients-overcome-anxiety\" target=\"_blank\" rel=\"noopener\">research study\u003c/a> in which people with terminal cancer were given a psychedelic called \u003ca href=\"https://www.npr.org/tags/140958387/psilocybin\" target=\"_blank\" rel=\"noopener\">psilocybin \u003c/a>— the active ingredient in \"magic mushrooms\" — to help them deal with their distress.\u003c/p>\n\u003cp>\"This seemed like such a crazy idea that I began looking into it,\" Pollan says. \"Why should a drug from a mushroom help people deal with their mortality?\"\u003c/p>\n\u003cp>Pollan, whose previous books include \u003ca href=\"https://www.npr.org/books/titles/137946336/the-omnivores-dilemma-a-natural-history-of-four-meals\" target=\"_blank\" rel=\"noopener\">The Omnivore's Dilemma\u003c/a> and \u003ca href=\"https://www.npr.org/templates/story/story.php?storyId=17725932\" target=\"_blank\" rel=\"noopener\">In Defense Of Food\u003c/a>, started researching different experimental therapeutic uses of psychedelics, and found that the drugs were being used to treat depression, addiction and the fear of death.\u003c/p>\n\u003cp>Then he decided to go one step further: A self-described \"reluctant psychonaut,\" Pollan enlisted guides to help him experiment with LSD, psilocybin and 5-MeO-DMT, a substance in the venom of the Sonoran Desert toad.\u003c/p>\n\u003cp>Each of Pollan's experiences with psychedelics was preceded by worry and self-doubt. But, he says, \"I realized later that was my ego trying to convince me not to do this thing that was going to challenge my ego.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Pollan's new book, \u003cem>How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence\u003c/em>, recounts his experiences with the drugs and also examines the history of psychedelics as well as their possible therapeutic uses.\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>Interview Highlights\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>On how the psychedelic psilocybin is administered in therapy for depression \u003c/strong>\u003c/p>\n\u003cp>The way [psilocybin is] being used is in a very controlled or guided setting. ... They don't just give you a pill and send you home; you're in a room. You're with two guides, one male, one female. You're lying down on a comfortable couch. You're wearing headphones listening to a really carefully curated playlist of music — instrumental compositions for the most part — and you're wearing eyeshades, all of which is to encourage a very inward journey.\u003c/p>\n\u003cp>Someone is kind of looking out for you, and they prepare you very carefully in advance. They give you a set of \"flight instructions,\" as they call them, which is what to do if you get really scared or you're beginning to have a bad trip. If you see a monster, for example, don't try to run away. Walk right up to it, plant your feet and say, \"What do you have to teach me? What are you doing in my mind?\" And if you do that, according to the flight instructions, your fear will morph into something much more positive very quickly.\u003c/p>\n\u003cp>\u003cstrong>On how psychedelics can help change the stories we tell about ourselves \u003c/strong>\u003c/p>\n\u003cp>The drugs foster new perspectives on old problems. One of the things our mind does is tell stories about ourselves. If you're depressed, you're being told a story perhaps that you're worthless, that no one could possibly love you, you're not worthy of love, that life will not get better. And these stories — which are enforced by our egos really — trap us in these ruminative loops that are very hard to get out of. They're very destructive patterns of thought.\u003c/p>\n\u003cp>What the drugs appear to do is disable for a period of time the part of the brain where the self talks to itself. It's called the \u003ca href=\"https://www.npr.org/tags/482443062/default-mode-network\" target=\"_blank\" rel=\"noopener\">default mode network\u003c/a>, and it's a group of structures that connect parts of the cortex — the evolutionarily most recent part of the brain — to deeper levels where emotion and memory reside. And it's a very important hub in the brain and lots of important things happen there: self-reflection and rumination, time travel. It's where we go to think about the future or the past, and theory of mind, the ability to imagine the mental states of other beings and, I think, most importantly, the autobiographical self. It's the part of the brain, it appears, where we incorporate things that happen to us, new information, with a sense of who we are, who we were and who we want to be. And that's where these stories get generated. And these stories can be really destructive, they trap us. ...\u003c/p>\n\u003cp>This network is downregulated [with psychedelics], it sort of goes offline for a period of time. And that's why you experience this dissolution of self or ego, which can be a terrifying or liberating thing, depending on your mindset. This is what allows people, I think, to have those new perspectives on themselves, to realize that they needn't be trapped in those stories and they might actually be able to write some new stories about themselves. That's what's liberating, I think, about the experience when it works.\u003c/p>\n\u003cp>\u003cstrong>On how psychedelics can help dying people face their deaths \u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.npr.org/tags/125941537/prozac\">Prozac\u003c/a> doesn't help when you're confronting your mortality. But here we have something that occasions an experience in people — a mystical experience — that somehow makes it easier to let go. And I think some of it has to do with the fact that you do experience the \"extinction\" of yourself and it's kind of a rehearsal for death. And I think that may be part of what helps people, that they expand their sense of what is your self-interest and your self-interest is something larger than what is contained by your skin. And when you have that recognition, I think dying becomes a little easier. ...\u003c/p>\n\u003cp>There's no way to prove this, obviously, and it's a question that really troubled me as an old-fashioned materialist skeptical journalist. It's like, \"What if these drugs are inducing an illusion in people?\" I got a variety of answers to that question from the researchers. One was, \"Who cares if it helps them?\" And I can see the point of that. The other was, \"Hey, this is beyond my pay grade; none of us know what happens after we die.\" And others say, \"Well, this is an open frontier.\" ...\u003c/p>\n\u003cp>The experiences that people have are very real to them — they're psychological facts. And one of the really interesting qualities of psychedelic experience is that the insights you have on them have a durability ... This isn't just an opinion, this is revealed truth, so the confidence people have is hard to shake, actually.\u003c/p>\n\u003cp>\u003cstrong>On a \u003c/strong>\u003ca href=\"https://www.hopkinsmedicine.org/news/stories/mushrooms_quit_smoking.html\" target=\"_blank\" rel=\"noopener\">\u003cstrong>Johns Hopkins study\u003c/strong>\u003c/a>\u003cstrong> on the use of psilocybin to help people quit smoking \u003c/strong>\u003c/p>\n\u003cp>Smoking is a very hard addiction to break. It's one of the hardest addictions to break. [I wanted to understand] how, after a single psilocybin trip, they could decide \"I'm never going to smoke again\" based on the perspective they had achieved. And they would say things like, \"Well, I had this amazing experience. I died three times. I sprouted wings. I flew through European histories. I beheld all these wonders. I saw my body on a funeral pyre on the Ganges. And I realized, the universe is so amazing and there's so much to do in it that killing myself seemed really stupid.\" And that was the insight. Yes, killing yourself is really stupid — but it had an authority it had never had. And that, I think, is the gift of these psychedelics.\u003c/p>\n\u003cp>\u003cstrong>On his own experience tripping on mushrooms \u003c/strong>\u003c/p>\n\u003cp>I had an experience that was by turns frightening and ecstatic and weird. ... I found myself in this place where I could no longer control my perceptions at all, and I felt my sense of self scatter to the wind — almost as if a pile of post-its had been released to the wind — but I was fine with it. I didn't feel any desire to pile the papers back together into my customary self ...\u003c/p>\n\u003cp>Then I looked out and saw myself spread over the landscape like a coat of paint or butter. I was outside myself, beside myself, literally, and the consciousness that beheld this ... was not my normal consciousness, it was completely unperturbed. It was dispassionate. It was content, as I watched myself dissolve over the landscape.\u003c/p>\n\u003cp>What I brought back from that experience was that I'm not identical to my ego, that there is another ground on which to plant our feet and that our ego is kind of this character that is chattering neurotically in our minds. And it's good for lots of things. I mean, the ego got the book written, but it also can be very harsh, and it's liberating to have some distance on it. And that was a great gift, I think.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Sam Briger 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=%27Reluctant+Psychonaut%27+Michael+Pollan+Embraces+The+%27New+Science%27+Of+Psychedelics+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Author Michael Pollan had always been curious about psychoactive plants, but his interest skyrocketed when he heard about a \u003ca href=\"https://www.npr.org/sections/health-shots/2016/12/03/504136736/how-a-psychedelic-drug-helps-cancer-patients-overcome-anxiety\" target=\"_blank\" rel=\"noopener\">research study\u003c/a> in which people with terminal cancer were given a psychedelic called \u003ca href=\"https://www.npr.org/tags/140958387/psilocybin\" target=\"_blank\" rel=\"noopener\">psilocybin \u003c/a>— the active ingredient in \"magic mushrooms\" — to help them deal with their distress.\u003c/p>\n\u003cp>\"This seemed like such a crazy idea that I began looking into it,\" Pollan says. \"Why should a drug from a mushroom help people deal with their mortality?\"\u003c/p>\n\u003cp>Pollan, whose previous books include \u003ca href=\"https://www.npr.org/books/titles/137946336/the-omnivores-dilemma-a-natural-history-of-four-meals\" target=\"_blank\" rel=\"noopener\">The Omnivore's Dilemma\u003c/a> and \u003ca href=\"https://www.npr.org/templates/story/story.php?storyId=17725932\" target=\"_blank\" rel=\"noopener\">In Defense Of Food\u003c/a>, started researching different experimental therapeutic uses of psychedelics, and found that the drugs were being used to treat depression, addiction and the fear of death.\u003c/p>\n\u003cp>Then he decided to go one step further: A self-described \"reluctant psychonaut,\" Pollan enlisted guides to help him experiment with LSD, psilocybin and 5-MeO-DMT, a substance in the venom of the Sonoran Desert toad.\u003c/p>\n\u003cp>Each of Pollan's experiences with psychedelics was preceded by worry and self-doubt. But, he says, \"I realized later that was my ego trying to convince me not to do this thing that was going to challenge my ego.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Pollan's new book, \u003cem>How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence\u003c/em>, recounts his experiences with the drugs and also examines the history of psychedelics as well as their possible therapeutic uses.\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>Interview Highlights\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>On how the psychedelic psilocybin is administered in therapy for depression \u003c/strong>\u003c/p>\n\u003cp>The way [psilocybin is] being used is in a very controlled or guided setting. ... They don't just give you a pill and send you home; you're in a room. You're with two guides, one male, one female. You're lying down on a comfortable couch. You're wearing headphones listening to a really carefully curated playlist of music — instrumental compositions for the most part — and you're wearing eyeshades, all of which is to encourage a very inward journey.\u003c/p>\n\u003cp>Someone is kind of looking out for you, and they prepare you very carefully in advance. They give you a set of \"flight instructions,\" as they call them, which is what to do if you get really scared or you're beginning to have a bad trip. If you see a monster, for example, don't try to run away. Walk right up to it, plant your feet and say, \"What do you have to teach me? What are you doing in my mind?\" And if you do that, according to the flight instructions, your fear will morph into something much more positive very quickly.\u003c/p>\n\u003cp>\u003cstrong>On how psychedelics can help change the stories we tell about ourselves \u003c/strong>\u003c/p>\n\u003cp>The drugs foster new perspectives on old problems. One of the things our mind does is tell stories about ourselves. If you're depressed, you're being told a story perhaps that you're worthless, that no one could possibly love you, you're not worthy of love, that life will not get better. And these stories — which are enforced by our egos really — trap us in these ruminative loops that are very hard to get out of. They're very destructive patterns of thought.\u003c/p>\n\u003cp>What the drugs appear to do is disable for a period of time the part of the brain where the self talks to itself. It's called the \u003ca href=\"https://www.npr.org/tags/482443062/default-mode-network\" target=\"_blank\" rel=\"noopener\">default mode network\u003c/a>, and it's a group of structures that connect parts of the cortex — the evolutionarily most recent part of the brain — to deeper levels where emotion and memory reside. And it's a very important hub in the brain and lots of important things happen there: self-reflection and rumination, time travel. It's where we go to think about the future or the past, and theory of mind, the ability to imagine the mental states of other beings and, I think, most importantly, the autobiographical self. It's the part of the brain, it appears, where we incorporate things that happen to us, new information, with a sense of who we are, who we were and who we want to be. And that's where these stories get generated. And these stories can be really destructive, they trap us. ...\u003c/p>\n\u003cp>This network is downregulated [with psychedelics], it sort of goes offline for a period of time. And that's why you experience this dissolution of self or ego, which can be a terrifying or liberating thing, depending on your mindset. This is what allows people, I think, to have those new perspectives on themselves, to realize that they needn't be trapped in those stories and they might actually be able to write some new stories about themselves. That's what's liberating, I think, about the experience when it works.\u003c/p>\n\u003cp>\u003cstrong>On how psychedelics can help dying people face their deaths \u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"https://www.npr.org/tags/125941537/prozac\">Prozac\u003c/a> doesn't help when you're confronting your mortality. But here we have something that occasions an experience in people — a mystical experience — that somehow makes it easier to let go. And I think some of it has to do with the fact that you do experience the \"extinction\" of yourself and it's kind of a rehearsal for death. And I think that may be part of what helps people, that they expand their sense of what is your self-interest and your self-interest is something larger than what is contained by your skin. And when you have that recognition, I think dying becomes a little easier. ...\u003c/p>\n\u003cp>There's no way to prove this, obviously, and it's a question that really troubled me as an old-fashioned materialist skeptical journalist. It's like, \"What if these drugs are inducing an illusion in people?\" I got a variety of answers to that question from the researchers. One was, \"Who cares if it helps them?\" And I can see the point of that. The other was, \"Hey, this is beyond my pay grade; none of us know what happens after we die.\" And others say, \"Well, this is an open frontier.\" ...\u003c/p>\n\u003cp>The experiences that people have are very real to them — they're psychological facts. And one of the really interesting qualities of psychedelic experience is that the insights you have on them have a durability ... This isn't just an opinion, this is revealed truth, so the confidence people have is hard to shake, actually.\u003c/p>\n\u003cp>\u003cstrong>On a \u003c/strong>\u003ca href=\"https://www.hopkinsmedicine.org/news/stories/mushrooms_quit_smoking.html\" target=\"_blank\" rel=\"noopener\">\u003cstrong>Johns Hopkins study\u003c/strong>\u003c/a>\u003cstrong> on the use of psilocybin to help people quit smoking \u003c/strong>\u003c/p>\n\u003cp>Smoking is a very hard addiction to break. It's one of the hardest addictions to break. [I wanted to understand] how, after a single psilocybin trip, they could decide \"I'm never going to smoke again\" based on the perspective they had achieved. And they would say things like, \"Well, I had this amazing experience. I died three times. I sprouted wings. I flew through European histories. I beheld all these wonders. I saw my body on a funeral pyre on the Ganges. And I realized, the universe is so amazing and there's so much to do in it that killing myself seemed really stupid.\" And that was the insight. Yes, killing yourself is really stupid — but it had an authority it had never had. And that, I think, is the gift of these psychedelics.\u003c/p>\n\u003cp>\u003cstrong>On his own experience tripping on mushrooms \u003c/strong>\u003c/p>\n\u003cp>I had an experience that was by turns frightening and ecstatic and weird. ... I found myself in this place where I could no longer control my perceptions at all, and I felt my sense of self scatter to the wind — almost as if a pile of post-its had been released to the wind — but I was fine with it. I didn't feel any desire to pile the papers back together into my customary self ...\u003c/p>\n\u003cp>Then I looked out and saw myself spread over the landscape like a coat of paint or butter. I was outside myself, beside myself, literally, and the consciousness that beheld this ... was not my normal consciousness, it was completely unperturbed. It was dispassionate. It was content, as I watched myself dissolve over the landscape.\u003c/p>\n\u003cp>What I brought back from that experience was that I'm not identical to my ego, that there is another ground on which to plant our feet and that our ego is kind of this character that is chattering neurotically in our minds. And it's good for lots of things. I mean, the ego got the book written, but it also can be very harsh, and it's liberating to have some distance on it. And that was a great gift, I think.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The Food and Drug Administration has approved a first-of-its-kind drug that reduces the number of migraines among people prone to these sometimes crippling headaches.[contextly_sidebar id=\"eVSpdADwfHP9wNaEEpapPJOooMFjlmTD\"]\u003c/p>\n\u003cp>That's welcome news to some of the millions of Americans who suffer from these \u003ca href=\"https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page\" target=\"_blank\" rel=\"noopener\">potentially debilitating headaches\u003c/a>. Much more common in women than men, these throbbing headaches can also come with nausea, visual disturbances and sensitivity to light. People who suffer them frequently sometimes find themselves anxious, depressed and even disabled.\u003c/p>\n\u003cp>Most of the drugs on the market today are used to control the symptoms of migraine.\u003c/p>\n\u003cp>The new drug, Aimovig was \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm608120.htm\" target=\"_blank\" rel=\"noopener\">approved by the FDA on Thursday\u003c/a>. It's the first medicine in a new class that's designed to reduce the number of migraines among people who suffer them frequently. The medicine, known generically as erenumab-aooe, is being sold by Amgen in the U.S.\u003c/p>\n\u003cp>Aimovig and several other migraine drugs in development are based on research begun in the 1980s. Scientists found people having migraine attacks have high levels of something called \"calcitonin gene–related peptide,\" or CGRP, in their blood, as Lauren Gravitz \u003ca href=\"https://www.npr.org/sections/health-shots/2018/02/03/581092093/gone-with-a-shot-hopeful-new-signs-of-relief-for-migraine-sufferers\" target=\"_blank\" rel=\"noopener\">reported for Shots in February\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the peptide was injected in people prone to migraines, it triggered headaches. People not prone to migraines were unaffected by the peptide injections.\u003c/p>\n\u003cp>With this insight in hand, drugmakers worked to make antibodies to block the peptide's activity inside the body as a way to prevent migraines.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1705848\" target=\"_blank\" rel=\"noopener\">one of the large studies\u003c/a> that set the stage for FDA approval of Aimovig, the number of migraines per month dropped from eight to fewer than five, on average. Patients taking dummy \"placebo\" shots also had fewer migraines.\u003c/p>\n\u003cp>Patients in Aimovig studies reported generally mild side effects, though any long-term or rarer risks from Aimovig could come to light only over time.[contextly_sidebar id=\"qA38kZhQPznYkiyYxVV7PlTRdiD9ko0z\"]\u003c/p>\n\u003cp>People inject the drug themselves using a pen-like device, like those used for insulin.\u003c/p>\n\u003cp>Aimovig is an expensive type of medication called a monoclonal antibody. Antibodies are produced in living cells rather than in a chemical laboratory.\u003c/p>\n\u003cp>Drugmaker \u003ca href=\"https://www.amgen.com/media/news-releases/2018/05/fda-approves-aimovig-erenumabaooe-a-novel-treatment-developed-specifically-for-migraine-prevention/\" target=\"_blank\" rel=\"noopener\">Amgen says is has set the list price\u003c/a> at $6,900 a year.\u003c/p>\n\u003cp>Some analysts had expected the initial price of this drug to be set substantially higher – at $10,000 a year or more. But high prices have recently been generating political backlash, and \u003ca href=\"https://www.statnews.com/2016/10/28/cholesterol-drug-failure/\" target=\"_blank\" rel=\"noopener\">some expensive drugs have fizzled\u003c/a> after insurance companies sharply limited which patients they would cover.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With the new migraine drug, those questions will come to the fore quickly, as Amgen says it's ready to put the drug on the market within a week, and has programs in place to help ease the cost to some patients.\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=New+Type+Of+Drug+To+Prevent+Migraines+Heads+To+Market&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Food and Drug Administration has approved a first-of-its-kind drug that reduces the number of migraines among people prone to these sometimes crippling headaches.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That's welcome news to some of the millions of Americans who suffer from these \u003ca href=\"https://www.ninds.nih.gov/Disorders/All-Disorders/Migraine-Information-Page\" target=\"_blank\" rel=\"noopener\">potentially debilitating headaches\u003c/a>. Much more common in women than men, these throbbing headaches can also come with nausea, visual disturbances and sensitivity to light. People who suffer them frequently sometimes find themselves anxious, depressed and even disabled.\u003c/p>\n\u003cp>Most of the drugs on the market today are used to control the symptoms of migraine.\u003c/p>\n\u003cp>The new drug, Aimovig was \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm608120.htm\" target=\"_blank\" rel=\"noopener\">approved by the FDA on Thursday\u003c/a>. It's the first medicine in a new class that's designed to reduce the number of migraines among people who suffer them frequently. The medicine, known generically as erenumab-aooe, is being sold by Amgen in the U.S.\u003c/p>\n\u003cp>Aimovig and several other migraine drugs in development are based on research begun in the 1980s. Scientists found people having migraine attacks have high levels of something called \"calcitonin gene–related peptide,\" or CGRP, in their blood, as Lauren Gravitz \u003ca href=\"https://www.npr.org/sections/health-shots/2018/02/03/581092093/gone-with-a-shot-hopeful-new-signs-of-relief-for-migraine-sufferers\" target=\"_blank\" rel=\"noopener\">reported for Shots in February\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When the peptide was injected in people prone to migraines, it triggered headaches. People not prone to migraines were unaffected by the peptide injections.\u003c/p>\n\u003cp>With this insight in hand, drugmakers worked to make antibodies to block the peptide's activity inside the body as a way to prevent migraines.\u003c/p>\n\u003cp>In \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1705848\" target=\"_blank\" rel=\"noopener\">one of the large studies\u003c/a> that set the stage for FDA approval of Aimovig, the number of migraines per month dropped from eight to fewer than five, on average. Patients taking dummy \"placebo\" shots also had fewer migraines.\u003c/p>\n\u003cp>Patients in Aimovig studies reported generally mild side effects, though any long-term or rarer risks from Aimovig could come to light only over time.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>People inject the drug themselves using a pen-like device, like those used for insulin.\u003c/p>\n\u003cp>Aimovig is an expensive type of medication called a monoclonal antibody. Antibodies are produced in living cells rather than in a chemical laboratory.\u003c/p>\n\u003cp>Drugmaker \u003ca href=\"https://www.amgen.com/media/news-releases/2018/05/fda-approves-aimovig-erenumabaooe-a-novel-treatment-developed-specifically-for-migraine-prevention/\" target=\"_blank\" rel=\"noopener\">Amgen says is has set the list price\u003c/a> at $6,900 a year.\u003c/p>\n\u003cp>Some analysts had expected the initial price of this drug to be set substantially higher – at $10,000 a year or more. But high prices have recently been generating political backlash, and \u003ca href=\"https://www.statnews.com/2016/10/28/cholesterol-drug-failure/\" target=\"_blank\" rel=\"noopener\">some expensive drugs have fizzled\u003c/a> after insurance companies sharply limited which patients they would cover.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>With the new migraine drug, those questions will come to the fore quickly, as Amgen says it's ready to put the drug on the market within a week, and has programs in place to help ease the cost to some patients.\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=New+Type+Of+Drug+To+Prevent+Migraines+Heads+To+Market&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Mounting Evidence Shows Diet Soda May Be Hurting Your Diet — Here's How",
"title": "Mounting Evidence Shows Diet Soda May Be Hurting Your Diet — Here's How",
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"content": "\u003cp>Artificial sweeteners are everywhere, but the jury is still out on whether these chemicals are harmless. Also called non-nutritive sweeteners, these can be synthetic – such as saccharin and aspartame – or naturally derived, such as steviol, which comes from the Stevia plant. To date, the U.S. Food and Drug Administration has approved \u003ca href=\"https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm\" target=\"_blank\" rel=\"noopener\">six types of artificial and two types of natural non-nutritive sweeteners\u003c/a> for use in food.[contextly_sidebar id=\"9cHOWFJBVWEQQfvraluyBJ45Elnnkn5i\"]\u003c/p>\n\u003cp>That’s been great news for those working hard to curb their sugar consumption. \u003ca href=\"https://doi.org/10.3945/ajcn.111.030833\" target=\"_blank\" rel=\"noopener\">Aspartame\u003c/a>, for example, is found in more than 6,000 foods worldwide, and about 5,000-5,500 tons are consumed every year in the United States alone.\u003c/p>\n\u003cp>The American Diabetes Association – the most well-respected professional group focusing on diabetes – \u003ca href=\"http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/what-can-i-drink.html\" target=\"_blank\" rel=\"noopener\">officially recommends diet soda as an alternative\u003c/a> to sugar-sweetened beverages. To date, seven U.S. municipalities have imposed a sugary beverage tax to discourage consumption.\u003c/p>\n\u003cp>However, recent medical studies suggest that policymakers eager to implement a soda tax may also want to include diet drinks because these sweeteners may be contributing to chronic diabetes and cardiovascular diseases as well.\u003c/p>\n\u003cp>\u003cstrong>Why Are These Sweeteners Calorie-Free?\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The key to these virtually calorie-free sweeteners is that they are not broken down during digestion into natural sugars like glucose, fructose and galactose, which are then either used for energy or converted into fat.\u003c/p>\n\u003cp>Non-nutritive sweeteners have different byproducts that are not converted into calories. Aspartame, for example, undergoes a different metabolic process that doesn’t yield simple sugars. Others such as saccharin and sucralose are not broken down at all, but instead are absorbed directly into the bloodstream and excreted in the urine.\u003c/p>\n\u003cp>Theoretically, these sweeteners should be a “better” choice than sugar for diabetics. Glucose stimulates release of insulin, a hormone that regulates blood sugar levels. Type 2 diabetes occurs when the body no longer responds as well to insulin as it should, leading to higher levels of glucose in the blood that damages the nerves, kidneys, blood vessels and heart. Since non-nutritive sweeteners aren’t actually sugar, they should sidestep this problem.\u003c/p>\n\u003cp>\u003cstrong>Artificial Sweeteners, Your Brain and Your Microbiome\u003c/strong>\u003c/p>\n\u003cp>However, there is growing evidence over the last decade that these sweeteners can alter healthy metabolic processes in other ways, specifically in the gut.\u003c/p>\n\u003cp>Long-term use of these sweeteners has \u003ca href=\"https://doi.org/10.2337/dc08-1799\" target=\"_blank\" rel=\"noopener\">been associated with a higher risk of Type 2 diabetes\u003c/a>. Sweeteners, such as saccharin, have been shown to \u003ca href=\"http://doi.org/10.1038/nature13793\" target=\"_blank\" rel=\"noopener\">change the type and function of the gut microbiome\u003c/a>, the community of microorganisms that live in the intestine. Aspartame \u003ca href=\"https://doi.org/10.1139/apnm-2016-0346\" target=\"_blank\" rel=\"noopener\">decreases the activity of a gut enzyme\u003c/a> that is normally protective against Type 2 diabetes. Furthermore, this response may be exacerbated by the “mismatch” between the body perceiving something as tasting sweet and the expected associated calories. The greater the discrepancy between the sweetness and actual caloric content, the \u003ca href=\"http://doi.org/10.1016/j.cub.2017.07.018\" target=\"_blank\" rel=\"noopener\">greater the metabolic dysregulation\u003c/a>.[contextly_sidebar id=\"1WiRRvjeXSgRFmENuLBZhCvtglNEvId8\"]\u003c/p>\n\u003cp>Sweeteners have also been shown to change brain activity associated with eating sweet foods. A functional MRI exam, which studies brain activity by measuring blood flow, has shown that sucralose, compared to regular sugar, \u003ca href=\"https://doi.org/10.1016/j.appet.2011.12.001\">decreases activity in the amygdala\u003c/a>, a part of the brain involved with taste perception and the experience of eating.\u003c/p>\n\u003cp>Another study revealed that longer-term and higher diet soda consumption are linked to \u003ca href=\"https://doi.org/10.1016/j.physbeh.2012.05.006\">lower activity in the brain’s “caudate head,”\u003c/a> a region that mediates the reward pathway and is necessary for generating a feeling of satisfaction. Researchers have hypothesized that this decreased activity could lead a diet soda drinker to compensate for the lack of pleasure they now derive from the food by increasing their consumption of all foods, not just soda.\u003c/p>\n\u003cp>Together these cellular and brain studies may explain why people who consume sweeteners still have a \u003ca href=\"https://doi.org/10.1371/journal.pone.0167241\">higher risk of obesity\u003c/a> than individuals who don’t consume these products.\u003c/p>\n\u003cp>\u003ca href=\"https://doi.org/10.1503/cmaj.161390\">As this debate on the pros and cons of these sugar substitutes rages on\u003c/a>, we must view these behavioral studies with a grain of salt (or sugar) because many diet soda drinkers – or any health-conscious individual who consumes zero-calorie sweeteners – already has the risk factors for obesity, diabetes, hypertension or heart disease. Those who are already overweight or obese may turn toward low-calorie drinks, making it look as though the diet sodas are causing their weight gain.\u003c/p>\n\u003cp>This same group may also be less likely to moderate their consumption. For example, those people may think that having a diet soda multiple times a week is much healthier than drinking one case of soda with sugar.[contextly_sidebar id=\"nPADPRMuF9gHM8AprlV1Wgo1Jciefs8f\"]\u003c/p>\n\u003cp>These findings signal that consumers and health practitioners all need to check our assumptions about the health benefits of these products. Sweeteners are everywhere, from beverages to salad dressing, from cookies to yogurt, and we must recognize that there is no guarantee that these chemicals won’t increase the burden of metabolic diseases in the future.\u003c/p>\n\u003cp>As a physician of internal medicine specializing in general prevention and public health, I would like to be able to tell my patients what the true risks and benefits are if they drink diet soda instead of water.\u003c/p>\n\u003cp>Legislators considering soda taxes to encourage better dietary habits perhaps should think about including foods with non-nutritive sweeteners. Of course, there is an argument to be made for being realistic and pursuing the lesser of two evils. But even if the negative consequences of sugar substitutes doesn’t sway our tax policy – for now – at least the medical community should be honest with the public about what they stand to lose or gain, consuming these foods.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan class=\"fn author-name\">Eunice Zhang is a c\u003c/span>linical fellow of preventive medicine at the University of Michigan. This article was originally published on \u003ca href=\"https://theconversation.com/diet-soda-may-be-hurting-your-diet-96181\" target=\"_blank\" rel=\"noopener\">The Conversation\u003c/a>.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Artificial sweeteners are everywhere, but the jury is still out on whether these chemicals are harmless. Also called non-nutritive sweeteners, these can be synthetic – such as saccharin and aspartame – or naturally derived, such as steviol, which comes from the Stevia plant. To date, the U.S. Food and Drug Administration has approved \u003ca href=\"https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm\" target=\"_blank\" rel=\"noopener\">six types of artificial and two types of natural non-nutritive sweeteners\u003c/a> for use in food.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That’s been great news for those working hard to curb their sugar consumption. \u003ca href=\"https://doi.org/10.3945/ajcn.111.030833\" target=\"_blank\" rel=\"noopener\">Aspartame\u003c/a>, for example, is found in more than 6,000 foods worldwide, and about 5,000-5,500 tons are consumed every year in the United States alone.\u003c/p>\n\u003cp>The American Diabetes Association – the most well-respected professional group focusing on diabetes – \u003ca href=\"http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/what-can-i-drink.html\" target=\"_blank\" rel=\"noopener\">officially recommends diet soda as an alternative\u003c/a> to sugar-sweetened beverages. To date, seven U.S. municipalities have imposed a sugary beverage tax to discourage consumption.\u003c/p>\n\u003cp>However, recent medical studies suggest that policymakers eager to implement a soda tax may also want to include diet drinks because these sweeteners may be contributing to chronic diabetes and cardiovascular diseases as well.\u003c/p>\n\u003cp>\u003cstrong>Why Are These Sweeteners Calorie-Free?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The key to these virtually calorie-free sweeteners is that they are not broken down during digestion into natural sugars like glucose, fructose and galactose, which are then either used for energy or converted into fat.\u003c/p>\n\u003cp>Non-nutritive sweeteners have different byproducts that are not converted into calories. Aspartame, for example, undergoes a different metabolic process that doesn’t yield simple sugars. Others such as saccharin and sucralose are not broken down at all, but instead are absorbed directly into the bloodstream and excreted in the urine.\u003c/p>\n\u003cp>Theoretically, these sweeteners should be a “better” choice than sugar for diabetics. Glucose stimulates release of insulin, a hormone that regulates blood sugar levels. Type 2 diabetes occurs when the body no longer responds as well to insulin as it should, leading to higher levels of glucose in the blood that damages the nerves, kidneys, blood vessels and heart. Since non-nutritive sweeteners aren’t actually sugar, they should sidestep this problem.\u003c/p>\n\u003cp>\u003cstrong>Artificial Sweeteners, Your Brain and Your Microbiome\u003c/strong>\u003c/p>\n\u003cp>However, there is growing evidence over the last decade that these sweeteners can alter healthy metabolic processes in other ways, specifically in the gut.\u003c/p>\n\u003cp>Long-term use of these sweeteners has \u003ca href=\"https://doi.org/10.2337/dc08-1799\" target=\"_blank\" rel=\"noopener\">been associated with a higher risk of Type 2 diabetes\u003c/a>. Sweeteners, such as saccharin, have been shown to \u003ca href=\"http://doi.org/10.1038/nature13793\" target=\"_blank\" rel=\"noopener\">change the type and function of the gut microbiome\u003c/a>, the community of microorganisms that live in the intestine. Aspartame \u003ca href=\"https://doi.org/10.1139/apnm-2016-0346\" target=\"_blank\" rel=\"noopener\">decreases the activity of a gut enzyme\u003c/a> that is normally protective against Type 2 diabetes. Furthermore, this response may be exacerbated by the “mismatch” between the body perceiving something as tasting sweet and the expected associated calories. The greater the discrepancy between the sweetness and actual caloric content, the \u003ca href=\"http://doi.org/10.1016/j.cub.2017.07.018\" target=\"_blank\" rel=\"noopener\">greater the metabolic dysregulation\u003c/a>.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Sweeteners have also been shown to change brain activity associated with eating sweet foods. A functional MRI exam, which studies brain activity by measuring blood flow, has shown that sucralose, compared to regular sugar, \u003ca href=\"https://doi.org/10.1016/j.appet.2011.12.001\">decreases activity in the amygdala\u003c/a>, a part of the brain involved with taste perception and the experience of eating.\u003c/p>\n\u003cp>Another study revealed that longer-term and higher diet soda consumption are linked to \u003ca href=\"https://doi.org/10.1016/j.physbeh.2012.05.006\">lower activity in the brain’s “caudate head,”\u003c/a> a region that mediates the reward pathway and is necessary for generating a feeling of satisfaction. Researchers have hypothesized that this decreased activity could lead a diet soda drinker to compensate for the lack of pleasure they now derive from the food by increasing their consumption of all foods, not just soda.\u003c/p>\n\u003cp>Together these cellular and brain studies may explain why people who consume sweeteners still have a \u003ca href=\"https://doi.org/10.1371/journal.pone.0167241\">higher risk of obesity\u003c/a> than individuals who don’t consume these products.\u003c/p>\n\u003cp>\u003ca href=\"https://doi.org/10.1503/cmaj.161390\">As this debate on the pros and cons of these sugar substitutes rages on\u003c/a>, we must view these behavioral studies with a grain of salt (or sugar) because many diet soda drinkers – or any health-conscious individual who consumes zero-calorie sweeteners – already has the risk factors for obesity, diabetes, hypertension or heart disease. Those who are already overweight or obese may turn toward low-calorie drinks, making it look as though the diet sodas are causing their weight gain.\u003c/p>\n\u003cp>This same group may also be less likely to moderate their consumption. For example, those people may think that having a diet soda multiple times a week is much healthier than drinking one case of soda with sugar.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>These findings signal that consumers and health practitioners all need to check our assumptions about the health benefits of these products. Sweeteners are everywhere, from beverages to salad dressing, from cookies to yogurt, and we must recognize that there is no guarantee that these chemicals won’t increase the burden of metabolic diseases in the future.\u003c/p>\n\u003cp>As a physician of internal medicine specializing in general prevention and public health, I would like to be able to tell my patients what the true risks and benefits are if they drink diet soda instead of water.\u003c/p>\n\u003cp>Legislators considering soda taxes to encourage better dietary habits perhaps should think about including foods with non-nutritive sweeteners. Of course, there is an argument to be made for being realistic and pursuing the lesser of two evils. But even if the negative consequences of sugar substitutes doesn’t sway our tax policy – for now – at least the medical community should be honest with the public about what they stand to lose or gain, consuming these foods.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003cspan class=\"fn author-name\">Eunice Zhang is a c\u003c/span>linical fellow of preventive medicine at the University of Michigan. This article was originally published on \u003ca href=\"https://theconversation.com/diet-soda-may-be-hurting-your-diet-96181\" target=\"_blank\" rel=\"noopener\">The Conversation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Reversing An Overdose Isn't Complicated, But Getting The Antidote Can Be",
"title": "Reversing An Overdose Isn't Complicated, But Getting The Antidote Can Be",
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"content": "\u003cp>A few months ago, Kourtnaye Sturgeon helped save someone's life. She was driving in downtown Indianapolis when she saw people gathered around a car on the side of the road. Sturgeon pulled over and a man told her there was nothing she could do: Two men had overdosed on opioids and appeared to be dead.[contextly_sidebar id=\"HkPN1j5HI7DwfkcHFXdJSPtWQTk7V2zs\"]\u003c/p>\n\u003cp>\"I kind of recall saying, 'No man, I've got Narcan,' \" she says, referring to the brand- name version of the opioid overdose antidote, naloxone. \"Which sounds so silly, but I'm pretty sure that's what came out.\"\u003c/p>\n\u003cp>Sturgeon sprayed a dose of the drug up the driver's nose, and waited for it to take effect. About a minute later, she says, the paramedics showed up.\u003c/p>\n\u003cp>\"As they were walking towards us, the driver started slowly moving,\" she says. Both people survived.\u003c/p>\n\u003cp>Sturgeon had the drug with her because she works for Overdose Lifeline, a non-profit devoted to distributing naloxone, but many bystanders would be unprepared to help.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Last month, U.S. Surgeon General Jerome Adams\u003ca href=\"https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory.html\"> issued an advisory\u003c/a> urging more Americans to learn to use naloxone, and carry it with them in case they encounter someone who has overdosed.\u003c/p>\n\u003cp>With the increase in overdoses nationwide, the advisory suggests that lay responders — people who may witness an overdose before police or EMS arrive — can play a critical role in saving lives.\u003c/p>\n\u003cp>But if you're not a medical professional, getting a dose of naloxone can be difficult. It is a prescription drug and normally a doctor or nurse would have to directly prescribe it for the person at risk of overdosing. \u003ca href=\"http://www.healthlaw.org/about/staff/corey-davis\">Corey Davis\u003c/a>, an attorney for the National Health Law Program, says that creates a barrier for people with addiction.\u003c/p>\n\u003cp>\"A lot of people at risk of an overdose don't have contact with a medical provider or they're afraid because of stigma,\" he says.\u003c/p>\n\u003cp>To broaden access, every state and Washington, D.C., have\u003ca href=\"https://www.networkforphl.org/_asset/qz5pvn/legal-interventions-to-reduce-overdose.pdf\"> passed laws\u003c/a> making it easier for friends and family members or bystanders to get and use naloxone. Just how easy it is still depends on your state, or even the pharmacy you go to.[contextly_sidebar id=\"OLtZshPozlILTWQu7Kb7ffUBScI9pFPe\"]\u003c/p>\n\u003cp>Davis says most states allow something called third-party prescribing, which lets doctors prescribe naloxone to someone who knows the person at risk of an overdose. And most states have also passed \u003ca href=\"http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx#Calling%20911\">some kind of Good Samaritan law \u003c/a>providing legal immunity for people who administer the drug or call 911.\u003c/p>\n\u003cp>Davis says another type of law allows a kind of prescription called a standing order.\u003c/p>\n\u003cp>\"But instead of having a person's name on it, it has a group of people,\" says Davis.\u003c/p>\n\u003cp>A standing order could apply, for example, to anyone who takes opioid painkillers, or suffers from addiction. Or, Davis says, \"Anybody who might be in a position to assist someone, which unfortunately, today means essentially everybody.\"\u003c/p>\n\u003cp>In his home state of Indiana, Jerome Adams signed a statewide standing order in 2016, while serving as the state's health commissioner. It allows pharmacies, local health departments or nonprofits that register with the state and follow certain requirements to dispense the drug to anyone who requests it.\u003c/p>\n\u003cp>But two years later, only about half of Indiana pharmacies are registered, and local advocates say many people, even some pharmacists, are still unaware of the law.\u003c/p>\n\u003cp>Even if you understand the laws regulating naloxone in your state — and you feel comfortable asking for it at the pharmacy counter — there's still the cost, which has \u003ca href=\"https://www.npr.org/sections/health-shots/2017/08/08/541626627/first-responders-spending-more-on-overdose-reversal-drug\">gone up\u003c/a> in recent years. Two pharmacies near WFYI in Indianapolis, stock naloxone. One charged $80 for two doses of the generic form of the drug. The other charged $95 for two doses of Narcan, the brand-name version.\u003c/p>\n\u003cp>\"It's expensive,\" says Brad Ray, a researcher at Indiana University's School of Public and Environmental Affairs. \"People who are users are scraping money together to buy drugs. They're not prepared to buy naloxone with that money.\"\u003c/p>\n\u003cp>Several U.S. Senators have signed on to a\u003ca href=\"https://www.stabenow.senate.gov/news/stabenow-peters-call-on-administration-to-take-immediate-action-to-reduce-price-of-naloxone-a-life-saving-opioid-overdose-reversal-drug\"> letter\u003c/a> urging Health and Human Services Secretary Alex Azar to negotiate with drug companies to lower the price of naloxone.\u003c/p>\n\u003cp>For people who can't afford the drug, Ray says health departments and nonprofits can help. Laws in many states allow these organizations to dispense naloxone to lay responders.\u003c/p>\n\u003cp>Indiana's health department used federal and state funds to purchase nearly 14,000 naloxone kits since 2016, the state reports. The state distributes those free doses through county health departments. But nearly half of Indiana counties didn't request kits. And the majority of the kits went to first responders.[contextly_sidebar id=\"QGKuFYIV9TrVnnf8y5d9ZQaPW24b1pNM\"]\u003c/p>\n\u003cp>Local health departments, Ray says, need to work harder to get naloxone to people who might use it. People who use drugs, after all, may not feel comfortable going to the government for naloxone.\u003c/p>\n\u003cp>\"Getting it in the hands of users — that's the trick we need to figure out,\" Ray says.\u003c/p>\n\u003cp>Corey Davis says there is one change that could really help. The Food and Drug Administration or Congress could make naloxone an over-the-counter medication to make it easier to access, and maybe cheaper. FDA Commissioner Scott Gottlieb has the authority to do so, Davis says, but so far he has not.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership with NPR, WFYI, \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org/\">\u003cem>Side Effects Public Media\u003c/em>\u003c/a>\u003cem> and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Reversing+An+Overdose+Isn%27t+Complicated%2C+But+Getting+The+Antidote+Can+Be+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "The U.S. surgeon general has recommended that naloxone, the opioid overdose reversal drug, be widely available to consumers. But there are several barriers to consumers' ability to acquire it.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A few months ago, Kourtnaye Sturgeon helped save someone's life. She was driving in downtown Indianapolis when she saw people gathered around a car on the side of the road. Sturgeon pulled over and a man told her there was nothing she could do: Two men had overdosed on opioids and appeared to be dead.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"I kind of recall saying, 'No man, I've got Narcan,' \" she says, referring to the brand- name version of the opioid overdose antidote, naloxone. \"Which sounds so silly, but I'm pretty sure that's what came out.\"\u003c/p>\n\u003cp>Sturgeon sprayed a dose of the drug up the driver's nose, and waited for it to take effect. About a minute later, she says, the paramedics showed up.\u003c/p>\n\u003cp>\"As they were walking towards us, the driver started slowly moving,\" she says. Both people survived.\u003c/p>\n\u003cp>Sturgeon had the drug with her because she works for Overdose Lifeline, a non-profit devoted to distributing naloxone, but many bystanders would be unprepared to help.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Last month, U.S. Surgeon General Jerome Adams\u003ca href=\"https://www.surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory.html\"> issued an advisory\u003c/a> urging more Americans to learn to use naloxone, and carry it with them in case they encounter someone who has overdosed.\u003c/p>\n\u003cp>With the increase in overdoses nationwide, the advisory suggests that lay responders — people who may witness an overdose before police or EMS arrive — can play a critical role in saving lives.\u003c/p>\n\u003cp>But if you're not a medical professional, getting a dose of naloxone can be difficult. It is a prescription drug and normally a doctor or nurse would have to directly prescribe it for the person at risk of overdosing. \u003ca href=\"http://www.healthlaw.org/about/staff/corey-davis\">Corey Davis\u003c/a>, an attorney for the National Health Law Program, says that creates a barrier for people with addiction.\u003c/p>\n\u003cp>\"A lot of people at risk of an overdose don't have contact with a medical provider or they're afraid because of stigma,\" he says.\u003c/p>\n\u003cp>To broaden access, every state and Washington, D.C., have\u003ca href=\"https://www.networkforphl.org/_asset/qz5pvn/legal-interventions-to-reduce-overdose.pdf\"> passed laws\u003c/a> making it easier for friends and family members or bystanders to get and use naloxone. Just how easy it is still depends on your state, or even the pharmacy you go to.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Davis says most states allow something called third-party prescribing, which lets doctors prescribe naloxone to someone who knows the person at risk of an overdose. And most states have also passed \u003ca href=\"http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx#Calling%20911\">some kind of Good Samaritan law \u003c/a>providing legal immunity for people who administer the drug or call 911.\u003c/p>\n\u003cp>Davis says another type of law allows a kind of prescription called a standing order.\u003c/p>\n\u003cp>\"But instead of having a person's name on it, it has a group of people,\" says Davis.\u003c/p>\n\u003cp>A standing order could apply, for example, to anyone who takes opioid painkillers, or suffers from addiction. Or, Davis says, \"Anybody who might be in a position to assist someone, which unfortunately, today means essentially everybody.\"\u003c/p>\n\u003cp>In his home state of Indiana, Jerome Adams signed a statewide standing order in 2016, while serving as the state's health commissioner. It allows pharmacies, local health departments or nonprofits that register with the state and follow certain requirements to dispense the drug to anyone who requests it.\u003c/p>\n\u003cp>But two years later, only about half of Indiana pharmacies are registered, and local advocates say many people, even some pharmacists, are still unaware of the law.\u003c/p>\n\u003cp>Even if you understand the laws regulating naloxone in your state — and you feel comfortable asking for it at the pharmacy counter — there's still the cost, which has \u003ca href=\"https://www.npr.org/sections/health-shots/2017/08/08/541626627/first-responders-spending-more-on-overdose-reversal-drug\">gone up\u003c/a> in recent years. Two pharmacies near WFYI in Indianapolis, stock naloxone. One charged $80 for two doses of the generic form of the drug. The other charged $95 for two doses of Narcan, the brand-name version.\u003c/p>\n\u003cp>\"It's expensive,\" says Brad Ray, a researcher at Indiana University's School of Public and Environmental Affairs. \"People who are users are scraping money together to buy drugs. They're not prepared to buy naloxone with that money.\"\u003c/p>\n\u003cp>Several U.S. Senators have signed on to a\u003ca href=\"https://www.stabenow.senate.gov/news/stabenow-peters-call-on-administration-to-take-immediate-action-to-reduce-price-of-naloxone-a-life-saving-opioid-overdose-reversal-drug\"> letter\u003c/a> urging Health and Human Services Secretary Alex Azar to negotiate with drug companies to lower the price of naloxone.\u003c/p>\n\u003cp>For people who can't afford the drug, Ray says health departments and nonprofits can help. Laws in many states allow these organizations to dispense naloxone to lay responders.\u003c/p>\n\u003cp>Indiana's health department used federal and state funds to purchase nearly 14,000 naloxone kits since 2016, the state reports. The state distributes those free doses through county health departments. But nearly half of Indiana counties didn't request kits. And the majority of the kits went to first responders.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Local health departments, Ray says, need to work harder to get naloxone to people who might use it. People who use drugs, after all, may not feel comfortable going to the government for naloxone.\u003c/p>\n\u003cp>\"Getting it in the hands of users — that's the trick we need to figure out,\" Ray says.\u003c/p>\n\u003cp>Corey Davis says there is one change that could really help. The Food and Drug Administration or Congress could make naloxone an over-the-counter medication to make it easier to access, and maybe cheaper. FDA Commissioner Scott Gottlieb has the authority to do so, Davis says, but so far he has not.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story is part of a reporting partnership with NPR, WFYI, \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org/\">\u003cem>Side Effects Public Media\u003c/em>\u003c/a>\u003cem> and \u003c/em>\u003ca href=\"http://www.kaiserhealthnews.org\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem>. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Reversing+An+Overdose+Isn%27t+Complicated%2C+But+Getting+The+Antidote+Can+Be+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Lyme Disease Is On The Rise Again. Here's How To Prevent It",
"title": "Lyme Disease Is On The Rise Again. Here's How To Prevent It",
"headTitle": "KQED Future of You | KQED Science",
"content": "\u003cp>Lyme disease was once unheard of in western Pennsylvania, where \u003ca href=\"http://entomology.umd.edu/thorne-barbara-l.html\" target=\"_blank\" rel=\"noopener\">Barbara Thorne\u003c/a>, now an entomologist at the University of Maryland, spent time as a kid.[contextly_sidebar id=\"E5lWczNbOj0QujgLs3u3AfAeFh9XRm6X\"]\u003c/p>\n\u003cp>Thorne knew that if black-legged ticks are infected with bacteria called \u003cem>Borrelia burgdorferi\u003c/em>, they can \u003ca href=\"https://www.cdc.gov/lyme/index.html\" target=\"_blank\" rel=\"noopener\">transmit Lyme to people\u003c/a> and, that if untreated, symptoms can range from fever, fatigue and a rash, to serious damage to the joints, heart and nervous system.\u003c/p>\n\u003cp>But she didn't realize that ticks in that part of Pennsylvania had become broadly infected with the bacteria. That is, until she was bitten during a family reunion weekend.\u003c/p>\n\u003cp>She never saw the tick on her body. But about eight or nine days later, after returning home, she became suspicious.\u003c/p>\n\u003cp>\"I noticed a \u003ca href=\"https://phpa.health.maryland.gov/OIDEOR/CZVBD/Shared%20Documents/Lyme_MD_poster_FINAL.pdf\" target=\"_blank\" rel=\"noopener\">roundish red rash\u003c/a> above my waistline and it expanded each day,\" she recalls. \"I was also feeling sick with exhaustion and achiness.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Her primary care doctor diagnosed her with Lyme disease and prescribed a course of antibiotics. After a few months, she felt better.\u003c/p>\n\u003cp>\"I felt very lucky to have had the rash appear as literally a red flag,\" Thorne says. It's a telltale warning sign of the disease.\u003c/p>\n\u003cp>But not everyone with a Lyme infection develops a rash. And other symptoms, such as fatigue and aches, overlap with common illnesses. So, spotting Lyme disease can be tricky. Some people don't realize they're infected and don't seek medical treatment.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention estimates the actual prevalence of Lyme disease infections is 10 times higher than the number of reported cases.\u003c/p>\n\u003cp>Tick-borne diseases have been \"steadily going up every year ... as the diseases expand to new areas around the country,\" Lyle Peterson of the CDC told reporters in a recent conference call announcing the updated infection \u003ca href=\"https://www.cdc.gov/vitalsigns/vector-borne/\" target=\"_blank\" rel=\"noopener\">estimates\u003c/a>. Lyme disease accounts for about 80 percent of the \u003ca href=\"https://www.cdc.gov/ticks/Diseases/\" target=\"_blank\" rel=\"noopener\">tick-borne illnesses\u003c/a> in the U.S.[contextly_sidebar id=\"BEEx9bfux3jHbZOJBeYj9WisqBPO0MxG\"]\u003c/p>\n\u003cp>Another factor that can contribute to the underreporting of cases is a lack of effective surveillance and tracking.\u003c/p>\n\u003cp>\"People just go to their local doctor to be treated,\" says Peterson, and the doctor may not report the case to the local or state health department. Or, if the case \u003cem>is\u003c/em> reported by the doctor, he says, sometimes \"state health departments have a very difficult time keeping up with the sheer number of cases reports.\"\u003c/p>\n\u003cp>There's another factor at play, too: shortcomings in the way the infection is diagnosed.\u003c/p>\n\u003cp>\"Many of the tests for Lyme disease are negative at the time that patients first visit their doctor,\" says \u003ca href=\"https://medicine.yale.edu/pathology/people/PNF2.profile\" target=\"_blank\" rel=\"noopener\">Dr. Paul Fiedler\u003c/a>, a clinical pathologist on Yale School of Medicine's faculty who also heads the department of pathology at Western Connecticut Health Network.\u003c/p>\n\u003cp>Blood tests to detect Lyme disease rely on a person's immune response, Fiedler explains, and after infection with the bacteria, it takes time — sometimes as long as 10 to 30 days — for the body to mount a measurable response. The blood tests detect Lyme-specific antibodies.\u003c/p>\n\u003cp>If somebody is tested before the immune system has produced enough antibodies, the result will be a false negative.\u003c/p>\n\u003cp>\"And the diagnosis could be missed,\" Fiedler says. The subsequent lack of treatment after a missed diagnosis can lead to \u003ca href=\"https://www.cdc.gov/lyme/resources/brochure/lymediseasebrochure.pdf\" target=\"_blank\" rel=\"noopener\">serious health problems\u003c/a>.\u003c/p>\n\u003cp>But Thorne says it's possible to take steps to help prevent Lyme disease if you're meticulous.\u003c/p>\n\u003cp>In the spring, \u003ca href=\"http://wnpr.org/post/six-things-know-about-ticks-and-lyme-disease\" target=\"_blank\" rel=\"noopener\">tick nymphs\u003c/a> — young versions that transmit most of the Lyme infections — are abundant. They're tiny, no bigger than a pinhead or poppy seed, and tend to hang out in or near wooded areas, in brush or tall grass.[contextly_sidebar id=\"f5MAXyeLkwMp2ontpm3K4PW45yEGQUWn\"]\u003c/p>\n\u003cp>The ticks need a blood meal to stay alive. They tend to \u003ca href=\"https://www.cdc.gov/ticks/life_cycle_and_hosts.html\">feed \u003c/a>on small mammals, such as mice, or birds. But if you happen to brush against a stick, blade or stem they're clinging to, they can easily hitch a ride on you. And you won't feel a thing.\u003c/p>\n\u003cp>If you're hiking in or near a wooded area, it's wise to be on the lookout for nymphs on your skin or clothing when you get home. \"They're small, but they're not invisible,\" Thorne says.\u003c/p>\n\u003cp>She recommends light-colored clothing (to increase likelihood you'll notice the darker fleck of an insect) and long sleeves. Insect repellent may help, but Thorne says the most effective strategy is a thorough tick check of your body after you've been in tick-infested areas.\u003c/p>\n\u003cp>\"The ticks do tend to climb upward — like they climb up your legs,\" Thorne says. \"They often attach where there was a constriction of clothing, like around the waistline.\" (She's compiled personal protection \u003ca href=\"https://extension.umd.edu/sites/extension.umd.edu/files/_images/programs/hgic/Publications/non_HGIC_FS/FS595.pdf\" target=\"_blank\" rel=\"noopener\">tips in this bulletin\u003c/a>.)\u003c/p>\n\u003cp>Other favorite hiding spots include armpits, or behind your ears. If you do find one attached to your body, use a pair of narrow tweezers to \u003ca href=\"https://www.cdc.gov/ticks/removing_a_tick.html\" target=\"_blank\" rel=\"noopener\">grasp the tick very near the surface of the skin\u003c/a> and tug upward with steady pressure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Don't freak out if the insect's been attached a few hours. In general, the CDC says, ticks need to be attached for 36 to 48 hours before they can transmit the bacteria that cause Lyme disease.\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=Lyme+Disease+Is+On+The+Rise+Again.+Here%27s+How+To+Prevent+It&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Lyme disease was once unheard of in western Pennsylvania, where \u003ca href=\"http://entomology.umd.edu/thorne-barbara-l.html\" target=\"_blank\" rel=\"noopener\">Barbara Thorne\u003c/a>, now an entomologist at the University of Maryland, spent time as a kid.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Thorne knew that if black-legged ticks are infected with bacteria called \u003cem>Borrelia burgdorferi\u003c/em>, they can \u003ca href=\"https://www.cdc.gov/lyme/index.html\" target=\"_blank\" rel=\"noopener\">transmit Lyme to people\u003c/a> and, that if untreated, symptoms can range from fever, fatigue and a rash, to serious damage to the joints, heart and nervous system.\u003c/p>\n\u003cp>But she didn't realize that ticks in that part of Pennsylvania had become broadly infected with the bacteria. That is, until she was bitten during a family reunion weekend.\u003c/p>\n\u003cp>She never saw the tick on her body. But about eight or nine days later, after returning home, she became suspicious.\u003c/p>\n\u003cp>\"I noticed a \u003ca href=\"https://phpa.health.maryland.gov/OIDEOR/CZVBD/Shared%20Documents/Lyme_MD_poster_FINAL.pdf\" target=\"_blank\" rel=\"noopener\">roundish red rash\u003c/a> above my waistline and it expanded each day,\" she recalls. \"I was also feeling sick with exhaustion and achiness.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Her primary care doctor diagnosed her with Lyme disease and prescribed a course of antibiotics. After a few months, she felt better.\u003c/p>\n\u003cp>\"I felt very lucky to have had the rash appear as literally a red flag,\" Thorne says. It's a telltale warning sign of the disease.\u003c/p>\n\u003cp>But not everyone with a Lyme infection develops a rash. And other symptoms, such as fatigue and aches, overlap with common illnesses. So, spotting Lyme disease can be tricky. Some people don't realize they're infected and don't seek medical treatment.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention estimates the actual prevalence of Lyme disease infections is 10 times higher than the number of reported cases.\u003c/p>\n\u003cp>Tick-borne diseases have been \"steadily going up every year ... as the diseases expand to new areas around the country,\" Lyle Peterson of the CDC told reporters in a recent conference call announcing the updated infection \u003ca href=\"https://www.cdc.gov/vitalsigns/vector-borne/\" target=\"_blank\" rel=\"noopener\">estimates\u003c/a>. Lyme disease accounts for about 80 percent of the \u003ca href=\"https://www.cdc.gov/ticks/Diseases/\" target=\"_blank\" rel=\"noopener\">tick-borne illnesses\u003c/a> in the U.S.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Another factor that can contribute to the underreporting of cases is a lack of effective surveillance and tracking.\u003c/p>\n\u003cp>\"People just go to their local doctor to be treated,\" says Peterson, and the doctor may not report the case to the local or state health department. Or, if the case \u003cem>is\u003c/em> reported by the doctor, he says, sometimes \"state health departments have a very difficult time keeping up with the sheer number of cases reports.\"\u003c/p>\n\u003cp>There's another factor at play, too: shortcomings in the way the infection is diagnosed.\u003c/p>\n\u003cp>\"Many of the tests for Lyme disease are negative at the time that patients first visit their doctor,\" says \u003ca href=\"https://medicine.yale.edu/pathology/people/PNF2.profile\" target=\"_blank\" rel=\"noopener\">Dr. Paul Fiedler\u003c/a>, a clinical pathologist on Yale School of Medicine's faculty who also heads the department of pathology at Western Connecticut Health Network.\u003c/p>\n\u003cp>Blood tests to detect Lyme disease rely on a person's immune response, Fiedler explains, and after infection with the bacteria, it takes time — sometimes as long as 10 to 30 days — for the body to mount a measurable response. The blood tests detect Lyme-specific antibodies.\u003c/p>\n\u003cp>If somebody is tested before the immune system has produced enough antibodies, the result will be a false negative.\u003c/p>\n\u003cp>\"And the diagnosis could be missed,\" Fiedler says. The subsequent lack of treatment after a missed diagnosis can lead to \u003ca href=\"https://www.cdc.gov/lyme/resources/brochure/lymediseasebrochure.pdf\" target=\"_blank\" rel=\"noopener\">serious health problems\u003c/a>.\u003c/p>\n\u003cp>But Thorne says it's possible to take steps to help prevent Lyme disease if you're meticulous.\u003c/p>\n\u003cp>In the spring, \u003ca href=\"http://wnpr.org/post/six-things-know-about-ticks-and-lyme-disease\" target=\"_blank\" rel=\"noopener\">tick nymphs\u003c/a> — young versions that transmit most of the Lyme infections — are abundant. They're tiny, no bigger than a pinhead or poppy seed, and tend to hang out in or near wooded areas, in brush or tall grass.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The ticks need a blood meal to stay alive. They tend to \u003ca href=\"https://www.cdc.gov/ticks/life_cycle_and_hosts.html\">feed \u003c/a>on small mammals, such as mice, or birds. But if you happen to brush against a stick, blade or stem they're clinging to, they can easily hitch a ride on you. And you won't feel a thing.\u003c/p>\n\u003cp>If you're hiking in or near a wooded area, it's wise to be on the lookout for nymphs on your skin or clothing when you get home. \"They're small, but they're not invisible,\" Thorne says.\u003c/p>\n\u003cp>She recommends light-colored clothing (to increase likelihood you'll notice the darker fleck of an insect) and long sleeves. Insect repellent may help, but Thorne says the most effective strategy is a thorough tick check of your body after you've been in tick-infested areas.\u003c/p>\n\u003cp>\"The ticks do tend to climb upward — like they climb up your legs,\" Thorne says. \"They often attach where there was a constriction of clothing, like around the waistline.\" (She's compiled personal protection \u003ca href=\"https://extension.umd.edu/sites/extension.umd.edu/files/_images/programs/hgic/Publications/non_HGIC_FS/FS595.pdf\" target=\"_blank\" rel=\"noopener\">tips in this bulletin\u003c/a>.)\u003c/p>\n\u003cp>Other favorite hiding spots include armpits, or behind your ears. If you do find one attached to your body, use a pair of narrow tweezers to \u003ca href=\"https://www.cdc.gov/ticks/removing_a_tick.html\" target=\"_blank\" rel=\"noopener\">grasp the tick very near the surface of the skin\u003c/a> and tug upward with steady pressure.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Don't freak out if the insect's been attached a few hours. In general, the CDC says, ticks need to be attached for 36 to 48 hours before they can transmit the bacteria that cause Lyme disease.\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=Lyme+Disease+Is+On+The+Rise+Again.+Here%27s+How+To+Prevent+It&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Parenting of the Future: Converting Ordinary Cells Into Sperm and Eggs",
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"content": "\u003cp>So you want to have a baby.\u003c/p>\n\u003cp>Would you like a dark-haired girl with a high risk of someday getting colon cancer, but a good chance of above-average music ability?[contextly_sidebar id=\"hGdwiHda2M4gvFM3sXPeB5lpQehOV9JO\"]\u003c/p>\n\u003cp>Or would you prefer a girl with a good prospect for high SAT scores and a good shot at being athletic, but who also is likely to run an above-average risk of bipolar disorder and lupus as an adult?\u003c/p>\n\u003cp>How about a boy with a good shot at having musical ability and dodging asthma, but who also would be predisposed to cataracts and type 2 diabetes?\u003c/p>\n\u003cp>Confused? You’re just getting started. There are dozens more choices for which of your embryos should be placed in the womb to become your child.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>That’s the future a biomedical ethics expert envisions for 20 to 40 years from now — soon enough that today’s children may face it when they start their own families.\u003c/p>\n\u003cp>“The majority of babies of people who have good health coverage will be conceived this way,” predicts Henry Greely, a Stanford University law professor who works in bioethics.\u003c/p>\n\u003cp>You’ve probably read about concerns over “designer babies,” whose DNA is shaped by gene editing. Greely is focused on a different technology that has gotten much less attention: In a startling bit of biological alchemy, scientists have shown that in mice, they can turn ordinary cells into sperm and eggs.\u003c/p>\n\u003cp class=\"caption\">[contextly_sidebar id=\"eTManZd4WaqVP8G2asFbvl91UNkETnUW\"]A prominent biomedical ethics expert says that in 20 to 40 years, many prospective parents may choose from dozens of embryos to become their babies and would be provided with genetic information about each embryo to help make the choice. (April 18)\u003c/p>\n\u003cp>It’s too soon to know if it could be done in people. But if it can, it could become a powerful infertility treatment, permitting genetic parenthood for people who can’t make their own sperm or eggs.\u003c/p>\n\u003cp>It also would mean that a woman who wants to get pregnant could produce dozens more eggs per attempt than with the current procedure of harvesting some from her ovaries.\u003c/p>\n\u003cp>And that means a lot of choices.\u003c/p>\n\u003cp>\u003cstrong>An Array of Embryos\u003c/strong>\u003cbr>\nHere’s what Greely envisions: A man and woman walk into a fertility clinic. The man drops off some sperm. The woman leaves some skin cells, which are turned into eggs and fertilized with the man’s sperm.\u003c/p>\n\u003cp>Unlike in vitro fertilization today, which typically yields around eight eggs per try, the new method could result in 100 embryos.\u003c/p>\n\u003cp>The embryos’ complete library of DNA would be decoded and analyzed to reveal genetic predispositions, both for disease and personal traits. The man and woman would get dossiers on the embryos that pass minimum tests for suitability.\u003c/p>\n\u003cp>Out of, say, 80 suitable embryos, the couple would then choose one or two to implant.\u003c/p>\n\u003cp>The possibilities don’t stop there. The technology might also help open the door to same-sex couples having children genetically related to both of them, though the additional twist of making eggs from men or sperm from women would be a huge biological challenge.[contextly_sidebar id=\"SrDdSI0zE6VxuvIcDgGVohz7igj80GaU\"]\u003c/p>\n\u003cp>More worrisome is the so-called Brad Pitt scenario: We all shed a bit of sloughed-off DNA every day, like on the lip of a coffee cup. Such discarded material could be secretly snatched up to turn an unwitting celebrity into a genetic parent.\u003c/p>\n\u003cp>It is a long way in the future, but real life is already creeping toward it. Some scientists are trying to make human eggs and sperm in the lab. They are working with “iPS cells,” which are ordinary body cells that have been morphed into a malleable state.\u003c/p>\n\u003cp>Amander Clark of the University of California, Los Angeles, says her goal is to aid basic research into why some people are infertile. She acknowledges the technique might itself be used to treat some infertility, particularly in young people made sterile by cancer treatments.\u003c/p>\n\u003cp>As for decoding the complete DNA library of embryos, Dr. Louanne Hudgins, who studies prenatal genetic screening and diagnosis at Stanford, says some pregnant patients there say they’ve already had fertility clinics do that. They didn’t reveal why, Hudgins said.\u003c/p>\n\u003cp>Hudgins, who’s president of the American College of Medical Genetics and Genomics, said no national medical association has endorsed decoding all the DNA of an embryo, which is called its genome. So she believes no insurance company would pay for that now.\u003c/p>\n\u003cp>\u003cstrong>‘Easy' Prenatal Diagnosis\u003c/strong>\u003cbr>\nGreely, who lays out his ideas in a book called “The End of Sex and the Future of Human Reproduction,” calls his vision “easy PGD,” or prenatal genetic diagnosis.\u003c/p>\n\u003cp>Ordinary PGD has been done for decades. When a couple is known to be at risk for having a child with a specific genetic disorder, such as cystic fibrosis or sickle cell anemia, the woman undergoes a procedure to remove some eggs. After fertilization, some cells are plucked from the embryos and examined to identify those without carry the disease-causing abnormality.\u003c/p>\n\u003cp>That procedure looks for a specific problem in a few embryos, not entire genomes from dozens of them. If a couple wants to select a “super baby,” says Dr. Richard Scott Jr., a founding partner of Reproductive Medicine Associates of New Jersey, “we tell them we can’t do it.”\u003c/p>\n\u003cp>In fact, Scott and others say, even wide-ranging analysis would not provide a precise forecast of how a child will turn out.\u003c/p>\n\u003cp>[contextly_sidebar id=\"izPvBHygWyTNurqnYm1uuauGvc2JdDjo\"]If DNA is the hardware, there’s also the software: chemical modifications that determine when and where particular genes turn on and off. Much of this “epigenome” would develop after an embryo’s genes are sampled, Scott said.\u003c/p>\n\u003cp>“Your child may not turn out to be the three-sport All-American at Stanford,” because “the epigenome didn’t work out,” Scott said.\u003c/p>\n\u003cp>Greely agrees that predictions about behavioral traits like intelligence and athletic ability will be imprecise, because of epigenetics and because of basic uncertainties about what genes are involved and how they interact. And a person’s upbringing and life experiences have a big effect.\u003c/p>\n\u003cp>\u003cstrong>What Would Couples Do?\u003cbr>\n\u003c/strong>Even if the predictions aren’t perfect, would couples want to take steps to control their child’s genetics? Many experts doubt it.\u003c/p>\n\u003cp>Only a “very small minority” seek a perfect baby, says Stanford’s Hudgins. In her practice, she said she often finds women pass up all screening because they figure the baby’s fate is “in God’s hands.”\u003c/p>\n\u003cp>Dr. James Grifo of the New York University Fertility Center also questions how popular the idea would be.\u003c/p>\n\u003cp>“No patient has ever came to me and said, ’I want a designer baby,’” said Grifo, who’s performed in vitro fertilization since 1988.\u003c/p>\n\u003cp>[contextly_sidebar id=\"hN50KvG8BIKoBQkiV9DDiJW3PjvffZIF\"]Greely doubts that influencing brainpower or athleticism would be a major draw for parents. Instead, he thinks they would care most about avoiding awful diseases that strike in infancy or childhood. They’ll probably be less concerned about illnesses that might show up later in life, such as Alzheimer’s or Parkinson’s. For one thing, he says, parents-to-be may see them as becoming treatable by the time a child becomes vulnerable.\u003c/p>\n\u003cp>He thinks easy PGD is coming, and it would be better if properly handled. He says it should be proven safe, subsidized, monitored for long-term effects, and regulated so that parents can choose whether to use it and decide what embryonic traits to focus on. And he’d outlaw stealing somebody’s DNA and unwittingly making them a parent.\u003c/p>\n\u003cp>\u003cstrong>Others See Pitfalls\u003c/strong>\u003cbr>\nOnce the genetic profile is done, could it come back to haunt a child if, say, a life insurer or nursing home demanded to see it to assess disease risk? How would the large number of rejected embryos be handled ethically and politically?\u003c/p>\n\u003cp>Perhaps future regulation could limit the number of embryos created, as well as what traits a couple could select for, said I. Glenn Cohen, a Harvard law professor.\u003c/p>\n\u003cp>Lori B. Andrews, a professor at the Chicago-Kent College of Law, summed up her views in a review of Greely’s book.\u003c/p>\n\u003cp>“The idea of easy PGD,” she wrote, “should make us uneasy indeed.”\u003c/p>\n\u003cp>Still, even some who doubt the idea’s feasibility say Greely is right to raise the issue.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>“It’s certainly something we have to take seriously and think through now,” said Marcy Darnovsky, who writes on the politics of human biotechnology as executive director of the Center for Genetics and Society in Berkeley, California. “This is not just a technical or science question.”\u003cbr>\n__\u003cbr>\nThis Associated Press \u003ca href=\"https://apnews.com/tag/GeneticFrontiers\" target=\"_blank\" rel=\"noopener\">series\u003c/a> was produced in \u003ca href=\"https://www.ap.org/press-releases/2018/ap-hhmi-expand-collaboration-to-bolster-health-science-coverage\" target=\"_blank\" rel=\"noopener\">partnership\u003c/a> with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>So you want to have a baby.\u003c/p>\n\u003cp>Would you like a dark-haired girl with a high risk of someday getting colon cancer, but a good chance of above-average music ability?\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Or would you prefer a girl with a good prospect for high SAT scores and a good shot at being athletic, but who also is likely to run an above-average risk of bipolar disorder and lupus as an adult?\u003c/p>\n\u003cp>How about a boy with a good shot at having musical ability and dodging asthma, but who also would be predisposed to cataracts and type 2 diabetes?\u003c/p>\n\u003cp>Confused? You’re just getting started. There are dozens more choices for which of your embryos should be placed in the womb to become your child.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>That’s the future a biomedical ethics expert envisions for 20 to 40 years from now — soon enough that today’s children may face it when they start their own families.\u003c/p>\n\u003cp>“The majority of babies of people who have good health coverage will be conceived this way,” predicts Henry Greely, a Stanford University law professor who works in bioethics.\u003c/p>\n\u003cp>You’ve probably read about concerns over “designer babies,” whose DNA is shaped by gene editing. Greely is focused on a different technology that has gotten much less attention: In a startling bit of biological alchemy, scientists have shown that in mice, they can turn ordinary cells into sperm and eggs.\u003c/p>\n\u003cp class=\"caption\">\u003c/p>\u003cp>\u003c/p>\u003cp>A prominent biomedical ethics expert says that in 20 to 40 years, many prospective parents may choose from dozens of embryos to become their babies and would be provided with genetic information about each embryo to help make the choice. (April 18)\u003c/p>\n\u003cp>It’s too soon to know if it could be done in people. But if it can, it could become a powerful infertility treatment, permitting genetic parenthood for people who can’t make their own sperm or eggs.\u003c/p>\n\u003cp>It also would mean that a woman who wants to get pregnant could produce dozens more eggs per attempt than with the current procedure of harvesting some from her ovaries.\u003c/p>\n\u003cp>And that means a lot of choices.\u003c/p>\n\u003cp>\u003cstrong>An Array of Embryos\u003c/strong>\u003cbr>\nHere’s what Greely envisions: A man and woman walk into a fertility clinic. The man drops off some sperm. The woman leaves some skin cells, which are turned into eggs and fertilized with the man’s sperm.\u003c/p>\n\u003cp>Unlike in vitro fertilization today, which typically yields around eight eggs per try, the new method could result in 100 embryos.\u003c/p>\n\u003cp>The embryos’ complete library of DNA would be decoded and analyzed to reveal genetic predispositions, both for disease and personal traits. The man and woman would get dossiers on the embryos that pass minimum tests for suitability.\u003c/p>\n\u003cp>Out of, say, 80 suitable embryos, the couple would then choose one or two to implant.\u003c/p>\n\u003cp>The possibilities don’t stop there. The technology might also help open the door to same-sex couples having children genetically related to both of them, though the additional twist of making eggs from men or sperm from women would be a huge biological challenge.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>More worrisome is the so-called Brad Pitt scenario: We all shed a bit of sloughed-off DNA every day, like on the lip of a coffee cup. Such discarded material could be secretly snatched up to turn an unwitting celebrity into a genetic parent.\u003c/p>\n\u003cp>It is a long way in the future, but real life is already creeping toward it. Some scientists are trying to make human eggs and sperm in the lab. They are working with “iPS cells,” which are ordinary body cells that have been morphed into a malleable state.\u003c/p>\n\u003cp>Amander Clark of the University of California, Los Angeles, says her goal is to aid basic research into why some people are infertile. She acknowledges the technique might itself be used to treat some infertility, particularly in young people made sterile by cancer treatments.\u003c/p>\n\u003cp>As for decoding the complete DNA library of embryos, Dr. Louanne Hudgins, who studies prenatal genetic screening and diagnosis at Stanford, says some pregnant patients there say they’ve already had fertility clinics do that. They didn’t reveal why, Hudgins said.\u003c/p>\n\u003cp>Hudgins, who’s president of the American College of Medical Genetics and Genomics, said no national medical association has endorsed decoding all the DNA of an embryo, which is called its genome. So she believes no insurance company would pay for that now.\u003c/p>\n\u003cp>\u003cstrong>‘Easy' Prenatal Diagnosis\u003c/strong>\u003cbr>\nGreely, who lays out his ideas in a book called “The End of Sex and the Future of Human Reproduction,” calls his vision “easy PGD,” or prenatal genetic diagnosis.\u003c/p>\n\u003cp>Ordinary PGD has been done for decades. When a couple is known to be at risk for having a child with a specific genetic disorder, such as cystic fibrosis or sickle cell anemia, the woman undergoes a procedure to remove some eggs. After fertilization, some cells are plucked from the embryos and examined to identify those without carry the disease-causing abnormality.\u003c/p>\n\u003cp>That procedure looks for a specific problem in a few embryos, not entire genomes from dozens of them. If a couple wants to select a “super baby,” says Dr. Richard Scott Jr., a founding partner of Reproductive Medicine Associates of New Jersey, “we tell them we can’t do it.”\u003c/p>\n\u003cp>In fact, Scott and others say, even wide-ranging analysis would not provide a precise forecast of how a child will turn out.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>If DNA is the hardware, there’s also the software: chemical modifications that determine when and where particular genes turn on and off. Much of this “epigenome” would develop after an embryo’s genes are sampled, Scott said.\u003c/p>\n\u003cp>“Your child may not turn out to be the three-sport All-American at Stanford,” because “the epigenome didn’t work out,” Scott said.\u003c/p>\n\u003cp>Greely agrees that predictions about behavioral traits like intelligence and athletic ability will be imprecise, because of epigenetics and because of basic uncertainties about what genes are involved and how they interact. And a person’s upbringing and life experiences have a big effect.\u003c/p>\n\u003cp>\u003cstrong>What Would Couples Do?\u003cbr>\n\u003c/strong>Even if the predictions aren’t perfect, would couples want to take steps to control their child’s genetics? Many experts doubt it.\u003c/p>\n\u003cp>Only a “very small minority” seek a perfect baby, says Stanford’s Hudgins. In her practice, she said she often finds women pass up all screening because they figure the baby’s fate is “in God’s hands.”\u003c/p>\n\u003cp>Dr. James Grifo of the New York University Fertility Center also questions how popular the idea would be.\u003c/p>\n\u003cp>“No patient has ever came to me and said, ’I want a designer baby,’” said Grifo, who’s performed in vitro fertilization since 1988.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Greely doubts that influencing brainpower or athleticism would be a major draw for parents. Instead, he thinks they would care most about avoiding awful diseases that strike in infancy or childhood. They’ll probably be less concerned about illnesses that might show up later in life, such as Alzheimer’s or Parkinson’s. For one thing, he says, parents-to-be may see them as becoming treatable by the time a child becomes vulnerable.\u003c/p>\n\u003cp>He thinks easy PGD is coming, and it would be better if properly handled. He says it should be proven safe, subsidized, monitored for long-term effects, and regulated so that parents can choose whether to use it and decide what embryonic traits to focus on. And he’d outlaw stealing somebody’s DNA and unwittingly making them a parent.\u003c/p>\n\u003cp>\u003cstrong>Others See Pitfalls\u003c/strong>\u003cbr>\nOnce the genetic profile is done, could it come back to haunt a child if, say, a life insurer or nursing home demanded to see it to assess disease risk? How would the large number of rejected embryos be handled ethically and politically?\u003c/p>\n\u003cp>Perhaps future regulation could limit the number of embryos created, as well as what traits a couple could select for, said I. Glenn Cohen, a Harvard law professor.\u003c/p>\n\u003cp>Lori B. Andrews, a professor at the Chicago-Kent College of Law, summed up her views in a review of Greely’s book.\u003c/p>\n\u003cp>“The idea of easy PGD,” she wrote, “should make us uneasy indeed.”\u003c/p>\n\u003cp>Still, even some who doubt the idea’s feasibility say Greely is right to raise the issue.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“It’s certainly something we have to take seriously and think through now,” said Marcy Darnovsky, who writes on the politics of human biotechnology as executive director of the Center for Genetics and Society in Berkeley, California. “This is not just a technical or science question.”\u003cbr>\n__\u003cbr>\nThis Associated Press \u003ca href=\"https://apnews.com/tag/GeneticFrontiers\" target=\"_blank\" rel=\"noopener\">series\u003c/a> was produced in \u003ca href=\"https://www.ap.org/press-releases/2018/ap-hhmi-expand-collaboration-to-bolster-health-science-coverage\" target=\"_blank\" rel=\"noopener\">partnership\u003c/a> with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "For Chronic Pain, A Change In Habits Can Beat Opioids For Relief",
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"content": "\u003cp>It took several months and a team of half a dozen doctors, nurses and therapists to help Kim Brown taper off the opioid painkillers she'd been on for two years.\u003c/p>\n\u003cp>Brown, 57, had been taking the pills since a back injury in 2010. It wasn't until she met Dr. Dennis McManus, a neurologist who specializes in managing pain without drugs, that she learned she had some control over her pain.\u003c/p>\n\u003cp>\"That's when life changed,\" she said.\u003c/p>\n\u003cp>During a 12-week series of appointments at McManus' clinic in Peoria, Ill., Brown learned new ways to prevent and cope with pain, as she gradually reduced her opioid doses.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a single year, health care providers write enough opioid prescriptions for every adult in the U.S. to have a bottle of pills.’\u003c/aside>\n\u003cp>Roughly \u003ca href=\"http://www.nationalacademies.org/hmd/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Report-Brief.aspx\" target=\"_blank\" rel=\"noopener\">a third of Americans live with chronic pain\u003c/a>, and many of them become dependent on opioids prescribed to treat it. But there's a growing consensus among pain specialists that a low-tech approach focused on lifestyle changes can be more effective.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>This kind of treatment can be more expensive — and less convenient — than a bottle of pills. But pain experts say it can save money over the long term by helping patients get off addictive medications and improving their quality of life.\u003c/p>\n\u003cp>\"It's important to remember that the main treatments that are recommended for these pain conditions are not medication treatments,\" said Dr. Erin Krebs, a primary care physician and researcher at the Minneapolis VA Health Care System.[contextly_sidebar id=\"V0C48krhDpEf36aihsYishHMpftd4maj\"]\u003c/p>\n\u003cp>Recently, Krebs published the first \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2673971?redirect=true\" target=\"_blank\" rel=\"noopener\">long-term randomized trial of opioids\u003c/a> for treating chronic back pain and arthritis, and found that opioids are no better than nonopioid medications. She said drugs of any kind are the lesser choice for the vast majority of patients.\u003c/p>\n\u003cp>The gold standard for treatment, she said, is a combination of things like exercise, rehabilitation therapies, yoga and cognitive behavioral therapies.\u003c/p>\n\u003cp>This approach is consistent with the most recent guidelines \u003ca href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm\" target=\"_blank\" rel=\"noopener\">from the Centers for Disease Control and Prevention\u003c/a> for prescribing opioids for chronic pain. But it's still uncommon.\u003c/p>\n\u003cp>Brown's painkiller use started after she blew out a disk in her back.\u003c/p>\n\u003cp>\"It was the simplest thing,\" Brown said. \"I picked up a bag of garbage with my right hand, and I immediately knew something was wrong.\"[contextly_sidebar id=\"KxtsC3dvl0zmNmyhnx0NVfydGpZ8NYsa\"]\u003c/p>\n\u003cp>She was put on opioids, like so many others who see the doctor about pain. In a single year, health care providers write enough opioid prescriptions for \u003ca href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm\" target=\"_blank\" rel=\"noopener\">every adult in the U.S.\u003c/a> to have a bottle of pills.\u003c/p>\n\u003cp>Each time Brown came back, still in pain, another opioid was added to the list. She was eventually taking four different drugs — Percocet, Vicodin, morphine and Dilaudid — popping pills every two hours.\u003c/p>\n\u003cp>\"I was just drugged constantly,\" Brown said. \"And even with that, it didn't take care of the pain.\"\u003c/p>\n\u003cp>Not only did the drugs not help with the pain, the side effects made it worse. Brown had such severe abdominal pain from constipation she could hardly walk.\u003c/p>\n\u003cp>\"It kills your life. It totally robs you of every aspect,\" she said. \"I couldn't do anything because of the pain. But I couldn't do anything because of the pain meds. And I couldn't talk to anyone about it, because it was so embarrassing.\"[contextly_sidebar id=\"vuwfumTsjRlj4bRQzDECQ4gkdOYjrq9B\"]\u003c/p>\n\u003cp>Brown tried to quit on her own. But after nine days of nausea and fainting from withdrawal, she was back on the medications.\u003c/p>\n\u003cp>\"I finally went to my family doctor and said, 'I need help, I've got to get off this stuff. I can't live like this anymore,' \" she said.\u003c/p>\n\u003cp>That's when she was referred to McManus, director of the OSF Central Illinois Pain Center in Peoria. He specializes in helping chronic pain sufferers like Brown get off opioids.\u003c/p>\n\u003cp>\"From my perspective, if you stabilize the dose and slowly taper off, these patients do remarkably well,\" he said.\u003c/p>\n\u003cp>At the center, a team of providers works together to help patients make lifestyle changes that reduce pain during everyday activities.\u003c/p>\n\u003cp>The approach includes a combination of physical and occupational therapy, massage and nutrition counseling. Patients also participate in cognitive behavioral therapy to address the psychological issues that often accompany pain — such as overcoming fears of letting go of medications they've become dependent on. A nurse coordinator oversees all the moving parts and does follow-up assessments after the program is completed.\u003c/p>\n\u003cp>[contextly_sidebar id=\"prJEo6QPBRmwbqUUojWuQEFBS0fOvffp\"]At the clinic, Brown met occupational therapist Gabe Stickling, who taught her things like how to properly lift heavy objects and how to safely keep exercising even when she feels a twinge of pain.\u003c/p>\n\u003cp>Stickling said people with chronic pain often avoid physical activity \"because they're afraid they're going to injure themselves or damage their bodies.\" But inactivity can make the pain worse.\u003c/p>\n\u003cp>McManus said some of his chronic pain patients can taper off opioids with a less intensive treatment. But for some of his patients, the multidisciplinary program is most effective — if they're willing to commit to making change.\u003c/p>\n\u003cp>\"Most people just really want to have the magic wand that will get them all better,\" he said. \"And I'm just trying to say, I don't have a magic wand but I might have a way out of this jungle that you're in.\"[contextly_sidebar id=\"ljkiJf2Vl2dDfHJZPYML2MxBJQo2QVzo\"]\u003c/p>\n\u003cp>And because pain treatments that don't rely on drugs are hands-on and time-intensive, it can be hard to find a clinic that offers them — and to get insurance to cover them.\u003c/p>\n\u003cp>This wasn't always the case. Until the 1980s, the multidisciplinary approach was the go-to treatment for chronic pain, according to a \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0376871617300030#!\" target=\"_blank\" rel=\"noopener\">2016 review\u003c/a> on the history of chronic pain management. Its popularity declined as reimbursement rates went down and hospitals began to emphasize more lucrative procedures. Gradually, opioid treatment became the predominant strategy for pain treatment strategy.\u003c/p>\n\u003cp>Today, McManus said his practice spends a lot of time fighting to get the treatments covered. \"The pain program is not considered to be worthy of the price,\" McManus said.\u003c/p>\n\u003cp>Costs vary but run to several thousand dollars for a program like the one Kim Brown went through.\u003c/p>\n\u003cp>\"If you compare a fairly intensive multidisciplinary program to surgery and to drugs, the cost is not high,\" said Steven Kamper, a public health researcher at the University of Sydney in Australia. He's co-author of a \u003ca href=\"http://www.cochrane.org/CD000963/BACK_multidisciplinary-treatment-for-back-pain\" target=\"_blank\" rel=\"noopener\">2014 meta-analysis\u003c/a> that found modest benefits for multidisciplinary treatment programs for chronic low back pain.[contextly_sidebar id=\"t5KGSGdfaVMwNHpSdqorpggRmDpacuwm\"]\u003c/p>\n\u003cp>Kamper said, the costs are reasonable especially if you consider the long-term effects of living in pain. Many chronic pain sufferers are unable to work and become eligible for disability insurance.\u003c/p>\n\u003cp>\"The big costs of chronic pain are in productivity losses,\" Kamper said.\u003c/p>\n\u003cp>Krebs is hopeful non-drug therapies will regain popularity, as communities recognize the hidden costs of opioids.\u003c/p>\n\u003cp>\"It's not just the price of the pills,\" she said. \"It's also the price of the consequences when you over-rely on something.\"\u003c/p>\n\u003cp>Krebs and Kamper agree more research into pain treatment is needed. But when choosing between an addictive medication with no evidence of benefit, and low-tech therapies with some evidence of benefits, McManus said the choice is clear.\u003c/p>\n\u003cp>\"I did take an oath: First do no harm,\" McManus said. \"As a pain physician, I have a responsibility to use evidence-based medicine to manage my patients that have chronic pain.\"\u003c/p>\n\u003cp>Brown is thankful that the multidisciplinary approach helped her taper off opioids and get her life back, even though it's a different life than before her injury.\u003c/p>\n\u003cp>\"There's no such thing as a pain-free day for me,\" Brown said. \"It never, never fully goes away.\"\u003c/p>\n\u003cp>She has just learned how to manage life with it.\u003c/p>\n\u003chr>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org/\" target=\"_blank\" rel=\"noopener\">Side Effects Public Media\u003c/a>, \u003cem>a news collaborative covering public health. You can follow Christine Herman on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/CTHerman\" target=\"_blank\" rel=\"noopener\">@CTHerman\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Chronic+Pain%2C+A+Change+In+Habits+Can+Beat+Opioids+For+Relief&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It took several months and a team of half a dozen doctors, nurses and therapists to help Kim Brown taper off the opioid painkillers she'd been on for two years.\u003c/p>\n\u003cp>Brown, 57, had been taking the pills since a back injury in 2010. It wasn't until she met Dr. Dennis McManus, a neurologist who specializes in managing pain without drugs, that she learned she had some control over her pain.\u003c/p>\n\u003cp>\"That's when life changed,\" she said.\u003c/p>\n\u003cp>During a 12-week series of appointments at McManus' clinic in Peoria, Ill., Brown learned new ways to prevent and cope with pain, as she gradually reduced her opioid doses.\u003c/p>\n\u003caside class=\"pullquote alignright\">'In a single year, health care providers write enough opioid prescriptions for every adult in the U.S. to have a bottle of pills.’\u003c/aside>\n\u003cp>Roughly \u003ca href=\"http://www.nationalacademies.org/hmd/Reports/2011/Relieving-Pain-in-America-A-Blueprint-for-Transforming-Prevention-Care-Education-Research/Report-Brief.aspx\" target=\"_blank\" rel=\"noopener\">a third of Americans live with chronic pain\u003c/a>, and many of them become dependent on opioids prescribed to treat it. But there's a growing consensus among pain specialists that a low-tech approach focused on lifestyle changes can be more effective.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>This kind of treatment can be more expensive — and less convenient — than a bottle of pills. But pain experts say it can save money over the long term by helping patients get off addictive medications and improving their quality of life.\u003c/p>\n\u003cp>\"It's important to remember that the main treatments that are recommended for these pain conditions are not medication treatments,\" said Dr. Erin Krebs, a primary care physician and researcher at the Minneapolis VA Health Care System.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Recently, Krebs published the first \u003ca href=\"https://jamanetwork.com/journals/jama/article-abstract/2673971?redirect=true\" target=\"_blank\" rel=\"noopener\">long-term randomized trial of opioids\u003c/a> for treating chronic back pain and arthritis, and found that opioids are no better than nonopioid medications. She said drugs of any kind are the lesser choice for the vast majority of patients.\u003c/p>\n\u003cp>The gold standard for treatment, she said, is a combination of things like exercise, rehabilitation therapies, yoga and cognitive behavioral therapies.\u003c/p>\n\u003cp>This approach is consistent with the most recent guidelines \u003ca href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm\" target=\"_blank\" rel=\"noopener\">from the Centers for Disease Control and Prevention\u003c/a> for prescribing opioids for chronic pain. But it's still uncommon.\u003c/p>\n\u003cp>Brown's painkiller use started after she blew out a disk in her back.\u003c/p>\n\u003cp>\"It was the simplest thing,\" Brown said. \"I picked up a bag of garbage with my right hand, and I immediately knew something was wrong.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>She was put on opioids, like so many others who see the doctor about pain. In a single year, health care providers write enough opioid prescriptions for \u003ca href=\"https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm\" target=\"_blank\" rel=\"noopener\">every adult in the U.S.\u003c/a> to have a bottle of pills.\u003c/p>\n\u003cp>Each time Brown came back, still in pain, another opioid was added to the list. She was eventually taking four different drugs — Percocet, Vicodin, morphine and Dilaudid — popping pills every two hours.\u003c/p>\n\u003cp>\"I was just drugged constantly,\" Brown said. \"And even with that, it didn't take care of the pain.\"\u003c/p>\n\u003cp>Not only did the drugs not help with the pain, the side effects made it worse. Brown had such severe abdominal pain from constipation she could hardly walk.\u003c/p>\n\u003cp>\"It kills your life. It totally robs you of every aspect,\" she said. \"I couldn't do anything because of the pain. But I couldn't do anything because of the pain meds. And I couldn't talk to anyone about it, because it was so embarrassing.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Brown tried to quit on her own. But after nine days of nausea and fainting from withdrawal, she was back on the medications.\u003c/p>\n\u003cp>\"I finally went to my family doctor and said, 'I need help, I've got to get off this stuff. I can't live like this anymore,' \" she said.\u003c/p>\n\u003cp>That's when she was referred to McManus, director of the OSF Central Illinois Pain Center in Peoria. He specializes in helping chronic pain sufferers like Brown get off opioids.\u003c/p>\n\u003cp>\"From my perspective, if you stabilize the dose and slowly taper off, these patients do remarkably well,\" he said.\u003c/p>\n\u003cp>At the center, a team of providers works together to help patients make lifestyle changes that reduce pain during everyday activities.\u003c/p>\n\u003cp>The approach includes a combination of physical and occupational therapy, massage and nutrition counseling. Patients also participate in cognitive behavioral therapy to address the psychological issues that often accompany pain — such as overcoming fears of letting go of medications they've become dependent on. A nurse coordinator oversees all the moving parts and does follow-up assessments after the program is completed.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>At the clinic, Brown met occupational therapist Gabe Stickling, who taught her things like how to properly lift heavy objects and how to safely keep exercising even when she feels a twinge of pain.\u003c/p>\n\u003cp>Stickling said people with chronic pain often avoid physical activity \"because they're afraid they're going to injure themselves or damage their bodies.\" But inactivity can make the pain worse.\u003c/p>\n\u003cp>McManus said some of his chronic pain patients can taper off opioids with a less intensive treatment. But for some of his patients, the multidisciplinary program is most effective — if they're willing to commit to making change.\u003c/p>\n\u003cp>\"Most people just really want to have the magic wand that will get them all better,\" he said. \"And I'm just trying to say, I don't have a magic wand but I might have a way out of this jungle that you're in.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>And because pain treatments that don't rely on drugs are hands-on and time-intensive, it can be hard to find a clinic that offers them — and to get insurance to cover them.\u003c/p>\n\u003cp>This wasn't always the case. Until the 1980s, the multidisciplinary approach was the go-to treatment for chronic pain, according to a \u003ca href=\"https://www.sciencedirect.com/science/article/pii/S0376871617300030#!\" target=\"_blank\" rel=\"noopener\">2016 review\u003c/a> on the history of chronic pain management. Its popularity declined as reimbursement rates went down and hospitals began to emphasize more lucrative procedures. Gradually, opioid treatment became the predominant strategy for pain treatment strategy.\u003c/p>\n\u003cp>Today, McManus said his practice spends a lot of time fighting to get the treatments covered. \"The pain program is not considered to be worthy of the price,\" McManus said.\u003c/p>\n\u003cp>Costs vary but run to several thousand dollars for a program like the one Kim Brown went through.\u003c/p>\n\u003cp>\"If you compare a fairly intensive multidisciplinary program to surgery and to drugs, the cost is not high,\" said Steven Kamper, a public health researcher at the University of Sydney in Australia. He's co-author of a \u003ca href=\"http://www.cochrane.org/CD000963/BACK_multidisciplinary-treatment-for-back-pain\" target=\"_blank\" rel=\"noopener\">2014 meta-analysis\u003c/a> that found modest benefits for multidisciplinary treatment programs for chronic low back pain.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Kamper said, the costs are reasonable especially if you consider the long-term effects of living in pain. Many chronic pain sufferers are unable to work and become eligible for disability insurance.\u003c/p>\n\u003cp>\"The big costs of chronic pain are in productivity losses,\" Kamper said.\u003c/p>\n\u003cp>Krebs is hopeful non-drug therapies will regain popularity, as communities recognize the hidden costs of opioids.\u003c/p>\n\u003cp>\"It's not just the price of the pills,\" she said. \"It's also the price of the consequences when you over-rely on something.\"\u003c/p>\n\u003cp>Krebs and Kamper agree more research into pain treatment is needed. But when choosing between an addictive medication with no evidence of benefit, and low-tech therapies with some evidence of benefits, McManus said the choice is clear.\u003c/p>\n\u003cp>\"I did take an oath: First do no harm,\" McManus said. \"As a pain physician, I have a responsibility to use evidence-based medicine to manage my patients that have chronic pain.\"\u003c/p>\n\u003cp>Brown is thankful that the multidisciplinary approach helped her taper off opioids and get her life back, even though it's a different life than before her injury.\u003c/p>\n\u003cp>\"There's no such thing as a pain-free day for me,\" Brown said. \"It never, never fully goes away.\"\u003c/p>\n\u003cp>She has just learned how to manage life with it.\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003ca href=\"http://sideeffectspublicmedia.org/\" target=\"_blank\" rel=\"noopener\">Side Effects Public Media\u003c/a>, \u003cem>a news collaborative covering public health. You can follow Christine Herman on Twitter: \u003c/em>\u003ca href=\"https://twitter.com/CTHerman\" target=\"_blank\" rel=\"noopener\">@CTHerman\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Side Effects Public Media. To see more, visit \u003ca>Side Effects Public Media\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=For+Chronic+Pain%2C+A+Change+In+Habits+Can+Beat+Opioids+For+Relief&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>\u003ciframe width=\"640\" height=\"360\" src=\"https://www.youtube.com/embed/ckYSydGYKRU?feature=oembed\" frameborder=\"0\" allow=\"autoplay; encrypted-media\" allowfullscreen>\u003c/iframe>\u003c/p>\n\u003cp>\u003cem>Welcome to \u003c/em>Invisibilia\u003cem> Season 4! The NPR program and \u003c/em>\u003ca href=\"http://www.npr.org/podcasts/510307/invisibilia\" target=\"_blank\" rel=\"noopener\">podcast\u003c/a>\u003cem> explores the invisible forces that shape human behavior, and we here at Shots are joining in to probe the science of why we act the way we do. In Episode 5, they're investigating how it feels to live \"in between,\" to be in two worlds at once. In the episode, and in the animation above, we meet M, a woman who worries that her intense daydreaming is interfering with her actual life.\u003c/em>\u003c/p>\n\u003cp>The story of M begins innocently enough. She was a girl who felt isolated and misunderstood, so she began spending hours at a time on the swings in her backyard, daydreaming.\u003c/p>\n\u003cp>She imagined herself as many characters, blasting off to other planets, fighting crime and just generally saving the day. This made her feel loved, accepted, even understood.\u003c/p>\n\u003cp>[contextly_sidebar id=\"PN5qpfkUkdC6IDaS53jvI12s3Nkk5Y8D\"]M began to realize her daydreaming was not normal when her mother yelled at her and asked her why she was moving her lips. So she kept up her daydreaming in secret, hiding from friends at school, pretending to read a book, plugging in earphones to make it appear as if she was listening to music.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Then one day by chance, M met with a former classmate who drew her out. They fell in love, married and had a child, and for a while, the daydreams subsided.\u003c/p>\n\u003cp>But as life became more middle-class and mundane — dishwasher unloading, toothpaste in the sink — she found herself sneaking back into a world where she was the hero, the boss and every character in between.\u003c/p>\n\u003cp>[contextly_sidebar id=\"0rxdI3CFoOWSBss3ToB6u1S84tVyjhnE\"]M worries that she has a newly diagnosed condition known as \u003ca href=\"https://www.healthline.com/health/mental-health/maladaptive-daydreaming#complications\" target=\"_blank\" rel=\"noopener\">maladaptive daydreaming\u003c/a>. Now, it's not in the mental health bible, aka the \u003cem>Diagnostic and Statistical Manual of Mental Disorders,\u003c/em> and doctors don't know what causes it. There's no official treatment, although \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/19062309\" target=\"_blank\" rel=\"noopener\">one case study\u003c/a> suggests fluvoxamine, an OCD drug, may help control the daydreams.\u003c/p>\n\u003cp>Whatever maladaptive daydreaming is, it can have real effects on a person's daily life. People who say they have the condition report having trouble making friends or even leaving the house. M worries she is one of them. She carves out time to daydream away from her husband and son who know nothing of her secret life. In fact, she says she has never told anyone about it.\u003c/p>\n\u003cp>M loves her never-ending story, yet she acknowledges her secret is isolating.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"As much as I hate the feeling of being torn and being in two places, I'm not ready to give up my daydreaming and I'm not ready to give up my characters and the feelings that those daydreams give me,\" she says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Invisibilia%3A+When+Daydreaming+Gets+In+The+Way+Of+Real+Life&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Then one day by chance, M met with a former classmate who drew her out. They fell in love, married and had a child, and for a while, the daydreams subsided.\u003c/p>\n\u003cp>But as life became more middle-class and mundane — dishwasher unloading, toothpaste in the sink — she found herself sneaking back into a world where she was the hero, the boss and every character in between.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>M worries that she has a newly diagnosed condition known as \u003ca href=\"https://www.healthline.com/health/mental-health/maladaptive-daydreaming#complications\" target=\"_blank\" rel=\"noopener\">maladaptive daydreaming\u003c/a>. Now, it's not in the mental health bible, aka the \u003cem>Diagnostic and Statistical Manual of Mental Disorders,\u003c/em> and doctors don't know what causes it. There's no official treatment, although \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/19062309\" target=\"_blank\" rel=\"noopener\">one case study\u003c/a> suggests fluvoxamine, an OCD drug, may help control the daydreams.\u003c/p>\n\u003cp>Whatever maladaptive daydreaming is, it can have real effects on a person's daily life. People who say they have the condition report having trouble making friends or even leaving the house. M worries she is one of them. She carves out time to daydream away from her husband and son who know nothing of her secret life. In fact, she says she has never told anyone about it.\u003c/p>\n\u003cp>M loves her never-ending story, yet she acknowledges her secret is isolating.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"As much as I hate the feeling of being torn and being in two places, I'm not ready to give up my daydreaming and I'm not ready to give up my characters and the feelings that those daydreams give me,\" she says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Invisibilia%3A+When+Daydreaming+Gets+In+The+Way+Of+Real+Life&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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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": "Birth Control Apps Find a Big Market in 'Contraception Deserts'",
"title": "Birth Control Apps Find a Big Market in 'Contraception Deserts'",
"headTitle": "Women’s Health | Future of You | KQED Future of You | KQED Science",
"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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"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
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"marketplace": {
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"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
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},
"mindshift": {
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"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
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"order": 12
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
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"morning-edition": {
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"onourwatch": {
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"tagline": "Deeply-reported investigative journalism",
"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"on-the-media": {
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"info": "Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us",
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},
"pbs-newshour": {
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},
"perspectives": {
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"order": 14
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"info": "The economy explained. Imagine you could call up a friend and say, Meet me at the bar and tell me what's going on with the economy. Now imagine that's actually a fun evening.",
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"politicalbreakdown": {
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"title": "Political Breakdown",
"tagline": "Politics from a personal perspective",
"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
"airtime": "THU 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Political-Breakdown-2024-Podcast-Tile-703x703-1.jpg",
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"order": 5
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"possible": {
"id": "possible",
"title": "Possible",
"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.",
"airtime": "SUN 2pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.possible.fm/",
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"source": "Possible"
},
"link": "/radio/program/possible",
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"spotify": "https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"
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},
"pri-the-world": {
"id": "pri-the-world",
"title": "PRI's The World: Latest Edition",
"info": "Each weekday, host Marco Werman and his team of producers bring you the world's most interesting stories in an hour of radio that reminds us just how small our planet really is.",
"airtime": "MON-FRI 2pm-3pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-World-Podcast-Tile-360x360-1.jpg",
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},
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},
"radiolab": {
"id": "radiolab",
"title": "Radiolab",
"info": "A two-time Peabody Award-winner, Radiolab is an investigation told through sounds and stories, and centered around one big idea. In the Radiolab world, information sounds like music and science and culture collide. Hosted by Jad Abumrad and Robert Krulwich, the show is designed for listeners who demand skepticism, but appreciate wonder. WNYC Studios is the producer of other leading podcasts including Freakonomics Radio, Death, Sex & Money, On the Media and many more.",
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